Just a few things some of my hospital patients have said lately:

Forty year old woman: “I’m not worried about the cancer coming back.  Been through that already.   I’m over the fear.  I’m lucky; some people never get over it.”

Fifty-year old woman: “BRA-A-I-N surgery tomorrow.  They shaved all these patches out of my hair for these weird stickers.  My hair just started growing back too.”

Sixty-year old man:  “Heh, I love when you guys say that, ‘That’s the LEAST of your problems.’”

Eighty-year old woman: “I was on that boat in New York where all those seniors died.  Lost twenty of my friends.  Then I had a heart attack while on a cruise ship and I had the sick bay to myself the whole time.  God likes kickin’ me around.”

(Or maybe he’s telling you to stay off boats.)

Eighty-year old woman: “We’re retired.  We’re taking some time to rest and relax before it’s time for The Big Rest.”

Ninety-year old man: “At my age, if you wake up with vertigo and nausea, that’s a GOOD day.”

——————–

I also got a haircut today (it’s going to be that kind of blog).

This should be an ID badge or drivers license photo, not a blog pic.

I’m still studying for my medical boards recertification which is in three weeks.  I’m re-reviewing material I’ve mostly forgotten since the beginning of the year, like spent spells in a wizard’s repertoire.  [Warning!  Nerd alert!  Geek overload!]  Per 1st edition Dungeon & Dragon rules, one has to memorize that stuff over and over again.  It gets easier with time and experience though (a Staff of the Magi wouldn’t hurt either).

It’s taking its toll on my constitution.  Lately, I wake up with medical facts bouncing around in my head from the night before.   Sometimes I can’t sleep and my heart races [intermittent fast heart rate, hypertension, flushing = pheochromocytoma].   This afternoon my throat was on fire.  [Reflux -> Barrett's esophagus -> esophageal cancer.]  That’s what I get for eating after a midnight shift and crashing.  [High grade esophagus dysplasia = needs esophagectomy.]  My head was pounding too.  The differential diagnosis includes:

1) too little sleep,

2) too much stress,

3) too much studying,

4) too much caffeine or

5) not enough caffeine.

Coming down with a cough too.  [Dry cough + aches + bad X-ray + pharyngitis = mycoplasma or chamydophila.]  Yesterday I woke up just in time to pick the kids up at school.

My eyes were sore from lack of sleep [eye pain = optic neuritis = sign of early multiple sclerosis], but I spied Sun Su walking down the school steps.  He seemed so much older with his bag slung over his shoulder.  [Winged scapula = thoracic nerve injury.]  Little Ooseung followed at his side, her chin up to face a world slightly bigger than she is.  [Inability to look down = progressive supranuclear palsy.]

I acquiesced to their request to go on the playground.  Brain and body were too fatigued to resist.  My mood has become dark with the number of times I’ve had to tell them, “No, I can’t, I have to study,” these past couple months.  Supreme knowledge is a demanding, vengeful, and costly pursuit, isn’t it, Raistlin?  ["Gold" skin and pupils + psychiatric illness + weakened heart and liver = Wilson's Disease.]

Musical notes drifted strangely through the breezy air as my son led the trek to the playground.  [Auditory hallucinations = schizophrenia or stroke in temporal lobe.]  An afterschool child was playing on a mounted tube instrument like a novice bard.  Sun Su precariously climbed to the top of the monkey bar dome and smiled at me.

“Careful,” I said.  [Traumatic hyperextension of neck = Hangman's fracture, C-2 vertebra = death.]

Ooseung eyed the sandbox next to us, but then she ran over to the swings instead.  I was relieved.  [Sandbox = animal feces = tapeworm, intestinal parasite.]

“Look, Baby, a squirrel!”  Sun Su scouted, pointing at nothing that I could see.  [Rabies = rare in squirrels.]

“YAAAAAHHH!!  SQUIRRRRRELLL!!” she yelled out with berserker rage as she chased it down for dear life.

I shadowed my party of halflings into the woodlands behind the school.  “Adventure!” Sun Su exclaimed as he rangerly maneuvered around branches and slippery slopes.  Hmm, I didn’t teach him that word.  Treasure abounded – a bottle cap, a Baskin Robbins cup, a rotting apple with ants, a basketball, and a box of Cheez-its.

Our little leader scavenged two sticks strong enough to break other sticks among the fallen branches and trees.  He gave the big one to his little sister and engaged a sapling tree in swordplay, stopping only to point out another squirrel.  “SQUIRRELL!!  A BIG ONE!  A BIG ONE!!”  Ooseung went on the rampage again.  While ducking branches with soft earth underfoot, I felt a cool kiss on the cheek from what must have been a wind fairy.  I remembered these half-real, half-imaginary worlds from childhood.

Then I heard the sound of a child crying, not mine.  He was standing alone against the back wall of the school farther away.

“Do you know that kid?” I asked Sun Su.

“No.  Don’t go,” he cautioned.

I walked a little closer, but stayed a fair distance away so as not to scare the boy, “Hey!  Are you okay?  Are you lost?”

He stopped and looked at me.  “No.  I’m okay.”

“Are you sure?” I yelled back, before he disappeared around the corner.

“Let’s see what’s going on over there,” I told my young ranger and tiny barbarian.

We walked down a natural tunnel with webby school windows on one side and overarching trees on the other.  (Of course my iPhone batteries were dead at this point – hence, no pics here.)

“I hear voices,” I said.  Ooseung gripped my hand.  I looked around the corner.

It was another playground filled with more kids and several moms.  The crying boy was there too, playing, no hint of crying.  I suspect he was probably sent to The Wall in the first place by his mom (or a teacher) for misbehaving on the playground.  I forgot they used to do that back in elementary school.

“Appah, there’s no more squirrels!  UHNG!” Ooseung made her usual angry grunt.

“They’re probably all hiding from a little girl with a giant voice who says YAHHH!”

My little girl giggled,

“I just wanted to pet their soft fur.”

“Ready to go home?”

“Yeah,” then she boomed out, “SUN SU, WE’RE GOING !!”  Just like her ummah.  Sun Su emerged from his woods exploration with a disappointed sigh,

“Aww, do we have to?”

Back to reality and my spell books.

[Stimulation of oxytocin and vasopressin, psychological attachment, warmth = LOVE.]

“Hi Mr. Brown,” I said as I entered my new patient’s room.  The old man sat in a chair looking out at the construction crew tearing down the old hospital wing.

“Doctor Brown,” the old man corrected.

“Oh, right, I read that,” I slid a chair in front of him, “How are you feeling today?”

As he began his long-winded answer, I briefly wondered what kind of person demands to be addressed as doctor outside of their role at work.  Would I be like that someday?  I seriously doubted it.  I don’t care for the attention, positive or negative.  Plus it just puts people’s guards up.  Being understated and underestimated are advantages.

I sized him up by his doctor lingo.  He mispronounced a few of the newer medicine and test names.  He knew a few things but he wasn’t a practicing physician anymore, that’s for sure.   He didn’t do what I do.

Eventually his answer wandered into relevance.

“Just a little chest pain this morning.  A little diarrhea.”

“Well, the surgeons want to hold off on your heart bypass until the colitis is under control,” I informed.

“I agree.  This body can only take so much.  Seventy-eight years.  Longer than most I guess,” he shook his head, “I used to throw around 100-pound bags when I was a kid.  Now I can’t carry a grocery bag to the door.  I didn’t have any problems until I turned sixty-five.”

Retirement age.

“Now I’m on over a dozen pills.  Four of my heart vessels are blocked.  On prednisone for the past eight years.  This may be my last week on this earth.”

“We hope not,” I smiled.

He asked where I trained, how long, sized me up.  He told me about his days in pediatrics.

“You got kids?”

“Four and six – no, ages six and eight, girl and boy,” I corrected myself, surprised at losing track.

“Ah, you’re just beginning then.  Still got time,” he replied.

“Yeah, they’re fun.”

“Enjoy it.  I worked HARD,” he paused for a moment as I imagined him in the old-school workaholic hey-days of medicine, “I took a few good vacations, but … I always planned on my Golden Years.  These aren’t golden.”

“So I’ve heard,” I replied.

“They’re the Iron Years,” he said.

“I like that,” I nodded, thinking that I’ve got to write this stuff down.

“I had my fifty-year medical school reunion.  We visited our old anatomy lab.  Saw the cadavers.  Smelled the formaldehyde.  Brought back memories.  You get to look at life in a long way.”

Memories of my own came back, probably much like his.  There are only so many ways you can skin a body.  When I was just being born, he was my age now.  I looked at him, soberly, my professionally amiable doctor mask off for a moment, physician to physician.  His eyes were as black as mine.

“Things you waited to do, you can’t do, because your body’s falling apart.  Do them while you still can.  It’s the cycle.  Someday that cadaver in anatomy lab is going to be you.  Filled with formaldehyde.”

I stood up and smiled but this time had nothing to say.

“I’m not suicidal.  Not yet.  I can’t leave my wife like that.  But I am … pretty blue.”

“Hang in there, okay?  I’ll be back tomorrow.  Maybe the surgeons will let us both know what the plan is by then, haha.  We can make you better,” I said.

“We hope.  What’s your name again?”

“Dr. Scott.”

“Sorry, you don’t need me to preach to you, Dr. Scott,” he tapped a Bible on the table.

“No, not at all.  It was very … informative.  I’m looking forward to talking to you tomorrow.”

Doctor.

July.  The most dangerous month of the year to be in the hospital, but also the month with the freshest faces.

The interns with bright coats and loaded pockets rush from room to nurse to computer to attending, trying to stay afloat in the miasmal maelstrom.

One of the new nurses pops up in front of me to discuss our patient.  She’s in the prime of her life – young, thin, chipper, bright eyed – so shiny.  Her uniform is crisp and clean like her hair.  All of this will change.

The medical students and nursing students smile just for the fact that they aren’t cooped up in a library anymore.  So eager to impress and please and get dirtied by this huge rusty healthcare machine.  As if this is the greatest job on Earth.

At the end of the day, myself and two other colleagues congregate in our little office room, finishing up electronic notes on computers and answering pages.

Finally one hangs up the phone and says, “Ack!  This is too stressful!”

“I know,” I say while double-checking patients I’ve seen today.

“I need to do something else with my life,” she continues.

“Like what?”

“I think I’d like to be a teacher or a real estate contractor.”

“A what?,” I ask, trying to understand what seems like the opposite of fun to me, ”Hahaha!  Have you dabbled in real estate before?”

“Well, no, but I love looking at new houses.”

“What kind of teacher?”

“Maybe really young kids or college aged, but not the ones in between.”

“You could volunteer in your kid’s class.”

“Yeah, but they give me a headache.  Maybe teaching isn’t such a good idea.”

“If you could do anything,” I ask my other colleague, “What would your dream job be?”

“Me?  Hmm.  Photography.  For National Geographic.”

“That is really cool,” I say realizing this is the first non-work conversation I’ve had with this colleague in our several year acquaintance.  “Do you get to do a lot in your spare time?”

“Try to.  But at the end of the day, sometimes just loading the pics off my camera is all I can muster.  The days here are so exhausting.”

We all nod.

“What would you do?” someone asks me.

“Something where I could write and draw.  And paint.  Like my own comic book,” I say to a shocked audience of two.  I wonder what they thought I would say.  Golf?  Build miniature galleon replicas?  I wonder.

“My spouse doesn’t want me to change jobs now.  ‘You’re finally out of residency and making some money,’ he says.  But this is just too much.”

“Yeah.”

“This is not my dream job,” I quietly understate against the machine.

“Ha!  More like my nightmare job.”

“One of my patients this morning, the one with angioedema,” I say, “She asked if I could discharge her first thing tomorrow morning – because she LOVES her job and she wants to go back to work that afternoon.  You know what she does?  She’s a prison guard.”

“No way!  That’s so – ”

“Dangerous and stressful, right?  I didn’t get into details, but she said it’s the easiest job in the world and she loves it.”

“Wow.”

We sit quietly for a bit while giddily basking in our commiseration and revealed dreams as if saying them aloud made each a little more tangible, wondering what it must be like to love going to work every day.

I also wonder if I said too much.

A pager goes off.  And then another.  One person rushes off to the floor, another picks up a phone.  For some strange reason, I am relieved.

____________________________

SOMEDAYS IT’S HARD TO BE A HAMSTA

]]> http://www.medeasmemoirs.com/2010/07/19/understate-against-the-machine/feed/ 10 http://www.medeasmemoirs.com/2010/07/18/a-condolement/ http://www.medeasmemoirs.com/2010/07/18/a-condolement/#comments Sun, 18 Jul 2010 23:18:57 +0000 scott http://www.medeasmemoirs.com/?p=1924 I’m sorry…?

I just called to … tell you it wasn’t my fault?  To see how you were doing?  Express my condolences?  (What does that even mean?  Does anyone ever express just a single condolence?)

No, I don’t know how things changed so quickly.  Or why we couldn’t stop it.

No.  I don’t know what that is like.

I don’t know what I would do.  Either.

It took me five days to call the husband of the lady that had died so quickly and unexpectedly.  I shuffled phrases and calm answers in my mind; choosing ones that weren’t defensive or guilt-ridden or careless.  On the first two days postmortem, I figured he might be too sad, or angry, or busy with funeral arrangements.  On the other days I was just too exhausted from running around until late evening from rounding to ER to floor crisis to even consider calling.  Finally, at the end of the fifth day, I sucked it up and prepared for the worst.

“Hi, may I speak to Mr. A?”

“This is him.”

“Hi, Mr. A.  This is Scott L., Dr. Scott.  I was the attending who … admitted your wife to the hospital.  I heard what happened and I just called to express my condolences.  Um, how are you doing?”

“Oh.  Hello.  I’m doing okay.  It’s nice to hear from you.  Thank you.  We just had the open funeral.  It was a shock at first.  But I’m doing alright.”

“That’s good to hear.  It was a shock, to all of us.  The other docs feel bad too.  She was such a nice person, too young for this to happen.  We’re still trying to figure out what could have been done differently, if anything.”

“Yeah, but you know, she should have gone in sooner.  And everyone was so amazing.  I couldn’t believe how many doctors tried helping her that night.  If I didn’t see it with my own eyes, I really would not have believed it.  Really.  But I saw how hard everyone was trying.  You don’t have to worry none about that.”

“I … I’m glad you’re doing alright.”

“I wish I could thank each one of you personally and shake your hands.  I mean it.”

“I’ll pass it on.  I’m sure everyone will appreciate hearing that.  How are your kids dealing with it?”

“They’re 29 and 30.  Taking it hard.”

“Understandably.”

I was so relieved and a little surprised that their “children” were that age.  They seemed old enough to have a little of life’s foundation to fall back on.  My brother and I were 12 and 13 when our dad died.  You just never want someone else to go through that, especially during those formative years.  At that age, a parent’s death becomes your life’s foundation.

“But they’ll be okay.”

“Have, uh, any other docs contacted you?”

“No, you’re the first.”

“Yeah.  They’re just … scared.  And disappointed, and sorry about the whole thing.”

“Well, I appreciate what they tried to do.  I sure do.”

I recognized familiar sounds in the background, “I hear children.  Grandkids?”

“Yeah.  They’re playing, heheh.  They keep me young.”

—

Afterwards I sent an email to the colleague who covered that night, who also wondered what he could have done differently.  I wrote:

“FYI:

I actually called Mr. A today, just to express my condolences.  He is doing well.  He is grateful for the care everyone gave that night.  He was amazed so many physicians tried to help.  He had no questions or ill will.”

He emailed back that night:

“Thanks a lot, Scott.  He looked awful when the hell broke loose but then he had a gleam of hope….  I’ll call her husband as well.”

Copycat.