Cousins

An old one I never posted. A text to my dad.

Last night...


Have cousins here. They spent the night last night. The girls are still asleep in my bed. Last night we watched "Throw Mama from the Train" after eating at a little hole in the wall by their house, Jolly Cup. The cousins directed the dining and cinema choices and everyone really enjoyed themselves. You'll have to get the cousins to take you to Jolly Cup when you come. They have great Vietnamese sandwiches (banh mi) and shakes with tapioca balls. We were trying to find a cheap place where I could feed all 5 of them and they both were very much in favor of this place. At first oldest son tried to stage a hunger strike (he had been out-voted 4 to 1 against his choice, Chipotle) but the Big Dawg knows good food when he smells it and eventually his sense of taste and smell won out over the his principles (must always have my way?). Jolly Cup was a good way to let the searing pain and humiliation from my 322nd back up into another car (can anyone say back up camera on the next car?) dissipate. Niece forgot her handmade gift to Uncle Lee so I decided that reversing down the cul-de-sac at night with a van full of kids would be the most expedient method of retrieval. Only we didn't get very far because our backward progress was impeded by a white Toyota Camry, which lucky for me, sustained no damage. We managed a quick get away without the gift and with only one explicative said aloud (which daughter was quick to spin for me in a moment of crisis. "You mean frick, mom, right? Because you hit the car? That's what she means 6 year old girl cousin"). Regardless, Vietnamese sandwiches in a dodgy strip mall in a restaurant filled with patrons who mostly spoke either Spanish or Vietnamese (except for the very loud 5 children who were alternately demonstrating Jane Fonda-esque aerobic maneuvers as can be done with your bar stool-niece with daughter as her star pupil or an 11 year old executive-nephew-handing out food orders whilst simultaneously looking very grand with a functionless blue tooth poking out on his right ear). Niece was generous enough to share her copy of Auto Trader magazine with me when she was done reading it and nephew was quick to explain the virtues of a giant bottle of communal Great Value Ranch Dressing vs bastardized barbecue sauce in a Siriracha bottle on your hot wings to his 10 year old cousin. Thankfully C-Span was playing on the 65" screen TV for all of us to enjoy.

On the car ride home I learned that Isaac likes niece as evidenced by his demonstration of love in kindergarten with a kiss to her forehead. The admiration is not reciprocal because niece has pledged her affections to Conner.

The girls started on a puzzle which generated a conversation about nerdiness; is it good or bad and what constitutes a nerd? The general consensus was, though they may like to study a lot, it was good to be a nerd although no one present was willing to be categorized as one.

The girls, very sweetly, laid in bed and read with me last night. Niece with her stack of Berenstain Bears books, daughter with her chapter books and me with my People magazine. And their they remain with books all over the bed. The boys all bunked in middle kid's room and nephew had emerged for a brief moment but went back to sleep when he learned he couldn't start playing video games at 7 am.





It's so comforting to be in their presence witnessing the creation of memories as a fly on the wall-just a facilitator. They all have their own unique and special role in the family dynamic and that sweet new baby niece better rest up now because she's gonna have to be ready to rumble soon enough!



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Giving Bad News

Giving bad news never gets easier. And the older I get the more difficult it becomes. I suppose it's because I now have more life experience and when I was a younger doctor I could easily separate patients' lives from my own. Recently, I had to tell a woman that she has metastatic cancer. I had suspected as much but, like her, I was holding out unrealistic hope.

The past week or so I've been having paroxysms of sharp pain in my right temple and in my back, over my ribs on the right. The pain doesn't last long, seconds, but the rib pain, especially, catches my breath.

Normally, I'm prone to ruminating over whatever ache or pain I may be experiencing. Let me clarify, I don't ruminate frequently, but when I do have a pain, my mind immediately conjures the worst case scenario with me dead within weeks to months.

The mind and body have such a powerful connection. I'm not particularly new-agey but things in your subconscious can manifest themselves in many different ways, both bizarre and simple. Over time, doctors develop coping mechanisms to deal with unpleasant and uncomfortable feelings. Humor and repression are two popular and convenient ways to handle them. My husband is on a committee that deals with professionalism and medical students. Many of the committee members are not clinicians, meaning they have no patient contact. To them, some of the things that are spoken during rounds or in clinic would be incredulous. What they don't understand is that clinicians, on the whole, aren't cold and insensitive; we're simply trying to stay sane. In his brilliance, my husband has developed something called "the box of unprofessionalism". It's kind of like a confessional booth in that while you are standing in the box of unprofessionalism (which is far away from patient care areas and behind closed doors) you can say whatever you like without reprimand. It's not that he embraces insensitivity or crassness, rather he understands the importance of decompressing during incredibly stressful situations. (Maybe this is why he wins so many teaching awards).

For several days I've been repressing my grief over my patient's diagnosis. I had to tell someone, speak aloud, the words no one wants to hear. Every year Lee and I, along with one of our colleague's, give a lecture to the medical students about being a doctor and having an illness. We all discuss how your life changes the day you (or a loved one) receive the unwelcome news. All of the sudden you have to alter the landscape of your life. As a doctor, I don't think I can discount or underestimate the significance of giving another person equally life-altering news. What's the correct way to process? There is no course in medical school or residency that tells you how you are supposed to act, feel, behave. And for how long afterwards should you feel like shit? What's that patient thinking right now? Is she scared? Resolved? Indignant? Angry? I'll tell you how I feel, overwhelmingly sad and if I'm really honest with myself, guilty. Why her and not me? Why do I have the burden and responsibility of reminding someone of their own mortality and why is her number up and not mine?

I think that if I could get alone for a bit I'd probably have a good cry and I think I need a good cry. Not just for myself, but for that lady. Maybe the lump in my throat would go away and the pain in my head and the ache in my back.

One last thing, especially since I'm typing this on my phone while my family is on a road trip and my kids are about to mutiny because they want lunch (and maybe that's why I can finally think about this. I'm not helping someone with homework, or finishing a yearbook, or paying a bill. I'm on vacation); it's a story from medical school. When I was a second year student on my general surgery rotation, my friend and I were given the task of sewing closed a young man's chest cavity after he had died. I can't remember the mechanism of his accident, either a gun shot wound or a car accident, but he had been brought into the emergency room as a shock, meaning he was being artificially resuscitated. Well, chest compressions alone weren't reviving him, so the surgeons cracked his chest and performed cardiac massage. After what seemed like an eternity, they called the code realizing nothing was going bring the guy back to life. What had moments before been a shock room full of frenzied activity was now silent, with me, my friend and the dead man. The nurses and surgeons had gone to talk to the family and left us to "close him up" so he would be presentable to his family and so we could "practice our suturing skills." So Carie and I stood there, silently, each carefully sewing up one side of his thorax. Sometimes we still talk about that night an how ill-equipped we were to be given such a responsibility and how, afterwards, no one but us thought it was a big deal. When the surgeon came back in he said, "Good job, but make sure to take the tube out of his mouth because it's upsetting to the family." And that was it.

In the 22 years since I started medical school, they have advanced a lot in terms of sensitivity training and all of that 21st century PC stuff (no such beast as a professionalism committee in the early 90s), but personally, it never gets any easier and I hope it never does.




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House Guests

Text sent to my father this morning, 2 days before our trek to visit him. No offense to any Lithuanians....

Yo daddy....you awake? Wanna make sure you and Jan are still ok w/ us coming out there. You seem a bit hesitant about the number of house guests. Is it stressing you or Jan out too much?

By the way...I hope you don't mind, but we are hosting a band of Lithuanian foreign exchange students and their flock of camels. We feel bad about leaving them behind with the language barrier and all. We figure there is enough space for the camels in the yard and the Lithuanians don't take up too much space...they are compact and you can stack them on top of each other. Maybe one or two can sleep in the bed with you and Jan. They are cuddly creatures. By the way, the camels are gluten free, so would be good to have some grain free camel kibble for them. The good news is you can reuse the dung in your compost. You'll have award winning azaleas next year. If you don't get the grain free stuff, they get gassy and, pardon my language, but that shit smells and then the whole situation can get uncomfortable. On the whole, they've been delightful and I think you'll enjoy the lively, high spirited bunch. And the good news is they are a very loyal people so they are likely to come back next year and they usually bring with them many distant relatives and livestock


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