I bought my roommate a fair trade chocolate advent calender. Although there were no complaints about the quality of the milk chocolate, the Christmas story told in daily snippets was an object of some contention. My roomie is profoundly spiritual (when it comes to kayaks) and a devout atheist. So the story went something like this:
December 4th - "Angel Gabriel told Mary she had been chosen to have God's son."
Roomie - What?!? Where's the free will in all of this? She doesn't even get to choose to have the kid or not?
December 5th - "An angel came to Joseph in a dream and told him to name the baby Jesus."
Roomie - Oh my goodness, this is ridiculous! Not only is there no choice about having the baby, but they can't even pick the name?
And so the story continued, but it does make you think. As a woman in a decidedly patriarchal society, maybe even misogynistic, I wonder how much choice she really had . . . how much choice did any woman have about reproductive issues at the start of the common era two thousand years ago. Heck, if a life-size glowing angel appeared in my room, I'd either say "Yeah, sure, just like you said!" . . . or, admit myself directly to the closest psychiatric ward.
My dad says the universe was thinner back then. That people were less stuck to science and more open and aware of the spiritual world interacting with the material one. The topic of women in the bible I am convinced must be taken with a healthy understanding of history.
Tuesday, December 25, 2007
Monday, December 24, 2007
Abject Incarnation
Christmas eve, the sun burning down, heat rising in waves from tin roofs, and I stand sticky in the dress I had no doubt been forced to wear. We had started that morning with bags of flour and rice spread across the floor of our small neighbourhood church in Arequipa, evaporated milk stacked in rows, making Christmas hampers. There was then a pick-up truck ride involving lots of dust, very exciting for a kid, and we eventually came to a crowded community some would have described as a shanty town. My memories of the sun and dust are vivid but other details are fuzzy. We stopped at a home to deliver a hamper, were greeted warmly, but the family didn't take it. Instead, they came with us and we drove up the mountain, apparently they knew a family who needed that flour and rice more than they did. I can't have been more than six or seven years old, but my memories of Christmas were of decorating the cactus 'Christmas tree' in our yard, baby Jesus, giving to those who didn't have as much as we did, sun, and definitely dust. Later, after moving to Scotland I remember much more in the way of exciting gifts and chocolate, athough my parents swear we did get presents in Peru as well.
I was putting out nativity scenes for my mom today, something I love doing. I've been collecting them as long as I can remember. I was never too sure about my parents' olive wood scene from Israel though, the pale baby Jesus lies serenely in his manger with arms outstretched in a position no baby ever takes. Mary kneels, her face blank of emotion, and the sheperd boy at the back with the lamb on his shoulder is forever falling over due to a broken foot. I prefer the rough clay set where one of the wise men carries a bunch of bananas as a gift and a donkey with buck teeth looks on, or the jungle Jesus who lacks a diaper and clearly has two descended testicles, or the wooden scene from Thailand with elephants and chickens welcoming God. More powerful to me than the crucifixion or resurection is the incarnation. A squirming, wet, mucous and blood-covered screaming smelly newborn surrounded by a goat or two and a clueless father. Did Joseph cut the cord? Did the placenta come out intact? Did Mary have a third degree tear? What were Jesus' Apgars? God came down the birth canal of an unmarried teenager? Who thought this stuff up anyway? There is a certain scandal to it all, very abject, very humble and not an image that the Christmas season gives us today.
I am forever grateful for the gift my parents have given me. They introduced me to the God of the poor, born surrounded by abject poverty and scandal. Where faith means hope and justice for the poor and marginalized here on earth.
I was putting out nativity scenes for my mom today, something I love doing. I've been collecting them as long as I can remember. I was never too sure about my parents' olive wood scene from Israel though, the pale baby Jesus lies serenely in his manger with arms outstretched in a position no baby ever takes. Mary kneels, her face blank of emotion, and the sheperd boy at the back with the lamb on his shoulder is forever falling over due to a broken foot. I prefer the rough clay set where one of the wise men carries a bunch of bananas as a gift and a donkey with buck teeth looks on, or the jungle Jesus who lacks a diaper and clearly has two descended testicles, or the wooden scene from Thailand with elephants and chickens welcoming God. More powerful to me than the crucifixion or resurection is the incarnation. A squirming, wet, mucous and blood-covered screaming smelly newborn surrounded by a goat or two and a clueless father. Did Joseph cut the cord? Did the placenta come out intact? Did Mary have a third degree tear? What were Jesus' Apgars? God came down the birth canal of an unmarried teenager? Who thought this stuff up anyway? There is a certain scandal to it all, very abject, very humble and not an image that the Christmas season gives us today.
I am forever grateful for the gift my parents have given me. They introduced me to the God of the poor, born surrounded by abject poverty and scandal. Where faith means hope and justice for the poor and marginalized here on earth.
Thursday, December 20, 2007
Christmas is Coming
Tck tck tck tck tck.
Tck tck tck tck tck.
Like a computer game the red laser beam at the end of the scope shoots holes in the rough yellow rock lodged firmly in tunnel of the ureter projected on the screen above my head. My shoulders are weighed down by the lead apron we wear under the surgical gown (to protect my little ovaries from the x-rays) . My glasses dig into my nose from the pressure of the goggles to protect my eyes from the laser. It seems a little ludicrous that the laser beam will bounce off the kidney stone lodged in the ureter get all the way down the tube to the bladder and somehow out of the penis and bounce into my eyeball . . . oh well, protocol I suppose. After shooting up your rock you put in a little basket and pull out the pieces. Urologists really have fantastic tools and seemingly get to play video games all day.
Yesterday they took out someone's bladder because of cancer and made her a new one out of a piece of her colon. It took six and a half hours, but it was pretty incredible! There's a downside to any specialty though, even if they do have cool toys and fascinating operations. There's kidney transplants that don't work after family members have donated their own kidneys and there's always cancers that recur and eventually are untreatable.
Near the end of my day today I was called with a consult from the palliative ward. A 50 year old lady with a recent spread of her previously treated cancer now had a kidney that was swelling up and its function going downhill, just over the past week. This can often happen when cancers grow and block off one of your ureters. In my mind it was a no brainer, we just put a little tube in the ureter to release the pressure and save the kidney. Its a simple procedure and would relieve a lot of pain and nausea. I sat on her bed and explained it several times, listened to her questions, thinking myself quite convincing.
Eventually she asked a question that stopped me cold.
How would you want to die?
Skydiving perhaps? Maybe in the Congo.
Although I disagreed with her, even thought her foolish to want to die in such discomfort, I had to accept that this was her body and her life, not mine. I can explain things and give recommendations, but the choice is hers of how to go. Oh so somber a note as she lays in hospital with Christmas approaching. Merry Christmas to all, and to all a good night.
Tck tck tck tck tck.
Like a computer game the red laser beam at the end of the scope shoots holes in the rough yellow rock lodged firmly in tunnel of the ureter projected on the screen above my head. My shoulders are weighed down by the lead apron we wear under the surgical gown (to protect my little ovaries from the x-rays) . My glasses dig into my nose from the pressure of the goggles to protect my eyes from the laser. It seems a little ludicrous that the laser beam will bounce off the kidney stone lodged in the ureter get all the way down the tube to the bladder and somehow out of the penis and bounce into my eyeball . . . oh well, protocol I suppose. After shooting up your rock you put in a little basket and pull out the pieces. Urologists really have fantastic tools and seemingly get to play video games all day.
Yesterday they took out someone's bladder because of cancer and made her a new one out of a piece of her colon. It took six and a half hours, but it was pretty incredible! There's a downside to any specialty though, even if they do have cool toys and fascinating operations. There's kidney transplants that don't work after family members have donated their own kidneys and there's always cancers that recur and eventually are untreatable.
Near the end of my day today I was called with a consult from the palliative ward. A 50 year old lady with a recent spread of her previously treated cancer now had a kidney that was swelling up and its function going downhill, just over the past week. This can often happen when cancers grow and block off one of your ureters. In my mind it was a no brainer, we just put a little tube in the ureter to release the pressure and save the kidney. Its a simple procedure and would relieve a lot of pain and nausea. I sat on her bed and explained it several times, listened to her questions, thinking myself quite convincing.
Eventually she asked a question that stopped me cold.
How would you want to die?
Skydiving perhaps? Maybe in the Congo.
Although I disagreed with her, even thought her foolish to want to die in such discomfort, I had to accept that this was her body and her life, not mine. I can explain things and give recommendations, but the choice is hers of how to go. Oh so somber a note as she lays in hospital with Christmas approaching. Merry Christmas to all, and to all a good night.
Sunday, December 2, 2007
Snow Falling on Cedars
I awoke to snow drifting down in big juicy flakes onto the blanket of white covering the world. Unable to resist a run I went out clad in touque and gloves. My shoes sticking and squeaking with each stride. Silently and peacefully floating down around me. The water at Jericho beach lapping against the white carpet of the beach, melting the shore edge and turning it dark. Dark as the nearly black ocean spreading out towards the hidden north shore. Hidden by low deep gray misty clouds. Bull rushes with dainty snow caps, the snow turning the pond into an slushy gray pool. Dogs tumble in the snow, kids rolling snowballs, laying on the lawn, arms and legs flapping to make snow angels with mouths wide open catching the snow. As I pound my way home, snow flakes melt against the hot skin of my face, making salty rivulets down to my lips. A moment of perfection.
And this afternoon I will go to my shift at the emergency department just as I did yesterday, where I will see how others experience the snow. A split chin after slipping on the ice, an elderly woman with a broken elbow and then the things that aren't just accidents. The homeless hypothermic, the red swollen hands from exposure, the black toes needing amputation.
I am the privileged.
And this afternoon I will go to my shift at the emergency department just as I did yesterday, where I will see how others experience the snow. A split chin after slipping on the ice, an elderly woman with a broken elbow and then the things that aren't just accidents. The homeless hypothermic, the red swollen hands from exposure, the black toes needing amputation.
I am the privileged.
Monday, November 26, 2007
Just like on TV
I was pontificating on the differential diagnosis of a 'worst headache ever' with my preceptor . . . sub-arachnoid hemorrhage, encephalitis, stroke, cluster headache, mass effect . . . when one of the other emergency docs pops his head in the door.
Hey, there's a witnessed arrest coming in in v-tach, this would be as good one for you.
Oh, great! The words pop out of my mouth perkily without processing them.
Gown, gloves, and I stroll into the trauma room following paramedics, nurses, a respiratory therapist and two emergency docs. Standing at the back, observing, seeing what I can learn from this demonstration of the efficiencies of our wonderful medical system. Until the doc gestures at me to get to the head of the bed and thrusts the laryngoscope into my hand. Say what?!?
Have you intubated before?
Yup. Which is the truth, in fact, prior to this moment, my intubation success rate is 100%. That is, in the OR, with no stress and lots of time.
Our 'v-tach lady' had collapsed directly onto her face. A purple goose-egg was starting to swell up on her brow, her nose and chin were scraped and her front teeth loose, jutting out at strange angles and bleeding. Also of note, she had no neck and a receding chin. This combination is any doctors nightmare. It means that the magical smooth intubations you see on ER are in no way possible. And yes, its me currently holding the scope, not an ICU doc, not an anesthetist who has done thousands of these, and certainly not Noah Wyle, just little old me.
Okay, its a one shot deal. Go for it. 'Enough with the drama,' I silently say to my attending.
Metal blade slipping across the tongue, I haul on the handle desperately trying to see anything remotely resembling those golden vocal cords. All I see is blood and tongue. The sickening crunch of metal on teeth as I inadvertently preform a dental extraction and the nurse removes the loose tooth so it doesn't get in the way. When you learn this on the model in med school the head makes a little beeping sound when you lean on the teeth too hard . . . no such warning beep here.
Suction please. I can't see anything. Sluuuuuuuurrrrrrrp.
The emerg doc takes over, tries twice. Eventually getting in a bougie to thread the tube into place. He said it was the worst intubation he'd ever seen. Which didn't make me feel so bad.
I'm under the impression that the emergency department is great fun. Probably because I'm not the one who's really responsible for the patients in the end. But like any rotation there's the good that bad and the ugly.
The good. I got to sew a nose back together that had been sliced cleanly by the knife of 'This One Guy' at 2am when the patient had just been minding his own business out on the street.
The bad. I've had to do a significant amount of DREs (digital rectal exams . . . where the digital part has nothing to do with a Nintendo Wii . . . Wee.)
The ugly. My first ever 'trench foot' experience. Named after what happened to soldier's feet in the world wars from walking around in wet trenches for months on end. To describe it would be too traumatic for all those involved. Smell. Rot. Geeahrgh.
One thing I have learned: if you have friends called 'This One Guy' or 'That Bitch', don't give them your PIN number/welfare check/go drinking with them because they will without a doubt take off with your money/slice your nose open/sleep with your best friend/steal your drugs. In fact, maybe consider not seeing them at all, ever, and getting some new friends.
So yeah, its just like on TV. We even make out in the supply closets now and then.
Hey, there's a witnessed arrest coming in in v-tach, this would be as good one for you.
Oh, great! The words pop out of my mouth perkily without processing them.
Gown, gloves, and I stroll into the trauma room following paramedics, nurses, a respiratory therapist and two emergency docs. Standing at the back, observing, seeing what I can learn from this demonstration of the efficiencies of our wonderful medical system. Until the doc gestures at me to get to the head of the bed and thrusts the laryngoscope into my hand. Say what?!?
Have you intubated before?
Yup. Which is the truth, in fact, prior to this moment, my intubation success rate is 100%. That is, in the OR, with no stress and lots of time.
Our 'v-tach lady' had collapsed directly onto her face. A purple goose-egg was starting to swell up on her brow, her nose and chin were scraped and her front teeth loose, jutting out at strange angles and bleeding. Also of note, she had no neck and a receding chin. This combination is any doctors nightmare. It means that the magical smooth intubations you see on ER are in no way possible. And yes, its me currently holding the scope, not an ICU doc, not an anesthetist who has done thousands of these, and certainly not Noah Wyle, just little old me.
Okay, its a one shot deal. Go for it. 'Enough with the drama,' I silently say to my attending.
Metal blade slipping across the tongue, I haul on the handle desperately trying to see anything remotely resembling those golden vocal cords. All I see is blood and tongue. The sickening crunch of metal on teeth as I inadvertently preform a dental extraction and the nurse removes the loose tooth so it doesn't get in the way. When you learn this on the model in med school the head makes a little beeping sound when you lean on the teeth too hard . . . no such warning beep here.
Suction please. I can't see anything. Sluuuuuuuurrrrrrrp.
The emerg doc takes over, tries twice. Eventually getting in a bougie to thread the tube into place. He said it was the worst intubation he'd ever seen. Which didn't make me feel so bad.
I'm under the impression that the emergency department is great fun. Probably because I'm not the one who's really responsible for the patients in the end. But like any rotation there's the good that bad and the ugly.
The good. I got to sew a nose back together that had been sliced cleanly by the knife of 'This One Guy' at 2am when the patient had just been minding his own business out on the street.
The bad. I've had to do a significant amount of DREs (digital rectal exams . . . where the digital part has nothing to do with a Nintendo Wii . . . Wee.)
The ugly. My first ever 'trench foot' experience. Named after what happened to soldier's feet in the world wars from walking around in wet trenches for months on end. To describe it would be too traumatic for all those involved. Smell. Rot. Geeahrgh.
One thing I have learned: if you have friends called 'This One Guy' or 'That Bitch', don't give them your PIN number/welfare check/go drinking with them because they will without a doubt take off with your money/slice your nose open/sleep with your best friend/steal your drugs. In fact, maybe consider not seeing them at all, ever, and getting some new friends.
So yeah, its just like on TV. We even make out in the supply closets now and then.
Friday, November 16, 2007
Crack-a-Lackin'
She sat across the table from us crossing and uncrossing her legs. Pushing herself up in the chair, shifting back and forth. Fingernails scratching endlessly, her knee, back arching to scratch her flank, then her head tilts to the side to itch behind her ear. She looks at me intently, then switches to the psychiatrist next to me, back and forth, and back. She wears a pink tank top and a shirt worn as a skirt that reaches nowhere near her mid-thigh. A smile on her face never pausing in her speech for a reaction.
"I just need some passes I feel so couped up in here there's no air I need some fresh air I have to go to my NA meeting tomorrow its not that I don't like it here I just get so bored just give me a chance to prove to you guys that I can do this I swear I didn't touch his pipe yesterday he just blew the smoke in my face that's why the test was positive I just need some passes I'm so done with him he stole my check he said he was going to make money with it but he just smoked it all away I told him he can't visit me anymore because he tried to sell me drugs after that and why would I stay with him a boyfriend should give me drugs if he's dealing I just need a pass just to go for a walk and get some fresh air."
She is young. On the streets since she was a teen and has never been in a relationship where she wasn't abused and taken advantage of. Its not a unique story. She's friendly with a bright smile and her slightly spread eyes give a hint of fetal alcohol syndrome. She turns a trick now and then when she runs out of money which she needs for her fairly substantial crack/cocaine addiction. Her mood is upbeat as she shifts and squirms in her seat. A disposition that turn directly to tears and irritability when we tell her she can only go on pass with staff. Her outfit has changed four times in the last 15 minutes before the interview. The girl is practically hopping in her chair and being eaten alive by her cravings. There is no doubt in our minds that as soon as she is discharged or goes on pass she'll use again.
So how does one react? Do I feel pity for her? Is she a hopeless case? Does she bring this cycle of sexual abuse and drugs on herself? Drugs that cause terrifying hallucinations of bodies being hacked to pieces that bring her into hospital.
I can't. I feel none of those things. I see her as a young woman who never had a chance. Who society has failed starting several generations ago. It makes something burn inside of me, something bittersweet. Her actions don't frustrate me. Her return to crack and her abuser don't surprise me anymore. I see smoldering hope in her eyes, and I don't THINK its just the bloodshotness.
I'm learning a lot about inner-city life. I know how much crack is a lot of crack, I know which the less seedy of seedy downtown hotels are and I know how to ask how quickly their check has gone to what drugs. But my problem is that I still trust people. And yes, its a problem but I see myself changing, for better or worse I'm not sure. My naive questions about abuse are now worded very differently, the queries about sex trade now flow naturally off my tongue. People hurt each other and they lie, steal, and cheat. My conundrum that I repeatedly come back to is how to keep my skin thick and my heart soft. For life to make any sense I have to believe that people are good, we're all just out there doing our best, a bunch of people trying to be. Each one of us with flaws and baggage.
"I just need some passes I feel so couped up in here there's no air I need some fresh air I have to go to my NA meeting tomorrow its not that I don't like it here I just get so bored just give me a chance to prove to you guys that I can do this I swear I didn't touch his pipe yesterday he just blew the smoke in my face that's why the test was positive I just need some passes I'm so done with him he stole my check he said he was going to make money with it but he just smoked it all away I told him he can't visit me anymore because he tried to sell me drugs after that and why would I stay with him a boyfriend should give me drugs if he's dealing I just need a pass just to go for a walk and get some fresh air."
She is young. On the streets since she was a teen and has never been in a relationship where she wasn't abused and taken advantage of. Its not a unique story. She's friendly with a bright smile and her slightly spread eyes give a hint of fetal alcohol syndrome. She turns a trick now and then when she runs out of money which she needs for her fairly substantial crack/cocaine addiction. Her mood is upbeat as she shifts and squirms in her seat. A disposition that turn directly to tears and irritability when we tell her she can only go on pass with staff. Her outfit has changed four times in the last 15 minutes before the interview. The girl is practically hopping in her chair and being eaten alive by her cravings. There is no doubt in our minds that as soon as she is discharged or goes on pass she'll use again.
So how does one react? Do I feel pity for her? Is she a hopeless case? Does she bring this cycle of sexual abuse and drugs on herself? Drugs that cause terrifying hallucinations of bodies being hacked to pieces that bring her into hospital.
I can't. I feel none of those things. I see her as a young woman who never had a chance. Who society has failed starting several generations ago. It makes something burn inside of me, something bittersweet. Her actions don't frustrate me. Her return to crack and her abuser don't surprise me anymore. I see smoldering hope in her eyes, and I don't THINK its just the bloodshotness.
I'm learning a lot about inner-city life. I know how much crack is a lot of crack, I know which the less seedy of seedy downtown hotels are and I know how to ask how quickly their check has gone to what drugs. But my problem is that I still trust people. And yes, its a problem but I see myself changing, for better or worse I'm not sure. My naive questions about abuse are now worded very differently, the queries about sex trade now flow naturally off my tongue. People hurt each other and they lie, steal, and cheat. My conundrum that I repeatedly come back to is how to keep my skin thick and my heart soft. For life to make any sense I have to believe that people are good, we're all just out there doing our best, a bunch of people trying to be. Each one of us with flaws and baggage.
Tuesday, November 13, 2007
Tasered
A few weeks ago a man arrived at the Vancouver airport from Poland. He was acting strange, pacing back and forth and speaking in a language his fellow passengers didn't understand (presumably Polish). His name was Robert Dziekanski, it was his first international flight and as the story goes he was visiting his mother. A new country, a strange language, sleep deprivation, exhaustion. I can all too easily imagine the rising anxiety he must have felt, much like I felt on the Slovakian boarder with Austria a few years ago, but I digress, I just got harassed, not tasered. To get to the point, the police were called, approached him, tasered him and he collapsed. No CPR was started for 5-8 minutes. Last I checked, police officers are trained to do it. The paramedics arrived, but by that time his heart wasn't even twitching anymore.
It made me sad.
It made me think.
Cops have a tough job.
Also, tasers suck.
Three patients of mine experienced police force recently. One is stocky and muscular. I completely understood why he needed five officers and a paddy wagon to be brought in. He sported a dislocated finger and a gruesome black eye, the white of his eye bright red with blood. No need to taser this guy of course.
The second, well, I can see how she might be feisty but the truth is she's a tiny five foot Asian girl who weighs 100lbs soaking wet, okay, maybe 105. The police officer felt 'threatened' as she proceeded down the road towards him (with no weapon) so he 'bumped' her with the police car before they got out and tasered her. She definitely needed the taser she got. Oh, can't get my tongue unstuck from my cheek.
The third, also aggressive, out of control in his apartment. I had never seen the actual results of a taser before. A bruise the size of a pomelo, Citrus maxima (yes, we always use food to describe sizes) on his torso with two central dots where the actual 'taser' parts of the taser stick in the skin.
Now don't get me wrong. I'm glad they're using a taser gun and not the bullet variety, the whole point of it is to reduce mortality. People get out of control, they go 'crazy', for medical and non-medical reasons and really, I probably actually trust cops . . . most of the time. I sure wouldn't want their job.
But I don't think Robert Dziekanski was crazy. I think he was anxious and scared. And no one took the time to assess the situation and try to understand him. I'm starting to think that everyone expects the worst from people . . . especially when they are agitated and in an international airport. We all make mistakes. Maybe it hit home because their mistake cost a human life, and that's not so far from my personal fears.
It made me sad.
It made me think.
Cops have a tough job.
Also, tasers suck.
Three patients of mine experienced police force recently. One is stocky and muscular. I completely understood why he needed five officers and a paddy wagon to be brought in. He sported a dislocated finger and a gruesome black eye, the white of his eye bright red with blood. No need to taser this guy of course.
The second, well, I can see how she might be feisty but the truth is she's a tiny five foot Asian girl who weighs 100lbs soaking wet, okay, maybe 105. The police officer felt 'threatened' as she proceeded down the road towards him (with no weapon) so he 'bumped' her with the police car before they got out and tasered her. She definitely needed the taser she got. Oh, can't get my tongue unstuck from my cheek.
The third, also aggressive, out of control in his apartment. I had never seen the actual results of a taser before. A bruise the size of a pomelo, Citrus maxima (yes, we always use food to describe sizes) on his torso with two central dots where the actual 'taser' parts of the taser stick in the skin.
Now don't get me wrong. I'm glad they're using a taser gun and not the bullet variety, the whole point of it is to reduce mortality. People get out of control, they go 'crazy', for medical and non-medical reasons and really, I probably actually trust cops . . . most of the time. I sure wouldn't want their job.
But I don't think Robert Dziekanski was crazy. I think he was anxious and scared. And no one took the time to assess the situation and try to understand him. I'm starting to think that everyone expects the worst from people . . . especially when they are agitated and in an international airport. We all make mistakes. Maybe it hit home because their mistake cost a human life, and that's not so far from my personal fears.
Tuesday, October 30, 2007
Queens, God, and Hell's Angels
If my calling had been psychiatry I would be in poor shape. Not that I don't enjoy the interactions with patients, its purely because I don't understand it. I just don't get it. When I see patients on a daily basis, what's the actual goal of my conversations with them? You can't just ask concrete things like, how's your pain, are you peeing, and how's breast feeding going. Instead you explore their delusions of grandeur or paranoia, you dive into the depths of their feelings of worthlessness depression and terrifying anxiety to see how the neurotransmitters in their brain are being affected by the cocktail of blockers or stimulators that you have them taking. You go up gradually on the anti-psychotics, play around with their sleep medication until they come back in touch with reality as we know it. Of course, those with more training in psychotherapy give cognitive behaviour homework to those with depressive and anxiety disorders, and together we work through coping strategies. But if you're frankly psychotic, if you think you're the queen of England, there is no logical reasoning that can make you believe otherwise. So we tinker with the neurons in their brain.
There are times when I'm intrigued by perceptions of reality and get caught up in the stories. I want to probe into their theories of spirituality and understand their relationships with God. But then I realize they are God and we're not actually talking about the same thing. As a medical student I remember walking through the unit and there was a patient lying on the ping pong table proclaiming that they were the Messiah. Another patient came up to her and said, "are you really God?" To which God responded indignantly, "yes, of course I am!" The reply came with a snort, "well do I ever have a bone to pick with you!"
Last week it was 'Welfare Wednesday' which meant being on call Sunday was incredibly busy. As it was explained to me, you get your check Wednesday, go buy your drug of choice, alcohol, crystal meth, crack, whatever, have your binge which can last two or three days and by the weekend you're in withdrawal and come to hospital with you heart about to stop or thinking Hell's Angels are hunting you down. Now some crazy people can be hilarious, bursting into song and quite comfortable in their role as the queen and its fun to joke about, but when Hell's Angels want you dead the fear is palpable. You see terror in their eyes and you can nearly smell their angst. Then its not funny at all, its terrifying, and all you want to do is convince then that they're safe . . . which you can't do, so you play with their neurons again.
So I am left fascinated by the mind and unable to understand its complexities. Entertained at times and heartbroken the next minute. It seems a lot of time is spent convincing people to take medications that they desperately need with the rest spent convincing people NOT to take drugs that alter their mental state. My mind is hopelessly concrete, and although I am intrigued by the minds of others, my skills lay in more surgical things . . . and catching babies on the happiness ward of course.
There are times when I'm intrigued by perceptions of reality and get caught up in the stories. I want to probe into their theories of spirituality and understand their relationships with God. But then I realize they are God and we're not actually talking about the same thing. As a medical student I remember walking through the unit and there was a patient lying on the ping pong table proclaiming that they were the Messiah. Another patient came up to her and said, "are you really God?" To which God responded indignantly, "yes, of course I am!" The reply came with a snort, "well do I ever have a bone to pick with you!"
Last week it was 'Welfare Wednesday' which meant being on call Sunday was incredibly busy. As it was explained to me, you get your check Wednesday, go buy your drug of choice, alcohol, crystal meth, crack, whatever, have your binge which can last two or three days and by the weekend you're in withdrawal and come to hospital with you heart about to stop or thinking Hell's Angels are hunting you down. Now some crazy people can be hilarious, bursting into song and quite comfortable in their role as the queen and its fun to joke about, but when Hell's Angels want you dead the fear is palpable. You see terror in their eyes and you can nearly smell their angst. Then its not funny at all, its terrifying, and all you want to do is convince then that they're safe . . . which you can't do, so you play with their neurons again.
So I am left fascinated by the mind and unable to understand its complexities. Entertained at times and heartbroken the next minute. It seems a lot of time is spent convincing people to take medications that they desperately need with the rest spent convincing people NOT to take drugs that alter their mental state. My mind is hopelessly concrete, and although I am intrigued by the minds of others, my skills lay in more surgical things . . . and catching babies on the happiness ward of course.
Wednesday, October 24, 2007
Psychosis NOS*
Well, I've had a hard life. I'm not gonna lie to you. Why would I lie? Would you lie? Sorry, I don't mean to accuse you or anything, its just that you don't know who you can trust. Everyone has their own motives you know. But yes, my life is hard. Its hard being this sought after. They watch me all the time you know. I see them drive by me in cars when I ride my bike to work, or sometimes they just follow me, not overtaking just so they can watch me. Do I think someone's going to harm me? Oh no! Of course not, well, maybe kidnap me for a ransom, but only because I'm so well connected. My dad was a cocaine trafficker in his younger years--this is off the record, right? Anyway, so he's pretty wealthy and then there's the 'celebrity by association' that I get from my job. What job? I'm surprised you don't know! I guess you don't read the news much. Angelina, I'm her agent. Its busy, well, and complicated. Its a long story, but the problem is she's actually got quite the crush on me, hard to handle, you know, professionalism is vital these days with media coverage being what it is. But Brad's a bit jealous, as he gets, of course I'm not interested in the slightest, all she's got is skin, bones, tatoos, and lips. They send me these messages that get me all rilled up though. No, not voicemail, they usually talk through the TV and tell me to do things. I don't like it. What do they ask me to do? Oh, things like making sure no bad press gets out about them. Sometimes I just get so MAD! Today I had to take all 'The Enquirer' magazines off the shelves in Safeway and burn them. Security and the fire department are such idiots, they just don't understand the brilliance behind my actions. Yeah, I think that's who drove me here. Why am I even talking to you?
Anyway, so I might move to Peru, people know me there as well, but at least I'd get away from Angelina and her crazy boyfriend. Geez. What would I do in Peru? You must only watch sitcoms. I'm next in line to the throne. You'd have to pay some good money to get this kind of interview with me there. No royal family in Peru? Did you even finish high school? Hello . . . the Inca royal family! Basically I'm a direct descendant of Inti Raimi. Yeah, so my job possibilities there are basically endless. I could work on my classical guitar career, yeah, I'm pretty good, I've played with some of the greats. Led Zepellin and I actually did a duet together on his last album.
Do I hear things that other people don't? How should I know, I don't know what other people hear, its not like I'm inside their head or anything! Would I ever hurt myself? Are you nuts?!? I have endless possibility, money, AND I'm famous, my life is great! Why else would all these people be monitoring my movements if I wasn't something special? I'm actually most likely going to be the next prime minister of Canada, yeah, Stevie Harper is on the way out, did you hear that throne speech? He's nuts. But God has really given me a lot of gifts, I think I'm up for the task, I'd feed those poor people and set up all sorts of social programs to end inequality in the world.
Pills? You want me to take pills? You think I'll fall for that one? I only eat organic things, and those are NOT organic, I don't want to put chemicals into my body! Besides how do I know I can trust you? You keep on asking these weird questions, maybe you should see a psychiatrist. I get one phone call, right? I'm calling Angelina, and boy, is she ever gonna be pissed at you!
* not otherwise specified
Anyway, so I might move to Peru, people know me there as well, but at least I'd get away from Angelina and her crazy boyfriend. Geez. What would I do in Peru? You must only watch sitcoms. I'm next in line to the throne. You'd have to pay some good money to get this kind of interview with me there. No royal family in Peru? Did you even finish high school? Hello . . . the Inca royal family! Basically I'm a direct descendant of Inti Raimi. Yeah, so my job possibilities there are basically endless. I could work on my classical guitar career, yeah, I'm pretty good, I've played with some of the greats. Led Zepellin and I actually did a duet together on his last album.
Do I hear things that other people don't? How should I know, I don't know what other people hear, its not like I'm inside their head or anything! Would I ever hurt myself? Are you nuts?!? I have endless possibility, money, AND I'm famous, my life is great! Why else would all these people be monitoring my movements if I wasn't something special? I'm actually most likely going to be the next prime minister of Canada, yeah, Stevie Harper is on the way out, did you hear that throne speech? He's nuts. But God has really given me a lot of gifts, I think I'm up for the task, I'd feed those poor people and set up all sorts of social programs to end inequality in the world.
Pills? You want me to take pills? You think I'll fall for that one? I only eat organic things, and those are NOT organic, I don't want to put chemicals into my body! Besides how do I know I can trust you? You keep on asking these weird questions, maybe you should see a psychiatrist. I get one phone call, right? I'm calling Angelina, and boy, is she ever gonna be pissed at you!
* not otherwise specified
Saturday, October 20, 2007
Morilla, Meatloaf, and 10,000 cows
We crawl through the fence and into the barnyard. Chickens, sheep, pygmy goats, regular goats, and a variety of cows, oh yeah, and a couple dogs. My aunt has names for all of them, well, maybe not the chickens. I follow her out to the pasture where the Jersey cows and calves are congregated, my new sneakers with the pink flowers on them encounter the slipperiness of a cow-paddy despite my best efforts. We throw bails over the fence for the cows. Scratchy, itchy hay on my arms, the warmth of the cows reassuring, manure on my jeans, the bright blue sky, farm house in the distance, the pasture scattered with farm machinery my grandparents used in the first part of the last century. Its all so familiar to me. I remember dusty summers exploring the woods, mud fights in the dug-out, riding horses (and getting bucked off), chasing cows, hot sleepless nights with mosquitoes biting and coyotes howling. Summers at the farm.
I visit a friend who has known me since I first came to Canada. I swear she's the reason I got through university . . . private tutoring and she didn't even start charging! Now she's married with a bun in the oven (notice the official obstetrician terminology), they live on a farmstead, have started a market garden and are building a new house. In my wildest dreams I never imagined her raising chickens and goats but now it seems like the most natural thing in the world. It somehow felt right to be eating things that were grown only a few hundred meters away. Maybe I'm idealizing it but the connection to seasons and the land is a different concept than in the city where our peas come from China year-round and apples are shipped from Washington instead of the Okanagan.
From the idyllic farmstead where I see all that is good about life in rural Alberta I went to the feedlot that my cousin manages. 10,000 head of cattle. To be honest I was expecting to be horrified with vagrant abuse of animals. To be even honester I was horrified at how naturally I accepted it as imperative to our lifestyle by the end of the day. To provide the all-powerful consumer with the beef we want at the right price this is how the system must work. 9lbs of grain for 1lb of meat. The healthiest, fattest cows I've ever seen. Vaccinations and growth hormone when they get shipped in, then they eat all day everyday, continuously monitored to make sure they stay healthy. Meat is big business in Alberta. I'm ashamed that I can't quite bring myself to tell my extended family that I'm mostly a vegetarian, it seems like the most intimate of betrayals that I am rejecting their very livelihood. Of course, I still love my cousin. "Different strokes for different folks," I tell him when he asks what I think of it all.
I loved every minute spent not thinking about anything remotely related to work. Of course, it can't be avoided when your cousin rips off his shirt and asks for his rash to be diagnosed or your aunt wants to know your opinion on cancer causation. I tried to spend lots of time kicking through crisp dry leaves and watching sunrises and sunsets. Life is good.
A large pumpkin, a mammoth zucchini, gourds, and garlic accompanied me on the Greyhound back to Calgary.
As far as my post-holiday resolutions:
Live more. Love more. Volunteer. Eat beets. Play guitar. Laugh more.
P.S. Morilla is a Jersey cow and Meatloaf is a pygmy goat.
I visit a friend who has known me since I first came to Canada. I swear she's the reason I got through university . . . private tutoring and she didn't even start charging! Now she's married with a bun in the oven (notice the official obstetrician terminology), they live on a farmstead, have started a market garden and are building a new house. In my wildest dreams I never imagined her raising chickens and goats but now it seems like the most natural thing in the world. It somehow felt right to be eating things that were grown only a few hundred meters away. Maybe I'm idealizing it but the connection to seasons and the land is a different concept than in the city where our peas come from China year-round and apples are shipped from Washington instead of the Okanagan.
From the idyllic farmstead where I see all that is good about life in rural Alberta I went to the feedlot that my cousin manages. 10,000 head of cattle. To be honest I was expecting to be horrified with vagrant abuse of animals. To be even honester I was horrified at how naturally I accepted it as imperative to our lifestyle by the end of the day. To provide the all-powerful consumer with the beef we want at the right price this is how the system must work. 9lbs of grain for 1lb of meat. The healthiest, fattest cows I've ever seen. Vaccinations and growth hormone when they get shipped in, then they eat all day everyday, continuously monitored to make sure they stay healthy. Meat is big business in Alberta. I'm ashamed that I can't quite bring myself to tell my extended family that I'm mostly a vegetarian, it seems like the most intimate of betrayals that I am rejecting their very livelihood. Of course, I still love my cousin. "Different strokes for different folks," I tell him when he asks what I think of it all.
I loved every minute spent not thinking about anything remotely related to work. Of course, it can't be avoided when your cousin rips off his shirt and asks for his rash to be diagnosed or your aunt wants to know your opinion on cancer causation. I tried to spend lots of time kicking through crisp dry leaves and watching sunrises and sunsets. Life is good.
A large pumpkin, a mammoth zucchini, gourds, and garlic accompanied me on the Greyhound back to Calgary.
As far as my post-holiday resolutions:
Live more. Love more. Volunteer. Eat beets. Play guitar. Laugh more.
P.S. Morilla is a Jersey cow and Meatloaf is a pygmy goat.
Saturday, October 6, 2007
Alberta Bound
Friday brought with it an epic journey. First squeezing through the narrow pass of Phimosis, only to be met on the other side by the sticky pit of chronic Balanitis with crusting around the edges. Then, after wading through the mushy swamp of Prostatitis I ended my foul run of luck along the meandering stream of Epidydimitis with tender hard boiled eggs (without the shell).
Sticky foreskins and sensitive testicles aside, in all seriousness I have found a new appreciation for men's health over the past few days. Turns out sexual issues are important for the health of men as well as women . . . who knew?
Fortunately, after seeing four patients complaining of problems with 'the boys' my day brought a bit of variety. There was a lovely three year-old whose mom brought him in with a cold. He played doctor with my stethoscope and obediently opened his mouth wide for me to take a look. To me he was a little miracle, so smart and inquisitive, crawling up and down from the examining table with endless questions. Both his mom and dad are HIV +. He is negative and as healthy as any kid his age (snotty nose included!) Seeing him filled me with endless hope and optimism, that this can happen, and not just in Canada.
The afternoon was a bit more disturbing. A young guy of the exact same age as me and currently at university. He had a sore throat and had noticed a lump on his neck. I examined him and reassured him that he had a cold and most of the time you do get some swollen lymph nodes. He didn't buy it. "But why have I never had it before with a cold? This isn't normal." When the questions kept coming I realized there was something else going on. So I asked if he was worried about anything specific. The can of worms opened. Throat cancer and HIV. Lots of high risk sexual activity. However, he was skeptical about HIV. Wasn't it possible that its all just a money making scheme for doctors and drug companies. People are killing themselves with the drugs they take, you can treat it with diet.
I could nearly hear the creaking of my jaw dropping as he spoke. Speechless. Where do I even start? We had a long discussion, and I hope I opened some doors for dialogue. He went to get the blood work done and we'll see what happens. When I talked to my preceptor about him he said without hesitation, "he needs to wake up, or he's going to die."
In the span of a few hours I went from an explanation of a foreskin re-growing contraption, to a deep feeling of hope in the eyes of a child, to shock at a population that has somehow fallen through the cracks in understanding the gravity of what HIV means. The absurd, the wonderful, and the disturbing . . . its nuts! My work day came to a close on a high note with my evaluation. Stronger than your peers at this level. (What?!? Don't they know I went to U of C and am clearly deficient in pharmacology and anatomy?) Fantastic with patients, great people skills, open-minded and sensitive to patient issues. (Okay, I guess they do know I went to U of C).
And then . . . freedom. Frantic packing. Airport. Plane. Cowboy on plane. Calgary. Hugs, family. Bright sun, blue sky, golden leaves and of course, turkey.
Sticky foreskins and sensitive testicles aside, in all seriousness I have found a new appreciation for men's health over the past few days. Turns out sexual issues are important for the health of men as well as women . . . who knew?
Fortunately, after seeing four patients complaining of problems with 'the boys' my day brought a bit of variety. There was a lovely three year-old whose mom brought him in with a cold. He played doctor with my stethoscope and obediently opened his mouth wide for me to take a look. To me he was a little miracle, so smart and inquisitive, crawling up and down from the examining table with endless questions. Both his mom and dad are HIV +. He is negative and as healthy as any kid his age (snotty nose included!) Seeing him filled me with endless hope and optimism, that this can happen, and not just in Canada.
The afternoon was a bit more disturbing. A young guy of the exact same age as me and currently at university. He had a sore throat and had noticed a lump on his neck. I examined him and reassured him that he had a cold and most of the time you do get some swollen lymph nodes. He didn't buy it. "But why have I never had it before with a cold? This isn't normal." When the questions kept coming I realized there was something else going on. So I asked if he was worried about anything specific. The can of worms opened. Throat cancer and HIV. Lots of high risk sexual activity. However, he was skeptical about HIV. Wasn't it possible that its all just a money making scheme for doctors and drug companies. People are killing themselves with the drugs they take, you can treat it with diet.
I could nearly hear the creaking of my jaw dropping as he spoke. Speechless. Where do I even start? We had a long discussion, and I hope I opened some doors for dialogue. He went to get the blood work done and we'll see what happens. When I talked to my preceptor about him he said without hesitation, "he needs to wake up, or he's going to die."
In the span of a few hours I went from an explanation of a foreskin re-growing contraption, to a deep feeling of hope in the eyes of a child, to shock at a population that has somehow fallen through the cracks in understanding the gravity of what HIV means. The absurd, the wonderful, and the disturbing . . . its nuts! My work day came to a close on a high note with my evaluation. Stronger than your peers at this level. (What?!? Don't they know I went to U of C and am clearly deficient in pharmacology and anatomy?) Fantastic with patients, great people skills, open-minded and sensitive to patient issues. (Okay, I guess they do know I went to U of C).
And then . . . freedom. Frantic packing. Airport. Plane. Cowboy on plane. Calgary. Hugs, family. Bright sun, blue sky, golden leaves and of course, turkey.
Friday, September 28, 2007
Gay Men and African Women
"Come on, don't be scared, just say it! FAGGOTS. That's the highest risk group in Vancouver." My preceptor spat out the words as he egged me on with a grin. He is a tall, ridiculously good looking, tanned and muscular gay man with salt and pepper stubble on his ever smiling face.
"I won't say it, so don't even try." Was my determined response.
For someone who sees herself as fairly open-minded and worldly my assumptions and stereotypes have been given a good beating this week, which is fantastic! I'm working at a clinic that functions as a family practice but focuses on the HIV+ population and specifically gay men. There have been both funny anecdotes and serious ethical questions that I've stumbled across which at week's end I find hard to process coherently.
There was the diagnosis I nearly missed because I didn't ask about nipple bitting . . . of course, silly me. Next I had a young businessman who skipped all pleasantries as he rushed into the room. "I have a rash." In a second, shirt and tie were off and he dropped his pants to show me the distribution. On the bright side, my choice of obstetrics has been confirmed. Although I love the HIV medicine, seriously folks, scrotal rashes are gross. I was also recruited to do a pap smear on a transgender young man who was going through gender reassignment but still had his uterus. So many fascinating and complex medical issues. Heck, not just medical issues.
A well-educated man in his 70s divulged to me just as he went out the door that he wouldn't even shake hands with 'them', he hadn't realized that the majority of the patients here were gay. He had even ignored the hand the doctor I was working with offered him. "You never know how you might catch it." Before retirement he had worked in a microbiology research lab. I was shocked by his views and told him that he should know better . . . with my usual undertone of humour of course.
The fashionista-shop-a-holic-I'm-in-love-with-Justin-Timberlake nurse shared his frustration with me after meeting with someone who had just found out they were HIV+. The patient is in his early thirties, as is the nurse. "There's just no excuse, I don't understand it. In this day and age we know about the disease, we know how prevalent it is and we know how to prevent it. I don't want to judge, but I just don't get how people go ahead and do what they do." My reaction was a bit of surprise I suppose. I thought that this nurse, having worked in the area for several years, with first hand experience would have some insight into why people are still getting infected. Even though HIV is no longer a death sentence and is treatable, it still turns lives upside down.
Perhaps it was similar to the shock I felt when on returning to Tanzania I ran into the husband of the head nurse I had worked with in Uha. We were waiting for transport out to the village. He was returning from her funeral, having died of the unspeakable disease and leaving two young sons. She knew all there was to know about the disease. We led HIV/AIDS seminars together for women, she counseled people to get tested and tell their partners, she delivered the babies of women we knew were infected and saw their fear and pain. But still, with all her education and experience she could not completely control her own health. Was her husband sleeping around? Had she been cheating on him? It doesn't matter, does it? Disease doesn't take a moral stand.
That's the conclusion I've come to. Several people asked me this week that it must be so different working with HIV populations here compared to Africa. More resources? Yes. But the loneliness is the same. Sickness and suffering unite us in our humanity. To look in the eyes of a middle-aged white professional man or to hold the calloused hand of a young mother from Uha I feel the same heaviness is my chest. That this world is not as it should be, and in the depth of our suffering there is inexplicable hope when we realize we suffer together.
"I won't say it, so don't even try." Was my determined response.
For someone who sees herself as fairly open-minded and worldly my assumptions and stereotypes have been given a good beating this week, which is fantastic! I'm working at a clinic that functions as a family practice but focuses on the HIV+ population and specifically gay men. There have been both funny anecdotes and serious ethical questions that I've stumbled across which at week's end I find hard to process coherently.
There was the diagnosis I nearly missed because I didn't ask about nipple bitting . . . of course, silly me. Next I had a young businessman who skipped all pleasantries as he rushed into the room. "I have a rash." In a second, shirt and tie were off and he dropped his pants to show me the distribution. On the bright side, my choice of obstetrics has been confirmed. Although I love the HIV medicine, seriously folks, scrotal rashes are gross. I was also recruited to do a pap smear on a transgender young man who was going through gender reassignment but still had his uterus. So many fascinating and complex medical issues. Heck, not just medical issues.
A well-educated man in his 70s divulged to me just as he went out the door that he wouldn't even shake hands with 'them', he hadn't realized that the majority of the patients here were gay. He had even ignored the hand the doctor I was working with offered him. "You never know how you might catch it." Before retirement he had worked in a microbiology research lab. I was shocked by his views and told him that he should know better . . . with my usual undertone of humour of course.
The fashionista-shop-a-holic-I'm-in-love-with-Justin-Timberlake nurse shared his frustration with me after meeting with someone who had just found out they were HIV+. The patient is in his early thirties, as is the nurse. "There's just no excuse, I don't understand it. In this day and age we know about the disease, we know how prevalent it is and we know how to prevent it. I don't want to judge, but I just don't get how people go ahead and do what they do." My reaction was a bit of surprise I suppose. I thought that this nurse, having worked in the area for several years, with first hand experience would have some insight into why people are still getting infected. Even though HIV is no longer a death sentence and is treatable, it still turns lives upside down.
Perhaps it was similar to the shock I felt when on returning to Tanzania I ran into the husband of the head nurse I had worked with in Uha. We were waiting for transport out to the village. He was returning from her funeral, having died of the unspeakable disease and leaving two young sons. She knew all there was to know about the disease. We led HIV/AIDS seminars together for women, she counseled people to get tested and tell their partners, she delivered the babies of women we knew were infected and saw their fear and pain. But still, with all her education and experience she could not completely control her own health. Was her husband sleeping around? Had she been cheating on him? It doesn't matter, does it? Disease doesn't take a moral stand.
That's the conclusion I've come to. Several people asked me this week that it must be so different working with HIV populations here compared to Africa. More resources? Yes. But the loneliness is the same. Sickness and suffering unite us in our humanity. To look in the eyes of a middle-aged white professional man or to hold the calloused hand of a young mother from Uha I feel the same heaviness is my chest. That this world is not as it should be, and in the depth of our suffering there is inexplicable hope when we realize we suffer together.
Tuesday, September 25, 2007
Life is Beautiful
Life was not beautiful at 2pm when I was still at the hospital on Thursday afternoon after being up most of the night. Its the tightness you get in your temples, the blurry vision and incomplete sentences that are frustrating to no end. The ultimate problem is that you stop caring. I swear I dosed off while peeing then jerked awake and later found myself 'resting my eyes' when walking down long corridors (just for efficiency's sake of course). Not that the night was uneventful, we extracted a bottle of Dove shampoo from an unnamed body orifice (take a wild guess which one). It brought a whole new approach to the Dove campaign for real beauty. As the story goes he had been "watching a documentary on the male G-spot", which is surprising, because normally the story is "I was doing my laundry naked and I just fell on the flashlight" or "I slipped in the shower and . . ." Nice to have an honest answer I guess. But ANYWAY, I digress . . .
Eventually I got home, collapsed for an hour nap, dragged my pathetic self out of bed for a shower and headed to the airport to pick up a friend visiting from Calgary. And so began my lovely long weekend. There were three friends from various locations crashing at our house Thursday night. Friday was a deliciously relaxing day involving warm gooey cinnamon buns for breakfast, an exquisite foot spa (apparently that means pedicure with benefits), a run through the endowment lands and along the beach in the rain culminating with yoga by the ocean. This was directly followed by hot tea and the whole day was peppered with endless discussions about love, poverty, economics, and toe nail polish.
By 8pm Friday I was on the ferry with another set of friends heading to Galiano island. Saturday morning brought with it a brilliant blue sky and calm waters as we crammed our camping gear into the kayaks and battened down the hatches. Of course Bertha (my camera) was strapped to the deck of my kayak in her fancy Pelican box. We paddled along the coast, past intricate sandstone carvings molded by the ocean, turkey vultures circling overhead, cormorants skimmed the water as we came upon their nesting site and dozens of seals sunned themselves on rocks. A pair of otters crawled out of the water and playfully rubbed water from their eyes as they scurried around the rocks. The whole time our chatter was nearly with pressured speech about all the challenges and experiences that residency has brought interspersed with silence in awe of the beauty around us. We crossed the straight to Wallace island, camping on the northern tip. Uncontrollable laughter accompanied our racoon-safe food hang before our pitas, hummus and wine appetizer. The sun sank slowly behind Saltspring island to the West sending shimmering gold across the water to our feet. A day of perfection, surreal in its beauty and a lifetime away from anything mildly related to medicine.
Sunday morning the sun greeted us again, unheard of on a random weekend in September on the West coast! The wind had picked up but we had a 'following sea' which pushed as back along the coast. Out of sheer necessity I actually started paddling with good technique, figuring out how to isolate those back muscles (fortunately my roomie is a professional!) Soggy, chilled, and blissfully exhausted we glided back into the Montague marina.
Life is beautiful. I am profoundly privileged and blessed to be who I am where I am right now. This situation is helped by the fact that I'm now working in a clinic that doesn't start until 9am! Can you believe it?!? 9 to 5, its novel, and no call! In the mornings I curl up in a chair sipping tea and listen to morning meditations courtesy of the world-wide-web and the Jesuits. The outlook is good!
Eventually I got home, collapsed for an hour nap, dragged my pathetic self out of bed for a shower and headed to the airport to pick up a friend visiting from Calgary. And so began my lovely long weekend. There were three friends from various locations crashing at our house Thursday night. Friday was a deliciously relaxing day involving warm gooey cinnamon buns for breakfast, an exquisite foot spa (apparently that means pedicure with benefits), a run through the endowment lands and along the beach in the rain culminating with yoga by the ocean. This was directly followed by hot tea and the whole day was peppered with endless discussions about love, poverty, economics, and toe nail polish.
By 8pm Friday I was on the ferry with another set of friends heading to Galiano island. Saturday morning brought with it a brilliant blue sky and calm waters as we crammed our camping gear into the kayaks and battened down the hatches. Of course Bertha (my camera) was strapped to the deck of my kayak in her fancy Pelican box. We paddled along the coast, past intricate sandstone carvings molded by the ocean, turkey vultures circling overhead, cormorants skimmed the water as we came upon their nesting site and dozens of seals sunned themselves on rocks. A pair of otters crawled out of the water and playfully rubbed water from their eyes as they scurried around the rocks. The whole time our chatter was nearly with pressured speech about all the challenges and experiences that residency has brought interspersed with silence in awe of the beauty around us. We crossed the straight to Wallace island, camping on the northern tip. Uncontrollable laughter accompanied our racoon-safe food hang before our pitas, hummus and wine appetizer. The sun sank slowly behind Saltspring island to the West sending shimmering gold across the water to our feet. A day of perfection, surreal in its beauty and a lifetime away from anything mildly related to medicine.
Sunday morning the sun greeted us again, unheard of on a random weekend in September on the West coast! The wind had picked up but we had a 'following sea' which pushed as back along the coast. Out of sheer necessity I actually started paddling with good technique, figuring out how to isolate those back muscles (fortunately my roomie is a professional!) Soggy, chilled, and blissfully exhausted we glided back into the Montague marina.
Life is beautiful. I am profoundly privileged and blessed to be who I am where I am right now. This situation is helped by the fact that I'm now working in a clinic that doesn't start until 9am! Can you believe it?!? 9 to 5, its novel, and no call! In the mornings I curl up in a chair sipping tea and listen to morning meditations courtesy of the world-wide-web and the Jesuits. The outlook is good!
Tuesday, September 18, 2007
Nostalgia
The sky was bright but the rain fell steadily, pattering softly on the roof and I sat inside insulated from the cold dampness. Slippers on, cozy in my hoodie. Something about today made me want to be back in Tanzania. Maybe it was reading about flooding in Africa on the BBC news, or the frustration of running around doing nothing at work today, who knows. Maybe its the rain.
The memories so vivid. Breeze blowing through tall grass on the plains, clouds rolling across the hills. Bright green maize sprouting in rows of dark brown earth. Women in the fields, weeding, children on their backs. Visitors, always visitors. Children holding my hand, doing homework on the cool cement floor of my living room/kitchen, kicking the soccer ball out in front of my house. Surrounded by people. Walking down dusty paths to visit people, flip flops reassuringly slapping my heels with each step. Shared chai, scalding my mouth, ginger warming my throat. When it rained I couldn't hear my roommate Atu over the thundering on the metal roof. Water seeped under the door and earwigs fell from the roof. No insulation from life. Every moment was about being, not doing. I learned how to fully appreciate the present, not regretting the past or worrying about the future. "Time is not passing, it is coming."
The rain petered out as the sun set and transformed the low-lying clouds over Vancouver into delicious golden peaches and oranges. We slurped noodles on the front porch watching bikers whiz by and dogs pull their humans out for evening strolls. The long long distance from Tanzania isn't just geographical but living in the present seemed like it was infinitely possible in the moment as the moon rose and the light faded. So tomorrow I'll got back to the same hospital with the same people, but I'll try to be instead of do.
The memories so vivid. Breeze blowing through tall grass on the plains, clouds rolling across the hills. Bright green maize sprouting in rows of dark brown earth. Women in the fields, weeding, children on their backs. Visitors, always visitors. Children holding my hand, doing homework on the cool cement floor of my living room/kitchen, kicking the soccer ball out in front of my house. Surrounded by people. Walking down dusty paths to visit people, flip flops reassuringly slapping my heels with each step. Shared chai, scalding my mouth, ginger warming my throat. When it rained I couldn't hear my roommate Atu over the thundering on the metal roof. Water seeped under the door and earwigs fell from the roof. No insulation from life. Every moment was about being, not doing. I learned how to fully appreciate the present, not regretting the past or worrying about the future. "Time is not passing, it is coming."
The rain petered out as the sun set and transformed the low-lying clouds over Vancouver into delicious golden peaches and oranges. We slurped noodles on the front porch watching bikers whiz by and dogs pull their humans out for evening strolls. The long long distance from Tanzania isn't just geographical but living in the present seemed like it was infinitely possible in the moment as the moon rose and the light faded. So tomorrow I'll got back to the same hospital with the same people, but I'll try to be instead of do.
Wednesday, September 12, 2007
Voldemort and Sierra Leone
Blurp-blurp. Blurp-blurp. The submarine sonar sound of my pager swims in my ears through the thick darkness. I page the number.
"Trauma team activation. Multiple stabbings."
Then I'm in the trauma room, everything is happening through a fog. Nurses, paremedics and the emergency doctor are there but no one is doing anything. Blood everywhere. Then somehow its me, gasping for breath, blood coming from the side of my chest, standing there bent over.
The scar on my forehead burns as I'm ordering two large bore IVs, bolus 2 litres, CBC, type and screen for the trauma patient. The image in my head (as pain sears through the scar on my forehead) is of a fetal heart rate tracing, plunging lower and lower, the sound of the doppler pounding out the heart rate getting slower and slower. Wawumph, wawumph . . . wawumph. Nobody is doing anything about it. I hear myself yelling at the shock of no one rushing the woman to the operating room as the baby's heart rate drops. And then I'm running as if through wet cement, the air thicker than molasses, trying to get to the labour and delivery ward in time to save the baby. The elevators are blocked by scrawny African teenage boys with AK-47s, their eyes dead, their voices threaten me as I'm yelling, desperate to get upstairs. I can't control my body's movements. Then my surrounding are no longer the hospital halls but a war zone in Sierra Leone. A young boy with his machine gun hanging down his back pushes a wheelbarrow through tall grass in front of him piled with dead bodies. Flies. Heat. Fear.
Blurp-blurp. Blurp-blurp.
I wake with a start, my heart racing, full of fear, clammy with sweat. The dim shapes of the call room come into focus.
"Mrs. K hasn't peed for 6 hours."
Clearly I'm going nuts. Surgery must be stressing me out. That and I'm reading too much Harry Potter. I'm also reading "A long way gone: memoirs of a boy soldier". Vivid and moving. Maybe too vivid for me these days.
P.S. I don't actually have a scar on my forehead the connects me directly to labour and delivery and the mind of Voldemort . . . I don't think.
"Trauma team activation. Multiple stabbings."
Then I'm in the trauma room, everything is happening through a fog. Nurses, paremedics and the emergency doctor are there but no one is doing anything. Blood everywhere. Then somehow its me, gasping for breath, blood coming from the side of my chest, standing there bent over.
The scar on my forehead burns as I'm ordering two large bore IVs, bolus 2 litres, CBC, type and screen for the trauma patient. The image in my head (as pain sears through the scar on my forehead) is of a fetal heart rate tracing, plunging lower and lower, the sound of the doppler pounding out the heart rate getting slower and slower. Wawumph, wawumph . . . wawumph. Nobody is doing anything about it. I hear myself yelling at the shock of no one rushing the woman to the operating room as the baby's heart rate drops. And then I'm running as if through wet cement, the air thicker than molasses, trying to get to the labour and delivery ward in time to save the baby. The elevators are blocked by scrawny African teenage boys with AK-47s, their eyes dead, their voices threaten me as I'm yelling, desperate to get upstairs. I can't control my body's movements. Then my surrounding are no longer the hospital halls but a war zone in Sierra Leone. A young boy with his machine gun hanging down his back pushes a wheelbarrow through tall grass in front of him piled with dead bodies. Flies. Heat. Fear.
Blurp-blurp. Blurp-blurp.
I wake with a start, my heart racing, full of fear, clammy with sweat. The dim shapes of the call room come into focus.
"Mrs. K hasn't peed for 6 hours."
Clearly I'm going nuts. Surgery must be stressing me out. That and I'm reading too much Harry Potter. I'm also reading "A long way gone: memoirs of a boy soldier". Vivid and moving. Maybe too vivid for me these days.
P.S. I don't actually have a scar on my forehead the connects me directly to labour and delivery and the mind of Voldemort . . . I don't think.
Monday, September 10, 2007
Cutting
Its official. I'm addicted. I love cutting. I can't even explain the exhilaration of it, probably some psychiatric problem I'm sure.
Mr. A is a divorced videographer in his 50s. We got a call from the ICU, it was one of the more, um, exuberant residents. This is how it went when we returned the page:
"F***, what's his name? What's the fat guys name? Anyway, we have a guy with alcoholic pancreatitis and he's going to f***ing die if you don't cut his belly open, we can't even ventilate him anymore."
Years and years of education to come up with such eloquent and concise vocabulary, that's quality.
The 'fat guy' had abdominal compartment syndrome. Pancreatitis is really quite nasty, your pancreas digests itself and then works on digesting the rest of your insides. The pressure in Mr. A's belly was so high it was pushing up against his chest and they were having difficulty getting air into his lungs. Unfortunately, his deaf mother in a nursing home was his next of kin (i.e. decision maker) so she signed things over to his ex-wife . . . who decided he didn't really need the said 'life-saving' surgery. So, we did what most patriarchal medical doctors do when the decision-maker doesn't agree with their treatment . . . two ICU physicians signed a form to make the decision for him, that is, the decision we wanted made.
Our part was the decompressive laparotomy. Quite barbaric really. Although the really barbaric part was when the chief resident handed me the scalpel. The belly before us distended and rock hard from the pressure.
Cut with the belly of the knife. 90 degrees to the skin. One smooth, continuous motion. And there I went. From just below his sternum, around the belly button, and down to his pubic bone. Then we cauterized through the thick layer of fat, through the muscle, fascia and then pink intestines just oozed out, worming their way out of the pressurized cavity. An image of a snake pit from an Indiana Jones movie crossed my mind. Dark brown fluid poured from the opening. Dirty yellow omental fat covered with what looked like white lichen, where its being digested by pancreatic enzymes. Quite the rush.
We didn't close him up, instead we put layer after layer of sticky saran wrap over the gapping belly, cut a whole in the middle and connect it to a vacuum. Back to the ICU he went, most likely to die.
I love cutting. I can't deny that I find surgery stimulating and fascinating, but its just not the same as obstetrics. The full words to describe my thoughts fail me, but the fact is, I'm a better person when I'm doing obstetrics and women's health. My heart felt cold as we wheeled Mr A back to the ICU. In my mind he was the 'fat guy'. I had no connection to him, and yes, compassion, but no empathy.
Three weeks ago there was a woman here on holiday from Spain. She was 17 week pregnant and having a miscarriage. I spend most of my day with her and her husband. I suppose it helped that I spoke Spanish but my soul resonated with their situation. First talking to her and explaining what to expect. Then assuring she had a private room in the emergency department (no small feat). Then fighting again as she was transferred up to the surgery ward to a four-person room as she laboured. Finally staying after I could have gone home to reassure both her and the nursing staff who had never had anything like this happen on their floor before. At days end I caught that tiny being cupped in my hand, wrapped him in a towel and placed him by the window for the priest to come and bless him. Neither of the parents wanted to see. After that, I examined him and slid his miniature body into the plastic pathology container to be sent off. I left them that night feeling not only like a real doctor but a deeply human one.
The reality is that you can't identify with everyone. My hope is that everyone can empathize with someone, being aware of feelings towards patients is probably the first step. Maybe cutting isn't everything, it makes my heart beat fast, but it doesn't make it sing.
Mr. A is a divorced videographer in his 50s. We got a call from the ICU, it was one of the more, um, exuberant residents. This is how it went when we returned the page:
"F***, what's his name? What's the fat guys name? Anyway, we have a guy with alcoholic pancreatitis and he's going to f***ing die if you don't cut his belly open, we can't even ventilate him anymore."
Years and years of education to come up with such eloquent and concise vocabulary, that's quality.
The 'fat guy' had abdominal compartment syndrome. Pancreatitis is really quite nasty, your pancreas digests itself and then works on digesting the rest of your insides. The pressure in Mr. A's belly was so high it was pushing up against his chest and they were having difficulty getting air into his lungs. Unfortunately, his deaf mother in a nursing home was his next of kin (i.e. decision maker) so she signed things over to his ex-wife . . . who decided he didn't really need the said 'life-saving' surgery. So, we did what most patriarchal medical doctors do when the decision-maker doesn't agree with their treatment . . . two ICU physicians signed a form to make the decision for him, that is, the decision we wanted made.
Our part was the decompressive laparotomy. Quite barbaric really. Although the really barbaric part was when the chief resident handed me the scalpel. The belly before us distended and rock hard from the pressure.
Cut with the belly of the knife. 90 degrees to the skin. One smooth, continuous motion. And there I went. From just below his sternum, around the belly button, and down to his pubic bone. Then we cauterized through the thick layer of fat, through the muscle, fascia and then pink intestines just oozed out, worming their way out of the pressurized cavity. An image of a snake pit from an Indiana Jones movie crossed my mind. Dark brown fluid poured from the opening. Dirty yellow omental fat covered with what looked like white lichen, where its being digested by pancreatic enzymes. Quite the rush.
We didn't close him up, instead we put layer after layer of sticky saran wrap over the gapping belly, cut a whole in the middle and connect it to a vacuum. Back to the ICU he went, most likely to die.
I love cutting. I can't deny that I find surgery stimulating and fascinating, but its just not the same as obstetrics. The full words to describe my thoughts fail me, but the fact is, I'm a better person when I'm doing obstetrics and women's health. My heart felt cold as we wheeled Mr A back to the ICU. In my mind he was the 'fat guy'. I had no connection to him, and yes, compassion, but no empathy.
Three weeks ago there was a woman here on holiday from Spain. She was 17 week pregnant and having a miscarriage. I spend most of my day with her and her husband. I suppose it helped that I spoke Spanish but my soul resonated with their situation. First talking to her and explaining what to expect. Then assuring she had a private room in the emergency department (no small feat). Then fighting again as she was transferred up to the surgery ward to a four-person room as she laboured. Finally staying after I could have gone home to reassure both her and the nursing staff who had never had anything like this happen on their floor before. At days end I caught that tiny being cupped in my hand, wrapped him in a towel and placed him by the window for the priest to come and bless him. Neither of the parents wanted to see. After that, I examined him and slid his miniature body into the plastic pathology container to be sent off. I left them that night feeling not only like a real doctor but a deeply human one.
The reality is that you can't identify with everyone. My hope is that everyone can empathize with someone, being aware of feelings towards patients is probably the first step. Maybe cutting isn't everything, it makes my heart beat fast, but it doesn't make it sing.
Monday, September 3, 2007
Paradise Plagiarism
This is copied (with permission) from someone very dear to me. Her description makes my eyes well up with emotion and then smile at the next paragraph. It is both beautiful and tragic, reminding me of the world outside my everyday bubble. Heartbreaking, frustrating, and hopeful all at once. She has a gift, both in how she shares this story, and in the work that she does so passionately.
FRIDAY
You work with it most days. You’re trained to not let it affect your innards. You see it all the time all around you, but some days it just kicks you in the gut. You can feel it in your stomach and the discomfort is intense and doesn’t go away.
Tuesday, August 28, 2007
Smoking is the devil
"Hoedit, hoedit!" An escalating raspy voice calls down the hall to hold the elevator and his electric wheelchair whizzes into view as the doors close. I lunged for the open door button since my attending, chief resident, and two drunk guys in the elevator with me all seemed blissfully oblivious to what was going on.
I had seen him before in the halls. His long, thin frame propped awkwardly on his wheelchair, his body stiff. Most of both his feet are missing, bandaged and oozing but somehow he manages to hold his IV pole between them, in front of his chair as he motors around. The stubs of his index finger and thumb on his right control the joystick on his chair. I don't think he has any teeth and appears to be hooked up to a milky-yellow IV bag for all his nutrients. His pale face with sunken cheeks and stubble is friendly, the toothless grin never leaving, an unlit cigarette between his lips, he's on his way outside for a smoke. Smoking 'till his last days.
Yesterday was my first day of general surgery, and as Murphy's law goes, I was on call. Unlike obstetrics, there is no senior resident or attending staff 'in house' so you're it overnight unless something big happens...then you're it until help comes. The reason I bring up my friend with missing fingers and feet is that the general surgery resident on call 'cross-covers' for all the vascular surgery patients overnight. The vascular resident gave me a call before she went home (after her 36 hours stint or so) to let me know about some patients I might 'hear about' overnight. Two of them had various levels of legs amputated, both DNR (do not resuscitate). "We really thought they'd die over the weekend, so any day now really, just make sure they're comfortable." Vascular surgery seems terribly depressing. Reconnecting and propping open arteries in an attempt to get perfusion to limbs. Arteries choc-full of nasty fatty plaques from long lives of smoking, high cholesterol, diabetes, and obesity. When people think of why they shouldn't smoke they probably think of lung cancer, but really, the heart attacks and rotting amputated limbs ultimately affect more people and needless to say, the impact on quality of life is fairly monstrous.
So I scrambled to figure out the patients on my own team, before reviewing the other general surgery team's patients AND all these vascular patients who had had surgeries I understood in only a simple textbook manner.
My senior resident left at 8pm after we had swamped our way through about six consults and booked an appendectomy for surgery later that night. I had a clear 'to-do' list in my mind of paperwork, dictations, labs and a CT scan to follow-up on to make sure we couldn't 'turf' one of our patients in the emergency department to GI and avoid admitting her. It was quite clear that I should call him only if I was really really uncomfortable with what was going on, in which case I should definitely call him...a fine balance.
A call from the ward at 2am.
"Are you familiar with Mr. Jones?"
"Nope. But you can tell me about him."
"Well, he doesn't have a pulse (I swear there was a pause here) in his left foot."
"Oh...what surgery did he have? Has he ever had a pulse in that foot?"
"Bilateral fem-pop last week." Pause. I hear the flip, flip, flip through the chart. "Actually, I guess we haven't ever picked up his dorsalis pedis pulse."
"Good...uh...I mean, not good, but no change then. Are his vitals stable otherwise?"
"Yes, sorry to bother you."
"No really, its okay, thanks for letting me know."
I clunk the phone down with relief. After clicking the light off, I lay down again on the ancient, hard, creaky hospital bed with thinly disguised rubber pillow that are standard in the call rooms. I'm exhausted but sleep and adrenaline don't mix well. Constantly dreading a call about my little lady with a bowel obstruction whose pain I just got under control an hour ago. The knowledge that I also hold the trauma pager is like a ball of lead in my stomach. I do get some sleep, but the pages continue, slowly I get comfortable and my heart stops pounding each time I hear the beeping.
Morning does eventually come. No one died, well, on my watch at least. The frenzied surgery rounds begin. Warp speed in and out of patients' rooms so the surgery residents can get to the ORs on time. When we finish the chief turns to me and says in a cheery voice, "I know you're post-call, but there are some great cases in the OR today. They'd be perfect for you to see as an OB/GYN resident. You're free to stay all day if you'd like!" Honestly, I wasn't really sure if he was serious or not... since I had only know him for a day I chose the 'serious' option instead of breaking into uncontrollable laughter like I felt like doing. I ended up staying for two surgeries that admittedly were very relevant and they actually let me do a fair amount which was a good trade-off for bleary-eyedness. Too bad for the ani of those involved of course.
I had seen him before in the halls. His long, thin frame propped awkwardly on his wheelchair, his body stiff. Most of both his feet are missing, bandaged and oozing but somehow he manages to hold his IV pole between them, in front of his chair as he motors around. The stubs of his index finger and thumb on his right control the joystick on his chair. I don't think he has any teeth and appears to be hooked up to a milky-yellow IV bag for all his nutrients. His pale face with sunken cheeks and stubble is friendly, the toothless grin never leaving, an unlit cigarette between his lips, he's on his way outside for a smoke. Smoking 'till his last days.
Yesterday was my first day of general surgery, and as Murphy's law goes, I was on call. Unlike obstetrics, there is no senior resident or attending staff 'in house' so you're it overnight unless something big happens...then you're it until help comes. The reason I bring up my friend with missing fingers and feet is that the general surgery resident on call 'cross-covers' for all the vascular surgery patients overnight. The vascular resident gave me a call before she went home (after her 36 hours stint or so) to let me know about some patients I might 'hear about' overnight. Two of them had various levels of legs amputated, both DNR (do not resuscitate). "We really thought they'd die over the weekend, so any day now really, just make sure they're comfortable." Vascular surgery seems terribly depressing. Reconnecting and propping open arteries in an attempt to get perfusion to limbs. Arteries choc-full of nasty fatty plaques from long lives of smoking, high cholesterol, diabetes, and obesity. When people think of why they shouldn't smoke they probably think of lung cancer, but really, the heart attacks and rotting amputated limbs ultimately affect more people and needless to say, the impact on quality of life is fairly monstrous.
So I scrambled to figure out the patients on my own team, before reviewing the other general surgery team's patients AND all these vascular patients who had had surgeries I understood in only a simple textbook manner.
My senior resident left at 8pm after we had swamped our way through about six consults and booked an appendectomy for surgery later that night. I had a clear 'to-do' list in my mind of paperwork, dictations, labs and a CT scan to follow-up on to make sure we couldn't 'turf' one of our patients in the emergency department to GI and avoid admitting her. It was quite clear that I should call him only if I was really really uncomfortable with what was going on, in which case I should definitely call him...a fine balance.
A call from the ward at 2am.
"Are you familiar with Mr. Jones?"
"Nope. But you can tell me about him."
"Well, he doesn't have a pulse (I swear there was a pause here) in his left foot."
"Oh...what surgery did he have? Has he ever had a pulse in that foot?"
"Bilateral fem-pop last week." Pause. I hear the flip, flip, flip through the chart. "Actually, I guess we haven't ever picked up his dorsalis pedis pulse."
"Good...uh...I mean, not good, but no change then. Are his vitals stable otherwise?"
"Yes, sorry to bother you."
"No really, its okay, thanks for letting me know."
I clunk the phone down with relief. After clicking the light off, I lay down again on the ancient, hard, creaky hospital bed with thinly disguised rubber pillow that are standard in the call rooms. I'm exhausted but sleep and adrenaline don't mix well. Constantly dreading a call about my little lady with a bowel obstruction whose pain I just got under control an hour ago. The knowledge that I also hold the trauma pager is like a ball of lead in my stomach. I do get some sleep, but the pages continue, slowly I get comfortable and my heart stops pounding each time I hear the beeping.
Morning does eventually come. No one died, well, on my watch at least. The frenzied surgery rounds begin. Warp speed in and out of patients' rooms so the surgery residents can get to the ORs on time. When we finish the chief turns to me and says in a cheery voice, "I know you're post-call, but there are some great cases in the OR today. They'd be perfect for you to see as an OB/GYN resident. You're free to stay all day if you'd like!" Honestly, I wasn't really sure if he was serious or not... since I had only know him for a day I chose the 'serious' option instead of breaking into uncontrollable laughter like I felt like doing. I ended up staying for two surgeries that admittedly were very relevant and they actually let me do a fair amount which was a good trade-off for bleary-eyedness. Too bad for the ani of those involved of course.
Thursday, August 23, 2007
To be known
My sister came to visit last week, I hadn't seen her since April. Post-call we went for what are advertised as 'the best' cinnamon buns in Vancouver and she listened to the exhausted kid sister who wishes she wasn't a doctor and doesn't really know how she'll survive residency or ever be in a healthy relationship. Then we hit IKEA so she could re-design my room. I had an unexplainable attraction to every single bed I saw, it was like a strong magnetic pull. She patiently pulled me out of each one I crawled into until we eventually got to the picture frame section where my energy was suddenly revived. I didn't have to be funny . . . or even awake apparently, she would still hang out with me in all my grumpy, sleepy, post-callness.
I managed to meet up with her for lunch on Davie street, just next to the hospital one day. She laughed at my scrubs and openly mocked me for wearing them in public. Of course, I hadn't had time to change clothes AND have lunch with her, how picky can you get?!? But she knows me. Underneath the Dr. name tag, stethoscope and greens I'm just a sister, as vulnerable, human, and mock-able as ever. And it felt good just to be me with no labels and no explanations.
On Galiano island, together we joked about the watery hippie chai they sold at the craft market, lacking in both substance and spice. My sister being the ultimate chai expert having drunk it on dodgy Indian trains in ceramic mugs. We read Harry Potter to each other on the beach with several smiles in our direction from passers-by. Then we did a rather soggy hike along a coast-line ridge, misty and beautiful. We were told it was a 'dry' rain . . . I still haven't got the west coast lingo down apparently since I have no idea how that describes pouring rain.
We talked about the past and the future, our hopes and fears, I laughed until my eyes watered. I was reminded of the power of being known and loved by someone. In the midst of the excitement and exhilaration of moving to an amazing new place, starting an overwhelming, scary, (and fantastic) new job you can sometimes push the loneliness away but it always pops up. My life seems like a never-ending cycle; wake-up, get on bike, work, come home, eat, run or bike, collapse into bed, then start over. I miss being known. I miss filling my time with people instead of activities. Which is why it was so good to remember that I am known. There may not be a tangible presence that I can touch, but I am known.
I managed to meet up with her for lunch on Davie street, just next to the hospital one day. She laughed at my scrubs and openly mocked me for wearing them in public. Of course, I hadn't had time to change clothes AND have lunch with her, how picky can you get?!? But she knows me. Underneath the Dr. name tag, stethoscope and greens I'm just a sister, as vulnerable, human, and mock-able as ever. And it felt good just to be me with no labels and no explanations.
On Galiano island, together we joked about the watery hippie chai they sold at the craft market, lacking in both substance and spice. My sister being the ultimate chai expert having drunk it on dodgy Indian trains in ceramic mugs. We read Harry Potter to each other on the beach with several smiles in our direction from passers-by. Then we did a rather soggy hike along a coast-line ridge, misty and beautiful. We were told it was a 'dry' rain . . . I still haven't got the west coast lingo down apparently since I have no idea how that describes pouring rain.
We talked about the past and the future, our hopes and fears, I laughed until my eyes watered. I was reminded of the power of being known and loved by someone. In the midst of the excitement and exhilaration of moving to an amazing new place, starting an overwhelming, scary, (and fantastic) new job you can sometimes push the loneliness away but it always pops up. My life seems like a never-ending cycle; wake-up, get on bike, work, come home, eat, run or bike, collapse into bed, then start over. I miss being known. I miss filling my time with people instead of activities. Which is why it was so good to remember that I am known. There may not be a tangible presence that I can touch, but I am known.
Monday, August 13, 2007
Urgent section... no senior
Rushing down the hall. Fumbling the ties of my mask as I walk together with the obstetrician.
Water running, pink foam covering hands. Scrub, scrub, scrub. Repeatedly. Nails, palms, individual fingers, one at a time. Wrists, then down the arm. Rinse, spraying water down my greens. Water running off my elbows. I back into the room through swinging doors, arms held out, at 90 degrees like a robot, hands pointing to the ceiling.
Sterile hand towel rough on my hands. I scoop my arms into the blue gown. Hands deep into latex gloves held out for me, snapping gratifyingly around my arms. Tight springiness of my gloves reassuring, sterile gown stiff as I move. The curves of the body on the table become only an anatomic circle of skin in a blue sterile operating field. Bright lights spotlight the belly swollen with pregnancy.
Cautery in place. Suction ready. Heart pounding. Hand steady. Knife. Exhilarated. Bleary eyes fully cleared with the adrenaline of the cut.
Flash of custard yellow shiny fat globules as the skin parts, then bright red specs, spread and flood the incision. Deeper now, a sheen of fat particles on the surface of pooling red blood. Tiny fountain from an artery. Snapping of clamps. Cautery buzzing. Pungent smell of burning blood, tissue, smoke. Suction slurping. Snipping scissors slice through fascia. Knife again. Green fluid spurts. Cord floats out. Then pressure. I'm standing on a stool pressing all my weight down onto her belly while matted wet black hair emerges from below. Scrunkled, wrinkled face finally forced out. Body gray, covered with thick whitish-yellow paste. A girl. Pause. Breathing stops. Silence. Snap. Snap. Scissors snip. Slimy warm limbs held tightly in my hands, I turn and place her in the sterile white flannel the nurse is holding. No cry. Suction slurps. Heads crowd around the warmer. Hands flying. Then a gurgling cry, squirming baby. The room breaths again.
Blood spurts, flooding the uterus as the placenta slips out. Warm, pulsating. Clamps, sutures. Suction squealing as dark livery clots dangle off its tip. Ties. Cautery. Gauze. Gaping uterus closed, fascia comes together. Back up to the custard fat, no longer shiny. Krink krink krink as I staple the final edges together.
Only now does my heart slow, tearing off my gown, gloves sticky with dried blood snapped into the garbage. Blood and fluid all over my ankles and feet. Scattered bloody footprints bright on the floor.
Wading in the exhilaration of it all. Senses overloaded. Wow, that was cool.
Water running, pink foam covering hands. Scrub, scrub, scrub. Repeatedly. Nails, palms, individual fingers, one at a time. Wrists, then down the arm. Rinse, spraying water down my greens. Water running off my elbows. I back into the room through swinging doors, arms held out, at 90 degrees like a robot, hands pointing to the ceiling.
Sterile hand towel rough on my hands. I scoop my arms into the blue gown. Hands deep into latex gloves held out for me, snapping gratifyingly around my arms. Tight springiness of my gloves reassuring, sterile gown stiff as I move. The curves of the body on the table become only an anatomic circle of skin in a blue sterile operating field. Bright lights spotlight the belly swollen with pregnancy.
Cautery in place. Suction ready. Heart pounding. Hand steady. Knife. Exhilarated. Bleary eyes fully cleared with the adrenaline of the cut.
Flash of custard yellow shiny fat globules as the skin parts, then bright red specs, spread and flood the incision. Deeper now, a sheen of fat particles on the surface of pooling red blood. Tiny fountain from an artery. Snapping of clamps. Cautery buzzing. Pungent smell of burning blood, tissue, smoke. Suction slurping. Snipping scissors slice through fascia. Knife again. Green fluid spurts. Cord floats out. Then pressure. I'm standing on a stool pressing all my weight down onto her belly while matted wet black hair emerges from below. Scrunkled, wrinkled face finally forced out. Body gray, covered with thick whitish-yellow paste. A girl. Pause. Breathing stops. Silence. Snap. Snap. Scissors snip. Slimy warm limbs held tightly in my hands, I turn and place her in the sterile white flannel the nurse is holding. No cry. Suction slurps. Heads crowd around the warmer. Hands flying. Then a gurgling cry, squirming baby. The room breaths again.
Blood spurts, flooding the uterus as the placenta slips out. Warm, pulsating. Clamps, sutures. Suction squealing as dark livery clots dangle off its tip. Ties. Cautery. Gauze. Gaping uterus closed, fascia comes together. Back up to the custard fat, no longer shiny. Krink krink krink as I staple the final edges together.
Only now does my heart slow, tearing off my gown, gloves sticky with dried blood snapped into the garbage. Blood and fluid all over my ankles and feet. Scattered bloody footprints bright on the floor.
Wading in the exhilaration of it all. Senses overloaded. Wow, that was cool.
Wednesday, August 8, 2007
The problem with pain
She came in weeks ago, blissfully oblivious to how her world was literally about to turn upside-down. We'll call her Suzie. She was at her routine 20 week ultrasound and they found that she was 4cm dilated. That's bad news. A diagnosis of cervical insufficiency, meaning your cervix just doesn't stay closed if any pressure is put on it. Previously, its been called cervical incompetency, somehow implying a deficiency on the mother's part, that she was incompetent in carrying a baby. An active high school teacher, Suzie was now given the choice of a 'rescue' stitch in her cervix and complete bed rest until delivery (with a fairly low success rate), or to just let labour happen and put in a prophylactic stitch early in her next pregnancy. Suzie and her hubby chose the procedure and bed rest. They desperately wanted this pregnancy, having already experienced two miscarriages. It would be at least 4 weeks until baby would even be a candidate for resuscitation at 24 weeks. As days went by, and turned into weeks, Suzie bled a bit, sometimes she cramped. Then we wouldn't even let her up to the bathroom and we but her in 'Trendelenburg' position, so she lay every day, all day, with her head far below her feet. Scared even to have a bowel movement.
At 23 weeks, babies born are not resuscitated, the cut-off for viability is 24 weeks, even then, only 50% actually survive and 85-90% will be blind, deaf, or have mental or physical disabilities. But parents can request resus at 24 weeks. After 25 weeks, resuscitation happens most of the time, regardless of parental choice. A strange set of rules, built like a fence around the ethical principles of trying to do more good than harm.
We were updated each day, until she hit 23 weeks and 5 days. Suzie's water broke, she went into labour and we had to take her to the operating room to remove the stitches so they wouldn't completely tear through her cervix and permanently damage it for any future attempts at pregnancy.
Some images will forever be burned into my mind, and this is one of them. A small, tight, shiny membrane slowly proceeding from the vagina, feet first. Tiny feet in a glass globe coming out towards us, each only 2 or 3 cm long with five delicate, miniature toes on each foot. Imprinting their footprints forever onto my heart as they came.
We swam in the sorrow and intensity of the moment. The air felt like viscous liquid around me. Their grief making waves that hit each person in the room. Completely enveloping me in the heart-wrenching, soul-destroying pain of the present moment. A father's tears dripping freely onto the face of his tiny tiny son, swaddled in towels, eyelids still fused. Time stood still. Masked faces in sterile gowns blurred in the periphery of the operating room and the only thing real was a husband and wife, a sister gazing and embracing this tiny being, silently yelling out in agony, guilt, and anger. Raw. Abject. The physical pain and emotional intensity of this delivery not followed by pure joy and sheer bewilderment at the miracle of a new living, breathing, crying being that most deliveries have.
I've watched dozens of partners, mothers, and friends watch their loved one go through the exquisitely miserable pain of labour. Some are so uncomfortable they have to leave often, to get ice chips, a blanket, anything, to feel like they are doing something. I remember one husband unable to coach or encourage, but could only hold his wife's head close to his, looking straight into her eyes, never moving for over an hour, being fully present in her reality with unspoken intensity. Its near impossible to watch someone go through such agonizing suffering and not be able to alleviate it or share their burden. Being a religious person, pain and suffering are central to my understanding of our place in the world and really, a huge part of what life is all about. Sharing in the messiness and aching of humanity, crying out in unison at all the injustice that life may bring.
This past week, a dear dear friend of mine had to have labour induced after her baby was found to no longer have a heartbeat. It wasn't unexpected, and we had discussed all sort of options and decisions they may have had to make in the future. But the all-consuming brokenness and grief that comes with the loss of a child, with all the hopes for their future is devastating. It gave my experiences at work a whole new meaning. Dimensions that I never imagined were clear to me, as I saw my friend's story in each of my patients. Her fears and her dreams, and now her brokenness. There are no neat answers to explain the pain. No glib words of comfort or encouragement. This all-consuming pain must be experienced completely and without filters.
Pain is a personal thing. You can witness it, you may even share in it and feel like you're drowning in it, but it must always be owned. You can't take it away from someone else to free them from it. Somehow, unexplainably, I find hope in the midst of these messy emotions. A hope found in the knowledge that this pain is at the center of what it means to be truly human.
At 23 weeks, babies born are not resuscitated, the cut-off for viability is 24 weeks, even then, only 50% actually survive and 85-90% will be blind, deaf, or have mental or physical disabilities. But parents can request resus at 24 weeks. After 25 weeks, resuscitation happens most of the time, regardless of parental choice. A strange set of rules, built like a fence around the ethical principles of trying to do more good than harm.
We were updated each day, until she hit 23 weeks and 5 days. Suzie's water broke, she went into labour and we had to take her to the operating room to remove the stitches so they wouldn't completely tear through her cervix and permanently damage it for any future attempts at pregnancy.
Some images will forever be burned into my mind, and this is one of them. A small, tight, shiny membrane slowly proceeding from the vagina, feet first. Tiny feet in a glass globe coming out towards us, each only 2 or 3 cm long with five delicate, miniature toes on each foot. Imprinting their footprints forever onto my heart as they came.
We swam in the sorrow and intensity of the moment. The air felt like viscous liquid around me. Their grief making waves that hit each person in the room. Completely enveloping me in the heart-wrenching, soul-destroying pain of the present moment. A father's tears dripping freely onto the face of his tiny tiny son, swaddled in towels, eyelids still fused. Time stood still. Masked faces in sterile gowns blurred in the periphery of the operating room and the only thing real was a husband and wife, a sister gazing and embracing this tiny being, silently yelling out in agony, guilt, and anger. Raw. Abject. The physical pain and emotional intensity of this delivery not followed by pure joy and sheer bewilderment at the miracle of a new living, breathing, crying being that most deliveries have.
I've watched dozens of partners, mothers, and friends watch their loved one go through the exquisitely miserable pain of labour. Some are so uncomfortable they have to leave often, to get ice chips, a blanket, anything, to feel like they are doing something. I remember one husband unable to coach or encourage, but could only hold his wife's head close to his, looking straight into her eyes, never moving for over an hour, being fully present in her reality with unspoken intensity. Its near impossible to watch someone go through such agonizing suffering and not be able to alleviate it or share their burden. Being a religious person, pain and suffering are central to my understanding of our place in the world and really, a huge part of what life is all about. Sharing in the messiness and aching of humanity, crying out in unison at all the injustice that life may bring.
This past week, a dear dear friend of mine had to have labour induced after her baby was found to no longer have a heartbeat. It wasn't unexpected, and we had discussed all sort of options and decisions they may have had to make in the future. But the all-consuming brokenness and grief that comes with the loss of a child, with all the hopes for their future is devastating. It gave my experiences at work a whole new meaning. Dimensions that I never imagined were clear to me, as I saw my friend's story in each of my patients. Her fears and her dreams, and now her brokenness. There are no neat answers to explain the pain. No glib words of comfort or encouragement. This all-consuming pain must be experienced completely and without filters.
Pain is a personal thing. You can witness it, you may even share in it and feel like you're drowning in it, but it must always be owned. You can't take it away from someone else to free them from it. Somehow, unexplainably, I find hope in the midst of these messy emotions. A hope found in the knowledge that this pain is at the center of what it means to be truly human.
Friday, August 3, 2007
Lost in Dictation
I didn't have to do much dictating in medical school, but now that I'm a lowly resident there isn't a day that goes by without having to participate in this dreadful ritual. How it works? You call a number, and talk to the phone about a patient. You have to do it for all consults, deliveries, and yes, the dreaded discharge summaries which get sent to the family docs so they have a clue about what's happening to their patients. It was only in my third week that I discovered the pause and rewind buttons, those poor, poor, people who have to transcribe these things! "Ummm . . . uhh . . . note to transcriber, delete that last sentence . . . uh . . . I . . . uh meant to say . . . " Then last week, I had my first official doze-off during a discharge summary which I was trying to do before going home post-call . . . I'm such a dimwit!
As my friends and family can attest, I have a mumbling problem. In regular conversation, this isn't an issue, people just look at me funny and I pause and repeat. One friend, in the middle of an animated story I was telling her, tilted her head to the side, squinted her eyes and said, "funny, sound is coming out, but your lips just aren't moving." Unfortunately, as I found out when I actually read one of the consults I dictated, it may become a more of an issue. One of my patients ended up having a 67cm abscess in her pelvis. Now, even if you're not an expert in abscesses or the pelvis, wouldn't you maybe question something the size of an exercise ball being drained through someone's vagina?!? It was actually 6-7cm of course, but reading it on the computer I laughed out loud, imagining this slim woman waddling around. I was at the nursing station and everyone promptly assumed I was on Facebook. Hehehe, nope, doesn't take much to amuse me.
It made me think of one of my classmate's attempts at getting some tips on how to dictate and googled "medical transcription tips". The results were hilarious, although I can only remember a few of them:
1) When dictating, please place the receiver as far into your armpit as possible and whisper softly.
2) If you need to cough or sneeze at any time, please remove from armpit, and do so directly into the phone receiver.
3) Please make sure to spell out uncommon names like "Brown" or "Smith" but don't waste time spelling simple names like Ghchoayeyzfhgfr.
Then some of the mistakes that have been made:
1) Because the couple is having trouble conceiving, I have referred them to a futility expert.
2) On rectal exam, the thyroid was found to be enlarged.
3) During her first visit to the emergency department, she was examined, x-rated, and discharged home.
So my new goal is to speak clearly, mostly to avoid medico-legal problems in the future, and ultimately, I sure hope those nice people at transcription have a whole lot of patience and a sense of humour (I always thank them copiously after each dictation).
As my friends and family can attest, I have a mumbling problem. In regular conversation, this isn't an issue, people just look at me funny and I pause and repeat. One friend, in the middle of an animated story I was telling her, tilted her head to the side, squinted her eyes and said, "funny, sound is coming out, but your lips just aren't moving." Unfortunately, as I found out when I actually read one of the consults I dictated, it may become a more of an issue. One of my patients ended up having a 67cm abscess in her pelvis. Now, even if you're not an expert in abscesses or the pelvis, wouldn't you maybe question something the size of an exercise ball being drained through someone's vagina?!? It was actually 6-7cm of course, but reading it on the computer I laughed out loud, imagining this slim woman waddling around. I was at the nursing station and everyone promptly assumed I was on Facebook. Hehehe, nope, doesn't take much to amuse me.
It made me think of one of my classmate's attempts at getting some tips on how to dictate and googled "medical transcription tips". The results were hilarious, although I can only remember a few of them:
1) When dictating, please place the receiver as far into your armpit as possible and whisper softly.
2) If you need to cough or sneeze at any time, please remove from armpit, and do so directly into the phone receiver.
3) Please make sure to spell out uncommon names like "Brown" or "Smith" but don't waste time spelling simple names like Ghchoayeyzfhgfr.
Then some of the mistakes that have been made:
1) Because the couple is having trouble conceiving, I have referred them to a futility expert.
2) On rectal exam, the thyroid was found to be enlarged.
3) During her first visit to the emergency department, she was examined, x-rated, and discharged home.
So my new goal is to speak clearly, mostly to avoid medico-legal problems in the future, and ultimately, I sure hope those nice people at transcription have a whole lot of patience and a sense of humour (I always thank them copiously after each dictation).
Wednesday, August 1, 2007
3 kisses and a love note
Today was an exceptionally good day.
It started out with a patient leaving us a large box of chocolate truffles. Absolutely heavenly, or devilish, I can't quite decide, either way, they were so good it was practically scandalous. Creamy richness melting on my tongue.
Then my lovely little Thai patient gave me a big sloppy kiss on the neck when she was hugging me on the way out the door (after she had a picture taken with baby and me). She may have been going for my cheek, but she just wasn't tall enough, her chin was about up to my elbow.
Later in the day my other favourite patient, a young girl here doing a masters from Ecuador, wrote me a sweet note on a postcard from Quito. Her story had inspired me and the nurses had found me more than once just sitting chatting with her and her mom in their room. I'm keeping the note to read on the bad days:
Agosto 1, 2007
Dra Shohona,
Espero que siempre conserves tu sonrisa y buen caracter, y que alegres a tus pacientes. Exitos y bendiciones. Gracias por todo.
Rita, Karla, y Nicole
That was two more kisses which put my tally up to three, although I'm not sure if Ecuadorian 'besitos' really count. Its more like shaking hands, everyone kisses everyone in Ecuador! Oh well, I'll count them anyway.
I realize that I'm deeply blessed and privileged to share just a little of the beauty of life with each of these people, each with their own stories of love and pain.
Today there was also a memorial held for the woman who died last week. Unfortunately I couldn't make it, but the still fresh memories of death and sorrow made a striking juxtaposition on the joy and gratefulness I was filled with today. Life is such a contradiction, so hard yet happy, so miserable yet lovely. But today, today was a good day.
It started out with a patient leaving us a large box of chocolate truffles. Absolutely heavenly, or devilish, I can't quite decide, either way, they were so good it was practically scandalous. Creamy richness melting on my tongue.
Then my lovely little Thai patient gave me a big sloppy kiss on the neck when she was hugging me on the way out the door (after she had a picture taken with baby and me). She may have been going for my cheek, but she just wasn't tall enough, her chin was about up to my elbow.
Later in the day my other favourite patient, a young girl here doing a masters from Ecuador, wrote me a sweet note on a postcard from Quito. Her story had inspired me and the nurses had found me more than once just sitting chatting with her and her mom in their room. I'm keeping the note to read on the bad days:
Agosto 1, 2007
Dra Shohona,
Espero que siempre conserves tu sonrisa y buen caracter, y que alegres a tus pacientes. Exitos y bendiciones. Gracias por todo.
Rita, Karla, y Nicole
That was two more kisses which put my tally up to three, although I'm not sure if Ecuadorian 'besitos' really count. Its more like shaking hands, everyone kisses everyone in Ecuador! Oh well, I'll count them anyway.
I realize that I'm deeply blessed and privileged to share just a little of the beauty of life with each of these people, each with their own stories of love and pain.
Today there was also a memorial held for the woman who died last week. Unfortunately I couldn't make it, but the still fresh memories of death and sorrow made a striking juxtaposition on the joy and gratefulness I was filled with today. Life is such a contradiction, so hard yet happy, so miserable yet lovely. But today, today was a good day.
Tuesday, July 31, 2007
Money, money, money
The first official doctor pay-check was deposited into our accounts last week, incredibly anti-climactic, it seemed smaller than I had imagined. Quite funny, they calculate pay assuming you have worked 67.5 hours in two weeks. I kept on staring at the pay slip trying to figure out why it said 67.5 hours. Do normal people actually work that many hours? Isn't that part time work? I work more than that in one week. Oh, I wish I was normal! (Yes, go ahead and laugh). The calculation per hour, something I really shouldn't have done, works out to just under $9/hour. Which I believe is just under minimum wage in BC. Tim Horton's here I come!
Don't get me wrong, I'm not exactly complaining about it, this is a 900% improvement from the $1/hour you get as a final year medical student (minus tuition of course), but I imagined I might actually be able to get out the the red. BC's standards are just too high. Lets review my recent costs:
My rent has doubled.
My car insurance has doubled (screw you ICBC!)
My blueberry addiction is costing me $2.96/day.
My car (which was serviced in June in Alberta) needed an inspection to get registered ($152), the tail light was burnt out ($28), the front brake pads were the wrong size and worn out ($190), the brake wheel cylinders were cracked and leaking ($90), and my brake fluid needed flushed ($10, optional). Total $950.
Sushi obsession ($8/call shift).
My stethoscope was stolen ($238 + tax).
Skinny-little textbook on how to dictate obstetrics and gynecology surgeries ($121).
Fenders for my bike ($15).
Did I mention blueberries ($2.96 daily)?
Okay, this is getting boring, but you get the picture. I'm hemorrhaging money faster than Lenny Kravitz in a guitar shop. I can't believe I spent over $1000 today, just on a car and a book!
So I came up with a plan (of sorts), okay, its not even really a plan, just some random ideas all in succession that will help me get out of debt, brainstorming shall we say.
1) Get my budget-minded sister to assess my finances and make a plan when she comes to visit.
2) Sell my car (its just too pricey), and buy a road bike AND a macro lens for my camera.
3) Cancel #2 since it cancels out the money I would have gained by selling my car.
4) Get a sugar-daddy.
5) Start a drug dealing business with my newly acquired prescription writing skills and easy access to the down town East-side.
Fine, I give up. I'll just keep working, the rest of the world has to do it to survive, why shouldn't I? Ultimately, life's not really about the money, I wouldn't trade the blueberries for cheaper rent anyway.
Don't get me wrong, I'm not exactly complaining about it, this is a 900% improvement from the $1/hour you get as a final year medical student (minus tuition of course), but I imagined I might actually be able to get out the the red. BC's standards are just too high. Lets review my recent costs:
My rent has doubled.
My car insurance has doubled (screw you ICBC!)
My blueberry addiction is costing me $2.96/day.
My car (which was serviced in June in Alberta) needed an inspection to get registered ($152), the tail light was burnt out ($28), the front brake pads were the wrong size and worn out ($190), the brake wheel cylinders were cracked and leaking ($90), and my brake fluid needed flushed ($10, optional). Total $950.
Sushi obsession ($8/call shift).
My stethoscope was stolen ($238 + tax).
Skinny-little textbook on how to dictate obstetrics and gynecology surgeries ($121).
Fenders for my bike ($15).
Did I mention blueberries ($2.96 daily)?
Okay, this is getting boring, but you get the picture. I'm hemorrhaging money faster than Lenny Kravitz in a guitar shop. I can't believe I spent over $1000 today, just on a car and a book!
So I came up with a plan (of sorts), okay, its not even really a plan, just some random ideas all in succession that will help me get out of debt, brainstorming shall we say.
1) Get my budget-minded sister to assess my finances and make a plan when she comes to visit.
2) Sell my car (its just too pricey), and buy a road bike AND a macro lens for my camera.
3) Cancel #2 since it cancels out the money I would have gained by selling my car.
4) Get a sugar-daddy.
5) Start a drug dealing business with my newly acquired prescription writing skills and easy access to the down town East-side.
Fine, I give up. I'll just keep working, the rest of the world has to do it to survive, why shouldn't I? Ultimately, life's not really about the money, I wouldn't trade the blueberries for cheaper rent anyway.
Saturday, July 28, 2007
Thursday, July 26, 2007
I see dead people
Deceased. It just popped up on my patient list next to her name. That was it. Done. Not that we hadn't know this was coming, she was in the ICU and had been deteriorating for weeks but it seemed like an abrupt ending. She had come in off the street, initially admitted for psychosis (i.e. craziness) she had then slowly lost consciousness and developed sepsis. Kidney failure, liver failure, and a mushy brain . . . all just kind of unexplainable. I had seen her several times, they were trying to rule out any gyne causes. Then suddenly 'deceased' on my list. Everything felt numb. I have trouble imagining people dead, since all my memories of people are so alive.
I'm in obstetrics because I don't like sick people and I don't like dead people, its simple. 95% of the time, you get a happy healthy mom, a gurgling happy baby, and a proud as heck dad out of the deal, its all happy clappy. Patients hug you and take pictures of you and buy you cherries and chocolates and cinnamon buns. But today was different, it was just a bit soul destroying. To call it tragic and heart-breaking doesn't even begin to describe it. My day started and ended with the same word.
The woman came is last night, 28 weeks pregnant and with horrible abdominal pain. So much that we couldn't even examine her without giving morphine, screaming out in pain. The first thought was abruption, bleeding in the uterus when the placenta pulls away from the wall. But baby looked fine, all the lab results were normal, just excruciating pain. She had been into the emergency room twice before with similar pain, chalked up to constipation, it resolved, and she went home. We were just talking about her in rounds when I got paged. A distressed emergency doc was on the phone. "She's gone tachy, she looks terrible, and I can't get a fetal heart. I need you here now."
I grabbed a senior resident, realizing immediately this was way out of my league. Within minutes we knew. It was an IUFD. We talk in code. Intra-uterine fetal demise.
She's white as a sheet, snowed on morphine but still in pain, heart rate through the roof. Ultrasound is repeated, its now been done four times. I've seen dozens of scans and there's nothing as bone chilling as seeing the spine and rib cage with no tiny heart moving up and down. The husband stands by the stretcher in the trauma room, squeezing her hand, stroking her hair. Her fingers look so pale they are nearly translucent in his strong brown hands. We walk in and out of the room, hushed tones, "get the attending here stat." It seems sick and twisted that we can't tell the husband until we've dotted all the i's and crossed the t's. "Medico-legally imperative" I'm told. A wave of nausea sweeps over me, I'm disgusted at the system I am so actively a part of. A husband is watching his wife writhe in pain, knowing that something is wrong with his child, asking and asking but we can't officially tell him. Frustration, anger, pain.
Finally they know, her eyes dart around the room, I see terror and confusion in her eyes, it makes no sense. The father, well-built and articulate chokes with emotion. "But it was fine, 8 hours ago the baby was fine. How did this happen? The baby was fine!" Why, why, why? Dozens of questions, anger spilling out at this injustice, this tragedy of horrific proportions. Talking to the emergency physician her eyes well up and she holds her head in her hands. She was on all night, saw the patient when she came in and woke her up this morning to check on her. "Let's play the what-if game, what did I miss?" The answer, for now, is nothing. Because no one can carry that weight on their shoulders without being crushed.
As if the loss of a child is not painful enough, the initial plan was to induce labour. An emotionally laden process.
That didn't happen, mom 'crashed'. She was rushed to the OR for an emergency C-section. Dead baby out. Uterus sewn up. Then all they can see is black small bowel. Five feet of dead gut. That's what caused her pain. General surgery comes in, of course you can't live without a gut, so they sew her up and send her to ICU, intubated, ultimately to die.
Numb. A man has lost a child and then his wife, can life ever go on? She's someone's daughter, someone's sister, someone's best friend and she would have been a mother. He thought she was constipated and now she dead.
I want a debriefing session, to sit with everyone involved and talk of the horror, to reassure each other that we didn't miss anything. I want to process this, to try to understand what just happened. But my pager just keeps on going off.
I'm called to see a distressed woman, emotional and crying after bleeding for weeks after a D&C for a miscarriage. "I just want it to be over, I need closure. This isn't fair, I still feel like I'm pregnant, my breasts are still full, but I keep on passing these clots. When will it be over? Is it blood? Is that a piece of baby coming out? I can't handle this, I need it to be over." Sobbing, nearly hysterical. I listen and listen, and empathize and reassure and book her for the OR for another D&C. I don't even leave the ER before I get grabbed for more consults. A cyst next to someone's urethra (yawn), bleeding that won't stop, pain and pain and pain. Then a woman who blacked out and rolled her car . . . and is 16 weeks pregnant. Scared. A broken arm, a worried husband.
If anyone says that the medical system is uncaring and doesn't feel pain I will dispute it with passion. All day in the emergency department, in the halls, on the maternity ward, nurses, residents, and attendings stopped me to ask if it was really true. If this unbelievable tragedy had really happened right in front of our eyes. It was as if as the first obstetrics resident on the scene I could offer some insight, some reassurance, a person they could identify as a place to share their grief. If I could have stepped out of my own emotions around the issue I probably would have found it fascinating.
I keep going and going, trying to fully engage with each person and their own personal pain but I'm drained. I have nothing more to give. Numb. As I write up the notes I find myself zoning out and starring at the page without focusing. By 4pm I can't stop my hand from shaking as a pick-up the phone to return a page. At that point I realized that I hadn't eaten or had a drink since 5:30 this morning. In fact, I hadn't even peed since then, what am I? Superhuman? At which point I raid the limitless supply of egg-salad sandwiches and potent orange Tang in the ER fridge.
This is the worst job on earth, there's nothing but pain. Why can't I make lattes for a living, where a bad day means that I used 2% instead of soy and the espresso machine is broken?
But at the end of the day, I get to go home. To splurge on creamy Greek yogurt and stacks of local blueberries. I pound out every ounce of anger, sadness, and sheer emotional exhaustion into the pedals of my bike. Disappearing into the thick cool forest of the endowment lands, skidding around corners, speeding down the hill to the ocean and along the coast. I can leave that pain behind and start a new day, but they can't, because ultimately its their pain and not mine. I can only try to share it with them when I'm present in their reality, in some watered-down version. No, I don't really want to make lattes, I want to be present with people in their pain, this is real, this is life.
I'm in obstetrics because I don't like sick people and I don't like dead people, its simple. 95% of the time, you get a happy healthy mom, a gurgling happy baby, and a proud as heck dad out of the deal, its all happy clappy. Patients hug you and take pictures of you and buy you cherries and chocolates and cinnamon buns. But today was different, it was just a bit soul destroying. To call it tragic and heart-breaking doesn't even begin to describe it. My day started and ended with the same word.
The woman came is last night, 28 weeks pregnant and with horrible abdominal pain. So much that we couldn't even examine her without giving morphine, screaming out in pain. The first thought was abruption, bleeding in the uterus when the placenta pulls away from the wall. But baby looked fine, all the lab results were normal, just excruciating pain. She had been into the emergency room twice before with similar pain, chalked up to constipation, it resolved, and she went home. We were just talking about her in rounds when I got paged. A distressed emergency doc was on the phone. "She's gone tachy, she looks terrible, and I can't get a fetal heart. I need you here now."
I grabbed a senior resident, realizing immediately this was way out of my league. Within minutes we knew. It was an IUFD. We talk in code. Intra-uterine fetal demise.
She's white as a sheet, snowed on morphine but still in pain, heart rate through the roof. Ultrasound is repeated, its now been done four times. I've seen dozens of scans and there's nothing as bone chilling as seeing the spine and rib cage with no tiny heart moving up and down. The husband stands by the stretcher in the trauma room, squeezing her hand, stroking her hair. Her fingers look so pale they are nearly translucent in his strong brown hands. We walk in and out of the room, hushed tones, "get the attending here stat." It seems sick and twisted that we can't tell the husband until we've dotted all the i's and crossed the t's. "Medico-legally imperative" I'm told. A wave of nausea sweeps over me, I'm disgusted at the system I am so actively a part of. A husband is watching his wife writhe in pain, knowing that something is wrong with his child, asking and asking but we can't officially tell him. Frustration, anger, pain.
Finally they know, her eyes dart around the room, I see terror and confusion in her eyes, it makes no sense. The father, well-built and articulate chokes with emotion. "But it was fine, 8 hours ago the baby was fine. How did this happen? The baby was fine!" Why, why, why? Dozens of questions, anger spilling out at this injustice, this tragedy of horrific proportions. Talking to the emergency physician her eyes well up and she holds her head in her hands. She was on all night, saw the patient when she came in and woke her up this morning to check on her. "Let's play the what-if game, what did I miss?" The answer, for now, is nothing. Because no one can carry that weight on their shoulders without being crushed.
As if the loss of a child is not painful enough, the initial plan was to induce labour. An emotionally laden process.
That didn't happen, mom 'crashed'. She was rushed to the OR for an emergency C-section. Dead baby out. Uterus sewn up. Then all they can see is black small bowel. Five feet of dead gut. That's what caused her pain. General surgery comes in, of course you can't live without a gut, so they sew her up and send her to ICU, intubated, ultimately to die.
Numb. A man has lost a child and then his wife, can life ever go on? She's someone's daughter, someone's sister, someone's best friend and she would have been a mother. He thought she was constipated and now she dead.
I want a debriefing session, to sit with everyone involved and talk of the horror, to reassure each other that we didn't miss anything. I want to process this, to try to understand what just happened. But my pager just keeps on going off.
I'm called to see a distressed woman, emotional and crying after bleeding for weeks after a D&C for a miscarriage. "I just want it to be over, I need closure. This isn't fair, I still feel like I'm pregnant, my breasts are still full, but I keep on passing these clots. When will it be over? Is it blood? Is that a piece of baby coming out? I can't handle this, I need it to be over." Sobbing, nearly hysterical. I listen and listen, and empathize and reassure and book her for the OR for another D&C. I don't even leave the ER before I get grabbed for more consults. A cyst next to someone's urethra (yawn), bleeding that won't stop, pain and pain and pain. Then a woman who blacked out and rolled her car . . . and is 16 weeks pregnant. Scared. A broken arm, a worried husband.
If anyone says that the medical system is uncaring and doesn't feel pain I will dispute it with passion. All day in the emergency department, in the halls, on the maternity ward, nurses, residents, and attendings stopped me to ask if it was really true. If this unbelievable tragedy had really happened right in front of our eyes. It was as if as the first obstetrics resident on the scene I could offer some insight, some reassurance, a person they could identify as a place to share their grief. If I could have stepped out of my own emotions around the issue I probably would have found it fascinating.
I keep going and going, trying to fully engage with each person and their own personal pain but I'm drained. I have nothing more to give. Numb. As I write up the notes I find myself zoning out and starring at the page without focusing. By 4pm I can't stop my hand from shaking as a pick-up the phone to return a page. At that point I realized that I hadn't eaten or had a drink since 5:30 this morning. In fact, I hadn't even peed since then, what am I? Superhuman? At which point I raid the limitless supply of egg-salad sandwiches and potent orange Tang in the ER fridge.
This is the worst job on earth, there's nothing but pain. Why can't I make lattes for a living, where a bad day means that I used 2% instead of soy and the espresso machine is broken?
But at the end of the day, I get to go home. To splurge on creamy Greek yogurt and stacks of local blueberries. I pound out every ounce of anger, sadness, and sheer emotional exhaustion into the pedals of my bike. Disappearing into the thick cool forest of the endowment lands, skidding around corners, speeding down the hill to the ocean and along the coast. I can leave that pain behind and start a new day, but they can't, because ultimately its their pain and not mine. I can only try to share it with them when I'm present in their reality, in some watered-down version. No, I don't really want to make lattes, I want to be present with people in their pain, this is real, this is life.
Monday, July 23, 2007
Village Idiot
For as long as I can remember, I have made people laugh. And for equally long, I've never known whether people laugh because they think I'm an idiot, or because I've said or done something genuinely funny. Are they laughing at me, or because of me? The conclusion I've come to is probably a bit of both.
Today I was on the gynecology service, it was a bit of a slow day, no one with a raging pelvic infection or a ruptured tubal pregnancy needing rushed to the OR. So I was sitting reading relevant academic literature for part of the day on the labour and delivery floor. The other residents being busy with doctor-type stuff a nurse decided I would do, and asked me what I thought was a pretty funny question, so I responded (I thought) accordingly. She was charting, and couldn't think of how to describe a procedure done on a newborn.
"He has a little skin tag below his left nipple and the pediatrician has tied a suture around it [to make it fall off], what's that called?"
"Oh yeah, the medical term for that is a 'nubin', like a third nipple, just like Chandler had on Friends. The procedure is called 'castration', its the same thing they do on little calves testicles with an elastic band. So you could write 'nubin castration noted' in the chart." I said matter-of-factly.
Pause.
Burst of laughter.
People keep on commenting on how studious I am (funniest joke EVER), the attending staff does some teaching with me and one of the other junior residents, of course I ask scads of questions, because really, why not, when someone's teaching you. Somewhere along the way (and for the life of me I can't remember when), between my joking with nurses and residents, reading about inducing labour and eating cherries one of the patients gave us, the attending obstetrician asks me what program I'm in. When I reply 'OB' she bursts out laughing. Not just a bit of a chuckle, but side-splitting laughter. So much so, I was worried that not only would she fall off her chair and fracture something but that she might lose voluntary control of her bladder. Tears started rolling down her cheeks, her face went red, and she couldn't even talk. The whole nursing station now stops to try and figure out what on earth is happening. I helpfully pipe-up: "I think she's just shocked that I'm such an idiot." To which of course, everyone laughs anew, the attending now gasping for air.
The same feeling came over me when I was determined to learn how to carry water on my head in Tanzania. Everyone gathered around the water tap for entertainment. Its a mixture of profound embarrassment and feeling like you are contributing to community or team dynamics by providing quality entertainment.
So much for being a professional, eloquent doctor. I will probably always be just a bit of a village idiot. Humility 101.
Today I was on the gynecology service, it was a bit of a slow day, no one with a raging pelvic infection or a ruptured tubal pregnancy needing rushed to the OR. So I was sitting reading relevant academic literature for part of the day on the labour and delivery floor. The other residents being busy with doctor-type stuff a nurse decided I would do, and asked me what I thought was a pretty funny question, so I responded (I thought) accordingly. She was charting, and couldn't think of how to describe a procedure done on a newborn.
"He has a little skin tag below his left nipple and the pediatrician has tied a suture around it [to make it fall off], what's that called?"
"Oh yeah, the medical term for that is a 'nubin', like a third nipple, just like Chandler had on Friends. The procedure is called 'castration', its the same thing they do on little calves testicles with an elastic band. So you could write 'nubin castration noted' in the chart." I said matter-of-factly.
Pause.
Burst of laughter.
People keep on commenting on how studious I am (funniest joke EVER), the attending staff does some teaching with me and one of the other junior residents, of course I ask scads of questions, because really, why not, when someone's teaching you. Somewhere along the way (and for the life of me I can't remember when), between my joking with nurses and residents, reading about inducing labour and eating cherries one of the patients gave us, the attending obstetrician asks me what program I'm in. When I reply 'OB' she bursts out laughing. Not just a bit of a chuckle, but side-splitting laughter. So much so, I was worried that not only would she fall off her chair and fracture something but that she might lose voluntary control of her bladder. Tears started rolling down her cheeks, her face went red, and she couldn't even talk. The whole nursing station now stops to try and figure out what on earth is happening. I helpfully pipe-up: "I think she's just shocked that I'm such an idiot." To which of course, everyone laughs anew, the attending now gasping for air.
The same feeling came over me when I was determined to learn how to carry water on my head in Tanzania. Everyone gathered around the water tap for entertainment. Its a mixture of profound embarrassment and feeling like you are contributing to community or team dynamics by providing quality entertainment.
So much for being a professional, eloquent doctor. I will probably always be just a bit of a village idiot. Humility 101.
Thursday, July 19, 2007
Wanted: Fenders and a Brolly
Apparently it rains in Vancouver.
I know, I know, this is not something I hadn't heard before, but now I've actually experienced it. For several weeks now as I drank in the glorious sunny days and beautiful evenings I've thought this 'Vancouver is rainy and gray' stuff was an unsubstantiated, vicious rumour. Turns out its true.
Monday morning dawned gray and soggy. I grabbed my fancy gortex jacket (yes, the one that I could have fed a small village for a month with), and felt pretty cool speeding off into the rain. Not so cool. Shoes soaked, puddle water sprayed up my back, face speckled with rain I emerged from the parkade steaming. Not only was I a little damp, I was positively drenched. Right down to my knickers. What to do, what to do? Soggy knickers, hmmm.
A little known fact is that the most comfortable underwear in the world are in fact disposable hospital underwear. How do I know, you ask? I just happen to have experience sitting in pools of amniotic fluid while catching babies and have tried them in the past. So I snuck into the triage room (getting a couple of strange looks) and did the deed. At first sight they look like a pile of gauze, however, on closer inspection they are more like white fishnet stocking (in a square-ish shape). They may look a bit odd, but they do the trick. It would not have mattered that they were unsightly if it wasn't for the fact that all the scrubs have a hole where the drawstring tie at the side that either show off your thigh or your underwear, depending on your style. Yup, jokes on me Vancouver, apparently it rains here.
Either I'm going to have to keep a disposable knicker stash in my locker or I'll have to invest in some fenders. The fenders may be the least humbling option.
I know, I know, this is not something I hadn't heard before, but now I've actually experienced it. For several weeks now as I drank in the glorious sunny days and beautiful evenings I've thought this 'Vancouver is rainy and gray' stuff was an unsubstantiated, vicious rumour. Turns out its true.
Monday morning dawned gray and soggy. I grabbed my fancy gortex jacket (yes, the one that I could have fed a small village for a month with), and felt pretty cool speeding off into the rain. Not so cool. Shoes soaked, puddle water sprayed up my back, face speckled with rain I emerged from the parkade steaming. Not only was I a little damp, I was positively drenched. Right down to my knickers. What to do, what to do? Soggy knickers, hmmm.
A little known fact is that the most comfortable underwear in the world are in fact disposable hospital underwear. How do I know, you ask? I just happen to have experience sitting in pools of amniotic fluid while catching babies and have tried them in the past. So I snuck into the triage room (getting a couple of strange looks) and did the deed. At first sight they look like a pile of gauze, however, on closer inspection they are more like white fishnet stocking (in a square-ish shape). They may look a bit odd, but they do the trick. It would not have mattered that they were unsightly if it wasn't for the fact that all the scrubs have a hole where the drawstring tie at the side that either show off your thigh or your underwear, depending on your style. Yup, jokes on me Vancouver, apparently it rains here.
Either I'm going to have to keep a disposable knicker stash in my locker or I'll have to invest in some fenders. The fenders may be the least humbling option.
Tuesday, July 17, 2007
I didn't get the memo
I didn't get the memo that said doctors don't get to cuddle babies. Its one of lives profound injustices that the nurses get all the fun. They just didn't mention in medical school that due to my official title I would just never have the time to sit in a rocking chair and hold a newborn, and even if I did have the time, this was clearly not my job.
So I'm pretending I don't know. In the rare moments between following up a hemoglobin, ordering packed red cells and assessing a woman to see if she really has broken her water I sneak out the back door of the nursing station, across the hall, and into the special care nursery. They know me now.
The world slows down between the rows of boxed babies. I breath calmly, life is now as it should be, things have stopped moving at warp speed. A brand new complete package of humanity, a whole being, nestled in my arms. My world stops spinning out of control. Delicate fingers grasping out at the harsh world, miniature monkey toes on my palm and I am at peace with the universe.
In the photo archive that is my early life, there is picture after picture of me holding babies. When I was no more than 4 years old I remember my mom propping my arm on a pillow so it wouldn't get tired as I sat and gazed at the little nose, soft tiny ears. In an instant all my rambunctious, mischievous, hyperactive traits ceased and I sat in stillness, a miracle my mother would say.
During my time in Africa, I would come to town from my village, sometimes exhausted and disillusioned, unsure that there was any good left in this world of pain. All I had to do was sit on Mama Kiri's porch with a two year-old Baraka in my arms, waking up from his nap to know that all was well in the world, that there is always new life and hope and peace.
I smile as I see a grunt and then feel a rumbling in the diaper, my pager conveniently pierces the silence and I'm jolted back into a different world as I stand up from the rocking chair and tuck baby back into her box. Apologizing profusely to the nurse for not changing the diaper of course and off to see why Mrs. Jones can't pee.
So I'm pretending I don't know. In the rare moments between following up a hemoglobin, ordering packed red cells and assessing a woman to see if she really has broken her water I sneak out the back door of the nursing station, across the hall, and into the special care nursery. They know me now.
The world slows down between the rows of boxed babies. I breath calmly, life is now as it should be, things have stopped moving at warp speed. A brand new complete package of humanity, a whole being, nestled in my arms. My world stops spinning out of control. Delicate fingers grasping out at the harsh world, miniature monkey toes on my palm and I am at peace with the universe.
In the photo archive that is my early life, there is picture after picture of me holding babies. When I was no more than 4 years old I remember my mom propping my arm on a pillow so it wouldn't get tired as I sat and gazed at the little nose, soft tiny ears. In an instant all my rambunctious, mischievous, hyperactive traits ceased and I sat in stillness, a miracle my mother would say.
During my time in Africa, I would come to town from my village, sometimes exhausted and disillusioned, unsure that there was any good left in this world of pain. All I had to do was sit on Mama Kiri's porch with a two year-old Baraka in my arms, waking up from his nap to know that all was well in the world, that there is always new life and hope and peace.
I smile as I see a grunt and then feel a rumbling in the diaper, my pager conveniently pierces the silence and I'm jolted back into a different world as I stand up from the rocking chair and tuck baby back into her box. Apologizing profusely to the nurse for not changing the diaper of course and off to see why Mrs. Jones can't pee.
Wednesday, July 11, 2007
Who really failed?
Nurse: So, does she really have late stage cancer?
Me: Probably, its not looking very good.
N: When where you guys going to let her know about what you think?
M: Oh, you mean she doesn't know?
N: She doesn't have any idea.
M: Right, I'll get on that.
An anxious discomfort gnawed at my gut. I paged my senior resident who told me just to go ahead and let her know we thought it might be cancer but still had to run more tests (classic cop out doctor line . . . more tests.) In med school you practice 'breaking bad news', but its with actors as patients and your classmates are on the other side of the 2-way mirror ready to give you feedback.
A soft-spoken artist in her late 50s had come to the emergency department vomiting, abdomen distended, complaining of gradual weight loss over the last year, drenching night sweats, and weakness. She had a bowel obstruction. When I felt her stomach later it had a huge tender irregularly shaped mass that went from her pelvis to above her belly button. She hadn't been feeling well for a long time she said, but enemas and vitamins from her naturopath had been helpful on and off. On further questioning she had actually had menstrual bleeding for the last six years. We were always taught that bleeding after menopause means uterine cancer until proven otherwise. Imaging showed nasty necrotic masses. On exam foul smelling pus and blood oozed freely from her cervix. She had known she hadn't been well, but earlier in life had been seriously scarred by her interactions with the medical system and had avoided it at all costs. I felt this woman deserved so much more than what a two week-old doctor could give.
So I went to talk with her now that she had been up on the ward for a day. After pleasantries about her orchids and art, nausea and pain, I tried to explain some things.
Me (outside voice): We're worried this might be cancer in your uterus.
Her: Oh, so what's next?
Me (inside voice): If it was me I'd just take off into the wilderness and spend my last months surrounded by beauty . . . or maybe sky-diving, hmmmmm . . .
Outside voice: We'd like to do some more tests to see what our options are.
Her: Do you think its bad?
Inside voice: Bad? No, not bad, try horrific. Or maybe more of a tragic injustice of unimaginable consequence!
Outside voice: We don't know, but it does sound like you've been sick for a while.
She asked a few more questions, which I could only answer in the same evasive manner. We were transferring her to the cancer center and they would admit her there. But then she was quiet . . . pensive, overwhelmed, swimming in this new reality. What was going through her head? Anger? Regret? Sadness? Or a complete unawareness of what was happening?
I suppose it was tempting to join my colleagues in the anger band-wagon, to say that alternative medicine practitioners do more damage than good, that they even kill people and should be held responsible. But instead I was overwhelmed with sadness. Sadness that we had failed this woman. Bleeding for six years. In unexplained pain for over a year, and yet she would not come see a doctor until she was in agony, unable to even eat. What damage had Western medicine done to her in the past that she was so hesitant to seek help?
Maybe if we had listened, maybe if she had been heard years ago. Then I would be meeting her at an art show not sitting on her bed with the curtain drawn around it in a muggy shared hospital room. I'm going to wipe the image of the weak pale woman laying powerlessly in a foreign bed from my mind and replace it with a vibrant artist molding a creation out of clay on a potter's wheel in a rustic home in interior BC.
Me: Probably, its not looking very good.
N: When where you guys going to let her know about what you think?
M: Oh, you mean she doesn't know?
N: She doesn't have any idea.
M: Right, I'll get on that.
An anxious discomfort gnawed at my gut. I paged my senior resident who told me just to go ahead and let her know we thought it might be cancer but still had to run more tests (classic cop out doctor line . . . more tests.) In med school you practice 'breaking bad news', but its with actors as patients and your classmates are on the other side of the 2-way mirror ready to give you feedback.
A soft-spoken artist in her late 50s had come to the emergency department vomiting, abdomen distended, complaining of gradual weight loss over the last year, drenching night sweats, and weakness. She had a bowel obstruction. When I felt her stomach later it had a huge tender irregularly shaped mass that went from her pelvis to above her belly button. She hadn't been feeling well for a long time she said, but enemas and vitamins from her naturopath had been helpful on and off. On further questioning she had actually had menstrual bleeding for the last six years. We were always taught that bleeding after menopause means uterine cancer until proven otherwise. Imaging showed nasty necrotic masses. On exam foul smelling pus and blood oozed freely from her cervix. She had known she hadn't been well, but earlier in life had been seriously scarred by her interactions with the medical system and had avoided it at all costs. I felt this woman deserved so much more than what a two week-old doctor could give.
So I went to talk with her now that she had been up on the ward for a day. After pleasantries about her orchids and art, nausea and pain, I tried to explain some things.
Me (outside voice): We're worried this might be cancer in your uterus.
Her: Oh, so what's next?
Me (inside voice): If it was me I'd just take off into the wilderness and spend my last months surrounded by beauty . . . or maybe sky-diving, hmmmmm . . .
Outside voice: We'd like to do some more tests to see what our options are.
Her: Do you think its bad?
Inside voice: Bad? No, not bad, try horrific. Or maybe more of a tragic injustice of unimaginable consequence!
Outside voice: We don't know, but it does sound like you've been sick for a while.
She asked a few more questions, which I could only answer in the same evasive manner. We were transferring her to the cancer center and they would admit her there. But then she was quiet . . . pensive, overwhelmed, swimming in this new reality. What was going through her head? Anger? Regret? Sadness? Or a complete unawareness of what was happening?
I suppose it was tempting to join my colleagues in the anger band-wagon, to say that alternative medicine practitioners do more damage than good, that they even kill people and should be held responsible. But instead I was overwhelmed with sadness. Sadness that we had failed this woman. Bleeding for six years. In unexplained pain for over a year, and yet she would not come see a doctor until she was in agony, unable to even eat. What damage had Western medicine done to her in the past that she was so hesitant to seek help?
Maybe if we had listened, maybe if she had been heard years ago. Then I would be meeting her at an art show not sitting on her bed with the curtain drawn around it in a muggy shared hospital room. I'm going to wipe the image of the weak pale woman laying powerlessly in a foreign bed from my mind and replace it with a vibrant artist molding a creation out of clay on a potter's wheel in a rustic home in interior BC.
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