XX v. XY

I'm currently at the VA Atlanta Medical Center on my second month of internal medicine. Read: lots of old crotchety men. Many have fought in the Vietnam War. Many have PTSD. Clearly, I pick and choose who I tell that I'm Vietnamese.

I spent one morning talking to a Navy veteran who had served in WWII, Korean War and Vietnam War. His wife was at his bedside and the easy comfortable love that flowed between them was palpable. He suffers from dementia and repeated himself often but his personality and spunk were wholly intact.

Some of his pearls of "wisdom":
"It's not, did I shoot down any kamikazes. It's how many did I shoot?"
"When you discover something bad, name it after me!"
"Every day is a holiday and every meal is a banquet."

Point is, I like old crotchety men. And they like me. And it's making me reconsider my current decision to go into OB/GYN. Read: lots of women.

What's a girl to do?

I know what she should do. Take a year off. Get her MPH. And spend that year deciding what she'll be when she eventually "grows up."

The Rain in Spain

good food.
good times.
good company.
what more could a girl ask for?

bearing witness.

This week I performed chest compressions on a patient who was coding.
This week the patient passed away.
This week has been hard.

Mr. R was only 36 years old. He came into Grady with severe abdominal pain and distention. During his work-up, our team newly diagnosed end-stage liver cancer that had metastasized to his spine and bones. The final pathology report was still pending but his prognosis was not good. The goal of this admission was to control his pain and to have him follow-up with oncology as an outpatient.

But on day # 6 of his stay, he coded. As I pumped on his chest - ironically to the rate of the Bee Gees' song "Stayin' Alive" - I thought of his 9 year old daughter. She had lost her mother when she was 2 years old; she had died suddenly in the home while pregnant, likely secondary to preeclampsia complications. The body was found a few days later with the small child alone in the home. With each pump, I thought to myself, "That little girl is not going to become an orphan today, not today."

Mr. R was resuscitated, but before being transferred to the medical ICU, he looked directly into my eyes and asked, "Am I dead?" I answered, "No sir, you're going to be okay. Hang in there. We're going to take care of you," as I stroked his hand.
After a family meeting, his code status was changed to DNR/DNI: do not resuscitate/do not intubate. The following morning, he coded again and passed away at around 7am. His little girl, only 9 years old, was now an orphan.

My friend Howie once challenged me to write more uplifting blogs. But it's hard. I don't feel the need to write as much when I'm full of cheer and glee. But when something causes the emotional equivalent of a punch to the gut, I'm more likely to put my scattered thoughts into words. I debated on a public blog vs a private journal entry. But I opted for the more public option: as a means of bearing witness to this man's life, as a way to remember that we were a part of this man's care at the end of his life, as a way to document one of those defining moments of my fledgling medical career.

I had helped keep this man alive by literally keeping his heart pumping. And less than 24 hours later, he was gone.

I cried in my car as I drove away from Grady that afternoon. And then I went about my business: a haircut followed by dinner at a Thai restaurant. It was surreal to be going through the motions of everyday life - small talk with the stylist, ordering a beer at dinner, reading an article on acute chest syndrome - while waves of raw emotion intermittently drowned me. I tried to talk to my mother and that didn't help. I tried to talk to my sister and that didn't help. I tried to talk to classmates and that didn't help.

I wanted to cry and scream but instead, I packaged my emotions into a neat little box ... and moved on.

week in review.

I finished my surgery rotation.
I turned 27.
I leave for my Spanish holiday.

...in my book, that's not a bad week...

See you in 2010.

This picture made me think of my sister.

 
p.s. I'll eventually muster up enough energy to put some actual thoughts into words. Eventually.

Fall is here.

[photo courtesy of dreameveryday]

Do better.

When you try your best but you don't succeed
When you get what you want but not what you need
When you feel so tired but you can't sleep

I am humbled every day: by patients, by patients' families, by doctors and nurses, by other students. In the face of illness and disease, there is so much information to retain with so little cranial space to contain it. I'm not used to feeling inadequate. But I do, daily. I thought that by the end of medical school, with the extra M.D. and M.P.H. letters behind my name, that I'd be this vessel of knowledge, or maybe a gourd of knowledge at least. (Gourd, I like that word). But perhaps the greatest lesson I'll leave Emory with in a few years is: I won't ever know all the answers. It'd be so much easier if the world was painted in only black & white, but where's the beauty in that? Gray, it's the new black.

And the tears come streaming down your face
When you lose something you can't replace
I admit it. I've become a crier. I spent years of my childhood and adolescence bottling my emotions away and functioning as a tomboy independent hard-ass. All of that has been thrown out the window though. I am one of two regular tear-shedders during small group meetings. I often turn away during patient encounters to hide the welling tears. When it gets really bad, I feign the need to pee and bawl a bit in a bathroom stall. And now, I write if it gets to be too much. But I don't care. Emotions, they're also the new black.
I promise you I will learn from my mistakes
And I will try to fix you
I don't have any semblance of a "God complex." I recognize that I will make mistakes. I already have. I expect my bad days to get worst but also for my good days to get better. But ultimately, I expect this from myself:

DO BETTER.

-Coldplay's "Fix You"

p.s. Listen to the moving version of Coldplay's "Fix You" from the film Young@Heart

p.p.s. Don't be fooled. I may cry but I'm still an independent hard-ass ... only I'm in a dress these days.

Taste of Chicago

some things never change

partial 829 reunion

mca = hipsters' playground

take your time: olafur eliasson

movies in grant park

my kind of town, chicago is

Kids say the darndest things.

Overheard today in the pediatric brain tumor clinic:

"Mom, I'm going to glue your mouth shut. Your eyes too."
- 9 year old boy with a relapsed medulloblastoma that had metastasized all over his brain, who now had right-sided weakness and looked plain tuckered out sitting in his chair, one hand on his IV stand, one hand playing Pac-Man. He was waiting to be admitted for a 5-day inpatient stay of hardcore, heavy-duty chemo.

"Owie. Owie. Owie."
- 12 month old girl with an optic pathway glioma as she saw the needle coming toward her to access the chemo port in her chest. Her dad tried to avert her attention with a Piglet stuffed toy.
"I just want to go to school and be with my friends."
- 11 year old girl with a non-germinoma germ cell tumor who is currently homebound after a recent hospitalization for swine flu and was in the outpatient clinic for cycle 5 of her chemo. We talked about Zac Efron and High School Musical. Yeah, I've got my ears to the streets, folks. I know what's hip.

"Owie. Owie. That's going to hurt."
- 3 year old bilingual girl with a diffuse intrinsic brainstem glioma. We ate Goldfish and played with toys on the floor of her room before the Benadryl knocked her out.

"Please take it out. PLEASE! PLEASE!"
-6 year old boy with a pilocytic astrocytoma that had wiped out the satiety control center in his hypothalamus so that he was now weighing in at well over 100 lbs

Lesson #1: It is never fun to hear a child whimper in pain and fear. Period.
My heart has been simultaneously breaking and singing this week. Oncology is hard. Pediatric oncology is harder.

Lesson #2: Kids are just kids, even if they are sick.
I coo at the babies and bounce them up and down. I talk about boys and clothes with my pre-teen girls. I even chatted about Nascar with one boy who had just recently met his hero, Tony Stewart, over the Labor Day weekend thanks to Make-A-Wish. Seeing as how I know next to nothing about Nascar, it was fun to have this little boy, weakened by chemo, still be able to roll his eyes at me in scorn and disbelief.

Lesson #3: Heroes can come in so many different packages.

Rise up this mornin',
Smiled with the risin' sun,
Three little birds
Pitch by my doorstep
Singin' sweet songs
Of melodies pure and true,
Sayin', "This is my message to you-ou-ou:"
Singin': "Don't worry about a thing, worry about a thing, oh!
Every little thing gonna be alright. Don't worry!"

Some mornings, I need a little Bob Marley to get me going. Today was one of those mornings. I was tired and cranky and about to start a 13-hour nursery shift while on my pediatrics rotation. Then I saw Baby D, swaddled in hospital blankets and lying in his neonatal ICU (NICU) crib. I grinned widely to myself.

Mommy D had been my patient at the end of July when I was on the Labor & Delivery OB service. She was 25 years old, just a year younger than me, and she was pregnant with Baby #4. Of her 3 kids, she only had custody of one; she wasn't even sure if she was going to keep Baby D.

Mommy D was addicted to crack cocaine.

It could have been the reason why her water ruptured prematurely at 30.2 weeks. And now Baby D was struggling in utero with almost no amniotic fluid to cushion him. On ultrasound, he wasn't breathing or moving much. We tried to prolong Baby D's delivery as long as possible, to give his body a chance to mature, but he was eventually welcomed to the world, albeit 2 months early.

Fast forward one month. Mommy D has not visited or called about Baby D in the NICU since she was discharged from the hospital. Baby D has periventricular leukomalacia and some calcifications of the brain (maybe due to a maternal TORCH infection). He may also have microcephaly and neuro deficits. Essentially, Mommy D's addiction has caused holes in Baby D's brain. It was like one of those Saturday morning public service announcements - this is your brain on drugs - but in the flesh, in the form of this infant in my arms.

DFACS has been called and Baby D will probably be discharged to foster care once he's stable. As I rocked him for almost an hour, holding him tight to my chest and humming a song, I couldn't keep the tears back. What a sweet, sweet baby. With so many cards stacked against him already.

I'm going to listen to Whitney and my mentor on this one: Crack is whack. It ruins lives. It strips people of their futures. It kills hope.

So often, I'm plagued by the question: Is every little thing gonna be alright? I'd like to think so. But I know the truth is: not always.

So, I'll make sure to hug Baby D extra tight tomorrow, even if it does cause tears to roll down my face.