VACATION!

Day 1 of vacation! I've managed to get a few re-entry things done today. I have been able to do my laundry. Have been able to do some preliminary cleaning. Have made a few calls, and made a list of things to get done in the coming days.

I almost booked a flight back to Denver, to leave tomorrow. It would be great to get a few days to spend with people... but decided what I really need is a few days here to just relax, and to start getting stuff in order!

Here are some pics from Xmas dinner:

"I'm Going to Die."

This is what she told me.

And she said it with acceptance, almost in reflection.

I. Am. Going. To. Die.

Well, not tonight, but soon I guess. And I stood by her bedside, with lots of things to say. But I didn't need to say anything. She didn't need to hear me talk. She just just needed to think and say some things out loud. She knew. Those aches in her bones were due to the holes where bits of cancer are eating away. She thought maybe those aches were in her head. "Well maybe it is in my head," she points to her skull and grins, "I mean I thought the aches were things I imagined, but I guess the cancer's in my head too." She made a joke. I smiled, and thought it was funny. She tells me, "I have a dark humor." No wonder I like this woman.

She's known. She knew when her bone scan was done last week. Her biggest concern is not her dying. It's the pain and suffering her sister will endure when she dies. I wouldn't have asked before, but now I'm learning that my own discomfort in asking certain questions is really my issue. Why I ask.

Only in the past few years have these sisters become close. And now that close bond will be cut prematurely short. I think about how my own brothers were celebrating one of my nephews second birthday yesterday, and how through many twists and turns we've managed to become close, and I feel lucky.

"What do I do, I don't want chemo again." We talk about what's important to her. I'm not a specialist in palliative care. And I don't know much about cancer. And maybe that makes the conversation easier. It's important that she enjoys the quality of her remaining time, quantity is not the issue. We talk about pain control, no chemo, and other details, and I add, now it's ok to eat all the chocolate and ice-cream she wants. "Yeah," she grins, "you're absolutely right, chocolate and ice-cream."

Bad News

1) Tomorrow I have to tell one of my clinic patients that they have cancer. I haven't seen this person in a while. I would imagine that the clinic calling to schedule a test result would invoke a bit of panic, given that pts usually can't get in to see us.

2) We started our day, at 8:30 am with telling a mid-20s woman (who is a patient on our team) that her mother had been pronounced dead in the ICU. Her sister died yesterday as well. We then took her to her father's room (who is also a patient on our team) and she told him that his ex-wife was dead, and his daughter had died the day before. Not fun stuff.

3) I had to call a family member of another patient to tell them that it was possible we would be intubating her brother by the end of the day. As it turns out, he has been able to avoid the tube so far.

I'm tired.

Hanging out with Jameson

Just chilling.

Jameson is the emergency break for my mind. Pulling the handle, making the craziness of life grind to a stop.

I'm hanging out with Jameson, listening to Dar Williams wondering how the fuck I've gotten to be 32, single, living here, working in a great hospital, in a job I like most days, contemplating taking a year out of my life going to South Africa, wondering when I'm ever going to have time to see friends in Washington, Dublin, Geneva, California, Australia, New Zealand, Pittsburgh, Burlington, Hawaii, wondering when I'm ever going to have time to email/call those I'm on the verge of losing touch with, leaving dinner tonight wondering why I'm single, realizing that I'm tired now and should just go to bed, thinking about how HW and I had a pact to discuss at dinner what was fun and fabulous about our days and realizing that day go by now without any fun or fabulous events, thinking about a crush and why I never told him, thinking about last night and how my friend is such an amazing person and if I were straight I would marry her in a minute and then realizing that this applies to many women I know, but very few men, wishing I had a dog, realizing that all of the above is pointless because I'm going to work tomorrow and for the next 12 days in a row and will have no time to think about any of these issues again until I am on break, and wondering if life is simple or complex, and trying to remember a conversation I had this summer with KE in which the summary was that there will never be enough time to do everything, and just wishing that I had met up with JA who knows how to keep life simple and fun, and that is what I need in life, a partner who would make life simple and fun, and now the nip of Jameson is gone, and somehow there is no resolution on any of the above issues but it doesn't really matter because I have flannel sheets on my bed which await me, and I will wake alone tomorrow, and somehow will become comfortable knowing that I may wake solo for the rest of my life but in the big scheme of things, that's a minor detail, the major details are that I am lucky to be working in my chosen profession and somehow have amassed a beautiful collection of family and friends, and Jameson is a friend who slows things down so I can think about these things.

The above isn't open for conversation when you see me. It's random thoughts that Jameson had me write down so that I can go and sleep in peace.

24 hours

In the past 24 hours I have:

-slept 3 hours
-rounded on 11 patients
-attended one holiday party
-bailed 1 friend out of jail
-pronounced one patient dead
-gone to the gym
-told one man his wife of 52 years was dying, and should go to hospice on Monday
-made a list of all the people I should call tomorrow, doubting that I will manage to get in touch with half of them

Displaced Coloradoan

A foot of snow... Get out of here. One of the problems of not having a TV is not watching the news, and then not knowing that it is going to snow A FOOT.

This news made my day. It's so nice to get dumped on, and when I got off work tonight (an hour late because the night residents had problems getting in), I had damn ball cruising through the snow. The Liberty is a joy to drive in the snow.

I got the sense that I was the only one who was happy about the snow...

Xmas Party #1

Dave had his annual tacky christmas sweater part. A great time to get the group together and let loose a bit. Though, this year was by far the tamest year. I don't think I posted any pics from last year, and for good reason..

Beth and John
Christina, Kenny, Me, Todd
Ted and Sharon
The Med-Peds 3rd year photo (minus one resident)
Why do parties always gravitate toward the kitchen?

Eire

Friday night Mayu and I drove down to see Mason and Kim and their gorgeous daughter Eire.

Mayu and Eire
Kim and I

Dinner

"...must be nice to be able to stop for dinner."

It's 6pm, I'm in the cafeteria.

"Actually, this is breakfast, lunch, and dinner."

Aside from commando runs to the resident room to grab an apple, or banana, 6pm was the first break of the day. Just one of those days. But it was kind of fun.. I rounded on patients, and it was one of those days where I really felt like I was making good decisions, where my attending agreed with my plans. Kind of a nice feeling.

Ethics

This is one of the few nights were I can't seem to sleep. There is no logical reason to be awake at this hour.

This evening, right as I was getting ready to sign out (telling the covering resident about my patients), a nurse paged me about a patient who was a bit tachycardic. Made sense... she was febrile, and thinking about her course for the day figured she was likely a dehydrated as well. (I make a mental note to review appropriate IV fluids with the interns). But, she'd been getting more ill as the day went on, and for some reason I decided to go to the bedside and just see her myself.

She has an illness, which her family doesn't know about. It isn't something simple. It's causing her to be very unwell. And I worry that she will die. In my multiple family meetings today, I asked again and again her medical history, watching this woman's husband, her brothers, her sister for some kind of sign or even a flinch, which would tell me that they knew about her illness. But nothing. The husband re-affirmed that she was to be fully resuscitated.

Arriving at the bedside, I saw the monitor, and she was tachycardic, but it looked sinus to me. Fever to 103. Pulse strong. What the hell, might as well get the EKG to be complete. It was done, and as I walked back into the room to tell the nurse she could go to radiology, right before my eyes she coded, and right behind my back was her family, who I had just re-assured that the EKG was as expected, and that her heart rate would settle with tylenol and IV fluids. Family out. Code cart in. She's back in sinus rhythm. And then the decision to intubate.

Fuck.

Fuck.

Fuck.

Back to talk to the family.

They understand the seriousness.

And all I can think about is that if/when she dies, this illness will be listed on her death certificate and they will be shattered.

Next Chapter & Final Chapter

Next Chapter: as I was getting ready to leave from work last night, one of the pediatric residents paged me to let me know that PJ (Sept 07) was back in the emergency department. We haven't seen him since he was discharged to a specialist for further care of his brain tumor. Apparently, he has been receiving radiation treatment and a new experimental chemotherapy. It was nice to see him and his mom, and to get an update on the status of his condition. However, he looks remarkably different than when I saw him back in September. His long-term prognosis is still not very favorable.

Final Chapter: JP died this week. She was admitted to the pediatric intensive care unit with an infection, and her prognosis was extremely poor. Her family and the team made the decision to withdraw life support, and she died within a matter of minutes. Inside her small room in the PICU, just before she died, were all of her family members. And they had a birthday party. She would have turned two this coming Thursday. So her family gathered, had cake and ice cream at her bedside, and celebrated her short life. I will continue to be amazed by how incredible JP's mom is.

I am back on medicine wards this month, as the senior ward resident. In addition to covering my own patients yesterday, I was responsible for precepting all of the new admissions that the interns did.