She Had Come So Far, With So Far Left To Go

   When I met her, I didn't know her story.  I didn't ask.  I know enough to know that each woman has her own story, her own journey that has brought her to the moment where she must decide.  I sat with her while she waited, asking if she had any questions.  She didn't, she just felt a little bit nervous about the procedure she was about to undergo.  She was quite calm considering it was her first time.  She had waited long enough to get to this moment.  She was supposed to be here a month ago, but she needed more time to scrummage up the money.  And she was so young.  She had to be about 16 or 17.  But I didn't ask.

   Her partner held her hand during the pre-procedure ultrasound.  As the physician switched from the trans-vaginal probe to the trans-abdominal probe to "see better," I knew something was wrong.  She was too far along.  In the extra time she spent gathering enough funds for the abortion, she had crossed over the maximum threshold that could be taken care of in this particular clinic.  She had waited long enough, and we had to turn her away.

   We referred her somewhere where she could get the services she needed, but this somewhere was even father away, and most likely even more expensive.  And her window of opportunity would not be open very much longer.  The reality of her hopeless situation set in on me, the endless slue of hurdles society throws at women, and I felt so upset for her.  But she was so calm.  She thanked us for our time, and quietly left the clinic.  She didn't get angry, she didn't cry.  She simply thanked us.

   As I drove home, I wondered if she would find the strength to overcome the additional obstacles thrown at her.  I pondered how she had gotten to this point, but I knew it didn't matter.  What mattered is that this women needed our help, and it breaks my heart that we weren't able to give it to her.  The more I thought about it, the more I found tears streaming down my face.  How could she be so calm and gracious in such a hopeless, disappointing situation?  I truly hope she finds the help she needs.

Dear Right Side of Brain, Please Wake Up

   One of the unfortunate consequences of going into a super left-sided-brain profession, is that if you don't make an effort to nurture the right side of your brain, it atrophies*.  I can make a ton of excuses about lack of time, lack of energy, blah blah blah.  But the truth of the matter is that I have done a piss-poor job of paying attention to my right brain.

   I wasn't always this asymmetric.  Back in high school I was extremely creative and working on projects ALL THE TIME.  I used to sew, paint, collage, draw, dance, you-name-it!  College rolled around, and I sorta lost my creative juices in the midst of studying and doin' what college kids do.  Flash forward to med school where I briefly went through a photography phase, taking a ton of pictures of everything and everyone.  But once I started studying for boards, I turned off the right side of my brain in order to buckle down, and I recently realized that I may have forgotten to turn it back on...

   There have been times in med school when that poor half-a-brain tries to take a breath of air to come back to life. For example:

• my various attempts at pretty nails
• our genital bake-off
• when I tried to pretend I was an interior designer
• when I made these cute uteri magnets

   I have no excuses to continue neglecting my creative side now, and anyway, my head feels lop-sided.  So I am gonna turn on my creative juice faucet, just let it go and see what happens.  First on the agenda: I really wanna start journaling again.  I've done this from time to time in the past, and I'll keep up with it for months, but then I'll just get bored of it.  Also, I love blogging and all, but there are a lot of things that I don't feel comfortable writing on here for anyone in the public to see.  I like to use my blog more as a memoir of this crazy journey called med school - something that people can read, and either learn from or something they can relate to.  My goal is not to air all my dirty laundry.  

   Another reason I'd like to make artsy projects is because it really makes me happy.  I'm feeling so tired and burned out, and I just wanna feel like a fun, happy-go-lucky person again.  The happier you are, the more confident you are.  Besides, I could really use a confidence boost before I try to sell myself to residency programs during interviews.  

 *This is most likely not true; I'm just exaggerating. Though if anyone knows of any studies exploring this topic, I'd love to hear about it...        Oh great, now I'm using the left side of my brain AGAIN

Rosemary

   There are always patients on a service that the team will deem "crazy."  And this can have many meanings.  Sometimes it means that the patient is difficult to deal with.  Sometimes it means that the patient is a little odd.  And sometimes, it just means the person has a diagnosable mental illness.  For some reason, I tend to gravitate towards these "crazy" patients, and I find myself wanting to interact with them.

   When Rosemary*, an eccentric and talkative woman, was admitted to the Gyn Onc service, she was immediately given this title of "crazy."  When we would come in to round as a team, she would always say off-the-wall comments, all the while with a smirk on her face showing she just wanted to get a laugh out of us.  She even commented once that the cardiologist was no fun, as she had "tried to make him laugh and he didn't even crack a smile."

   She was very sick with interesting medical problems, so I took her on as one the patients I was following.  Every morning as I'd come in to pre-round on her, and we would chat for quite a while.  In fact, I learned to allot like 10-15 extra minutes to spend with her, since she was so chatty.  But I enjoyed it very much, as most of the time she was quite entertaining.  And she often had very insightful wisdom or advice.

   Since she was in the hospital so long with such a complicated course, she began to keep a written log of who she would meet and of the events that happened each day.  Early on in her stay she had me write down my name and title ("medical student", nothing exciting there).  A couple days later, she had one of the fellows write down her name.  So after she had written her name down, the fellow handed me the paper to show me something. It was the same paper I had written my name on a few days prior, and next to my name, Rosemary had penciled in "NICE GAL".

* As always, name and identifying information changed to protect privacy

In Medicine, We Sacrifice A Lot

 These last couple of years, we've heard over and over, when you go into medicine, you sacrifice so much.  I knew I'd have to sacrifice things, miss out on fun activities, delay important life milestones, and neglect relationships.  But man, we really do give up a lot.  It's hard to grasp it until you find yourself with no time, no patience, and no sympathy for others, even your loved ones.  My grandma just got discharged from the hospital for a UTI, but she is still delirious, and we're starting to worry if she's gonna get back to her mental baseline.  This issue is bringing up a lot of family drama, about who is gonna take care of her, what will we do for her, what can we do for her, and all I can think about is how I just can't.  I just can't deal with these things.  I don't have time, I don't have energy, I don't have the patience, the sympathy, the strength.  I just can't.

  I'm just gonna have to be selfish on this one, and stay out of it, let everyone else figure it out, and keep my head above water.  I can't afford to get involved, to be supportive, or to lend my time and energy, because sadly, I'm barely scraping by with what little I've got.  I'm just gonna do what I've gotten really good at this year, and remain numb.  Numb and selfish.  God I hope this version of me doesn't last forever.

   I guess the best way I can be helpful, but still keep my own head above water, is to support my parents while they help figure out this whole family crisis mess.  I can do that.

My friend L recently posted about third year in med school, and how it changes us.  And I really enjoyed it, because she perfectly explained exactly how I feel.

How Will You Spend Your Last Birthday?

   There was a patient in the ICU, who was brain dead, with no chance of meaningful recovery.  I didn't know her that well, but just listened when we rounded on her as a team.  The residents were getting annoyed because the family was dragging their feet on withdrawing care.  Not that they were obligated to withdraw care, but they had decided they were going to withdraw care, but kept prolonging the date they were gonna do it.

   Our attending remarked, "You know, as young physicians, I understand it is very hard not to be judgmental of patients and their families. But please, you must try to understand what they are going through.  This woman is somebody's wife, somebody's sister, somebody's daughter.  And this is the last moment in her life.  Just think about that.  Think about what it'd be like to be in their shoes.  The husband hasn't been sleeping for weeks.  He's a wreck, and he is understandably having a hard time dealing with this, so let's give him a little compassion."

  And as the attending gave his speech, the nurse walked in and began hanging pieces of paper around the room.  As I looked closer, I realized she was hanging signs with a picture of a birthday cake saying "Happy Birthday".  I almost lost it.  Here this woman was, laying in a coma, surrounded by doctors and med students she never met, with tubes and wires coming out of every inch of her body, while her family was at home agonizing about letting her go, on what will be her very last birthday.

Is It Normal To Feel High During A NSVD?

   First week of L&D is complete, and I absolutely love it.  The team is pretty nice, but I'm still waiting for a few of them to warm up to me - all in good time.  I absolutely love the patients.  I just being the "go-to girl" for all their "intimate issues".
   Yesterday, I was observing another NSVD (normal spontaneous vaginal delivery), and AGAIN had to keep myself under control to stop myself from crying tears of joy.  I just can't help it!  Everyone in the room is just so different after a birth.  The awaiting family is standing by with their cameras at the ready and ginormous grins on their faces.  The new mom can't take her eyes off her precious new baby, whispering, "I love you so much already" into baby's ear. All the physicians and nurses (even the ones who are usually cold and intense in all other situations), are giddy with excitement and congratulating the new mom on her wonderful job well done.  And last but not least, my very favorite part of all: the new dad is wiping tears of joy from his eyes, kissing mom on the forehead, with a look on his face that screams this is the happiest moment of his life.  This might not sound normal, but I swear, the feeling I get while all of this is going on feels like I'm high on happy drugs.  How could I not love doing this every day?!
   I know, every birth is different.  Each family experiences the important event differently.  And every once in a while, the event is somber or tense.  But if I could just participate in a birth as miraculous as yesterday every once in a while, it would make it all worth it.  I think - I hope - I've found my calling.

My Very First Psych Patient

*Disclaimer - Identifying patient information has been changed to comply with HIPAA*

    The other day, I had to say a very bittersweet goodbye to my very first psych patient.  Let's call her "H" for the purposes of this post.  One of the first days I started on the inpatient psych ward, I took H on as my first patient.  H was a great patient to start on, because she was euphoric, expansive, and delusional... which translates to fun, not scary, and entertaining, in my opinion.  H was a textbook example of mania, complete with grandiose delusions that she was a doctor, oceanographer, pilot in the army, etc.  H would pace the halls, and every time I would encounter her, she would get all excited, smile and start rapidly indulging in one of her many delusions.  On several occasions, H told me she was born blind at birth, all the while making super intense eye-contact with me.  Each day she would decide she was a different race; that's something you can just pick and choose, right?!  

   H took a special liking to me, if I do say so myself, and would tell me she loved me every day.  She also told me that she was getting married (not true), and excitedly invited me to the wedding, however told another staff member who made her mad that they were uninvited.  One day, H told me that she was Lady Diana, and that I could have her inheritance (how generous!).  The last couple of days of working with her, she kept insisting that I should get more diamond earrings, and even said she was "going to the diamond store when she got out, to check if I got them."  

   When the resident and I spoke with H on her last day, she told us, "You two are my favorite doctors, and you take real good care of me.  Can I take you with me?"  She said she would never forget me, and left me with a very special parting gift (see picture below).  Her very last words to me were, "Wait, can I tell you something? Merry Christmas, and a happy new year!" and then she burst into laughter.

     

"Fire away that is you best shot"
When I asked what it meant, she said, "it means I love you."

   Even if most of her shenanigans were the mania talking, I still grew very fond of her.  As much as I was glad to see her doing better and moving on with her life, I was sad to see her go.  I am going to miss her contagious smile and laughter, listening to her wild imaginative delusions, and watching her dance and sing like nobody was watching out in the courtyard.  I don't think I'll ever forget H either.  My first patient of third year.

Is He Sponge-Worthy?

   As you may or may not remember from my "recap of 2011" post, towards the end of last year I tried out online dating and started dating someone I met there shortly after.  Well, that didn't work out.  So now I'm single again.  I guess it's good timing since boards are getting closer and closer...

   Anyway, here is a funny story.  If you are a fan of the show Seinfeld, you'll probably remember the episode where there is a shortage of sponges (the contraceptive kind, not the cleaning kind). Elaine, who prefers sponges as her contraceptive of choice, decides to stock up since they are no longer being made anymore.  She buys the very last case in town, and becomes super critical of men she dates, trying to decide if they are "sponge-worthy" or not (worth using one of her precious sponges for).

   I noticed in the last couple of months that the price of my very favorite thing to eat - Kraft macaroni and cheese in the Spongebob shapes - has gone up.  You might not think it's a big deal, but it really upset me to see that the once 88-cent boxes are now $2 a piece.  So, in my own way, I have become a sponge-hoarder, just like Elaine from Seinfeld.  So now my friends joke around that I, too, will have to determine if future suitors are "sponge-worthy".  My friends are the best.

Found this lovely surprise on my doorstep

I love my friends

Feely Hearts

Today in The Healer's Art (an elective I am taking), our facilitator gave us each a "feely heart".  A "feely heart" is a small stuffed heart that was originally intended for kids who were dealing with the loss of a parent.  The feely heart, which is small enough to carry around in your pocket at all times, was meant so that these children could just hold it in their hands and remember their lost parent whenever they felt the need to.

A slightly different way to use the "feely heart" as a physician (or physician in training), is to carry it around in your pocket as a constant reminder for us to keep our hearts open to our patients.  It is a great memento to help us reflect on why we are doing what we are doing, and that to really take the best care of  our patients, we must listen to their stories, forming rewarding connections that make our work worthwhile.