Learning To Speak

Today’s prompt from the Daily Post is called “Take That, Rosetta!”  It asks the question: “If you could wake up tomorrow and be fluent in any language you don’t currently speak, which would it be? Why? What’s the first thing you do with your new linguistic skills?”

Tricky question.

I mean, I speak French.  I am not perfectly fluent in French.  I was doing pretty well when I was in high school doing higher level French courses and speaking in French with my Grandfather.  But, I haven’t had a French class since the 11th grade and rarely use my French at all now.  In fact, I am embarrassed to speak French because I fear I will look that ridiculous, unless of course the person speaks less English than I speak French, which happens from time to time at work.

So, if I could pick any language, I would pick French.  Because it would be the most useful.  And because given where I grew up and my heritage, I really should speak better French.

But, there is that whole stipulation about it being a languge I don’t currently speak.

This is more challenging.

I feel like I would pick Mandarin because it is probably the next most common language.

With either, I would be thrilled to finally speak to native speakers in  their own language and finally get the depth and wholeness of conversation that comes from talking with someone in their mother tongue.

Segueway…

Tonight, I had a conversation with some friends about language.  One of them teaches from time to time as a substitute in a language school for adults.  Today, she told us about teaching in a class that was for people who had no concept of the English language whatsoever.  As in they didn’t necessarily even know what way to hold the written page in some cases.  It is a lot of pointing and repeating.

Learning a language from the start is tough, especially when the teacher and all of the students speak different languages than you.  It is all about immersion and repetition.

It made me think about how crazy it is to learn language.

Medicine contains a lot of its own language.  In fact, each specialty has its own dialect.  Many words are the same, but there are some different ones or special meanings.  I am still trying to piece together some of the dialect that is Neurology and I have been doing that full time for a month.

I learned to speak French.  But, I had French words in my vocabulary my entire speaking life.  Even then, it was hard. I remember how tough it was when I started Immersion.  And again, my background was better than that of many other kids my age.  Even then, I was still sorting out the finer nuances of the English language and sorting out the intermediate-basics of French.

I did a summer program in the Netherlands and although Dutch does have some English or French appearing words, I was grateful that most people spoke English.  Being in a place where you don’t speak the language can be scary.

I can’t imagine being in a place where I don’t speak the language and nobody else speaks my language either.  Plus, factor in things like being in a new culture and country.

It must be so overwhelming.

When I was in med school, our school had this really awesome program where they would send in first and second year medical students with interpreters to get the medical histories from refugees new to Canada to help facilitate getting them family doctors (because with an interpreter, the visit is twice as long and often these people have complex histories and issues that would be too time consuming without screening and a starting plan).  It was a really eye opening experience for me and I do feel like it made a difference for some of the people.

I remember in one instance, I found out a woman was quite upset and concerned because she was due of her yearly pap smear two months before and nobody had offered one to her yet and she didn’t know where to go.  As it turns out, she had an abnormal pap in the past and had a sister die of cervical cancer and wanted to avoid that.  I got to red flag this issue and she was seen earlier because her concerns (which she was to embarrassed to tell to her case worker) were put out there.

Another time, we saw a whole family with sickle cell who hadn’t seen a specialist and were managing things like painful crises at home with no medications.  They were referred to hematology for assistance with management.

Sometimes, it was as simple as saying everyone was well and that they would just need maintance and preventative care.  Other times, we helped point people to dentists, emergency departments and urgent GP visits, so they could be referred to a specialist.

I feel like it made a difference.

It all wouldn’t have been possible without interpreters.

Language is so important.  We share so much in the human experience, but much of that is communicated with speech.  We take it for granted sometimes.

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Read it: “How Long Have I Got Left?”

This article that was in the New York Times blows my mind as one of those “Agh!  That could be me.” kind of things.

Read it:  How Long Have I Got Left?

I like it for a few reasons.

To start, I like his honesty and the way he addresses the fear that comes from knowing too much and yet not knowing enough.

I also like how he addresses the challenge in presenting statistics and likelihoods to patients and families regarding survival and mortality and how really, it is just a guess.  But at the same time how that is something we want to know so badly.  I tend to address this similarly.  I don’t like to give numbers.  It isn’t fair because we suck at knowing.  That being said, ball parks are nice while acknowledging that there are errors in this.  I mean, any of us can walk out and get hit by a bus.  But on the other hand, I admit that if it were me, I know I would want to know exact numbers even though I know that they are never really exact numbers.

I also like how he is doing well and is back to work and life.  Because cancer drugs are much better these days.  Particularly the kind that he is on.  People do well for a long time.

It is the kind of article that reminds me life is awesome, statistics suck, prognosis is such an important grey area and that cancer treatments continue to blow my mind.

What are your thoughts on this article?

Leave Your Shoes At The Door: Memory Clinic

This week’s writing challenge with the Daily Post and Rarasaur is kind of a take on one of my favourite quotes from one of my favourite books:

If you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it. –Atticus Finch in Harper Lee’s To Kill A Mockingbird.

The challenge is to consider things from a different point of view. 

I spent my morning in a memory clinic.  I have some choices in the current Neurology rotation I am doing, so I can pick from clinics being offered (that aren’t already occupied by other learners) to try to tailor my learning.

I chose to go to this clinic because memory issues are something that can be caused by cancer treatments I will in my future life administer.  I chose to go to this clinic because memory issues are common.  I chose to go to this clinic because memory issues are very personal for me.  I almost went to a different clinic for the same reason.

I can walk into this clinic wearing many different pairs of shoes in my mind.  These three are the most predominant.

I walk into the clinic as a part of the team. 

I don’t know these people.  I don’t know their past.  I can’t say for sure what their future holds.

I introduce myself.  He has that blank stare.  The lost look that dementia brings.  He is polite and shakes my hand.  Smiles back at me with a big grin.  I can see a stain on his shirt from breakfast.  He glances around uncomfortably as I meet his wife and daughter.  The daughter has a list of questions and a notepad in hand.

They sit down.

I ask what brings them in today.

He says, “a checkup.”

His daughter interjects, “He has been having trouble with his memory.  His family doctor thinks he has Alzheimer’s.  He repeats himself.  He doesn’t remember how to get home from his walks.  Mom isn’t coping well with him at home.  It isn’t safe.”

His wife looks tearful and ashamed.  She just nods along.

He then looks at me and asks, “Why am I here?  When can I go?”

I go on to ask questions.  How long has this been happening.  Talk about when things started, how the progressed, about safety issues, medicatons and family history.  I get to hear intimate details of their lives.  I listen to their fears and hopes, their belifs and misconceptions.  I listen to them bicker and laugh and cry.

I want so much to fix their hurt.  All I can do is offer the help that is available, a listening ear and a friendly smile.

I supported my family members as they have gone into a clinic like this. 

Unfortunately, I am aware that there is a good chance that one day I will sit on the other side of these figurative and real tables. 

I will be the daughter or daughter-in-law of the person being seen in the memory clinic.

I shake the resident’s hand and sit down with my Mom and Dad.

She explains the procedure and we laugh because we know the drill.

Mom tells her, “We’ve been here before. Plus, my baby here is a doctor.”

I am embarrassed.  “It never gets old,” I say and laugh.

The resident is puzzled, “You’ve been here before?”

“Oh yes, our Mothers were both through this clinic.  Alzheimer’s.  I guess its our turn now.”

My father sits silently, but smirks and shakes his head.

The resident looks confused at how casual we are about this.

“We have been expecting this.  It is kind of our way of coping.  Either way, we decided to come early.  Get on medication.  Plan ahead.  We have done this before.” I explain.

Later in the conversation, they are doing the testing.  I have given these tests more than I would have liked, but there is something different sitting behind your mother as they go through the questions.

She stumbles through serial 7s.  She can’t spell world backwards, but my Dad chimes in that she is “half dyslexic,” so that is probably why.  It isn’t.  She knows the season because we are wearing sandals and the date because she memorized it on the way in.

She draws the clock as I cringe when she almost mixes up the hands.  Almost.  I sigh with relief when she gets them right.

She can’t remember the name of my youngest child.  And my grandmother is still alive in a nursing home (we laugh because we joked that she would outlive us all, but in the end she didn’t).  She knows they downsized and moved to an apartment near my husband and I, but can’t recall their new address.

She glances back at us for confirmation.

The resident then asks for our help in sorting out the correct information.

I take a deep breath and give the correct information.  She smiles and nods alongs.  Agrees and laughs at her misinformation.  It is good that she is so good natured.

We smile and encourage her to continue but give eachother looks from the corner of our eyes.

We know.

Even more frightening is that one day, it might be me.

I’m sitting in an unfamiliar clinic room.  Something tells me I have been there before, but I just can’t place it.

Posters all around the room show pictures of human brains and nervous systems and drug advertisements.  This is my world.  This is what I know.

They come back in the room.  Patrick, my son, my daughter, two strangers one with a stethoscope around their neck.  I don’t know these people but they seem to know me.

Image from phenxtoolkit.org.

They pull out a test.  They say it was mine.

I recognize it.  An MoCA (Montreal Cognitive Assessment) test.  It is completed.  I must have done it earlier.

I don’t remember.

That is the frightening part.  I feel like I miss more and more with each coming month and I don’t even realize it all the time any more.

The resident is explaining the meaning of the results.

I know these things.  I used to do these things.

“Her level of education helps her get along.  Her scores have been fairly stable. When she first presented she got a 27, then a 25 six months later.   Since we switched her meds and started her on the trial drug, her score has  been hovering around 23.  But today, she got a 17.”

I stare at her. There has been some sort of mistake.  I have Alzheimer’s, but I am medicated.  I am a competent adult.  I am a physician and a mother and a wife.

She continues, “After all we talked about today, it seems your wife’s condition is progressing.  It is clear that she is having more difficulties with her short term memory and judgement, especially after the time she wandered out the other evening.  And that fact that she is no longer able to hide things very well any more.  Have you thought about what you are going to do when things get worse?”

I have.  I want to be put in a nursing home.  That much I know.   But, things aren’t that much worse, are they?  I try to remember getting lost.  I try to remember what clinic we are in.

Then I realize they are all staring at me.  How much time has passed?

I forgot to make my notes.  I always keep notes.  It is how I get by.  Memory cues.  I don’t know where we are in the conversation.  I feel overwhelmed.  I feel afraid.

My daughter takes my notebook from me and repeats what the doctor said about medication dosing and changes to my timing.  She says she will make sure the blister packs get replaced.

Someone from home care is coming by tomorrow to meet with us about getting some help at home.  She takes my calendar and marks that down.

Patrick is staying back to talk to the doctor.  I hate it when he stays behind.  I know what that means.  At least, I think I do, but I can’t be sure of anything anymore.

I want to stay.  I ask to stay.  I demand to stay.  It is my health and my body.  Back when I was first diagnosed, I could manage these issues.  Nobody figured it out until I was ready for them to know.  Medications are better now.  I am not my grandparents.  I just need to take better notes or add more pills or maybe take away more pills…

They tell me it will only be a minute.  I can’t understand why.  I just don’t like being apart from him.  He is one of the few people I know.  He helps me.

My daughter tells me we will go to the Starbucks across the street for lattes while we wait.

I tell her, “That sounds great, I haven’t had one of those for years and years.”

“Never withdraw care”

We should never really withdraw care.

This was a quote from a fabulous talk I went to today about communication.

It is true.

In medicine, we often say things like “withdrawal of care” and mean things like withdrawing life support or stopping “extreme” or “heroic” measures.  Sometimes it is even about things like stopping active treatment for incurable disease.

Taking those things out of the picture does not equate not doing appropriate supportive care.  Everyone needs supportive care.  Always.  Just in different ways.

But, if you are a family member, it can sound like you are taking everything away.

Like the health care professionals don’t care.  Like hope is gone.  Like they are being left to die.

That is where this quote came in.  How the language we use can really portray the wrong message.  Context is everything, but really, we need to try to keep context out and keep things clear.

And no matter what, we should still care.   It is in the term healthcare.  It just makes sense to care in medicine.  Medicine is a caring profession. Because sometimes caring is all you can do.

Care is always in the equation.  The definition of care is what can change.

Sometimes the most caring thing you can do is to stop intervening beyond basic symptom management and emotional support.

It isn’t giving up, it isn’t even always changing focus.  It is about context.  It is about our humanness.   It is about care at the root of the word.

Just some food for thought.

Losing memory and licenses

Last week, I wrote my first letter to officially take away someone’s license.

I had been involved with these scenarios as a med student and, as a resident, I have told people not to drive for so long after a procedure or taking a medication.  But, this was a first.

We saw someone in emerg with advancing dementia.  This person had gotten lost in their own neighbourhood twice and once drove 10 minutes in reverse because it was easier than getting turned around.  They were being aggressive towards their spouse who kept suggesting they shouldn’t drive and they came in because there was a question if the new worsening in behavior was due to an infection.  It wasn’t.

I have said before that dementias are the thing that kill me inside.  I can deal with them, but I find it exceedingly tough.  This from the oncologist-in-training.  Most people say that cancer is one of those things they like to avoid.  I don’t mind it.  Not saying it is easy, but I have found ways to cope.  There is hope in the grave situation.  Chances for cure or quality of life.  And I have ways to cope with people with dementia too.  But, for whatever reason (probably because of my family) impending forgetfulness without a defined endpoint or fix is worse than possible impending death and disability for me to observe.

Any situation can have some hope.  And in medicine, you learn to process those things.  But, memory loss strikes a chord with me.  Maybe it always will.

Back to my story…

So, after we rule out all of the reversible stuff, there is a conversation about where to manage things and about safety.

I had to tell this person they can no longer drive. This person who is the same age as my grandfather who just died.  This person who has been driving their entire life.  Who lives far from everything.

But, to complicate things, their judgment is poor.  Their insight is absent.   “I just forget a few unimportant things.  Who needs to know the date or the season.  That isn’t needed for driving,” they say.  They blame their spouse.  They yell at me.  They threaten to harm themselves if they can’t drive.  To destroy the car so nobody can enjoy it.

I empathize.  I mean, I can’t imagine what I would do if someone told me I couldn’t drive.  When I had that terrible torticollis earlier this year, I couldn’t drive for a week (something about moving one’s head that is important to the driving process) and I didn’t like it.

I empathize because my family had the discussion that when my grandfather lost his license, it would kill him.  I empathize because it crushed him, even though he was so sick, to hear that he shouldn’t drive.  I empathize because I have had family members get upset because I seemed to be stopping them from doing something they thought to be harmless for their own protection.

I had to explain that I will be sending a letter to the motor vehicle branch.  That they can be arrested and fined if they are caught driving.  That they are at risk of hurting someone, even though they would never mean to.  And that if I didn’t say something, I could be fined.

I know in my head anything I say won’t make a difference. That it is still, to that person a blow out of left field.  And that they will forget as soon as they leave and their poor spouse will have to deal with their anger.

I left to get something and came back.  They had already forgotten I told them not to drive.

I can’t imagine what it must be like.

I wrote the letter and dropped it off with the admin assistant to be sent.

I keep thinking of that person.  Their family.

My parents take care of both of their mothers.  Both of whom have Alzheimer’s .  They present very differently.  One is relatively easy, childlike.  The other is difficult and can, at times, be downright nasty.  They are both (as of yesterday) in facilities to keep them safe and help with their care.  Where we don’t have to worry quite as much about them getting hurt or lost.

Because really, keeping people safe is important.  But, sometimes it is more of a struggle to balance the safe and happy.

When I see people coming in, especially when these changes are new, I recognize the scared looks.  The uncertain questions.

I find it hard to not see it from their eyes.  Maybe because I am living it from the other side (when I can be there or at least vicariously).  Also maybe because I fear that one day I will be that family member or even that person.

I know it won’t be the last letter I write.  Or the last person with memory deficits I see.  I hope it will get easier, less personal.  But at the same time, I hope I keep the empathy.

Birth control can kill you, but so can pregnancy… Or life.

I went on Facebook yesterday evening and my head exploded.

Image from uproxx.com.

And no, it was not a stroke from birth control pills.  Although, I will be the first to tell you that I am at increased risk of stroke because of them.

It was a related topic, though.  The headline cited from CBC news on at least four of my NON-MEDICAL (please note) friends was “Yaz, Yasmin birth control pills suspected in 23 deaths” along with statements from the poster that they stopped taking their pill or were putting this warning out to protect their friends.

Image from litteratursiden.dk.

I had to read the article.  As soon as I read the title, I told Patrick that this was totally because some crazy person or people decided to sue the drug company because they had a stroke or a pulmonary embolism (blood clot to the lungs).  I was right.

It is actually a sad story, a young girl died from a massive PE while working out.  I feel badly.  It could be one of my friends.  Now, her family decided to sue the drug company that produces this particular pill and are entering a class action suit with a bunch of other people and families who have had potential complications from the pill.

I am not belittling the consequences of a PE or stroke or even a DVT.  The first two can kill you and all three can lead to requiring lifelong anticoagulation, which is in and of itself a risky treatment.

This article reports that Bayer, the producer of this particular OCP that contains a novel progestin (aka a different compound that mocks progesterone in the woman’s body) that is sometimes easier to tolerate has paid out millions in lawsuits in the U.S.  It also reports the Health Canada findings of reported deaths and serious events due to these particular oral contraceptives as slightly higher than others.

Then, today, to top everything off, I see a CBC community blog reposting some of the comments and social media backlash from the report.  Most of the article reiterates a few of the horror stories of people who did have clots and a few who are glad to have changed pills or want to change pills.  Then, at the end, they acknowledge that some people pointed out that with any medication there are risks and benefits.

And this brings me to my discussion of the article.

Let’s start with some science.

Image from evolvefish.com.

I know, what does science have to do with this, our lives are at risk!?!

Seriously, science is key here.

Blood clots are normal things are bodies make all the time.  Clotting is super complicated (and fascinating) and I am not going to get into the details.  Sometimes, our bodies clot too much and that can lead to clots forming in places we don’t want them to… Like our brains or in our legs.  And those clots in our legs can break off and get stuck in other places that are dangerous, like our lungs.

Image from bbc.co.uk.

A bunch of things put us at increased risk of clotting.

I checked out a few sources that quote clot risks for your average non-pregnant, non-OCP taking female from 1 to 4 in 10,000.

Some people have genetic alterations that put them at risk.  There are certain proteins that, when present make you more at risk of forming clots at baseline.  Just a crappy genetic hand.  If you have a few relatives that have had “unprovoked clots,” then you might too.

There are other things that provoke clots… Stasis.  Aka sitting around and doing nothing.  Long distance travel, for instance.  Sitting still for flights greater than 8-10 hours, for instance is quoted as a 0.5% risk for all ages not in a high risk category.  Or following surgery or a long period of bedrest, average risk women are at anywhere from a 5-10 fold increased risk of blood clots.  Some non-hormonal medications increase that risk.  Obesity and smoking each have been quote to almost double the clot risk.

Now we move on to the hormonal stuff.  I found this fabulous post here at The Blog Who Ate Manhattan if you are a visual sort of person.

Oral contraceptive pills and other hormonal birth control contain different quantities and formulations of hormone.

I will be the first to admit that studies offer varied accounts on the rates of side effects and clots are no different for this.  Different studies have different reporting criteria and sometimes rates are grossly underestimated, although overestimation is also possible depending on the age and risk group assessed.

Image from nationalnursingreview.com.

Your traditional OCP pill (like a tricyclen or evra) have a 3-6 per 10,000 risk of clot.  OCP with the novel progesterin like Yasmin have an anywhere from 3-9 in 10,000 risk of clot. The interesting piece with the OCPs is that clot risk is highest for the first year and then does drop a bit.  The patch also has an increased clot risk of anywhere from 3-10 in 10,000.  The ring increases risk too with a 3-8 per 10,000 risk.  Progesterone-only contraceptives are some of the only ones that don’t have evidence for increasing clot risk with rates from 1-3 per 10,000.

But wait… Pregnancy is the highest risk of all hormonal risks.  It increases the risk of clots up to 5 times.  FIVE TIMES!

A lot of numbers, I know.

image from nl.123rf.com.

So, to sum it all up… Everyone is at risk for blood clots.  Our risks increase based on the combination of risks we are at.  For instance, women over 35, especially those who smoke are almost never offered combination OCP or patches because that would put them at a rather significant clot risk, especially if they decide to go on a long flight and not move.

And yes, numbers do suggest that people on OCP are at increased risk of clots.  And that women who choose Yaz or the patch or the ring are at some increased risk of clot compared to others.  But then again, pregnancy is much worse!

So, hmmm… Are there lawsuits against other hormonal contraceptive drug companies?

Heck yes.

My research for this post shows that there are class action suits in the US against what looks like most drug companies who produce whatever hormonal contraceptive, but especially the higher risk ones… The Yasmin family, the patches and the vaginal rings.

But, I question this practice.

I also wonder why women don’t start suing their male partners for making them pregnant and increasing their clot risk.  I shouldn’t.  It probably has been done.

All medications have risks.

I have heard people tell me that they don’t want to put anything foreign into their bodies.  But, even taking a supplement can be potentially toxic and even Tylenol has risk and adverse reactions.  Sure, some things have significantly more risk.  But, if you are worried about that, you weigh the risks and the benefits.  Use some common sense.

Image from jantoo.com.

When I prescribe birth control (which is rare given I am an oncology resident), I like to have a discussion to assess for other clotting risks and regarding the risks and benefits of the medication as a whole.  I was taught (and was under the impression) that physicians ask about things like smoking, high blood pressure, family history of clots and migraines with auras to work out the risks that could happen when on a hormonal contraceptive.  I will be the first to acknowledge that we in medicine could do a better job at explaining risks and benefits of drugs, but I also need to point out how many drugs there are and how tight time is.

Clotting is a KNOWN risk of hormonal contraceptives. And therefore taking it, to me, acknowledges that increased risk.  Just like you might also get nauseous, have spotting or gain weight.  Just like people who take asprin may bleed or people who take antibiotics may have an allergic reaction.  There are rare adverse events and there are common adverse events.  You always discuss the common and the life-threatening rare.   And you weigh the risks.

Clotting is also a known risk to being human.  So, really, it is sometimes difficult to attribute every complication to the pill, even if a woman is taking it.

I will be my own example.

I have no clotting risk factors.  But, I have migraines with aura.  Having a migraine with aura puts me at double the risk of stroke than my normal counterparts (stroke risk in women 15-34 is somewhere between 2 and 3 per 10,000).  Adding a combination hormonal contraceptive to the migraine pot increases that risk to anywhere from 11-23 per 10,000.  Pregnancy will increase my stroke risk to similar or greater odds.

When I learned this, I opted to take a progesterone only contraceptive.  It is a bit less effective and more use dependent, but it was worth it.  Will I still get pregnant?  Hopefully.  Risk versus benefit.  Baby>stroke risk.  OCP (that potentially worsens the migraines anyway)<stroke risk.

If I were to take a combined OCP, I could have a stroke.  I could also have a stroke without taking it.  But, who can say for sure.  It is just a probability.

The media likes to sensationalize things.  And people freak out about stuff.  And thus this makes great news.

I don’t like that the people of the media or society who freak out about crap like that is that they don’t think of the other reprecussions.  I mean, sure they are making people aware of the risk and maybe stopping a few people from taking a fine medication and thus decreasing their clot risk slightly.  But, they are also making people come off of a medication that works for them just because of heresay.  Everyone gets side effects and now many will catastrophize them because of this.  Some people will get worse side effects from a different pill.  Some people will still get a clot.  And many people could get pregnant because of their fear of the pill.

Does the cost of unwanted pregnancies that have risks of their own outweigh someone’s need for repayment, the media’s need for publicity or even a few complications (as terrible as that sounds)?

So, this whole news thing makes me crazy.  Everyone is coming out of the woodwork with their problems and their cautions.  These are KNOWN risks and KNOWN problems.  They are much less than the issues that arise with pregnancy and those that arise in people with unwanted pregnancies.

Plus, it is fostering further mistrust in the medical system.  I will be the first to acknowledge the system isn’t perfect and we make mistakes, but it is unfair to put such fear and paranoia into people.

Image from vitalia.pl.

If you want to make an informed decision read legitimate research, not news sites and private blogs (seriously, don’t take my word for it).  Talk to your doctor and your pharmacist and weigh your options and your personal risk.

Sometimes bad stuff just happens even if every other risk factor is 0.  And sometimes you can have a giant “hit me” sign on your chest and be fine.  Such is life and biology and probability.

I wish people didn’t have to hurt, but I wish they wouldn’t inflict such wrath while trying to get “justice.”

Who am I again here, where am I supposed to be and what should I be doing?

There was this horror movie a few years ago.  I can’t remember what it was called.  It isn’t like I watched it.  But, for some reason, every movie we saw one summer had it as one of the previews.  There was a step-dad in this family and at one point he is telling his wife something “or I wouldn’t be [so and so]” and then she looks at him strangely and he says “who am I again here?”  Freaked me out to no end.

Patrick still quotes it to me on a regular basis.

My Grandmothers both have Alzheimer’s and my family is expert at the who/where am I again questions.  They come up more often than not.  It is just kind of a part of life now and we make light of it.

Today, I had a “where do I need to be?” kind of moment.

Image from hanyangchirps.blogspot.com.

I looked at my clinic schedule on Friday and noticed there were some sort of presentations happening this morning.  I showed up to work early to do some post-call documentation and when I wandered to where I thought the presentations would be, I discovered they were not there.  In fact, I had no clue where they were.

I wandered and looked sad until I found someone in the clinic who knew where they were.  At the hospital.  Ugh.

So, I call Patrick back.  Thankfully, he wasn’t working this morning and he takes me to the hospital.  Where the presentations were in one of two possible places.

I found my way there.  It all worked out.

I was pretty ticked off this morning.  I like knowing what is going on.  And that really threw me off.

The thing is, it happens all the time.  Where am I going again?  Who am I working with?  What am I doing today?  These are especially common questions when you wander service to service.

In a way, I feel like I have adjusted to the lost feeling.  I have mastered the awkward hover.  I have developed skills in tracking down lists and information missing when people fail to communicate.  I have adjusted to feeling like I just don’t know what I am doing or where I am going (okay, not quite, but I try).

I have spent chunks of days looking for people.  Holding up walls is a skill I should put on my resume.  There are days where I feel like a detective trying to piece together the email of the person I am supposed to meet or deciphering based on previous sightings start times.  I have in the past gone from clinic to clinic begging for someone to let me do some work.  I have powerwalked from lecture room to lecture room prowling for a particular talk (the ability to stealthly enter, eavesdrop and exit is highly coveted).

I suppose these are good life skills to have.  That things aren’t always so cut and dry.  Sometimes it feels like you just wander the desert aimlessly.  That sometimes we have location/scheduling identity crises.    The key is to try to be proactive and avoid them where possible (or at least be early and be prepared to be stuck late).

The big bonus is that they generally aren’t because my husband is secretly a serial killer who marries random people (at least not that I noticed).  They are just because I am going through a series of rotations (that may or may not be trying to kill me… The jury is still out on that one).

Stranger

I always seem to be behind on the Daily Prompts… Probably because I don’t seek out to do them, but every once in awhile one of them catches my eye… This is the second one this week… Crazyness.

The prompt I am choosing to follow is entitled “Stranger.”  It asks, “Have you ever had a random encounter or fleeting moment with a stranger that stuck with you?”

My response is heck yes.

I tend to attract random encounters.  I am the person who talks to people on airplanes, helps you find an item in a store or runs head on into in the hall.

This particular encounter played a massive role in me settling into Nuc Med and into Medicine as a career.

I call it a God-moment.  Some people call it fate.  Others randomness.  Whatever it was, I am grateful for it.

So, flash back to February or March 2005.  I am a first year Science student, it is the one afternoon a week I don’t have class and I pick up a flauta from the nice man at the City Market (who is still there, might I add) and hopped on the bus back to the hospital.

It was the day of my Nuc Med interview.  If I got in to this program, then I would transfer degrees and I would be set for a career at the end of this.  No pressure.

I went to the hospital cafeteria to kill time and eat my flauta.  It was super busy, but I found a seat at a table for two that overlooked the lobby, hauled out my flauta and a book, popped in my headphones (aka my anti-social devices) and planned to kill the next 30 minutes studying for whatever quiz was upcoming (and trying to ignore the serious case of butterflies I had).

This adorable elderly lady came up to me with her tray… A sandwich and tea.  She asked if she could sit with me because the place is packed.

In my head I wanted to tell her no.  That the last thing I wanted to do was share my table and actually possibly have a conversation.

My Mother did not raise me to say such things.

So, I invited her to sit down.

She was stressed.  Her husband was in the hospital.  Cancer and there was something wrong with his heart too, she thought.  He went for tests, so she came down to eat something.

She asked what I was doing there.  I told her I was there for an interview.  She didn’t really understand what for and asked if I was going to be a doctor.

This was something I was toying with at that time.  It was a possibility.  A distant one, but something that had bounced around in my head.

I told her maybe, but that this interview was to be something like a person who does x-rays.

She then told me about how wonderful everyone was with her husband.  She assured me I will be a wonderful doctor and that my interview would be fine.  She then went on her way.

I never saw her again.

I thought the encounter was a bit funny.  I thought it was just an old lady not understanding that I wasn’t going to be a doctor.  That I might actually wind up becoming and engineer or some sort of scientist.

She did make me feel more at ease.

The interview went well. I got in.  And years later I became a doctor.

It sounds silly, but I felt like God stuck her there to encourage me.  To keep me from freaking out.  And maybe to keep me pointed in that direction.

I wonder what became of her, and of her husband.

I may never know.

But, her simple words, that random encounter sticks with me.

Genuine Feeling Placement

I sometimes struggle with being genuine with people.

I don’t want people to feel sad or take on my hurt.  I also don’t always know what to say.

This weekend, we were home and I was being asked every seven seconds how work is going, what rotation am I on and then when I say Peds Onc they gasp and tell me how terrible or difficult it must be.  I don’t like to burden other people with my feelings, so I always smile and say things are going well and that I like Peds Onc.

It isn’t like I am lying.  I am doing well on my evaluations, things are going smoothly at work and I LOVE peds and I LOVE oncology, I would even say I LOVE Peds Onc.  But, last week was a bad week and there is only so much life-ruining, hard-hitting stuff one can deal with before a person gets feeling down.

My honest answer this weekend should have been that Peds Onc broke me.  That my week was awful and yet amazing.  But, I think that would freak people out.

I have been having problems verbalizing that.  I just don’t really know where to put what I am feeling, how to process what has happened and then say it in a way that doesn’t make me burst into tears or put off other people.  Plus, to top it all off, I don’t want people to think I am weak or can’t handle it, especially when it is something I think I could do for the rest of my life as a part of my practice.

So, all weekend, I smiled and answered in half-truths and avoided the meat of the issue.  I tried once or twice to verbalize it, but I am not good at that at the best of times.  I am the person that people go to with their problems.  I am not good at being the person that goes to others…  And often when I try to bring up how tough it is, that just gets turned around into a how tough the other person would find it or some other random thing.

It gets frustrating sometimes.

Patrick tries to get it, but he admits that he can’t.  I have other resident friends, but their experience and outlook are obviously different than mine, although they help.

I don’t know where to put what I feel.  I can’t process telling 15 year olds about relapsed cancer and having parents who are at a similar age and stage in life break down crying because their baby is sick.  I in one breath say cancer in kids is very curable and in another realize that that means nothing to the child who isn’t cured.  I am having a hard time trying to figure out what to do with it at the end of the day.  I normally am fine with that kind of stuff.  I accept death as a part of life.  Illness as something we go through.    I have cared for people my own age before… But, the kids scare me more.

I keep imagining what if they were my kids.  I keep worrying about my unborn baby’s potential to develop a neuroblastoma.  How we would cope with months of chemo and surgery and radiation.   It breaks my heart to see any kid sick, but the thought of my own child being sick paralyzes me.  It actually causes me to reconsider having kids (just for a second).

I have a hard time processing because despite how much the bad stuff sucks when people are little and young, I feel guilty that I don’t have this tough a time in the adult world.  At least not always.  I can rationalize the treatment potential.  I can more easily accept that adults die, sometimes young.  Adults seem less helpless, even if sometimes that is untrue.

I have a hard time processing because it is difficult to see God in some of these situations.  I step back now and I see Him everywhere, but sometimes in the moment, even after the moment, I question and that scares me.

I have a hard time processing because I am supposed to be able to deal with this stuff.  And I want to do this in my practice and how can I do that if I get upset every time a kid gets diagnosed?  I know compartmentalizing is not healthy, but there needs to be some degree of this to function appropriately.

I felt as if I was broken.  I felt sad.  And yet, I was loving my job, which made me feel a bit more awful in a sense.

Some of this is because it was a busy week and I was tired.  But, some of it is because I care.  Some might argue I care too much.  I like to think I am human.  But, my human-ness needs to take a breather sometimes.

I don’t know where to put these feelings.

But I am glad I have them.

I am glad I can try to put myself in other people’s shoes… Even if my perception isn’t always accurate.  I am glad that I can bond with a little child over “Toopy et Binou”, that a Grandmother can feel comfortable spilling her guts to me, that most kids do get better and grow up and do things just like me.

I need to take care of myself.  I can’t take it all on myself.  But, it is good that this bothers me.  And that I love it despite that.

So, no, work isn’t a cakewalk, but it is going well.  I am on Peds Heme/Onc and my heart breaks for these kids and families every day, but I still smile more than I frown and I am happy and am enjoying myself even though I sometimes feel sad.

So yes, I was down this weekend.  And yes, I find it frustrating that I can’t always effectively verbalize how I feel, especially to people who are just asking a general question.  Sometimes I just don’t feel like talking about it. And that is okay.  Sometimes, I come home and cry a little and that is okay too (although I probably won’t admit that to your face).  Interestingly, despite all that, I am kind of  happy except that I feel I have to lie about how I feel overall.

The good thing is that this work does make a difference.  Even when the outcome is not what we like to see.  And I love kids and want to see them live as fully as they can for as long as they can.  Because that is what it is really all about.  That is why I want this potentially incorporated in my practice

Everyone feels down sometimes.  Different things eat away at us.  It is interesting how sometimes the very thing that breaks your heart can also be a thing that brings you much joy.

I don’t know where to put these feelings.

I just wish I had a word to honestly explain them.

Cheerful

I have been told I have a high baseline.

I am a cheerful person.

I remain happy and positive when other people get bitter.

I do have my bad days.  I get sad like everyone else.

I am empathetic to a fault.  I put myself in people’s shoes to the point that I reflect and dwell on tough stuff sometimes too long.

Today, for the second time in my life, I was told today in a simulated communication session I am too cheerful.  That it puts people off in difficult situations because I seem like I am too busy frolicking through my day to really seem that I care.

I never want that to be what happens.  I care greatly for people.  And although my personality follows me, I have always thought that it shows through and that I seem caring and empathetic when I need to be.  Patrick jokes I have a “serious doctor voice.”

I would think if it were actually a problem that this would be feedback I would get more often.  That it would be a problem.  That I would notice it puts people off.

I adjust based on situations.  But, I am still me.  When I walk into a room, until I gauge a situation, I am who I am.  I adjust my tone of voice, I grasp when things are grim or sad.  But, if I don’t know for sure, I will offer a smile and an upbeat greeting.  It just seems polite to me.  You can be professional and empathetic, but also be a happy, positive person.

Do I really need to check my personality when I walk into a room?

Patrick thinks no.  And that if it were a real issue, it would come up more.  That I probably charm more people than I offend with my sunny disposition.  That I have always seemed appropriate when he is around in tough circumstances.

I get that personalities don’t always click.  And I am in a learning setting, so people will give feedback and not always agree with how I approach things.  Especially when that is what they are specifically looking for.  And I get sometimes I come on too chipper.  But, most of the time, does that colour an entire encounter?  Especially when I adjust based on the circumstance?  Or at least I thought I did.

How do  I process that when every other time, including the other three situations in this day, I have had nothing but praise (and of course, some more minor basic approach feedback)?  When the verbal feedback starts with pointing out that my personality is probably “cheerful”?  And basically only included that I was too cheerful coming in and initiating our conversation and how that colored our entire discussion that was too serious to start with such a friendly introduction.

I felt that the scenario didn’t go as well as I would have liked because I felt I didn’t have as much time as I would have liked and wound up trying to almost rush part of it… Because I tried to take more time to flesh out other stuff.  Because I thought that piece was as important as some of the later discussion stuff that in real life would be a dialogue over time or at least beyond the 12 minute timeline.  But I took that extra time early on for the other stuff because I care… That much.  Even if it is imaginary.

I didn’t cover everything because I ran out of time.  So, I didn’t get every tick box.   I didn’t miss stuff because I was avoiding it.  I missed it because I was trying to communicate effectively about the issues at hand.  And if it were graded, I still would have passed.

But, it bothers me.  Because I could have done better in that regard.  Had I had more time.  Or managed my time differently.    Yes, we have time limits.  Yes, there are ways to be efficient.  That is a fine thing to work on.  But, some things are just so important I think we should take our time.

But it bothers me more that cheerful disposition threw the person off…  Made them feel like we didn’t have a partnership.  Maybe made it more difficult to share.

I would never want that.

What if that happens other times and I don’t know?

When I was in Med 1, I had an SP tell me that I was too cheerful during a physical exam session.  That I should consider toning it down a notch sometimes.  But that it is good that I talk to people.  Just that I don’t always have to seem so happy to be poking them in the thyroid.

That is also how I sound when I get really nervous, interestingly enough.

I asked for feedback on my cheerfulness with others and there was no complaint the rest of the year.  So, I figured it was okay.  So long as I don’t let myself get too nervous.

In this case, I shifted when the mood shifted.  At least I thought so.  Initially, I was my chipper self, but I adjusted when we got serious.  I thought I adjusted to the mood in the room.  My voice was still too sunny early on, though.   Maybe I missed the boat?

But, do I really need to change my style?  Do I have to change me?

Or do I just chalk it up to a difference of opinion?  A one-off event?  A bad moment on my part or the person’s?  And maybe some nerves?

Or maybe it is somewhere in between…

The whole thing makes my head hurt.  I don’t know how to grapple with it.  Except to take it at face value and try to more consistently subdue myself before going into unknowns.   I don’t want to lose myself in the process, though.  Generally, it works for me.

I want to do what is best.

It is only the second time I had someone comment on my cheerful disposition negatively.  But, it hurt my feelings.  As foolish as that may be given the circumstance.