Saturday, May 31, 2008

Living on the edge

The cable guy came to fix Graci's basic cable hook-up today. When he was done, she suddenly had 100 channels she doesn't pay for. She has butt-load of FREE CABLE now. She also seems to have a gas leak. So, if we fall asleep watching the Food Network, we'll probably die. My apartment has life-sustaining oxygen, but no TV.

Sometimes, you have to take a risk.

Wednesday, May 28, 2008


Every morning, the students on my team ask, "How's your grandpa?"

The answer is that he is not good. He has no energy and his legs are very weak. While walking through the yard the other day, his legs gave out and he fell into a bush. His friend Steve, the big, strong police detective, was with him. He scooped him up and sat him on the porch swing. Then, Grandpa cried. Not because he was hurt, but because he is frustrated with his lack of energy, and he's scared that he's going to lose all his dignity.

The other day, Grandpa asked Steve if he could have an officer patrol the neighborhood at night. He and Grandma live on a quiet suburban street, but Grandpa said he's not strong enough to protect her should anything happen. Someone else will have to do that from now on.

In the middle of rounds last week, my grandma called with lab results. His primary care physician had ordered a little blood work. When it came back abnormal, he didn't know what to do with it. He said as much and referred him to a specialist. That appointment is on Monday, but he's going to see a different family doctor tomorrow--someone who will, hopefully, know how to interpret these results. Frankly, they aren't mysterious. He has cancer. His white blood cells are crowding out everything else in his bone marrow. He's terribly anemic, and he'd feel a hell of a lot better with a few units of red blood cells.

I spoke to Grandpa briefly this morning. I had just finished seeing my patients and had a few minutes before rounds started, so I called to check in. He said, "Well, we go to that new doctor tomorrow. I'm just hoping they can do something to get me half way back to normal. Just half way."

He sounded so incredibly sad. I found myself leaning into the wall as I listened to him, as if the weight of his sadness was falling on me. I am incredibly frustrated by knowing what to do without the power to do it. I can see the note I'd write if he was my patient. I know the few tests I'd order, and I know what I'd do for him to make him feel better.

He's not looking for a cure, just half way. I wish I could get him half way.

Tuesday, May 27, 2008

I guess I'll be studying that AGAIN

Don't you hate it when you get grilled on metabolic alkalosis in the middle of rounds and you miraculously can't answer a single question despite the fact that just this weekend you spent THREE FUCKING HOURS reading about the condition commonly referred to as metabolic alkalosis?

And then, you call radiology to schedule your own MRI because your doctor wants to make sure that ringing in your ear is a psych disorder and not a neurologic problem and suddenly you're convinced that just by scheduling the damn thing you may have somehow resigned yourself to a brain tumor that is, as we speak, feeding on the synapses where you could have sworn you stored all that shit on metabolic alkalosis.

Don't you hate that?

Yeah, me too.

Sunday, May 25, 2008

The job

There are lots of times I sit down to write about work and end up never publishing the post. I struggle with how much to tell these stories because they are, at least in part, stories about patients. These are other people’s intimate moments. They may not be mine to tell. As a result, most of my really great days at work are not recorded here.

But, this time, I'm going to go ahead with a work story, mostly because I don't ever want to forget why I do this. This is a story about a patient named Jane and her partner, Anne. In telling it, with every word I write, I am asking myself, If these women ran across this post some day and saw themselves in it, would they be honored by what I wrote here? I hope so.

A little over a week ago, Jane came in with what looked like a hell of a sinus infection. When she came to the hospital, she thought she’d only be in a few days. But then, she got sicker. A lot sicker. Around this time, the medical student who was assigned to Jane’s case quit coming to work. He’s on a two to three day a week schedule now. More power to the turd for getting away with that shit.

On the first of many of Turd’s vacation days, I stole his patient. I was fascinated by the whole sicker for no reason thing she had going on. And, although this may sound a little strange, I also felt like someone was missing from Jane's case.

A few days earlier, during our morning rounds, Jane had a visitor—a woman who gave off odd vibes. She introduced herself as Jane’s good friend, but something about her smelled like an opportunistic jaded wannabe girlfriend. No one else smelled that, but I often have the most powerful nose in the room. I trust it because it’s big and usually right. As we walked out of her room that day, I thought, Jane is gay. She has a partner somewhere. We need to find her.

And so…when Turd quit coming to work, I stole Jane as my patient. On that first day, I had a long conversation with the infectious disease doctor. In discussing Jane with her, she suggested that I call someone who knew her well to try to get a very detailed history.

I hunted down Jane’s emergency contact form where I found the names of a couple of cousins and one local friend. I tried everyone on the list. Twice. I finally got a hold of cousin’s wife who gave me her husband’s work number. I explained to him who I was and that everyone’s vitals were stable. This is important when you call from the hospital. Until the person on the other end hears that no one is dying, he or she hears nothing else. I went on to explain that I needed some important information from whoever may know Jane best. He gave me the name of a boy she dated when she was 14—forty years ago. I was thinking, Dude, you’ve got to be fucking kidding me. But, I took a breath and said, "Okay…anyone else?"

He paused and said, "Well…there is a woman who she’s friends with. Her name is Anne."

I got the number, hung up with the cousin, and called Anne. I explained that no one was dying and then started asking questions. Does she swim in fresh water? Does she drink unpasteurized milk? Does she live with cats? Does she eat raw seafood? Does she breed mosquitoes? Or raise earthworms? Does she vacation in Sub-Saharan Africa? Does she spend her spare time tipping cows? Or licking bats?

As Anne answered my questions, I got the distinct impression that she was more than just a friend. I had avoided saying much about Jane’s condition. Anne wasn’t on the emergency contact form, and giving her information would have violated privacy laws. I knew what I was hearing, though. Finally, I said, "Anne, I have a 54 year old woman here with three cousins and a two friends. I feel like we’re missing someone."

Anne answered, "We’ve been together for 20 years. I’m just out of state right now because of a job."

"You’re the person I’ve been looking for for two days."

"Well, you found me," she said, "and I'm on my way." She was on the next flight.

I’m not going to go into the specifics of how all this happened—how Anne’s name ended up being left off of that emergency contact form. I will say this…when we institutionalize bigotry by writing it into law, it is not difficult for individuals (in this case, hospital employees) to exercise discrimination. If Anne and Jane had been married, even if separated by thousands of miles, Anne would have been on that form.

Because she wasn’t on the form and wasn’t getting information from anyone else, I told her I would meet her when she got here. At 8:30 that evening, long after the rest of the team had gone home, I drove back to the hospital to find Anne and introduce myself.

Anne and I met and spent awhile talking. Understandably, she had a lot of questions. Jane had been out of it since Anne arrived. She didn’t even know Anne was there. I explained to Anne that she needed to find the Durable Power of Attorney paperwork that she and Jane had completed. And, praying that such paperwork actually existed and that I wasn’t violating 746 privacy laws and flushing my career down the shitter by doing so, I went ahead and updated her on Jane’s condition. I answered all of her questions as best I could.

At 9:00, as Anne and I talked in the hall outside the ICU, Jane’s nurse ran out to say, "She’s awake." We all high-tailed to Jane’s room. Anne wanted to see her. I wanted to see Jane’s reaction, to reassure myself that I had found the right person.

When Anne walked into that room, Jane took a huge breath and smiled. Anne slid between the IV pole and the bed, leaned over the side rail, wrapped Jane in her arms, and began whispering in her ear.

I don’t know what she said. I can imagine. But, I will never forget the look on Jane’s face as Anne held her. I leaned against the wall of that ICU room and thought, This is it. And this…this is worth it.

The next day, as I walked down the hall towards the ICU, Anne stepped off the elevators, appropriate legal documents in hand. She smiled and said, "Thought I better bring these in. You know, so they don’t kick you out of med school." I thanked her for saving my skin and gave her the names of all the physicians she should ask to speak to.

"Now that you're all official," I said, "you should get your updates from someone besides the med student. You deserve better."

In truth, though, Anne still gets most of her updates from me. I wish I could say that all of her love has healed Jane. Unfortunately, she’s not quite there yet. What I can say is that I am absolutely privileged to have met these two women, to have been a small part of this amazing week.

I am incredibly lucky to have this job.
All the work…it’s worth it.

Wednesday, May 21, 2008

A close call

I just called Graci to tell her she had to drive across town on $4/gallon gas to come kill an insect. Quit rolling your eyes. The fucker had 15 PAIRS OF LEGS.

I could picture ALL 30 LEGS crawling into my mouth as I slept tonight. The creepy crawliness would surely wake me up, but not enough to expectorate the creature, just enough to freak out and choke on it. And, with the current status of my immune system, beaten down by all this work, I would surely catch aspiration pneumonia. Repeated bronchoscopies to try and remove the dead and rotting bug would fail to retrieve all 30 legs, some of which would remain a source of festering lung infection.

In short, I would be dead in a month.

I'm not an entomologist or a pulmonologist, but I'm pretty sure that if you asked those people, they would say that's how it goes when something with 15 PAIRS OF LEGS crawls around your bedroom at night.

Graci, you saved my life.

Sunday, May 18, 2008

The women in this family...we come

The days all ran together, one into the other, this week. One week ago, it was Mother’s Day. It feels like it’s been a month.

On Tuesday night, my mom called to say that she was headed to my grandparents for the night. Grandma had called her in a bit of panic. At 6:00, Grandpa told her that he was going to bed and that she could wake him up Friday for his test (he had a CT scan scheduled).

Grandma was worried he was never going to wake up, that he was going to die that night, and she didn’t want to be alone in the house when that happened. So, she called my mom, and my mom called me. I didn't tell my mom I was coming because I didn't want to hear all the, "Oh, honey you don't have to do that" bullshit. But, I was packing before we even hung up. I drove to the turnpike, set the cruise control at 87 mph, and two hours later, I was standing at my grandma’s back door. My mom simply smiled and said, "I knew you'd come. I told your dad, She's on her way. He asked how I knew. I said, Because the women in this family...we come."

For the next few hours, Grandma and my mom and I sat in the in my grandma's living room, the garage light streaming through the windows. We talked about Grandpa and, well…shit, now I don’t really remember what else. We laughed a lot. We cried a little.

At about 11:30, three hours after her normal bedtime, Grandma went to bed. She had considered going to bed, tried to go to bed twice before then. She couldn’t stop talking, didn’t want to be alone in bed next to Grandpa with her thoughts. But, eventually, exhaustion took her.

My mom and I talked another hour, and then she went to sleep in the room she grew up in. I crawled under a throw blanket and lay down on the couch. I lay there and stared at the red leaves on the bush outside the living room window. I thought about how short this night was. Too short. I wanted to stop time right there. To lay on that couch with my grandparents and my mom sleeping down the hall. To make that quiet stillness hold us a while longer. Things were moving too fast.

Two hours later, my cell phone alarm went off, reminding me to drive back across the state and round on patients. My grandma was waiting for me when I woke up. She watched me gather my things, waited for me as I went to the bathroom to wet my hair, and then walked me to the back door. She apologized again for panicking when it seemed as though Grandpa was probably fine for now. And, she wanted to know if I thought she would be okay when he wasn’t.

She said, “I’ve been thinking about it, and I know I’ll be really sad for a really long time, probably forever. But, I think that I will be okay. You think I’ll be okay, right?”

“Yes. I think you’ll be okay,” I said. I was standing on her back steps, one step above her. I kissed the top of her head, something I’ve never done before. She walked me to my car, told me not to talk to strangers, and waved me off into the dark.

It was 4:00 in the morning by the time I left. I drove until 5:00, when the turnpike Starbucks open, and stopped for espresso. It did little to energize me. In fact, I’ve been exhausted since.

The story of the rest of the week, the week at work, will have to wait. It was incredibly infuriating and frustrating and amazing and rewarding—in short, it was completely draining. I hope to get to it tomorrow. No promises, though, okay?

Friday, May 16, 2008

A cowboy known for his discerning tastes

It's been quite the week. I plan to tell you all about it. Tomorrow.
Tonight, I had a couple of these with a few good friends...

According to the bottle, Buffalo Bill also loved Bass. Buffalo Bill won the Medal of Honor. I am working for Honors in Internal Medicine. To this end, I drink the pale ale of champions.

Monday, May 12, 2008

Lilacs, my favorite

I went home to see my grandpa. I'm too tired to talk about the day, except to say thank you to the friend who filled my bathroom with the smell of these...

A reminder that even as things end, we are in the midst of a beautiful spring.

Friday, May 9, 2008

This is the part that makes me cry

I called my grandma to ask her for my aunt's address. I don't keep an address book, I just call the one or two people I know who do. Anyway, I called for the address. Forty five minutes later, I got it.

Grandma really needed to talk. About how Grandpa is sleeping so much now. About how he can't drive anymore. About how this is all going so fast. And, about how the other night, she couldn't sleep at all.

It went like this...

I was serving at this big wedding at church all day. And you know, normally Grandpa would come with me to help with all the lifting. But, he was just too tired. So, I served the wedding alone. And, by the time I got home, I was exhausted. I took my bath and went straight to bed. And, well, he was asleep the whole time. He didn't even wake up when I came in, which, you know, really isn't like him.

And then, well, I just couldn't sleep. I was totally exhausted, but I couldn't sleep. I just laid there next to him, and I cried all night long.

Suddenly, I was so mad at him. And this is so stupid, but I was thinking, I've never even pumped my own gas! How could you leave me like this? I know that sounds stupid and so self-centered, but I couldn't help it. I was just so mad at him. I just kept saying, I can't believe you're leaving me.

I heard myself saying that, and I realized how ridiculous it sounded--me being mad at him because I've never pumped gas. I just started laughing. I did. I laughed out loud. I was laughing and crying. But, I never got any sleep all night long. The sheets were soaked with all my crying.

I'm feeling a little better now, though. Kelsy came over with Logyn today. When I told her the story, she was so sweet. She said, "It's okay, Grandma. We can teach you how to pump gas." I told her I'm sure I can learn.

But, you know, it's not really about the gas. It's about...

And, with a quiver in her voice, she swallowed her words and stopped there. She had said all she could say.

Tuesday, May 6, 2008

White wrinkles

My mom called last night to tell me that my grandpa is dying. For medical reasons I just don't care to explain, the news itself wasn't a complete surprise. But, the phone call from my mother last night was. I guess I just didn't expect to be having that conversation so soon.

The best part of this dying is that Grandpa is still living. He isn't in any pain, and he is still able to do all the things he wants to do. In fact, as I type this, he's lying shirtless in his sun-chair in the middle of the driveway. As soon as the temperature tops 55, he covers himself in iodine and baby oil and begins working on his savage tan. By mid April, he is a lovely shade of brown.

Last time I was home, I found myself staring at the white wrinkles on his dark face. The little lines of skin are tucked away in creases when he lies in the sun. But, when we talk, when he smiles and laughs, I get small glimpses of those tiny white lines.

When I go home for Mother's Day this weekend, I am going to try to capture his face with my camera.

It's those little wrinkles that I don't want to forget.

Sunday, May 4, 2008

Sunday preaching

Last week, Bill Moyers interviewed Rev. Jeremiah Wright. This week, he talked about him. I was struck by what Mr. Moyers had to say about the conflation of “the man in the pulpit who wasn't running for president with the man in the pew who was.”

Behold the double standard: John McCain sought out the endorsement of John Hagee, the war-mongering Catholic-bashing Texas preacher who said the people of New Orleans got what they deserved for their sins. But no one suggests McCain shares Hagee's delusions, or thinks AIDS is God's punishment for homosexuality. Pat Robertson called for the assassination of a foreign head of state and asked God to remove Supreme Court justices, yet he remains a force in the Republican religious right. After 9/11, Jerry Falwell said the attack was God's judgment on America for having been driven out of our schools and the public square, but when McCain goes after the endorsement of the preacher he once condemned as an agent of intolerance, the press gives him a pass.

Jon Stewart recently played a tape from the Nixon White House in which Billy Graham talks in the oval office about how he has friends who are Jewish, but he knows in his heart that they are undermining America. This is crazy; this is wrong -- white preachers are given leeway in politics that others aren't.

Friday, May 2, 2008

Saying goodbye

I was sitting on the couch, studying. A Sex in the City re-run with the volume down low was providing just enough distraction to keep me awake. She came in from the computer room and leaned over the back of the couch to give me a hug. A long, hard hug. And, with the hug, without speaking a word, we both said thank you.

When she finally let me go, she said, “You know, I think that this was good for both of us.” I agreed. I’m not sure that I can say exactly what staying with her has done for me, but I suspect it’s a combination of her genuine hospitality and her expertise as a retired psychiatric nurse that has kept me together these past four weeks. And, although I knew I would miss her, I was surprised by the lump in my throat when she hugged me. I did not expect to have to gulp down a few tears as we said goodbye.

She went on to bed, and I stayed up to finish Sex and the City, uh…I mean, study. When the show ended, I turned out the lights, put my books away, and tiptoed back through the dark house to her kitchen window. Leaning with my elbows on the counter, my chin propped in my hands, I stared at the street light at the end of her cul-de-sac. The lamp post has been enveloped by a Bradford pear tree in full bloom.

The blossoms on the tree glowing in the dark, the soft light rounding the corners of the neighbor’s mailbox, the shadows resting on the lawn…

Places like this, people like Dorothy will always feel like home. I am restless, eager to move on and build a life for myself elsewhere. But, part of me will always be here.

Someone get her a drink

I just called my dad to warn him that I'm planning to spend September rotating through Mt. Sinai's trauma anesthesia program in Queens. I suggested he start slipping Valium into my mom's coffee now so that when I finally tell her, we don't have to shoot her with that horse tranquilizer we keep just in case.

My mother would prefer that I do all of my electives in Chicago. She likes Chicago because she has driven there several times. She's confident that if I called in the middle of the night to say that my head had fallen off, she could get to me without directions.

She has only been to New York once. She can't find it in the dark. If my head falls off in New York, she'll have to waste precious time mapquesting Queens--time she could be spending driving 187 mph to come screw it back on. And it would have to go back on, because, without it, I may not fully appreciate that charming story about how hard it was to birth in the first place.