death

this morning i met a patient. she's 92. she is blind. she reads rolling stone magazine in braille. she loves hip hop music. she's dying.

her next-door-neighbor is a patient who is 85 and loves country music. he has 50+ tattoos, some of which he has given himself. the nurses report he even has a tattoo on his you-know-what, although he certainly didn't give himself THAT one. he is also dying.

down the hall is a 55 yr old who is the primary caregiver for both of his parents who suffer from Alzheimer's dementia. he is angry at the world. he has six weeks to live.

yesterday, i met an 82 yr old patient whose daughter was by her bedside. she was sleeping, but i admired her freshly manicured nails. her daughter had painted them a deep pink, and completed the look by adding some flower decals. the patient died today.

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where am i and what am i doing? i'm spending a week on the palliative care units at the VA and university hospitals.

palliative care is the type of care patients can receive when they have a terminal, incurable disease. many of these patients have cancer or other end-stage organ disease, and they attempted curative treatments without cure. many of these patients have multiple disease processes. palliative care focuses on the patient's comfort and symptom relief. dying is a natural process, and the focus is not to prolong it unnecessarily once it is imminent.

it's hard to simplify what i'm doing and seeing, and here's why: death is taboo in American society. we watch "shoot 'em up" movies all the time, but when it comes to someone we know dying, people are incredibly uncomfortable with death.

even in medicine, it is our goal as physicians to "cheat death" or at least prolong its inevitability. we constantly talk of "adding years to our lives" or "preventing mortality." we prescribe treatments to asymptomatic patients to prevent long-term consequences of high blood pressure among other things.

the premise of palliative care, then, where we basically say, "death, you win" has been paradigm-shifting for me. all bets are off. in a patient who has 6 weeks to live, he may eat whatever he chooses. there's happy hour on the palliative care unit. pain medicine is given out liberally. this is not "traditional medicine" as we are taught in medical school, but a hybrid of symptomatology and compassion.

i chose to spend a week on the palliative care unit to see what goes on, but also to sort out my own feelings about death. it's probably natural to be uncomfortable with death, even so, this discomfort undoubtedly stems from the mystery of death. we all fear what we cannot understand. for me, it's been therapeutic to participate in the dying process with these patients. they've taught me much in their few short last days.

in any case, waterproof mascara is recommended. and a box of tissues.

new place, new strategies

although i've not used this blog as a vehicle to update the world on my every move, here's an update: henry and i moved to a new apt 2 weeks ago and we absolutely love it. we're not entirely unpacked yet, but it's a lot newer, cleaner, and well... everything's more level. it's true.

we've done a few new things that we're proud of since we've been here that have enriched our lives and/or saved us money.

1. putting up bird feeders. this is more strictly an "enriching our lives" endeavor (but quite honestly, it's not very costly. only $3.96/each for bird feeders and ~$7 for a 15lb. bag of bird seed at Home Depot). we put the two bird feeders up on friday and within a few hours we had a variety of birds already munching. our cats have been glued to the windows, too.

2. combing the publix ads. henry and i are self-proclaimed couponers, anyways, but before the two weekly shopping trips we've taken since living at the new apartment, we've sat down with the weekly publix ad and circled/made a list of the specific things on sale we would get. we also went through coupons. we usually spend ~$100/week for groceries before coupons. these past two weeks, our bills have come up to ~$60, with a bold "you saved ~$40" declared at the bottom of the receipt. MONEY. literally.

3. living cable-less. when we moved, henry made the bold suggestion that we drop our cable tv. *gasp* as an avid watcher of food network, HGTV, and discovery channel (just to name a few), i was a little resistant at first. i came around, though. the fact is, henry and i don't really watch much tv. neither of us follow any shows regularly. we figured if there are any shows we want to watch, there's always hulu.com. and, on top of that, we bought an HD antenna (~$30 from Walmart) with which we can pick up all of the local networks (CBS, ABC, NBC, etc) through the free digital HD signals over the airwaves. so march madness? yup, we get that for free on CBS. in HD. huzzah. and honestly, i don't really miss cable. in fact, i'm watching "APT Create" right now, APT's version of an HGTV/food network hybrid. it's lower budget, but it's totally up my alley... and guys? it's FREE. (anybody backpacking in europe ever get the rick steves books? right now i'm watching "rick steves europe: venice." it's awesome. it's like an awesomer version of samantha brown's "passport to europe" from the travel channel.)

moving to the new apartment has given henry and i the opportunity to reevaluate the way we do a number of things in our daily lives - it's funny how moving every single thing you own and having to find new places for each of them will do that. the experience of doing something like dropping cable has been a huge encouragement to find other ways to save and re-shuffle our budget. here's hoping we'll continue this 'spring-cleaning' of sorts. cheers!

psychiatry

psychiatry. where to begin? today was the last day of my 4 weeks on this rotation. the schedule is great. the patients are challenging. it's definitely not boring.

psychiatry is one of those fields where you collect an excess of wonderful dinner party stories. i'm serious. i probably collected enough over 4 weeks to last me a lifetime.

why? the presentation of acute mental illness is usually completely socially unacceptable, but somehow humorous at the same time. patients are paranoid, suspicious, bizarre, withdrawn, talk to themselves, injure themselves, pace, stare, younameit. they make other people uncomfortable. as someone in the community, this may be all you would ever see. as someone who treats them in the hospital, these patients open up to us. they tell us their beliefs. many believe others are after them. some believe they have special powers. some see codes. still others have even more bizarre beliefs. some see and hear things we cannot. the list of symptoms goes on.

here's one example of many. while on service, i daily interviewed a patient who was very ill. she was brought in by the police because she was found wandering the streets confused. she smeared her bodily fluids at every opportunity (on anyone, anything). she did not answer questions appropriately or know where she was. every morning the nurses gave report that she was constantly naked. she was sexually inappropriate with other patients. she endorsed hearing voices. she saw bright things on the wall. she told us that she had a gift from god. she could open doors that were locked. she could hurt people if she wanted to. on one particular occasion when i was interviewing her, she was looking out the window at construction workers on a nearby roof. "you see them?" she asked me, staring blankly. "i can make them fall off the roof if i want." over the course of her stay she has gotten better - she really has. but it was both troubling and entertaining to talk with her each day. you never quite knew what to expect.

will i be a psychiatrist? nope. i'm glad for the experience. the stories will stay with me for a lifetime.

hem/onc jesus

so for my last week of pediatrics (last week), i was on inpatient hematology/oncology (for non-medical people, this is the blood diseases/cancer service). it was actually really interesting and fun. our kids were sick, but many were getting better. my attending was fabulous. he was a recent transplant from st. jude in memphis ("the mecca", our fellow liked to call it), and he made a huge production of teaching me every second he had available. he'd pull up powerpoints from "the mecca" and the fellow would roll her eyes (then secretly smile). he'd call to me from across the ward - "are you ready?" - and take me into patient rooms. he would teach these poor sweet overwhelmed families how to calculate absolute neutrophil counts. it might have been a little overboard, but it was awesome. i ate it up.

the hem/onc ward itself was pretty much like any other floor in the hospital. slightly different equipment, etc, but more or less the same. on one particular day, however, i was sitting at the computer in the unit looking at labs and glanced over at my hand holding the mouse to see jesus staring up at me. no, i was no hallucinating. it was jesus.

this is the best approximation of him my google search results could find.

i kept one eye on 4inch plastic jesus while i finished my computer business, then i left the nurse's station. i actually didn't think much about it that day.

the next day i came in, i looked for jesus. in fact, he was lying face down near some phone books. oye! i didn't mess with him, but that seemed sort of weird.

the next day when i came in, jesus was up on the top of the counter of the nurse's station next to a chart, situated in such a way that just his little face was looking out over the patient's chart and his body was obscured.

i found this entire thing very odd. my first thought was: "oh, this is the hem/onc floor -> kids with cancer ->prayers needed -> jesus can watch over them." but then my second thought was: "they sure treat 4in plastic jesus pretty crappy if they're hoping for him to watch over people." and then my third thought was: "this is the only children's hospital in the state, nay, the region and i imagine it's a pretty culturally diverse place, so where's the 4in plastic buddha and muhammad and mother mary, etc." ... and at some point i stopped thinking and just enjoyed the irony of the situation: a 4in plastic jesus was getting tossed around a nursing unit where we miraculously cure children of cancer daily.

it's that time again!

and i don't mean furniture rearrangement... except for i sort of do! it's true. we're moving again.

but don't worry, we didn't get kicked out of our current place. we kicked ourselves out. our lease is coming up in another month and it came time to decide - stay another year or move on?

it was our hope when we moved to this apartment a year ago that we would stay here for two years - until the end of my med school (and probably our move out of birmingham). we made a lot of compromises picking our current place - no dishwasher, tiny bathroom, oldoldold everything, putting our washer/dryer in the dingy basement, shady parking situation (which most of you know resulted in my car being totaled last summer), etc. we thought that the awesome location, the millions of windows, the gas range, and the "charm" would be enough to hold us over. unfortunately, we were wrong.

even so, it wasn't necessarily our intention to look to move. i'm in the middle of my stressful 3rd year (as i'm sure can be deduced from my recent posts) and henry's nearing completion of his master's degree... not exactly the most convenient time to undertake a move. but we have had our eyes open for a few weeks looking at what's available. we'd talked it out and agreed that we would only go through with the huge task if it would solve a few major problems: kitchen, bathroom, laundry, and parking without creating any major new ones: location, overall size, price. we also really wanted to be saving money rather than spending more or even paying the same amount. pretty tall bill, eh?

so our new place, discovered almost by accident, is a 2bed/2ba behind the summit. it will save us $175/month baseline on rent. ! this is 1 more bathroom than we have now. laundry INSIDE the apartment. huge kitchen with dishwasher. walk-in closets. marked parking spaces in a lot. etcetcetc. compromise? probably location. we'll have to factor in the drive to work. all that said, henry and i are ecstatic. there is a unit available exactly when we need to move in, and what's more, henry's employer is "preferred", so the app fee and deposit were cut in half. everything fell into place so smoothly and fit our incredibly tall order - it's easy to be confident this is where we're supposed to be.

so... in 3 weeks... we return to the land of buildings which are 1. up to code, 2. relatively level, and 3. free of lead paint and excessive amounts of mold. can't wait to take a bath in a tub that hasn't been PAINTED. !!!!!!!!! (not kidding there.)

celebrations

happy chinese new year! xin nian kuai le!

it's been a big weekend for events: opening ceremonies of the olympics, chinese new year and valentine's today. other events going on in the city/region: mercedes marathon, mardi gras parades, and a "snow-storm".

ah, the olympics. i've had the opening ceremonies for the olympics on my calendar for a few weeks; i get pretty excited about the olympics. my obsession probably started when i was in the 3rd grade when i was asked to do a project for class. that was the winter olympics of 1994 in lillehammer. shortly after, my family moved to birmingham and the olympics were in atlanta in 1996. i saved clippings from the newspaper and made an olympics "scrapbook". some of the soccer games were actually in birmingham, so it was incredibly close to home. in summer 2004, i pretty much watched every event that was televised, as i was bound to the couch after having sinus surgery. i've never really been a kid with any hopes of competing in the olympics; i'm not an athlete and don't dream of being one. there's just something thrilling about the games, all the nations, the drama of it all that has kept me excited through different ages and stages in life. this weekend i've found myself once again transfixed by the competition. here's to two more weeks of hypnotizing entertainment!

we had a very low-key new year's celebration with henry's parents last night, and his mom brought us sushi today. mmmmmm. always good food.

valentine's day was also a pretty low-key celebration for us. henry got sick at the end of the week with some sort of yucky upper respiratory infection, so he's been taking it easy. we were pretty lazy all day, and it was wonderful. the idea of valentine's day sort of conflicts me; when you have a valentine who treats you special every day it seems silly to ask him to go above and beyond that already high level of awesomeness on some made-up holiday. still, henry surprised me with flowers and a cookie cake. i'm a lucky lady to be married to such a consistently loving, caring partner in life.

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last weekend, henry and i made the trip up to louisville, ky to visit my sister beth and her husband drew. they recently bought an adorable house with oodles of charm. we spent time with them eating, playing, watching movies, and generally having the time of our lives. on sunday morning, we drove to lexington, ky where my dear friend amanda and her husband ben live. we planned to have lunch with them there. another dear friend and college roommate, laura, came down from cincinnati with her boyfriend to meet us. what a reunion! the whole weekend made me long to live closer to both my sister and my close friends.

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back to reality. this week i'll be in the well-baby nursery at uab. it's where all the freshly born, healthy babies go when they are not with their moms. it should be a fun week! i mean, there will still be lots of screaming babies, but at least they won't be sick. next week i'll be on inpatient hem-onc... those kids will be sick. i'm interested to see how that will go. then pediatrics will be over. i won't lie - i'm not sad for it to end. glad for the experience, glad it will be over. such is the story of third year.

180.

i just finished my four weeks of inpatient pediatrics. the first few days helped me realize that pediatrics is not my life's path.

somewhere in the middle of the month, one of the other teams' residents mentioned to my resident that she was about to go admit a 'crappy patient.' it didn't register for me until a few minutes later that she used the adjective 'crappy' to describe her newest admit. understandably, crap is not a foreign substance to a children's hospital, so this is not surprising. but in this case, the resident was talking about the patient being crappy - an undesirable patient. the patient had a chromosomal abnormality, present from conception, that caused a constellation of medical problems.

it hit me later that day why pediatrics wasn't appealing to me. on inpatient pediatrics, all of our patients were as the residents' newest admit - complicated and suffering some type of long-term incurable illness - or incredibly uncomplicated. by uncomplicated i mean: has a cold and can't eat, so has to be admitted for IV fluids and will go home the next day. obviously this is a gross generalization, but surprisingly accurate.

there's a list of other things that don't appeal to me about pediatrics: working with 75% female residents, dealing with primarily non-verbal/non-history-giving patients, dealing with parents, being out-of-touch with adult medicine, and calculating medicine/fluid/calories based on weight of individual patients among others. then there's the list of illnesses common in a pediatric population, many of which have some connection to embryology and/or genetics (neither of which hold my interest much).

after all is said and done, i also realized about myself - surprisingly - that i don't like taking care of kids medically. i've always been someone who is passionate about understanding people and helping others understand things. enter - pediatrics. it's impossible to explain to a 5-year-old why it's necessary to place stitches on her lacerated chin. impossible. i tried. don't get me wrong - i don't expect every patient i ever have to understand. it's just going to be a much more plausible task in a 30 yr old vs a 3 yr old.

nonetheless, pediatrics has taught me loads about myself and how i relate to people of different ages. prior to starting pediatrics, i was certain it was my career path. halfway through, i'm certain it's not. disorienting? yes. exciting? double-yes. can't wait to see how much more 3rd year will shape my own self-awareness.