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!

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Breaking The Sound Of Silence

This week’s writing challenge with the Daily Post is called “The Sound of Silence.”

I am choosing to approach the topic from the perspective of breaking the silence on a topic.  One that I have been very reluctant to talk about on here, with most of my friends or family and until recently, God.  And yet, I have been toying with a post on the topic for ages (I did kind of address the issue a bit here).

My silence comes from a place of privacy.  Because people don’t need to know all of my business.

But moreso it comes from a place of shame and jealousy, both of which are sin.

In our current small group, we share what we call redemption stories – stories of how God is redeeming our lives for Him.  This was the topic of my redemption story.

Fertility issues and pregnancy loss are getting more attention these days.  But, still they are little talked about.  Even in medicine.

Although before the last year I could tell you that it is not worth investigating the absence of conception with couples having appropriately timed intercourse until they have been at it for a year (if they are under 35).  I also could have told you that it is very common for pregnancy to end in miscarriage, sometimes even before a woman knows she is pregnant.

Then, I lived it.

The plan was always to have a baby in my PGY2 year.  It is the best year in my program to do this.  More flexibility, you aren’t into the swing of being “on service” all that stuff.

My plan failed.

Because it was my plan.  Not God’s plan.  Not even Patrick’s plan (although he was game for it, he was cool with kids before I was).  The best laid plans can fall apart.  And mine did.

We have existed through month after month of disappointment.  I didn’t know I could experience such disappointment.  It seems not that long ago that we were first married and pregnancy seemed one of the worst things that could happen.

I would sit and church and hear about our all loving and knowing God and how He only wants good in my life and I would wonder where my good was.  I would hear baby announcements and be happy and crushed all at the same time.  I would politely smile and answer an obligatory some day when people would ask when we were having kids.

I know all the textbook answers (okay, not all of them, I haven’t done any obstetrics outside of LMCC studying since Med 3).   I know that I have some family history of fertility struggles.  I also know that there is likely nothing wrong with me to cause this “delay” (it doesn’t change my thinking that there is 50 times per day).

I know miscarriages are common.  That didn’t change the hearbreak I felt when I realized that I had a chemical pregnancy and that my body clearly did not want to house that tiny collection of cells for whatever reason.

I felt alone and defective.

And really, I wasn’t.

I mean, lots of people go through this.  Tons.  In fact, it is perfectly normal to not have a kid first go around, or second or even tenth.  It is also perfectly normal to lose a pregnancy.  It is our body’s amazing way of cleaning up genetic mistakes.

Heck, even Sarah in the Bible had these kinds of struggles and she ended up being huge in history.

By faith Sarah herself also received strength to conceive seed, and she bore a child when she was past the age, because she judged Him faithful who had promised.  Hebrews 11:11

I have friends and a family who I could have shared this with, but I chose to keep it a secret.  I tried to keep much of this grief from Patrick too, but that is nearly impossible.

I did this partly because I am selfish and human and wanted to keep my pain just for me.  Partly because I was angry at God.  And mostly because I blamed myself and felt mind boggling shame.

I’d love to say that one day a light turned on and I felt better about it.  But really, that would be a lie.

God has been working me through it.

I have met people in different phases of the journey.  They are great encouragements.  One person said to me that really, we shouldn’t be ashamed.  It isn’t our story.  It is God’s story.  And He isn’t ashamed. We just don’t see the whole picture.

I have heard someone say that shame is often the devil trying to draw you away from God.  Or that shame is a form of selfishness.  For me, it acted as both.  Shame and selfishness begets more shame and selfishness.  It is a vicious cycle that can draw you away from all kinds of good.  When you get caught up in it, you can only see your own hurt and not the good and rational in the world.

In church, we talked about the difference between fundamental joy and joy that we derive from other things.  I am generally a joyful person.  I find great joy in God and in simple things in life.  In Jesus, we have fundamental joy.  I still felt that joy, but felt like a piece was starting to be missing. I was trying to (and still am much of the time) derive joy from something I didn’t have.  That isn’t fair to me or God.

May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope.  -Romans 15:13

I hate the cliché when people say you need to be satisfied in God before thing X will come about.  But, I think this has been a huge lesson in that.  Especially as someone who has had a pretty darn good life, I have come to realize that I need to be satisfied in God in the times where I feel crummy or am unhappy, not just when stuff is going well.

And the Lord will guide you continually and satisfy your desire in scorched places and make your bones strong; and you shall be like a watered garden, like a spring of water, whose waters do not fail.  -Isaiah 58:11

I have been reminded countless times that we are “fearfully and wonderfully made.”  It doesn’t always feel like that, but in conversation with a friend this past weekend, I was reminded that the human body is amazing creation that we often just take for granted.  It made me remember that includes my body, so maybe I shouldn’t give it such a hard time.

For you formed my inward parts; you knitted me together in my mother’s womb.  I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well.  My frame was not hidden from you, when I was being made in secret, intricately woven in the depths of the earth.  Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them.  -Psalm 139: 13-16

But more importantly, I am coming to realize that this situation is because of our fallen world and that God is still in it with me.

God is still working me through my sin around these struggles and my shame both when coming to Him and telling others.  But, at least I talk to Him about it now instead of just stewing to myself in my head.

Also, I see purpose in the whole thing.  My growth both emotionally and spiritually has been slow, but significant. I now have a new empathy for people without kids or coping with loss.  I have learned a boatload about what people deal with trying to conceive that could one day help friends or patients.

And one day, maybe soon, we will have a kid and that will be super cool and awesome and I can tell this story and show how huge God was in all of it.  Because really, that is what it is all about (cue musical interlude).

I am a work in progress.  That is what makes us human.

I just hope that this glimpse of my humanness, this break of silence will make a difference for someone else caught up in the web of shame, guilt and worry.  It was a big step for me, at least.

One of THOSE days

Have you ever had one of THOSE days?

One of the days where doing your job… The job that you love and feel called to do feel feels like a chore.  Where duties that you like are enough to make you want to gouge your eyes out and you drag your feel at every step?

That was my today.

Well, at least that is how my today turned out.

It started out like any other day doing routine morning rounds on the inpatients when I got a call about one of my sicker and more complicated patients.  They weren’t well and were asking for the attending to come see them.  Instead, they got me.

Needless to say, although we like eachother (I think) they weren’t thrilled to see me.  And I really couldn’t do very much at all to help, except hold hands (until I got yelled at because I was limited in what I could give or do until I spoke with someone else).

And thus began a roller coaster of a day.  I somehow managed to speak to every consultant involved during the course of the day, some of which have starkly different opinions and approaches, all of whom want me to in speaking with my staff have a million changes happen.  And some of them are discongruent.  And I seem to be one of the only common points of discussion except the patient.

As the day went on, I found myself caught up in a he-said she-said drama and somehow managed to get paged at least once an hour about some sort of issue with orders, a need to reassess a new symptom, talk to a new family member/team member and yet still needing to do the rest of my work.  And I still needed to complete my other regular duties (not that they are particularly heavy at the moment, but nonetheless they do exist and I missed rounding with staff on our other patients and teaching and part of clinic due to this important, but relatively non-life threatening conglomerate of events…)

Normally, I would take all of this in stride.  But, by noon, I was frustrated with being pulled in different directions, tired of having to go back to that floor every time I tried to leave and annoyed… Not with the patient or their family or the team, none of this is within their control (one might argue the team could do better, but it is really complicated), but with the whole package and with myself for being annoyed.  I began to feel resentment at whomever was the source of my pages.  A little voice inside my head wanted to yell “No, I don’t want to go up and reassess the patient!”

But, I didn’t do that.   I took a deep breath and prayed for the patient and for myself.  Then, I smiled and ploughed on.  There was a lot of fake it until you make it happening on my end today.

I feel awful when I don’t want to see patients or when I get annoyed with people calling me.  It is my job and it is their job.  I try not to show it ever and it doesn’t happen often, but sometimes, it really can be a struggle. Sometimes calls or duties that are not necessary happen.  Sometimes you work with people who you don’t always enjoy spending time with.  Neither of these sometimes were in this situation, this was more of a sheer volume and confusion thing.   And often, it snowballs and the feelings get more intense if I don’t do something to calm down and regain perspective.

Was I the picture of perfect?

Nope.  I sighed and occasionally rolled my eyes while writing notes.  At one point I contemplated throwing my pager out the window.

By the time the afternoon was starting to come to a close, I thought I was in the clear.  But, then I had to go do a procedure.  Which, of course, like the trend of my day was not without complication and then a page from my staff wanting to see the patient immediately after (which turned out to be longer than they would have liked).

This all made me think of this song by (one of Patrick’s favourites) Mark Schultz… Including the getting the name wrong piece… One of the staff I work with is convinced my name is Krista, no matter what I tell him.

I would like to say I was never so happy to go home, but as it turns out, I was on call.  I missed the last shuttle to the other hospital, so I had to power walk with all of my stuff.  Where it has been busy since my arrival up to right now.

But again, there is something to be said about keeping my cool.

I know the nurses appreciate it.  And as irritated the patient and family are with the circumstance, they probably prefer me to be calm and pleasant (I hope anyway…).  And I always appreciate people who are nice, especially if I expect them to start getting annoyed.

The day is far from over.  And, to be completely honest, I want nothing more right now but to go home and curl up in the fetal position next to my husband. However, I look at it like this… I am usually happy.  I love what I do.  It was a bad day and things like that happen.  I remind myself I did my best.

I am far from perfect.  I know I wear my emotions on my face.  I have been told that before.  So, I am sure someone along the way picked up on my frustration or angst or fatigue.  And sometimes I overcompensate.  But, I like to think I was still helpful and open and wiling to try at a times (and they were multiple today) where I could have thrown in the towel or avoided the situation.

Tonight, I still feel on edge.  I still feel bitter about a ton of things that happened.  I also feel good about some of the things that happened.  About what I learned.  About the progress we made, even if it felt small.

But, the cool part of it all is that this is just one day in a million. There will be other bad days, but there will be many more okay days and some awesome days too.

The other cool part is how great God is at getting me through the suckyness without gouging out someone’s eyes.

Without Him, I would never have the patience or the perseverance to deal with stuff.  As strange as it may sound to some of you “Trisha is all crazy and Jesus-freaky sometimes” folks, the brief pause to say a prayer is time to gather myself.  And my premorbid personality is such that I get annoyed with inefficiency, disorganization and complaining, three things that today was full of.  So, without big changes that have taken place in my life, this would have been much worse.

I also firmly believe that God acts in some of the tough situations to help work things out.  Can I prove it?  Not especially, but I still believe it (maybe I am crazy, or maybe I have seen some pretty weird things work out the right way).

And God keeps my perspective right.  Again, this is something people can do without God, but I like having Him in the equation, I think it makes it easier.  But, I try to see people how God might.  With love, with respect and I try to treat them as such, even when I don’t want to.  It is hard.

I guess you could say I tried to Golden Rule-it-up today by treating others how I wanted to be treated.  And some of them treated me nicely back… Even though their days were clearly going poorly too.  Funny how that works?!

Sometimes, I think people need a V-8 (remember those V-8 commercials where people would smash others on the forehead?  No… Well, I do.).  It isn’t always my place to give it.  And some days, I do too.   And sometimes there doesn’t seem to be anyone to crack me on the head.  So, you get through it and carry on.

When you love what you do, when it is a calling, not just a career, having one of THOSE days is not enough to make you want to quit, but it is enough to require you to take a step back and breathe (and possibly consider taking up some bad for you habit as a vice), but then carry on happily (maybe not quite that same day, but a few days later).