“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?

For the Birds

July 30, 2010 § 2 Comments

This month of night float is almost over…THANK GOD!

That lifestyle is for the birds

The things that this schedule has done to my metabolism, mood, waistline, circadian rhythm, personal relationships, work ethic are catastrophic.  I have never felt more out of touch with the world, even while I made my monthly cross country treks during my last two years of school.

It’s such a struggle for me to look on the bright side of things right now.  I hate seeing these changes in my life.  I have been venting non stop to one of my favorite people how my life feels so out of whack right now and how I’m not sure how much more of it I can take – having second thoughts on a daily basis and wishing I had chosen surgery or ER over internal medicine.  Dammit, I had the scores (I think).  Why did I choose internal medicine out of the fear that I wasn’t cut throat enough to survive a surgical residency or fear that I wouldn’t get interviews? Why didn’t I tell the program director at my ER rotation that I would do anything to switch to his program because it was so strong in both didactic and clinical areas? I’m so damn sensitive.  Why the hell did I settle? Maybe these ridiculous questions are just part of this treacherous territory. It’ll most likely all work out in the end…only if I get that cardio fellowship (fingers crossed).

The main goal of this post was to highlight how my body and mind have changed drastically this month.  I have to look on the bright side and congratulate myself for the strides I know I’ve made.  I started spin class when I knew my stress level was a bit high, fell in love with it and now I can’t get enough.  I  spin about 3 times a week and I’ve continued my C25K on days opposite spinning, almost right on schedule. That’s pretty stinking good, right?  I typically only leave one day out of the week to rest my muscles one weekly.  I’m so f^&*ng proud of myself for the determination that takes.

There’s a but….

Despite how much more exercise Im getting and how the scale reassures me that things are going well overall, I still look at my gut and overly large chest in the mirror and wonder why they won’t budge.  Aggravation!  I have attributed it to a few things, all related to night float (for the most part). I’m not doing nearly as much yoga/pilates as I was during my slightly flatter belly days, not eating on a normal diurnal cycle, and not eating the most of the healthy foods I used to crave – simply because night shift is such an abusive schedule on the body.  I used to eat once every three hours and barely ate carbs simply because I didn’t crave them.  I would have one of the major meals of the day and creaking it up with a Kind bar, fruit, little yogurt shakes, SOMETHING of substance.  I can’t eat on my normal schedule when I’m sleeping at odd times and eating when I can.  These days all I crave are bagles, Dunkin’ donuts grilled cheese flatbreads, chocolate, sweet breads, chips and salsa, chinese food, salty, and more chocolate.  What the F*** is that about?  I suppose my body is just in freak out mode because of the change in cycle – I think that’s why the carbs are being over desired.  This is no bueno.

so….

I’m going to attempt to take these changes in stride.  It’s OK that I put on pound on this week – after all, the nurses loved working with my co-intern and I so much that both the ICU and the ER had little parties for us. That meant pizza, wings, ice cream cake, garden fresh veggies, homemade brownies/choc chip cookies, and my favorite – cheese and crackers.  This, by the way, is an extremely rare thing for nurses to do for interns (so I’ve heard) so I’ll give myself (and my co-intern) a huge pat on the back for keeping the RNs happy. (Plus of the month) It’s OK that I ate that way.

I’ll also have to learn to forget the scale for the time being.  I didn’t go for my weigh in this week because I knew what the situation was and I didn’t want to be too much harder on myself.  I know what this night-style is doing to me so I’m letting it go. Along those lines, I’ll have to let go the negative feelings I have about my job right now.  I think the mental and emotional hardship is part of the game at this point and I have to remember that I’m still learning.  I think it’ll all be OK at the end.

My main goal of the week will be to add more of my Yoga or Pilates as my schedule changes to day team, finally.  I’ll see how that schedule works out and if I have time for the yoga, I’ll do it; if not, then so be it.

Happy Reading 🙂

I am what I eat

July 11, 2010 § 5 Comments

Gross

I feel so gross.  Residency finally started and I’m working night float so that means I’m not really eating much because I’ve never been a night eater, right? I thought that when I shifted my sleep schedule that I’d also eat much less  and I’d be busy enough to stave off cravings.  I couldn’t have been further off.  The only accurate part is that I’m not, or at least I didn’t think I was, a nighttime snacker.   Working nights has made me soft, literally.  Some how I’m hungry every hour. I have been trying to stick within my WW points and pack little 4-point almond butter and banana sandwiches, apple, greek yogurt with granola and fruit, and by sticking to my all bran in the AM.  I have even stuck with my eating every three hours rule and have an eating schedule planned out in my head.  None of this is helping.  For some reason I’ve re-developed my love handles and my abdomen looks like something I’ve only come across on maternity units.  My measured weight is actually continuing to decrease while my image in the mirror is NOT what is was when I graduated last month.

I’ve been eating so much more…and not just when I’m at work, it’s mainly when I wake up in the afternoon. I’ve completely let myself go to the point I had TacoBell two times last week while hanging out with the little bad influence Runt-my sister.  I hadn’t touched bad-for-you-nutrient-deplete fast food in months. MONTHS.  Then she introduced me to the crunch wrap supreme. 12 fucking points.  12!!!!! Mind you, this was at 1 a.m. It’s been downhill from there.  I had tiramisu, went to a wedding and had cake and a cannoli, multiple sweet mixed drinks, I’ve even gone back for more TacoBell.

I miss my last few months of people making fun of me for eating so healthfully and for my self-control around desserts/junk at work.  I’ve never had control like that before.  As much as I say I want to get back where I was with my self control i feel like it won’t be as easy this time because i don’t have a particular goal.  Last time it was that I didn’t want my classmates seeing me as a fatty at graduation.  I haven’t been able to find a new short term fitness goal.  I know this is what works best for me.

The only thing I’ve go going for me lately is that I’ve been exercising A LOT lately.  I’ve been doubling up on spin and running; a little speed-junkie I guess.  The only thing I really miss is my hot yoga… and I guess pilates.  I’m pretty sure those were the two things that really helped me tighten up and tone…the only issue is that I can’t afford the Bikram anymore and I have no patience for pilates.  It’s just not what I need these days.  I’ve got to get back into it.

I need some tips and encouragement/motivation ASAP.

happy Eating…. 🙂

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