259-264: Exhaustion

This week has seemed so long comparatively.  It probably doesn't help that it followed the conference in Boston last week.  It also probably doesn't help that it's the first time I've really worked since January, other than my one week on hospice back in February.  Between both my and the attending's crazy schedule, I have felt that I can be more efficient than I give myself credit for.  To see 4 people between 11 and 3, get notes done, eat lunch, and get stuck in an elevator for 20 minutes on Friday, I might be able to be an attending in September.  Am I intimidated? Yes, but I will be able to do it.

This week has seen a full clinic on Tuesday, academic half-day on Wednesday followed by Boris's appointment at the vet, taking Boris back to the vet on Thursday morning and acupuncture in the afternoon, and food tasting on Friday for the wedding.  We will dissect the parts that are important.

First, Tuesday's clinic.  We still finished at 1.  We still had 2 no shows.  The difference was we were double booked for the schedule, so usually we are seeing 4ish patients.  Tuesday, we had 6.  I saw both news, and two of the follow-ups.  I am trying to do better about not spending too much time with the patients to hold us up.  It hasn't helped that people are showing up or getting roomed late.  When we start 30min behind in a palliative care clinic, it's near impossible to make that time up.  But I feel like I'm doing better with what I have some of the time.

Wednesday academic half-day was interesting.  Part of it was supposed to be an hour discussion of "what we learned at the AAHPM conference".  It turned into a 50 minute presentation of what the program director learned with 10 min for me to present.  I didn't present much because I still had to check-out with the attending I was working with and then leave in time to go with LOML to take Boris to the vet.

Boris is my oldest cat.  He will be 12 in June.  We have been through a lot together with his dietary restrictions and weight issues when I first adopted him.  A couple weeks ago, he developed a swelling on his chin.  We thought he had been bitten by Alex, but the vet was concerned about cat acne.  We changed out the bowls, as recommended, and used to wipes as directed.  Unfortunately, his chin worsened.  On Wednesday, the vet couldn't tell the extent of the mass.  He went back in Thursday for his dental and a more in-depth evaluation as well as a biopsy.  The vet felt like the mass only involved the dermis, and did not extend into his mouth or jaw.  We won't know the results of the biopsy until next week.  We are switching him back to the food he used to eat out of concern that the new food is triggering the reaction.  It seems to be mildly better at this point, but still swollen.  Our hope is that it isn't cancer.  It is reassuring that it is not effecting his eating in any way, and he hasn't lost significant weight (even though he needs to).

Acupuncture was interesting.  I spent the better part of Thursday telling myself I would believe in its ability to work.  I went into the office (which is a doctor's office) but the room is set up like a massage spa.  We talk, and I explain the areas of concern, and then was told to strip down to my undies and get under warm blankets.  Next, sewing needle-size needles are placed along appropriate meridians: ear for relaxation, wrist for sinuses, back and feet to help with my neck pain.  A heat lamp was placed over my upper back, and I lay there for about 20-30 minutes.  I was unable to move due to concern that the needles would dig in deeper and cause pain.  So all you can do is listen to the calming music in the room and rest.  I think that may be part of why it works.  It doesn't completely explain why the knots I've had in my neck for the last 3 months are gone.  That was really nice.  I realize that there is more to acupuncture, and I would likely do it again in the future.  It helps knowing that our patients have to be able to lie there for 20-30 minutes to be able to reap the benefits of the procedure.

Friday was interesting for two reasons.  The first was getting stuck in an elevator.  My attending and I were on the 8th floor in one of the hospital towers and trying to get to the 4th floor.  We got on the elevator along with two med techs who were going to the 7th floor.  The elevator doors closed and then momentarily, we sat at the 8th floor before going to the 7th.  The med techs got off, and the doors closed and then reopened.  That should have been my cue to get off, but we didn't.  As the doors were closing, the buttons wouldn't work, and I knew we were in trouble, but it was too late.  I thought maybe it would start again, but it didn't.  We sat for a minute, I told my attending that I didn't think we were going to get out without help, and I called the help phone.  The help phone, coincidentally, connects to the 911 operator, so imagine the joy of telling them I was stuck in an elevator in the hospital.  I'm thankful it was during normal working hours.  Security got there relatively quickly as both my attending and I talked about our issues with claustrophobia before talking about the wedding.  They were able to finally get us out without the elevator becoming the "Tower of Terror" ride.

The second thing that made Friday interesting was learning that LOML and I had been shuffled on to our third event coordinator at Graylyn.  It explains why we had so many issues with communication with the second coordinator as "life was taking her other places" despite her thinking she would be at Graylyn long-term.  Needless to say, the current coordinator is very on top of things and great with communication, so I'm hoping we keep her through our wedding.  The food for the wedding was delicious.  I am very excited for that.  We also did a quick walk-through with just the three of us before the full walk-through with everyone tomorrow.

We met with the DJ today who I am very impressed with.  He has a calm demeanor, and seems very dependable.  He met us when he was coming in early for a wedding reception he was doing, and was worried about the weather.  He also is very receptive, and is going to be very good with helping to keep everything moving smoothly.  I am thankful to have a strong team working with LOML and I for this.  It is helping alleviate some of the stress, even if there is still some to be had.

Obviously, the week has been eventful.  I don't foresee quieter weeks any time soon.  I am looking forward to the honeymoon when we can relax for a little while.

Days 245-258: Compassion Refueling

I have not had the desire to blog in quite some time as noted by only posting about once a week until the two week hiatus.  I was tired and stressed.  There has been a lot going on, and not all of it super positive.  I got to hit the reset button last week at the AAHPM annual assembly in Boston, MA.  The annual assembly is the yearly conference for hospice and palliative medicine practitioners.  I say practitioners because it is more than just doctors.  It's social works, NPs, PAs, RNs, chaplains.  Anyone who has an interest in HPM.  I think having the interdisciplinary approach improves the conference greatly.  You get a variety of perspectives and approaches to the care provided to our patients.  There also is an understanding that to provide great care, you have to foster the creative side of each of us.  I got to color with crayons, play with therapy dogs, write poetry, go to book club, escape a room with a team of other HPM practioners by completing many different puzzles.  It was the best conference I have ever been to.  There was a perfect balance of education and wholesome fun.  We laughed and learned together.  It was a sharing of ideas across disciplines that allows for a more holistic approach to patient care.

It also gave me a break from wedding planning, trying to figure out taxes, and the drama that comes out around the time of a wedding.  It was a welcome break.  I have been stressing about how I was going to get my taxes done because I have additional taxes thanks to my moonlighting.  There are several forms that I have needed to complete in preparation for the wedding.  We haven't taken the time to complete any of them, and then the number of emails to keep straight has been unreal.  I got to forget all of that for a little while.  I got to refuel for my job.

Today has been spent listing out what I needed to get done now that I'm back in Winston.  LOML and I are at the 6 week mark for the wedding.  We finally submitted the form for the ceremony musicians.  We emailed the DJ about dates to meet but are still working on the plan for the reception.We have completed the form for the photographer but need to send the picture planner and the timeline.  We have a tasting date, but need to double check the date for the walk-through.  We are still waiting to hear back from the officiant regarding the ceremony LOML and I created.  It's so funny how the little details take over at the end when LOML and I should be focused on supporting each other as we prepare to become man and wife.  I am so excited to be his wife.  I have to keep focusing on the importance of that statement.

Days 240-244: Dysfunction

Today was a day of interesting encounters.  The first was of a lady who used to be quite ornery until she declined and became non-verbal.  She still wasn't very happy with us today as we moved her around to complete her exam.  She is dying, and while she has very loving caregivers, they aren't able to give her medications if she can't swallow.  We ended up having to move her into the hospice facility to be able to receive liquid, oral medications for symptom relief.

Next was the patient who just wanted to stay in her room.  Her family kept talking about how crazy she was.  She was the most sane of the group.  She clearly was not in a happy marriage.  The nurse and I listened to a sermon from her husband, who then had the audacity to tell her, "you may be good but you sure aren't pretty" when she responded to the nurse's question about how she was doing with a "pretty good".  The daughter did not stop talking, and did not want to rescind control of the patient's care.

Then we went to the top of the mountain to see a third patient whose symptoms are worsening as his disease progresses.  His wife needed coaching on medication administration, but was kind and present for her husband.

Finally, we had the guy who was actively dying, and had a sweet and doting family who had really helped provide the best care possible for him in his situation.  They asked questions about his presentation, if he appeared uncomfortable, and what the best options were for his care.  It really was a good end to an interesting day.