This month I am working in our county hospital, which is one of the most run-down, dirty, mismanaged places I have ever had the sad privilege of seeing with my own two eyes.
Walking from the parking lot, through the bowels of the hospital every morning, the hot steam from the pipes above me floats down, settling like a fog on my head, staying with me all day long.
In this fog, I've been doing a lot of thinking about what I am and who I don't want to be. And I've been thinking about the lies we tell, and how, if ever, to come clean.
There is a family who is living in the ICU right now, waiting for their daughter to wake up after alcohol, drugs and the wrong direction down a highway shoved her face first into a deep, disturbed sleep. Her lungs look bad and her brain looks worse. Everyday we see her and tell her red-eyed parents that she is doing well. "Is she getting better?" they will ask. No. We say, not better, just the same. Not worse either. "Will she recover?" they wonder. Can't say for sure. There's no way to know! We are all hoping for the best.
The lie we tell is not that we believe she will recover, when silently we don't. Nor is it the other way around. No, the lie we tell is one of omission. We make them believe that we have no opinion.
We tiptoe around the hospital offering neither hope or despair, just an empty bowl of nothing, served with a fake smile. And a side of Percocet.
"But why would you want to crush what little hope they are holding onto?" my Attending asked me at lunch, as I sipped my coffee and tried, unsuccessfully, to clear my head of the fog.
"I don't." I replied.
I just didn't know what peace felt like until I dipped my hand into the water and skimmed my palm across the river I was floating down.
And didn't realize how numb I'd become until a one-man-folk-band hit the perfect chord on his guitar and the entire coffee shop smiled in contentment with their individual lives, as a whole.
And while some people feel comforted by living in this fog, I'm not sure that I am one of them.
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Now playing: Katie Herzig - I Hurt Too
via FoxyTunes
Wednesday, July 08, 2009
Thursday, July 02, 2009
Bright Eyes
While not all chemotherapies make your hair fall out, some of them do.
A few days into treatment, she was in the playroom, putting on an apron for finger-painting when her mom, in teasing, rubbed her head and a large mound of coarse, blond, 7-year-old little girl hair floated down onto the tiled floor.
Her big, brown eyes widened and her lips popped open in surprise.
"It's okay Mommy! Don't worry. I'm just shedding!"
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Now playing: The Weepies - How You Survived the War
via FoxyTunes
A few days into treatment, she was in the playroom, putting on an apron for finger-painting when her mom, in teasing, rubbed her head and a large mound of coarse, blond, 7-year-old little girl hair floated down onto the tiled floor.
Her big, brown eyes widened and her lips popped open in surprise.
"It's okay Mommy! Don't worry. I'm just shedding!"
----------------
Now playing: The Weepies - How You Survived the War
via FoxyTunes
Sunday, June 28, 2009
Cartwheel Carnage
To celebrate the end of intern year, our class planned a day-long canoe trip. And like any good canoe trip, there was a pre-canoe trip party the night before.
We played kickball, grilled burgers and hot dogs, ate sticky watermelon, partook of heart-healthy adult beverages (in moderation) and genuinely enjoyed our last night together as interns.
We've made it! We're REAL doctors now. We've done spinal taps on wrinkly babies and chest compressions on tiny, limp bodies. We've helped things be born and watched them die. We've changed tracheostomies and g-tubes. We've examined x-rays and given out stickers. We have arrived!
As we were just about to hold hands and sing campfire songs, my friend and fellow intern ran towards the kickball field in unabashed happiness to do a cartwheel. As she placed her left hand on the cool, tall grass to catapult her body into the muggy air, her arm gave way and she fell smack down on her face.
From the picnic tables, we interns collectively cocked our heads and watched for her to stand up again. And when she didn't, we ran over to examine the damage. What we found was a mangled and dislocated elbow attached to a hyperventilating friend. "Fix it!" She yelled.
And we all just looked at each other. "I don't know how to reduce that? Do you?" "Are you sure it isn't broken?" "No. I have no idea!" "What if there is nerve damage?" "Hey, guys? Should we get an x-ray?" "Dude. Do you SEE a Radiology department in this park?"
I will never forget seeing 15 doctors huddled around her limp arm, all looking at one another and shrugging our shoulders.
So we did what any logical person would do, we called for her husband, the only non-doctor in the group. Then we piled into a few cars and drove her to the Emergency Department where we took up the entire waiting room as some other doctors sedated, set and splinted her.
Sometimes, you have to know your own boundaries. And that when you go to do a cartwheel, your friends will be right there to catch you. Or, at the least, they will navigate you to the nearest hospital.
----------------
Now playing: Chris Castle - A Hundred Billion Years
via FoxyTunes
We played kickball, grilled burgers and hot dogs, ate sticky watermelon, partook of heart-healthy adult beverages (in moderation) and genuinely enjoyed our last night together as interns.
We've made it! We're REAL doctors now. We've done spinal taps on wrinkly babies and chest compressions on tiny, limp bodies. We've helped things be born and watched them die. We've changed tracheostomies and g-tubes. We've examined x-rays and given out stickers. We have arrived!
As we were just about to hold hands and sing campfire songs, my friend and fellow intern ran towards the kickball field in unabashed happiness to do a cartwheel. As she placed her left hand on the cool, tall grass to catapult her body into the muggy air, her arm gave way and she fell smack down on her face.
From the picnic tables, we interns collectively cocked our heads and watched for her to stand up again. And when she didn't, we ran over to examine the damage. What we found was a mangled and dislocated elbow attached to a hyperventilating friend. "Fix it!" She yelled.
And we all just looked at each other. "I don't know how to reduce that? Do you?" "Are you sure it isn't broken?" "No. I have no idea!" "What if there is nerve damage?" "Hey, guys? Should we get an x-ray?" "Dude. Do you SEE a Radiology department in this park?"
I will never forget seeing 15 doctors huddled around her limp arm, all looking at one another and shrugging our shoulders.
So we did what any logical person would do, we called for her husband, the only non-doctor in the group. Then we piled into a few cars and drove her to the Emergency Department where we took up the entire waiting room as some other doctors sedated, set and splinted her.
Sometimes, you have to know your own boundaries. And that when you go to do a cartwheel, your friends will be right there to catch you. Or, at the least, they will navigate you to the nearest hospital.
----------------
Now playing: Chris Castle - A Hundred Billion Years
via FoxyTunes
Monday, June 22, 2009
Where the Water Is
Standing in the brightly-lit hallway, we stopped her parents short as they entered their daughter's room with a paper bag filled with muffins and three steaming cups of hot cocoa.
"We need to talk." the Oncologist said, as the smell of burnt, black coffee drifted up and out from one of the cups I had thought to be full of cocoa. The smell burned my nose and turned my already heavy stomach.
We filed into he room where she, looking much older than her 12 years, sat propped up in bed, short hair spiked with gel, wearing horned-rimmed glasses and watching a documentary, only further solidifying her as one of the coolest people I've ever met.
"Hi guys!" she said cheerily. She didn't get up, however, because jabbed straight into her right side was a large plastic tube, a chest tube, draining out the liters of fluid that surrounded her right lung and prevented her from preforming in her local drama club yesterday, thus prompting her visit to our hospital.
When she was 7, she was diagnosed with a common tumor that, with aggressive treatment, is curable. But by no means a surprise to anyone, her tumor was different. Wild and stubborn. And it took many treatments to get rid of it. But after years of chemotherapy, radiation and surgery, they received the news that she was officially in remission. So she went to drama club and school and camp until one day she couldn't breathe and I met her here.
A pneumonia, I'm sure. No, maybe a pleural effusion? In went the chest tube, let's monitor some labs. Nobody worry! The tumor? Back? No way. Sit back and relax. Here, have some Tylenol.
But when the fluid kept gushing out, frank blood now, and her breathing became even worse, we sent her for a scan and sure enough, it was back. Monstrous in size, compressing her lung and vessels and breaking through her diaphragm about to impede on her bowels and bladder.
And before we could tell her, before we could tell them, before we CAT scan was even loaded onto the screen, I knew that she knew. Looking back now, I realize she knew even before the chest tube went in. Before the X-ray and before the ER visit. She knew it was back, growing inside her.
So we told them. We told them that after 11 chemotherapy medications, 3 experimental drug trials, losing her all her hair, stunting her growth, radiation burns, throwing up, collapsed lungs, missing her 6th grade dance and every family reunion since her diagnosis, IT had finally won.
Because I knew that she knew, far before we ever did, I expected her to sob quietly. To hold her mom's hand and let her dad kiss her head and ask us, the doctors, to step out of her room.
Instead her eyes widened and she pushed her parents away from her. Her heart rate monitor accelerated and beeped and her breathing became rapid and shallow.
"Are you serious?" she whispered quietly, like a half-hearted whimper, because the chest tube pain limited her movement. "This can't be happening..."
She looked around the room. "Mom? Dad?" She sat completely still--paralyzed from the pain of the chest tube, so much so that she couldn't cry out or sniffle or reach for a Kleenex, so her tears simply poured down her face, dripped onto her gown and trickled down the sleek, uncomfortable material to land, cold, on her mother's hands, which rested trembling on her bed.
The Oncologist tried to excuse us, to give the family a moment alone with the devastating news.
"Don't you dare leave me here!" she cried out.
And so we hung our heads and watched.
----------------
Now playing: Eve- Sandra McCracken with Derek Webb
via FoxyTunes
"We need to talk." the Oncologist said, as the smell of burnt, black coffee drifted up and out from one of the cups I had thought to be full of cocoa. The smell burned my nose and turned my already heavy stomach.
We filed into he room where she, looking much older than her 12 years, sat propped up in bed, short hair spiked with gel, wearing horned-rimmed glasses and watching a documentary, only further solidifying her as one of the coolest people I've ever met.
"Hi guys!" she said cheerily. She didn't get up, however, because jabbed straight into her right side was a large plastic tube, a chest tube, draining out the liters of fluid that surrounded her right lung and prevented her from preforming in her local drama club yesterday, thus prompting her visit to our hospital.
When she was 7, she was diagnosed with a common tumor that, with aggressive treatment, is curable. But by no means a surprise to anyone, her tumor was different. Wild and stubborn. And it took many treatments to get rid of it. But after years of chemotherapy, radiation and surgery, they received the news that she was officially in remission. So she went to drama club and school and camp until one day she couldn't breathe and I met her here.
A pneumonia, I'm sure. No, maybe a pleural effusion? In went the chest tube, let's monitor some labs. Nobody worry! The tumor? Back? No way. Sit back and relax. Here, have some Tylenol.
But when the fluid kept gushing out, frank blood now, and her breathing became even worse, we sent her for a scan and sure enough, it was back. Monstrous in size, compressing her lung and vessels and breaking through her diaphragm about to impede on her bowels and bladder.
And before we could tell her, before we could tell them, before we CAT scan was even loaded onto the screen, I knew that she knew. Looking back now, I realize she knew even before the chest tube went in. Before the X-ray and before the ER visit. She knew it was back, growing inside her.
So we told them. We told them that after 11 chemotherapy medications, 3 experimental drug trials, losing her all her hair, stunting her growth, radiation burns, throwing up, collapsed lungs, missing her 6th grade dance and every family reunion since her diagnosis, IT had finally won.
Because I knew that she knew, far before we ever did, I expected her to sob quietly. To hold her mom's hand and let her dad kiss her head and ask us, the doctors, to step out of her room.
Instead her eyes widened and she pushed her parents away from her. Her heart rate monitor accelerated and beeped and her breathing became rapid and shallow.
"Are you serious?" she whispered quietly, like a half-hearted whimper, because the chest tube pain limited her movement. "This can't be happening..."
She looked around the room. "Mom? Dad?" She sat completely still--paralyzed from the pain of the chest tube, so much so that she couldn't cry out or sniffle or reach for a Kleenex, so her tears simply poured down her face, dripped onto her gown and trickled down the sleek, uncomfortable material to land, cold, on her mother's hands, which rested trembling on her bed.
The Oncologist tried to excuse us, to give the family a moment alone with the devastating news.
"Don't you dare leave me here!" she cried out.
And so we hung our heads and watched.
----------------
Now playing: Eve- Sandra McCracken with Derek Webb
via FoxyTunes
Thursday, June 18, 2009
How to be a Pediatrician, Part 2
Wear shirts that make other doctors laugh.
PCR= expensive test for viruses. You can test for any virus, even if it won't change your clinical management and has no effect on the patient. Very cost effective :) Ha ha. And just like Apple. There's an app for that!
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Now playing: Mates of State - My Only Offer
via FoxyTunes
PCR= expensive test for viruses. You can test for any virus, even if it won't change your clinical management and has no effect on the patient. Very cost effective :) Ha ha. And just like Apple. There's an app for that!
----------------
Now playing: Mates of State - My Only Offer
via FoxyTunes
Tuesday, June 16, 2009
Coffee To Go
On rounds this morning, I presented a 3-year-old little boy with ALL who was in for fever and neutropenia. He's almost done with his stay and feeling much better. And he's also gotten used to me. When I come around in the morning to check on him, he is usually awake watching Dora and will jabber to me while I listen to his heart and lungs. Sometimes he will show me a piece of his plastic pizza set, but he will never let me "eat it." I try to take a "bite" and he pulls it away and giggles.
This morning, I was reading off the numbers to the team and he slid out of his bed, dug around in his diaper bag, pulled something out and waddled over to me.
"He was afebrile overnight and all of his vitals remained stable. His ANC this morning is..."
:::poke:::
He poked my leg and I look down at him.
He held up a purple teacup and said, "Hey! Drink coffee!"
I gulped it down, and everyone giggled.
Best cup of coffee I have ever had.
----------------
Now playing: Postal Service - Nothing Better
via FoxyTunes
This morning, I was reading off the numbers to the team and he slid out of his bed, dug around in his diaper bag, pulled something out and waddled over to me.
"He was afebrile overnight and all of his vitals remained stable. His ANC this morning is..."
:::poke:::
He poked my leg and I look down at him.
He held up a purple teacup and said, "Hey! Drink coffee!"
I gulped it down, and everyone giggled.
Best cup of coffee I have ever had.
----------------
Now playing: Postal Service - Nothing Better
via FoxyTunes
Monday, June 15, 2009
How to be a Pediatrician, Part 1
If your patient is celebrating their birthday in the hospital:
Get a group.
Bring cake.
Sing loud.
Wear a hat.
And if you're bald, wear two.
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Now playing: Joshua Radin - We Are Okay
via FoxyTunes
Get a group.
Bring cake.
Sing loud.
Wear a hat.
And if you're bald, wear two.
----------------
Now playing: Joshua Radin - We Are Okay
via FoxyTunes
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