Wednesday, October 20, 2010

Pain and suffering

I started oncology today.

It's been difficult to write lately for various reasons:
1. I work all the freaking time
2. When I am home, I don't really want to think about the hospital. I've actually spent 4 years honing the Dr. Kelso skill of dropping my cares off when I leave the hospital. That clip is in Spanish, but it's really the faces that count.
3. Looking at a computer for a long time makes me want to vomit. Really.
4. Because I'm pregnant.

It's added an extra spice to my usual demeanor at the hospital. When I was on night float I was about 7-8 weeks along. Not eating at the normal times, sleeping about 5 hours a day and dealing with the massive stupidity that passes for RN's at night time (not all were terrible, let me clarify) meant I spent my free time eating the two things that sounded good--all fruit popsicles and English muffins, both of which I can't look at now--and popping Zofran to keep myself from throwing up too many times.

When someone woke me up for a blood pressure of 150/80, I wanted to burn the whole unit down. I am not kidding. I am seriously afraid my baby will have rage problems because of the time I spent on the night shift.

Starting Oncology has depressed me for various reasons. Like everybody is dying. And, I have to be at work at 6am 6 days a week until April. I shouldn't be awake.

Today I saw a young guy with a son who looked like he was around 5 years old. This kid was CUTE. And his dad was going home on hospice. I started to feel the crush of sadness settle over me, then I thought about the tiny baby who was at the mercy of my moods. Part of me worried about whether this would ever happen to me. Then a better part of me said, "Just flood that baby with love. That's the best thing you can do now."

I certainly wish I'd thought to do that the other day when I cried for ten minutes over an episode of Battlestar Galactica just because of a scene where a somewhat nerdy character was eating alone and looking sad and lonely. Yeah.

In the end, I really don't give a crap about this year. I am being forced to do a year of internal medicine do to an archaic system that is slow to change due to money and IM departments reluctant to give up their cheap smart labor (anyone who gets into a competetive residency that requires a prelim year is usually pretty darn competent. I don't know how I got in.) It was always going to be difficult, whether or not I was especially hormonal or occasionally throwing up. I had the thought this morning that it would be a year I'd look back on and wonder how I survived. Usually I don't realize that until after I've had the year. :-)

And now, after that round of wallowing in self-pity, you can see why I don't always blog! I'll have a funny story next.

Sunday, October 17, 2010

Dryer than a Popcorn Fart

My elderly patients crack me up. Sometimes they are whiners, but sometimes they are the funniest things this side of an emergency room.

That title was one of my favorite quotes from one of my favorite patients. This guy got up like every other day of his life, gave his neck a pop, and broke it.

Yes. He broke his own neck.

I’ve known this could happen for years. By known, I mean the grotesque image has run through my mind whenever I see someone crack their neck, and I try to stifle my shudder and use my doctor voice to convince them of something I’m sure of, namely, that they are going to break their own necks right in front of me.

Blech.

Anyway, though I believe I was proven right, I guess I should add something else to the story. He had cancer he didn’t know about, and it had grown metastases in his spine, weakening it. So he still broke his own neck, but his neck did have a few fragile spots.

Unfortunately, the cancer/contrast from the scans that found the cancer also shot his kidneys. The man has been in a halo (he has screws coming out of his skull, yes, through his skin that attach to a halo with a fabric-covered harness down over his shoulders midway to his belly button. He can’t sit up for dialysis in an outpatient clinic, so he can’t go to a nursing home. None of the Long-Term Acute Care facilities (kind hospital-lite) will take him to chemotherapy, so he can’t go to an LTACH. He’s been stuck here for over a month for no reason other than administrative policies. Plus at first they gave him a crappy renal diet, then by the time we figured out to give him whatever he wanted, the chemo had already made him lose his appetite.

You’d figure the guy has every reason to be a grump. But he’s not. He’s always upbeat. He always says, “Oh, I’m doing pretty good!” when you ask him how his day is. Every now and then he says something like, “I need you to blow me out again.” (the first time he said he was constipated, I told him I was going to “blow him out because that was one thing I know how to do well.”).

With the dialysis we realized we might have been pulling a little too much fluid off of him. My attending asked, “Do you feel like you’re thirsty?” to which he replied, “Doc, my mouth’s dryer than a popcorn fart!” I don’t even know what that means, but it was awesome to see my attending try to keep a straight face.