It was the sitemeter. The damn sitemeter. I couldn't take my mind off of it as I sped down the highway to the hospital. The sun inched over the horizon and a blur of headlights swarmed and then passed my car.
I should have never put a sitemeter on my blog. I didn't need to stare down the barrel of cold incontrovertible proof. I already knew that my posts disappeared into the ether as fast as I pushed the publish button. But I sure didn't need confirmation.
*
I remember back to when I started blogging. I built a web site selling artwork. I called it Fine Art Doctor. It was a hobby to fulfill the emptiness from those early years of practice.
The blog was a companion to the web site. I wrote about various art related topics. But I was flat. Uninflamed by the controversies of the art world I searched the Internet for more.
What I came across was a well known blogger named Gruntdoc. When I surfed his site I knew I was onto something. I left a comment on one of his posts and started to change the direction of my blog to focus on medical topics.
It was 2006 and the Grand Dame of the medical blogosphere was a woman named Moof (I know your lurking out there somewhere!). Moof followed from Gruntdoc and introduced me along with Doctor Anonymous (Mike Sevilla) to the community.
It was an inspiring time. I remember reading the likes of Charity Doc and Doctor Charles (before he left and then came back). TBTAM was on hiatus. KevinMD still rained supreme but in a slightly lesser way.
*
I turned the radio up as Adele was playing in the background. Her voice, sweet and soft, was becoming bigger and more powerful each second.
In the beginning I had quite a following. I started with medical narratives and poetry. Eventually I graduated to writing fictional stories. I celebrated with each comment. Sometimes I got as many as ten per post.
I felt creative and liberated. Like part of a community. I even got some face time on KevinMD. Sure I would sometimes fall off the bandwagon and go days without posting. Maybe even weeks. But I would always come back.
That is until the morning I had a car accident. I wasn't hurt but I was shaken. And then I arrived at my office to turn on the computer and find that my blog was gone. A word press glitch.
I finally got the content back weeks later but it was imported to a new web address.
With the snap of a finger I lost my blog. I lost my community. I lost my voice.
*
Adele is now barely audible. Her voice vibrates with charisma but soft...emotional.
I migrated over to blogger with little fanfare and little following. I would have loved to be able to brag about my stamina but I couldn't. My blog had been mute for weeks or sometimes months at a time. Posts came and went. Sometimes barely audible.
So why did I do it. Why did I keep writing in such a public way to an audience that had all but disappeared?
*
My mind slowed. My shoulders relaxed and I listened to the music:
I hate to turn up out of the blue uninvited.
But I couldn't stay away I couldn't fight it.
I'd hoped you'd see my face & that you'd be reminded
That for me it isn't over.
As I listened to the lyrics my emotions swelled. A few words masterfully twisted and tangled with a little melody brought up such vivid feelings. Snapshots. Memories. It reminded me why.
*
I write because I envy people like Adele. I envy the master craftsman who with a twist and flourish can reach down deep into our souls and produce something different in each and every one of us.
I yearn to use a few words to paint a million pictures on each reader's private canvas. To pull out from them that which they secretly want to expose but hold fiercely close to their hearts. To teach. To learn.
I would write if there was no blog, or paper, or pen. I would scrawl my awkward musings in the sand with a stick.
I would write because I have to.
Even if no one is listening.
Tuesday, September 13, 2011
Sunday, September 11, 2011
A Hospice Story
If cats have nine lives surely Paul had at least two. There was the one he led for his first thirty years. Lonely and introspective he struggled with a secret that was far too large for his conservative Catholic upbringing. So he closeted his feelings. He closeted his hopes and dreams. And he closeted his sexual orientation.
His second life began on his thirty first birthday when he confessed his heart to his parents and sister. A heated argument ensued which caught Paul completely by surprise. He left his childhood home in the tony Chicago suburbs and never looked back.
A decade later I stood next to his bed my body shading the stream of light pouring in from the east facing window of his room. I fidgeted uncomfortably as I asked if there was something I could do. It was my first day on the hospice unit. His partner nodded slowly. They wanted to see the chaplain.
*
My earliest clinical experiences occurred during the first year of medical school as a hospice volunteer. Each week I would leave the cloistered environment of the library and anatomy lab and wend my way through the hospital to the hospice ward. It was the mid nineties and people were still dying of AIDS.
Paul had withstood every cruel manifestation of an emotionally and physically disfiguring disease. Lymphoma, Kaposi's Sarcoma, pneumocystis pneumonia. He was tired. And for the most part he was ready to die.
As dying people go, Paul had it all. A caring partner. A slew of friends that visited him constantly, and a kind and generous demeanor. He rarely complained of physical pain. He, however, could not overcome the internal unrest that snatched the dream of a peaceful death from his frail clutches.
Paul had not spoken to his family in over ten years. They had no idea that he was sick or dying in the hospital. He called once six months prior. But his father hung up before he could explain his situation. He yearned to see his father and mother once more...to hug his baby sister.
*
On a sunny October morning the chaplain sat down at the nurses station to call Paul's parents. His mother answered the phone cheerily. The chaplain gently explained who he was and why he was calling.
A barricade that took a decade to traverse emotionally melted away in minutes as his family rushed the short distance from the suburbs to the city hospital. By the time they entered his room, he was unconscious.
I watched as Paul's father, mother, and sister sat attentively at the bedside for a few minutes. Then they would leave and his partner and friends would enter to take their rightful place. This back and forth continued for hours.
As Paul's breathing slowed the chaplain approached his family and beckoned them to come. They joined the others standing in his room. Each family member jockeyed amongst the crowd to get one last look. Touch his body one last time.
The chaplain asked that they hold hands to say a prayer. And there stood Paul's loves ones. His father holding his partner's hand. His mother and sister interspersed among his friends.
Paul's eyes opened briefly before he took his last breath. As he looked up a faint smile formed at the corner of his lips.
He had found peace. He could die now.
The two parts of his life...
had finally come together.
His second life began on his thirty first birthday when he confessed his heart to his parents and sister. A heated argument ensued which caught Paul completely by surprise. He left his childhood home in the tony Chicago suburbs and never looked back.
A decade later I stood next to his bed my body shading the stream of light pouring in from the east facing window of his room. I fidgeted uncomfortably as I asked if there was something I could do. It was my first day on the hospice unit. His partner nodded slowly. They wanted to see the chaplain.
*
My earliest clinical experiences occurred during the first year of medical school as a hospice volunteer. Each week I would leave the cloistered environment of the library and anatomy lab and wend my way through the hospital to the hospice ward. It was the mid nineties and people were still dying of AIDS.
Paul had withstood every cruel manifestation of an emotionally and physically disfiguring disease. Lymphoma, Kaposi's Sarcoma, pneumocystis pneumonia. He was tired. And for the most part he was ready to die.
As dying people go, Paul had it all. A caring partner. A slew of friends that visited him constantly, and a kind and generous demeanor. He rarely complained of physical pain. He, however, could not overcome the internal unrest that snatched the dream of a peaceful death from his frail clutches.
Paul had not spoken to his family in over ten years. They had no idea that he was sick or dying in the hospital. He called once six months prior. But his father hung up before he could explain his situation. He yearned to see his father and mother once more...to hug his baby sister.
*
On a sunny October morning the chaplain sat down at the nurses station to call Paul's parents. His mother answered the phone cheerily. The chaplain gently explained who he was and why he was calling.
A barricade that took a decade to traverse emotionally melted away in minutes as his family rushed the short distance from the suburbs to the city hospital. By the time they entered his room, he was unconscious.
I watched as Paul's father, mother, and sister sat attentively at the bedside for a few minutes. Then they would leave and his partner and friends would enter to take their rightful place. This back and forth continued for hours.
As Paul's breathing slowed the chaplain approached his family and beckoned them to come. They joined the others standing in his room. Each family member jockeyed amongst the crowd to get one last look. Touch his body one last time.
The chaplain asked that they hold hands to say a prayer. And there stood Paul's loves ones. His father holding his partner's hand. His mother and sister interspersed among his friends.
Paul's eyes opened briefly before he took his last breath. As he looked up a faint smile formed at the corner of his lips.
He had found peace. He could die now.
The two parts of his life...
had finally come together.
Saturday, September 10, 2011
Sexual Dysfunction And Hearing Loss..A Story
As I barged into the exam room I could feel my cape catching on the door knob as the few strands of hair left on my balding head blew luxuriously in the wind. I halted a moment to catch my breath.
Doctor....doctor you must help me.
My thoughts raced. Could it be a heart attack. A stroke. Hemorrhoids? I strode through the door and sat down on the edge of the chair. I was prepared for anything.
You see doctor....it's an emergency. I went to sleep three days ago and when I woke I couldn't hear out of my left ear.
His mouth twisted as he chocked out the last sentence. My keen medical mind surveyed the situation. He was in moderate distress. His head swayed back and forth with each word as if trying to position his right ear for better volume control. His brow was damp. His hands shook with excitement and fear.
He began to explain the dilemma further but I lifted my hand dismissively. Quiet man...I don't need to know such insignificant details.
I propped him up on the exam table with one hand as I pulled my trusty otoscope of the wall. I agiley placed the tip in his left ear.
First line: AECD. Second: QSTR
He waited for a moment and confusedly blurted out: what...what are you saying?
Oh nothing. I replied nonchalantly. I was just reading the eye chart on the other side of your head. Just as I expected! Even through the otoscope I have perfect vision!
He swayed in his chair as I finished the exam.
It appears you have an obstruction. Nurse...nurse...get me the irrigation tray.
I filled the syringe with scalding water and draped his shoulders with a gown. After five or six vigorous sprays a small blue pill fell out of his ear and onto the exam table.
I picked it up and examined it. Why it's a Viagra pill!
His eyes grew big and his jaw dropped. So that's where it went...I've been looking for that all over.
My eyebrows rose quizzically as he fidgeted and blurted out an explanation.
You see doc....my wife was trying to be all sexy like and leave a pill on my pillow. But I got so tired I didn't even see it. I laid down on my left side as usual to take a nap...
By then I had turned to leave the exam room. There was another life to save the next door over. Hearing loss as a side effect of Viagra. You better believe I was going to report that adverse event to the FDA.
Doc...Doc...one more thing. He thrust his hand toward me. Can I have the pill back.
Those things are expensive.
Doctor....doctor you must help me.
My thoughts raced. Could it be a heart attack. A stroke. Hemorrhoids? I strode through the door and sat down on the edge of the chair. I was prepared for anything.
You see doctor....it's an emergency. I went to sleep three days ago and when I woke I couldn't hear out of my left ear.
His mouth twisted as he chocked out the last sentence. My keen medical mind surveyed the situation. He was in moderate distress. His head swayed back and forth with each word as if trying to position his right ear for better volume control. His brow was damp. His hands shook with excitement and fear.
He began to explain the dilemma further but I lifted my hand dismissively. Quiet man...I don't need to know such insignificant details.
I propped him up on the exam table with one hand as I pulled my trusty otoscope of the wall. I agiley placed the tip in his left ear.
First line: AECD. Second: QSTR
He waited for a moment and confusedly blurted out: what...what are you saying?
Oh nothing. I replied nonchalantly. I was just reading the eye chart on the other side of your head. Just as I expected! Even through the otoscope I have perfect vision!
He swayed in his chair as I finished the exam.
It appears you have an obstruction. Nurse...nurse...get me the irrigation tray.
I filled the syringe with scalding water and draped his shoulders with a gown. After five or six vigorous sprays a small blue pill fell out of his ear and onto the exam table.
I picked it up and examined it. Why it's a Viagra pill!
His eyes grew big and his jaw dropped. So that's where it went...I've been looking for that all over.
My eyebrows rose quizzically as he fidgeted and blurted out an explanation.
You see doc....my wife was trying to be all sexy like and leave a pill on my pillow. But I got so tired I didn't even see it. I laid down on my left side as usual to take a nap...
By then I had turned to leave the exam room. There was another life to save the next door over. Hearing loss as a side effect of Viagra. You better believe I was going to report that adverse event to the FDA.
Doc...Doc...one more thing. He thrust his hand toward me. Can I have the pill back.
Those things are expensive.
Friday, September 9, 2011
Unacceptable
They were like two peas in a pod. The pod a sterile deodorized nursing home and the peas withered and wrinkled.
I remember the first time I made the trip to the end of the hall and turned a sharp left into their room. I felt as if transported from a frigid blustery Chicago day into a cozy den. The fire crackling. The smokey smell of home.
I would later recognize this warmth as the rapturous, indignant heat of unrequited love. But for now it welcomed me into their surroundings. Bayed me to come. Spoke to me. Sit down and talk awhile.
*
Her medicine list was as long as an elephant's trunk. Her litany of diseases filled the tomes of her disheveled chart. Papers hung loosely to the binder perilously close to breaking free.
He was the more healthy of the two. Eighty five years old on dialysis with heart disease. They were the poster children for our healthcare system. Death was no longer an endpoint but more a bothersome tick, a flea. Annoying but something that could be dealt with.
I followed her in and out of the hospital. Seizures, heart attacks, strokes...she suffered them all. And each time she would return to their little room together. He doting over her with the patience and anxiety of a father watching his sickly child.
The love in the room was palpable. So much so that one day I asked how long they had been married. I expected five or six decades. Instead he answered quietly: Twenty five years.
I, shocked by his answer, pulled up a chair and placed it at the edge of the beds.
Tell me about it.
She looked over in his direction. Her eyes silently encouraging. You explain to him. You always tell it so well!
*
They dated in college. On graduation night spurred by the confidence of alcohol he asked for her hand in marriage. At this point in the story she averted her eyes in faux embarrassment. For some reason she declined.
Fast forward thirty years, two divorces, and five children later. Destiny brought them back together. As he said this a devilish glimmer momentarily flittered across his face. The subtlety was not lost on me. He likely engineered the meeting. Maybe she knew....maybe she didn't.
They lived happily together, of course, till illness brought turmoil to their lives. She was losing strength. Her will to live was faltering. And he was suffering.
He pleaded with me every visit. Please doctor...please. Don't let her die! I couldn't live without her!
Despite my best intentions. Intravenous fluids and antibiotics. Steroids and chemotherapy. Despite all I humbly had to offer. I received the call one morning. She was unresponsive. I arrived at the same time as the paramedics.
We were too late. I sat with him in a vacant room as the nurses prepared her body for transport. I held his hand and tried to stop it from shaking. He was silent. He was empty.
The next few weeks were difficult. He struggled with depression and pain. He was afraid to be alone. His family tried to comfort him.
One morning a medical assistant walked into his room and found him dead. His body finally reaching his soul.
*
As I sat in my office filling out his death certificate I felt both sorrow and triumph. I would later learn that he died on the morning of his beloveds birthday. She would have been eighty years old.
With unusual candor I filled out the rest of the death certificate. But my mind was elsewhere.
We doctors are like little Napoleons. We annex the human body as if unclaimed territory. We grapple as if we have any control over human fecundity.
I dropped the paper in the fax bin. A few minutes later the funeral home sent a fresh certificate with a note attached:
Dear Dr. Grumet,
Please repopulate the "cause of death" field on the attached form.
Your previous answer: "A Broken Heart"
is unacceptable
I remember the first time I made the trip to the end of the hall and turned a sharp left into their room. I felt as if transported from a frigid blustery Chicago day into a cozy den. The fire crackling. The smokey smell of home.
I would later recognize this warmth as the rapturous, indignant heat of unrequited love. But for now it welcomed me into their surroundings. Bayed me to come. Spoke to me. Sit down and talk awhile.
*
Her medicine list was as long as an elephant's trunk. Her litany of diseases filled the tomes of her disheveled chart. Papers hung loosely to the binder perilously close to breaking free.
He was the more healthy of the two. Eighty five years old on dialysis with heart disease. They were the poster children for our healthcare system. Death was no longer an endpoint but more a bothersome tick, a flea. Annoying but something that could be dealt with.
I followed her in and out of the hospital. Seizures, heart attacks, strokes...she suffered them all. And each time she would return to their little room together. He doting over her with the patience and anxiety of a father watching his sickly child.
The love in the room was palpable. So much so that one day I asked how long they had been married. I expected five or six decades. Instead he answered quietly: Twenty five years.
I, shocked by his answer, pulled up a chair and placed it at the edge of the beds.
Tell me about it.
She looked over in his direction. Her eyes silently encouraging. You explain to him. You always tell it so well!
*
They dated in college. On graduation night spurred by the confidence of alcohol he asked for her hand in marriage. At this point in the story she averted her eyes in faux embarrassment. For some reason she declined.
Fast forward thirty years, two divorces, and five children later. Destiny brought them back together. As he said this a devilish glimmer momentarily flittered across his face. The subtlety was not lost on me. He likely engineered the meeting. Maybe she knew....maybe she didn't.
They lived happily together, of course, till illness brought turmoil to their lives. She was losing strength. Her will to live was faltering. And he was suffering.
He pleaded with me every visit. Please doctor...please. Don't let her die! I couldn't live without her!
Despite my best intentions. Intravenous fluids and antibiotics. Steroids and chemotherapy. Despite all I humbly had to offer. I received the call one morning. She was unresponsive. I arrived at the same time as the paramedics.
We were too late. I sat with him in a vacant room as the nurses prepared her body for transport. I held his hand and tried to stop it from shaking. He was silent. He was empty.
The next few weeks were difficult. He struggled with depression and pain. He was afraid to be alone. His family tried to comfort him.
One morning a medical assistant walked into his room and found him dead. His body finally reaching his soul.
*
As I sat in my office filling out his death certificate I felt both sorrow and triumph. I would later learn that he died on the morning of his beloveds birthday. She would have been eighty years old.
With unusual candor I filled out the rest of the death certificate. But my mind was elsewhere.
We doctors are like little Napoleons. We annex the human body as if unclaimed territory. We grapple as if we have any control over human fecundity.
I dropped the paper in the fax bin. A few minutes later the funeral home sent a fresh certificate with a note attached:
Dear Dr. Grumet,
Please repopulate the "cause of death" field on the attached form.
Your previous answer: "A Broken Heart"
is unacceptable
Wednesday, September 7, 2011
A Moment Of Clarity
Although the name on the chart was oddly familiar I couldn't place her. I was covering for a partner who was on vacation. It felt like my day would never end.
When she bopped into the office I knew immediately. We went to school together. Years ago. She sat down quietly on the exam table typing away on her mobile phone. I approached cautiously my mind musing on occupational hazards. I wondered if she would recognize me.
As I introduced myself I searched her countenance for signs of familiarity. I quickly realized that she was too busy talking to even notice. She was a classic example of today's connected youth. She grew up in the email/text message generation. Conversations were more a one way soliloquy then a rational bidirectional exchange of information.
I found myself only half listening as she continued to harangue me with unimportant non sequiturs. Please be a cold...be a cold...be low back pain.
I awoke from my reverie horrified by the one phrase that struck terror down to the core of my being.... I'm having a little itch and discharge....by the way do we know each other?.
I brushed off her question and entered doctor mode. This is what I trained for. If I could run a code and make life changing decisions I certainly could pretend I didn't know a young woman I was doing a pelvic on. (Wow...did I really just write that!)
I handed her a gown and left the room to collect an assistant. This was one exam I wouldn't be doing solo.
When I returned the technician had placed her on the exam table. Her legs were up in stirrups and her gown was folded over. Smack dab in the center of the commotion was the chair of honor reserved for yours truly. I donned a pair of gloves and inspected the speculum. As I sat down my medical assistant stood above me...ready.
And their laid our patient. Fingers tapping away at her cell phone as she continued to talk at random. She urgently chewed a piece of gum that appeared in her mouth as quickly as her clothes came off.
While placing the speculum and collecting samples I froze. Oh...I know! We went to high school together!
All of the sudden the room became unbearably hot. My face burned a shade of crimson. The medical assistant bit her lip and squeezed my shoulder tightly in order to stem the tide of laughter. Yes....yes...maybe.
I quickly finished the pelvic and left the room to send the specimens to the lab. Upon returning my patient had fully dressed. As I explained my findings I could barely look her in the eyes. With great embarrassment I gave her a script to treat a yeast infection and rushed out the door.
As she left I could hear her chatting away with the receptionist without a care in the world. I fled to my office and closed the door. I took a few deep breaths. A drop of sweat raced down the side of my face.
And then I had a moment of clarity.
It was like she was the doctor.
and I...befuddled, afraid, and powerless...
was the patient.
When she bopped into the office I knew immediately. We went to school together. Years ago. She sat down quietly on the exam table typing away on her mobile phone. I approached cautiously my mind musing on occupational hazards. I wondered if she would recognize me.
As I introduced myself I searched her countenance for signs of familiarity. I quickly realized that she was too busy talking to even notice. She was a classic example of today's connected youth. She grew up in the email/text message generation. Conversations were more a one way soliloquy then a rational bidirectional exchange of information.
I found myself only half listening as she continued to harangue me with unimportant non sequiturs. Please be a cold...be a cold...be low back pain.
I awoke from my reverie horrified by the one phrase that struck terror down to the core of my being.... I'm having a little itch and discharge....by the way do we know each other?.
I brushed off her question and entered doctor mode. This is what I trained for. If I could run a code and make life changing decisions I certainly could pretend I didn't know a young woman I was doing a pelvic on. (Wow...did I really just write that!)
I handed her a gown and left the room to collect an assistant. This was one exam I wouldn't be doing solo.
When I returned the technician had placed her on the exam table. Her legs were up in stirrups and her gown was folded over. Smack dab in the center of the commotion was the chair of honor reserved for yours truly. I donned a pair of gloves and inspected the speculum. As I sat down my medical assistant stood above me...ready.
And their laid our patient. Fingers tapping away at her cell phone as she continued to talk at random. She urgently chewed a piece of gum that appeared in her mouth as quickly as her clothes came off.
While placing the speculum and collecting samples I froze. Oh...I know! We went to high school together!
All of the sudden the room became unbearably hot. My face burned a shade of crimson. The medical assistant bit her lip and squeezed my shoulder tightly in order to stem the tide of laughter. Yes....yes...maybe.
I quickly finished the pelvic and left the room to send the specimens to the lab. Upon returning my patient had fully dressed. As I explained my findings I could barely look her in the eyes. With great embarrassment I gave her a script to treat a yeast infection and rushed out the door.
As she left I could hear her chatting away with the receptionist without a care in the world. I fled to my office and closed the door. I took a few deep breaths. A drop of sweat raced down the side of my face.
And then I had a moment of clarity.
It was like she was the doctor.
and I...befuddled, afraid, and powerless...
was the patient.
Tuesday, September 6, 2011
This Is Not One Of Those
My dream is always the same...
It’s just another day in hell. I stand on the Bone Marrow Transplant unit. There are no windows. Suddenly the building starts to shake. The ceiling cracks letting in rays of sunlight. The ground rumbles below.
Sadness, grief, and despair spew from the floor. They rise as black lava erupting from the innards of the building and drag me to the street. I am swept forward as black death encompasses the earth and moves to envelop the sun. It carries me to the east…..always to the east.
*
I've never thrown a punch. Never been in a fight or carried a gun. So if you ask me what it is like to do battle…I only have a limited set of experiences to draw from.
I did, however, catch a glimpse of the desperation of war during residency when I spent a month in the Bone Marrow Transplant unit. I felt continuously under fire, attacked from all sides, desperate. I experienced death every day.
It wasn't just the elderly...it was also the young. Mothers, fathers, children…no one was spared!
*
The Bone Marrow Transplant program during residency was large. There were fifty patients on the unit and then twenty to thirty scattered amongst the oncology floors.
We had ten admissions a day and the same number of discharges. On average one patient died every 24 hours.
The job of taking care of these patients fell on two fellows, two residents, one attending physician, and countless dedicated nurses.
There are many beautiful life affirming stories that occur on a Bone Marrow Transplant floor.
This is not one of those.
*
I remember my last day on the unit. I spent the morning avoiding ambush. There were no codes. All our patients survived the night.
I stepped into Mrs. P’s room gingerly. Mrs. P had been in the hospital for over 6 months. She had a stubborn lymphoma that persisted despite treatment. She knew that she would never return home.
She knitted every morning as she watched the news. As with so many patients, our conversation moved from cordial greetings to a discussion of world events. I went through the motions of my examination as she recounted the most recent atrocities. They were particularly horrible today.
We did this every morning. She telling me who recently died, or was killed, or robbed. And I feigning interest although in reality I had lost touch with life outside the unit. The world could fall apart around me but I was too busy…scurrying after labs, running codes, talking to family members. Secretly trying to protect myself from the death and destruction that surrounded me.
If you listened closely to the discussions that we had every morning the essence of what was said would sound something like this…
“Doctor, I watch TV and see that in the world things are happening, and I am still here”. And dutifully I would respond, “yes, yes, bad things are happening in the world and yet, thankfully, you are still here!”
Mrs. P’s days were limited. And my days on the unit were almost over. I worked 12 hours a day, every day, for a month. My time at home, in-between shifts, was surreal. I would sleep, eat, have conversations. Mostly exhausted bridges to my next stint on the unit.
I had become a robot, a zombie.
I was withdrawing.
*
It was just another day in hell.
I sat down for rounds that morning. Mrs. P was right...things were happening in the world and strangely I couldn't’t relate. The TV above us was blaring the latest news. My attending was sitting down with his daily Tab and being prepped by the other residents.
The hum of the nursing station had reached a fevered pitch. I glanced at my progress notes and realized that I forgot to add the date and time. I looked at the clock on my pager:
10:45 AM
09/11/01
The world had instantly changed.
And it would take a good deal of time and spiritual healing to realize that it wasn’t just another day..
of death and destruction on the unit.
It’s just another day in hell. I stand on the Bone Marrow Transplant unit. There are no windows. Suddenly the building starts to shake. The ceiling cracks letting in rays of sunlight. The ground rumbles below.
Sadness, grief, and despair spew from the floor. They rise as black lava erupting from the innards of the building and drag me to the street. I am swept forward as black death encompasses the earth and moves to envelop the sun. It carries me to the east…..always to the east.
*
I've never thrown a punch. Never been in a fight or carried a gun. So if you ask me what it is like to do battle…I only have a limited set of experiences to draw from.
I did, however, catch a glimpse of the desperation of war during residency when I spent a month in the Bone Marrow Transplant unit. I felt continuously under fire, attacked from all sides, desperate. I experienced death every day.
It wasn't just the elderly...it was also the young. Mothers, fathers, children…no one was spared!
*
The Bone Marrow Transplant program during residency was large. There were fifty patients on the unit and then twenty to thirty scattered amongst the oncology floors.
We had ten admissions a day and the same number of discharges. On average one patient died every 24 hours.
The job of taking care of these patients fell on two fellows, two residents, one attending physician, and countless dedicated nurses.
There are many beautiful life affirming stories that occur on a Bone Marrow Transplant floor.
This is not one of those.
*
I remember my last day on the unit. I spent the morning avoiding ambush. There were no codes. All our patients survived the night.
I stepped into Mrs. P’s room gingerly. Mrs. P had been in the hospital for over 6 months. She had a stubborn lymphoma that persisted despite treatment. She knew that she would never return home.
She knitted every morning as she watched the news. As with so many patients, our conversation moved from cordial greetings to a discussion of world events. I went through the motions of my examination as she recounted the most recent atrocities. They were particularly horrible today.
We did this every morning. She telling me who recently died, or was killed, or robbed. And I feigning interest although in reality I had lost touch with life outside the unit. The world could fall apart around me but I was too busy…scurrying after labs, running codes, talking to family members. Secretly trying to protect myself from the death and destruction that surrounded me.
If you listened closely to the discussions that we had every morning the essence of what was said would sound something like this…
“Doctor, I watch TV and see that in the world things are happening, and I am still here”. And dutifully I would respond, “yes, yes, bad things are happening in the world and yet, thankfully, you are still here!”
Mrs. P’s days were limited. And my days on the unit were almost over. I worked 12 hours a day, every day, for a month. My time at home, in-between shifts, was surreal. I would sleep, eat, have conversations. Mostly exhausted bridges to my next stint on the unit.
I had become a robot, a zombie.
I was withdrawing.
*
It was just another day in hell.
I sat down for rounds that morning. Mrs. P was right...things were happening in the world and strangely I couldn't’t relate. The TV above us was blaring the latest news. My attending was sitting down with his daily Tab and being prepped by the other residents.
The hum of the nursing station had reached a fevered pitch. I glanced at my progress notes and realized that I forgot to add the date and time. I looked at the clock on my pager:
10:45 AM
09/11/01
The world had instantly changed.
And it would take a good deal of time and spiritual healing to realize that it wasn’t just another day..
of death and destruction on the unit.
Sunday, September 4, 2011
Mary's Disease Was Not Measured In CT Scans
You killed my patient.
His words were like venom. He spit them in the direction of the phone held by his left hand which bobbed in front of his face.
You mean the one with the metastatic lung cancer? The one whose finger like tumor strangled her esophagus making the act of swallowing similar to trying to fit a hamburger through a closed vice grip?
I could feel the heat emanate through the line as his temperature rose. I could sense the amplitude of his body shaking as his words came out an uneven staccato.
Yes the one whose disease burden had noticeably shrunk on last nights cat scan.
I felt calm. I had watched from the periphery as Mary's physical and mental condition declined dramatically. Although she was my partner's patient, I grew fond of her during a recent hospitalization.
She struggled to comprehend the changes overtaking her. She was lost in a whirlwind of chemotherapy and radiation, medication and complications. Her oncologist spoke of the future as if it was already written. Full of hope...he never mentioned prognosis. Never talked of life expectancy.
He managed her disease on a cellular level. He thought in terms of tumor growing...tumor shrinking. But Mary's disease was not measured in ct scans or labs tests. One look revealed life's harshest reality. She could no longer walk. She could no longer eat. She was dying.
Two weeks ago Mary developed a fever. She became confused. And she refused to get out of bed. Her family brought her to the oncologist who prescribed antibiotics. Her physical state improved initially but was now receding. Mary's family, overwhelmed and afraid, brought her to the emergency room.
The ICU nurse woke me form a sound sleep. There was no DNR order and Mary needed to be intubated. The oncologist had already given the order to ventilate but the nursing staff was reticent. Lack of familiarity added clarity to their perspective. There was no history or personal involvement to falsely color the obvious.
I quietly spoke to Mary's husband.
What would she say if she could see what is happening?
She'd be horrified!
Would she want to be on a ventilator?
No!
Should we just make her comfortable?
Please!
I asked for the nurse and ordered a morphine drip and ativan. When I arrived the next morning I found a crowd huddled at the bedside. Mary was peacefully unconscious. Her husband was somber yet relieved.
She died and hour later.
The oncologist lit into me mercilessly. She had pneumonia. We could have treated her. You let her die.
I took a deep breath and paused.
All of our patients die. We have no control over that.
If we are lucky we can allow for a little dignity. Perhaps help them control how and when.
Upon finishing I realized that the oncologist missed my last sentence. The sound of the dial tone on the other end confirmed..
he had already hung up.
His words were like venom. He spit them in the direction of the phone held by his left hand which bobbed in front of his face.
You mean the one with the metastatic lung cancer? The one whose finger like tumor strangled her esophagus making the act of swallowing similar to trying to fit a hamburger through a closed vice grip?
I could feel the heat emanate through the line as his temperature rose. I could sense the amplitude of his body shaking as his words came out an uneven staccato.
Yes the one whose disease burden had noticeably shrunk on last nights cat scan.
I felt calm. I had watched from the periphery as Mary's physical and mental condition declined dramatically. Although she was my partner's patient, I grew fond of her during a recent hospitalization.
She struggled to comprehend the changes overtaking her. She was lost in a whirlwind of chemotherapy and radiation, medication and complications. Her oncologist spoke of the future as if it was already written. Full of hope...he never mentioned prognosis. Never talked of life expectancy.
He managed her disease on a cellular level. He thought in terms of tumor growing...tumor shrinking. But Mary's disease was not measured in ct scans or labs tests. One look revealed life's harshest reality. She could no longer walk. She could no longer eat. She was dying.
Two weeks ago Mary developed a fever. She became confused. And she refused to get out of bed. Her family brought her to the oncologist who prescribed antibiotics. Her physical state improved initially but was now receding. Mary's family, overwhelmed and afraid, brought her to the emergency room.
The ICU nurse woke me form a sound sleep. There was no DNR order and Mary needed to be intubated. The oncologist had already given the order to ventilate but the nursing staff was reticent. Lack of familiarity added clarity to their perspective. There was no history or personal involvement to falsely color the obvious.
I quietly spoke to Mary's husband.
What would she say if she could see what is happening?
She'd be horrified!
Would she want to be on a ventilator?
No!
Should we just make her comfortable?
Please!
I asked for the nurse and ordered a morphine drip and ativan. When I arrived the next morning I found a crowd huddled at the bedside. Mary was peacefully unconscious. Her husband was somber yet relieved.
She died and hour later.
The oncologist lit into me mercilessly. She had pneumonia. We could have treated her. You let her die.
I took a deep breath and paused.
All of our patients die. We have no control over that.
If we are lucky we can allow for a little dignity. Perhaps help them control how and when.
Upon finishing I realized that the oncologist missed my last sentence. The sound of the dial tone on the other end confirmed..
he had already hung up.
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