Sunday, December 27, 2009

Best Christmas Ever

So, imagine that it's Christmas Eve. You're with your wife and 2 grown daughters. They don't live very far, and they've come over for brunch.

Your pager goes off.

Except that you're not a doctor. Or a fire fighter. You're a patient with end-stage liver disease and that pager means a new liver. You call the transplant coordinator, and she tells you that there's a local match. It's time to drive down to the Hospital and prepare for surgery. Good thing you hadn't eaten that brunch yet.

So, after approximately 10 hours of surgery, you got a new liver. It's nearly midnight and your family is in your ICU room. It'll be a few days before you're extubated, so you're going to miss Christmas.

Somehow, I don't think Mr. H will mind. He and his new liver and doing well. He's not out of the woods yet, but the first critical days are going by smoothly. Even though his memories of Christmas 2009 will be foggy at best, something tells me it'll go down as the best Christmas ever.

Thursday, December 24, 2009

"It's been a good experience"

I did some moonlighting today, so I saw some patients who aren't normally mine.

One is a 54-ish year old guy with newly diagnosed lymphoma. He's been in the hospital for a few weeks - he says he was a terrible mess when he came in, but he looks good now. He pointed out that I hadn't seen him back then but if I had it's night-and-day compared to now.

Right now, he's 20lb heavier from water weight - though he points out that he was up 40lbs a week or so ago, so it's improving. Right now, he's yellow. Right now, his liver and spleen are riddled with metastatic lesions, though some of the MDs comment that it's looking better. Right now, his white blood cell count is in the toilet, making him at high risk for infections. He quickly points out that he's not having fevers anymore, so that's an improvement.

Right now, his 27-year-old daughter is at home, having just flown in from DC where she works. She doesn't know how sick her dad is. He has gotten a few rounds of chemo and was deathly afraid of losing his hair. He's not vain, he just wants to ease his daughter into this diagnosis. His nightmare was having her walk through the door to see a yellow, swollen, bald man claiming to be her dad. He called Patient Relations a few days ago and asked them how he can get a hair cut. He wanted it to be short (but not shaved), in case he did start losing his hair. He figured it wouldn't look as bad if it was patchy and shorter.

Whaddya know - Patient Relations called up Al the barber. I didn't know we had a barber. Apparently, Al comes in and cuts hair for those patients who can't leave the hospital. Al's daughter was (is?) a nurse at the hospital and got started doing this awhile back. Al is 82. My patient said that Al did a great job with the tools in his little black satchel, jumping over IV tubing, ducking antibiotic bags, etc. He is really glad his hair hasn't started falling out yet (it might never), and he was extremely happy to have had Al come by.

Mr. T looked at me and said, "You know, it's been a good experience, being in here." I just looked at him - jaundiced, edematous, belly full of over sized organs. His prognosis is up in the air, mostly because his type of lymphoma is so rare there's not a lot of data on it. Mr. T looked at his wife, who smiled, and then looked back at me, "I know that must be weird to hear me say, but it's true. You, the nurses,'s been a good experience."

I wished him a merry Christmas with his daughter and complemented his hair cut. Then I left before I started to cry in front of him.

Tuesday, December 22, 2009

Merry Christmas! You have cancer.

So, Christmas time is great, except when you're sick. And except when you're taking care of the sick people. This past week has been full of not-fun things.

- I diagnosed someone with metastatic cancer
- I watched a family opt to turn off life support
- I told a daughter that grandma won't be able to leave the hospital in time to go on the family cruise
- I can't figure out why my lady with her second organ transplant is back in the ICU
- I handed a man his vomit bucket as he told me hasn't been able to eat in 17 days
- I got the autopsy results from a 33 year old patient, and I'm still not sure why he died

It's been full of little miracles, too, if I think about it.

- Mr. M took his first steps in the 6 weeks since his liver transplant
- Mr. L is going to make it home on Thursday, in time for Christmas with his wife
- Mr. H got his liver transplant a week ago and is sailing along
- Ms. O is home, even though she doesn't have a diagnosis yet
- Mr. K isn't having 18 bowel movements a day since the treatment finally started to work

I guess that's the way life is. Ebbs and flows. Ups and downs. Without one, how would you know the other? Without a low, how could you recognize (let alone appreciate) a high? So, I'll be thankful today for both the trials and the joys. I can learn from the trials, making the joys that much more exhilarating.

Tuesday, December 15, 2009


I was recently asked to talk about one of my favorite holiday memories. I have so many funny family stories. How to pick just one...

Perhaps one of the most memorable occurred about 15 years ago, when my youngest brother was about 10. Being the youngest, he was, of course, the most excited for Christmas. He also wanted to get up at the crack of dawn to open his gifts.

The other siblings and I were in our mid-teens. We loved Christmas, but we also loved sleep. You remember those teenage years when you couldn't sleep enough? That was all three of us. We all had our own room at this point. My other brother was in the basement. My sister and I were down the hall from each other upstairs. The little guy was across the hall from us.

Around 5am, the little guy comes in to my room. He shakes my shoulder until I wake up. He can barely keep his excited voice in a whisper as he tells me it's Christmas. With a sense of urgency, he tells me that it's time to get up and open our presents. "Is Brother up yet?" I ask, my eyes drifting close. He admits that no, Brother is not up yet. "Well, go get Brother, and when he's up, let me know. I'll come right down." The little guy goes skipping down the hall and down, down to the basement.

About 10 minutes later, he comes walking back in. I hear the patter of his feet and open my eyes. "So...?" He drops his arms down, leans on my bed and sighs with the weight of a hundred years. "Brother asked if you and Sister were awake, and when you were both downstairs he'd come up for presents." I just smiled. "Ok, so go get Sister, tell her to go downstairs. Then tell Brother to meet us. Then, come get me." I must have sounded convincing because he left for another round of trying to convince each of us to be the first to get up.

Sister caved first, probably because she was second she is easily worn down by whining. Brother and I held out for a long time, sending the little guy up and down 2 flights of stairs several times. By the time we both agreed to get up (it's probably only 6am at this point), the little guy had separated all of the presents into nice piles for each of us, arranged pillows and chairs near the stacks, and was grinning madly near his stash. Brother and I laughed as we realized we had sent him back and forth no less than 4 times. It was at this point that we learned that the little guy had been up since 4a and had watched an old VHS copy of Scrooged before coming to get us. Watching Scrooged became a yearly tradition for him, and I'm actually not sure if he's outgrown it yet...15 years later...

Tuesday, December 8, 2009

Can I get a liver?

I was recently consulted on a patient who developed acute liver failure of unknown etiology. He was fine until 3 weeks ago when he felt tired and achy. Then someone at the store told him his eyes looked yellow. Two weeks later he was transferred to our hospital because we do liver transplants. Infectious Diseases physicians are consulted to make sure the patient has no infectious contraindications to a transplant as well as to make sure they are on proper antibiotic prophylaxis pre-operatively.

This patient crashed fast. He was intubated, on continuous dialysis, on 2 medications to support his blood pressure, and his heart rate kept plummeting. We had done a bone marrow biopsy on him a few days earlier because his blood cell counts were a little off. As we waited for that result, and many other lab tests, to come back, we were supporting him in every way we could.

Yesterday morning, I was in his room in the ICU when the transplant surgery fellow came in. I've gotten to know him well, since we share a lot of the same patients. The nurse was also in the room. A few minutes later, the patient's wife and a priest came in. The 3 of us healthcare providers took a step back and let the priest pray over the patient. The surgeon's eyes never left the heart monitor, but his lips moved with the Lord's Prayer. The nurse watched the dialysis machine while she made the sign of the cross. I stood, hands folded, and alternated watching the priest and the ventilator.

Then, the priest and the wife left, and we all went back to examining the patient and talking about what we needed to do next. It was a very surreal moment, and it wasn't one that happens often. But, it was nice.

We later found out that the patient had an aggressive type of lymphoma, which rendered him "not a transplant candidate." He died shortly after.

Sunday, December 6, 2009

3 Years Later

I got this amazing email the other day. Before I go into it, I'll need to go back three years. My memory is a little foggy because of a) early onset dementia and b) the sheer number of patients I see in a given day/week/month. I don't always remember details about each of them. Except for Raphael*. Beautiful Raphael. But that's another story for another day.

(*not his real name, of course)

I was doing a rotation at one of the free clinics on the west side of town. I must have had a patient that I saw more than once in that month and that I connected with more than just the normal amount. I remember her name but not why I saw her. I remember she had a brother with leukemia (he was about 22 years old) who was in the hospital. She mentioned to me that his favorite show was House, MD and that he watched it faithfully even while in the hospital. I happened to know people on that show, and I mentioned that to the patient. She couldn't wait to tell her brother. I spoke with my friends and got a signed cast photo, which I then mailed to my patient's brother. I never heard from her again, but I didn't think anything of it. I moved on to another rotation and that's life.

Until this past week, when I got an email from her:
"It has been almost three years since we have communicated. I'm not sure you remember me, but I remember you for the beautiful things you did for me and my brother. I once asked you if you can get me the signatures of your friends who are actors from the show "House". I never got a chance to thank you, but thank you. Unfortunately my brother passed away in October of 2007. We got the news that he was getting close about a year before which was when you mailed us the pictures. My brother loved them! But it has been tough. I hope you can remember me, and not think that I completely forgot about what a thoughtful thing you did.
-M. P."

Wow, did that cause me to pause. It made my day, of course, but it also made me think about all the little things we do every day that someone else doesn't look at as being so "little." The cards we send, the candy bar we give, the CD we make. Those little extra gestures that really make a big impact on someone else. So, this week, I am going to be uber aware of the extra mile I can go for others because just maybe it'll be something that sticks with them forever.