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 22, 2009
Tuesday, December 15, 2009
Memories
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 youngest...plus 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...
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 youngest...plus 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.
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.
(*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.
Saturday, November 28, 2009
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.
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.
Friday, November 6, 2009
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.
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.
Monday, November 2, 2009
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!
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