Monday, December 31, 2012

Yet again we're the only ones

Well, let's get it in before the end of the year, because here it is. The year came to a close quickly, before I could really wrap my head around it. And this is maybe the funniest year of them all, with the joke being on me, since I have to go to bed prior to the transition of 2012 to 2013. Such is the reality of my two week stint in the ICU.

About that I'm not sorry though. The holidays put on too much pressure, demand too much conformity, and I have no use for such things nowadays. Besides which, the ICU teaches you all about perspective. Family meetings every day, bad news broken on a steady schedule. Updates that end with hope or heartbreak. And of course, patients falling apart right in front of your face.

Some people have bad luck. Some people keep making the same mistakes over and over again. Some people are the few fortunate ones. Then there are those of us who get to watch it all unfold, who see that entire spectrum, and there is a certain privilege in that.

But the amazing thing I've learned is that perspective only comes to you if you are receptive to it. Even the anvils that the ICU deliver upon your head can go unheeded by those too caught up in their own nonsense to pay attention to it.

This year was so very necessary. That's the only way I can really describe it. I'm starting to understand how much the low points in life are intertwined with the higher ones. Despite my Eeyore-like exterior, my handle is brimful and the song which is the inspiration of my namesake is a pun about hope. This is the secret I keep for you and for myself. This is me, equal parts realist and dreamer, equal parts resigned and reaching. I have the capacity to be kind or to be cruel, and I try, try, try to do the right thing, to make the right choices. But I understand why sometimes others would see it differently. This is me, equal parts deeply flawed and perfect. None of that would be so, if it weren't for this past year.

Friday, December 07, 2012

I hear the bells

Sometimes I think my continued insistence of posting here is much like those cantankerous old writers who insist they only ever use a typewriter. But I still think there's too much brevity in the new world. And I refuse to believe people are only interested in soundbite-sized thoughts. Some thoughts require more explanation. None of my thoughts, mind you, but some thoughts.

Here are some thoughts I have had this week:
  • In geriatrics clinic yesterday, I heard the best stories. The first involved a retired police officer who had developed dementia. His younger wife is his primary caretaker, so we were asking her how things have been going. She told a story of how her husband had wandered into the neighbor's house one day and told them that a crazy woman was in his house, trying to order him new clothes. She shrugged and said, "in fairness, it was Cyber Monday, and I had tried to buy him a lot of new shirts." They'd had a laugh about it. She finds it hard- her husband had just retired five years ago, and they had plans to travel and enjoy their time together, but the dementia had changed all of that. But she was remarkably amused by all of it. The next patient I saw had more advanced dementia. He was mostly non-verbal. His wife and I sat down for a while to chat about how things had been going. She almost made me cry three times, and I don't have a heart, let me tell you. She takes care of her husband every day, helps him bathe, takes him with her everywhere because he can't be left alone. But she was so remarkably serene about it all. She said it wasn't that bad a task, because her husband is very sweet and he doesn't ask for much, and his suffering seems much worse than hers, in her opinion, and after all, he tells her every day that he loves her very much. Geez oh pete's, you guys. I'm not made of stone.

  • Every time I hear the melody of "Castle on a Cloud," I turn into a 14 year old dork, unreasonably excited about Christmas day. There was a time, in high school, after I'd gone to New York for the first time, and seen the Broadway production of Les Miserables that I was full-on geeked out on the musical. Then I thought I'd pretty much gotten it out of my system and that it had been an adolescent thing. Then I watched NPH and Jason Segel reenact The Confrontation and giggled, and just thought I found it amusing. Then I saw Jackman's determined expression as Jean Valjean, and I realized, nope, I'm still a geek. I'm going to be that annoying person in the theater, I can tell already.

  • Even though I rarely wear dresses or get dressed up in general, I have somehow become obsessed with sweater dresses. I own three now. I've been forcing myself to actually wear them, which is actually a bigger undertaking than it should be. Here's the thing- I'm happiest when no one makes any remarks about what I wear, good or bad. But the problem is, there's standard issue attire I've become known for over the years, because I don't like a lot of fuss. So when I wear a skirt or dress, there are usually no less than 17 comments made about this, and I want to run out of whatever bar or restaurant I'm in and change into jeans and a sweatshirt. I really should be more comfortable with myself, and I am about a lot of things, but not apparel, apparently.

  • I hope someone will yell at me if I don't come through on all these stupid holiday baking plans I have. I have lots of thoughts in my head, people. Thoughts about marshmallows and caramels and cookies and tartlets. But my head is often in the clouds, and a lot of these ideas often end up not happening. I really hope that doesn't happen this year. Otherwise, I will be mighty ashamed.

  • I've been at war with ants ever since the rains arrived. I'm winning, but the battle continues.

  • Also, there is a matter of much drama and peptic ulcer disease in my life, and I'm really glad that I've been separating myself from it. One of my married friends has been exhibiting some highly inappropriate behavior towards a guy, and it has been giving me angina for a while now. It's nice at this point in my life to trust my instincts enough to know that, even if you can't put your finger right on something, you have a good sense of what is right and what is wrong. And even though I feel badly that this friend is no longer really a friend, I don't miss all that unnecessary discomfort associated with it.

    Monday, December 03, 2012

    maybe just half a drink more

    Yesterday was a less hectic work day and some of the other residents and I were gathered in the work room, getting some notes squared away. One of the residents put some Pandora holiday station on, and the work room became Christmas carol central. I'm not exactly a grinch. I don't like all the fuss about most things in general, but I like the holiday season. I like getting in the spirit.

    One of my co-residents grilled me for 20 minutes yesterday because I recognized Rufus Wainwright in less than 4 notes. And until yesterday, I can honestly say that, although I am fond of song lyrics in general, I did not know that Baby It's Cold Outside included this gem:

    at least there will be plenty implied  
    if you caught pneumonia and died

    That's a bit morbid!

    I don't know if the carols got me in the spirit. It might have been all of us in the work room, chatting gaily, and laughing from our bellies. This time of year, I reflect on how lucky I am, even when I sometimes have this pang of self-pity. Whatever I have to complain about, I do have the privilege of having a job that I love-- and it is true love, which means that sometimes I want to spit and scream at it, and other times I am swooning, but either way, we are meant to be. I like what I do, I enjoy my co-workers, and though I might sometimes come down with annoying coughs, I have my health. My loved ones are well.

    I don't know. I saw a patient in clinic today, who I quickly learned had been battling depression for a long time, and my preceptor asked him when he was last happy. He said, "never" and it wasn't a ploy. But then he said he had a period of a few years when he felt an "interior sense of joy," and that stuck with me. It seems like a good thing to have. I guess I always assumed that, should one achieve that state, that sense, that it would be permanent. I guess nothing is.

    But I don't know if I believe that either.

    Anyway, getting to the point. This year, I'm free enough to do a little baking in December. So I got myself in the true holiday spirit in the only way that would work for me. I made a batch of molasses spice cookies, because nothing reminds me more of the holidays than those. And I fixed myself a Domaine Canton with ginger ale. And then it was 'tis the season and all of that.

    Saturday, December 01, 2012

    trapped between two lungs

    I'm almost done yet another stint of working in the hospital (as opposed to the clinic, where I spend the other portion of my time), and it's been a strange week. After that last call that landed me a missed Thanksgiving day, I got progressively sicker. It started with an itch of the throat and some sinus congestion, then it turned into sinus congestion and a cough. Then it turned into one of the worst coughs I've ever had- at one point, I actually wondered if I'd forgotten that I have an extensive smoking history (I've never been a cigarette smoker) because I sounded like a 75 year old veteran with emphysema. At another point, after my last call, the coughing fit got so bad that I could not sleep, and my abdominal muscles were actually sore (so at least I got a work-out as a consolation prize).

    It's just a virus. I know that. I tried to treat the symptoms with benign over-the-counter medications, none of which really helped. I finally started to feel better when I just gave up and drank copious amounts of Good Earth decaffeinated tea and water, and tried to catch up on sleep. I still have this barking, alarming cough that is scaring most of my patients. And I'm still wheezing, which makes me feel a bit sorry for myself.

    Except medicine gives you little room for that. As a general rule, physicians won't call in sick during residency unless a limb is falling off, there's intractable vomiting or uncontrolled bleeding in play. Otherwise- suck it up and soldier on. And if you are even thinking about feeling sorry for yourself, one of your patients will set you straight.

    Yesterday, that patient was a young guy, a decade younger than me, who had been diagnosed with testicular cancer this past year. He had undergone surgery, and then he had started chemotherapy because there was still some evidence of leftover disease, and each chemotherapy cycle had taken its toll. Then after his third cycle of chemotherapy, he started developing difficulty breathing, and after an extensive evaluation, it had been determined that he had a bad reaction to one of the chemotherapeutic agents. This had resulted in lung toxicity. So now this 20-something kid with a very treatable cancer is facing respiratory failure. His lungs are totally shot. Over the past month, he went from being what one of my colleagues calls a "walkie-talkie" to being unable to move without oxygen. When I saw him this morning, he was breathing shallow and couldn't say more than a word at a time without running out of air. The frail young boy that was in the bed before me just said we should do what we need to do, he was up for whatever we thought was best. It's one of the hardest things to see a patient exhibit that kind of bravery, that sort of will to live, when you know they are facing something that is largely untreatable.

    So, in the end, there wasn't much to lament about my stupid cough.