Thursday

Thursday, the last day of January 2008, ticks away. This month has passed quickly but then they all seem to zip by at record pace. I am "off" today but thinking ahead to my next 4 1/2 days of work with some dread, unable to just let it all go and enjoy the present moment. It is cold but bright outside; I should be out there walking briskly instead of sitting here eating cookies and drinking water infused with vitamin C and glucosamine/chondroitin. But, it's cozy here by the fireplace with the "fake logs" fueled by natural gas glowing and creating some warmth in this drafty house of mine. The cat sleeps by my side and music plays in the background. I've swept the hardwood floors, made the bed, and vacuumed the downstairs carpets/rugs. Lunch was a hardboiled egg and dessert, of course....cookies from Costco that have me hooked. Deceptively light they make me feel that eating a half dozen is nothing at all. Ahhhhhh.

I got the word from my sports med doc yesterday that the best fix for the torn cartilage in my right knee is arthroscopic surgery. I don't have to do it; it's just that my knee will continue to hurt me in certain positions if I don't take this step. If I wasn't so invested in being a mid-life athlete, I'd say "what's the point?" but as I'm trying to stay fit and know this knee thing will interfere, I guess I'll go ahead. But when? When is the best time for this sort of aggravation? Recovery is quick, not like a ligament injury they say. I'll have to pull out the calendar and work around spring break, work schedules and Mom and Dad's needs.

I'm reading today; hoping to finish up a really weird book I picked up last month called The Brief History of the Dead by Kevin Brockmeier. It isn't my typical pick but this futuristic bit of fiction caught my eye in the bookstore. It's pretty good and based on the premise that when we die we go to a place where we keep living (sort of) until the last of those who knew us on earth also die. Then, we pass on into another "beyond".

Browsing around Magnolia's Bookstore today I also picked up What is the What by Dave Eggers. The book is a fictionalized account of a Sudanese youth (one of the Lost Boys) who braved all odds to find freedom (?) in the United States. This one received excellent reviews and is a bookclub selection (joined a new bookclub recently) for later this year. I also bought Eckhart Tolle's, A New Earth: Awakening to Your Life's Purpose. Sure, it's an Oprah pick but I've read his other book, The Power of Now which was enlightening even if the message evaporated quickly. I have read so many of these inspiring books, hoping that one will stick on me like super glue. I figure it will take more than just reading to actually incorporate these states of being into my everyday life. A little here, a little there; would that it would add up to something bigger. I will try again.

I also passed the clothing store in Magnolia Village this morning and stood mesmerized by a red dress (just in time for Valentine's Day?) in the window. Although the color and the fabric are the same as my red dress, this one has a covered back but a charming criss cross front. A more sedate style, certainly much more appropriate for my stage in life. This makes me sad. I don't think this red dress of mine will every make another showing unless it's to dust the house or run in the Valentine's Day Dash (I made that up but my red dress could certainly double as a great sports top coupled with a pair of red or black tights. Ha! Guess my back can only be out there legitimately if I'm at the pool, at the beach, or running a race.

And so, I'm done with my musing for this sunny but cold and windy late January day. Things are a rumblin'. There's work to be done both inside and out. Life's a mystery. Open up those sleepy eyes and witness.

A Pain in the Knee

Registration for the 2008 Danskin Triathlon is just ahead; sometime in early February. I'm going to sign up but am concerned that I may not be able to participate as I did last year, much less push the boundaries of my time last year. It all started in the weeks after the August 2007 Tri; my right knee started to talk to me and say, "Hey, I hurt, something isn't right". My response was to lay off the exercise but I still noted that certain positions like a squat or sitting cross legged or in balasana pose during yoga would "zing" my knee. Surely this is a tendinitis, I rationalized. It will get better with time. Not.

The MRI shows a torn medial meniscus in my right knee. I don't know when it happened; there was no particular moment when I was aware of a sudden pain. Mind you, everyday activities are pretty cool. My knees love doing stairs and walking on even surfaces. Yesterday I went out to run and did a mile and although I've got sore muscles, the knee isn't too bad. Today I see my sports medicine doc for advice on what to do about this pesky issue in my knee. I know very little about this ailment; it is far removed from the world of kidneys and truly, the last time I gave the knee much thought was during an orthopedics rotation in medical school. I do know that arthroscopy has revolutionized the management of certain knee problems over the last decades and that removing torn cartilage is one of the "bread and butter" procedures of the orthopedic profession. We shall see.

I want very much to swim, bike and run on August 17, 2008 in the Danskin Triathlon. Prepping (aka training) for this event and participating did amazing things for my body and mind. I don't recall a high quite like the one I experienced in the hours and days post Tri. I want that back again. There is some resistance to getting in the water however; I know I'll have to start from scratch with my swim stroke and re-gain stamina. The swim is the hardest part of this journey and the most humbling. I watch the effortless strokes of good swimmers and marvel. This is beauty, captured in an endless rhythmic slice through water. Biking and running? Well, they are just that.

And so, I will wait to see what unfolds in the journey towards this year's Danskin Tri.

Critical Care Medicine

Today, rounding in the intensive care unit, I was able to spend more time watching the activities of the young in training and was struck by the changes (good ones) that have evolved since I was a resident rounding on the critically ill with my senior attending physicians. The tradition then and into the majority of my years as a practicing physician was to make the official bedside rounds "closed"; that is only for the doctors, medical students, and the nurse taking care of the patient. Nowadays, a flock of people hover around the door to the patient's room. In addition to the doctors, there is a respiratory therapist, a pharmacist, possibly a social worker and to my great surprise, significant others of the patients (spouse, partner, parents, or grown children).

At first I bristled at the idea of these all inclusive bedside rounds particularly in the intensive care unit. I told myself that families had no business listening to the hum drum reality world of hospital rounds which are nothing like what goes on in "E.R." or "Grey's Anatomy". Besides, wouldn't the rounds take forever with each medical term, abbreviation, or inside communication needing to be translated for family? And then, what happens when we simply "don't know what to do" about whatever situation exists; how do we brainstorm options without looking like we are total idiots and poorly qualified to be making major decisions in the care of loved ones? Wouldn't we have to be "on guard" and pay attention to every word, innuendo, and stray comment so as not to cause confusion, misunderstanding, or at worst anger and pain in family or patient (who in some cases is able to listen in, depending on the severity of illness)?

But today, as I watched and participated in a group discussion of a complex patient with both of her parents present, I witnessed a very professional, thorough, and important gathering of key players (family included). Medical terminology flourished, give and take discussion (teaching points) occurred and it left me quite impressed. The work flow and decision making occurred and I was left with the sense that including family in the process was more helpful than a hindrance. Times change, styles change, and we move forward, hopefully for the better.

I know that these doctors must convene at a later time to share their thoughts about the care of critically ill patients and allow the unknowns of medicine the opportunity to flourish. There is so much about the critically ill that we can impact but also much that we are forced to accept as just "what is". To accept that we cannot be healers at all times, that we may chose a path that ultimately was likely not the best one for our patient, and to teach and be taught behind "closed doors" is also very important. This, in my opinion, is work that must be done outside the patient's room and away from family.

'Tis a balance. But, I must say that I liked the way family was included into these very thorough bedside rounds. I believe this is happening more commonly, especially in the intensive care unit where such inclusiveness on the critically ill was never felt appropriate, until now. Progress indeed.

A Day with Mom and Dad

It is Sunday morning; I am still at Merrill Gardens. Ineke, one of Mom's favorite caregivers, will arrive shortly to "relieve me" after my time spent with Mom and Dad all day Saturday and through the night. I wanted to see with my own eyes the needs of my parents as they look ahead to another move, this time to an assisted living facility in Seattle's north end. I worry about Mom because for the last two months plus she has had round the clock care in the apartment with one-on-one response to her every need. This intensity of service won't be available in assisted living and I'm trying to get an idea of how safely (or un-safely) she navigates her days. I tried to get her to do as much on her own as possible and only provided assistance when she asked for it (other than fetching water and snacks from the kitchen which I didn't insist she do for herself...) It was a worthwhile investment of my time if for no other reason than simply being with my parents, a privilege and a rarity at their ages.

I had brought several books with me to read knowing there would be lots of "quiet time". But, I filled those hours knitting furiously; made two tightly woven cotton scrubbing cloths ("rags") and a scarf. My right forearm is a bit sore today and my fingertips dried out from maneuvering the needles and yarn as I completed hundreds of stitches. I found that I could observe, listen, and talk while knitting and the repetitive activity kept my mind from wandering to places it ought not have gone.

We ate lunch downstairs and then Mom had a hair appointment at the salon around 12:30. She's always there for over an hour; Mary, the stylist, takes her time which is nice. Mary always serves Mom a granola bar and yesterday a special treat, some Japanese crackers wrapped in a dried seaweed. We both choked those (crackers) down, smiling nicely but hating the taste. Have I inherited this trait from my Mother? Mom looked great and she made it all the way to and from the salon on her own steam with the walker.

Shortly after the hair appointment, Ineke came by with her dog for a visit. A perfect lap dog, sweet and longing for affection, he sat in Mom's lap for fifteen minutes and delighted her. Pets are such wonderful companions for those who are lonely, isolated, and in need of connection. There are even services out there that regularly bring pets into nursing homes and even to private fee for service customers. I wonder if Boo would ever take to this sort of visiting; I can see putting him in his cat crate and toting him up to visit Mom every week or so.

The rest of the day was rather routine; assisting Mom in and out of the chair to the bathroom or the kitchen, administering medications, opening the mail, watching TV, talking when there was something that inspired us to do so, undressing and dressing. And then at 6 PM we were treated to the Lawrence Welk show which Dad favors but Mom watches grudgingly. Me too; it bites. I had to bust out the Heineken at that point and Dad and I sat with beers in hand and a bowl of cashews. The treats made the show tolerable. I had to laugh outloud; Dad couldn't figure out why but Mom sure did.

The night was easy although sleeping on the couch isn't that comfortable. Mom, all bundled in flannel P.J.s, fleece socks and a white lace hairnet, fell asleep in her chair around 10 PM and never stirred until 7:15 AM. I heard her dreaming at one point but for the most part, quiet indeed. I wonder if this is typical or atypical; the log notes from night time caregivers usually indicate a busier night. Was it my presence? Was it just a really good night? I suppose we'll never know.

What will I do with this information from my 24 hours of observation? I guess it may be helpful to the nurse who does the intake interview at the assisted living this week. Once we pass that hurdle, we will be making plans in earnest for the big move. Everyone dreads the process but we shall persevere. I have to trust that this is the right decision; it certainly seems so at this time.

The Next Wave of Doctors

This is the season for recruitment of the new wave of residents into postgraduate training programs at medical centers around the country. Young men and women, seniors in medical school, interview for positions in residency programs which provide them the practical training in their chosen fields. The time spent touring various programs offers each the opportunity to see firsthand what the hospital and teaching faculty offers to their individual educational goals. They dress in dark suits and their hair is combed, their faces fresh, enthusiastic, and young. They arrive in groups, often on a Friday and spend the day seeing and being seen (for our program directors are carefully sizing them up as well).

Today I saw a group of half a dozen of these young "doctors to be" escorted through our hospital, walking through the intensive care unit and the corridors outside the emergency room, led by a senior resident of our program who fielded questions and cast our program in the best possible light. Historically, our training programs fills easily; these are highly sought positions at a well respected hospital offering residency training in Internal Medicine, Surgery, Radiology, and Anesthesiology.

I must say, these applicants look younger all the time. I remember when I was in their shoes, dressed in my suit, stockings and low heeled pumps back in 1979. I interviewed for positions in Internal Medicine at programs throughout Texas and a few out-of-state locations. Denny and I were in our second year of marriage, 25 years old, and we applied as a couple which meant that either we both were accepted at the same institution or not at all. Our top choice was to stay put at U.T. Health Science Center at Houston and fortunately, that all worked out.

Now almost 30 years later, when I see these youthful faces, excited about their future in medicine, propelled forward by a genuine passion for their chosen fields, energetic, and eager to learn from mentors and colleagues, I'm reminded how much my life in the field has changed over this period of time. Obviously, I've lost some of the "hey wow" attitude and have gained an uncanny ability to predict (or at least not be surprised) by outcomes. I have matured and allowed experience, one day at a time to flourish. I have grown into the white coat and go about my daily tasks with a familiarity that is such second nature that I am barely conscious of how I move through my day. I am struck by the countless decisions that I make on behalf of those entrusted to my care. But I never forget how humbled I am by the many unpredictable twists and turns that mark each day, the fact that medicine never sleeps, and the uniqueness of each patient encounter. I am always grateful for the trust my patients place in my abilities and experience as I participate in the walk through the storm, be it minor or major.

For all my years in the profession, I am most in awe of our abilities as human beings; as caretakers, caregivers, and listeners, as people privileged to touch the raw edged souls of those in greatest need. Seemingly small gestures, choice of words, extra moments, a lighthearted comment, or even a tear at the right moment become hugely relevant to the connection. Today I sat with the parents of a patient who is critically ill. I chose to preface some disturbing news with the hopeful statement that their daughter's "youth and healthy body" were in her favor and that in my experience (the accumulating years offer me rich examples on which to base my comments) individuals in this particular predicament generally have a favorable outcome. The journey may be long, frustrating, and complex but hope, not in the form of a promise of success but a probability of a win, is the gift I can give to those most terrified. To see their tears, whether outwardly or inwardly expressed, to feel my own in the same way, to acknowledge the connection between us and to savor the powerful reminder that we are all indelibly linked one to another is the meaning. THIS is what we are called to do in tandem with the exercise of diagnosis and treatment.

So, to these youthful new recruits; go forth, learn, grow and experience just what it means to carry the terrifying, yet powerful and important burden of your chosen field. And step up to the plate quickly so that I can continue to step away. I have been there, I have seen, I have wept and I have laughed. There are wins and there are losses. But there is always a time when comfort, the only thing left to give, is the most important gift of all.

In fact, in 1979 when Denny and I graduated from medical school, we received a gift from his sister Maureen; a framed print of the quote..."To cure sometimes, to assuage often, to comfort always". We connected with these thoughts then in a simplistic way but as the years passed, with more understanding, depth, and recognition. This, young doctors, is "it".

Willingness

WILLINGNESS In the willingness to feel, there is healing. In the choice not to closet, cast aside or deny experience, energy is freed, and I dive deeper into life. There may be maturity in choosing not to act, but there are no rewards for suppression and denial. To be fully alive is saying yes to the wide array of human feelings. When I soften, release and breathe, I discover I am more than what I think, feel, reason, or believe. Poems from the Heart of Yoga By Danna Faulds

Crystalline Insight

Today is one of those crystalline winter days where the blue of the sky is so boldly beautiful that it seems unnatural. The air, crisp and jolting, screams out for attention and recognition. That it is so cold makes the blue that much richer. The Olympic Mountains stand out like jagged ice cliffs, the white caps alternatively in full sun and shade as the sun passes overhead. Gorgeous.





Today I've gained a bit of positive ground thanks to powerful wisdom that escorts the garbled mess of my mind to a calmer place. Sharing the angst with a trusted receiver has once again given me permission to consider myself and what I want from this "one wild and precious life". ***

I've been to this most precious place where living one's dreams is possible so I know I can go back again; it's a place of peace, acceptance, self-love and surrender. Had I never been there, I would boldly deny the existence of this possibility. But, having lived genuinely for snippets of time varying from minutes to days and weeks, I know that it is there for the taking. I own the key but need to put it in the lock. The key will appear in my hand when I lose the sense that I can control the outcome of these brisk currents, the snow on these tall mountains. or the cyclic changes that come to barren branches. I am close, breathing close to the possibility.

*** From poet Mary Oliver