Monday, December 21, 2009
Holiday Break
On break now and looking forward to some relaxation time. Well, to the extent possible-you see, I have spent my life in the sun - California, New Mexico, Texas, Hawaii and Colorado is where I've spent most of my life. As a result I have extensive sun damage to the skin on my face. My dermatologist looked me over, and I mean ALL over, and suggested I apply 5% fluorouricil cream to zap the extensive actinic keratosis on my face. Two weeks from the start of therapy and I look hideous. Angry red sore cover 90% of my face. They, hurt, burn, itch and sting. Needless to say I garner many stares when I am out in public and the neighborhood kids ask me what's wrong with my face. I hope that my follow-up visit with the dermatologist tomorrow will be the last day I have use the cream. But if it isn't I'll keep going, keep using it, and show up to my mental health rotation ready to give my patients some bad dreams. It's not like I had an excess of good looks to draw from in the first place so I am looking forward to being back to a 5 or 6 rather than the 1 I am now.
Monday, December 7, 2009
I cried today
I am not proud of it, but I'm not really embarrassed by it either. I don't want to do it ever again either.
We have a patient in hospice who is in her twenties. She has EXTENSIVE adenocarcinoma, that she ignored while she was caring for her ailing mother. She knew she shouldn't have been bleeding like she was or having the massive discharge that she was experiencing but rather than address it, she ignored the existence of any problem. A year later her mom forced her see a doctor but by that time it was way too late for any kind of treatment. She has a massive wound and an even more massive tumor burden, has been in hospice for over a month now and has been stable and in no acute distress. She participates in activities to the extent someone who is bedridden can. She is usually outwordly cheerful and upbeat, if not denying any problem really exists. Since late last week she has been getting worse (bleeding, tumor growth) and today we informed her that she may not have long to live. It was the first time I saw her openly grieve her own loss and perhaps accept that she would soon die. We left the patient to cry alone, as she requested, and a couple minutes after I left her room I began to cry. Not sobbing or whimpering, just quietly letting tears stream from my eyes. The PA followed and we sat down together to discuss my feelings and how this young lady's imminent death had effected me. It had touched me so much because she is so young and I know that there are so many things she has missed out on and will never get to experience. Too, I felt that I had whitnessed her accepting her death. Literally accepting the fact that she would not only never get better, but that she would soon no longer be on this planet. So we talked and I let a few more tears fly and blew my nose a couple times. The PA gave me some words of comfort and advice and we got up and went to see the next person not long for this world.
We have a patient in hospice who is in her twenties. She has EXTENSIVE adenocarcinoma, that she ignored while she was caring for her ailing mother. She knew she shouldn't have been bleeding like she was or having the massive discharge that she was experiencing but rather than address it, she ignored the existence of any problem. A year later her mom forced her see a doctor but by that time it was way too late for any kind of treatment. She has a massive wound and an even more massive tumor burden, has been in hospice for over a month now and has been stable and in no acute distress. She participates in activities to the extent someone who is bedridden can. She is usually outwordly cheerful and upbeat, if not denying any problem really exists. Since late last week she has been getting worse (bleeding, tumor growth) and today we informed her that she may not have long to live. It was the first time I saw her openly grieve her own loss and perhaps accept that she would soon die. We left the patient to cry alone, as she requested, and a couple minutes after I left her room I began to cry. Not sobbing or whimpering, just quietly letting tears stream from my eyes. The PA followed and we sat down together to discuss my feelings and how this young lady's imminent death had effected me. It had touched me so much because she is so young and I know that there are so many things she has missed out on and will never get to experience. Too, I felt that I had whitnessed her accepting her death. Literally accepting the fact that she would not only never get better, but that she would soon no longer be on this planet. So we talked and I let a few more tears fly and blew my nose a couple times. The PA gave me some words of comfort and advice and we got up and went to see the next person not long for this world.
Wednesday, December 2, 2009
Hospice
My rotation in hospice is very interesting. We aren't running around doing procedures or doing detailed exams or even prescribing that much medications. We do focus on making the "patient" and their family comfortable, well informed and supported from many different angles. It is such a unique perspective to spend so much time with dying people and their grieving families. I am really just learning how to listen to people and to openly and comfortably discuss death and the process of dying.
The team that I work with is great. They truly work as a team and really get along quite well. The doctor treats me with respect and introduces me as his "colleague, PA Phooey." The PA is also great and is fun to work with. They both take time to teach me about listening and ideals of hospice and palliative care. I am really impressed with this group, as are most all the families who come here and can see why everyone has worked in the same place for so long. Not too many places have such a strong group of providers, nurses, social workers and clergy. I can't recall a place where everyone worked so well together.
I am slowly growing comfortable talking to families of dying patients, but have almost broken up a couple times when visiting with families or dying patients who are still able to communicate. The ones who come in already unresponsive are, for me, a little easier to deal with. It's just hard having a conversation with someone you know won't be alive in week. This is a good experience and will certainly help me help my patients deal with death and dying.
The team that I work with is great. They truly work as a team and really get along quite well. The doctor treats me with respect and introduces me as his "colleague, PA Phooey." The PA is also great and is fun to work with. They both take time to teach me about listening and ideals of hospice and palliative care. I am really impressed with this group, as are most all the families who come here and can see why everyone has worked in the same place for so long. Not too many places have such a strong group of providers, nurses, social workers and clergy. I can't recall a place where everyone worked so well together.
I am slowly growing comfortable talking to families of dying patients, but have almost broken up a couple times when visiting with families or dying patients who are still able to communicate. The ones who come in already unresponsive are, for me, a little easier to deal with. It's just hard having a conversation with someone you know won't be alive in week. This is a good experience and will certainly help me help my patients deal with death and dying.
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