Turning Tables – Treating Physicians

Today, one of the other residents and I had an interesting conversation.

Somehow, the topic of treating physicians came up.  And it is something that terrifies us both.  And not just for the reasons you might think.

I will confess, treating other health care people is always nerve wracking because you worry even more about saying something wrong or stupid because you always wonder if they are secretly judging your skills.

But the bigger thing is that when we see them, they are being faced with a cancer diagnosis.  And for some reason, most physicians and nurses get the bad ones and all the complications.   And that is horrible for anyone.

The issue is, they know too much.  Sometimes, having some uncertainty is a good thing.  But, when you have cared for people with the same thing.  When you understand the odds and get the treatments, it is a whole other level.  You know the worst case scenarios.  All of them. Sometimes the unknown bits of the known are the worst.  Especially when your whole world gets turned upside down.

That is the hard part.  The anxiety, the sadness, the anger and guilt.  The fact that sometimes, the person who knows too much coming in can’t be easily comforted.  That the numbers that scare everyone have too much meaning.

It also forces us to face our own mortality.

We both agreed that given we work in Oncology and given the odds in the world today, we will both one day have cancer.  And we will probably die from it.   Those are simply real odds.  And the “comedy” that is life.

And we know this and accept it.  In fact, we laugh about it in an uncomfortable kind of way.  Sure, I might have a heart attack or an accident, but it is more likely I get dementia or die of cancer… Or both.

Really, it is something I accept.  But, it is still something that is terrifying. And maybe that won’t happen.  Maybe I’ll just die in my sleep in old age.

Either way the reality of seeing people who dedicate their lives to healing others broken, afraid and unwell is terrifying.  They are “one of us” who became “one of them.  It is just too real sometimes.  Too close to home.

I just want to fix the hurt.  I want to prevent the hurt.  I want to be out of a job (kind of).

But I can’t.  So, we do the best we can.  With every person.  Because one day the tables will turn in one way or another.

Snow. Yay?

I got a text from a friend while I was getting ready for work this morning.  It read “SNOW!”

In the mornings, I stagger from my closed curtains bedroom into our windowless bathroom, so I exist in oblivion to the weather unless it is raining hard enough for our leak to drip or is windy enough to shake the windows or sunny enough to shine through the curtains (which is not likely at 7am where we live right now).  It has been unseasonably mild the last two days or so, and I live in a bubble in which I check the weather only  before venturing outside to catch the bus, so that wasn’t exactly on my radar.

Now, lets be realistic.  I live in Canada and it is Fall, so snow is a given.  But that wasn’t the shock factor.  The shock factor was my initial gut response…. “Yay!”

WHAT?!?!

I don’t say yay to snow.  I’m more of a bah humbug, go away winter kind of person.  Usually I’m anti-festive until December and even then I get cranky if things are excessive.  I only like snow on the holidays not overlapping my travel plans (which it always does). The one thing I always love are Starbucks peppermint mochas and gingerbread lattes.  Mmmm.

But, that has been changing.  I started doing things like sending out cards (I need to buy my cards this year) and decorating.  I still don’t like excessive or commercialism, but I think because I am embracing the reason we celebrate, I am embracing the celebration more.

But moreso, I think friend is rubbing off on me too much.  And I’m okay with that.

So, I almost said yay to snow.  Not quite.  But almost.

Work in the midst of call

This weekend, amidst all of my call-y goodness, I am trying to get some work done on a few upcoming projects/presentations.

I have a journal club a week from Tuesday, so I picked some articles.  Head and neck cancer supportive care.  Look out world.  I’m about to critique the pulp out of an article on prophylactic versus reactive feeding tubes and hemoglobin levels and transfusions in head and neck folks.

And then, I spent a bunch of time looking into stuff for career day.  Every year, I help out with career day.  And every year, I say we will make it better next year.  You see, Rad Onc, much like me in high school, is kind of one of the nerdier, quiet and obscure specialties out there.  As a result, most people walk right past our booth.  Seriously.  You should see them all flock to the surgical simulators and fake airways at Gen Surg or Anesthesia.  And everyone wants to know how much the Radiologists make to sit in a dark room.  But, the Rad Onc folks.  They have creepy masks and a powerpoint.

Image from ebroc.com.

Not this year.  Okay, we will still have creepy masks and a powerpoint running.  That is who we are.  But this year, I am cracking out some YouTube videos of some of the “cooler” aspects (that’s right… big machines and computer animations).

They are cool to me.  And at least they give people something to ask questions about.

Plus, I think I have found an online application that we can use to make ourselves “interactive.”  A try your hand at contouring station, perhaps.

I know, not as cool as intubating a dummy.  But, maybe we’ll get to tell another couple people who we really are.

I just have to get approval from the powers that be (and acquire the technology to make it all happen).

Today I decided to clean out my email inbox instead of starting to actually work on the journal club.  Because that is just too much energy.

I got about 2 minutes in when I realized something.  I have something like 30+ One45 emails.

For those of you in the world who don’t use One45, it is an online evaluation system people in the medicine world love.  And we evaluate every single flipping session we ever attend.  And get evaluated almost as often.

Image from imerrill.umd.edu.

Usually, I’m on top of those things.  I hammer them out once a week or so.

The last two months or so, not so much.

I know what I’m doing this evening.  It involves a likert scale, good music and trying to reach back into the recesses of my memory.

The Christian “Look”

Sorry for the lameness in lack of posts recently.  I won’t make excuses.

I will, however share with you this awesome article from Relevantmagazine.com a few friends of mine just posted on Facebook called “Being a Christian Doesn’t Always Look Like You Think It Should.”

The article speaks well about how grace and “real” Christianity does not always look the way other Christians or society wants it to look.  Really, by looking for Christians to appear a certain way, we are putting God in a box.  Grace is a process, we are works in progress and we are made perfect only in Christ, but still exist in changing earthly bodies with personalities and characteristics that change and grow and may not always be perfectly Christ-like.  And maybe being Christ-like isn’t what we all imagine it is sometimes.

I go to church at an inner city church plant.  The pastor call the congregation a “motley crew” and it is true.  We come from all walks of life.  There are hipsters and homeless people and wealthy people and young and old.  People are grappling with addictions, with difficult life circumstances with being students or stay at home moms or with growing up in this world in general.  We are all sinners.  Our thing in common is Jesus and what God’s grace is doing in our lives.

If someone walked in looking for people to look or act a certain way, they might be shocked.  People should know Christians because they are different.  Because of the love and grace the exude.  That does not mean they all have to be extroverts who dress and behave a certain way.  They can have tattoos and piercings or wear skirts and have long hair.  They all still struggle in one way or another.

I am guilty of it.  As humans, we all judge.  We compare and put people and things in boxes.

We need to stop putting God in a box.  And just as much, we need to stop putting what God does in, with and through people in a box.

The Happy In My Halloween

Today was a happy in my Halloween.

I managed to arrange for transfer for one of my patients.  It is always good to get people back to home hospital, but it is especially good when it also makes my day start off well.

I presented Morbidity and Mortality rounds today and people actually kind of participated.

It is Friday half day, which means an afternoon of lectures, which is tough at the best of times, but especially on Fridays.  This week, I was supposed to have Radiobiology from 4-5, which is the most potent form of educational torture there is.  Unfortunately, our instructor went home sick with the flu.  Fortunately, that meant we didn’t have that lecture and although it has to be rescheduled, I was glad to not sit through it at 4 on Friday.

Also in Friday half day, the radiologist who taught us an awesome head and neck lecture brought us Halloween candy.  And not just any Halloween candy… The good stuff with peanuts in it that can kill people but tastes soooooo good.

I realized in said head and neck lecture that I am finally beginning to figure out head and neck and knew things in the lecture.  It was an exciting “ah ha” moment for me.  And thank goodness it is starting to come together because I have a treatment planning exam this week and it is yet again on head and neck (the universe or at least my staff seem to hate me on this front).

Patrick and his class went on a field trip today and had a good party afterwards (complete with cookies he made last night).  I was impressed at his craftiness and ability to get through Halloween with a classroom full of third graders.

We went to a Mexican restaurant tonight for supper where I got to feed my most recent craving… Spicy chilli.  I love a good burrito.

It is Jeter’s “birthday.”  The anniversary of when we inherited him two years ago.  He threw up on the carpet for us when we got home from work and is now happily carrying around his new “birthday” replacement feather on a stick.

We are settling in for a night of watching Charlie Brown and other relevant specials while waiting for the kids that never come to our apartment. It is to bed early tonight for band and a day full of studying, house cleaning and a potential games night!

Happy Halloween!

To Elim, On Your Estimated Due Date

Dear Elim,

I thought I would write to you on this, your estimated due date, to say a few things that have been on my heart. Had we not lived in this fallen world, you would be in my arms by now or I would be just itching to have you the heck out of me so we could cuddle and do all that newborn-mommy stuff. But alas, that was not how it was to be.

I want you to know first of all that I love you. And I always will. Even though I barely knew you, I know God made you and I will cherish our short time together before you went to heaven to be with Jesus. A lot of other people loved you and mourned your short life too.

I miss you. I miss what could have been. But, I am so happy you are in heaven now. That you are safe and protected and loved. One day, I’ll actually get to meet you and that will be awesome.

You are a gift. You are an answer to prayers and longings. And you were used by God to teach me big lessons about redemption, real love and how to celebrate well and suffer well.

Because of you, I appreciate new lives more. I appreciate the miracle that it is to see a pregnancy progress and babies be born and children who grow. I want to celebrate new lives instead of hiding them with secrets and fear. I will be honest and say, I also know how fragile life can be and it scares me a little and that is okay. I empathize better with other Moms and Dads who have to miss their kids until they see them again for all kinds of reasons.

Because of you, your Dad and I got to learn to lean on God and each other a whole lot more. We got to grow up more (which I’m sure sounds crazy because we are theoretically grown ups, but even grown ups have more growing to do).  We got to see God do amazing things with what seemed like a terrible situation.  That is what He does, but I suppose you had that figured out already.

I been counting down to this day for many months. Not because of some sick fascination or because I wanted to feel sad or bad. Just out of instinct. I like numbers and it is simple math to know where I would have been with you at any given point. Plus, today’s date has been etched in my mind. And to be honest, I wanted to remember when you would have hypothetically come into this world. Just like I will remember when I knew you went out. Because I care. These are important moments, even though others may not see them as such.

You will have brothers or sisters, maybe both someday. I will be grateful for each of them and know them as individuals. I pray every day that they get the chance to grow up and that it will hopefully be a long time before you meet them (no offense). I also pray that they will all one day meet you in heaven. Know that in my heart you will always have a special place and when they are ready and old enough to understand, I will tell them about you.

You count in my kid count in my heart. So, happy “birthday.”

Love you always and forever,

Mom

Reblog: “In Defense of Doctors”

I read this the other day on a friend’s Facebook page and I liked it enough to want to share it with other people.  Check it out, it is called “In Defense of Doctors” by The Murrays.

In a day and age where everyone has information at their fingertips, it seems that distrust of the medical system is everywhere.  I work and function in that system every day.  I also am a patient in that same system.  I have to trust it.  I can be well educated and informed, but I go in expecting my physician or nurse or other caregiver to know their stuff too.  These people go to school for years.  They sacrifice their lives.  They don’t want to do stuff to harm you.  I’m certain of it.

I have on more than one occasion come home and worried about a patient I left at work.  Or spent hours scouring the internet for the right answer.  That is what it means to be in a caring profession.

Please trust that we care.  And we have your best interest at heart.  We sacrificed a lot to get here.  It doesn’t stop with you.

My flu shot soapbox

Please allow me to pull up my soap box…

It is time for what is becoming my annual flu shot rant (see here and here for previous).

I got my flu shot this week.

Unless you are allergic to it or have another medical indication to not get it, you should too.

I mean, we are all running around terrified of Ebola and really, afraid of getting sick in general.  But, most of us are too chicken (or cocky or ill informed or paranoid) to get a simple measure that prevents a common and potentially deadly illness.  It is simple, it does not make you sick and the risks are really low (you can actually get some similar complications at random or from a bout of the flu).

Just to point out some facts… You can get the flu shot if you are pregnant.  This came up at work the other day.  It is not contraindicated.  It is advised (I know, there is limited data on fetal risk because the population data does not suggest an issue, but if there was a giant issue, they wouldn’t be doling it out to pregnant women… That is bad PR and asking for a lawsuit).  You can also get the flu shot while on most cancer treatments if you time it based on the advice of your doctor (ao came up at work)ls.  It is free in a bunch of workplaces and also if you have a chronic condition that puts you at risk if you were to get the flu.

Last year, I had, at one point, 3 people in ICU on ventilators (aka life support) with the flu.  The FLU.  And they were all in their 40s-60s.  Not old people.  Not necessarily people who were sickly before.  Crappy luck.  Bad strains.  None of them had received flu shots.  They all survived.  Not everyone is that lucky…  I also had a patient I cared for on an oncology related service die from complications related to the flu during their cancer treatment.

I have watched people die or nearly die from the flu.  I don’t want to watch more.

I know the vaccine isn’t perfect. Sure, there are years where they miss the mark in picking the viruses, but they still do confer some immunity and other years they are spot on.  I know people don’t trust doctors because apparently we have been brain washed.  And there is limited research on each specific year’s vaccine (because they are basically similar with different strains).   But, I like to hedge my bets.  It is simple, quick, easy and has more evidence behind it than most of the stuff seen on talk shows.

Don’t kill my patients.  Don’t kill my family.  Get the shot, it is extremely unlikely to make things worse and it probably will make things better.

Rant over.  I’ll step down again for now.

 

“Holiday” Monday

After a lovely weekend at home, I have a lieu day for working the Thanksgiving holiday last week.  That means long weekend for me!

As a result, I am now making turkey soup from scratch, am catching up on laundry and binge watching Grey’s Anatomy.  I feel very domestic.

I have shared my angst about still watching Grey’s before and it still hasn’t left me.

I cringe at all of the changes, especially the last few seasons.  I hate the drama.  I hate that everyone and yet nobody dies all at the same time.  And yet, I watched it since the first season and I am sticking it out.

As a result, I am curled up on the couch and kind of look like this…

Image from gifsoup.com.

Happy Monday.

Thanksgiving Turkey and “Meeosh”

Yesterday was Thanksgiving here.

I was on call.  It is how I roll these days, it seems.

Despite that,  I thought it would be a good idea to have people over for Thanksgiving dinner.  Because we have a biggish dining room and I like to cook.

It was a good idea.

Some planning ahead and good luck meant that we had a lovely Thanksgiving dinner with Child, D and Dr. Bond.

I was ridiculously excited that I found a “decently priced” fresh turkey that was small enough to fit in our oven and the disposable baking pan that would also fit in our oven.

Jeter made it his main goal in life to eat the turkey.  He tried to eat it raw, he tried to pick the chunk of extra skin out of the garbage can and then, once everyone arrived, he proceeded to jump on the counter and try to steal a bite repeatedly.  That cat likes his meat.

I like having some “family” away from biological family.

I also like hosting Thanksgiving because it means we wind up with leftovers… My favourite.

Tonight we had what my family calls “Meeosh.”  The recipe: Take all of the leftovers, mix and fry them together in a frying pan, then put extra gravy on top.  Other people call it hash.  I call it delicious.  Patrick and I both looked forward to it all day.

Interestingly, Patrick had never had “Meeosh” until he married me.  In fact, he never had anything quite like it.  He thought us a bit odd that time as my Mom and I combined everything we pulled from the fridge in a giant frying pan.  He was pleasantly surprised and has never gone back.

Mmmm… Turkey.