25 y/o G2P1 (second pregnancy, one child already delivered) presents to triage at 38 wks with no prenatal care in labor with a baby found to be double footling breech (both feet down instead of head down). Baby is born by emergency c-section, and mom decides to give him up for adoption. I talk her through the possibilities of open vs. closed, available agencies. I hold her hand as she cries over her selfless decision, over the baby she holds and gives away. I rejoice quietly with her as she picks a family from the profiles the agency showed her, a family with another little boy, a brother for her baby. I marvel silently at the strength she shows.
21 y/o G1P1 seen in clinic for routine gyn care. Oh, by the way, my last period was more than a month ago, a bit late now, unusual for me. We chat around the Pap and pelvic exam about the Gardasil vaccine and contraceptive options, her life living with her mother to save money to stay at home with her two-year-old, her questions about this or that health-related topic. Near the end before signing the orders for some vaccines and prescribing her birth control choice, I check a pregnancy test just to be sure. Positive. I go back in to tell her, and she bursts into tears. I sit back down, wondering inside at the irony that there are people who would cry tears of joy for this positive test that only brings pain and chaos to my patient and her life. We chat about options, me recalling my last difficult conversation with a patient in a similar situation who I now see for regular prenatal care since she never went for that abortion she had initially planned. I give this patient information about resources related with all her options - parenting, adoption, abortion - advising her of the support available for her should she choose to parent or form an adoption plan. I wish again that I had easy answers about my role in this counseling, my patient's decision, or at least an easy spiel of what to say and how to say it instead of the ambivalent wading through beliefs and values, situations and specifics, reactions logical and emotional. We agree to meet up again in two weeks to talk about her final decision.
55 y/o woman with known history of alcohol abuse comes in with alcoholic hepatitis. She is then intubated for hepatic encephalopathy with failing liver and eventually kidneys, too, as she develops hepatorenal syndrome. Unexpectedly, she survives her extubation planned for when her family can be there and moves slowly towards comfort measures as she is now alert enough to make her own health care decisions. I visit her the weekend before she moves to inpatient hospice to check on how she is feeling and end up sitting at her bedside giving her sips of the dozen or two juice bottles beside her bed and spoonfuls of cool sherbet that make her dry mouth less uncomfortable as her failing liver's inability to make protein to keep the fluid in her blood vessels slowly allows her to become more swollen otherwise and more dry inside the vessels. I lotion her dry, jaundiced hands and arms, recalling the elderly nursing home residents for whom I did this routinely for five summers through college. I wonder about how she must feel, relatively young and knowing that her drinking caused this poisoned liver, the dry itchy skin, the slow dying. Vicarious regrets fill me, and I mourn for what her life could have been.
27 y/o woman with family history of blood clots comes in with chest pain and shortness of breath. She is mildly anxious (never having been to the ER as a patient before), tachycardic (fast heart rate), tachypnic (fast respiratory rate), but pulse ox is normal. She tells the ER physician of her family history and risk factors for blood clots - the birth control pills she started herself on for acne, the long trip out to Indiana and Minnesota to see friends and family on her one-week vacation from residency a week and a half ago. She is found to have a pulmonary embolism (blood clot) in her lungs and is placed on blood thinners for the next six months. After the blood thinner level comes up appropriately and her pain is controlled, she goes home to stay with her parents for a few days to recuperate.
A routine case - one I have seen two or three times already this year in various transmutations - except that this time six weeks ago the patient was me. It has been frustrating and educational to be on this side of medicine for a change, getting regular blood work, waiting for phone calls from my own doctor for dosage changes on medications based on the labs, filling prescriptions at the pharmacy and bemoaning how expensive medications are (and I have good insurance!). I also identify more now with the fear of being in pain before the diagnosis is made, the lack of control over a body that no longer acts as it normally does (short of breath with walking, pain when lying down flat to sleep - now all resolved, thank God). And I am grateful for the family and friends (despite being in this place for only seven months) that support me during the time when I felt sick as well as now when I now feel normal but still have to do the follow up things (blood work, making up the week of work I missed, occasional checkups).
21 y/o G1P1 seen in clinic for routine gyn care. Oh, by the way, my last period was more than a month ago, a bit late now, unusual for me. We chat around the Pap and pelvic exam about the Gardasil vaccine and contraceptive options, her life living with her mother to save money to stay at home with her two-year-old, her questions about this or that health-related topic. Near the end before signing the orders for some vaccines and prescribing her birth control choice, I check a pregnancy test just to be sure. Positive. I go back in to tell her, and she bursts into tears. I sit back down, wondering inside at the irony that there are people who would cry tears of joy for this positive test that only brings pain and chaos to my patient and her life. We chat about options, me recalling my last difficult conversation with a patient in a similar situation who I now see for regular prenatal care since she never went for that abortion she had initially planned. I give this patient information about resources related with all her options - parenting, adoption, abortion - advising her of the support available for her should she choose to parent or form an adoption plan. I wish again that I had easy answers about my role in this counseling, my patient's decision, or at least an easy spiel of what to say and how to say it instead of the ambivalent wading through beliefs and values, situations and specifics, reactions logical and emotional. We agree to meet up again in two weeks to talk about her final decision.
55 y/o woman with known history of alcohol abuse comes in with alcoholic hepatitis. She is then intubated for hepatic encephalopathy with failing liver and eventually kidneys, too, as she develops hepatorenal syndrome. Unexpectedly, she survives her extubation planned for when her family can be there and moves slowly towards comfort measures as she is now alert enough to make her own health care decisions. I visit her the weekend before she moves to inpatient hospice to check on how she is feeling and end up sitting at her bedside giving her sips of the dozen or two juice bottles beside her bed and spoonfuls of cool sherbet that make her dry mouth less uncomfortable as her failing liver's inability to make protein to keep the fluid in her blood vessels slowly allows her to become more swollen otherwise and more dry inside the vessels. I lotion her dry, jaundiced hands and arms, recalling the elderly nursing home residents for whom I did this routinely for five summers through college. I wonder about how she must feel, relatively young and knowing that her drinking caused this poisoned liver, the dry itchy skin, the slow dying. Vicarious regrets fill me, and I mourn for what her life could have been.
27 y/o woman with family history of blood clots comes in with chest pain and shortness of breath. She is mildly anxious (never having been to the ER as a patient before), tachycardic (fast heart rate), tachypnic (fast respiratory rate), but pulse ox is normal. She tells the ER physician of her family history and risk factors for blood clots - the birth control pills she started herself on for acne, the long trip out to Indiana and Minnesota to see friends and family on her one-week vacation from residency a week and a half ago. She is found to have a pulmonary embolism (blood clot) in her lungs and is placed on blood thinners for the next six months. After the blood thinner level comes up appropriately and her pain is controlled, she goes home to stay with her parents for a few days to recuperate.
A routine case - one I have seen two or three times already this year in various transmutations - except that this time six weeks ago the patient was me. It has been frustrating and educational to be on this side of medicine for a change, getting regular blood work, waiting for phone calls from my own doctor for dosage changes on medications based on the labs, filling prescriptions at the pharmacy and bemoaning how expensive medications are (and I have good insurance!). I also identify more now with the fear of being in pain before the diagnosis is made, the lack of control over a body that no longer acts as it normally does (short of breath with walking, pain when lying down flat to sleep - now all resolved, thank God). And I am grateful for the family and friends (despite being in this place for only seven months) that support me during the time when I felt sick as well as now when I now feel normal but still have to do the follow up things (blood work, making up the week of work I missed, occasional checkups).
thanks for sharing the stories. i love you and am grateful yours has a happy ending.
ReplyDelete- Bekah
I love your blog and your stories. Your writing is so honest and gives a beautiful insight into the struggles and challenges of your journey in medicine. Love it!! (And so glad to hear you are okay!)
ReplyDelete