Alternative

This article “What Do Doctors Say To ‘Alternative Therapists’ When a Patient Dies?” by Ranjana Srivastava appeared on my Facebook newsfeed yesterday.  I couldn’t resist reading it.  I think you should read it too.

First of all, it is clear I am a big nerd when this is the most eye catching thing I saw on Facebook.

But, the big reason it is eye catching is because I was curious what it would say.  And it said what I thought it would.  We say nothing.  We don’t talk about it with others.  We talk about it amongst ourselves.

It also echoed a lot of feelings I would describe having around alternative therapies.

I am probably one of the more “loosey-goosey” of the people in my department when it comes to alternative therapies.  I am touchy feely, I inherently trust people and I do believe that there is value in a lot of things we can’t or haven’t necessarily studied.  I’m that kid who did a presentation on medical marijuana in research rounds and concluded that it isn’t all bad and we really need to look into the stuff more because people are using it whether or not we think they are or should.

I ask people what they take over the counter or with supplements.  I explain why I ask.  You see, some products, although “natural” act in ways that counteract the actions of chemotherapies or radiation or other drugs.  Sometimes in terribly harmful ways.  Ways that make cancers not respond to treatments.  Or ways that make side effects worse.  I ask because I care.  Not because I want to judge you or make you feel foolish.

Actually, some of the drugs that we give people are “natural.”  Some chemotherapies are plant derived.  They are natural and very toxic, but when used appropriately can treat cancers.

I see nothing wrong with trying something different when nothing is working.  I see nothing wrong with adding things that have low risks of harms that may help.  I see nothing wrong with doing things that are healthy for you.

I do see something wrong with people who are encouraged to spend their life savings on a “miracle drug.”  When people risk their lives to procure enough cannabis to make the oil they were told online was a “cure.”  When people entrust their health to internet “doctors” and people who make a profit from preying on the sick and the scared.

Many of the “miracle” agents on the internet are anecdotes.  Sure, everything starts as an anecdote.  But, that is why things are tested, because we are often wrong and they are one-off events.

There is some laboratory in anecdotal data about cannabinoids.  I’m not refuting it.  I’ve read it.  But, there is no cold hard evidence for it as a cure for cancer in humans beyond the odd case.  Could it be coming?  Maybe… But that day isn’t today.  And there is cold hard evidence for other treatments in some cancers.

It scares me that some people believe the person that will make a fortune off of them buying their concoctions is more trustworthy than the person who makes the same amount of money whether or not they take the treatment.   It upsets me that people think I am the one brainwashed because I am offering medicine with evidence behind it, with the experience of time, the monitoring of governing bodies and the backup of provincial funding.

It terrifies me to know that supplements and some complementary therapies (not all) are not regulated at all.  In fact, often they aren’t even containing what they claim or have contaminants that can be harmful.    And people die from complications from these therapies.  Just like conventional medicine.  But in a lot of cases we don’t even know some of the risks.

When something claims to work almost all of the time or have no side effects… It probably isn’t for real.  Too good to be true is something I see a lot.  But people want it to be true.  And why not?  Some people have nothing left to lose.  But really, everyone has something to lose.

It also makes me sad that some of my colleagues think all complementary or alternative therapies are bad or dangerous.  It is scary to see people doing things we don’t understand, so I get it.  And it is hard to trust when people you cared for and gave your all for die, sometimes because they gave it all up for the wrong choice.

Miracles happen.  There are things we don’t understand how they work, but they do.  There are things we know do work and they scare some people because of misinformation or lies spread through all kinds of media.

When people forgo conventional treatments or risk counteracting treatments for something advertised on the internet or sold by an alternative provider, it makes me uncomfortable.  I’ll be honest.  When people die doing this, it makes me sad.

Complimentary and alternative therapies can be many things… I send people for massages, acupuncture, reiki and I think chiropractors do good work. I encourage spirituality and  and exercise.  I preach good diets and appropriate vitamin supplementation depending on need.   I think cannabis can be an option for some people for symptom control.  I am okay with you doing something else so long as it isn’t putting you or your treatment at risk.  I can’t stop you from doing something I don’t agree with or trust because you are your own person.  But, I can be honest and tell you why it is concerning.  I can review the evidence.  I can help you interpret it because I have a background in reading that kind of stuff when many people don’t.   I’d rather know than not know in any case because your health is important to me.  And I make no gains or losses by having someone take “my treatments.”

I just want people to be healthy and safe.

Conventional medicine can’t save everyone.  Neither can alternative medicine.

It is scary, but things go wrong.  Alternative therapies (namely the various supplements and drugs and cleanses) can cause a lot of problems.  But, we don’t talk about it when things go right.  We also don’t talk about it when things go wrong.

Talking would be a good start. Regulations would be wonderful.

There will always be people out there trying to make money and preying on the sick and vulnerable. Sadly, these people give everyone a bad reputation and are the source of my distrust and skepticism.  I know there are practitioners out there who think they are doing good and maybe are not.  That is where better regulations and research could make a change.  And I know there are practitioners out there doing amazing work with the best interest of the patient at heart.

An open mind is good.  Educated professionals are better.  But, I think that opening up the lines of communication between professionals but also with patients could make a movement towards making a difference.  At least in some cases.

Teacher, teacher

I’m doing an education elective this month.

I have almost always wanted to be a teacher (and an author).  Well, after I got over the wanting to be a vet (my parents quashed that dream when I was about 4 when they informed me that if I was a vet, I would have to take a bath every day) and work at KFC (I was a chubby kid who really liked the way it smelled, despite the fact that I was informed I would no longer like KFC if I smelled it every day… I didn’t even have to smell it everyday to develop a dislike for KFC as an adult).  Honestly, medicine came much, much later in life.

I realized as a teenager that I hate kids in mass, so perhaps teaching elementary or middle school was out of the question.  I also realized science was very fun.

Once I hit medicine, though, I came to this crazy realization that maybe, just maybe I could “have it all.”  Who knew doctors teach?

Probably most people.

But, the fact that it could be my reality blew my mind a little.

So, I have always thought teaching was important.  I tutored in med school, mentored new students, all that stuff.  And now, I am doing an education elective and launching some new education related stuff in my department.  It has confirmed that I want to teach more.  I think I might even start working on my masters in the next year or two (depending on how this whole juggling residency and baby thing goes).

The funny thing is about the elective is that, for the first time in a long while, it is like being a student again.  Sure, there is no call and my hours are a bit more set, but I have assigned readings and projects and assignments.  Plus, the studying/prep for my usual program academics.  I forgot a bit what it was like to be a “real” student.  I have a love-hate relationship with being like a “real” student.

My focus is suboptimal.  Lectures from 8-12 and 1-4:30  That is a lot now.  Friday afternoon half-day is like torture and that is just 1-5 one day a week.  Plus, the degree of interaction is much more than I’m used to.  Group work?  Heck, usually my whole program is the size of a group they have me working with.  Non-clinical assigned readings are novelties.  Doing assignments and writing papers are things I do much more rarely now, but they are becoming regular occurrences.  Presentations and teaching practice prep is similar, but different.  And then there is switching focus completely to study for my usual departmental half-day stuff and exams.

That being said, it is neat to learn more about being a better teacher.  And knowing that it is something I can do.  And will do.

Seeing the enthusiasm of the Med 1s in tutorial and how everything is challenging and exciting is super cool.  Learning about what always seemed to be the top secret world of designing OSCE stations and training standardized patients makes me realize how much goes in to our learning.  Finding ways to make things better for newer trainees is encouraging.  Even figuring out how and why I learn the way I do and how to make that work for me is useful.

Most of my friends are teachers.  Heck, I’m married to a teacher.  And I am realizing that in more ways than I originally thought, I am a teacher too.

I know, I’m a huge geek.  But, I’m okay with that.  Just humour me.

My Study Buddy

I’m studying.  Again.

You see, I have another sporadically scheduled treatment planning exam this Tuesday.  I had one last Tuesday (which got cancelled… And has yet to be rescheduled… UGH).  It seems that I have a “get me to do something” sign taped to my face.  This week’s topic is Rectal Cancer.  Last week’s was Small Cell Lung Cancer.  We can’t get much further apart.

I spent my morning picking up a few things at the grocery store and cleaning (ah, I do love a clean house (just don’t look in the guest/to-be-baby room or our room)).  I have mac and cheese in the slow cooker and the oven preheating to make some veggie crisps (looked like a good idea on the internet).  Patrick is playing Wii with his little brother with Big Brothers Big Sisters (great organization, by the way).

I decided to hole up finally and get some studying done.

I can’t study on my own anymore.  I have these two study buddies.  One goes everywhere with me, thanks to a little thing I call the placenta.  The other is the feline that can only travel as far as the confines of the apartment (hypothetically).

Jeter has a strange obsession with sticking nearby.  Today, he passed out on my textbooks.  Including the one I wanted to read. 10325749_10153286555099316_5885870976480320603_n

Silly cat.

Plus, the placenta attached study buddy is having a small dance party in my uterus.

Clearly these folks are not the best study partners.  They did not get the memo.

So, I’m updating my phone and my laptop and writing a blog post.  With a textbook open in front of me.  If it is open, it at least half counts, right?

Positives in the Tunnel

I wish I could say there is a light at the end of my tunnel of insanity.

But alas, there isn’t one.

Sometimes being a resident and a wife and having a life is discouraging.  Sometimes because it is so hard to do it all.

But, on a bright side to my frustrations, I do have a supportive program.  I may have a million expectations and things to do.  But, it is also a place where the staff person I worked with on call this weekend offered (insisted, really) to take my pager overnight for a few hours so baby and I can get some sleep.  And where I get encouraged to go to appointments and eat.

And I have a supportive husband.  Who picks me up late and is okay with a haphazard supper (again).  Who puts up with my hours of studying and pauses the TV when the pager beeps and who lets me take the car when I have a chance to go to a church ladies’ movie night.

Plus, I have outside friends who try to get it.

And a kind of cuddly and entertaining cat (with a bald spot that is finally growing in (that is a story for another time)).

And of course, I have a great Saviour who is the reason I can do and be all of these things and get through the day.

There are lots of things to be thankful for amidst the crazy.

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.

Head and Neck

I got an email with the topic for my very first treatment planning exam.

Aside… A treatment planning exam is an oral exam where we get grilled on our management of patients from presentation to treatment and follow-up to help us practice for our licensing exams at the end of residency.  It can include basic questions right up to referencing why we do treatment in a certain schedule and where a target its. They start in third year, which is where I am now.  They are supposed to start off easier and get harder as time goes by.  At least in theory.

The site is “Head and Neck.”

Agh!

My issue with this?

Head and neck is probably one of the most difficult sites to treat and master.

I mean, we don’t do much head and neck related stuff in med school or even the first two years of residency and then, bam!  I’m treating cancers there.

At least, I have for the last two and a half weeks of this rotation.

I like head and neck.  I have said it is likely a site I’ll want to treat.  That doesn’t mean I feel anywhere near confident in it.

And it is my first exam.

When I opened the email, I just cracked up laughing.

Apparently most people get something like bone metastases from another primary.  Nope, not me.

Maybe it will be more simple than it sounds.

But, I don’t feel optimistic.

It is going to force me to read more.  But, I really was hoping for a relaxing weekend home.

That is how life works.  And how residency works.

Learning is good.  Looking stupid is part of learning.  I just need to embrace that.

Thank goodness Dr. Bond gave me some notes and tips.

I just hope my examiners remember I’m just in third year.

How Did That Happen?: How Did My Job Eat My Life? And How Do I Make It Stop?

It has been almost a week since I last posted.  And what a week it has been…

For this week’s How Did That Happen?  I present How Did My Job Eat My Life?  And How Do I Make It Stop?stethoscopes1

Being in medicine is a time commitment.  I have heard people say it is a lifestyle or a sacrifice.  The guy from the bank who was trying to sell me a credit card called it those things and more.

Those were the last words I wanted to hear.

Usually I feel like my work-life balance is pretty good.  At least half decent.  But, the past few weeks before and after this conference, I am questioning that.  And this week, I had significantly more work than life.

So, how did my job eat my life?

Step one… Work with staff who seem like to take extra consults, at least at this time, and acquire sick inpatients.

Step two…  If something could go wrong with a patient, my computer, my schedule… It will.  And probably more than once.

Step three… The internet never has the information I am seeking readily available.  Clearly, I can’t find a good how to delineate a mediastinum on the internet.  Or good information on BRCA2 in men and cancer screening outcomes.   Lots of random stuff, but not what I want to see.

Step four…  Try to get things done in a reasonable order.  Suddenly everything less important will become a priority.  And get rescheduled.

Step five… Someone will send you an assignment for half day the night before.

Step six… The number of inpatients will increase nearly exponentially over the course of the week before you are on call.

Step seven…. Lose all sense of organization on your desk so that it is covered with papers that need to be filed, organized or shredded.  Get distressed by this whenever you sit at your desk then waste time trying to figure out if you have time to deal with it.

Step eight… Realize that your job has eaten your life and that you haven’t been home before 7 all week.  Then realize you are on call for the weekend.  And then worry about one of your inpatients such that you are up half the night even though you weren’t on call that night.

So yes, life eating has prevailed.

My plan to beat this is captured in this picture….

IMG_0429.JPGI’m on call… I can’t undo that.

But, I will win otherwise.

I will eat my delicious burrito and read a fun book tonight… Even if I take pages in between.

I will not work on research or study tomorrow or Sunday because it is already very apparent I’ll be at work a good chunk of the day rounding and admitting and all that stuff one has to do.

I will spend time with our friends visiting from home in between all of the work stuff.

I will say no to the second research project I already said I would work on because it isn’t something I am super excited about and I have other things that might come up.  I will not die because I said no to something.   I don’t have to say yes to everything.  And I was kindly reminded this week that not everything that is work or residency related is necessary because it may not meet my end career goals.

I figured out this week that if I go to the gym by 6:20, I can get a workout in and still be at work for 8.  That means I’m only dragging myself out of  bed an hour earlier than normal.  It still stinks.  But, even if I do it once or twice a week that will increase my gym time, which is great for my energy and health and all that stuff.  That also takes back some of my evening for studying or Patrick or other stuff.

I joined a band.  Small groups are starting up again soon.

I finally got a day planner and it is awesome.  Especially for planning ahead for presentations and classes (when they don’t get rescheduled a million times).

Work will stop eating my life.  At least for the most part.  I just need to be proactive about it.  And remember that some weeks work is hungrier than others.  I just need to make life fight back.

 

 

How Did That Happen: How I Got Through Med School Orientation

I realized today that it is about time for med school to be starting up again.  It blows my mind that about a 6 years ago, I hopped on a plane with 4 giant suitcases and my drugged mother (she was hopped up on cough syrup) to move to the town where I did med school.  Interestingly, I am leaving today for that same city to visit some friends and attend a conference.

I had been there twice before.  Once for my interview and once on a whirlwind room renting hunt.

To be honest, I was less scared of moving or even starting med school.  The thing that produced the most anxiety in me was orientation.

Yes, you got that right… Orientation.

I mean, yes, of course med school was terrifying and being told some of us WILL fail in orientation did not help.  Each first had its own level of terrifying… First lab, first exam, first standardized patient.  But orientation still wins in my books.

Thus for all of you shy, introverted (I say both because they are different) new to everything about a place people, here is my How Did That Happen? for the week.  How I Got Through Med School Orientation.stethoscopes1

I know some people love that kind of stuff.  Socials, dances, sporting events.  Not so much my scene.  I get that some people consider these sorts of events a highlight.  Or at least they don’t dread them. I dread them.  That’s just how I roll.

My med school took the whole orientation thing seriously.  I’m talking a full week of stuff.  And it was “mandatory.”

Seriously, mandatory “fun”?  Sounds like cadet camp all over again (seriously, they had these evenings where we were obligated to attend a “fun” activity like sports (ew) or the zoo (okay the first time, but it was a pretty lame zoo) or a movie (probably a bad one).  We called it mandatory fun night.  It was funny because it was by far not the most fun night of the week (dances or concert nights or parade nights won every time).

Events for this mandatory fun included whale watching (the best part by far).  An 80s mixer (ummm… I like the 80s, but when you stick them in a mixer, not so much).  Outdoor games complete with a slip n slide.  A pub crawl.  Various talks.  Photo scavenger hunt (epic, but not as fun when you don’t know where you are or who you’re with).  Dinner with some Med2s followed by a dance.

I was not pumped.  Except for the whale watching.

I knew one person I went to high school with.  Not well.

70% of people knew most everyone.  They all did undergrads together, they did their masters together, heck, they did all of their schooling together and they live down the road.

Just shoot me.

So, enough whining… I’m supposed to be talking about getting through it.

First of all, I tried to embrace the fact there were other people as lost as me.  I found them.  Found the first one lost in a hall as ridiculously early as I was.  I stuck with them.  She fell asleep on the bus on the way back from whale watching.  I fought the urge to run away.  As it turns out, we sat togther through most of our classes.   The randoms I stumbled upon ended up becomign some of my best friends through med  school.  So, find someone looking as lost and sad as you and say hi.

Realize that med school is like high school.  There are cool kids and cliques.  It did not take me long to conclude I was not cool, nor would I be part of the key cliques.  They were already formed before I even came in.  That’s okay.  I’ve never been one of the cool ones.

Show up for events.  Seriously.  They said it was mandatory, but not everyone came and this ticked some people off.  When you are as shy as I am this is nausea inducing, but it was also how I actually was forced to meet people.  Nothing says get to know people than getting thrown in a 2 door car with 4 other people you have never met to tear around the city taking pictures (especially when we ended up breaking into a more senior med student’s (who I also didn’t know)  house…).

Have fun.  I mean, if you have to be there and people worked hard to plan it, there probably is some fun in there.  Some of our stuff was really awesome.  Other stuff was awesome for people who weren’t me.   Just try to have fun.  Fake it until you make it.  I was pleasantly surprised.

Find out what is okay to skip and know that it is okay to take a breather.  Yes everyone will question your decision.  At least the people who noticed you exist.  But mental health for the win!

Participate.  If everyone is doing something to make themselves look stupid, you might as well do it too.  It might end up being fun, or at least make for a funny story.  My team in these messed up olympics they held won.  We got gift cards for coffee or booze.  It was thrilling.

There is free stuff at some of the events.  Free reflex hammers (which is like gold when you are just getting started and anything “medical” is the best thing ever), free bags, pens and best of all, free food!  Moving and doing a million more years of school is expensive.  Love the free stuff!

There really is useful information in there.  You won’t remember it all.  But they do tell you some important stuff.

If your school is anything like mine, the dean of something or other will get up and tell you scary stats about failures, people crying and people quitting.  This really does happen, but it will be okay.  It is an important reality check, but it does really sting.  Especially when odds are you were already nervous.

Tell yourself it will be fun and okay and all that good stuff.  It will be.  At least some of the time.

Remind yourself that despite the social anxiety and such, this really is one of the most relaxed times in med school.  Embrace that.  The real work is coming.

Remind yourself it is just a week (or less, if you’re lucky).

If you’re from away, it gives a chance to at least kind of figure out how to get to and from school, where some key stuff is and get settled before the real work starts (although the hours were so crazy, it was still tough to get any real unpacking done).

Things like orientations are just a bit awkward.  They end and eventually you know people well enough, you kind of wish you could have done that with the same people a year later.  Not all of that stuff, but some of it.

As much as I think I could have done without so much mandatory “fun,” I really do think orientations are important.  I still say they are overwhelming.  But once it was over with, I had other stuff to worry about, so no need to dwell.

What was your orientation like?  Do you love or hate them?  Do you have any tricks to get through orientations and mandatory “fun.”

Dance Party… Residents’ room edition.

Dr. Bond and I had a mini dance party in the residents’ room yesterday to this song.

Let’s face it.  It is an awesome song.  And dancing is great stress relief.

I am sure the social worker in the office next door thinks we are crazy.  That being said, I am pretty sure she already knows that by hearing some of our conversations across the office.

I have developed a new love for the website rdio.  Partly because the hospital hasn’t blocked it yet and partly because it lets me listen to various playlists and CDs without killing my phone or my pocketbook.

Yesterday was contouring to 50s and 60s music.  

A couple weeks ago, I was working on my research to Boomfalleralla by Afasi Filthy from The Fault In Our Stars soundtrack (ps the movie is almost as good as the book and the soundtrack is equally as good as the book.  I then went down a rabbit hole listening to more music from this Swedish group.  

Another day it was clinic prep to cover songs.

You get the picture.  I really like some background noise, especially when I am doing stuff requiring concentration.  Not everyone else does, but it works for me.  And it makes for some priceless “what are you listening to!?!?” moments, as well as the odd dance party.

Whatever gets the job done, I suppose.   

How Did That Happen?: How I Survive Breaking Bad News

It is due time for another How Did That Happen? post. This one is How I Survive Breaking Bad News. Not how to break bad news. That gets covered all over the place. I’m talking about the facing people later, living the rest of your life kind of survival.stethoscopes1

This one is a result of my week of breaking bad news. I know, I am an oncology resident. More days than not, I break bad news. I tell people about pathology reports they don’t want to hear about. I tell them they have cancer (not always for the first time, but sometimes for the first time they really process it). I tell them their cancer is back. That it isn’t curable. That they need treatments they didn’t want. That they are going to die… Soon.

Breaking bad news is tough. So tough it is its own section in many med school communication classes. So tough most people do a crappy job of it because they are scared.

I’m a weirdo. I don’t love breaking bad news, but I like to do it. Because I believe people have the right to know the truth. And to hear it in such a way it is understood and compassionate.

This week has been especially bad newsy. From clinic to call to pediatric brain tumor clinic, I have delivered or been in on delivering all kinds of crumminess. It wears on a person.

  • It is okay to cry. Seriously. Sometimes, stuff is really tough and you just have to let it out. I’m not saying sob on the shoulder of the person you are talking to, but it is okay to shed some tears then or later.
  • It is okay to be angry or disappointed or relieved. Emotions are good.
  • I’m going to sound cliché, but reflect on it. Sometimes, you say stuff that is stupid or comes off the wrong way and other times it goes well. Actually think back on it, even if it is tough and then learn from it and move on. I tend to really stew on things, so this is something I’m working on.
  • Find the rays of hope. This is also helpful when delivering and discussing the news, but I really mean it is important for me too.   Sometimes, I start to feel like I am the grim reaper or that life is a miserable existence. It is good to find the bright sides, like how fortunate I am, how that person will have a good outcome or good days or whatever. Just something positive.
  • Count your own blessings. If I get really discouraged, I find it helpful to think of how fortunate I am despite the bad in the world.
  • Talk about it. Confidentiality is important to maintain, but there is nothing wrong with discussing it with co-workers involved in the case, or even just your thoughts around it without disclosing details with a friend or family member.
  • Have an outlet. I sing and dance like a fool. Or exercise. Or write. Just something not work that helps get some of that badness out.
  • Do something happy. I like ice cream. Or spending time with friends. Or music. Or books.
  • Mix it up. This isn’t always an option. But, I love that my job involves lots of time on the computer doing technical stuff or research, not just difficult conversations. I also love that there are really good positive things mixed with the difficult in clinics.
  • My faith is super helpful to me at those times too.

What are your bad news survival tips?