I woke in a panic. My heart felt like it was thumping out of my chest. I sat up and waited for the blare of the alarm radio to wash out of my ears. The room was pitch black. I pushed the covers aside and crawled out of bed and inched my way to the bathroom. The cold morning air did nothing to soothe my nerves.
I showered, dressed, and locked the door behind me as I made my way to the garage. Although my stomach was growling, mild nausea overpowered my sense of hunger. I turned the key in the ignition and was met by the throaty voice of a public radio announcer.
By the time I hit the on ramp, I settled into my morning drive. I felt an overwhelming sense of unease as I remembered the dream that yanked me out of sleep.
*
It's the first day of high school, or maybe college, and I am sitting contentedly in class. As I look around the room a panic overtakes me.
I forgot to bring my class schedule!
I forage through my backpack without luck. It's a new semester and I have no idea where I need to be next. Without room numbers or building names, I am lost. I start to breath rapidly as the fear overtakes me. My head pounds and my eyes begin to water.
I feel a strange sense of doom about starting the year off this way. It's as if somehow by missing the first day of classes, I will suffer great harm. I will lose some essential piece of information that will be devastating. I will fail miserably.
I jump out of my seat and sprint to the door. I have to quickly get to the administration building to print up a new schedule. But when I exit the class, I can't seem to remember which way to go.
I walk back and forth aimlessly trying to reconstruct the correct path. With each failed attempt my mind races even further out of control. I feel like I just got punched in the gut. I glance repeatedly at my watch as if I could freeze time.
When I finally get to the front of the administration building, I heave a sigh of relief. I walk up the steps and approach the entrance.
The door is locked.
*
The fetid odor of cleaning products mixed with the refuse of human illness is the first thing that hits me as I enter the medical floor. I try not to breath out of my nose. A demented patient is lost somewhere in the jungles of Viet Nam and swings at his nurse. He just barely misses her.
It is six in the morning and the maintenance man walks past me pushing the floor cleaning machine. It sounds like a garbage truck and the noise disrupts the otherwise quiet hallway where sick patients try to get their rest.
I take a deep breath, and for the first time this morning, I feel the calm wash over me. My heart is no longer racing and the nausea is gone. I have finally shaken the stress of my nightmare.
Thank God I'm no longer a student!
Wednesday, December 21, 2011
Tuesday, December 20, 2011
Loyalty
I broke my stethoscope the other day. Or actually, the stethoscope broke, it really wasn’t my fault. A couple of weeks ago I noticed that the tubing was beginning to tear. As I am wont to do, I ignored the situation and tried to tape it up. Of course my temporary solution only worked for a short while. After multiple tapings, it finally broke. Imagine my embarrassment as I went to put the ear piece in my ears and it split in half, right in front of a patient. There I was wide eyed with half the stethoscope in one ear and the other ear piece dangling disconnected in my hand. As you can imagine it was quite a site.
So I threw my stethoscope in the garbage and borrowed a loner from a colleague. I ordered a new one and waited for it to come in the mail. A few weeks later I tried out my new model and it didn’t feel the same; maybe it was the way it fit in my ears, maybe the length of the tubing. Who knows? It just didn’t feel right. And then I started to think.
I threw out my stethoscope! The same stethoscope I bought with such pride on my first day of medical school. The stethoscope that had literally touched every single patient I had seen throughout my medical career (it had never broken before). And like an idiot I just tossed it aside. I didn't perform any ceremonies, no thank yous for a job well done, no tender thoughts of all we had been through together.
Sure my new stethoscope will likely be just as good. Hell, it probably will function better. But I guess that’s not the point. The point is that somehow down the line I lost my loyalty. I lost my respect for a relationship forged by closeness, shared experience, and yes years of time spent together.
I know what you’re saying:
it’s a stethoscope-an inanimate object!
But maybe there is some importance here we’re missing. Maybe our health care system is taking a turn for the worse. Maybe we are losing our loyalty in other places. Hospitals and doctors are becoming less friendly. Staff turnover is rampant and you no longer recognize the faces when you enter your doctor’s office. Physicians are moving, changing locations, or even swapping careers.
I got a letter from a patient the other day. We had been through so much together. She battled depression and a divorce. She survived a horrendous cancer and was still dealing with her diabetes. We knew each other for years.
I guess I didn’t take it personally that she was leaving. Her health insurance changed and I was no longer on her plan.
But as the tears well up in my eyes I can’t seem to stop thinking about that damn stethoscope.
How could I have just thrown it away?
So I threw my stethoscope in the garbage and borrowed a loner from a colleague. I ordered a new one and waited for it to come in the mail. A few weeks later I tried out my new model and it didn’t feel the same; maybe it was the way it fit in my ears, maybe the length of the tubing. Who knows? It just didn’t feel right. And then I started to think.
I threw out my stethoscope! The same stethoscope I bought with such pride on my first day of medical school. The stethoscope that had literally touched every single patient I had seen throughout my medical career (it had never broken before). And like an idiot I just tossed it aside. I didn't perform any ceremonies, no thank yous for a job well done, no tender thoughts of all we had been through together.
Sure my new stethoscope will likely be just as good. Hell, it probably will function better. But I guess that’s not the point. The point is that somehow down the line I lost my loyalty. I lost my respect for a relationship forged by closeness, shared experience, and yes years of time spent together.
I know what you’re saying:
it’s a stethoscope-an inanimate object!
But maybe there is some importance here we’re missing. Maybe our health care system is taking a turn for the worse. Maybe we are losing our loyalty in other places. Hospitals and doctors are becoming less friendly. Staff turnover is rampant and you no longer recognize the faces when you enter your doctor’s office. Physicians are moving, changing locations, or even swapping careers.
I got a letter from a patient the other day. We had been through so much together. She battled depression and a divorce. She survived a horrendous cancer and was still dealing with her diabetes. We knew each other for years.
I guess I didn’t take it personally that she was leaving. Her health insurance changed and I was no longer on her plan.
But as the tears well up in my eyes I can’t seem to stop thinking about that damn stethoscope.
How could I have just thrown it away?
Sunday, December 18, 2011
Disclosure
Jack's youthful appearance and boyish eyes were betrayed by a body more fitting his grandfather. He hobbled into the office in his usual manner. His ambling gate was hampered by painful knee joints which creaked and crackled with every movement. His forty year old posture was marked by the cruelty of early onset rheumatoid arthritis.
His visit to the rheumatologist had been modestly fruitful. After injections to both knees, he was able to stop using the wheel chair. But joint replacement surgery was coming on the horizon. No matter how long he tried to prolong the inevitable, his day of reckoning was near.
He leaned back in his chair and tried to get comfortable. As he closed his eyes the sweat began to poor down his face. He reached over to the desk and helped himself to a tissue. He dabbed his forehead and looked in my direction.
If I knew how painful my forties would be, I would have had a lot more fun in my thirties!
We both laughed, but I knew that he was only partially joking. We spent alot of time in the exam room talking about what this disease was doing to his self image. The physical toll was matched, if not overcome, by the metal anguish of disability. Once a track star in college, he now considered himself a cripple.
As so often happens, I struggled to express comfort and understanding without being demeaning. How could I know what it felt like for Jack to not be able to ruff house with his kids;to not be able to pick up his crying daughter? I had no inkling of the painful stiffness he woke up with every mourning or the feeling of nausea brought on by his medications.
I found myself repeating familiar words.
I won't even pretend to know what it feels like to walk in your shoes because I haven't. But I've seen people in your situation and I know it is very difficult. Let's see if there are some things I can do to lessen your burden.
Jack sat quietly for a few moments absorbing my words. When he looked up, our eyes met and he started to speak. What he said next caught me completely by surprise.
I read your blog.
I felt a sense of doom arise from the pit of my stomach. I mentally scanned through my last few posts. Had I said anything inappropriate? Jack recognized the look of panic on my face and quickly reassured me.
I was really impressed! It would have never occurred to me that doctors think about such things.
As I listened to the squeaking of Jack's walker as he rolled toward the checkout counter, the weight of his words began to sink in.
Maybe our patients don't know that we suffer through difficult decisions. Maybe they don't realize that our insomniac brains toss and turn during sleepless nights where worry and fear become our dark companions.
And they likely don't realize that the pain and suffering we witness leaves disfiguring scars.
How could they?
Unless, of course, we tell them.
His visit to the rheumatologist had been modestly fruitful. After injections to both knees, he was able to stop using the wheel chair. But joint replacement surgery was coming on the horizon. No matter how long he tried to prolong the inevitable, his day of reckoning was near.
He leaned back in his chair and tried to get comfortable. As he closed his eyes the sweat began to poor down his face. He reached over to the desk and helped himself to a tissue. He dabbed his forehead and looked in my direction.
If I knew how painful my forties would be, I would have had a lot more fun in my thirties!
We both laughed, but I knew that he was only partially joking. We spent alot of time in the exam room talking about what this disease was doing to his self image. The physical toll was matched, if not overcome, by the metal anguish of disability. Once a track star in college, he now considered himself a cripple.
As so often happens, I struggled to express comfort and understanding without being demeaning. How could I know what it felt like for Jack to not be able to ruff house with his kids;to not be able to pick up his crying daughter? I had no inkling of the painful stiffness he woke up with every mourning or the feeling of nausea brought on by his medications.
I found myself repeating familiar words.
I won't even pretend to know what it feels like to walk in your shoes because I haven't. But I've seen people in your situation and I know it is very difficult. Let's see if there are some things I can do to lessen your burden.
Jack sat quietly for a few moments absorbing my words. When he looked up, our eyes met and he started to speak. What he said next caught me completely by surprise.
I read your blog.
I felt a sense of doom arise from the pit of my stomach. I mentally scanned through my last few posts. Had I said anything inappropriate? Jack recognized the look of panic on my face and quickly reassured me.
I was really impressed! It would have never occurred to me that doctors think about such things.
As I listened to the squeaking of Jack's walker as he rolled toward the checkout counter, the weight of his words began to sink in.
Maybe our patients don't know that we suffer through difficult decisions. Maybe they don't realize that our insomniac brains toss and turn during sleepless nights where worry and fear become our dark companions.
And they likely don't realize that the pain and suffering we witness leaves disfiguring scars.
How could they?
Unless, of course, we tell them.
Friday, December 16, 2011
Post Traumatic
You'll have to excuse my pessimism.
I've bathed in death. The senescent skin cells fall into the basin and expose new facial wrinkles. My hair is thinning and strands of gray streak through the jet black landscape. The gulp of water streaming down the drain is the only interruption of a perfect mornings silence.
I've choked on grief. The tasteless globs of oatmeal stick in my throat. I barely awake from my reverie to notice the glass of juice sitting beside me. The windows reflect the last memories of undisturbed night.
I've exhaled desperation. The breaths escape and take form and then disappear into the air. The path from the parking lot to the hospital expands and contracts with the whim of my mood.
And I've stumbled on sadness. The land mines in the office are frequent and offer little space to negotiate in between.
So you'll have to forgive that I jump at the sound of an unexpected phone call or the pleading voice of my daughter.
She has woken up in the middle of the night.
It's probably just a headache.
I've bathed in death. The senescent skin cells fall into the basin and expose new facial wrinkles. My hair is thinning and strands of gray streak through the jet black landscape. The gulp of water streaming down the drain is the only interruption of a perfect mornings silence.
I've choked on grief. The tasteless globs of oatmeal stick in my throat. I barely awake from my reverie to notice the glass of juice sitting beside me. The windows reflect the last memories of undisturbed night.
I've exhaled desperation. The breaths escape and take form and then disappear into the air. The path from the parking lot to the hospital expands and contracts with the whim of my mood.
And I've stumbled on sadness. The land mines in the office are frequent and offer little space to negotiate in between.
So you'll have to forgive that I jump at the sound of an unexpected phone call or the pleading voice of my daughter.
She has woken up in the middle of the night.
It's probably just a headache.
Wednesday, December 14, 2011
Will It Hurt?
Will it hurt?
I am lying on the bed in my parent's room. My six year old legs fidget like a frog who has been pinned on his back. My father stands over me and opens a small box of tools by splaying the paper wrapping and spreading it across the night stand.
He gingerly unfolds two thin sheets of wax paper to reveal a set of sterile gloves. He grasps the first on the outer bent lip and pulls his arm through. Using his covered hand he scoops his fingers under the bend of the other glove.
As my father lifts the forceps out of the box a stream of sunlight catches the metal and bounces onto my face, blinding me.
Should I close my eyes yet?
He doesn't answer my question but commands me not to move. He takes a moment to survey the clean line of sutures above my right brow. As he pauses, I feel his breath caress my skin. The faint smell of mustard reminds me of the deli sandwiches we ate an hour before. It intermingles with the acrid perfume of alcohol being applied to my skin.
He squints through his glasses as he approaches my forehead with scissors in one hand and forceps in the other. I shut my lids tightly, waiting for the pain that is sure to come.
His shadow blocks the light from the window and I sense his body leaning over me even though my eyes are closed. He pulls at the edge of the suture with one hand and snips with the other. I feel a sharp sting as my skin leaps to meet the scissors.
Each suture is methodically cut and removed in similar fashion. Minutes later we are finished. I sit up on the bed and smile at my father. He is arranging his tools. He stops what he is doing and reaches up to my face. He cups my chin and gently pushes upward. He surveys his work.
Not bad!
Six months later I will fall and need stitches again. But by then, my father will be dead and I will have to go back to the doctor's office to have them removed.
This memory came flooding back to me the other day as I stood over my own patient with scissors and forceps in hand.
It had been so many years-I had forgotten.
I am lying on the bed in my parent's room. My six year old legs fidget like a frog who has been pinned on his back. My father stands over me and opens a small box of tools by splaying the paper wrapping and spreading it across the night stand.
He gingerly unfolds two thin sheets of wax paper to reveal a set of sterile gloves. He grasps the first on the outer bent lip and pulls his arm through. Using his covered hand he scoops his fingers under the bend of the other glove.
As my father lifts the forceps out of the box a stream of sunlight catches the metal and bounces onto my face, blinding me.
Should I close my eyes yet?
He doesn't answer my question but commands me not to move. He takes a moment to survey the clean line of sutures above my right brow. As he pauses, I feel his breath caress my skin. The faint smell of mustard reminds me of the deli sandwiches we ate an hour before. It intermingles with the acrid perfume of alcohol being applied to my skin.
He squints through his glasses as he approaches my forehead with scissors in one hand and forceps in the other. I shut my lids tightly, waiting for the pain that is sure to come.
His shadow blocks the light from the window and I sense his body leaning over me even though my eyes are closed. He pulls at the edge of the suture with one hand and snips with the other. I feel a sharp sting as my skin leaps to meet the scissors.
Each suture is methodically cut and removed in similar fashion. Minutes later we are finished. I sit up on the bed and smile at my father. He is arranging his tools. He stops what he is doing and reaches up to my face. He cups my chin and gently pushes upward. He surveys his work.
Not bad!
Six months later I will fall and need stitches again. But by then, my father will be dead and I will have to go back to the doctor's office to have them removed.
This memory came flooding back to me the other day as I stood over my own patient with scissors and forceps in hand.
It had been so many years-I had forgotten.
Tuesday, December 13, 2011
Forgotten
I want a Diet Coke!
It was the first thing I thought as I woke up this morning. Although I had mostly kicked the addiction, occasionally the urge was strong. I recently relegated my caffeine drinking to availability. I refused to buy soda at the grocery store. I strutted past the vending machines as if they didn't exist.
Once in awhile, I allowed myself to partake: a drug lunch here, a sporting event there. If a Diet Coke was placed in front of my face, I would drink it. So it wasn't a complete surprise that I woke up with such cravings. After years of drinking six pack after six pack, I was convinced that my brain chemistry had been altered.
When I stopped by the office before rounding at the hospital, I rummaged through the refrigerator hoping to find buried treasure. No such luck! I knew that I would pass a bank of vending machines in the long hallway that led to the hospital, but I had sworn off such a willful solution to my lusting.
This morning, I would have to forgo my needs.
*
The hospital census was large and active. I worked my way through the telemetry and ICU floors. I stopped at each patent's bedside and then the nursing station to chart at a computer. There was a hodge-podge of bread and butter medical and surgical care.
I quietly entered the room of my last patient for the morning. Mrs. Brooks was nearly one hundred years old. Her dementia had progressed severely over the last few years, and she was admitted for a urinary tract infection. Her verbal ability was limited to the single word "yes".
Mrs Brooks, it's good to see you....yes.
Are you feeling better then yesterday...yes
Do you want to go back to the nursing home....yes
Mrs. Brooks had no children and the rest of her family had died or moved away. Her medical decisions were made by a distant nephew, who I had talked to on the phone, but never met in person.
After examining Mrs. Brooks, I turned to leave the room. Out of the corner of my eye I saw a glimmer of aluminum on the desk. I turned my head and my mouth started to water like one of Pavlov's dogs. Sitting on the table was a six pack of Diet Coke.
I couldn't resist the lure of the silver can enshrouded in a white label. Perverse thoughts ran through my head. I was Gollum from Lord of the rings stretching for my "precious".
She's demented! She'll never know!
Mrs. Brooks can I have a Diet Coke....yes.
*
As I reached for the can I had a shocking moment of clarity. It was if, all the sudden, someone turned on a spot light and pointed it in my direction. I was standing in a demented woman's hospital room stealing her Diet Coke.
I felt a great sense of shame. After all of these years learning and caring for the elderly I had stooped to this.
Mrs. Brooks had been forgotten. She was abandoned and relegated to the dark corners of a nursing home where society didn't have to acknowledge her.
It somehow escaped me this morning.
It was my job to protect her.
It was the first thing I thought as I woke up this morning. Although I had mostly kicked the addiction, occasionally the urge was strong. I recently relegated my caffeine drinking to availability. I refused to buy soda at the grocery store. I strutted past the vending machines as if they didn't exist.
Once in awhile, I allowed myself to partake: a drug lunch here, a sporting event there. If a Diet Coke was placed in front of my face, I would drink it. So it wasn't a complete surprise that I woke up with such cravings. After years of drinking six pack after six pack, I was convinced that my brain chemistry had been altered.
When I stopped by the office before rounding at the hospital, I rummaged through the refrigerator hoping to find buried treasure. No such luck! I knew that I would pass a bank of vending machines in the long hallway that led to the hospital, but I had sworn off such a willful solution to my lusting.
This morning, I would have to forgo my needs.
*
The hospital census was large and active. I worked my way through the telemetry and ICU floors. I stopped at each patent's bedside and then the nursing station to chart at a computer. There was a hodge-podge of bread and butter medical and surgical care.
I quietly entered the room of my last patient for the morning. Mrs. Brooks was nearly one hundred years old. Her dementia had progressed severely over the last few years, and she was admitted for a urinary tract infection. Her verbal ability was limited to the single word "yes".
Mrs Brooks, it's good to see you....yes.
Are you feeling better then yesterday...yes
Do you want to go back to the nursing home....yes
Mrs. Brooks had no children and the rest of her family had died or moved away. Her medical decisions were made by a distant nephew, who I had talked to on the phone, but never met in person.
After examining Mrs. Brooks, I turned to leave the room. Out of the corner of my eye I saw a glimmer of aluminum on the desk. I turned my head and my mouth started to water like one of Pavlov's dogs. Sitting on the table was a six pack of Diet Coke.
I couldn't resist the lure of the silver can enshrouded in a white label. Perverse thoughts ran through my head. I was Gollum from Lord of the rings stretching for my "precious".
She's demented! She'll never know!
Mrs. Brooks can I have a Diet Coke....yes.
*
As I reached for the can I had a shocking moment of clarity. It was if, all the sudden, someone turned on a spot light and pointed it in my direction. I was standing in a demented woman's hospital room stealing her Diet Coke.
I felt a great sense of shame. After all of these years learning and caring for the elderly I had stooped to this.
Mrs. Brooks had been forgotten. She was abandoned and relegated to the dark corners of a nursing home where society didn't have to acknowledge her.
It somehow escaped me this morning.
It was my job to protect her.
Monday, December 12, 2011
Sign Of The Times
No matter how hard I tried, I couldn't control Lisa's blood pressure. We experimented with countless combinations of medication with no luck. She was working on diet and exercise. I started to feel desperate. I imagined her confidence in my abilities was faltering although she hadn't said a word. Our weekly visits had been fruitless.
As she climbed up onto the exam table, I retrieved the blood pressure cuff from where it rested on the wall. I repeatedly squeezed the bulb until the meter read above 200. The cuff crackled on Lisa's arm. I released the air valve and became quiet. I held my breath in anticipation.
Please be lower. Be lower...
When the liquid past the 180 mark, the dreaded thumping pounded through my stethoscope. Lisa's blood pressure was no better.
I took the cuff off and settled back into my chair.
So tell me what's going on in your life?
Lisa stared blankly at the wall for a moment, and then a tear formed at the corner of her eye. I could barley hear her speak.
If debt was a cancer, my husband and I would have been ten feet under long ago.
As the words stumbled out of her mouth the image of her twelve year old twins flashed through my mind. I leaned over the desk and handed her a box of Kleenex. I had little in my bag of tricks to fix her situation.
We sat silently in the room for a few minutes. How much had changed with my patients over the last few years. The faltering of our countries financial health was being mirrored in the day to day ailments that crossed the threshold of my office doors. The illness was contagious.
I took out my prescription pad and started to write. Lisa glanced at me quizzically. She waited in anticipation for me to explain which new medication was being added.
Often the great difficulty of being a doctor is discovering what it is that each individual truly needs. Sometimes the answer is something that we as physicians are not trained to give.
Lisa read silently the scrawled glyphs on the paper that I handed to her. She looked up at me with confusion etched into her tear soaked face.
Whats this? She asked as she wiped her face with a tissue.
I waited until our eyes met.
It's the number of my accountant, he can do more for your blood pressure then I.
As she climbed up onto the exam table, I retrieved the blood pressure cuff from where it rested on the wall. I repeatedly squeezed the bulb until the meter read above 200. The cuff crackled on Lisa's arm. I released the air valve and became quiet. I held my breath in anticipation.
Please be lower. Be lower...
When the liquid past the 180 mark, the dreaded thumping pounded through my stethoscope. Lisa's blood pressure was no better.
I took the cuff off and settled back into my chair.
So tell me what's going on in your life?
Lisa stared blankly at the wall for a moment, and then a tear formed at the corner of her eye. I could barley hear her speak.
If debt was a cancer, my husband and I would have been ten feet under long ago.
As the words stumbled out of her mouth the image of her twelve year old twins flashed through my mind. I leaned over the desk and handed her a box of Kleenex. I had little in my bag of tricks to fix her situation.
We sat silently in the room for a few minutes. How much had changed with my patients over the last few years. The faltering of our countries financial health was being mirrored in the day to day ailments that crossed the threshold of my office doors. The illness was contagious.
I took out my prescription pad and started to write. Lisa glanced at me quizzically. She waited in anticipation for me to explain which new medication was being added.
Often the great difficulty of being a doctor is discovering what it is that each individual truly needs. Sometimes the answer is something that we as physicians are not trained to give.
Lisa read silently the scrawled glyphs on the paper that I handed to her. She looked up at me with confusion etched into her tear soaked face.
Whats this? She asked as she wiped her face with a tissue.
I waited until our eyes met.
It's the number of my accountant, he can do more for your blood pressure then I.
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