|
| So it has been quite a while since I have journaled....and unfortunately this is not a very worthy cause, but I think Will is tired of hearing me complain so instead I turn to those who may empathize with my frustration with Dr. Cox.....yes that is his name....that doesnt help matters. This is one of many interesting encounters over the past month
We had our midterm evaluation meeting tonight, and we are sitting at the table together. "Bailey!" he says, " Are you familiar with the fourth year student named Bailey?". "No, I'm not," I say. He continues, " Oh, well, she doesnt look anything like you.....I mean, she looks like her last name might be Bailey.....What are you Philipino or something?" Me, "No, Irish and Japanese mainly." Him, "Oh, well you really look Philipino, Im sure you've been told that, Anyway, you still remind me of her, you two have the same mannerisms. Id say you were related if you didnt look so different. I hope you do better in this course than her.....she didnt like psychiatry.....shes going to be a pathologist.....but I dont think you seem at all like a pathologist......you like psychiatry right?"
So here's the thing. If you want to talk about transference, I have been irritated by few doctors the way this man irritates me. And what irritates me most is that his job is to speak to and provide support to emotionally fragile and unstable people yet without even trying he can anger me, relatively mild queen of que sera sera, me. So I am glad to know that he associates me by something as simple as my last name with some student he has already established a dislike for. I certaily realize and confront my own pre conceived notions about doctors named Cox. Again as a psychiatrist he ought to be cognizant of these things.not to mention the thnic labeling, I wont even go into that, but I would like to know what exatly a Bailey looks like. Ok, ok Im done....in the whole scheme of things, Dr. Cox is a perfectly surmountable obstacle to my enjoyment of this rotation, and I am enjoying it, most especially the hour I get to spend with each patient. I will have more worthy stories and less complaining when I start SCMHTC next week.
| | |
| I am kidding myself by trying to get through primary care practice test
questions, so my drug of choice at this moment will be xanga....much
more healthy and therapeutic than ice cream I think.
Over the past few days I have had some life changing experiences...here are three of them
I had a rotation through hospice this week and saw two amazing and very different views of the end of life
Three Vignettes on Death
The first patient I visited was a two year old boy, diagnosed with
Rhabdomyosarcoma at three months of age, and after years of fighting,
succumbing to its devastating effects. His belly, his genitals, his
legs, everything was swollen, and between moments of delerious babbling
came excruciating muscle spasms that caused him to lurch and scream in
pain. His doses of morphine were no longer controlling the pain. His
mother was a stoic figure. There seemed to be little life left in her
after two years of helplessly watching her child waste away . She broke
down when she talked about how guilty she felt about missing out on the
last two years of her other childrens lives. The two young siblings
played in the living room contentedly with me, but I still noticed
their muscles tensing, their skin prickling each time their brother
cried out. The hospice nurse informed the mother that the only recourse
now for her childs pain would be to keep him fully sedated and allow
him to pass in peace when his time came. The mother was beside herself,
she knew there would be an end sometime, and she knew it was best for
her son to eliminate his pain, but this was like two deaths, having to
kill his spirit before his physical body was ready to die. This was the
second time this year that I had to cry for a patient.
I could tell that the second house I visited was very different from
the moment I pulled into the driveway. Happy young people were gathered
on the lawn and moving in and out of the house carrying large amounts
of alcohol. I worked my way through the crowd inside and out to find my
patient, a man in end stage renal failure who had made the decision to
stop dialysis. This gave him at most a few days of cognition before his
lack of kidney function overcame him, so he decided to celebrate in
style with a huge party with all of his extended family. Mariachi music
played in the background and this man was the designated whistle
blower, only he was extremely short of breath, so if he could muster up
the energy to blow the whistle, everyone had to celebrate with a drink.
I began taking his vitals and reviewing his remaining medications with
him and he stopped me and asked that I stop talking about serious stuff
and challenged me to chug a beer with him. I told him that I probably
shouldnt because I was working/representing the hospital and
school/driving. He rolled his eyes and said that he bet I didnt have
nearly as much fun in life as I ought to and said that it would be his
dying request for me to enjoy a beer with him. I told him jokingly,
"thats not fair, you cant pull the dying line on me." He responded, "
Maybe, but I AM dying, and its been a while since Ive had the chance to
try to convince a pretty young girl to drink more than she should, and
if you do this, then you might always remember me and you might tell
all your friends about me and I will live on as that guy who asked you
to chug a beer while you were working." So I did, and even in kidney
failure he still beat me. It was a surreal moment. I am happy to
fulfill my promise of letting his story live on.
This week I visited my own grandmother in hospice. She had been
bedbound for over a month following a hip fracture. She had battled all
her life with what I have always unprofessionaly diagnosed as bipolar
depression, and her infirmity only exacerbated it. She spent her days
making sure we knew how miserable she was and that we werent doing
enough to make it better. She made sure to review with us the people
who had not come to visit her and how ungrateful and disrespectful they
were. She refused physical therapy and got weaker and weaker. She asked
that she be able to wear diapers so she wouldnt have to get up to go to
the bathroom, she asked my mom to spoon feed her all her meals. As
miserable as it sounds, though, I think that this past month, for the
first time in a long time, she was content, because finally she was
getting the attention she felt she had been missing for so long. I
think we all understood this, so although the lavishing attention was
only creating a monster and encouraging her to stay in bed and not try
to get better, we somehow knew this was not the time for tough love. On
this visit though, her edge had softened, and she was receiving
visitors with warmth. Many family members came, and I had the chance to
spend many hours with her. She told me she was proud of me and what I
am doing. I hadnt realized till then how much I had needed to hear
that. I cant even count anymore the times she has not so subtly
inferred that I ruined her life by defying my gender and pursuing a
career rather than getting married and satisfying her only wish to see
great grand children before she died. But really, my visit with her
tuesday was so nice, nicer than any interaction we've had in a long
time. She passed away this evening.....and I am studying the various
stages of grief as they exhibit themselves in my family and realized
that her passing is affecting us so much differently than I ever
expected. My mom, who has the countenance of a saint, is I think angry,
as of she's offended that my grandmother chose to die. My father, well,
I guess that could be classified as denial, denial that anything ever
affects him. My sister....she's 16...and feeling just about every
emotion under the sun as 16 year olds do. Me, I believe I am
confused.....for almost 20 years now, our family dynamic has revolved
around assuaging her moods, and Im not sure we know what to do with
ourselves with her gone. I also realize that I am now without any
grandparents, a whole generation of my family gone, and I am realizing
that tomorrow returning to work at the VA with all my elderly patients
will not be so easy....
"In three words I can sum up everything I've learned about life: it goes on."
Robert Frost
| | |
|
So, the long awaited mother of all
entries…three weeks into my first rotation, Im expecting this to be pretty
hefty, but there probably wont be another for a while so you can take it in
pieces if you’d like. In terms of my whole private entry stint, there were too
many people not interested in making xanga accounts but still interested in hearing
from me, and also I googled and it seems all the cool med students and docs are
telling anonymous stories about their patient encounters so I guess that makes
it ok for me too…and no if all my friends jumped off a bridge I wouldn’t do it
too (ok actually that’s a pretty insensitive cliché considering what I am about
to write, but you’ll have to forgive me) but at least if one of us goes down,
we go down together. And my intentions really are the best, because these are
some amazing things Im learning from some amazing people.
So…my second Friday….the following all happened in one day
In the morning
I experienced my first official pickup by a resident, as well as my first
official moral failing as a med student. For those not down with the hospital
social ladder, residents, most especially residents in their last year, can
tend to have some tunnel vison. They are almost through with their education
ie. coming to a point where ass kissing will no longer have to be a part of
their regular routine, they are on the verge of having a real stable job with a
real, stable salary, so they think, hey, its maybe time to get myself married. At
this point they take a look around and zone in on the nearest thing with two
legs that is of the appropriate age, gender and education level…for example,
medical students. So the resident I was assigned to asked me to go to breakfast
with him because our first patient hadn’t come in. Now, they tell us over and
over again not to let residents buy us food with their residents card because
that is the hospitals money that we are misusing…but you know, I am paying them
$30,000 a year for the joy of doing what they tell me every day, so I didn’t feel
too bad about a $4.00 french toast plate and, at the time, I wasn’t aware of
any ulterior motive on the part of my resident. So we start some polite banter,
where did you go to school, what do you like to eat etc. So I learn that my
resident is a Sacramento native and he asked me,
“ So how do you think you would feel about raising a family in Sacramento?” Umm, what? I let this slide
because I assumed I misinterpreted what he said. He then asked, “ So, those are
some fancy rings you have on…do they mean anything special?” Not so smooth, but
still, I bear no ill will towards the guy, I just let slip a random comment
about me and my BOYFRIEND to hopefully squelch any further confusion or
uncomfortableness on either of our parts. Long story short this intervention
was missed and I did eventually take the high road and cordially refused a
further invitation to free lunch. But if anyone out there is interested, I can
point you to a young asian doctor who is apparently on the market : )
In clinic
that morning, I have a 10 day old well baby follow up. Babies are always super
fun, I could go forever on the way that young parents look when they are
staring into their new baby’s eyes. This, however, was not the case for my
little patient. She was a fourth child from a fourth unknown father conceived
even though her mother was on birth control at the time. Her mother seemed
rather not pleased with this occurrence. She kept referring to the baby as “it”
and responded to my questions with “yeah whatever, its not like I’ve never done
this before” But I asked her all the screening questions about post partum and
she was ok, and she DID show up to the babies appointment, so there was no way
to prove neglect or abuse…yet. I went to get a preceptor in hopes that they,
being much smarter than me, would know the right questions to get at what I saw
pretty obviously…..but in the end, you cant do anything to someone for just not
being a loving mom, and it was overall very frustrating to let that little one
walk out the door.
Still Friday,
afternoon clinic I’m on same day admit, meaning people with acute but not
emergent symptoms that drop in to be seen. So my first patient is a woman with
vaginal bleeding. So, as I pick up her chart and walk in the door, Im going
over in my head all the differentials for bleeding and what questions I need to
ask….I go through my questions feeling pretty ok about myself, and ask my
patient to get up on the table so I can examine her. She stops me and says, “
Umm, doc, I just want to let you know, just so you aren’t surprised…that I am a
hermaphrodite.” So my first thought is, wow, cool, I’ve never seen
hermaphrodite genitalia in person, this will be a good experience….but then I
realize my whole differential might be shot…this was 20 mins of lecture 2 years
ago and maybe a page in first aid…does she have ovaries ? Is it ok for her to
bleed ever? The speculum exam could be quite difficult with other appendages in
the way….but I just decide that I will continue as usual and if I doubt myself
at all, I will call my attending. So she gets up on the table, I take a look…and
it appears…..all girl…..nothing but girl. So I think….maybe she meant she used
to be and she had surgery….so I ask her about any past surgeries, she says no. And I am worried at this point, that if this
is something deeply psychological, it might really hurt her if I disturb her world,
at least right now while she’s all half naked and vulnerable. So, I ask her if
she’s been told if she is an XY or an XX…..” Oh, XY” she says, “Im a male.” Oh….I
see ( actually I don’t see). So I think, maybe she is transgender or wishing to
be, and ask her just that…and again, “ No, Im just a hermaphrodite.” At this
point I can officially say I am doubting my expertise with this patient, so I go
get my attending. When I relay the circumstances to my attending, she
unfortunately says, “ Hey, I do depression and anxiety and generally making
people feel happy, I think this is out of my realm too.” But we make a plan to
invite into the room, the patients partner who is sitting in the waiting room. As
we are talking with the two of them, the partner is also affirming my patients
hermaphrodite status…..interesting. The resolution of the story seems to be
that they are both lesbians from very traditional homes, unable to completely
accept their lesbian status and compensating for that fact by deluding
themselves that one partner is actually somewhat male….but that is my
completely not professional opinion….but we referred them for some couples
counseling so someone can hopefully help them to love themselves as they are.
Same day,
next patient, my attending hands me a chart for a foot surgery follow up, easy
peasy pumpkineesy she says. All I have to do is ask about pain and healing and
bleeding and rehab and meds. So I go in and my patient is recovering quite
well, I ask all the obligatory questions, and just as I am about to be done,
the phrase that makes all physicians get goosebumps a little, “ Oh and one last
thing doctor….” She asks me if she can show me some pictures, and pulls out a
folder. Im not really sure what to expect, but how could I say no, sounds like
a simple enough request. The first picture is the new cat and kittens she has
adopted, so that was pretty sweet. The second is her den….only you cant even
tell it is a den because there is junk from wall to wall, floor to ceiling, it
was really terrible. She went on to show me her living room, her garage etc. She
tells me, “ I have a disease, its called hoarding, it’s a type of OCD, here’s a
pamphlet about it for you.” So that was
nice of her, but I was still in my comfort zone, packratism and cat ladyism aren’t
such rare occurrences. She goes on, “ But I wanted to bring in these pictures
for you to show you I’ve been improving and as you can see here, I cleared a
path to all the exits, so you don’t have to call the fire department on me.” I
told her I wasn’t even aware I was required to report to the fire department,
but that since she had taught me something valuable, I wouldn’t report her this
time.” She continues, “ But this isn’t really what I wanted to talk to you
about. When I was cleaning a few months ago, I found some gay pornography that
belonged to my husband. Oh….did I mention that he is a hoarder too? Anyway, he
is a writer and at first he said it was just some research he was doing for a
story. … Later I found some e-mails he exchanged with a gay chat internet site.
When I asked him he said it had just been a phase and a time when he was really
depressed and needed people to talk to, but he’d never had any encounters or
acted on anything…..I was cleaning again and found a whole pile of five years
worth of receipts to gay film festivals and gay interest events….and I just
really don’t know what to do with this…..but I do want you to know, that we
have been married for twenty years and we have had some good sex…in my womens
studies classes I was always the one raising my hand about having multiple
orgasms…I had no reason to suspect” On further counsel, I actually determined
that this lady had a pretty good outlook on her situation and really just
wanted her husband to be open with her and to be happy in whatever lifestyle
was meant for him, but that they probably really needed some mediation and her
husband definitely needed to talk to someone because I cant imagine what damage
a lifetime of squelching ones sexuality could do. So I mentioned to her getting
her husband to see a counselor and she says, as casually and nonchalantly as
one could ever say something, “ Well, you know, I’ve been a woman for 15 years
now, and I have enough woman’s intuition to know that he cant go on living like
this forever.” I pretty much just about fell out of my chair.....especially the
way she said it just in passing….so, married 20 years, been a woman for 15, no
reason to suspect husband gay….oy! I don’t remember this page in “Oh the places
you’ll go” but in the end, she really was a sweet woman and I was honored to
have been confided in so deeply…but even though in my previous case I didn’t appreciate
the false warning, this time I could have used some slightly bigger clues
before I got completely blindsided.
Alright, this is already too long, and it was just one day….
I’m calling it quits for now, but don’t worry, there is more to come
| | |
| Alright, so I promise there will be a fun patient entry this weekend,
but things got a little overwhelming this week, plus its apparently
more difficult than I thought to do private entries so I may be
rethinking that
On the up side, I got a really nice anniversary surprise from Will, two
tickets fifth row to the sold out Foo Fighters Acoustic show tomorrow
in Berkeley...so that was kind of nice...especially since Dave Grohl is
a demigod and all, especially when he does acoustic music with an
orchestra....yeah, thats pretty much my definition of hot.
Speaking of hot, Will also decided for some reason ( I think bar
studying is driving him crazy a little) that it was absolutely
necessary for him to have a piano....right now. So he had his parents
ship up his dad's heirloom turn of the century upright which now sits
in my living room. Not that Im really so much against it. So it may not
be exactly the backup guitarist I always wanted in highschool, but Im
learning to accept my band geek and it really is just as attractive
sitting down singing broadway tunes at the piano and how Walden Pond
will we be when we find free music so we can do guitar and piano duets?
All we need now is a fire and some egg nog or something.....but I will
NEVER own a matching monogramed sweaters.
And since this entry seems to have a theme...I was discussing with my
little sister earlier, what exactly is it about musical men that is so
attractive. Perhaps it does indicate sensitivity or at the very least
an attention span....and is different from painting or writing because
performing also requires confidence. In any event, its nice to know
that I can still somewhat identify with sixteen year olds. Although,
she is a drummer's girl because she likes her guys a little whacked out
while I prefer the second guitar, intelligence and passion, minus the
cockiness and drug issues
Wow, this entry was pretty much about nothing, I promise the next will have much more worthy content.
| | |
| So I've decided to only sort of comply with privacy rules. Because I am
having so many interesting encounters and I know that I need to write
them down for posterity when I become old and jaded about my patient
visits, but I would so love to share them with my colleagues.
So....from now on, if you would like to partake of my journaling, I'll
have to add you to my readers list because Ill be setting all my
entries to private. If you are a frequent commenter on my site, your
name is probably already on the list. Thanks everyone
| | |
|
