The day is long. Stressful. So-and-so has a lytic lesion at T1. Mrs. X just got intubated and is in the ICU. Mr. Y has called 10 times in the last hour about his upcoming prostate surgery. It's stressful. It's wonderful. It sucks. It's amazing.
My job is so diverse. A million different decisions occur every day. Affects so many people. Being a doctor is being a lifelong student of people. And, God, sometimes, I just want to curl up in a ball and cry. But, I keep coming back. I love it. I hate it. I need the money. Screw the money. I should have been a dermatologist.
And then it happens. A flirtation. An intimacy. You work with someone. You're getting crushed in the hospital. The job is killing you. You're there all the time. Hey, there's that nurse smiling at you. That married pulmonologist complaining about her accountant husband. The secretary with the deadbeat dad/husband.
The Weakness. It hits us all. You justify it, saying you're stressed. You say you're overworked. That no one understands you. But it's not true. I've seen it before so many times. I see it all the time now. A dalliance. A brightness to the day. A smile. A shared story.
I used to wonder how people had affairs. It seemed so abstract to me. I don't wonder any more. I see it all around me. It pulls me. It probably pulls my partner. The combined beauty and curse of our Internet modern life is that we have endless choice. Endless exposure to anything. Not just my city or even my state. Europe, the world, anonymous.
Maybe it's just the natural hormonal infidelity that grips all people in any line of work. But, I see the cliche doctor's affairs all the time. I see it. I understand it now. I've just got to avoid it all and just go home and work out or something.... just meditate. But, I see it.
The chemo part is easy. It's the living that's tough sometimes.
Friday, February 15, 2008
Friday, February 08, 2008
Does You Really Think They Look Okay?
"Hmm, I don't know..."
"C'mon, Dr. ________, my husband noticed the other day. I think he's right"
"Well, uh, there's definitely a slight shift to the right and, hmm, let me see again... yes, maybe..."
"Oww!"
"Sorry" (sheepishly)
"How about the other breast?"
"That one is okay, symmetric. No problems"
"Do you feel any lymph nodes?"
"No"
"Why does the implant shift like that?"
"Well, sometimes the healing process takes months, you know... scar tissue, etc."
"I have another question..." (as she puts her bra on)
"Okay, go ahead, shoot"
"What about vaginal dryness?"
"Are you experiencing pain during intercourse?"
"Yes, it hurts when we... you know.."
"Have you tried K-Y or Astroglide?"
"Yes, but, it's not always ready... not always spontaneous. Why is that?"
"It's the tamoxifen"
"Really? Will it get better?"
"Maybe... but, the drugs basically put you into early menopause..."
"But, I'm only 32"
"Yes, I know. How about your libido?"
"It's low. Sometimes, I just don't feel like doing it. I don't feel attractive. I mean, something seems strange. And my husband just doesn't understand. He tries, but he gets frustrated."
(Pause. Silence.)
"Tell me more"
"I just don't feel whole. I know the odds are okay. But, I'm 32 for Christsakes. THIRTY-TWO. I'll never have children. My body feels disfigured. I hate this goddamn breast! I mean, look at them. They look so strange.
(More silence)
"Do you really think they look okay?"
"C'mon, Dr. ________, my husband noticed the other day. I think he's right"
"Well, uh, there's definitely a slight shift to the right and, hmm, let me see again... yes, maybe..."
"Oww!"
"Sorry" (sheepishly)
"How about the other breast?"
"That one is okay, symmetric. No problems"
"Do you feel any lymph nodes?"
"No"
"Why does the implant shift like that?"
"Well, sometimes the healing process takes months, you know... scar tissue, etc."
"I have another question..." (as she puts her bra on)
"Okay, go ahead, shoot"
"What about vaginal dryness?"
"Are you experiencing pain during intercourse?"
"Yes, it hurts when we... you know.."
"Have you tried K-Y or Astroglide?"
"Yes, but, it's not always ready... not always spontaneous. Why is that?"
"It's the tamoxifen"
"Really? Will it get better?"
"Maybe... but, the drugs basically put you into early menopause..."
"But, I'm only 32"
"Yes, I know. How about your libido?"
"It's low. Sometimes, I just don't feel like doing it. I don't feel attractive. I mean, something seems strange. And my husband just doesn't understand. He tries, but he gets frustrated."
(Pause. Silence.)
"Tell me more"
"I just don't feel whole. I know the odds are okay. But, I'm 32 for Christsakes. THIRTY-TWO. I'll never have children. My body feels disfigured. I hate this goddamn breast! I mean, look at them. They look so strange.
(More silence)
"Do you really think they look okay?"
Thursday, January 10, 2008
Consumption
I get it. I do now. For years, after hours, days, years, even decades of studying, then student loans, 100-hour workweeks, I always told myself that I do/did what I do/did because of love, passion, honor and so on. For the love of it. That was true, no doubt. But, now that I make a decent salary for the first time EVER and I have started paying my student loans, I understand what it is to consume, to want, to spend, quite frankly.
I don't know where it comes from. But, it comes. Like this vile force rising out of my bosom, this desire to spend, to consume, to purchase, to attain, it overwhelms me. I usually think of myself as progressive. I drive a respectable car (a Honda), I have energy-efficient lightbulbs. I give to the Sierra club and PBS. Blah, blah.
But, when I come home, when I sit in the quiet of my home, I waver between various emotions. Sadness at my day. Fatigue. Joy. I exercise. I eat. I read. I make love. I do the things that we all do. But, whether it's the new-found salary or my position or the impending burnout of my job, or a combination of all... I feel this urge to buy things, to drown my sorrows in possessions.
I'm trying to fight it. I know that it is pathetic. That it is transitory. But the cashmere sweater, the silk tie, the new suit... it somehow makes me feel better, makes me forget my problems, if only for a moment.
Yet it's dismal. Empty as the cliche goes. Money for money's sake. Mix boredom or depression, misery, etc. and you have the generic human experience. I fight it. I do. But, sometimes you just want a sweater that feels nice....
I don't know where it comes from. But, it comes. Like this vile force rising out of my bosom, this desire to spend, to consume, to purchase, to attain, it overwhelms me. I usually think of myself as progressive. I drive a respectable car (a Honda), I have energy-efficient lightbulbs. I give to the Sierra club and PBS. Blah, blah.
But, when I come home, when I sit in the quiet of my home, I waver between various emotions. Sadness at my day. Fatigue. Joy. I exercise. I eat. I read. I make love. I do the things that we all do. But, whether it's the new-found salary or my position or the impending burnout of my job, or a combination of all... I feel this urge to buy things, to drown my sorrows in possessions.
I'm trying to fight it. I know that it is pathetic. That it is transitory. But the cashmere sweater, the silk tie, the new suit... it somehow makes me feel better, makes me forget my problems, if only for a moment.
Yet it's dismal. Empty as the cliche goes. Money for money's sake. Mix boredom or depression, misery, etc. and you have the generic human experience. I fight it. I do. But, sometimes you just want a sweater that feels nice....
Friday, December 28, 2007
Bhutto
Sad. It's sad. Why would the death of someone somewhere in Pakistan make me so sad? She wasn't a saint, despite the hagiography that CNN would promulgate on you. She had scandals, controversy, drama. Not a saint. Not by a long shot. It's not the Islam-thing. The 9/11 B.S. It's the death of someone, some-thing, something that had the potential to "turn the page". Like the end of a marriage or an affair, or recovering from a loss or graduation, there is something about moving on, about moving forward. For a person, for a country. The death of Benazir Bhutto was like ice water splashed on my chest.
Makes me fear for our future. Not for the future in little old Baltimore. I doubt someone wants to blow up Towson, Maryland. But, it just feels like we in the US need some chance to move on... from Bush, from Iraq, from "terror". Just to freakin' move on, or move back to an America that we once loved and cherished.
Bhutto's death makes that return more fragile. Sad. Real sad.
Why care about the other end of the Earth?
Because it will be at our doorstep before we know it...
Our little America. This country that I truly love.
Makes me fear for our future. Not for the future in little old Baltimore. I doubt someone wants to blow up Towson, Maryland. But, it just feels like we in the US need some chance to move on... from Bush, from Iraq, from "terror". Just to freakin' move on, or move back to an America that we once loved and cherished.
Bhutto's death makes that return more fragile. Sad. Real sad.
Why care about the other end of the Earth?
Because it will be at our doorstep before we know it...
Our little America. This country that I truly love.
Thursday, December 20, 2007
Making Money and Slogging Chemo
It's been a while since I wrote anything. I'm not sure why. I suppose I could feed some bullshit about the "emotional toll of being an oncologist"... the reality is I probably am just a combination of fried and lazy. I'm sitting here in my living room, days before yet another Yuletide moment and another New Year and there is just a whole lot to absorb about the WWI-like year I've had. I'm shellshocked, PTSD'd, thrashed.... I don't know the words for it.
Private practice oncology is a mixture of compassion, death, science, love, business, you name it. Nothing in my fellowship prepared me for it. I got a figurine from one of my patients today. This wonderful 50 year old woman with lung cancer who finds time in her day to thank me for cranking up some chemo in her veins and praying that she is a survivor. This wonderful woman, no kids, husband a fireman, trying to make the most out of limited funds and a lot of drugs, pain, wheezing, whatever. And, yet, she has time to think of me, to give me a figurine of a doctor, a "healer", as if that is the most appropriate appellation for yours truly.
Death. Lots of it. Some of my favorite patients. Some people that just struck me so hard and so fast. Struck them so hard and fast. Mary, with her lung cancer and her children and her husband with whom she was supposed to spend the "golden" years. Irma, matriarch of the family, that blessed family from Highlandtown, that nurtured her children to dream big and rise above working-class Baltimore.... Irma always asked if "you are eating well". How about Jaswinder? Can't speak much English. Shitty insurance. 3 kids. 38 years old. Breast cancer disaster. How's that for a Christmas? Makes you believe in the G-d, doesn't it?
People ask my why I've stopped writing. It's not because I lack things to say. I just feel burnt. Burnt already.
All those fucking tests. The little tests, the labs, the scans.
Oh, and the money... don't forget the money...
Private practice oncology is a mixture of compassion, death, science, love, business, you name it. Nothing in my fellowship prepared me for it. I got a figurine from one of my patients today. This wonderful 50 year old woman with lung cancer who finds time in her day to thank me for cranking up some chemo in her veins and praying that she is a survivor. This wonderful woman, no kids, husband a fireman, trying to make the most out of limited funds and a lot of drugs, pain, wheezing, whatever. And, yet, she has time to think of me, to give me a figurine of a doctor, a "healer", as if that is the most appropriate appellation for yours truly.
Death. Lots of it. Some of my favorite patients. Some people that just struck me so hard and so fast. Struck them so hard and fast. Mary, with her lung cancer and her children and her husband with whom she was supposed to spend the "golden" years. Irma, matriarch of the family, that blessed family from Highlandtown, that nurtured her children to dream big and rise above working-class Baltimore.... Irma always asked if "you are eating well". How about Jaswinder? Can't speak much English. Shitty insurance. 3 kids. 38 years old. Breast cancer disaster. How's that for a Christmas? Makes you believe in the G-d, doesn't it?
People ask my why I've stopped writing. It's not because I lack things to say. I just feel burnt. Burnt already.
All those fucking tests. The little tests, the labs, the scans.
Oh, and the money... don't forget the money...
Tuesday, May 29, 2007
Yellow Week
I'll call him Jack. Eighty-four years old, 57 years married to the same woman, WWII vet, all-around nice guy. Shows up one day to his primary care physician YELLOW. Eyes, skin, urine, I'm sure his tears are yellow if we checked. Pancreatic cancer. In retrospect, that's what that nagging backache was after finishing the back nine last weekend. That's why he had success for the first time in years shedding that tire around his waist. That's why he's a little more tired.
Bradley. Fifty-four, schoolteacher, 3 kids. Christian man, as if that matters (I'm Buddhist) somehow. YELLOW. Just sitting around one day, on a Sunday, kids in tow, when his wife notices a strange tinge in his eyes. Never seen it before. More pronounced in the natural sunlight of the outdoors. Hmm. Maybe it's nothing. The next day it's worse. Did you eat something weird? Nausea, anything? Nah, just yellow. Imagine the shock on those five faces when I tell them that he's got bile duct cancer. Say what? What the f-ck is bile duct cancer? Well... sir... blah, blah, blah... it sucks.
Sally. Fifty-one, mother of one, divorced, two sisters. Very, very funny woman. Coarse, crass, was once probably a really good-looking woman, but a few too many six-packs and a couple decades of Camel Lights really show themselves. But, there is something just "illuminating" about her. Call it personality. Call it spunk. She's funny. Bitingly funny. Oh, yep, and she's yellow as all get out. Some right upper quadrant abdominal pain for weeks. Liver cancer. Oh and a little cirrhosis to boot. Yikes. Double yikes...
Then there is the 74 year old woman with relapsed breast cancer and a belly swollen as all get out... the ninety year old with metastatic lung cancer... he was yellow, but the roto-rooter GI specialists took care of that blockage... well, at least for the next few weeks. then there is... on and on...
Things always seem to come in bunches. Kind of like when you just can't seem to buy a date and then other times, when you're in a great relationship and it seems like everyone and her mother is giving you the "come on" sign. Well, sometimes it seems like symptoms come in bunches.
This week is Yellow Week. Stent here, ERCP there, chemo, radiation, Whipple, unblock, reblock, percutaneous. Jaundice (as being yellow is termed officially) is never a good thing. It's downright disturbing and scary. For doctor as well as patient. There is something so profoundly upsetting as such a change in appearance as COLOR. Something that just screams of illness, that dehumanizes and debilitates and changes forever our perception of ourselves and others. Jaundice. Even the word stinks.
Bradley. Fifty-four, schoolteacher, 3 kids. Christian man, as if that matters (I'm Buddhist) somehow. YELLOW. Just sitting around one day, on a Sunday, kids in tow, when his wife notices a strange tinge in his eyes. Never seen it before. More pronounced in the natural sunlight of the outdoors. Hmm. Maybe it's nothing. The next day it's worse. Did you eat something weird? Nausea, anything? Nah, just yellow. Imagine the shock on those five faces when I tell them that he's got bile duct cancer. Say what? What the f-ck is bile duct cancer? Well... sir... blah, blah, blah... it sucks.
Sally. Fifty-one, mother of one, divorced, two sisters. Very, very funny woman. Coarse, crass, was once probably a really good-looking woman, but a few too many six-packs and a couple decades of Camel Lights really show themselves. But, there is something just "illuminating" about her. Call it personality. Call it spunk. She's funny. Bitingly funny. Oh, yep, and she's yellow as all get out. Some right upper quadrant abdominal pain for weeks. Liver cancer. Oh and a little cirrhosis to boot. Yikes. Double yikes...
Then there is the 74 year old woman with relapsed breast cancer and a belly swollen as all get out... the ninety year old with metastatic lung cancer... he was yellow, but the roto-rooter GI specialists took care of that blockage... well, at least for the next few weeks. then there is... on and on...
Things always seem to come in bunches. Kind of like when you just can't seem to buy a date and then other times, when you're in a great relationship and it seems like everyone and her mother is giving you the "come on" sign. Well, sometimes it seems like symptoms come in bunches.
This week is Yellow Week. Stent here, ERCP there, chemo, radiation, Whipple, unblock, reblock, percutaneous. Jaundice (as being yellow is termed officially) is never a good thing. It's downright disturbing and scary. For doctor as well as patient. There is something so profoundly upsetting as such a change in appearance as COLOR. Something that just screams of illness, that dehumanizes and debilitates and changes forever our perception of ourselves and others. Jaundice. Even the word stinks.
Thursday, May 17, 2007
When to Be the Doctor, When to Be the Patient
This past week has been surreal for me. Cast for the first time in my life on the receiving end of bad news rather than the delivering end, it's opened my eyes again on the nature of the "doctor-patient" relationship and the boundaries, emotional and physical, of our knowledge and our profession.
Someone really special and dear to me learned this past week that her mother, a healthy, health-conscious, vivacious 64 year old woman with no medical problems had a potentially fatal disease: hepatocellular liver cancer. This is usually something that occurs in patients with known liver disease, hepatitis or cirrhosis.
Devastating. You know, as many times as I've given bad news, I've never sat with someone I knew and loved and received some bad news, or, for that matter, received my own bad news. I've seen the hollow devastated looks on patients' faces. Seeing it on my friend was something totally different.
When my friend, Elephant Number 5, died last year, it was different. She was in the "fighting" phase. I wasn't there for the diagnosis. She was already pushing forward, had battled the disease for years when I met her, and was resigned to this being the end of her life.
This is different. Shock. Flabbergasted. Compounded by the fact that my friend is ALSO an oncologist. A doc. She knows the score. She knows that this is probably fatal. I don't think I'll ever get the sound of her sobs and crying out of my head. I've always thought that things would be easier because I'm a doctor, but that's just a pile of crap.
What's more painful is watching someone you care about run around like crazy, just crushed and frantic, and you just don't know what to do. You just listen and cry and hold hands and listen more and buy food and listen. I've had to try to put away my "medical" hat and just be a friend. There are enough experts working on this case. We're trying not to be that stereotype of the doctor who is a nightmare patient or family member, just torching the medical staff with questions and second-guessing. But it's hard... sometimes, the medical staff sucks...
For months, my friend's mom had nausea. We kept telling her that maybe she needed a scan. Hell, we're oncologists. All we ever see is cancer. We kept wondering why a scan hadn't been performed. And now that it shows this, we just keep wondering and banging our heads and second-guessing everything.
I know that this is what we all go through in our lives as we face illness and death. It's scary. No amount of education or status or training takes that fear away. We all have this one precious life on earth and it is sacred. And it hurts. It really does.
I don't think I'll forget that the next time I talk to a patient. I'll look for that fear and hope in their eyes. Hopefully, they won't see it in mine also.
Someone really special and dear to me learned this past week that her mother, a healthy, health-conscious, vivacious 64 year old woman with no medical problems had a potentially fatal disease: hepatocellular liver cancer. This is usually something that occurs in patients with known liver disease, hepatitis or cirrhosis.
Devastating. You know, as many times as I've given bad news, I've never sat with someone I knew and loved and received some bad news, or, for that matter, received my own bad news. I've seen the hollow devastated looks on patients' faces. Seeing it on my friend was something totally different.
When my friend, Elephant Number 5, died last year, it was different. She was in the "fighting" phase. I wasn't there for the diagnosis. She was already pushing forward, had battled the disease for years when I met her, and was resigned to this being the end of her life.
This is different. Shock. Flabbergasted. Compounded by the fact that my friend is ALSO an oncologist. A doc. She knows the score. She knows that this is probably fatal. I don't think I'll ever get the sound of her sobs and crying out of my head. I've always thought that things would be easier because I'm a doctor, but that's just a pile of crap.
What's more painful is watching someone you care about run around like crazy, just crushed and frantic, and you just don't know what to do. You just listen and cry and hold hands and listen more and buy food and listen. I've had to try to put away my "medical" hat and just be a friend. There are enough experts working on this case. We're trying not to be that stereotype of the doctor who is a nightmare patient or family member, just torching the medical staff with questions and second-guessing. But it's hard... sometimes, the medical staff sucks...
For months, my friend's mom had nausea. We kept telling her that maybe she needed a scan. Hell, we're oncologists. All we ever see is cancer. We kept wondering why a scan hadn't been performed. And now that it shows this, we just keep wondering and banging our heads and second-guessing everything.
I know that this is what we all go through in our lives as we face illness and death. It's scary. No amount of education or status or training takes that fear away. We all have this one precious life on earth and it is sacred. And it hurts. It really does.
I don't think I'll forget that the next time I talk to a patient. I'll look for that fear and hope in their eyes. Hopefully, they won't see it in mine also.
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