“Everything in life is only for now”

May 3, 2011 § Leave a comment

Everything in life is only for now – quote from Avenue Q imprinted on a pin that one of my patients wore on her hospital gown everyday
Residency

This post will focus on what I’ve gained, both with respect to my medical knowledge and my fitness.  It’s been an emotional and physical test of my ability to cope with loss, gains, and learning what is most important in medicine.  It’s been painfully humbling to say the very least.

This month has been a particularly challenging one, not in terms of the medicine, but in terms of the emotional connectedness and empathy I felt on a daily basis.  I spent four weeks on the Hematology/Oncology ward.  This means I was taking care of patients with blood disorders such as obscure anemias, bleeding disorders, leukemia, lymphoma, and specific cancers such as lung and melanoma.  There is no other service that teaches you how to connect with your patient or fosters an environment where bedside manner can make or break your relationship with the ill patient.  This was, in all respects, my favorite rotation of intern year.

Human connectedness

Those two words describe the essence of the service.  I have never developed connections with my patients as I did this month.  Yes, of course I care for all of my patients and am generally interested in their well being, but let me assure you then when you have a patient who is experiencing end of life, the relationship beckons deeper love.  I think this was, by and large, a month where I learned more from my patients and was “helped” by them more than I could ever have done for them.  I found myself going the extra mile, staying many hours beyond my duty hours just to spend time with the families, ensure that crashing patients were safe, all loose ends were neatly tied, and, foremost discuss end-of-life decisions- the latter being the most emotionally moving aspect of my training to date.   It become my job to initiate a natural path to death with my beloved, terminally ill patients.  No other profession is honored with the rights to discuss DEATH with another being, to tell a true fighter that it’s ok to let go. I would do absolutely ANYTHING to allow them the most comfortable and peaceful path towards death. I grew intensely attached to my patients, regardless of age, stage of disease, or stage of grief.  I found myself calling the nurses long after I left to make sure the dying had enough pain meds, were comfortable, and that their families could call my cell if they needed. Humbling, terrifying, mystifying.  While the families we cared for were losing a loved one to sinister disease process, I was gaining insight into the depths of family values, the human experience, family dynamic and the meaning of love.

Losing patients to disease hit me so much harder and signing a patient’s DNR/DNI form would bring me to tears at times.  One patient’s decision to become DNR/DNI (meaning that they did  not wish to have CPR or any life support) led me to the closest bathroom where I spent a solid 30 minutes sobbing.  Of course I didn’t do this in front of the family during decisions of that magnitude, but I can assure you that I broke down into tears while holding the hand of several of several patients while  listening to their life story.  Beautiful.

Also, something that I saw on this service that I didn’t see an ounce of on my other rotations was POSITIVITY.  I was astounded at the positive attitude and zest for life that my patients had.  Considering the grave prognoses I wrote in charts daily, I was inspired that each patient was living for THIS day.  They focused only on THAT days’ total blood count, THAT days’ pain control, THAT days’ time with family, and some days even shared the travel plans they had for their last days.  There was only one time where I saw a patient cry over their disease, otherwise these patients were the embodiment of stoicism.  Again, they taught me lessons that a medical text book or attending could never teach me.  The quote in this post’s title was on a pin adorned by one of my myelodysplastic patients everyday.  She was preparing herself for a bone marrow transplant but was developing complicating infections because her immune system was being ravaged by the disease process.  Every morning I walked into her room she was playing vivaldi on her iPad, had her hair and make-up done, and would smile at me and say, “Good morning Miss Thing, I’ve missed you! How are we gonna start this day?”…and all the while all I could see was her rouge smile, while in the back of my mind knowing how ill she was, yet she saw past the disease and chose to live her life.  Her’s, as well as the experience from others, made me re-think those little things that I get worked up about, that we all stress about, and that we allow to ruin our day.  I thanked all of my patients at the end of the month, wished them well, sat in my car and and just cried, not wanting the month to end and not wanting to lose these patients.

Who would have thought that dying patients would teach me how to live. One day at a time.

Weight

Two weeks ago I reviewed my previous work-outs and saw that P90x (lean) made me put weight on and it was by no means only muscle weight. I went up a dress size and felt uncomfortable.   This gain did not make me happy but, like I said above, I have chosen to focus only on my activities and wise food choices I make THAT day.   I have several goal dates in mind (long term) but refocused on the short term goals by staying in the now.  With this mindset, a change in my exercise routine, a new exercise partner (mini-me, baby sis), discontinuing P90x (because there is not nearly enough cardio), I have lost two pounds this week.  This loss occurred despite going out to dinner and enjoying a few fantabulous vanilla bean cupcakes with Nutella frosting that I made for  my heme/onc nurses & attendings.

Recipe

I’ve chosen my French Onion soup because, like the experiences I’ve had this month, it’s simple, full of flavor, and the simplicity gives it it’s divine savory flavor. How fab does this look!?


French Onion Soup
As adapted from Gourmet, 2006

Ingredients

  • 2 lb medium onions, halved lengthwise, then thinly sliced lengthwise – **I actually used sweet onions**
  • 3 sprigs fresh thyme
  • 2 Turkish bay leaves
  • 3/4 teaspoon salt
  • 1/2 stick (1/4 cup) unsalted butter
  • 2 teaspoons all-purpose flour
  • 3/4 cup dry white wine – **I used equal amounts of Gewurtztraminer for the sweetness and acidity to offset the savory croutons and broth**
  • 4 cups reduced-sodium beef broth (32 fl oz) – **I used fat free, reduced sodium, minimal loss in flavor**
  • 1 1/2 cups water
  • 1/2 teaspoon black pepper
  • 6 (1/2-inch-thick) diagonal slices of baguette **I used freshly made, large cut Butter- garlic croutons** from the Fresh Market
  • 1 (1/2-lb) piece Gruyère
  • 2 tablespoons finely grated Parmigiano-Reggiano to sprinkle atop just before broiling
Prep

Cook onions, thyme, bay leaves, and salt in butter in a 4- to 5-quart heavy pot over moderate heat, uncovered, stirring frequently, until onions are very soft and deep golden brown, about 45 minutes. Add flour and cook, stirring, 1 minute. Stir in wine and cook, stirring, 2 minutes. Stir in broth, water, and pepper and simmer, uncovered, stirring occasionally, 30 minutes.

While soup simmers, put oven rack in middle position and preheat oven to 350°F.

Arrange bread in 1 layer on a large baking sheet and toast, turning over once, until completely dry, about 15 minutes.

Remove croûtes from oven and preheat broiler. Put crocks in a shallow baking pan.

Discard bay leaves and thyme from soup and divide soup among crocks, then float a croûte in each. Slice enough Gruyère (about 6 ounces total) with cheese plane to cover tops of crocks, allowing ends of cheese to hang over rims of crocks, then sprinkle with Parmigiano-Reggiano.

Broil 4 to 5 inches from heat until cheese is melted and bubbly, 1 to 2 minutes.

What experiences have reshaped you recently?

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