Days 114-118: Need Slo-Mo

Sometimes I wish there was an option to slow down time or pause everything else put yourself.  I'd get more sleep, study more, read more, write more.  If LOML was unpaused with me, we'd get more time together.  Quality time.  We make quality time for each other, but it never seems to be enough.  I always have something looming over me that needs to be done.  I wish that weren't always the case.  I wish I had time to actually be in the moment, not just tell myself I'm in the moment but really have my mind on other things I need to get done.  One of my mentors in medical school used to say that there is no such thing as work-life balance, it's a matter of what needs more of your focus at any given time.  Some days, work takes precedence.  During medical school, residency, and fellowship, work takes most of the focus.  At some point, the pendulum will swing, and a focus on life outside of work can be at the forefront.  What's really difficult are the times when both need attention at the same time.  That makes it even more stressful because neither receives the full attention they need so either one or the other isn't done to the best that's needed.  It can be frustrating.  Right now, I want to be able to take time away from everything I have to do for work to actually enjoy life.  I know my time is coming, it's just frustrating in this moment.  It helps that I have a very supportive family.

Days 112-113: Pent Up Anger

I can't believe it's already October and I've completed yet another narrative medicine prompt.  There was what seems to be a lot of pent up frustration and anger in this one.  More than I think I realized I had.  I hope it does not offend.

Prompt: Write your own poem in the spirit of Rafael Campo’s exploration of the difficulty of certain relationships in medicine, like with his patients

You never seem happy.

Every day, you talk to the wall,

Almost refusing to acknowledge me.

It seems to annoy you that I come each day

To check on your mom, my patient,

And offer no answers you want to hear

About how things will go.

You already know, you say.

You don't need me to tell you.

You want to tie her to a chair

So she can't continue to fall.

You claim she is your mom

Yes ask for her to be treated

Like an abused animal.

And when I try empathy,

It only makes you more perturbed.

I can't take the dementia

Or broken wrist

Or broken hip away.

I can't make her less impulsive.

I can offer supportive care,

And understand I will see you all again

The next time she falls

Because she isn't ready to die

Even though hospice isn't just about that.

You ask for support

Then turn it away.

I can't keep the energy for this

Day after day.

I'm tired and want to care for my patient

The best that I can

Without dealing with the anger

And frustration

And callous statements

Coming from you every morning.

Days 105-111: Missing Week

I can' believe we are in the last full week of October.  This month has flown by!  Last week was particularly rough.  The husband of one of my patient's unexpectedly died last week.  He came faithfully every day for the first week, and then stopped showing up early last week.  We finally asked police to go for a safety check to his house, and they found that he had passed away.  It is tragic and heart-breaking.  I enjoyed getting to sit and talk with him each day.  It gave me insight into his wife who has dementia.  He cared so deeply for her and loved her more than he was able to express.  It showed, though.  Boy did it show.  He was faithful and steadfast, and she's noticed that he isn't coming by anymore.  I'm sad that I don't get to talk with him anymore, too.  I know his family is grieving.

I had a patient come back to the hospital after being discharged.  In any other case, I might have felt responsible, but the current situation is not one that lends itself to being able to prevent rehospitalizations.  The patient has dementia and a broken hip and thinks she can still walk.  Naturally, she is going to fall.  I did what I could to try to prevent it, but it still is going to happen regardless of what we do.  The daughters realize it, but are frustrated with a system that is not designed to be supportive of the aging population.  It's unfortunate, and I wish we had more options.

Today, I had to have an in-depth conversation with a patient's family member over the phone.  Her stress was palpable, but I showed her respect for what she had done.  Through that, I was able to support her through some tough decisions, and ultimately help her better care for her loved one.  I don't think I ever imagined having some of these conversations over the phone like this.  I still have a lot of room to grow.  I feel like it's a huge compliment if the patient's daughter was able to sense through the phone how deeply I care about my patients and how much I love my career.  Despite being tired most of the time, it seems like I'm still able to show more empathy than I realize.  That's a really good thing.

I'm looking forward to finding a time when I can take a deep breath again.  Until then, I'll keep trucking along.

Days 102-104: Stress to the Max

This weekend has been crazy!  So, as noted in the previous post, a kitten jumped from a tree into my arms.  We named it Alex, and then weren't able to get the kitten to the vet until Saturday.  So Saturday morning, LOML and I do our third Walk to End Alzheimer's together in the morning.  Before kitten's vet appointment, our sweet Chiweenie, Odie, injures his paw while out running.  So we have a vet appointment for the kitten at 2:30 and for Odie at 5:30.  The kitten's appointment goes well.  We find out Alex is a boy (as I'd surmised), about 10 weeks old (a little older than I thought), covered in fleas, and with round worms (none of which are a surprised).  He's mildly underweight, but all energy and just as sweet as he can be.  Boy does he love staying right by my feet.  I've tripped over him a couple times now.  At any rate, we've got him on kitten food that he loves, the worms are gone and so are the fleas (and we are happy for all of that!).  His orange is getting darker each day, and his stripes are starting to come in.  Here are some pictures:

So after we finish at the vet with Alex, we practically turn around with Odie to have him evaluated since he is now limping on his right front foot.  After an assessment, the vet needs to give him hydromorphone to get him to relax enough to where they can examine him.  He went from this about 10 minutes later:

To this about 20 minutes later:

He was so out of it until Sunday morning.  Fortunately, no fractures in the foot.  He's on an anti-inflammatory which seems to be helping.  Minimal limping.  Only having to work through the associated constipation that comes with the use of narcotics.  It's so strange getting to see that medications I prescribe at work used on my animals.

Finally, we have the other cats, Julia and Boris, who are trying to stick together to phase the monster (AKA Alex) on the other side of the door.  Alex is off limits to them for the next couple weeks in case he is feline leukemia positive.  Hopefully he isn't and we can start introductions after his next round of vaccinations.  At any rate, the gray babies are trying to avoid the meowing baby.  I don't know how excited either will be when finally introduced.  Here are the other babies:

We have a house full of animals, but I wouldn't have it any other way.  It is hectic and stressful at times, but LOML and I are a team, and frankly, they're all really easy animals to take care of.

Days 100-101: When Kittens Fall from the Sky

Yesterday had an interesting end to it.  LOML and I went on our usual evening walk with the dog.  It takes us along the busy road we live on before we turn into one of the nearby neighborhoods that is a little quieter for the pup to do his business.  On one side of the side walk are a bunch of trees and bushes that act like a barrier to absorb some of the sound of the road to protect the neighborhood.  As we were walking by one of the trees, we hear what sounds like to loud meows.  LOML looks at me and says, "does that sound like a cat?"  I agree with relief knowing that I'm not actually hallucinating it, and then begin to search for the cat because that's what I do in these situations (disclaimer:  I did not know what I'd do in this situation until yesterday when it happened).  I look up, and about 3/4 of the way up one of the trees is a little orange kitten face.  It is so excited to see people, it partly climbs, partly falls, and partly jumps out of the tree and into my arms (after I'd flung the dog's leash at LOML).  As I'm sitting there holding it, looking bewildered that this is real life, LOML looks at me, sighs, and says, "we just adopted another cat didn't we?"  "Yep."  I have no idea how to care for a kitten despite having now parented three cats.  All were adopted on the older side (first kitty was 10, second was 6, and third was 10 months at the time of the adoption).  This little guy or gal is maybe 6-8 weeks old.  I'm not sure.  S/he ("she slash" as LOML referred to the kitten) was covered in fleas, but otherwise alert and active.  S/he purred the entire way home, as I feverishly called my family to figure out what to do.  My sister gave me some tips as did my dad (2 of my parents 3 cats were also "found".  One was in my dad's garden, the other was on the side of NC route 64.  Clearly this "finding cats" thing is genetic.).  So we got supplies, the kitty ate (although looks like s/he may have worms), and now will have its first checkup Saturday.  Definitely unexpected, but as one of my co-workers said today, "if the cat comes from the Heavens, you have to keep it".  And that's just what we'll do (despite LOML's trepidation at another cat, he is learning to love it...and let s/he fall asleep on him).

 Me and the kitten next to the tree it climbed out of

Post bath with Dawn to try to kill some of the fleas

(It really works! Dawn ftw!!)

Days 98-99: Time doesn't Slow Down for Nobody

I feel like time is flying by, yet it feels like forever until I take my geriatric boards.  I actually hate that I'm devoting so much time to geriatrics right now that I can't work on stuff for palliative care.  I genuinely wish I could study notes for palliative medicine.  For now, I can focus on palliative care during the day and geriatrics some nights and weekends.  I'm hoping things will settle down to where I can get a better routine in place.

I am trying to intersperse all the work with some fun/downtime.  I went to see the Russian Ballet perform Swan Lake this past weekend.  It was so good.  I love ballet, and was glad to get to spend the time with my parents and Drew.  It's also unreal that we are starting to do serious planning for our wedding.  With wedding, job, and potentially house on the horizon, I feel like in some ways time is flying by.

Weekends in October are full as are the weeks.  I barely feel like I have time to breathe.  I don't remember working this hard and enjoying it this much in the past.  It's exciting and daunting to know that I am going to be starting my first job as a physician in a short period of time.  It's surreal to be on this ledge ready to fall over.

Days 94-97: The Anniversary

I am woefully behind on blogging, mostly due to catching up on sleep and spending time with family.  The weekend will be covered tomorrow (hopefully).  Today is dedicated to yet another instance of delight in the midst of suffering.

One of the patient's I cared for last week celebrated her 67th wedding anniversary on Friday.  She was on the palliative care unit and we had discussed her impending death and referral to hospice only the day before.  Her family would be meeting with the hospice liaison the following day.  But Friday was her anniversary, and it was truly a celebration.  I started my morning watching her play with her granddaughter and great-granddaughter.  I came back to do her exam an hour later to find her covered in balloons and asking for a straight pin so she could start popping them.  Her family put up the balloons and streamers all over her room and her door.  She smiled from ear to ear as her husband asked her to marry him again.  She said yes.  A picture was brought in from when they were married in 1950.  They were a stunning couple in black-and-white.  There was cake and other snacks.  So much joy and fellowship mixed with periods of sadness knowing that it would be their last anniversary celebrated together for some time.  But the joy on both husband and wife's faces was unmistakable and unshakable even in the face of profound sorrow of the reasons for her hospitalization and the status of her discharge.  It was an honor to be allowed into such a tender, joyful moment.  It was a great reminder for what palliative care and hospice are supposed to look like.  Not the person dying and groping for closure, but the patient celebrating what life is left to live.  It was beautiful.

Day 93: Difference

Today, I was referred to as "awesome" and "a genius" which was preceded by comments of accolade and people wanting to work with me once I finish fellowship.  It is still beyond my comprehension that people really do like working with me and see me as someone worth pursuing for a colleague.  What's even more fascinating is the fact that I don't see myself as doing anything extraordinary.  I feel like what I do is inconsequential.  One of the medical students yesterday, during our debriefing, said that she reminds herself that what is mundane and part of our daily job is usually the most monumental day for the patient and their family that we are caring for.  As a medical student, I remember thinking how different it is that I got to leave the hospital of my will not someone else's.  I worked with two wonderful families who had arrived at the same place by different means.  Both had loved ones who are dying (one more quickly than the other).  Both wanted dignity, respect, and comfort above all else.  One family needed more hand holding and gentle guidance, and will continue to need that.  The other was more certain.  Both had chronic diseases that had slowly been changing their lives.  One had a catastrophic event.  Even though I spent more time with one of the families, both left feeling relieved that someone had heard them, met them where they were, and helped them to the next step in the journey.  I don't know that I could have ever imagined being at this position in life.  I knew I liked to talk.  I never imagined the difference I could make with being able to talk better.  It's very surreal at times.

Day 92: 13 weeks

I can't believe I am over 3 months into fellowship.  Some days I feel like I'm still back at the beginning.  I am humbled by how much faith patients and their families have in me.  I also can't believe I'm looking for my first job out of training.  It is surreal.  I don't always feel like I'm ready to take that step.  I worry that I am not good enough.  I worry about how to choose my next job.  What if I make a decision and then realize I want something else?  What if I'm not ready?

I got to hear Patrick Kennedy talk today.  He is a huge advocate for better mental health care in the US which I think is phenomenal.  He really is passionate.  It was exciting to know that he continues to be a huge advocate and use his sway to try to gain more support for the cause.  I hope that he can work to change the current system so that mental health is not stigmatized but viewed as a disease like diabetes or hypertension.  It sounds like he wants to start the process in North Carolina and then spread it to other states.  I am appreciative of the opportunities I have gained through this fellowship.  I hope I do a good job of showing my thanks.

Days 87-91: The Wedding

I think I am still recuperating from all the excitement of my sister's wedding this past weekend.  It was so great to see all my family and meet all of my sister's husband's family (that is so weird to type!).  It was a stunningly beautiful weekend, and my sister was radiant.  It was a little nerve-wracking to be the maid-of-honor, and sometimes I wish I had taken in the day more than I did.  There are certain images that will forever be with me, but it truly is hard to really take in all the moments.  I was so afraid that my wedding in 6 months would overshadow hers, but we were able to celebrate hers and still know that we would see everyone again at mine.  It didn't seem to detract from her happiness at all.  I am so thankful to have the sister that I have, even though we sometimes don't see eye-to-eye or fight over things we can't even remember (yep, that has happened).  She is funny, energetic, sweet, supportive.  I hope that I conveyed all that in my maid-of-honor speech.  I spent so much timing stressing over that darn speech!  It is so strange having the complete joy and delight of her wedding bracketed by days full of talking about death and prognosis and serious illness.  While that is going to be my job for life, it was such a stark contrast.  It's also strange going from saying, "I'll worry about [enter item for my wedding here] after my sister's wedding" and now it's after my sister's wedding and I have to start worrying about these things.  I'm excited, but the over-planner in me is a little nervous.  Wish I could take a page from my sister's book and sit back, relax, and enjoy whatever may come.