Turning Tables – Treating Physicians

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

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

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

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

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

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

It also forces us to face our own mortality.

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

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

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

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

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

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

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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 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.”

How Did That Happen?: How to overwhelm the pulp out of a new resident

I have been off my blogging game.

I blame starting core Rad Onc.  I keep staying late and studying at night and all of that stuff.  Funny how when you are doing something you actually love you tend to work more.

I also blame summer.  The nice weather nights have us out and about meeting up with friends.  Last night, we had a hymn sing at the nursing home we volunteer at with our small group and then went out for ice cream.  Tonight was coffee with a couple we know from back home who recently moved here.  So awesome.

I am a week overdue on a How Did That Happen? post.  So, that is what you shall receive.  stethoscopes1

I have been spending my last week orienting and mentoring our new, delightful R1.  My How Did That Happen? is how to overwhelm the pulp out of a new resident (in case you didn’t already know).

**Note: This is kind of sarcastic and based on things that really do happen.  There are some things I think administration and faculty can do better with.  There are some things that I can’t see solutions to… Just facts of starting new jobs.

  • First of all… DON’T OVERWHELM THEM.  This is my for real advice.  This will fail.  Starting residency at baseline is kind of overwhelming.  But, bits of information at a time and having someone available as help and back-up is better than just slamming it all in a book or presentation at once.
  • Have multiple giant orientation sessions for the incoming residents from the university, the hospital.  Fill them with tons of information that is both useful and useless intermixed with facts about failures, crying and patients dying.  Make sure that it is unclear what is useful or useless and make it seem like terrible things will happen.
  • Make sure to start them on call the first day or so of residency.  Nothing is better than really starting out with a bang.
  • Send out various passwords and user IDs to different email accounts and expect the person to sort them out themselves.
  • Have a very not user friendly computer system with a million different log-ons, passwords and variations.  Review these in orientations, but don’t do any practical training, that would be too helpful.
  • Use four digit paging in a hospital where you have to dial 7 numbers that can differ between sites.  Expect new person to call you back promptly.
  • Let new people loose in the hospital without giving a tour. 
  • Take the new person a tour on a hot day after a full day of orientation to show them everything.  Realize that they will remember very little of this.  Do it anyway.
  • Leave them to figure out everything on their own.
  • Tell them all of your call horror stories.
  • Take them to visit the ward.  Show them where everything is.  Show them the charts.  Talk about writing notes, finding computers and how the rooms are organized.  Introduce them to the all of the staff on the ward who promptly start asking who they are looking after. 
  • Go to a session about how to use an EMR only for the radiation oncology patients and for radiation planning.  Use technical terms just to really keep them on their toes.
  • Give them the sickest patients. 
  • Ask them to read around everything they saw that day.  The list of topics totals a page.  Oh, and review the clinic charts for tomorrow too.  Hope you can work the disconnected computer systems!
  • Talk to them about booking vacation.  That is months away.  On rotations that “you just need to take vacation from.”
  • Tell them you are so glad to be done intern year, it really does get better (this can be good… it can also instil fear of what is yet to come).
  • Try to tell them everything they need to know ever in one day.  Or at least make them think that is what is happening.

 

What things happened to you that overwhelmed you as a new resident or med student or employee in general?

 

G1P0A1

G1P0A1.

This was one of those weeks where you just can’t help but remember.

I went to visit my family doctor for the first time since we lost Elim today for some general prescription refills.  She did the right thing and asked how I was doing since the loss, if we were trying again and then reminded me that at least I know I can get pregnant.

I know.

She sent me off saying that she hoped she saw me again soon with good news.

Me too.

It doesn’t mean that I don’t exist in perpetual fear of another loss. Some days I wonder about losses that I don’t know about.

But, in that appointment, with our conversation, I realized that watching someone type those letters and numbers was bizarre.

G1P0A1.

In medicine, we have what I liken to a secret code when it comes to describing women and pregnancy. G means gravida. Number of pregnancies. P means para. Number of babies born after 20 weeks. A means aborta. Number of babies delivered before 20 weeks. Some expand it to GTPAL with G being number of pregnancies, T term deliveries, P preterm delivieries, A induced abortions or miscarriages and L live children.

When I learned this system, I found it awful. I found it really tough to keep straight and was forever getting my Gs and Ps mixed up. Plus, it bothered me that A was for both induced abortion and spontaneous abortion. People often specified, but both caused pain and one can have repercussions on future pregnancies if recurrent.

The system bothered me because you could look at those numbers and see joy or pain or fear. At least I could. My heart broke for people who had more Gs than Ps. I hated to ask about losses because I didn’t want to bring up that pain. For me, there was always something devastating about pregnancy loss. It was always something I worried about.

On the other side of the desk, knowing what it means, it still sucks. I think my fear of bringing it up with women was a bit excessive. I was uncomfortable then because it bothered me, not them. I mean, it is a fact of life and it kills me more when people ignore the fact that I had that loss than when they ask about it. I guess I needed to see that for myself.

I was grateful that she cared enough to ask how things were and where we were at.

Still. Seeing it on a screen was weird. Especially when I have thought it before. And knowing that really, months before Elim, there could be another G and A that I suspected, but never confirmed because it all happened so fast. It could be G2P0A2. But, I won’t know in this lifetime. And I think I’m okay with that because I never really knew for sure.

G1P0A1.

What if those numbers never change? What if the Gs change but the Ps never do? What if I match my Gs for Ps from here on out?

I can’t predict the future. I wish I could sometimes, but I can’t.

The things I do know are that I am healthy, that God is good and that there is so much to this life that I don’t understand. I know how much good has come out of our journey so far. That I have grown in leaps and bounds in my faith. That we have been tested as a couple and as individuals and keep coming out the other side. The experience has helped me to love other people in ways that I might not have otherwise had the opportunity to do.

I don’t talk about it a whole lot. I has become easier, but I miss my little A1 every day. Maybe I’ll tell you more about that one day.

It freaked me out to see the letters and numbers on the screen. Sometimes the letters and numbers in your head seem not so real until you realize someone else acknowledges the reality of the situation. In another sense, it made me feel better because it is only one, it is real and it is normal.
God is good. His timing is perfect. I am trying to hope in Him and not my future children (or job or spouse).

Letters and numbers don’t make me whole. They don’t save me from myself. They are just statistics. There are bigger things.

What is one thing?

What is one thing you can’t live without? That thing that would send you into a downward spiral if you lost it? That thing you need for your life to feel fulfilled?

Think about it for a minute.

That was a question we’ve been discussing in church and D-group the last couple of weeks. It makes my head hurt and yet has opened my eyes to how I perceive my reality.

My first instinct was Patrick. I can’t live without my husband.

But, I can live without my husband.

My second instinct was children. I want children. Living children.

But, I can live without children.

The list goes on… My family, my friends, my career, my home, my health.

Losing any of those things could send me on a downward spiral.

What does that say about me? What does that say about my faith?

Life goes on despite monumentous loss. We survive these things that we often can’t even fathom. I see people dealing with these things every day. How do we do it? How do I do it?

I know some people say strength and fortitude and a positive attitude.

I am talking about deeper purpose and something bigger than just getting through.

I know some people will disagree, but that something is Jesus. And maybe I am hum drum, but I don’t feel like I can find meaning in all of life and things without Him.

The passage we were looking at is John 6. It is a long sucker, but the cool part is that John is really intentional in his writing. He doesn’t include irrelevant details and generally stuff goes together to kind of show some bigger point about Jesus. He wrote the book, so that people would believe, so that makes sense.

This is the loaves and fishes chapter. It is also the walking on water and calming the seas passage.

I have seriously heard those stories a thousand times, so what is the big deal?

Well, check this out…

When they found him on the other side of the sea, they said to him, Rabbi, when did you come here?” Jesus answered them, “Truly, truly, I say to you, you are seeking me, not because you saw signs, but because you ate your fill of the loaves. Do not work for the food that perishes, but for the food that endures to eternal life, which the Son of Man will give to you. For on him God the Father has set his seal.” Then they said to him, “What must we do, to be doing the works of God?” Jesus answered them, “This is the work of God, that you believe in him whom he has sent.” So they said to him, “Then what sign do you do, that we may see and believe you? What work do you perform? Our fathers ate the manna in the wilderness; as it is written, ‘He gave them bread from heaven to eat.’” Jesus then said to them, “Truly, truly, I say to you, it was not Moses who gave you the bread from heaven, but my Father gives you the true bread from heaven. For the bread of God is he who comes down from heaven and gives life to the world.” They said to him, “Sir, give us this bread always.”

Jesus said to them, “I am the bread of life; whoever comes to me shall not hunger, and whoever believes in me shall never thirst. But I said to you that you have seen me and yet do not believe. All that the Father gives me will come to me, and whoever comes to me I will never cast out. For I have come down from heaven, not to do my own will but the will of him who sent me. And this is the will of him who sent me, that I should lose nothing of all that he has given me, but raise it up on the last day. For this is the will of my Father, that everyone wholooks on the Son and believes in him should have eternal life, and I will raise him up on the last day.” –John 6:25-40 ESV

It is kind of a ridiculous conversation. Jesus kind of talks in riddles (Is that blasphemous of me to say? I mean he really does kind of say stuff that comes off as bizarre and people don’t get him…) and the people He is teaching struggle with getting the point. Heck, even the disciples get kind of weirded out.

But this is what it is getting at (I am not that clever, this is what others say it is getting at and it makes sense to me)…

Jesus is enough.

Love the giver and not the gifts. You aren’t sustained (really) by things and relationships and all that stuff. In the end, even the thing you most want to cling to and think will make you complete won’t.

In essence, you can’t take it with you when you go. But when you go, you’re going to want Him on your side.

I like concrete things, so this is tough to process. How do I make Jesus enough. How do I stop being satisfied in stuff and people and start being satisfied in Him? How do I stop trying to fix and control things, but know that it is all completed through Him for His glory?

That isn’t something I just do.

In our conversations over the last little bit, our group has discussed that it is a tough thing to put into practice. It starts with having the desire (just like kicking or starting any habit, you need to want to start).

I’ve got that.

Action starts with awareness.

I have come to realize what I prioritize. What I think will fill me up and keep me content.

I am trying to remember that that satisfaction, although very real, is short lived and not complete. And that there is much more out there than having a happy marriage (although it is super important for a bunch of reasons).

Having real purpose and deep seated peace and joy is bigger than stuff. It is bigger than comfort. Sometimes we have to suffer well and know we aren’t alone in this.

Being sustained by Christ alone isn’t simple. It isn’t intuitive. And it is definitely by standards of our culture weird. But that’s okay (and I need to remember that).

Imposter Syndrome

Image from lizmartinresearch.wordpress.com.

I used to think imposter syndrome was when someone actually pretended to be someone they weren’t.  Kind of a crazy person, like people who tell everyone they are someone they aren’t. That kind of bizarre.

When I started residency, I remember someone talking at our orientation about how many of us will experience some degree of imposter syndrome.

And no, we aren’t just all crazy people pretending to be doctors. We just think we are.

Imposter syndrome is defined as a psychological phenomenon in which people are unable to internalize their accomplishments.  This means that despite objective evidence of competence, the individual is convinced that they are really a fraud and don’t deserve the success or accomplishments they have.  They can dismiss it as luck, bad judgement and often expect to one day be found out.

I found this graph kind of helpful. Except that I don’t see myself being that high on the how good you are scale to meet Imposter Syndrome criteria, which is kind of diagnostic. Image from saalonmuyo.wordpress.com.

Props to a combination of Wikipedia, and Webster’s Dictionary for helping me out with that explaination.

Today’s writing prompt from the Daily Post asks the question, “Are you full of confidence or have you ever suffered from imposter syndrome?”

My answer is that I experience imposter syndrome all the way. I think my photo could be under the definition.

Okay, I do have some confidence in some things.  Like public speaking (weird, I know), having difficult conversations with people, cooking.

But, I tend towards imposter syndrome and it is a constant struggle.

At least, I think I do based on what people tell me and some objective evidence.

Gosh, I even have impostor syndrome about my impostor syndrome.

Image from informedjourney.com.

I got through med school.  I know I passed all of my licensing exams.  I passed them with scores well above the mean.  I get consistent positive feedback.  I work hard.

Nonetheless, I still get a voice in the back of my head that says that one day they will figure me out.  That I am just lucky that nothing terrible has happened when I am on call or in charge. That I must have charmed my way into doing well.

Like anyone, I love getting positive feedback.  It is nice.  But, anything that addresses things I think I am still not good enough at makes me uncomfortable.

I know it is normal and even healthy to have a reasonable level of self-doubt. It helps keep you sharp. It keeps you from becoming complacent. It protects me from going all crazy and trying to do surgery on my own like Christina Yang.

And even beyond medicine, I have a hard time processing the fact that I am an adult.  A married adult with an apartment and car and bills  and responsibilities.  It is not what I thought it would be, therefore, it can’t be real.

Image from cheezburger.com.

There is a lot of stuff out there about imposter syndrome.  Especially in professionally women.  Apparently, I’m not the only one.

That being said, I think we make much out of it.  More than we probably should.  Awareness is good, but blaming that for failures is a whole other issue.  And we put getting over it too much on ourselves too.

It isn’t of God.  The doubts, the fear, the worry.  None of it.

It is of man and my reliance on self instead of on God.

For me, it isn’t just a confidence in me issue.  It is a confidence in God and His provision issue.

At least, I’m not alone in any of my crazy.

Facing My (Irrational) Fear… The Apple Store

Image from buyric.com.

The Apple Store also scares me.  I have never been in, but it looks too crowded and futuristic (like it came straight out of The Capitol) for my liking.  There are so many staff that you just have to interact with one.  And all kinds of people are just taking up space playing with stuff they can’t afford or don’t need.   I guess I should note that I bought my laptop online because this was before the era that you could just buy a Mac at Staples and there was clearly no Apple Store where I went to med school.

My laptop decided to not turn on while my charger light flashed orange (not my favourite colour in this instance) this morning.  I tried it in several outlets and still nothing.  So, I used my phone to google the problem.  I tried several possible “at home solutions” with no results.  Fail.

I check out the Apple Store website and they prompt me to make an appointment  at the Genius Bar.

Image from apple.com.

Really?  Genius Bar?

This is going to come off as harsh, but something tells me that although people working there might be tech savvy, genius may not be the best title.  But, relative to the rest of the world, maybe it is.

I wander in (probably looking terrified).  I get directed to the Genius Bar at the back and told to sit on a stool cramped between a mother and daughter getting the kid’s iPod touch fixed and a girl who spilled a can of pop on her laptop.

I notice that the Genius Bar geniuses are using iPads to direct much of what they do.  I could fix most people’s electronics if I had an iPad tell me all the secrets of what to do without fear of voiding the warrantee.   I clearly was feeling a bit conspiracy theory-ish.  There were obviously some people who worked there who were the more techy go-tos when things were really broken.

I sit at a ridiculously crowded “bar” and some guy tries plugging my laptop into their power source… Fail.  Then, resetting it… Fail.  I knew that.  I already tried those things at home because that is what the Apple help page told me to do.  Don’t people check those things first?   He then takes it out back, takes the back off and unplugs then reattaches the battery.  Presto chango.  He fixed my laptop.  That simple.  If only I would get at the battery without dismantling my computer.  I love Apple products, but really can’t you make it so that I don’t have to go in there?

I am excited to say that I survived my Apple store experience.  And that they were nice.  But it was way too crowded (you can’t tell me that many people buy or need all that stuff on a daily basis).  I will go back, though if something is dysfunctional.  Maybe I don’t have to try for weeks to fix my own stuff (like I did with my phone with the syncing problems… But, it did eventually work after a few week’s worth of reading and tinkering).

The place still gives me a bit of the heebie jeebies, though.

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.

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.”