Gratitude Here and Now
Yesterday I had another doctor's appointment. Our team was on call (which means admitting patients if any need help) but it was quiet so I got away for a while to see my neurologist. The first thing he did was apologize for the neuroradiologist who told me I was on the wrong medicines and that he would go into my head and pull out the clots. Apologize profusely and repeatedly and said if it were anyone other than the person it was (ie a neurorads fellow or resident instead of the director) he would try to get him fired. Yikes. I work with these people. But when I told him who it was he said this doctor was old and had been there forever and thought everything he did or said was right even though it was based on little to no evidence. Little to no evidence.
Dr. M, my neurologist, was livid that I had been told that I should get the clots removed mechanically. And Dr. H, my internist, call the radiologist, "full of shit." They both felt badly about the misinformation I had recieved and that had stressed me out so much I flared again. I do have a good team of doctors, who care about me immensely and try very hard to get me through all of these changes--physically, and mentally as much as they can. The mentally, I'm more in charge of; that makes it much harder. I find it hard to look at sometimes--in its entirety.
Dr. M went over my MRI with me and showed me that it is actually better! I have one important brain vein (the straight sinus) that has at least partially opened back up whereas it was entirely clotted off before. The inferior saggital sinus that is supposed to drain into the straight sinus is still entirely blocked off or was never there; and my transverse sinuses are less than gigantic, but the overall drainage seems to be adequate. The coumadin only helps clots from forming; it's my body that has to clean up the ones that already formed. He also said I probably bought myself a lifetime supply of coumadin therapy (except if I get pregnant because it makes babies bones form wrong--I'll have to do two lovenox shots a day if/when that happens). I figured I needed life-long anticoagulation; and now, stopping the coumadin would worry me, too. Every time I get a headache I worry I'm starting to stroke again. And he said this shouldn't affect my ability to process information. My thinking should be clear as long as I'm healthy and not flaring and not stressed out by radiologists. So many caveats to my existence now--but I suppose everyone has some of their own.
So far this month on wards at the VA, I am managing okay. We've only had one overnight call so far and those are usually the problem for me. I'll have another on Sunday. But in between those I'm working 12-14 hour days with just one day off in the two week stretch. Normally I would work four 80 hour weeks in a row, but they switched my schedule around so I work only two. That should help. Somewhat. The prednisone still makes it hard to sleep. And the thoughts about everything I forgot that I should know about my patients keeps me up hours after that (until I started taking medicine for that, too). "Did I order labs for the morning?" "Why is he anemic?" "How come his sodium keeps falling?" "How should I respond the next time my antisocial personality disorder patient calls me a liar?" "Why didn't I know the answer to that question when the attending asked?" "Where can I find that information?" Etc. etc. It's not all the medicine part that stresses me out. It's everything; it really is too much--for anyone.
Fortunately, my attending this month is fabulous. He's an infectious disease specialist; and he'd talked with me some about my illness before we started this ward shift, "Let me know if I can help," he said. And he means it. Today I went to take him a lemon bar after everyone else had gone home (I'm still baking like crazy trying to calm myself down). He accepted and then stood up and looked closely at me, "How are you doing?" I told him a little about the sleep problems and the prednisone and how hard it was to deal with mentally and about the changes in my MRI and that I keep considering other options. He said that is probably a good idea: other options with better hours. He's suggested pathology when we talked before. I like path, but I also like patients. He said I was doing well; that I care about the patients and am enthusiastic about medicine and that I seem to know my stuff and will only get better. Only get better. In more ways than one, I hope. He also said he thought I was a very brave woman. I think he meant brave to keep going, in spite of the lupus and the strokes and the clots.
People have called me "superwoman" through this. Others have said that I'm either a hero or a fool. Aren't they sometimes the same thing? Maybe I'm both. Maybe neither. Maybe I'm just doing what I can with this life I've been given, knowing now more than ever that it is indefinably finite. I don't know when all of this will end. All I know is what I can do with today. Hopefully tomorrow. Hopefully many days after that. But I don't know that for sure. No one does. The termination of here is more palpable to me than before. It makes me appreciate the here and now.
It makes me want to visit my WWII Navy vet who served on a submarine. He is featured in the veterans' calendar from last year and was proud to show me. He talked about illegal immigrants, too. I may not agree with his politics, but he is a remarkable man. This morning he told me a story about how his eyes used to be so good that he could see a boat on the horizon before any of the others or the electronics could detect it. "They're signalling to us," he told his captain. "They're firing at us!" And his submarine turned around. Perhaps he saved those men from dying that day. Lives change in instants like that. In the heres and nows that have been--and can be.
The vets spend more time thanking us than any other patient population. I updated the far-away brother of my liver disease patient on the phone the other day and he spent minutes thanking me and apologizing for taking up my valuable time. "It's my pleasure," I told him over and over. It is a pleasure to talk to the people who know and care about the patients you only meet in passing, sometimes as the candle of their existence flickers. That's where the humanity enters to make medicine more than science. That's where all the effort and learning and trying meet something that really matters.
Another of my patients wrote me a card that he gave me when I saw him first thing in the morning and told me I could read later. Just getting that card was the highlight of that day. The rest of the day was pretty awful. I came home a complete wreck and cried when Joseph and Jane so much as asked me how I was. The day had been too full of new patients and no time to get everything done and both I and the other intern had to go to clinic so we had only five hours to finish easily 10 hours worth of work. And Keith's package I'd mailed to him from Spain was wrecked. It was a terrible horrible no good very bad day--that day.
I didn't remember my patient's card in my white coat pocket until I got home, tried unsuccessfully to sleep off the frustration, only making it worse, and cried some more. In it, he said he had been in many hospitals, but never had it had such an enjoyable time as with me taking care of him. He said he'd learned a lot (we'd made a new diagnosis of type two diabetes for him and I spent time explaining what that meant for his lifestyle and changes to make) from me. And that he wishes that I were his doctor. Very high praise. I cried again. This time with elements of gratitude and relief mixed with the exhaustion and feelings of ineptitude.
"When our perils are passed, shall our gratitude sleep?" (George Canning)
I remain grateful to be alive--almost every day. I am grateful to find my car where I left it. I am grateful to have learned about iron storage today from our attending. I am grateful to be able to try to help people. I am grateful I finished work before the sun went down so I could stop and walk along the ocean and watch the sun setting in all its red and orange and pink glory over the ocean. I am grateful for where I live. I am grateful that two of my favorite people called tonight (even though I missed the calls; I'll call them back). I am grateful that I tried a new recipe last night (not baking!) with chicken and onions and red peppers and balsamic vinegar that is very fast and tasty. I am grateful that I have bananas that are almost soft enough to make bread or biscotti. I am grateful I found a Whole Foods market right by the VA. I am grateful I have Saturday off. I am grateful for a yoga class in 30 minutes. I'd better start getting there, in fact. I hope you have many things in your life for which to feel grateful.
Dr. M, my neurologist, was livid that I had been told that I should get the clots removed mechanically. And Dr. H, my internist, call the radiologist, "full of shit." They both felt badly about the misinformation I had recieved and that had stressed me out so much I flared again. I do have a good team of doctors, who care about me immensely and try very hard to get me through all of these changes--physically, and mentally as much as they can. The mentally, I'm more in charge of; that makes it much harder. I find it hard to look at sometimes--in its entirety.
Dr. M went over my MRI with me and showed me that it is actually better! I have one important brain vein (the straight sinus) that has at least partially opened back up whereas it was entirely clotted off before. The inferior saggital sinus that is supposed to drain into the straight sinus is still entirely blocked off or was never there; and my transverse sinuses are less than gigantic, but the overall drainage seems to be adequate. The coumadin only helps clots from forming; it's my body that has to clean up the ones that already formed. He also said I probably bought myself a lifetime supply of coumadin therapy (except if I get pregnant because it makes babies bones form wrong--I'll have to do two lovenox shots a day if/when that happens). I figured I needed life-long anticoagulation; and now, stopping the coumadin would worry me, too. Every time I get a headache I worry I'm starting to stroke again. And he said this shouldn't affect my ability to process information. My thinking should be clear as long as I'm healthy and not flaring and not stressed out by radiologists. So many caveats to my existence now--but I suppose everyone has some of their own.
So far this month on wards at the VA, I am managing okay. We've only had one overnight call so far and those are usually the problem for me. I'll have another on Sunday. But in between those I'm working 12-14 hour days with just one day off in the two week stretch. Normally I would work four 80 hour weeks in a row, but they switched my schedule around so I work only two. That should help. Somewhat. The prednisone still makes it hard to sleep. And the thoughts about everything I forgot that I should know about my patients keeps me up hours after that (until I started taking medicine for that, too). "Did I order labs for the morning?" "Why is he anemic?" "How come his sodium keeps falling?" "How should I respond the next time my antisocial personality disorder patient calls me a liar?" "Why didn't I know the answer to that question when the attending asked?" "Where can I find that information?" Etc. etc. It's not all the medicine part that stresses me out. It's everything; it really is too much--for anyone.
Fortunately, my attending this month is fabulous. He's an infectious disease specialist; and he'd talked with me some about my illness before we started this ward shift, "Let me know if I can help," he said. And he means it. Today I went to take him a lemon bar after everyone else had gone home (I'm still baking like crazy trying to calm myself down). He accepted and then stood up and looked closely at me, "How are you doing?" I told him a little about the sleep problems and the prednisone and how hard it was to deal with mentally and about the changes in my MRI and that I keep considering other options. He said that is probably a good idea: other options with better hours. He's suggested pathology when we talked before. I like path, but I also like patients. He said I was doing well; that I care about the patients and am enthusiastic about medicine and that I seem to know my stuff and will only get better. Only get better. In more ways than one, I hope. He also said he thought I was a very brave woman. I think he meant brave to keep going, in spite of the lupus and the strokes and the clots.
People have called me "superwoman" through this. Others have said that I'm either a hero or a fool. Aren't they sometimes the same thing? Maybe I'm both. Maybe neither. Maybe I'm just doing what I can with this life I've been given, knowing now more than ever that it is indefinably finite. I don't know when all of this will end. All I know is what I can do with today. Hopefully tomorrow. Hopefully many days after that. But I don't know that for sure. No one does. The termination of here is more palpable to me than before. It makes me appreciate the here and now.
It makes me want to visit my WWII Navy vet who served on a submarine. He is featured in the veterans' calendar from last year and was proud to show me. He talked about illegal immigrants, too. I may not agree with his politics, but he is a remarkable man. This morning he told me a story about how his eyes used to be so good that he could see a boat on the horizon before any of the others or the electronics could detect it. "They're signalling to us," he told his captain. "They're firing at us!" And his submarine turned around. Perhaps he saved those men from dying that day. Lives change in instants like that. In the heres and nows that have been--and can be.
The vets spend more time thanking us than any other patient population. I updated the far-away brother of my liver disease patient on the phone the other day and he spent minutes thanking me and apologizing for taking up my valuable time. "It's my pleasure," I told him over and over. It is a pleasure to talk to the people who know and care about the patients you only meet in passing, sometimes as the candle of their existence flickers. That's where the humanity enters to make medicine more than science. That's where all the effort and learning and trying meet something that really matters.
Another of my patients wrote me a card that he gave me when I saw him first thing in the morning and told me I could read later. Just getting that card was the highlight of that day. The rest of the day was pretty awful. I came home a complete wreck and cried when Joseph and Jane so much as asked me how I was. The day had been too full of new patients and no time to get everything done and both I and the other intern had to go to clinic so we had only five hours to finish easily 10 hours worth of work. And Keith's package I'd mailed to him from Spain was wrecked. It was a terrible horrible no good very bad day--that day.
I didn't remember my patient's card in my white coat pocket until I got home, tried unsuccessfully to sleep off the frustration, only making it worse, and cried some more. In it, he said he had been in many hospitals, but never had it had such an enjoyable time as with me taking care of him. He said he'd learned a lot (we'd made a new diagnosis of type two diabetes for him and I spent time explaining what that meant for his lifestyle and changes to make) from me. And that he wishes that I were his doctor. Very high praise. I cried again. This time with elements of gratitude and relief mixed with the exhaustion and feelings of ineptitude.
"When our perils are passed, shall our gratitude sleep?" (George Canning)
I remain grateful to be alive--almost every day. I am grateful to find my car where I left it. I am grateful to have learned about iron storage today from our attending. I am grateful to be able to try to help people. I am grateful I finished work before the sun went down so I could stop and walk along the ocean and watch the sun setting in all its red and orange and pink glory over the ocean. I am grateful for where I live. I am grateful that two of my favorite people called tonight (even though I missed the calls; I'll call them back). I am grateful that I tried a new recipe last night (not baking!) with chicken and onions and red peppers and balsamic vinegar that is very fast and tasty. I am grateful that I have bananas that are almost soft enough to make bread or biscotti. I am grateful I found a Whole Foods market right by the VA. I am grateful I have Saturday off. I am grateful for a yoga class in 30 minutes. I'd better start getting there, in fact. I hope you have many things in your life for which to feel grateful.
posted by S. at 6:17 PM
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