The heart of life

She started tearing up and reached over to clasp his hand.

"We're not going to leave you, Daddy," she said.

"Well, of course not. It's too hot to go outside!" he tried to joke, but the tremor in his voice gave him away, as his eyes started to well up as well.

My patient has small cell lung cancer. And even though he's currently getting palliative radiation, today we had the discussion about end-of-life goals of care. And today, we had to face the fact that our patient only has weeks to months to live.

Sure, we may have had numerous classes about difficult conversations. And this - this was probably the most difficult conversation of them all. Ask the patient what they know. Ask them how much they want to know. Be honest, and be compassionate. Allow them to ask questions. Don't rush. Be there. Offer tissues. Hold their hand, if appropriate.

But all the classes in the world couldn't prepare me for all the emotions that were in that room. All the emotions that made me start to tear up too.

Call your parents tonight and remind them you love them. Because, as my patient said, "tomorrow isn't a guarantee, it's a gift." Carpe diem, indeed.

Blow it all away

I love my days off. And with the recent switcheroo of senior residents, it's been eleven days since my last day off. When we start hitting the double digits, my body just gets so out of sorts, it doesn't know how to function.

Today's my day off. And I had big plans for it. Big giant do-everything-you-can-so-real-life-doesn't-get-in-the-way-of-Martin-visiting plans.

I was going to finally finish my study abroad application. I was going to fine-tune my personal statement and send it to all my letter of recommendation writers. I was going to clean my apartment and have people over for an actual sit-down dinner. I was going to study and do questions. I was going to finally tackle that molehill of laundry that has slowly evolved into a mountain. I was going to clean everything - my sheets, my blankets, and even my pillows, because I had just read on some do-it-yourself website that the more often you wash your pillows, the fluffier they are. My pillows had never been washed since I bought them a year ago. And my pillows were becoming flatter and flatter pancakes with each passing night.

So I woke up this morning, threw 2 pillows into the washing machine as instructed (to balance it, of course), and sat down at my computer to do a block of Step 2 questions.

Sixty minutes later, I finish my block of questions and answers, and go out to the kitchen to grab a Sunkist.

And the moment I open my bedroom door, my foot splashes into a puddle. Literally. Splashed. As in, my foot went down, and water came up and splattered around my ankles and calves.

Sometime while I was figuring out 44 questions, my washing machine overflowed. Leaving me with a giant lake in between my room, the kitchen, and the bathroom.

I threw down every single towel, rug, doohickey, and doodad I owned, hoping to absorb most of the water before it soaked down through the ceiling of my neighbors downstairs. But there seemed to be no end to it. My roommate had the good sense to call the maintenance people (not just for clogged drains, friends!), who finally came with this huge water vacuum. It was amazing. But not at all useful, unfortunately.

So now we're sitting here, with very damp carpet, and industry-sized fans blowing the crap out of it.

Per maintenance people, the fans need to stay on for 2 days straight. 2 days. 2 days of mindnumbingly loud whirring and shirring from this stupid fan, for this stupid lake.

Real life stuff really asserted itself on my day off. I just thought it was going to be real life application stuff. Not real real life. But I guess that's just how the cookie crumbles.

Angel tonight

Three days ago, we picked up a bounce-back patient. Three days ago, her family decided that they wanted to withdraw care. Yesterday night, her daughter from Florida arrived at the hospital.

Today, we held a family meeting.

And today, we started a fentanyl drip and took her off the machines. Two hours later, she was no longer with us.

I didn't know her personally, but it was still incredibly sad.

Fallin' for you

Hahahaha! I could not stop cracking up during this. Jason Lewis is pretty hot, though. Yum!

Idiots with Zoe Saldana & Kate Bosworth from Zoe Saldana

Smile through your pain

We all know that being in the hospital sucks. It's boring, there aren't that many TV stations to watch, you're anxious because you don't know what's wrong with you, and you can't get a decent night's sleep thanks to all the blood draws and constant vitals monitoring.

So I was understanding when I walked into my patient's room today, and she demanded to be allowed to go home. I didn't mind when she rolled her eyes at me and muttered indecipherable things under her breath, as I tried to tell her that we needed her to keep the telemetry monitoring on, so that we could make sure her heart wasn't doing anything crazy. I tried not to let it get to me when she turned up the volume on the TV when I asked if I could turn it off so that we could talk.

But then she called me a "stupid chink" and started cursing me out.

And I kinda lost it.

Ma'am, I'm just trying to help you. You fainted for no apparent reason and lost consciousness for ten minutes! And then you were confused for another thirty minutes. That's a LONG time. That is NOT normal. You haven't seen the doctor in twenty years, so all these checks? The blood draws and the blood pressure? They're to make sure that you're okay. I come in every day - not to annoy you, as you say - but to find out if there's anything else we can do to make sure that never happens again.

That would have been fine, but I don't know. Having gone through a whole year of having to put up with all the put downs by attendings/residents, and having dealt with my share of difficult patients, I don't know why I just snapped. I should have just bit my tongue and gone on my merry way. Instead, I kept going.

I am a human being, and I don't deserve to be yelled at like this.

She rolled her eyes at me.

Don't roll your eyes at me - yeah, I saw that. Don't call me racist names, and don't swear at me, because that is completely inappropriate. If you don't want to be here, you don't have to. If you want to walk out that door, you can. No one is stopping you.

I almost huffed out. I was so pissed. I didn't care what this woman said to the nurses about my behavior. I could care less what my residents thought. I have absolutely no motivation this year, and as long as I pass my clerkships, I could care less about being nice to this nasty horrible woman.

But then I realized that if she walked out and dropped dead because she had some cardiac abnormality that we didn't know about, I would feel so guilty. I would feel responsible. So I softened my tone, and continued.

Do I want you to walk out that door? No. Because I want you to get this echocardiogram we've ordered for you. Because I want to make sure that your heart is okay. Because I don't want this fainting business to happen again.

She still refused to look at me.

So, what do you say, Ms. Lily? Will you stay a couple more hours and get this echocardiogram? Because if you want to leave, I can go get your papers ready now. Regardless of what you think, this isn't a jail. We're not keeping you here against your will. We're keeping you here to find out what's wrong with your health. And you can go whenever you want.

She continued to stare at the TV, the volume blaring so loud I was positive the patient next door could hear Kathy Lee and Hoda hawking products on the Today Show.

I was dejected. I wasn't sure she had even heard anything I had just said. I sighed and turned to leave the room, ready to find that AMA document for her to sign. And then she said brusquely, each word cutting through the hostile air, "Fine. I'll stay. Whatever."

I should have been happy that I had convinced her to follow through with her health issues. But instead, I just walked back to my team room and asked to be removed from her care, because I just couldn't go back into that room. I felt like I hadn't gotten through to her. Instead, I had given a 63 year old woman a lecture I thought only my mother was capable of. I felt terrible. But what else could I have done? Maybe I should have just grinned and beared it as she called me "a f---ing c--- who doesn't deserve to be in the country that my forefathers fought for, unless you're washing my clothes. If we were in Arizona, you'd be f---ing deported back to the motherland."

Yeah, she said that.

No, I didn't punch her in the face.

I know she was frustrated. I know she was cranky. And I know she was taking it all out on me. But I didn't deserve that much abuse. That kind of abuse.

Foundations

Late entry for the end of third year, because instead of blogging, I just wanted to get out of dodge and see the boy:

HOLY CRAP, I SURVIVED AND I DIDN'T KILL ANYONE! WHEEEE!!

Phew.

Mouthwash

Yesterday, I got an email telling me I still had evaluations to fill out. Surgery evaluations in particular. Evaluations that had to filled out within 24 hours or I would risk having points taken away. Dun dun dun.

I had been avoiding it. I had actually filled out evals on all of my attendings and residents except for one. Everything was done, except for my eval on Dr. Meanie Bikini. Because while I talk a good game, I'm actually a nice person, and I couldn't imagine actually writing her a scathing eval that told her that she was a terrible terrible person.

I sat in front of my computer for over an hour, as I tried to craft an eval that described how terrible my month was - how terrible she was to me - while keeping it all respectful and professional.

So I started off as she did, praising the things she did well. Like pairing me with a general surgery team who actually seemed to care about my learning, and taught me basic surgical skills when they found out that I was getting absolutely no exposure in Dr. Meanie Bikini's OR. I praised how she actually watched me perform history and physicals - without mentioning the scathing comments she always made afterwards.

Then I threw in my huge "however" - the big "BUT" that you knew was coming. The big BUT that she had put in my evaluation.

That said, while I appreciated how Dr. Meanie Bikini was very dedicated to teaching me "how to become a doctor," I felt that it was impossible to measure up to her expectations. I always felt like I was disappointing her, even though I genuinely was trying very hard, and I did feel as though I improved throughout the month.

I did appreciate that she took time during her surgeries to ask me questions about anatomy and other pertinent key issues about patient care and management. However, I wish she would help the student reach the answer, instead of merely telling the student to "look it up" each time. In fact, I think I learn better when I'm allowed to reason through my answers.

From the first day of the clerkship - when I misspoke during an anatomy question that I clearly knew the answer to - to the very last week, Dr. Meanie Bikini constantly used the word "disappointment" and "unimpressive" and made me feel as though I could do nothing right. No student needs to be told that they are a disappointment, especially from a teacher. I put in a lot of effort to prepare for each case, but I felt consistently belittled without any constructive criticism.

Again, while I appreciate that Dr. Meanie Bikini may simply have been pushing me to become a better medical student, in my opinion she clearly went about this poorly. I truly believe that she could have been a great mentor if she had just realized that positive reinforcement does a lot to model a student's behavior. After all, positive feedback is just as valuable as well-meant criticism.

Overall, I thought it was pretty tame. At least compared to my first draft, it was drastically tame. I read it aloud to my roommate, to the Boy, to my sister, and fiddled around with it until they agreed that it sounded professional, while giving voice to my grievances. And then I hit submit, and wiped my hands of it.

This morning, as I was rounding on my patients, I saw Dr. Meanie Bikini on my floor, talking to a nurse. I had dreamed about this moment. This moment of redemption. Thought of what I would say. What I would do.

Yet, instead of doing all I promised Jean I would do, instead of going up to her and cursing the day she became my attending, I instead ducked into the supply closet and hid behind piles of chucks.

I freaked out. Was she looking for me, ready to dole out more hurt? Did my evaluation get sent to her the moment I hit submit? It was unlikely right? Had she read how I thought she was a terrible mentor? How I thought there wasn't a nice bone in her body?

I had dreamed about this moment, relishing it in my mind. But, instead of pointing at her from across the room and proclaiming "YOU! YOU were the disappointment! YOU are uninspiring! YOU are everything I hope I never become as a doctor!!" I simply hid.

I guess when it comes down to it, I just can't be as cruel as she was.

Go on

I just threw away all my ob/gyn things - pregnancy wheel, contraceptive chart, preconception checklist, fetal heart tones cheat sheet, and various self-made handouts on preterm labor, preeclampsia, gardasil, etc. - and, forgive the melodrama, but it felt like the end of a really bad breakup. You want to hold on, but know that you should move on. Know that you have to move on.

I did stare at it for a good 10 minutes before throwing it all into the trash.

Goodbye ob/gyn. You've been very good to me.

Home

I almost missed my flight today, because in the midst of all my Orbitz ticket drama, the customer service rep didn't tell me that they had switched me to a completely different airline. So I showed up at 3:30pm at the Alaska Airlines kiosk, more than an hour ahead of my scheduled flight, only to be told that they didn't have my reservation. No, I was at Terminal 3, but I was supposed to be in Terminal 7, which (in)conveniently was located halfway across the airport. "You should run," said the ever-helpful Alaska Airlines rep. Instead, Martin came back, picked me up, and drove me to my correct destination.

Then, of course, I had to run to my gate, per usual, but those five additional minutes with Martin were worth it.

If you're not the one

Yesterday, Martin and I went to The Grove after he finished work, to catch a movie.*

We waited to take the elevator along with two other guys. And then the taller one spoke, and I swear my head did a full 360 degrees swivel, as I turned to see who owned that rather distinctive voice - that voice that I used to hear on my TV once a week.

I started nudging Martin, and making faces trying to make him look at the somewhat ordinary-seeming guy standing next to us. Martin just looked at me, bemused, unaware that I wanted him to look at the guy, and not at my stupid faces.

You see, we were standing right next to Ethan Peck. Star of the just-cancelled the ABC family TV series, 10 Things I Hate About You. Grandson to my most favorite old timey star after Audrey Hepborn - Gregory Peck (of To Kill a Mockingbird and Roman Holiday fame). And Ethan Peck has the sexiest biceps to go along with his most distinctive sexy baritone voice.

At least, I'm pretty sure that was him. I didn't have the balls to actually ask him. And he seemed shorter in person. But that voice! Those biceps! It's unmistakable!

If I could have followed him into Toy Story 3D, I would have.

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*We saw Knight and Day, and Tom Cruise's desperation to save his action movie star career definitely shines through. And there were times when I wanted to smack Cameron Diaz's character for her stupidity and silliness. Why can't the damsel in distress be the damsel saving the day, for once? What happened to all the intelligent, non-clingy, independent women who threw their hands up at Beyonce in that one Destiny Child's song? Come on.