Today I finally had to concede that my favorite patient on the hospital service is slowly losing the fight...her lungs are filling up and with low blood pressure, renal failure, allergies to certain meds, etc...there is nothing we can do but watch and make her comfortable. I spoke with the family today and for the first time in my professional career, burst into tears in front of a family. I have cried in front of colleagues, attendings, nurses...but never lost my "mask" in front of a patient or their family. The family was/is wonderful an we are all struggling to support one another and Mrs. R. as she passes from this life. I was able to contain the tears while talking with Mrs. R...I am not embarrassed by the tears but do not want her to feel that she has to worry about me. I have no idea what the next few days will hold, but I hope and pray that we can get her more comfortable and help her to die with dignity.
On the other end of the spectrum, I had a wonderful compliment today. One of the most brilliant specialists I know asked me what year resident I was and when I answered "intern", he looked me in the eye and said "you do a really good job". This from a taciturn man who knows more than I can imagine knowing. I am constantly questioning my fund of knowledge. It always seems that my fellow interns remember more about what is the standard of care or latest treatment for some malady than I do. What I am good at is working hard, trying to make sure I have dotted all my "i's" etc, and communicating with people. It astounded me that this man who I am always asking questions believes that I am doing a good job. It helped remind me that the above qualities can be more important at times than a flawless fund of knowledge. As long as we recognize our weaknesses, ask questions, research, and know when to refer...being a good doctor is more about being dedicated and caring. I hope that I will be able to hold this belief strong in my heart and maybe stop beating up on myself when I cannot remember as much about the lastest treatment or research as my medical student.
"may the beauty we love be what we do" (paraphrased from Rumi)
I have gotten home somewhat early and am bored. My husband is gone somewhere and it seems that this is why I am bored. I have only been married for 10 months...in residency for 8 months...and I find myself more dependent on him than I have been with anyone in a long time. Us strong independent women hate to admit to dependency...but I find that I need his positivity and different way of dealing with things when things get hard during residency. I know deep down that I can get these things from others if need be...but for now, he is my sweetie and life is just more fun when he is around.
I am 37 years old and before I met my hubbie, had decided that I would most likely never marry. I could not imagine getting along with someone on a day to day basis...I could not imagine being married to most of the southern conservative hunting men who watched football every sunday who I found myself surrounded by. I also could not imagine having to care for myself and "take care" of someone else in the way it seemed most men required. I had begun making plans about adopting children as a single woman and began my medical carreer...and then two and 1/2 years into my medical training, I met this wonderful, funny, liberal, vegetarian man who cooks biscuits and makes things with his hands and never takes life too seriously. He may not love to talk about his emotions or always understand it when i am taking life so seriously but I find that I can live with him days, months, years at a time and still feel like myself. I don't have to take care of him...and he doesn't take care of me...but we care for one another and share so many views about the world. How amazing life really is...it just goes to show that one should never say never...life can always surprise us.
Only two more calls on "eternal" medicine. Then an easier month with some annual leave days and more free time during the day. It makes life easier when you have something to look forward to!
Mrs. R. died this morning at 5:45 am. Once again, it was my colleague that pronounced her. I felt relieved that she and her family were beyond the "suffering" and able to move on to grief. I felt relieved that I would not have to watch their suffering and close that chapter of my medical life. I seem to like the order of finishing one thing and moving on to another. Lingering debts, duties, pain, confusion...have always been fairly uncomfortable to me. Life is full of such lingering...but I have always had a sense of satisfaction when I can turn the page and move on. I know that Mrs. R. is in a better place. I can even fantasize that she was being kind to me when she passed away while I was at home getting ready for work...that she chose to die two days (rather than two weeks) after we all agreed that continuing treatment was only prolonging the inevitable and her suffering. She was a beautiful human being and I am honored to have known her. Her family tell me that she was famed for her bisuits and gravy and her turkey and dressing...she raised her grandchildren and some of her neices and nephews...she loved working in her garden and lived amiably with her oldest daughter. Her family spent the last week and a half alternating staying with her in the hospital. She was surrounded by love and respect...and a family who held her until her last moments and then quietly let her go. What more could anyone of us wish for.
Mrs. R., thank you for all you taught me and for the love and kindness you shared. God be with you til we meet again. :cloud9:
Tommorrow is my last internal medicine call this month...and only one more month of internal medicine to go. I am a family practice intern and our first year we do three months of internal medicine. The call and patient load is harder...and the attitude a little colder...but we sure do learn a hell of a lot. So I guess it is worth it but I am glad that May will be my last month!
It is Saturday Night and I am sitting on the couch with my husband and my cats watching the movie "Radio". It is a beautiful spring evening in the mountains and the sweet spring air is coming through the open windows. I crave more moments like this...more time to savor the pleasures of everyday living. The irony of it is that having less time to savor life tends to make those moments that I can do so all the more precious.
Well, let me go and savor the evening. Sweet dreams all.
My subconscious has a way of voicing itself in song. I will find myself humming a tune...or outright singing a song on the elevator (when I am alone...does anyone else do this?) and realize how appropriate it is to the situation at hand. Yesterday...my last day of my internal medicine rotation...I had to laugh when I found myself singing "Ding-Dong the witch is dead, the wicked witch, the witch is dead". I was striding out to my car with an irrepressible smile on my face feeling free as the munchkins on the day Dorothy arrived. The best thing about a difficult rotation is how much you appreciate time when it returns and perfuses your life!
Today I started the first day of an OB rotation with a terrifically nice attending. I met him at the hospital at 9am...three hours later than I have been coming in for the last month. It was heaven. Next month I will start another Internal Medicine rotation and I am sure that the return back to a 6am start will be as difficult as 9am is wonderful...such interesting times.
Lastly, I cannot close this short diary entry without remarking on the slow unfolding of Spring in my area. Driving home each day, I never stop being entranced by the subtle changes which are occurring around me. The trees which have been dark silhouettes framing the line where the mountains touch the sky have started to be touched by pale green, yellow, purple as the flowers and leaves unfurl. The brown-gray hills have started to be dotted with color...almost like a painting which is added to everyday and I love watching the change wash over the land. Yes this is corny, but I cannot explain how much I love living where the horizon is broken by uneven lines and you alternate between looking up towards a peak or down over a valley. I have only lived here for 9 months...but I find something every day on the drive home which is eye-candy for the soul. Please God help me stay this way.
Well, it has been over a week since my last entry. Interestingly enough, I have been on an easier rotation with more time...and have needed a diary less. I took my husband to Dollywood on Friday as a surprise. Good idea...bad day to go. I believe that everybody and their grandmother were there that day...and unbeknowst (sp?) to me, I was coming down with a stomach flu vs. food poisoning. My head was hurting, I felt more and more tired, and my muscles started to hurt...so after about 4 hours of amusement park we started the 2.5 hr drive home. By the time we got home, I had a fever of 102 and was feeling horrendous. The stomach part started later that evening. Today is the first day (now is monday) I have been able to get out of bed for longer than 5 minutes without getting sick. Luckily, I was not on call and had some sick leave I could take.
Being ill like this has increased my empathy for my patients...especially the ones with nausea that we try to give PO meds...and especially the ones without a loved one to help them while they are stuck in bed sick.
Even sitting up for a while makes me feel a little sick, so I will finish this for now and write again when I am more on the mend!