Three Ladies

I happen to have 3 female patients on my service right now who rock my world.

D is in her mid-thirties and has Down's Syndrome. Her intestine popped a hole in itself and she got a mad infection in her abdomen requiring surgery. She's doing quite well now, though it was touch-and-go for awhile there. She has slowly begun to trust me. Her mom is amazing; she's about mid-60s and is rarely away from D. The mom showed me some drawings D did recently (she is an avid artist). I told her I'd bring her in something of mine, so I sketched a little dog that looks like Muffy, her favorite stuffed animal who never leaves her side. D loved it and said she'll color it. She gave me a big smile and a high five.

Ms. O is close to 60 and has brain cancer. She has fought for 2 years and it recently recurred. Ms. O's younger sister is a saint. She has made the tough decision to not prolong Ms. O's suffering. Ms. O was having fevers to 105 with no identifiable source, so I attributed them to her brain cancer or recent seizures. A few days ago, I told Ms. O's sister that she is amazing for listening to her sister's wishes and making this hard decision. I told her that she shouldn't second guess herself, and that she needs to stay strong in this because that's what the patient wanted. She was tearful, but she thanked me. I hadn't seen the sister over the past few days (it was Thanksgiving), but I saw her today. She thanked me again for my kind words, and said she's at peace with everything now. Ms. O is even having periods of lucency where she tells her sister "thank you" and "I love you." The sister gave me a Starbucks gift card today and said, "Thank you again. Please, use this and think of us when you take a few minutes to yourself." I plan to take my own sister out for coffee with the card. I think Ms. O and her sister would like that.

K is also in her mid-30s, like D. K is a mystery because she seems to have a recurring illness. It's either reexposure to something leading to recurrent infection or a latent infection that comes up from time to time...or it's not infectious at all. It's a strange story, and one that I hope to figure out in the next few days. K and I hit it off, she's a great girl. She has a tattoo, and we got to talking about tattoos. She got hers with a few girlfriends - they all got the same one. She loves it and says she always will, "Because it meant so much to me when I got it." I told her that I was thinking of getting one, but I can't decide on something I'll want forever. She told me to just get one, because it will always be special to me. Today she was reading that book Push, which is what the movie Precious is based on. She said, "Just when you think you have it bad, you can just look at the person next to you." She has a great outlook on life, especially for someone who has been dealing with this recurrent mystery disease for 3 years. Then she said, "You know what? This world is filled with crazy."

She's right. This world is filled with Crazy. Once again, it takes a special patient to remind me to realize how blessed I am to not only survive amidst the Crazy but to flourish here. I love my job.

Soundtrack

I have a difficult patient.

Ok, I have many difficult patients. Attendings like to give me the difficult patients. I'm not sure why, but I have a few theories. 1) I'm nice but firm. 2) I'm a girl. 3) I don't complain about it. I'm not sure which of those theories factors most into the equation, but the end result is that I have a lot of difficult patients.

The positive side to my patient panel is that I occasionally make a break-through with a patient. Almost always, my patients at least start to prefer seeing me as opposed to the other fellows (we don't always get to see our own patients, due to scheduling conflicts). So, even if they hate me, they hate me less than they hate the others! Ah, the simple victories.

I have a patient - Mr. S. Mr. S is HIV+ and in an electric wheelchair. I'm not sure why he's in a wheelchair, because he can walk. I haven't dug deep enough in his chart to figure out why he has chronic leg pain. Maybe from HIV neuropathy. Maybe from HIV-associated bone destruction of his hips. I'm not sure.

Mr. S is difficult because he has a lot of psychiatric issues as well as his chronic pain. He gets a lot of narcotics to deal with the pain. He also takes a lot of anti-depressants and other psych meds. As a results, he can be drowsy and not a great historian. He's also a little whiney and demands a lot of attention.

Mr. S has outfitted his wheelchair with solar panels. I had never asked him about the panels, because he was never my patient. Until now. About 3 months ago, he got moved to my patient panel (see the above 3 reasons as to why). So, half way through our appointment, I asked him, "Are those solar panels?"

Long story short, he went into how they work, what they do, etc. Smart guy. They don't power his wheelchair. Oh, no. They power his sound system. Yes. Yes, I said sound system. Mr. S always rolls with music. He has a receiver and speakers that are rigged to an MP3 player. You can always hear when he's arrived to clinic. This week, he entered to Green Day and waited with Jimi Hendrix. He always turns the music off when he comes into the see the MD, though.

Next, I asked him what kind of music he likes. He said all kinds, and he explained that his current MP3 player got run over by his wheelchair, but still seemed to work. Mr. S actually got run over by a car a few days prior, but he still seemed to work, too. Fractured ankle, but doing ok.

He pushed play, and Tupac filled the room, singing about California Love. My favorite. So, I did the rest of his physical exam with Tupac jammin'. At that point I came to a conclusion:

All patients should come with a soundtrack.

Fellow Fellows

I just got back from Philadelphia and an IDSA conference. Nerdy ID docs from around the world come and listen to hours and hours of lectures about their favorite diseases. It was awesome. Really. I had a great time.

I really enjoyed Philadelphia, much to my surprise. I'm not sure why I was surprised. I didn't know much about Philly before I got there. I thought it was going to be dirty and run down. Not so. It was super cute! Lots to do and see. I could see myself living there. It's close to DC... And we all know how much I love DC.

The other pleasant surprise was how well my fellow fellows and I got along. I shared a room with 2 of them - A and T. I find them both hysterical people, very witty, fun to be around, etc. I was hoping we'd still be friends at the end of the trip -- 5 days of living with people you only really know at work could spell disaster. This time, it went great. I haven't laughed that much in I don't know how long. I love those guys.

Some of our adventures:
- 'A' trying 3 times, unsuccessfully, to give away his Ahi tuna leftovers to any homeless person we could find.
- Visiting the wawa store next to the hotel as often as possible for snacks and Diet Coke.
- Watching our 2 flat screens on the same channel in our hotel suite. The TVs were 10 feet apart. Max.
- Coming back, every day, to a room that was at least 54 degrees and still pumping out AC. We're not sure why Nicole, our cleaning lady, was trying to freeze us out.
- Taking a wrong turn on our run past the Rocky steps, making our 4 mile run a 7 mile run.
- Eating our weight in candy over those 5 days.
- Taking pictures of each other falling asleep during the lectures.
- Listening to our pharmacist try to sell 'T' on going out with her friend who "has a great personality" and "isn't hideous looking." He wasn't biting.
- Trying to come up with a clever title for 'T's talk on Neurosyphilis. I offered "Neurosyphilis: the other spirochete." He wasn't biting on that either.

So many more awesome memories. I'm very thankful that I work with 2 wonderful people. I look forward to our next adventure together!

Weekend Off

This is my first weekend off -- and in town -- since April 25. Holy cow. To be honest, the only reason I didn't sign up for a moonlighting shift was because I had 50/50 planned on going home to Chicago to see my parents and sister. I opted to stay back because I've got a presentation, a grant and a research proposal due in a week and a half.

Wow, April 25. That's so sad. Half of those weekends I was working for my fellowship, but the other half was moonlighting. I don't think people fully understand medical education. You work like a dog in med school to get good grades, learn the material and get to the residency you want. Then, residency is (at first) a lot of overnight call working 24-30 hours at a stretch. When you get to be in your final year of residency, you have less call and more consults/clinics - that means more 8a-6p type hours. So, you start moonlighting. Working extra clinic shifts at night, covering for attendings to make extra cash. At first, it's not a big deal, because you're so USED to working all the time. Now that you have free time, it's easy to give it up for some extra money, because you're not used to having the free time.

Then it's a vicious cycle: you get used to having the extra money, so you can't stop moonlighting, but you're so tired you want to stop, but if you stop you can't pay the new car payment or go visit your folks, etc. You establish a new income for yourself that you can't let go.

Well, I'm taking the weekend off. I'm nearly done with all of my work, and I'm going to have a day filled with no medical stuff tomorrow. I'm going for a long run in the morning. I'm going to enjoy a cup of coffee with my husband. I'm going to church for the first time in a loooong time. I'm going to look for a new satchel for work. I might even go to a cafe and read a book for fun. Crazy!!

I'm getting more and more of the mindset that life is for living. Not for working. If I never see the pyramids in Egypt because I didn't want to work X number of extra shifts, then so be it. I'll enjoy my friends and family right where I am. Life is too short to be living for tomorrow. Time to live for today.

One Phone Call

On Friday, I had Hepatitis Clinic. I love that clinic. I'm the only fellow that loves that clinic. I'm not sure why it is so hated by the GI and ID fellows alike. I only know that I find the patients interesting, the disease fascinating and the attendings knowledgeable and fun. Most of them.

I had one patient whose wife kept calling his cell phone during our appointment. He kept answering and telling her he'd call her back when we were done. From what I gathered a) she was supposed to come to the appointment with him but couldn't because of some other family situation; b) she was going to be coming to pick him up when he was done; c) she was afraid he was going to die.

Now that last statement is humorous because people don't die of Hepatitis C when they've had it for 20+ years. Death from Hepatitis C comes on slowly as the liver starts to fail. I'm not sure why she thought he was going to die, but she was very concerned about him. On her last call, I took the phone and told her that I would have more information for her after our visit, so could she please wait and we'd call her back.

After we were done and the attending had concurred with my plan, I asked the patient if I could call his wife back. I spoke with her for about 6 minutes. She had a lot of questions, mostly not understanding the chronic nature of Hep C. I took my time and explained things to her, and she was very grateful.

As I walked the patient out to the front desk where he could check out, he said, "You know, thank you for calling my wife. A lot of doctors don't like talking to the family, so it means a lot that you called her. I appreciate that." I remembered back to when my mom had my grandma's surgeon call me regarding her operation and how everything went. How much it meant to me and to my family that he took the time. I said he was quite welcome, and that I was looking forward to meeting her at this next appointment.

It's the little things - one phone call - that can mean so much to our patients.

New Patient and Correction

During my moonlighting today, one of my patients was a Cambodian refugee. I'm not sure when he came to the US and under what circumstances. He tried to commit suicide some time back, but it didn't work. He's terribly nice, and he currently has an infection that he'll recover from. I've seen him once before, actually, several months ago. I don't remember why.

As I sat with his chart, I didn't really think about his infectious issues. Instead, I kept wondering what he saw in Cambodia. What horrors did he experience? What was is like right before he came to the US? Did he come here first and then seek asylum, or did he try to get it prior to leaving his homeland? Was that his family that just walked out of his room? Did they come with him? Was he scared when he arrived here? Did he fear deportation? What kind of adjustment period did he go through? What lead him to eventually try to kill himself? Is he glad he failed?

So many questions for this soft spoken man. None of them relevant to his current infection, so none of them were asked. I mostly hoped and prayed that he was glad to be alive, and that whatever atrocious acts he saw and experienced were outweighed by the love he gets from his family and friends.

Correction: in my state of overwhelming gratitude (and in the confusion of too many initials) I left out an amazing friend. JS: Where to start! From an random roommate a true lifesaver. Thank you for your support.

Blessed

I'm feeling very emotional today. Not like I need a box of Kleenex or anything. Just overwhelmed by the wonderful people in my life.

I'd like to take a minute to thank some wonderful people (who may or may not read this blog, but that's beside the point):

AL: You are my glue. Seriously. Doesn't matter how far apart we are. Glue.

MW: Thank you for your wonderful blog which I have just stumbled upon. I still regret that we didn't spend more time together in DC.

JL: You're my rock in LA. Thank you for being there. Oh, I love the lungs, too. Remember that.

LR: My other LA rock. Thank you for trusting me and for being so trustworthy. We'll hike again soon.

RM: Our time at G'town went so fast. Thank you for being a great listener.

JB-C: Leaving stupid voicemails to each other will never get old. No matter how long it's been, when we talk it seems like we never left.

My sibs: You all rock. Thank you for making me a better (and funnier) person. Thank you for loving me through everything, even when I didn't deserve it. Thank you for keeping me humble. Thank you for giving me so much more than I could ever give back.

Remember to tell the people you love how much they mean to you. It'll make their day (and probably their week).