drive time.

i was driving yesterday during my now-weekly 240 mile journey between "home" and "WV" and realized how much i'll miss my time in the car.

kind of weird for me to be admitting that i'll miss living so far away from my husband (which please don't misunderstand me, i won't). weird for me to want to sit on my ever-growing rump 8 hours each weekend. and weird for me to have grown the desire to rebreathe the same air for 480 minutes four times each month.

but my drive time has grown to be a time of solitude. a time to listen to the Lord speak, to listen to podcasts, and to communicate with friends & family i otherwise would not make as much time for. and perhaps more importantly, my drive time has become a weekly journey of faith. i catch up on sermons, NPR, and oodles of podcasts. i listen to new music. and i create new conversations--depending on my cell phone battery.

as i pull out of our driveway in NC, i'm always tempted. tempted to turn around and give this up. tempted to choose the easy road in our lives right now and avoid the trials, temptations, and frustrations that come with living apart from a loved one. tempted to skew the loving words jon has spoken, tempted to let my frustations and anticipations build to the breaking point. and more times than i'd like to count, i've been tempted to believe that this wasn't God's plan afterall.

but every time. EVERY TIME, i arrive at my destination 4 hours later with a calm heart. one that has been personally touched by God's hand; one that has been reassurred that this is the road we are traveling right now...and that soon enough, there will be an exit.

bodily fluids.

There were two of them, and two red-heads of hair fashioned mullet-style greeted me at the door of the exam room. One, around age 7, sported think glasses with royal blue frames. The other, probably 5 years, sported lizard green glasses frames. Their faces speckled with freckles, I could tell they were happy to see me.

As soon as my foot crossed the threshold, it was like a motormouth competition over loud speakers exploded in the room. The jabber was almost more than I could bare. And both of them were getting wildly out of breath trying to out-speak the other.

And then it happened.

Between breaths, the 5 year old was temporarily silenced. And his blue-framed mullet-style 2-year-older freckled red-head brother shouted out at the top of his jabber mouth lungs:

HE VOMICKED!!!!!!!!!!!!!!!!!!!!!!!!!!

The 5 year old sat there stunned, seeming slightly embarrassed after what his almost-twin brother announced to the entire office (and probably the two adjacent to us). And after my ears stopped ringing, I realized that they might have heard him in China.

Which is right around the time when Mr. 5-year-old informed me, also at the top of his voice range, that "the “vomick” was green & chunky & had his hamburger from dinner in it."

Thank you. I guess that’s what brothers are for, huh?

well.being

i've been indulging lately. in guilty pleasures. like poptarts. and licorice. and when i found out Hershey's makes Pumpkin Spice kisses, my stomach flipped with joy inside my abdomen.

and i'll admit that i haven't made the best choices for my own health lately. not eating balanced meals. each much too quickly for gradual digestion. and mostly not listening to my body when it is telling me its tired or hungry or too overwhelmed with food.

i found this post today on this incredible blog. the woman inspires me--with 6 kids & a farm to oversee, it makes my work days sound like walks on the beach. or walks through snotty-nosed-kid alley, take your pick ;)

and so today, i'm sitting in the guilty chair. perhaps similar to the "time out"chair i used to be forced to sit in. and i'm going to try my best to take better care of my body--to eat better, to exercise more regularly, and to get restful bouts of sleep at night.

here we go....

weirdest question from a patient...

"How old would you be if you were fat?"

-patient

a belly.

best pain complaint

How long have you had this pain?

"Long time, I reckon."

What have you taken for the pain?

"A damn lotta nutin'"

a monday to remember

8:42 am: arrive on floor to check patient labs.
8:46 am: walk into patient room to complete history & physical exam.
8:50 am: patient able to identify herself, tell me where she is, the current year, and the President of the United States.
8:52 am: patient says she urgently needs to see Herman, her boss, who comes home with her each night. Herman wears dark glasses and plays cards with all the men in her house at night. Apparently he wears dark glasses so that the women can't see him in the garden.
8: 56 am: patient informs me that i am bipolar. and that she has been married forever, since the beginning of time.
8:58 am: patient wets the bed while i am interviewing her.

9:30 am: patient found half naked in the doorway to her room.
9:56am: patient found in the hallway, partially dressed with her hospital gown hanging wide open in the back. patient holding telemetry monitor, pretending to "take pictures" of the other patients with the monitor.

10:30 am: patient found completely undressed in room, leaning over side of bed. she claimed she was in labor having Herman's baby.

11:45 am: patient given drugs to calm her down.

1:35pm: patient found in hallways again, with "camera" in hand.
1:55pm: patient informs nursing staff that the Green Beret's are going to get them. she also informs attending physician that her husband is actually her boyfriend. and that he wears a Green Beret.

2pm: patient given Ativan.

...we call them "super psych"....

september weekends

conversation.

Four heads covered with silver hair bobbed up and down inside the room where the man lay. The women were deep in conversation, perhaps reminiscing about last evening’s 5 o’clock news or the weather that afternoon. One sat in a wheelchair, her distended belly protruding above the metal handles of the seat. Another sat in a chair near the corner, quietly nodding in agreement. But I couldn’t quite make out what they were saying from my perch at the nurses station. All I knew is that they were in that man’s room for a long time.

I could only see his legs. Large, matted with hair. His feet covered with hunter green fleece socks—not the teal green kind that the hospital issues. And he just lay there. Still. Asleep, I presume. His IV drip beeped every 10 minutes or so, indicating the bag that loaded liquid into the vein on his left hand was nearing its last few drops.

I watched them for awhile, at least ten minutes while the attending made phone calls & filled out patient charts with new orders for mediations, labs, and imaging studies.

While I stood there, constantly shifting my weight so the pains in my feet wouldn’t grow too intense, I couldn’t help but wonder who they were in that man’s life. Sisters? Aunts? Friends?

To be that group of aging women, gathering around a beloved friend in a time of need. Consoling a friend in a time of pain, uncertainty, and intimidation. And simply being there, as a hand to hold, an ear to listen, and a mouth to make conversation.

It’s an incredible thing in the hospital to see someone surrounded by people. Incredible almost more than family is the immediate community that flocks into the patients room bringing monetary gifts of flowers, teddy bears, and “get well soon” cards. Most gift-bearers hand them awkwardly to the patients, not knowing exactly what to say in a situation as dire as many face.

And perhaps that is what struck me about this group of women. They brought nothing. No freshly cut $5 flowers from Walmart stood on the shelves. No premade Hallmark greetings were placed in the metal card holder mounted on the wall. And no awkward gestures passed between them and the patient. They just brought themselves…and a bit of conversation.

So that is where I found them. In conversation. Perhaps reminiscing about last evenings 5 o’clock news, or the weather that afternoon. The words exchanged reminded the patient—and me at my perch near the nurses station—that sometimes busy chatter means more than words can adequately describe; it means that you are surrounded by people who care deeply enough to miss this evenings 5 o’clock news, who value the importance of community enough to look at the afternoons weather through two panes of glass on the second floor, and who cherish something as simple as a conversation.

a hand in healing...

I never believed I would be one of those physicians who had a “god-complex”—who thought that life & death was determined by their hands, and who played with the livelihood of their patients at will. And actually, I never believed that I’d be one of those physicians who was emotionless when delivering bad news, or who felt little-to-no empathy for patients scared, discomforted, or in pain.

But I am becoming one.

It’s not something I’m readily admitting on a daily basis. Not something I’ve even realized quite enough to surrender it to the Lord. But today I noticed that my emotional bank was drained just a little bit more than yesterday, which was a little more than the day before.

When I walked into the room of the forty-something year old man, I had no reaction. No empathy and less compassion than I would have expected even two weeks ago. He lay in bed, chest rising and falling much too fast for adequate oxygenation. His skin pale and clammy, we arrived to deliver the news of his transfer to a cardiothoracic surgeon in another city. He needed surgery…quickly. We’d found vegetations on his heart from years of IV drug abuse. And now, with his quickly-decompensating condition, his body could no longer withstand the stressors on his heart, lungs, and joints from his years of drugs, smoking, and hard labor. The only emotion I could muster was a small smile of pity because afterall, he was just another patient.

His voice, broken up by shallow breaths, was quiet. There was no dispute from him, no resistance to the serious news we’d just delivered. A dry mouth half opened between two sunken cheek bones, his only request was to see his nurse, who would enter the room shortly to change the urine pad that protected his bed.

Medicine & Christianity clash, no matter how you look at it. Many claim they clash educationally: that looking at the complexities of the human body somehow points away from a Great Creator and toward random design. Others claim they clash ethically: putting physicians’ beliefs above the patients’ own in order to gain wanted results. And still there are others, like me, who struggle with the clash emotionally.

The God who created the heavens and the Earth, who made man in his image—intricate in design & function; the Creator who gives life to all living things & moves mountains at will; that Being told me to LOVE, to have COMPASSION, and to look at each of His Creations as my brother or sister & treat them as such.

But I can’t.

I can’t wake up each morning and empty my heart (and my eyes) into each patients ailment. I can’t go to bed each night, struck with worry about the state of affairs of each body wearing a hospital gown. And I can’t go on with my days wondering about the eternal destination of every face I see. I would be emotionally drained, spiritually vacant, & physically exhausted.

The balance between Christian compassion & medical intervention is not so easy to find. The lines blur. There are too many gray areas to count. And many nights when I trudge back to my apartment, I’m left with conflicting thoughts about that fragile balance between compassion and distance, empathy and emotional-removal.

Truth be told, I don’t know if there is a balance. The scales sway in one direction and then the other, toward generous emotional sacrifice and then in the opposite direction nearing selfish emotional protection. Maybe it’s the method of finding equilibrium—not letting the scales tip too far or stay too long on one side or the other.

But then again, the compassion from God—the Ultimate Healer—is unending.

My grace is enough for you.

When you are weak,

my power is made perfect in you.

–2 Cor. 12:9

Grace, rain down on me today, tomorrow, and through the conflicts of my faith. Help my compassion to be never-ending, my love to be overflowing, and my healing be for Your glory.

someday when I learn....

It seems like an impossible large task—to know as much as physicians do. I know a lot of knowledge “comes with experience”, but I’m experiencing right now, aren’t I? My fear is that this year will pass…next year will pass…and I’ll still be walking into patients rooms with my head spinning & my knowledge bank crying out in terror “I DON’T KNOW HOW TO HELP YOU!!!”.

I have to keep in mind that this is only my second rotation. I’ve officially been out of the classroom for 10 active weeks. TEN. [And can I just say that it seems like decades?!]. But my overbearing tendencies to look toward the future are being just that again: overbearing. I’m thinking about how much time I don’t have left instead of how much time I do. I’m thinking about all the pages of textbooks left unturned instead of the myriad of highlighted words that stain the pages of the books that sit on my shelves. And I’m thinking about what the future might bring instead of how I’m going to handle it.

I’ll be honest: the next 22 months is a calendar of gargantuan intimidation. Where will I live? Who will I rotate with? Will Jon be okay? What will happen afterwards? Will I even get any interviews for residency? WHAT WILL MY LIFE BE LIKE?

Here I go again, dreaming of my crystal ball. Wasn’t it just last week that I was talking about trusting God more this year? ...

best dietary modification report

Have you been watching your diet like we talked about before? What have you been eating?

"Yes. I reckon I de-id.

I've been eatin' some mooora those veg-tables.

And I been eatin' me some of that sal-mens.

I do reckon I like them sal-mens."
-patient report on dietary modification, diabetic f/u visit

sick.

It was another hard day yesterday. Not because of the patients. But this time, I was the one that was sick. I’d had some indigestion for the two days prior, originally attributing it to something I ate. But on Monday morning when I woke up with stomach cramps, I knew it was something else—perhaps a friendly little virus that decided to set up camp in the rugal folds of my intestines? Probably.

I tried to tough-it-out. I tried to make it through the day. But I knew the day was off to a bad start when I had to use the restroom three times before and after one patient. Finally, my attending told me I looked sick & that I needed to go home.

His instructions were followed by at least 7 hours of sleep and a bowl of chicken noodle soup. I’m sticking to the B.R.A.T. diet for the next few days (bananas, rice, applesauce, and toast).

Kind of a crummy way to end such a great weekend? Or to start a new week, whichever way you look at it. I’ve gone home (to NC) each weekend so far & hopefully will be able to keep up the trend. With deployment on the horizon & away-rotations all over the country, Jon & I are trying to soak up as much time together as possible…

death & the hospital.

The hospital does things to people. It makes sick people sicker instead of encouraging healing. It causes people to revert back to childhood, appearing psychotic when the sun goes down (interested? Look up “sun downing”). And under one industrialized metal roof, it tends to highlight the joys & tragedies of life.

I was exhausted this weekend. And despite my physical exhaustion from a week of emotional transition, it seemed I was more than emotionally exhausted.

My patients came from different backgrounds. Enjoyed their place in different socioeconomic brackets. Regularly ate different foods for breakfast—the man in room 207 preferred pancakes & grits while the woman in room 368 insisted on eggs with salt & pepper beside one plain piece of white toast. And most of all, my patients made me open my textbooks to vastly different chapters with the slew of ailments they were admitted for.

I’ll be the first to admit that I didn’t consider myself a normally emotional person. I was able to detach my frontal lobe when necessary, reattaching it only every once-in-awhile to let out a good cry…or something of the sort. And I could say that it is all jon’s fault—that he is the one who makes me cradle my frontal lobe like its my beloved teddy bear. That he is the one that is causing all this emotional turmoil when I arrive at work each day—he is responsible for the growing collection of wet Kleenex in my pocket when I leave patients rooms with tear-stained cheeks. That I fell in love with him, causing my girl-crying-hormones to come out of hiding.

But if I blamed it all on him, I’d be lying to myself.

Because in addition to all those things that the hospital does, it also stirs up my emotions & leaves my brain spinning in utter exhaustion each night when I try to close my eyes. I try to imagine the patients in their homes. The smells. The sights. The sounds. I try to imagine them surrounded by loving family members, instead of the silence that pierces their hospital rooms. And I try to dream up all the beautiful places they’ve been, the fulfilling lives they’ve lead, and the belief that sustains my imagined faith for each one of them. But sometimes, my imagination only takes me so far….

And when I try to imagine farther, it ends up being make-believe.

I lie in bed at night & try to dream up fairytale lives for my patients in an effort to quell my own uneasiness about their transition from life to death. Inevitably, I’ve started thinking more & more about my own death; the death of my family members, my parents, my husband. My mind spins for what seems like hours…at which point I reach for the almost-empty Kleenex box that was newly opened last Sunday. And eventually I fall asleep to a pillow, moistened by my own tears of fear; evidence that despite my hard-knock façade, these realizations have biopsied the core of who I am…and what I believe.

I’ve never really faced the reality of my own death before. And although rather morbid, this Internal Medicine rotation is not only challenging me medically, it is also challenging me spiritually. It is causing me to ask the hard questions—the questions that, three weeks ago, I thought I had solid answers to. It is causing me to reflect on my own life and realign my priorities. And it is causing me to engage my own human reflex by scooping up my feelings & thoughts & priorities & life & putting them in my OWN “safe bag”—one guarded from negativity & the prospect of tragedy infecting my household.

Try as I might to resist sleep at night, God opens my eyes each morning with a new reminder that HE is ultimately in control. And when my feet hit the floor, God reminds me that HE has lessons to teach me this year. When my eyes focus & I sit down with my Bible, HE has consistently given me verses like this each morning:

“Now we know that if the earthly tent we live in is destroyed, we have a building from God,

an eternal house in heaven, not built by human hands.

Meanwhile we groan, longing to be clothed with our heavenly dwelling,

because when we are clothed, we will not be found naked.

For while we are in this tent, we groan and are burdened,

because we do not wish to be unclothed but to be clothed with our heavenly dwelling

so that what is mortal may be swallowed up by life.

Now it is God who has made us for this very purpose

and has given us the Spirit as a deposit, guaranteeing what is to come.

Therefore we are always confident and know

that as long as we are at home in the body we are away from the Lord.

We live by faith, not by sight…

so we make it our goal to please him, whether we are at home in the body or away from it

…Therefore, if anyone is in Christ, he is a new creation,

the old has gone, the new has come! "

-2 Corinthians 5: 1-7, 9, 17

I know God is trying to teach me to LET GO. To GIVE IT UP. And to TRUST HIM. But as you well know, TRUSTING is my biggest struggle.

Perhaps this is the year of breakthrough.

best past medical history

"For a period of two months, patient said she wasn't feeling well.

She reported that she felt like killing people.

She is feeling much better now."

-Physician SOAP note

{as if that should make me feel better}

daily {pixels}

i'm kind of in love with these photographers. and by "love", i mean that i feel kind of sad when i can't check their blog.

why??

because they are amazing. because they have darn cute kids. because they have an incredible eye through their lens. because they capture moments i've never seen in photographs before. and because they are honest, hilarious, & crazy cool in each of their blog posts :)

i'll miss these days.

little did i know, but our time together this summer would really change the attitude of our weekends this year. before living together, there were times that i felt we were "making up" for lost time on the weekends, spending the majority of our days on-the-go & most of our nights hurridly talking through conversations we might have had during the week.

but i think we've relaxed a bit. perhaps its just that we are comfortable around each other now, that we've been married over a year. or perhaps its because our attitudes towards life are changing & we are taking the time to slow down and enjoy the moments of solitude we have on the comfort of our own couch.

whatever it is, i LOVE IT. because it makes for a great weekend :)

golf. homemade wheat pizza with fresh vegetables from the garden (the crust & everything!). bbq with friends. movie night. errands. and time together. i gosh-darn-love saturday & sunday!