October 4, 2015

i've been everywhere, man

I've been everywhere, man
I've been everywhere, man
Crossed the desert's bare, man
I've breathed the mountain air, man
Of travel I've had my share, man
I've been everywhere
- Johnny Cash, among others

     A new month means a new job.  I go to a new place whether it be a different hospital or a different clinic.  I have a new boss.  In fact, I often have different bosses on different days.  I have different colleagues on different days, too.  The hours?  Those change, too.  Last month was working in a surgery outpatient clinic.  October is working nights delivering babies and triaging pregnant women coming into the hospital.  Except for one day where I work days in my own clinic seeing my own patients.  Sleep hygiene?  What's that?
     I've had to learn to adapt in order to survive.  After having been in the working world for so long, I'm not used to this constant change.  I'm the type of guy who goes to the same restaurant for ten years and orders the same thing.  I walk in, and they say, "the usual?" 
     Plus, I'm not young like my other colleagues.  And frankly, I don't have a spine like anyone of any age according to my neurosurgeon.  I can't pull a 14-16 hour shift night after night sitting at the triage desk.  Pain simply won't allow it.  So I make an arrangement with the nurses this month.  When no baby is close to dropping and no one is in triage, I'm lying down in one of the triage beds curled up in the fetal position.  It's not to sleep.  It's to take the strain off my back.  And I'm not really asking.  I'm just being polite.  In return, I change the sheets and leave the bed as I found it.  It's either that or I regress to a cane.  Or, according to my son and my dad, a wheelchair is not too far off in my distant future.

September 25, 2015

you never know where you'll learn

     Every night I deliberately choose her line to pay for my dinner, even if the wait is longer. Initially. it is because she always makes sure I get my full $10 worth of my meal ticket (we don't get change back). And if I go over a quarter or two over, she doesn't care and lets the 50 cents slide. But as the nights add up, I choose her line just to talk to her. She has this effusive, contagious personality and it brings a light into my nights while I'm on at the hospital. In some way, I am learning to become the doctor I want to be as much from her as I am from the medical staff. I'm not effusive and outrageous like her so I choose my own strengths. I'm strong, a rock, something to hold fast to during the storm. I constantly aim to bring that calm, confident mood to the patient's room just like she brings it to her cafeteria line.

September 22, 2015

the companionship of the dead

As we grow older we have more and more people to remember, people who have died before us. It is very important to remember those who have loved us and those we have loved. Remembering them means letting their spirits inspire us in our daily lives. They can become part of our spiritual communities and gently help us as we make decisions on our journeys. Parents, spouses, children, and friends can become true spiritual companions after they have died. Sometimes they can become even more intimate to us after death than when they were with us in life. Remembering the dead is choosing their ongoing companionship.
- Henri Nouwain, author of "The Wounded Healer"

September 21, 2015

well, do I have cancer? no

"At this time we cannot find any detectable presence of cancer," were the words spoken through the phone. Not that I wasn't relieved, but the qualifier 'at this time' sticks with me. The doc knew my family history and seemed to give voice to that thought, "when will it be my turn?"
     But for now I need not worry about cancer. The oncologist is still concerned about what happened, though. He intends to send me to a top endocrinologist for yet another work up. I'm beginning to get sick of doctors. 

September 18, 2015

black badge of courage

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

     I'm striding down the maze of hallways at midnight to the ER to do yet another admission. I'm tired and my back is feeling it from the constant sense of urgency that comes from an already busy night. I'm bent over ever so slightly as a consequence so my gaze is directed downward. I guess that's why our eyes met. He was in a wheelchair and the hospital gown gave his status as a patient away. He was lost and asking me for directions to the cafeteria. As I have trouble navigating out of a wet paper sack due to my lack of sense of direction, I told him to follow me as it was on my way to the ER.
     All I ask him is how is he doing this evening. That is it. Nothing more. Just being polite really. And slowly but steadily he begins to tell me troubles. Mid twenties. Made a living by the sweat of his brow and working with his hands. And now he is suddenly paralyzed because of multiple lesions in his brain. The neurologists think maybe infection, maybe cancer, maybe who knows. And he's telling me this without much detectable emotion but he's telling it in a way that is highly detailed. And it strikes me that he hasn't had the time nor the opportunity to talk about this, much less digest it. He's using me to help sort out all the thoughts and emotions whirling in his mind and heart. I do all that I know how to do which is to be fully present and just listen.
     After he found the cafeteria, he thanked me, shook my hand and abely rolled himself to get something to eat. In my mind, I'm wondering, "what the hell just happened?" Later, I ask my wife if I have something tattooed on me visible only to those in severe existential pain that says, "bear unto me the troubles of thine soul." She only half jokingly calls me an Angel of Death, but a merciful one. And, yes, she says that people can indeed feel something about me that invites them to open up. They can sense my pain like a dog can smell fear. I'm at a loss how they know but she's the intuitive one. And after knowing each other for over two decades, I've learned to trust that intuition of hers.

September 15, 2015

September 11, 2015

well. do I have cancer?

     There is a common axiom of prioritizing what matters most during your training. It is infinitely wise its brevity. Eat, sleep, shower. In that order, depending on the person. Me? I eat on the way home in the car so that gives me one less thing to prioritize. So where does one's health fall into this scheme? Traditionally, residents take horrible care of their health during training. For me, I have multiple health issues so those get triaged as to what is the most important at the time. Pain.
     So I went to a pain management specialist to receive spinal injections in an attempt to reduce pain. I did actually go and get the bone marrow biopsy done so why no results? It undid some of the pain relief I received from the spinal injections which then impacts sleep. Eventually, I just ran out of sleep. I could tell from my blood counts at the time of the bone marrow that cancer was becoming less and less likely.
     Plus, I figure if I had something ominous, my oncology doc would've called me. I bumped into them getting out of an elevator while they were getting in. Not enough time to discuss all the subtleties and nuances of a diagnosis and their face did not show any sign of concern. Plus, we need to discuss that if it wasn't cancer that altered my blood so that it leaked from my skin with simple pressure, what in the world was it? And to be honest, I don't have the physical or emotional energy to start another workup with yet another specialist. So I will wait for my appointment at the end of September with the oncologist fairly confident I don't have cancer. So, next month I'll get the ball rolling on the next specialist work up. So do I habe cancer? I hope not, but the final answer will be a couple of weeks waiting and I'm fine with that.