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.

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?

White As Snow

The M family has been on the road (minus our guard cat, Jeter). 

Vacation is a beautiful thing.  Especially when it is spent with friends and family (and good books and beautiful scenery).  It is late, we are still away and I am lazy, so no pictures for today.

I just wanted to quickly share a song that has been on my heart.  It is called “White As Snow” apparently, although, I thought it was called “Create In Me” so it took some epic searching to track down the actual song and not some random hymn.  We have been singing it a fair bit in church the last few months and some words in the song are taken from Psalm 51.  

 

 

 

 

Have mercy on me, oh God

According to your unfailing love

According to your great compassion

Blot out my transgressions

Have mercy on me, oh God

According to your unfailing love

According to your great compassion

Blot out my transgressions

 

Would you create in me a clean heart, oh God?

Restore in me the joy of your salvation

Would you create in me a clean heart, oh God?

Restore in me the joy of your salvation

 

The sacrifices of our God

Are broken in a contrite heart

Against you and you alone

Have I sinned?

The sacrifices of our God

Are broken in a contrite heart

Against you and you alone

Have I sinned?

 

Would you create in me a clean heart, oh God?

Restore in me the joy of your salvation

Would you create in me a clean heart, oh God?

Restore in me the joy of my salvation

 

Wash me white as snow

And I will be made whole

Wash me white as snow

And I will be made whole

Wash me white as snow

And I will be made whole

Wash me white as snow

 

Would you create in me a clean heart, oh God?

Restore in me the joy of your salvation

Would you create in me a clean heart, oh God?

Restore in me the joy of your salvation

I have been struggling with anger and guilt and a whole host of other emotions because of a friend and some other crummy circumstances life has thrown my way.  They have come to a head of late and I stated to notice some of my behaviours and tendencies.  To be honest, I don’t like them.  I also realized that although some circumstances are crummy, some people don’t always treat me the way I know I should be treated and some difficulties are bigger than I can fix, it doesn’t mean I can’t pray through them and love and act in such a way that demonstrates grace.  I haven’t been so grace filled.

And yes, I am human.  And yes, I am allowed to feel hurt.  But, it is wrong for me to be bitter.  And I shouldn’t be spiteful (even if it seems satisfying in my head at the time).  Really, I choose how I feel.  And yes, feelings are just feelings, but continuing to fester can be harmful.  And it is sinful.

So, basically I have been reminded that those thoughts, those tendencies, although completely human, they are wrong and hurtful to God.  And in the end, they are hurtful to me and those around me.  But, most importantly, they are wrongdoings against God who has done a ton for me and loves me despite the crap I do.

I don’t deserve to be forgiven for some of this garbage.  But, the cool part is that God has taken care of all that stuff.  A big sacrifice.  And I keep getting second chances.  And that is awesome.  And should make me more excited than it does sometimes.

I really want to be restored to that kind of joy.   The happiness that comes from knowing what I have been saved from and how loved I really am.  I want to move away from some of my harshness and bitterness.  I want to love those who hurt me and those who seem beyond my reach.  I want to be patient.  I know there is no magic switch.  Relationships are hard.  Life is complicated. I’m human.  

But, He is God.  So, He can move me in the right direction better than I or anyone else can.  So, this song is my prayer.

CAPO Review

It is the first Monday of the month and the last Medical Monday until September. Whoo. Time to check out some medical minded/affiliated blogs at the link below.


I am going to use this as an opportunity to expose you to some of the awesomeness I saw and learned about at the conference I went to this past week for the Canadian Association of Psychosocial Oncolology.

All last week, while at the conference, I was so excited, I wanted to tell the internet world about it, but resisted the urge in order to keep people from hating a million small updates about things that may not be as thrilling to everyone except me. But now, I will give a digest of some of the cool videos, tools and ideas that captured my attention at the conference and that I think might appeal to a wider audience.

First of all, every single keynote speaker pointed out that physicians are burnt out and that leads to poor communication, missing compassion and other issues. They also all cited a study of Internal Medicine residents showing that 76% displayed symptoms of burnout or depression. This made me feel depressed. Mostly because I know it is true. Also because I wanted to know what information was out there. So, I found a decent review article (IsHak et al. 2009) on the topic citing burnout rates to be anywhere between 25-76% and that self-care, counseling and system changes might help the residents and in turn improve patient care. Fascinating.

We have a system of health care, but not a system of caring.

Dignity is huge. Studies have shown that the factor that was seen as the make/break point in maintaining dignity was how the individual thought they appeared to others. Feeling dignity is supported if they feel they are being seen as a person and as a WHOLE PERSON, not just a disease.

One speaker talked about a thing they were doing at their hospital where they asked new patients to the palliative care service an additiona question, “What should I know about you as a person to help me take the best care of you that I can?” It changed care for many people.

Breast cancer risk is increased by smokng. But, interestingly, that risk is most increased when people smoke during periods of breast development. So, a group in BC designed videos targeting teens to try to make a change in this behavior. And it is working!

ReThink Breast Cancer is a nonprofit all about young women with breast cancer. They have support groups and events and all that good stuff. They even have a blog.  They also promoted a super cool publication in the form called Cancer Fabulous Diary, which is a book with coping tips and musings for young some with breast cancer.  It is written with the blogger from Cancer Fabulous, which is basically the experience of a young woman named Sylvia Soo who is a breast cancer survivor diagnosed at the young age of 24.

The Canadian Cancer Survivor Network has a webinar series on Thursdays about things like advocacy, drug funding and really relevant political/medical issues. Who knew? They aren’t the only ones though. Lots of other non-profits in cancer care have webinars with relevant topics.

No man is an island.

I went to a series of talks on decision making in older adults with cancer. About how they make decisions, how people get information and how they enroll in trials. Many people factor in their age, even more than providers sometimes expect. Family members are often divided into two categories, the super involved and the not involved. Both can have their pitfalls. Also, subtleties in communication with the provider influence the decisions a great deal. Sometimes the appearance of interest of a physician in a clinical trial will convince someone who was on the fence. Also, older adults cope better with a cancer diagnosis and treatment decision making than younger adults.

I saw a really cool video documentary on sexuality in young adult cancer survivors that addressed a lot of big issues.  The maker of the video is designing a website and taking the show on the road.  Unfortunately, it isn’t up yet, so I can’t show you.  But, it was very real and honest and not sugarcoated like a lot of stuff out there these days.

Psychosocial oncology is cool!

Call Conundrums

This weekend is a call weekend. And tomorrow I am off (after 8 and once I give appropriate handover), followed by a trip half way across the country to present my research. I am excited.

My calls lately have had some odd streaks to them.

For instance, I had one that was, well, a complete surprise.

The program administrator sent me my schedule for the next block including my 5 dates for call in the next four weeks. I didn’t get a copy of the master call schedule, but so long as I knew when I was on call, that is all that really mattered. I could call locating to find out who the staff was.

But, then, I was in teaching one day when one of the staff docs came in and gave me a post-it note, said we were on call together and all his info was there and left. I though it was for when I was on with him that coming holiday Monday.

Then I read the post-it. It informed me that we had 2 beds available, the floor was quiet and that we were on together tonight.

But I wasn’t scheduled for call. So I thought.

Turns out I was according to the board in the nursing unit. And Locating. Apparently, they forgot to list one of my dates when they sent out my schedule. Fail.

So much for a date night out with Patrick.

Call is the worst when you aren’t mentally prepared for it. Even if it is home call. I was rotted.

This weekend, I was super tired Friday night and decided to go to bed early after a very quiet night. I went to bed just before 10 and fell asleep. I woke up to my pager just after 11 with a “I wanted to call before you went to bed” call. Little do they know I am like an old person and was already asleep for an hour.

Yesterday, I was in and out of the hospital much of the day. So much so, the security staff (two of them) got to know me by name.

Also yesterday, I had to go to the university library to use their computers to get access to SPSS, the statistics program I did the stats for my research on. This because I discovered the university only licenses the downloads for one year for staff. And both of my supervisors aren’t around to take the time to email computing services and get a new code for me this week.

I get in to the library, which is strangely quiet and am working away when a random guy comes in and sits at the next set of computers away and starts watching something that was making horrifying screaming-like-someone-was-being-murdered noises and other bizarre sounds. I looked around and nobody else seemed to notice. I questioned whether I was part of a weird social experiment for a bit because it kept happening and he was making no effort to turn down his sound or plug in headphones. The sounds of murder had just stopped when my pager decides to go off. And I get a dirty look from some people.

Seriously? We just heard screams of death and other weirdness for the last 10 minutes and the 2 beeps of my pager it took to turn it off is what earns a look of death.

The cat picked up my pager by its “bungee cord” and dropped it in his litter box this morning while I was getting out of the shower. It was in a clean patch, thankfully. I think he hates it as much as I do.

Puffing

The first Monday of the month and the last Monday of Respirology.

Actually, I quite like Respirology. The consult service is busy, but I have legitimately learned a lot and am now less afraid to mess (constructively) with people’s puffers when they are admitted to me in the future.

I also quite like Medical Mondays. Check out other medically affiliated blogs at the link on the image below.

Since it is the second to last day of resp, I thought I would share this lovely image.

Image from pinterest.com.

I remember seeing this episode and laughing hysterically.

It is so true.

People have no clue how to use their puffers. And they think they do. And they often can’t figure out why they aren’t getting better. But it is often because something isn’t being done right. And often this is because nobody asked and nobody taught.

I know this from both sides of the hypothetical office.

I have been on puffers off and on since I was about 9. I am one of those weirdos that did not have childhood asthma in the wheezy since toddlerhood kind of ways. I developed asthma in my late kid years.

I finally gained control of my asthma when I was in my 20s.

I have CONSISTENTLY PROPERLY used my puffers never.

Okay, never isn’t a fair term. I have used them consistently and properly, but not for more than a few months at a time.

I had a puffer for the odd “chest infection” as a tween. I never had an aerochamber. We figured out how it worked by reading the instructions.

One time, I was prescribed a turbuhaler. That is a puffer that has a powder you suck in. There is no puff of aerosol. We couldn’t figure out why we couldn’t taste or see it (this is before the days of Google, boys and girls), so I took a good 20 hits of puffer before we figured it out.

Google would have shown me this… Instead of just the words on the tube. And helpful tidbits like you shouldn’t taste or see anything. Image from theasthmacenter.org.

I was first given an aerochamber at 14. By this point, my breathing issues were beyond asthma and got into this weird laryngeal spasm thing, so that not only did I wheeze, but I had stridor because I didn’t keep my airway open right any more for some reason that is still beyond me (and probably at least partly psychosomatic).

What 14 year old who audibly wheezes and hacks wants to add to her awesomeness by carrying an aerochamber everywhere?

Not this one.

So, I used it at home and no where else.

It took years of titrations, allergy shots and finally growing up enough to see the greatness of not being sick all the time to finally establish good asthma control. If I had actually used the darn puffers properly all the time, it might have been quicker. Maybe not because there was other stuff at play, but maybe.

Instead, I would take them until I felt well, then I would forget them most of the time until got a cold, which would then linger forever because my airways hated me. That is when I would start taking them properly again.

Now, I have an action plan. I have that figured out with lots of medical education, doctors orders and real experience.

I don’t always follow it. I miss days of my steroid inhaler sometimes. That usually comes back to bite me. I forget to restart my seasonal asthma/allergy medication when Spring comes (seriously, I just realized this now). My aerochamber (that I have had for an indeterminate period of time) has a crack in it (I will get a new one next time I see the doctor), so I confess, I haven’t been using it. And I also confess I never carry it with me.

So, if I, the doctor suck at managing my respiratory illness, I know that  most patients are probably kind of like me too. That being said, I think it is doable.

I mean, it is where your priorities are at…. Breathing is good. The problem is that when you feel good and a problem doesn’t flare that instant, you don’t always think (for instance, I would never skip my migraine prophylaxis because 1 or 2 missed doses and I am out for the count for a day).

What I am pointing out is that puffers are inconvenient. Moreso than taking a pill. If you have an aerochamber, they are bulky, need to be washed and don’t fit in a nice purse (especially if you are me and like to carry a book).

The directions for puffers are variable. Often, I see people who don’t understand why their directions are different from the ones on the bottle and different from their friend. They get mixed up. People don’t understand that one is to keep you well long term and another is for emergencies only.

And don’t even get me started on proper use.

One of the docs I work with said that he suspects 75% of people prescribed puffers don’t use them properly. Mind you probably 20 or 25% of those people don’t use them properly because they don’t actually need them (that is a rant for another day). I’d believe it.

Today, I saw someone grab their puffer from their bedside table and try to use it without the aerochamber with me, the resident working for the lung specialists, standing right there!

I put it together and showed her how it worked. She had never seen it used that way before. Mind you, it had a mask because this person had such bad respiratory distress taking a single deep breath and holding for 10 seconds was out of the question. But, until then, that is what the person tried to do, but couldn’t do.

Image from asthma.ca

That is why I ask how you use your puffers.

Because I don’t always do it right, but I want you to do it right. I like it when people show me up and do everything to a tea and rattle off the proper timing and dosing. But, when you don’t know, I show you.

You can’t get better if you don’t get appropriate drug.

That message is as much for me as it is the other millions of people with respiratory disease.

But seriously, if you would up here looking for advice on how to take your puffer… GO SEE YOUR DOCTOR!

Learning in Ultrasound: A Person is a Person…

I can’t believe how fast February flew by.  It is Medical Monday again, which means time to link up with some other lovely medically affiliated blogs.  Check them out at the link below.

As you may know, I am on a radiology rotation.

A few weeks ago, I decided it was time I go see some ultrasound imaging.  Other aspects of imaging are more comfortable for me (especially Nuc Med for obvious reasons), but ultrasound is my black box, so I figured learning is good.  So, I am doing ultrasound at the hospital where I usually work.  Lots of livers and thyroids and kidneys.

Then, up on the screen pops up a perfect looking 8 week embryo.  Cool, I think to myself, that might be my kid in another four weeks.

Image from babycenter.com.

I then remembered that all of the obstetrical ultrasounds are generally done at the children’s hospital unless there is someone in emerg.  I asked why this ultrasound was done at the hospital we were at.

Its for the TPU replied the fellow.

Termination of pregnancy unit.

My heart sank.

He said I could leave if I wanted to.  But really, this is part of my learning.  Part of life in a hospital and in this world.

I watched him read four ultrasounds of perfect little embryos between 6 and 11 weeks all with heartbeats and the works.  Perfect little embryos that might have otherwise grown up, although it is tough to say for sure because bad stuff happens.

I went home and cried to Patrick because it seemed so sad and so unfair that these babies had to die when maybe they wouldn’t.  It seemed so unfair that so many women want babies so badly and yet here are people who for whatever reason or circumstance don’t or can’t want their own.

Just over a week later, after losing my own baby, Elim, I sat in that department again.

Yet again, I saw babies getting their photo taken to confirm that they were indeed alive (because the procedure is different if they are alive or dead).  I saw one person who had terminated pregnancies 6 times.

I had an overwhelming urge to go in and yell at these people.  To tell them that I am here, working and trying to piece together what is left of my sanity because my baby died before it would have even been very visible on an ultrasound.  That I really wanted that baby.  That it isn’t fair that they get to choose, but I can’t.  To ask a big huge why.

But, I didn’t.

Because that isn’t fair of me (or very professional).

Their baby dying, my baby dying, really, it is all a loss.  Those kids are all with God now.  They all had potential.  They all died because they were made in a fallen world full of brokenness.

That mom may mourn the loss of her child like I do.  Everybody grieves differently.   Maybe not now, but maybe later.  I have heard of the struggles of moms who make that decision.  And maybe she won’t.  I can’t put myself entirely in her shoes.

We aren’t very good at putting ourselves in other people’s shoes.  We are, however, really good at trying to point out other people’s wrongs.

Image from chzbgr.com.

I’m not here to have the pro-choice or pro-life debate.  In fact, I don’t want to hear it because it is often hurtful, overdone and narrowminded on both sides of the coin.  Sin is sin.  Death is death.   Pain and anguish are universal.   We have free will.  That is all on that.

I read this blog post from The Lewis Note called “Why Miscarriage Matters When You’re Pro-Life.”   It was strangely timely based on the adventures of the last few weeks.  Check it out.

I read this post the night after my second day in the ultrasound department when I was really struggling with the value of life and how we see it as a society.

It rocked my world.  Because it is so true, especially in a Christian context, but I am sure it works for others as well.

I have already experienced both the good and the bad sides of this post.  Some people are really nice.  Other people aren’t.  And some nice people say stupid stuff (I sure do).

Thinking on how I responded to people who lost kids at the same point, I think I had empathy and sympathy for both.  I think I did place more value on the aborted baby.  I also think I had more sympathy for that child’s mother because there was action and potential.

Looking at scans, it is the same.  Already dead babies are already dead, so in a way, it seemed less sad than about to babies about to die.

That isn’t necessarily fair of me.

Both an electively aborted baby and a spontaneously aborted baby were both alive at one point and had potential and value.

And then, there is our approach to the mothers and fathers.

Don’t forget the fathers.  Many people do.

Everyone needs love.  It doesn’t matter how voluntary a loss was, it doesn’t matter how old the child was (although this does often impact they way people can grieve and what is considered “acceptable”).  You need people willing to live the grief with you.  To sit it out with you because that is what you might need, even when it is uncomfortable (just like sitting through scans that are upsetting helps us to learn and grow in a different way).

If you claim to care about a person, to care about life, then you should stand by the mourning no matter what they are mourning and no matter how long that what was alive.  If you want some practical suggestions and examples, check out that post.  I am the first person to admit that I tend to project my feelings on others, so if I think something would weird me out, I tend to avoid doing that for someone else or letting someone do it for me.  I’ve learned that I am often wrong and my assumptions were totally incorrect.  If you aren’t sure how to help or love someone where they are at, ask.

I guess I’m learning more than I anticipated on this radiology rotation.

The Blessing and Learning Curve of Gaining and Losing Elim (“ball of cells”)

Image from tochristifrommommy.blogspot.com.

Less than two weeks ago, I found out I was finally pregnant… I called the baby “ball of cells.”  That was my term of endearment.

My medical training made me cautious.  I know that pregnancy does not equal baby.  I know that life is fragile.  I took 3 tests to confirm before I even told Patrick because I wanted to be sure.

It didn’t change our excitement and happiness.  Talking about the future.  Planning for when to tell people. How to make work function.  What we would have to change or do.  Rejoicing.

I knew the longest besides God, of course.  I remember that first Sunday in church when it was still just our little secret thanking God for the new creation growing inside of me and wanting to tell the world and yet wanting to keep it to myself because if others knew, somehow something would go wrong.  The only other person who found out before stuff started going wrong was Patrick and I told him on Sunday night (with what I believe was a very adorable and entertaining card).

Then, we had to say goodbye to “ball of cells.”

I knew something was wrong mid-week.  I re-took a test.  The line got lighter and although this isn’t a perfect system, it wasn’t a good sign.  I told Patrick.

Usually I am the high-baseline, optimistic person.  This time it was him.  He refused to believe anything bad happened to “ball of cells.”  I didn’t want to go to the doctor.  I didn’t want to hear what I already knew inside.  Finally, I went to the doctor who instilled a bit of hope in me instead of flat out dashing our dreams.   I wanted hope.  Cautious hope, but hope nonetheless.

I went for bloodwork.  It was either going to confirm what I thought I knew or make everything better.  I hoped it would make things better.  I needed it to make things better.

Nothing is more bizarre than being congratulated on your pregnancy, being asked about your due date, where you plan to deliver and all that good stuff while sitting there with that gut feeling that your baby is dead.

I didn’t have the heart to tell them.  I didn’t want anyone to feel what I was feeling.

Also bizarre is walking around all weekend not knowing and yet knowing.  It feels surreal.  I have lovely best friends (three of them) who checked in incessantly.  I have a husband who bought me beautiful flowers, cooked me food and was all around over protective.  I don’t know what I would do without them.  I was just glad I wasn’t on call.

Sunday, we watched the Canadian men win the gold in hockey (WHOO!).  Happily, we went to church still not knowing whether we would be parents of a living baby in 8 months.  I was still having some morning sickness and weird headaches, but the acne was clearing up, the cramping was worse and I kind of felt empty.

I prayed for God’s will in my baby’s life and in our lives.  I prayed for strength.  I prayed that we would glorify him in whatever was to come.

We left church on our way to have lunch and board games with friends at our place and there was a voicemail on my phone.  It was my new doctor.  In summary:  My bloodwork was perfect except that my HCG was less than 5.

There would be no baby.

So much for that hope.

It is funny.  I have always thought pregnancy loss was a big deal.  I remember learning about it in med school and thinking how awful it was.  I remember when the first couple I knew miscarried shortly after telling everyone about their pregnancy.  I remember thinking that I didn’t know how they coped with it.

At the same time, I have always been kind of flippant about it, particularly when it comes to me and when it comes to early pregnancy.  I mean, an embryo is an organized ball of cells and odds are there is some sort of genetic flaw that is incompatible with life.  It just makes good scientific sense to clean up mistakes.

I thought calling “ball of cells” just that would make it more clear to me that it may not make it.  I thought explaining to my friends that I was waiting to make sure things were growing or dying appropriately made it all sound more clinical.

But really, there is nothing to be flippant about.

Sure, life goes on.  I know that.  It doesn’t change the hurt of the life that won’t.  Especially because I was one of the only people who really knew it.  And I didn’t even know it that well.  We only got to hang out for about 3 weeks total.  And 2 of them, I didn’t even know it was there.  And it died at some point in the last one.

I feel in some ways like I should care less.  This is technically still a chemical pregnancy (miscarriage before 6 weeks).  It felt different from what I thought might have been my last ?chemical where there was a squinter maybe positive (but in reality probably an evaporation line) and then definite negatives.  It was sad and disappointing, but really not the same as actually existing pregnant for several days when you know something is happening.  It is the difference between thinking maybe and knowing for sure.

It was literally just a ball of cells that wasn’t able to survive.  “It was God’s will” after all.  It was, I guess.  Still sucks though.  Maybe somehow they did have some sort of potential.

I am, in part, glad it happened so early.  Maybe I am less attached than I would have been if I was further along.  People have told me I should be less attached, at least.  That kind of makes me scared for this happening again later in pregnancy.  I have the utmost sympathy for women who loose babies who are more developed and for those who lose children.  At the same time, I am jealous because I was robbed of the experience of even seeing the little sucker on an ultrasound screen.

Sure, I will have more kids.  Sure, I am young.  I know most women go on to have no issues with future pregnancies and get pregnant shortly after something like this.  The statistics are on my side.  I also know I was in the wrong end of the 50% of women who have bleeding in early pregnancy.  Something has to go right.

It is a funny experience telling people you miscarried when they didn’t even know you were pregnant.  Not that we’re telling many people.  It makes them super uncomfortable.  It makes me uncomfortable too (and I often love embracing the awkward).  But, because nobody talks about, I kind of want to.  I know statistically, I am far from the only one to experience this.    I know because, like the big nerd I am, I have read everything I can on the subject.

Because “ball of cells” was so little, I have had a lot of anxiety around whether or not I would see him or her in heaven. Seems silly, right?  I mean, if you believe life begins at conception, of course “ball of cells” was alive and then died.  But, my scientific mind picturing a little cell collection had a hard time picturing my ball of cells chilling with Jesus and my Grandfather.  But, Jesus said, “Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these.” (Matthew 19:14)  Pretty cool, huh.  “Ball of cells” was a pretty little child, so I suppose he or she counts.

As a result of this, I then got thinking that we should give “ball of cells” a proper name because I am sure they don’t want to be known as “ball of cells” for all eternity.  That being said, the snarky and cold side of me didn’t want to name it because, well, that would make it more real and felt as if I was making much out of little.  Also, I could have other dead balls of cells that I don’t know of (most people probably do), so what about them (I don’t know how to answer this question)?  And, I didn’t want people to judge me (I, in the past would have).  Patrick liked the sounds of naming him or her too, so we went with it.

We named him or her Elim because I have been reading Exodus recently and about how God provided water for the Israelites in the wilderness.  Plus, it is a gender neutral name.

I’d love to say I am all better now, but to be blunt, I’m not.

I’m better in the sense that my body is no longer rejecting the remains of my child.  I’m better in the sense that I know for sure now that Elim died and is in heaven now (while his or her biochemical bits are somewhere in the sewers).

Grief is a funny thing.  And this grief is of a variety that I haven’t experienced before.  Even though I am okay with death, this doesn’t feel okay.  And that is okay too.

I’m sad.  I’m still a bit angry.  But, I feel a whole lot of peace and a whole lot of joy, which is a big testament to answered prayers and the awesomeness of God.

I know, you probably read joy and now think I am taking some sort of pills.  I’m not.

This isn’t smiling, frolicking joy.

So also you have sorrow now, but I will see you again, and your hearts will rejoice, and no one will take your joy from you. –John 16:22

It is more the I’m happy I’m okay, Patrick is okay and Elim is okay.  I’m happy Jesus came and that I’ll get to see my baby again, even though I don’t get the logistics because he or she was just a ball of cells.  I’m happy because I feel protected and loved despite the crap that has gone down.

The really cool thing is that I get something more now.  I have just a little bit of a better understanding of how much God must love us.

Sure, I’m still ticked He didn’t fix Elim and I’m not still barfy and headachey and pregnant (okay, confession… I was pretty excited when I was feeling physically well today).

The Lord gave, and the Lord hath taken away; blessed be the name of the Lord.  -Job 1:21

But, if I can love a little ball of unborn cells that I barely know that much…  So much that I am mourning their death… That is pretty huge.

If God loves me more than that, then I can’t even begin to imagine how sad he feels when we draw away from Him, when He loses one of us.

So yes.  This sucks.  I am not alone in this.  Neither are you.  But, I am growing and learning in my relationship with God and as a physician and human from this experience in ways I definitely didn’t expect.  Funny how gifts come in bizarre packages sometimes.

Image from spiritualinspiration.tumblr.com.

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.

On Blogging As A Resident

I can’t believe that it is the first Monday of the month again.  This last month feels like a blur and that is despite the fact that I have been on two of my least favourite rotations of residency (but not my least favourite because gen surg and cardiology will always be worse).

Regardless, it is Medical Monday and thus time for a link-up with other medically minded blogs.  Click the link-image thing below to see more.

Today is one of those days that I really don’t feel like blogging.

Everyone has days like that I am sure, but it made me think about what I think about being someone who blogs about all things life and medical.

First of all, time is an issue.  I mean, I work generally anywhere from 8-12 hours daily plus call.  Then, we are supposed to study and, you know, have a life and do research and such.  So, blogging is a scheduled in wind down activity for me most days… Usually I do it while watching TV with the husband (while he micromanages his basketball pool or catches up on the last 24 hours in sports).

Then there is the whole what to write about or not write about.  I very intentionally choose to not write about something immediately after it happens so I can think of ways to appropriately change details and keep things confidential and appropriate.  Some days I just want to write about situation X, but I know if I don’t process things properly, I could potentially say something I shouldn’t and so those posts get held on to until things are okay.

On the same coin, I don’t directly disclose my full name, nor our exact location (although I am sure some people have figured it out.. And no, that was not a challenge) or the names of our friends or family.  I do know that it is possible to figure out, so I avoid certain topics like very specific hospital politics etcetera.

I have been trying to keep a balance of being up front about things but keeping things at a place where I wouldn’t want to die (and wouldn’t get fired) if someone I knew from work or my family or wherever read this (and people I know do read this).

I have been trying to keep writing original things and thoughts and reflections, but also trying to build community (and having great fun) doing blog hops and list making and such.  I find it tough to balance those with my other writing.  Maybe because in a way formatted prompts are easier, but take time too.

That being said, there are things I would like to write about.   I feel like it took some time before I was comfortable addressing certain topics before, like faith or interviews or family stuff… I would like to be more transparent about some issues and struggles and the worry is that I might offend someone or surprise someone close to me or that it will shock someone or cause some sort of trouble I don’t want.  I guess that is life writing something on the internet.  Those are things I need to sort through.

The goal is to keep writing because I enjoy it.  And it makes me process and learn and grow  And I feel like it is an interesting medium to get through to people and share with people on a bunch of levels.  I get to share my faith.  I get to share my work.  I get to help people and I get help from people.  It is a two way street and that is part of what makes it so cool.

The competitive streak in me wonders if I write about the wrong things… If my stuff isn’t interesting enough.  If I don’t get enough views or that I don’t write well enough to “go viral” so to speak.   But really, that isn’t what it is all about.  And I would probably panic if something I wrote was that popular.  True story.

Really, I write for writing’s sake.  And for the communication aspect.  I want people to know that residents are people too, that medicine isn’t all bad, that marriage is good, Jesus is awesome and everyone needs to read and listen to music more.

So, on that note…

Are there things that people would want to read about as people who read my blog?  Is there something you want to hear me rant on or reflect on or share?