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.

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A Haunting Encounter

Today, I had a class on incorporating the humanities in medical education.  We were asked to write a short piece of prose or poetry on a patient encounter that haunts us.  Hearing what others wrote was way to much for my hormonal psyche.  I didn’t share mine because I was too busy trying not to let anyone see me cry about the ones that were shared.

I am not a poet, but it kind of has a poetic feel, I think… Here it is…

You did your best.  You knew something was wrong.  You were low risk, they said.  But, now, you are sit in clinic and don’t know how bad it really is.

You are angry and scared.  You cry when I review what is happening within your body.  I am gentle, but I am up front.  Medicine is so advanced, but so limited.  

Together, we bring you down off that ledge.  We have a plan.  You know what is likely to happen.  Then, I point out you need to meet my staff.  To keep in mind that a chance for second opinion isn’t gone.  

Gruff and curt, he approaches.  The plan changes and you are confused.  There is no explanation.  Just a closed door.

I try to help you understand.  I feel a sense of loss.  Like I am free falling in a place outside of my control.  It can’t compare to what you feel.

You don’t want another opinion.  You trust him.  Because you trust me.

In that moment, I don’t trust me.

I go home and review the literature.  I think and think.  I talk to another staff person.  I am right.  There may be more.  But, how does that get approached?  Who is willing to speak up?  

Everybody talks, but nobody deals.  That seems to be the way sometimes.  The questions are brought up, but I wonder if they were truly dealt with.  They get swept under rugs that some of us can’t help but look under.

This time, someone did say something.  This time, something did change.  Somehow, the suggestions were accepted.

I was relieved.  I want the best for you.  I want the best for all of you.  But still, the whole thing is unsettling.

In the long run, will it be enough?  Will you continue to get the care you deserve? 

If I hadn’t been there, if you didn’t trust me, would it be different?  Would you have made a different choice?

Maybe it is enough.  But, I wonder if we could do better.  I wonder if it is my fault.  That my being nice, that we “clicked” made you not question, not request that second opinion.

I won’t know.  I can’t help but wonder it is my fault.  And I’m not even sure what “it” is.

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 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?

 

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.

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.

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.

Stunned in a sea of infection

I am stunned in a sea of infection.

No, I do not have a delirium.  I just happen to be rotating through Infectious Diseases (herein ID).

I haven’t felt this dumb in a few rotations.

Image via escapeinabook.blogspot.com.

Okay, I haven’t been on a new rotation in a few rotations, so I guess that it is fair game.

But still… Last time I felt this stunned was Bone Marrow Transplant and prior to that, Cardiology.

I wish it was as cool as running around in hazmat suits trying to ward off the next pandemic superbug.  And some days, it feels a tiny bit like that.  Most of the time, it involves looking at stinky post-op wound infections (oh boy, did I ever smell a doozy today) and trying to sort our prolonged febrile neutropenias.

I like the detective work that can come from ID.  Sometimes, you have to piece together the presentation and patterns in fevers or bacteria to figure out the cause.  Sometimes, you get to find that kind of rare, super cool cause of something.  Just like on  House, MD but without the overqualified and giant team who can do whatever they basically want around the hospital… So, not really like that at all.

Image from housemdconfessions.tumblr.com.

I love the problem solving side of consult-based medicine.  The swoop in a problem solve is cool, but as I think I have said before, I much prefer the continuity of care that is being the prirmary caregiver.

But back to my feeling stunned…

I have never been a big one for microbiology and things.  Antibiotics are a big black box.  I know the go to antibiotic for the common problems and beyond that, I look it up or, well, call ID.  And anything beyond your common yeast infection or virus is basically outside of my comfort zone.

Thus, I find it challenging to sort out a lot of these cases.  It isn’t in my natural knowledge base and sometimes, I struggle even to know how or where to look it up.I get that this is the reason why we do this rotation.

I just hate that floundering feeling of seeing consults and follow-ups and sometimes not really having a clear grasp of what the plan is or will be.  And yes, that happens on most rotations at times, but as you learn, it happens less and less.  It just seems that hopping to this rotation, it is currently happening more and more.

It all comes with time and experience and reading. But until then, it also comes with a lot of, “I’ll look that up” or “I need to talk to my staff doctor about this” and, of course, the “I don’t know.”  Oh, and a lot of changes to my “assessment and plans,” which make me cringe a little.

That is the thing with medicine, the more you learn, the more you learn you don’t know.  This is yet again another area where I clearly don’t know a lot… At least I figured out that much.

Medical Mondays: Making Lists

It is Medical Monday again.  If you are somehow medically affliliated, check out the button below for information on linking up or for some interesting reading.


I love lists.

I am sure you noticed if you are around here very often.  I am all about top ten lists and the like.  I am pretty sure I could make a top ten list of my favourite top ten lists.

But it isn’t just ranking my favourite things.

It is also my favourite organizational tool.

I have my to do list on the wall in the resident’s room. I update it weekly and check things off and such, much to the fascination to the other residents.

photo

This is an over month old version of the list, but you get the picture.

I have our household chores list on the refrigerator. It even has magnets to check things off.photo

I am excited thinking about the address list I need to formulate in order to write and send our Christmas cards (on an aside, this is the first year I am properly sending out Christmas cards… It makes me feel very adult).

I was excited to find a Christmas card list. Okay, I probably won’t take it this far… Image from janesapple.com.

I make pro-con lists.  I made one about dating Patrick, marrying Patrick, getting a cat, picking an apartment, picking a residency program.  Yes.  I am pretty much the real-life Rory Gilmore of pro-con lists.

In medicine, we use a lot of lists.  We memorize protocols for different procedures or issues or differentials.  Some people mneumonics.  I hate those things.  I can’t do it.  I need to understand the logic, the pattern.  And then I can hammer out the list.

Image from protomag.com.

I have a life list.

As in I, although it is not written down, have a basic outline for how I see things going.  A 5 and 10 year plan, if you may.

I know that these things aren’t set in stone.  I mean, I get that.  I also get that it is not always in my control.  But, I know we are here until 2017… Probably more like 2018.  I know when we want to have a baby… And another baby.  I know what fellowship I want to do and where I want to work.  Where Patrick could work.

It is all in there in my head.

I hate it when my lists don’t work out.  When a condition doesn’t fit the pattern I expect.  When life throws a curve ball.  When I am out of the cleaning supply I need to get the next thing on the cleaning plan done.  When the budget doesn’t work out.

I like plans.  I like lists.

Life and medicine throws curveballs.

I feel like medicine excels at the curveball.

Curveballs mess with my lists.  They add to them or change them in ways I can’t otherwise predict.

But, figuring out how to get around the curveball is pretty cool too.  And trusting that eventually, it will hit the ground or your glove and then you get to try to start over from a different point.

Then, I can make a new list.  Or at least try.

And have the satisfaction of checking things off or sorting things out in the end.

The big picture thing for me is that God plays a HUGE role in the whole list thing and rearranging thing.  The rearranging often comes with me not paying attention to Him to see that He is moving things in a different direction or wants me to move in a different direction.  He has a bigger plan.

God is the ultimate list maker.

Sometimes I just like my list.  It is easier to see and to process.  But, I keep telling myself His is better.  And often our lists are the same.  But sometimes, He is the one that throws a curveball.  And I trust that those work out for the best in His time.

Some big things have been checked off my list recently.  The LMCCII, a presentation, some scheduling issues, getting a new coffee table set (it is sad how essential this was starting to become).  All of these are notches in the belt, ticks on the list.  Evidence of progress, even if it seems like there are a ton of big things still to come.

Progress is progress.  And plans and patterns are helpful, but they aren’t perfect.  I just want them to be sometimes to make things easier.  I just need to trust that there is a better list maker at work here.

LMCC est fini part two

A year and a half ago I wrote the first part to this post.  Well, kind of.  Check it out here.

A year and a half ago, I finished the first part of the LMCC.  It was a traumatic exam at the end of my fourth year of medical school.  I was warned that it would feel like I failed, but that in reality almost all Canadian grads pass it.

Today, I finished the second part of the LMCC.  This was the practical part.  The part where we wander from room to room pretending to be doctors while people pretend to be patients and then we answer questions about how we would doctor them in real life.    I was warned that it would also feel like death.  But again, that most Canadian, English as a first language grads do okay with it.

That being said, I seem to know a disproportionate number of people who failed.

That gave me some significant test taking anxiety.

I mean, I can count on one hand the things that count that I failed.  And by that, I really can only think of one thing.  And really, I was expected to fail that.

But still, between my intense imposter syndrome, my usual performance anxiety and the terror that comes from exams that cost almost my entire month’s pay and basically are necessary to my future employment, I was fearful.

Fearful is actually probably not the best word.  I was scared poopless.  In fact, I had the worst exam anxiety that I have had in a long time.

But now it is done.

If you landed here looking for exam advice.  I have none except do some studying and be a good doctor and expect to forget something at most stations.

I can’t really say anything else in detail because the LMCC exam people are very serious about the whole not talking about the exam thing and talking about the experience in any further detail beyond me saying that it was a practical exam could get me in to big trouble.  Like losing my current credentials, legal action and all around badness kind of trouble.  I like my license.  And I really don’t want to have to do exams over again.  And I really, really don’t like any kind of trouble.

It doesn’t matter because I am done.  Hopefully, forever.  And if not, at least until Spring.

Now, just to wait the month or two before the results miraculously appear in my inbox.

To make me feel better we booked our free flights and started planning a trip to New York in the Spring.  I am so excited for that.

I am also pumped to get back to the rest of my life!