A Circle of Life day10/12/2016 (Trigger warning: miscarriage/stillbirth)
So yesterday was day number…whatever…of this last call block. I’m off call today, going to a writing conference (ECWC). But before I could leave for ECWC, there was work to be done, and yesterday pushed the emotional and physical limits of my patients and me. Doesn’t help that I have a whopper of a cold. Yeah, no one wants to acknowledge it, but doctors get sick. Especially when I see every coughing, booger-oozing toddler in a twenty-mile radius for the past two weeks. And those same sick toddlers like to sneeze directly on me, or grab at my face with those grabby, snotty, glistening, crusty little hands. So that’s the background. Not at 100% to begin with on this last day of the call week. Yesterday. Phone rings at 6:30am. It’s the ER. 20 week patient has delivered a fetus literally 2 minutes ago in the ER, and the patient is bleeding badly. My head spins. Is it my patient? If so, which one? ER doc doesn’t give a name. Just asks me to get there quickly. I go from REM sleep to fully awake in 5 seconds and provide a few orders before pulling on clothes and hurrying to the hospital. En route, I’m thinking through hemorrhage protocols and meds, and also planning for the non-clinical things that need to be done to help the patient through such a devastating event. This week is a call block, which means yours truly is on call for 7 days in a row for Ob deliveries, if my colleagues need someone to do a C-section, and at times for all admissions to the hospital (adult or peds) and q15 minute calls from the nursing home. Call is always feast or famine. It could be boring. It could suck rocks. I work in a small, rural hospital, so FP’s do pretty much everything here.
If you live in a big city, then this job may seem like the unholy love child of Marcus Welby, M.D., Dr. Quinn Medicine Woman, and Dr. Joel Fleischman (Northern Exposure). And you’d be correct. The net result when I’m on my call stint? Poor sleep, putting out fires in the office and all hours of day and night, and difficulty doing anything but sit around and wait for the next call to light up the phone. If you read the recent post about my abnormal mammogram, you’ll know the depths of crazy that an abnormal test like that can take a person.
I also discussed the fact that, as a physician, I know way too much about the process and the likelihood of Medical Things Happening. Look, if you see enough of these types of cycles, you know how the process typically goes. Testing, results. Re-testing, results. Biopsy, results. Answer, treatment plan. So I fully expected to be finishing up this process with a biopsy, because 90%+ of the abnormal mammogram findings similar to mine end up going to biopsy. And often beyond the biopsy. As a result, all last weekend, my very rational, logical, calm, cool and collected brain just spun and spun. It’s amazing how worry can suck the energy out of a person. I got the repeat mammogram done this morning, and the tech (with whom I work) showed me the extra images and was like, “Um, yeah, the spot didn’t go away with the extra view. Let’s see what ultrasound says.” Thankfully, the ultrasound tech had an opening and got me right in for that step. That meant I would have results today, without having to wait another day. Good. That afternoon at 2pm, I got the result. Normal. No biopsy needed. Caveat: I might be a good doctor, but I’m not a great patient. And having knowledge about medical things doesn’t make anything easier when tests are abnormal. Maybe the opposite.
So here’s what happened. Last week, I got the standard mammogram, complete with uncomfortable chit-chat with the mammo tech who has chilly hands. You know the drill. Stand in an awkward position, let the tech scoot “the girls” between the plates, and hold perfectly still as the tech cranks down the vice to hold what little breast tissue I have in place. (Like I could go anywhere?) Repeat on the other side. Please understand I’m not dissing mammograms. No way. Not even close. I believe strongly in mammography as an excellent way to pick up breast cancer in its earliest stages so patients receive the best treatment. I just don’t appreciate being the one with the abnormal result. I’m the freakin’ doctor. Irony, much? Damn it. The first result was “BIRADS 0” which means inconclusive or needs more views and an ultrasound. I’m told my breasts are “dense” which is hilarious if you consider #1) there’s not much there and #2) the damned things are drifting sideways and south – there ain’t much density to them from where I stand. But some guy in a dark room looking at my films says they’re dense and he can’t make a definite conclusion as to whether the nodule is something worrisome or not? Who am I to argue? Growing up with autism4/29/2016 This is the post I didn't want to write.
When I sent out my last newsletter, as always, there was a health blurb. Since it was April, and that’s autism awareness month, I did a blurb on early detection of autism. A line in that article alluded to the fact that I grew up with two autistic brothers. Several readers then asked me to share more about that experience. Please recognize this is one woman’s observations and path, and the interactions with my brothers and family should not be taken as a mandate, a proscription, or even as typical of experiences with autism. What I’m describing is how these two guys impacted my life, so it’s a very narrow field of vision, and purposefully so. If I sound in any way callus, please understand that’s not the case at all. It’s learned gallows humor and the ability to objectively look at things that might come across as somewhat less than introspective. Frankly, if I get too emotional about this topic, I will not be able to write this post. Period. It's super personal stuff, and it’s rare that I talk freely about ‘growing up with autism’. But maybe it’s time. Feels right. Seems like time to write this now that I've gotten some distance. Since I love lists, and, well, they feel safe as a blog structure, then that’s how this blog post is going to go down. The good news? I love lists!
Ten reasons why Dr. Jill thinks you should get your colonoscopy. #1) If you have any GI symptoms, please don't chalk it up to "nothing". Let your doctor know about it. This 42 y/o guy today? TWO+ YEARS OF RECTAL BLEEDING? Damn it, you want to know what I saw when I got 5 cm into his rectum? Let's just say the mass was bleeding and fungating. When I mutter "crap" during a case, it has nothing to do with poopy. If he had come in shortly after the bleeding started, this would have been a simple polypectomy. Now it's chemotherapy + a colon resection + possible metastases + …..? What a raw deal. #2) It'll make your parents/family/boyfriend/girlfriend happier knowing that you're healthy. They don't want to worry about you. Why put them through the worry? #3) All the cool kids are doing it. #4) Propofol gives you the best nap of your life. Ever. And sometimes Propofol produces sexual fantasy dreams. For real. Patients have told me STORIES. Note to writers: a colonoscopy could lead to inspiration and narrative breakthrough! (Better than binge-watching Lost….) The practice of medicine has been part of my life for 15+ years now. The lessons keep coming. Just when I think I've got a great handle on things, new information comes out or I see something I've never seen before.
Here's what I've learned so far in medicine. 1) The learning doesn't stop at med school, residency or fellowship. That just scratches the surface. God, I was such a little punk then. Clueless. 2) Most of what is learned doesn't come from a book. It comes from experience, or it comes from instinct (a fancy word for experience + gut feeling). And it comes from trial and error. 3) Dr. House is right. Patients lie. All the time. Unless you can get them to trust you and tell you the whole ugly truth. Sometimes this will happen. But usually not when it involves controlled substance prescriptions. 4) There is humor in anything, even the process of dying. Sounds sick, right? Many patients have told me that they appreciate feeling "human" when I can still make (appropriate of course) jokes with them, even as they enter hospice. Everyone deserves to be treated like a human, not a collection or organs. 5) Emotional separation is necessary and possibly career-preserving for the physician. It's possible to care but not absorb all of the pain and suffering. Not having this ability to separate from the situation leads to depression and burnout. (been there) Old folks say the cutest things10/23/2014 Ok, straight up, I love my patients. I learn so much from them. Here's a few reasons why I think a bunch of these folks are great.
An 84 year old couple, the L's, who volunteer to sit with their fellow parishioners at the nursing home. A 93 year old gentleman Mr. W who tells me that some of his joint and weak bladder issues >might< be because he's "finally getting old". Mrs. J whose trip to the casino was interrupted by a face plant on concrete, who argued with the EMT's who made her go to the hospital, and she reminds me that she will turn 96 between now and her next appointment with me in a month. |
Jillian DavidAuthor, daydreamer, and practitioner of trying very hard to duct tape folks together and help when I can. Archives
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