Life isn't fair

My parents are splitting up.

It's wierd. I don't quite know what to think yet.

They've been married for thirty-three years. And now this. They met with the therapist and the mediator today. They said goodbye to each other. Probably until my brother's wedding in May.

Wierd.

When you get married, you never expect this to happen. As a child growing up with everyone telling you how in love your parents seems and how lucky you are, you never expect this to happen.

Is this some sort of strange and cruel mid-life crisis? What is going on? Is is it some sort of further test in the strength of my belief that there can be happy endings? It's not about me.

I think about my long ago post that my brother asked me to write about what I want in someone I will share my life with (The Assignment, Oct 2006, I think). And I think about the Wedding Singer.

When I first saw that movie, I think I was in the theater with my brothers one of the times they came to visit me in Tacoma when I was in college up there. When he sang the song at the end, "I wanna grow old with you," I was sobbing. At "Wedding Singer." I know. I know. It's ridiculous. It's a goofball cheesy movie, predictable to the n'th degree and there I was crying into the already soggy popcorn.

I guess it struck a cord then. And it does now.

I thought my parents would grow old together. It seemed like the plan. Investments in the property. Joint retirement. Three kids, for heaven's sakes.

And now I wonder if they regret ever being together. If the three of us were the reason they stayed together all those years. If we allowed them to bury what was going on under the surface. I try not to feel responsible for it.

I'm not in charge. I'm not in charge of them. I'm only in charge of me. I have to keep telling myself that.

I had my mid year evaluation with my program director yesterday and got mostly really really positive feedback, except from the f*&%face of a resident I had in the CCU who said I will have trouble managing a team and that I was "apathetic."

Anyway, my super sweet and supportive program director was telling me that his eval was totally off base and that I shouldn't put too much stock in it, but I woke up thinking about it this morning. "When all is said and done, you'll be rid of him and he'll still be an asshole," said a friend. Yeah. But still. It's hard to hear when you feel like everything is hard and you are already sort of questioning your skill level every day.

The eval made me think of my parents because my program director was asking what went on that month that made it so far from the rest of my other evaluations. Did I have anything personal going on? "Nothing big," I said, "Well, sort of, I guess. My parents are getting a divorce." I had been trying to put it out of my head mostly. It's hard to think about. I'm mostly angry with my dad but sometimes very sad, too. It's too nebulous to pin down.

For the first time in her office, though, I was close to crying. "That's a big deal," she said. And I realized that it was. No matter how much I am not in charge of what happens it affects me. How is that fair? I know, life isn't fair.

Guess?

My brother's girlfriend and I getting ready to head to my (other) brother's fiance's wedding shower. I know we look sorta silly, but there is a point. Can you guess the theme of the party?

Here's a hint from the bride to be herself:

Reality is Stranger than Fiction

One of the residents told me a really sad story the other day. They always say that life is stranger than fiction. And working in health care, and the beginning and ends, and intimate middles of people's lives, that becomes abundantly clear. Reality IS stranger than fiction.

That said, this story made me really sad and after she'd told it to me, I wish she hadn't. So if you don't want it to fester in your brain like it now will in mine, consider yourself warned and skip down and read the post about Mary Poppins instead. That is fiction that is better than reality. Or go watch "Neverland" and decide to believe in fairies.

She told me about a couple who had been married well over 50 years. They were both in their 80s by the time she learned their story when she was in med school. They'd both become frail and fragile and didn't want to go on living. And didn't want to die alone.

They decided to overdose on some of the many medications they took every day. They took the pills together. I imagine images of an older more modern version of "Romeo and Juliet."

But the overdose didn't work--for either of them. The husband was able to put the wife out of her misery by strangling her. How you could strangle the person you have loved for most of your life, I don't know. Maybe that is one of the ultimate expressions of love.

He strangled her, but he was still alive. And alone. And very sick in the ICU. And now a murderer. An 80 year old widower who killed his wife out of love.

This is when the resident telling me the story entered into the picture. She said that two armed guards were always outside his room, and that as soon as he was released from the ICU, he would be taken to jail.


Our discussion that spawned this remembrance began with end of life decisions and doctor's part in them. With the power of medicine it seems like in situations such as this we should be able to help couples such as this so they wouldn't have to go through this nightmare of reality.

But on the other hand, who decides? We already flirt with playing God at times. Deciding on life/death. Who can we save? Who can we let go? Then who should we let go? Or save? And if the individual(s) decide they want to leave this plane of existance, who are we to stop them? Why do we think that it is okay to help them hang on to scraps of this life but not okay to help them leave it behind?

We learn about "autonomy" in our medical school ethics classes. It means that a patient is autonomous, or able to make his or her own health care decisions; and even if the medical team doesn't agree with them, if the patient is found to have DMC ("decision making capacity"), meaning he or she has understanding of the risks and the benefits or his or her decision, they can rightfully accept or refuse treatment.

It sounds clear enough, but try applying it to real life situations, like the one above. Imagine this couple had come to their doctor and asked her to help them die. That is their decision. But it is against the law to help them (except in Oregon--and even then they must be eminently terminal).

Or try applying it to the 20 year old girl who came in with what appeared to be a fatal liver abscess but refused treatement and left AMA ("against medical advice"). Should we strap her down and make her undergo the life-saving therapy?

Where I grew up

Our little family before my brothers were born.



Pop and I walking across the field after some very important work for which I'm sure I was an essential help (or at least he made me feel like I was).



Fast forward. Here riding the daughter of my horse who died this year. She is not quite as smooth. Nor does she understand me as well, but we have fun, especially racing my mom's black lab.



It's pretty much dog heaven. We just had to put the golden retriever to sleep. He had cancer.



Both these dogs were getting old. Sometimes they can't get back across the creek on their own anymore so I had to go remind them the way back home.



One of the best swim holes on the creek on our property, across the field.



Have rafted the creek dozens of times. This one must have been soon after a skin cancer lecture for me.

Should have Stayed in Bed

Some days I should never get out of bed.

I was on call starting on...um Tuesday, didn't sleep a wink all night, forgot my clipboard at work, had to go back.

Didn't make it home until 2:30 pm (yes, awake for a good 35 hours), took a shower, fell asleep and didn't wake up until 5:30am this morning.

Fourteen hours of sleep and I could have slept more if I didn't have to wake up and go back to work...for a day which would end now and be the worst (but thankfully LAST!) day in the CCU.

My car wouldn't start to begin with, but that happens about 90% of the time lately, so that was an irritant, but nothing unexpected. I fixed it in the dark cloudiness of the morning and headed off to work.

Today is my grandmother's birthday and I'd intended to call her on my way into work, but my mom called me first. She and my youngest brother had to take his dog to the vet yesterday to be put to sleep.

I've had enough breaks to know that faster and cleaner is better than long and painful. Hope becomes the enemy at the end. The hardest to let go but the most painful to keep.

I had to go when I got to the parking garage. There's no signal in the elvator.

I got check out from the night intern, and my co intern. None of my patients had left, no big surprise there. I seem to have a bunch of rocks lately.

Prerounded. Rounded with cardiomyopathy attending. Rounded with cardiology attending who kept asking us questions pretty far over our heads, which is good learning but also makes me feel really stupid most of the time. He decided that four of my patients could go finally home. We rounded until 1pm. Grabbed a late lunch from the caf, thankfully the program had added more money to my meal card.

Then some of my patients just kept asking me the same questions all afternoon. "can i really go?" yes "but they said I couldn't" well i checked with them (several times). you can. "but can I really leave?" yes. "my chest hurts" it always hurts. it's because you got a reflux operation. "but can i really leave?" yes. "they said I should stay four days" no one ever said that. i talked to them. "so i can leave?" yes. yes. please, just leave! "but can I leave now?" OMG.

"so what is my diagnosis?" we aren't sure we just can rule out the really bad stuff that we can fix and you don't have that. "so what do you think is wrong with my heart?" well, i wish i could tell you, but we aren't sure. "why did it hurt?" i don't know.

For Heaven's Sake, I do not have all the answers. And I have even less this month when I feel like I'm always the last person to find out. My team seems to assume that I can magically read their mind and know what the plan is without telling me what they are thinking. I need a crystal ball instead of a stethoscope. Then again, I get the "what are you, stupid?" look. I don't know, maybe I am stupid. If everyone seems to think that, maybe they're right.

Then the nurses kept paging me about these same patients that I finally went to do my work at the nurses station so they could see me and ask me in the moment--"doctor? doctor? doctor clin-es-tecker? sarah, uh, i mean shawna?" What???? Sitting there, I even I got hit with some sort of flying dilaudid cap and the computer kept erasing all the discharge summaries that I had to type and retype and retype. And I got interrupted 15 times a minute. And the pharmacy paged about the discharge medications. And the nurses paged about new patients that I had that I hadn't even heard about yet. "you want a chest x-ray?" sure, okay. sometimes I just feel like the yes woman. Like I have no time to actually figure anything out or think. Just see and react. see and react. Faster, faster. Plus my residents kept asking why I wasn't finished yet. "Where have you been? what are you doing?" they didn't really want to know. they just wanted me to work faster and get things done so they wouldn't have to do it. All month long they have quitely begruged us our four total days off because then they have to cover our patients.

I had to write discharges for patients not even gone yet so the new intern wouldn't have to do it. Write all their discharge meds lists.

I had to blink back the tears of frusteration and exhaustion more than once, especially when I thought about how badly I needed a hug with full knowledge that I would just come home to the cat poop and barf on the floor and a roommate just back from a two month vacation who has no concept of how tired I am.

But, at work, I still had to figure out why no one would remove the dead toe on one of my paitents. Got yelled at repeatedly by vascular surgery. Had to swallow my pride for at least the 50th time as I thanked them for coming to see my patient finally. At least the ortho guy was nicer.

At the end of it all, I had to update the sign out, call the poor intern stepping into my shoes to update him on the patients, finish my notes from this morning and put them in all the charts. It was now close to 8 pm and the caf was almost closed. I knew I had no food at home so might as well eat dinner there, too. Sloppy Joes.

Actually better than I expected. I ate alone at a back table of the cafeteria. By the time I finished, there was smoke pouring out of the grill area where they were "cleaning" the grill. I snuck back in for a cheesecake and hurried out to the outside world.

Where it was raining. The smoke alarm went off as I was walking away from the hospital.

And my car wouldn't start. It was harder than usual to fix. I haven't had any time to go get the new part I need. And it's way overdue for an oil change.



Some days I should just stay in bed. Today was one of those days.

I start a new rotation tomorrow and I don't even know where I'm supposed to go. And there's the pediatric holiday party tomorrow night and I have no one who can go with me. And I just feel completely stupid and ugly and worthless and alone.

I should have just stayed in bed. Ugh!