L.D. was one of those patients that I sometimes get a crush on. Not in a teenage, pimply, excited kinda crush, but a chemotherapy, bald-person, gaunt, I-wonder-why-that-person-has-such-equanimity kinda crush.
Like, how is a 49 year old single female chiropractor with metastatic colon cancer and liver and omental metastases so cheerful coming into the clinic? So appropriate and mentally balanced despite being totally shafted by nature, biology, God and country?
Why does she smile and laugh after vomiting? Or pull clumps of hair cheerfully out of her scalp? Or gently respond patiently that she drove here alone for the umpteenth time? Or that she might check out acupuncture or Reike or craniofacial therapy or any host of things that are really cool, except if you have a fucking bowel obstruction.
Nasogastric tube placement. Now that's a good first date.
That's the kind of patient I go for.
Just so pretty on the inside. A supermodel of personality. The sexiness of humility and kindness.
I find myself wandering the infusion center just to chat with her. Maybe get a glimpse of what Victorian novel she's reading or just preening for a jaundiced smile or laugh at one of my canned cancer jokes. Hell, she sometimes looks at my Eeyore face and asked ME if I'm okay... sheesh. You had me at hello.
Her bloated stomach needing a paracentesis is something horrifyingly beautiful to me. Maybe it's the way she bears it, accepting in a yogic way that this is just the natural end of her life. What was it supposed to be? Why NOT me who gets cancer, she asks?
Children used to die in droves young, mothers in childbirth, men by some wayward industrial accident. It's not so abnormal for a young healthy vegetarian athlete to get huge goombas in her liver, is it?
Do you believe in God? No.
Do you have much other family? No.
Are you depressed? I don't think so.
Denial? Definitely not.
Bitter? No, I've had a wonderful life.
Are you an angel? (No answer)
Can you teach me how to accept my own life? (Just a smile and a squeeze of my hand)
L.D. died a few months ago. She elected not to get any more chemotherapy. She wanted to spend her remaining months with friends and traveling a bit.
She didn't travel much. Maybe a couple miles up and down I-95.
But, she traveled deeply into my mind and that strange, sensitive, underdeveloped place in the center of my chest, between my lungs, under my ribcage... that thing that seems so deadened sometimes by hospice talks and vomit and shit and bleeding and crying and mourning and loss.
The Tin Man would have had it bad for her.
Hair gray from stress and meds, gaunt, ascitic, bloated... but, still smiling. Still laughing. Never questioning why. Never blaming or lashing out.
I'm not the first person who ever was born, lived and died... it's just my time.
I still find myself sometimes looking for her in her favorite chair, my heartbeat quickening, my hands reaching to straighten my tie, trying to think of something funny and wise to say.
Quite a lady, that one. I'll miss you, L.D.
The Buddha didn't have goddamn a thing on you.
Tuesday, December 13, 2011
Phoenix Rising
There is something about insomnia that makes one want to express thoughts for anyone on Earth to read. Banal, predictable, but personal and sometimes pithy thoughts.
I've passed nearly the 6 (or is it 7) year mark in practice. G-d, it's hard to believe.
What are some of the highlights?
Engagement broken
Lawsuit
Cynicism and Depression (they need capital letters)
Failed romance
Nearly quitting my practice out of burnout/ethical disgust/boredom/emotional impairment
Hating my job
Selling the practice and becoming financially secure
Buying a lot of crap
Giving said crap away
Buying more crap
Taking a lot of trips
Feeling the escapism of said trips
Therapy
More therapy
Kung Fu
Yoga
Meditation
Friendships
Parents divorce saga
Parents individual healing
Lots of vacations with same parents (individually)
Broken relationships
Celibacy (hopefully not permanent)
Kindness of strangers
Letting go of perfectionism
Learning from so many patients and their struggles
Crying
More crying
Vulnerability
Actually feeling some emotions
Helping so, so many people die
Maybe curing a couple of folks
Being amazed at people's fortitude and love and perseverance
Coming to love my job
Being loved
Feeling human
Grace
God (or Brahman, take your pick)
Feeling honored again to be not just a doc, but a human being
It's funny. When you start medical school, there are these "soft" classes amidst the daily grind of anatomy, histology, pathophysiology and the like.
Classes like "Doctoring" and "Compassion" and "The Impaired Physician"
You meet older docs talking about their travails, their burnout, their personal relationships, their addictions, their frailties.
As a twenty something year old, it all just seems so foreign, so narcissistically weak and alien.
But, six (or seven) years into full bore clinical oncology practice, I see it. Not just in us, but in the other docs, in other specialties.
In me.
Physician, heal thyself.
It ain't that easy.
The perfectionism that works so abundantly well in calculating chemo doses or clipping through 25 patients a day really doesn't work so hot in your personal life.
Who are we when no one is looking?
Am I moral? Ingmar Bergman, you ain't got nothing.
I remember PBS having a long term documentary chronicling Harvard medical students as they go from their first days, through training and later decades of being attending physicians. The divorces and emotions, the idealism and despair, the physical and mental toll. The glimmer of youthful passion and idealism still there, peeking out shyly amidst the money and status and time demands and stress and oncoming aging of the once bushy-tailed participants.
Francis Weld Peabody once wrote that "the secret of the care of the patient is IN CARING FOR the patient."
And how can we care for someone if we cannot care for ourselves?
I see now the beauty of medicine, the holiness of it. I once talked of A.J. Cronin's "The Citadel" and how medicine was something to be cherished. How easy it is, as in the book, to slowly slip into something that you don't want to do or be. To lose that gentle naiveté, that openness to ideals and love of fellow man. That purpose that makes healing and palliating so wonderful.
It's so easy to crumble your dreams in the face of lawyers and accountants and diagnosis codes and RVUs and bonuses and mortgages and alimony.
It is easy to get caught up in narcissism and self-pity, self-gratification and banal materialism.
I know. I have been there in such a short time, despite my protestations.
But, there is a way, a more human way forward, I believe. Not the youthful blush of innocence, nor the jaded, self-absorbed path of pride.
But, in realizing that we are human. We caregivers are every bit as broken and in need of healing as our patients. My MD and my white coat are no shield against my own demons and diseases, real or imagined.
The care we give is the care someday we hope to receive.
If I can just serve another dying cancer patient in the dignified and humble way that I hope to someday be cared for myself, then perhaps I can rise again to the Citadel.
Accept myself and pick myself up and I will try not to forget to hold my patient's hand and cry for them as I will someday cry for my parents, my lovers, my children, myself.
The phoenix rises, older and different, less perfect. Less, but more.
That is the beauty of oncology. I am blessed to even touch this for my brief time on earth.
Thank you for waking me up, cancer.
Clean my body and soul my Guru, you bring light to the darkness.
I've passed nearly the 6 (or is it 7) year mark in practice. G-d, it's hard to believe.
What are some of the highlights?
Engagement broken
Lawsuit
Cynicism and Depression (they need capital letters)
Failed romance
Nearly quitting my practice out of burnout/ethical disgust/boredom/emotional impairment
Hating my job
Selling the practice and becoming financially secure
Buying a lot of crap
Giving said crap away
Buying more crap
Taking a lot of trips
Feeling the escapism of said trips
Therapy
More therapy
Kung Fu
Yoga
Meditation
Friendships
Parents divorce saga
Parents individual healing
Lots of vacations with same parents (individually)
Broken relationships
Celibacy (hopefully not permanent)
Kindness of strangers
Letting go of perfectionism
Learning from so many patients and their struggles
Crying
More crying
Vulnerability
Actually feeling some emotions
Helping so, so many people die
Maybe curing a couple of folks
Being amazed at people's fortitude and love and perseverance
Coming to love my job
Being loved
Feeling human
Grace
God (or Brahman, take your pick)
Feeling honored again to be not just a doc, but a human being
It's funny. When you start medical school, there are these "soft" classes amidst the daily grind of anatomy, histology, pathophysiology and the like.
Classes like "Doctoring" and "Compassion" and "The Impaired Physician"
You meet older docs talking about their travails, their burnout, their personal relationships, their addictions, their frailties.
As a twenty something year old, it all just seems so foreign, so narcissistically weak and alien.
But, six (or seven) years into full bore clinical oncology practice, I see it. Not just in us, but in the other docs, in other specialties.
In me.
Physician, heal thyself.
It ain't that easy.
The perfectionism that works so abundantly well in calculating chemo doses or clipping through 25 patients a day really doesn't work so hot in your personal life.
Who are we when no one is looking?
Am I moral? Ingmar Bergman, you ain't got nothing.
I remember PBS having a long term documentary chronicling Harvard medical students as they go from their first days, through training and later decades of being attending physicians. The divorces and emotions, the idealism and despair, the physical and mental toll. The glimmer of youthful passion and idealism still there, peeking out shyly amidst the money and status and time demands and stress and oncoming aging of the once bushy-tailed participants.
Francis Weld Peabody once wrote that "the secret of the care of the patient is IN CARING FOR the patient."
And how can we care for someone if we cannot care for ourselves?
I see now the beauty of medicine, the holiness of it. I once talked of A.J. Cronin's "The Citadel" and how medicine was something to be cherished. How easy it is, as in the book, to slowly slip into something that you don't want to do or be. To lose that gentle naiveté, that openness to ideals and love of fellow man. That purpose that makes healing and palliating so wonderful.
It's so easy to crumble your dreams in the face of lawyers and accountants and diagnosis codes and RVUs and bonuses and mortgages and alimony.
It is easy to get caught up in narcissism and self-pity, self-gratification and banal materialism.
I know. I have been there in such a short time, despite my protestations.
But, there is a way, a more human way forward, I believe. Not the youthful blush of innocence, nor the jaded, self-absorbed path of pride.
But, in realizing that we are human. We caregivers are every bit as broken and in need of healing as our patients. My MD and my white coat are no shield against my own demons and diseases, real or imagined.
The care we give is the care someday we hope to receive.
If I can just serve another dying cancer patient in the dignified and humble way that I hope to someday be cared for myself, then perhaps I can rise again to the Citadel.
Accept myself and pick myself up and I will try not to forget to hold my patient's hand and cry for them as I will someday cry for my parents, my lovers, my children, myself.
The phoenix rises, older and different, less perfect. Less, but more.
That is the beauty of oncology. I am blessed to even touch this for my brief time on earth.
Thank you for waking me up, cancer.
Clean my body and soul my Guru, you bring light to the darkness.
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