01.28.09 a day in the life

i guess you could call it writers block--i've been experiencing (experiencing?) a bit of trouble writing lately...my writers river is all dried up :) so instead, i'm resorting to pictures until the flood gates open & i'm once again inspired...

i thought it might be fun to share little snippets of a "typical" day on this rotation....the description below runs from left to right beginning at the top row.... 1) lunch packed? check. have purse? check. ready to walk out the door? check.
2) on the drive to work--what a metropolis i live in!!
3) arrive @ work & am greeted by the office door reminding me that this rotation is all about babies, boobs, & crotches ;)
4) step into the "patient education room", which i have since officially dubbed the "study room"--since it is where i sit ALL DAY studying.
5) this is where my bottom side rests most of the day...see how organized my preceptor is? (sarcasm, people, sarcasm)
6) my slew of bags waiting to be opened: book bag, purse, lunch box
7) books ready to be studied...i make quite a mess by the end of the day with all my pens & books, etc.--you'll see :)
8) if my preceptor is late (& he usually is), i get to watch Good Morning America & all the semi-ridiculousnes the show brings. today however, the show was frequently interrupted by a "Winter Weather Warning" for HIGH WINDS--as if a hurricane was going to come get us in the mountains...
9) in the time i was waiting for my preceptor, i watched Good Morning America, was scared to the high heavens about that horrid wind warning (not!), organized my study materials, & thumbed through a cross-cultural "baby book" where i found this hilarious photo :) i think i'm making one of these for our kids when they finally arrive...at least they can't go anywhere!!
10) the studying begins...
11) a few patients later & we get a call from the hospital informing us that one of our patients is 6cm dilated....off the the labor & delivery floor!
12) waiting for the baby to come (lots of watiting on this rotation)...i read a magazine all about list making & had one foot in heaven ;)
13) baby still wasn't there, so i was dismissed for a quick 10 minute lunch. ran down to the cafeteria where they have a microwave & slurped my soup...
14) still waiting....entered my daily food intake into my fancy calorie counter...
15) yay!! baby came! it was an adorable little girl....and i might have gotten a bit teary eyed...or not. i'm not telling. the photo is the 'evidence' from the delivery, since i wasn't allowed to bring my camera in the room
16) hand washing station...you can review the stages of cervical dilation if you'd like on that fancy blue+white tray behind the sink! how thoughtful, huh?
17) self portrait.
18) back to the office. 5 more physicals. writing notes on patient charts...
19) ready to go. still more patients to see.
20) found a book from 1899....
21) ...learned how to make a "nursing bra", in case anyone is interested....
22) finally! walking to my car
23) after 5:30...yup, definitely time to ditch that popcicle stand ;)
24) drive home from work. it was raining :)
25) dinner & email checking
26) change clothes for the gym
27) inside the classroom @ the gym--BodyPump on Wednesday nights...
28) post-gym facebook check
29) post-workout snack
30) at 10pm i drank a cup of green chai tea...& conveniently forgot about the HIGH caffeine content....i finally fell asleep after midnight :)

southern drawwlllll.....

The new patient had written "retard" on the patient information form. As tactfully as possible, I asked for clarification. He rolled his eyes at my obtuseness, but explained with great patience in his class [West Virginian]* drawl, "You know, I don't work anymore...I'm RETIRED."

*I read this story & thought it proper to substitute West Virginia for the Oklahoma, the original state featured in this short Medical Blooper.

hello, weekend.

...nice to see you again...

ooey gooey red stuff.

I heard that Grey’s Anatomy uses pig hearts & fake organs & red ketchup-like substances for blood. Because using real human organs would be inhumane, not to mention gross.

And so, I’m often left standing over a sterile abdomen underneath the operating room lights trying to convince myself that what I’m about to see really isn’t human; that instead it really is just pig hearts & fake organs & red ketchup-like substances that the nurses squirted on the patient during that 1/100th second it took me to blink.

Sometimes the mind games work. Sometimes I pretend that the giant blob of skin-looking stuff that’s glaring underneath the surgery lights is really a giant present from the aliens with lots of moving, gooey, red stuff inside. And other times I pretend that I really don’t know how babies are made & that they magically appear inside that giant blob of skin-looking stuff inside a nicely packaged thing that slightly resembles a picture of a uterus I saw just that one time when I was passively glancing through my anatomy book.

Playing stupid isn’t always a bad idea.

Because the truth is that I’ve quickly come to find that my body--& my hormonally driven emotions—don’t really care about the sterile field. Nor do they care about the REAL LIVE PERSON that is lying under those blue drapes. Nor do they care about the bustling staff that scurries about the OR making sure we don’t leave gauze or forceps or sponges inside that REAL LIVE PERSON that is lying under those blue drapes.

No, in fact, my body & my hormones only care about thrill.

And on Tuesday, it was thrill they got.

They also got a surprise trip to the cold concrete floor of the OR when I almost passed out during a C-section---{err, I mean a baby removal from that nicely packaged thing that slightly resembles a picture of a uterus I saw just that one time when I was passively glancing through my anatomy book}

Make the incision on that giant blob of skin-looking stuff.
I was fine.

That red-ketchup looking stuff started coming out.
I was fine.

More incisions with scalpels & scissors & hemostats.
I was fine.

Jlyn, please hold the retractor so you can look into this gaping slice we just made & see what kind of presents are inside.
I was fine.

Look! Do you see the babies head?
I was fine.

Dad was in the room & got all excited.
I was fine.

Baby came out—big chunky 8 pound boy.
I was fine.

Admiring the baby while hold the retractor & wondering how much that little guys back must hurt from being crammed in that tiny mommy’s belly.
I was fine.

Getting excited about the fact that I JUST PULLED A LIVING HUMAN BEING OUT OF SOMEONE ELSE’S STOMACH.
A little less fine…

Look! Do you see her colon!
Nope, not so fine…

Here we are, pretending to practice our cross-stitch on her uterus!
Definitely not fine…feeling quite warm by now….

Give me that big staple gun so I can punch her incision like I would a stack of paperwork!!!
Oh man….sweaty palms…sick stomach….

And the next thing I knew, the scrub nurse was stripping all my unnecessary clothes off—the sterile gloves, the gown, the extra hair net, the wet-apron….

What? We just delivered a baby?

Oh…cool. No thanks…I’ll just watch from the floor—the view is just fine from here. Thanks anyways—I’ll practice my cross-stitch on the next patient.

modern-day lepor.

It seemed a bit misfit for a Christmas Eve sermon; talking about lepors & their strange deformities with images of sweet baby Jesus & shining angels dressed in white embedded in my thoughts. And perhaps it was a bit misfit for Christmas Eve—but it was true…starkly, glaringly, effortlessly TRUE.

After all, the subject of the sermon was lepors—the greatest of all misfits in that Jewish vs. Gentile society. Cast aside. Covered in black spots, sometimes found with missing ears or hairs or digits. Accusatory glances from passerby, mothers bringing their children in closer, old men huddling against a stone-cold buildings while they passed—all part of the daily rhythm of seeing sunlight, finding food, & seeking JESUS.

Leprosy is still around, you know. Even in the United States. But there are drugs for it now. And treatment facilities. And incubation rooms. And other options. While it still exists & plagues many around the world, it’s a rarity these days to see a digit-less person missing patches of hair & half an ear frequenting the street corners. And while its bacteria still is isolated, grown, and treated in controlled facilities, there is another brand of misfits being bred at an alarmingly high rate…

Do you even know what she has??!

I heard the nurses whispering.

I can’t believe he is taking that risk—I don’t think I’d do it.

They were hushed, obviously trying to avert my intent listening ears.

Yeah, the one with the yellow scrub top said, he is one of the only ones in town that takes such dangerous cases….I just hope I don’t have to stick her.

And then they dispersed. Busying themselves with clipboards & pill cups & ice chips.

I walked over to the metal cart that held the aqua colored charts. My finger moved over the labels until I came to the thick binder bearing the patients name in question. I glanced at the red tab labeled “LABS” and flipped it open, like I’ve done a thousand times this year.

HEPATITIS C.

Oh.

My initial thought mirrored that of the nurses—I just hope I don’t have to stick her…or examine her…or assist in her c-section. But then I caught my breath…

Accusatory glances from passerby, mothers bringing their children in closer, old men huddling against a stone-cold buildling while they passed….two pairs of layered latex-free sterile gloves, hesitation at that needle stick, tension-filled silence in the operating room (OR) when the first incision is made….

What if God used two layers of gloves when he worked on my heart? What if heaven went quiet when I prayed—waiting in silent tension to see if the grimy contagiousness of my sin would spread & infect even the most holy of holy's? What if sterile masks & extra paper gowns & special shoe covers were used when God deals with my dirt?

When he came down from the mountainside, large crowds followed him. A man with leprosy came and knelt before him and said, "Lord, if you are willing, you can make me clean." Jesus reached out his hand and touched the man. "I am willing," he said. "Be clean!" Immediately he was cured of his leprosy. –Matthew 8:1-3

Am I willing? Am I willing to be touched by God? To be healed by the hand—the naked, gloveless, scarred hand of Jesus? Am I willing to be outcast because of my infections? To be segregated because of my stubbornness? Will passer-by huddle in corners & turn their faces from me because of the grimy layers of humanity evident on my freshly made-up face & name-brand clothes?

Perhaps more importantly, am I willing to go under the knife—to kneel down before my Lord and ask for the Ultimate Healing once again? For the ump-teenth time since I last saw him…for the billionth sin I’ve commited...

And will He heal me yet again?

Your cleansed and grateful life, not your words, will bear witness to what I have done. –Matthew 8:4

shots.

goals.2009

We’ve been on the road a lot over the past three weeks. In the car. On the plane. In the car again. Sitting by the fire or the kitchen table or the Christmas tree. And I’m fairly certain it was the silence, the presence of Jon next to me (a rarity these days), and the crackles of the fireplace that inspired me to think more than I normally do. Most days, aside from a few more active (typically more freezing) afternoons, I sat cozied on a couch or chair or bed and let my mind run (because my hind end certainly wasn't up exercising). One of the great things (there truly are few great things on my list these days) about medical school is that it has quenched my thirst for reading for the next twenty years. The read-8-books-each-summer bookworm I used to be is a thing of the past…I’m not holding my breath waiting for her return, either. I’d much rather listen. Or just sit (something which, had I been asked two years ago, I would have found horribly boring & overwhelming elderly). And while I used to lose myself in a book & let my imagination run wild, I find myself lost in thought more times than not these days—typically resulting in my future-prone mind inducing a slight anxiety attack resolved only by a nap or cup of chai (the latter of which hasn’t done any good for my pant size).

I’m not sure what 2009 will bring. My anxiety level—and my innate & extremely annoying tendency toward controlled planning—is already about an 8 on my 10-point-scale…which is not boding well for the rest of the year. BUT I’m trying my best to get over the slump of faith and JUST TRUST that things will once again, as they always have, just work out.

There are many rotations to schedule, a large number of which have limited spots with restricted application periods on a first-come-first-served basis. There are residency applications to complete, personal statements to write, tests to take, patients to see & *hopefully* learn from, books to read (textbooks, mind you), letters to write, farewells to prepare for, and snuggles to be had.

I’m looking forward to the last one the most.

Anyhow…with all this thinking time, I’ve come up with a brief list of goals for the duration of this year. Many are personal & won’t be shared on this public space…but for the more practical (& probably attainable) ones, my public declaration of listing will hopefully inspire their completion.

- Learn to make jam.
- Learn to make homemade applesauce.
- Make at least 2 quilts.
- Abort the all-or-nothing approach to Bible reading & at least make an attempt each day.
- Become a morning person—up with the sun.
- Write one letter/email/note each week.
- Keep writing. Journaling. Documenting.
- Make some attempt at working out at least three times weekly.
- Grow a vegetable garden.
- Keep at least one indoor plant alive…& remember to water it each week.
- Embrace fulfillment with the material possessions I’ve been given.
- Go at least three months without buying any clothing item.
- Take at least one long walk per week (unless I’m still in WV in which case it might be a danger to my well-being).
- Learn to love the practice & study of medicine again.
- Subscribe to one magazine while Jon is gone.
- Keep a prayer journal.
- Make an advent calendar.
- Get more sleep.

There are more. And then again, that list is rather long. I’m not holding myself to these goals in a do-or-perish fashion—I’m simply throwing them out there so that people (eehhheemmm MOM) can hold me to them & well, teach me how so I can cross at least four of them off my list.

Happy 2009…here’s to a long, challenging year of changes ahead.

And here’s to the Walk of Faith that will get me through it.

dish soap with a side of tissues.

They came with the dish soap today; the Dawn Simple Pleasures Water Lily & Jasmine dish soap—the same dish soap that sits on our sink ledge at home. They came, they were nonrelenting & soaking, dripping on the counter in the silence of my apartment.

And it was silent. Because once again, for the first time in five weeks, I was alone. And for the first time in five weeks, I didn’t feel like a wife today. And for the first time in five weeks, those feelings of dread & nomadic living came back with full force.

And I didn’t like it.

In fact, I still don’t like it. And although I’m well aware that my complaining & teardrops won’t get me anywhere but further into by celebratory self-pity party, sometimes its just good to have a cry.

If you knew me prior to this whole endeavor, you’d never know I’m referring to the same person. Because the past-me didn’t cry. The past-me didn’t worry about trivial things like dish soap—and certainly didn’t cry over them. The past-me trusted that things would work out. And the past-me was at least remotely optimistic. The truth is that I’ve changed. Drastically.

Love does that to people, you know. And so does distance. And trial. And tragedy. And situations beyond our control.

One of my goals in 2009 is to remain more faithfully optimistic. Because optimism, as you might have noticed, is one of the things in my life that has slowly been leaking, dripping slowly so that it is just now that the “Happiness Gauge” is registering EMPTY.

So to be totally honest, I’ve just about had enough—and so have my slightly-swollen eyelids. I’m tired of living apart from my husband—and completely, totally, utterly imtimidated by the 18 months we have ahead of us apart. I’m tired of moving, of packing up all my belongings in cars & boxes & Tupperware containers and moving every year. I moved every year in college & twice since then—that is 6 times in 7 years if the mental tally hadn’t computed quickly enough. I’m tired of this state, tired of studying, tired of being away from the people (mostly person) I love. I’m tired of sleeping in a smelly apartment with noisy neighbors in a run-down town. I’m tired of paying thousands of dollars each semester & being blind to the fruition from the profits of my tuition. I’m tired of teaching myself the medicine I’m supposed to be taught. I’m tired of the complacency I’ve let take over my exercise habits, eating, and devotional time. I’m tired of the all-or-nothing attitude I’ve flashed at studying, Bible reading, and relationship building.

I’m just tired. Emotionally exhausted. Mentally run-down. Spiritually dry.

At this point, I’m bold enough to make these lofty goals…to boast that I’m on the “upward swing”. When the truth is that at this point I feel like I’ve jumped off that swing and am just flying through the air, hoping to land on something other than a giant slab of concrete. Life isn’t easy right now. My faith isn’t strong. My trust isn’t there. My optimism is, well, EMPTY. And although I’d like to think that I have the power to turn my attitude around, I darn-well-know that I am not that strong.

Above all, though, I think my biggest fear lies in my yearning for something better. There have been so many nights over boxes of tissues that I’ve convinced myself that “if only” we could move home, then things would be better. “If only” we didn’t live apart, then things would be easier. “If only” I didn’t have to stay in this state, then I’d be happier. And while there is some truth to my thoughts of idealism, the bulk of that truth is that they are ideals: the best of the best situation(s) that may be just as disappointing or difficult or trying as the ones I’m in the midst of right now.

There really wasn’t a point to my writing this. Unlike most of my posts, I don’t have a happy ending. I don’t have a magic wand to wave & exclaim that God will save the day (although the annoying peppy voice in my ear is cheering that He will). I don’t have easy answers. And I certainly don’t feel like I have much left in me to give.

“Are you tired? Worn out? Burned out on religion?

Come to me. Get away with me & you’ll recover your life.

I’ll show you how to take a real rest.

Walk with me & work with me—watch how I do it.

Learn the unforced rhythms of grace.

I won’t lay anything heavy or ill-fitting on you.

Keep company with me & you’ll learn to live freely & lightly.”

–Matt. 11: 28, The Message

eskimo land

i'll be out in the Alaskan wilderness with family until Jan. 7th...then back to NC on Jan. 8th...

updates will be back on Jan. 9th :)

HAPPY NEW YEAR!!!

when it all comes together.

i got a lovely early christmas gift from my husband...& the best part was that i asked for it months ago. which not only meant that he listened to me but that he remembered it!!!

a few months ago i was struggling with the concept of scrapbooking. the frivilous paper & embellishments all seemed so wasteful--not to mention the time that it eats up. but after lamenting about all the money i'd wasted on supplies, i opened a box of old photos & couldn't remember the names of half the people in the pictures muchless where we were & why we had pink boa's on with facepaint at mid-teenagehood. which is when i had a moment of slight epiphany that i could document these memories in a way that didn't require a huge time commitment or a generous trust fund from some unknown relative to back my paper purchases.

since i'm too cheap to buy photoshop, i downloaded free software from the internet that allows me to change the size of my photos & replace the original 4x6 print with a mosaic of resized photos. i then plan out my pages (the most time consuming part) so that by the time i'm 30 i won't have 57 volumes of "Our Family Album". costco uploads my pictures & delivers them to my door within 3 days. i pick one weekend each month to forego studying & spend all day Saturday (after morning cleaning) working on piecing together the already-planned pages.

i've actually found that i'm having fun again :) and the best part is that i've given myself no size, photo, or layout restrictions; i only promise myself to stay focused on the photos + words & not make pages about how my pant size keeps climbing or how my dryer eats all my black socks. it is JUST THE IMPORTANT STUFF.

in the past two months of my alloted time for these projects, i've managed to make enough layouts fill up this entire scrapbook...maybe i should have told jon i wanted 2 :)

the most satisfactory part of this whole process is that jon supports it totally. once i had the new book filled up, he sat down for a good 20 minutes & looked at pages that span across our last year together...i think i even got a few smiles from him ;)

{i've created a new album in my Flickr account titled "scrapbook pages" for those of you who want to see more...}

christmas: cinnamon rolls

if you'd like to take your tastebuds for the ride of their lives, you'll have to spend a bit of time in the kitchen. but i assure you...you won't be disappointed!

i came across this recipe on The Pioneer Woman Cooks & trumped by skepticism by my accidental purchase of 4lbs. of flour that was sitting in my pantry. needless to say, i've widdled it down to a bit of a smaller volume :)

these cinnamon rolls, although not non-caloric, are a fantastic (& easy!) way to share that holiday-induced pant-tightening experience :) each batch makes about 6 pans of deliciouis, gooey rolls...

HERE is the recipe.

take some to your neighbors. not only will you be the most popular person on the block, you'll also bask in the glory of sharing those holiday calories that were once invading your kitchen ;)

christmas: card holder

i found this cute (& very easy) craft on good ol' martha's website...and thought it would be a fun project since our christmas cards from 2007 just came down at the beginning of december '08 :)...although i'll take the mitten's down this year, this is a super easy way to display christmas cards--& the best part is that it is super cheap!

i hosted the December Coffee for the wives in Jon's batallion a couple of weeks ago. we made these little mitten clips--it was so fun! the best part is that they don't have to be used as christmas card holders...they can be put on gifts, packages, or your nose. and you certainly aren't limited to making mittens...if you fancy starfish or space ships or snot drips, you can make those too!

nervous work.

She was fidgeting. Her toe tapped. Her leg shook. She sat in the corner chair—a green plastic one with little plastic noodles on its fraying edges; wringing her hands, touching her hair. The tissue in her hand was getting wet, evident from the tiny flecks of cotton that sprinkled on the linoleum floor like raindrops. It was quite obvious: she was nervous.

But really it didn’t surprise me that her palm was soaking the Kleenex or that she kept touching her hair. She’d come in for a recheck on her blood pressure, which previously had been alarmingly elevated.

Perhaps more than her nervous habits, my eyes were drawn to her body stature. It was obvious her ankles had lost definition years ago. The cotton house shoes she wore were dirty and the socks that lined them barely made it to the crease of where her ankles should have been. Those little plastic noodles were barely visible—her bottom & thighs covered the entire green plastic chair past its edges. Belly protruding. Breasts resting seemingly comfortable around the level of her tenth rib.

I think my reaction was similar to what many people’s reaction would have been: I felt sorry for her. She had to be at least four inches shorter than me, making her the “average” height of an American Woman. And at 300+ pounds, her height wasn’t handling her weight as well as it could have. Her stature inevitably caused her pain: knee pain, stomach pain, back pain; our bodies were not meant to fight with a center of gravity thrown off kilter by an excess 300 pounds, nor was our blood supply meant to be choked by an abdominal girth of hormone-producing fat cells. Although she could breathe & fidget & shake her leg, each day was a struggle for her cells…a struggle that one day she would lose, possibly sooner than expected.

Through a series of questions, I discovered that she was living with her mother—and had been for the past decade-or-so. She hadn’t had a job since she rounded the track at thirty years old—at least 15 years ago. Her bills were paid each month from an envelope that was delivered to her mailbox: a disability check.

Her disability? Apparently she “got nervous” at work.

I had to clarify the situation with my attending. Because in all honesty, I couldn’t believe it was factual. Here is a woman, in her mid-forties living each day without a job while the government paid for her non-contributory existence.

His answer: YES.

And I can’t get her rounded ankles or tissue raindrops or tapping toe out of my head today. Because this morning I woke up with a painfully swollen arm. And Monday morning I got nervous to go to work. And Jon had a bad day on Tuesday. And one of my parents had the flu yesterday. But we all showed up. And either I need another dose of sympathy or I’m quickly becoming hardened to this tainted world we live in.

This week I’ve heard stories about third-generation welfare families, workers who are addicted to pain pills & suing their employers for workers compensation because they fell in the bathroom & got a goose-egg on their forehead. I’ve heard stories about factory workers who are overworked & injured on the job without any form of compensation, daycare workers who are filing claims because they are required to lift the children under their care that weigh over 40 pounds, and the requirements of businesses to hire people less-than-qualified (physically or mentally) for the job description.

And it just doesn’t seem fair. In fact, it isn’t fair at all. In a case-by-case fashion, it is NOT fair: sometimes to the injured workers, sometimes to the employers…but 99% of the time to the taxpayers.

The taxpayers who are paying for this woman to sit on her couch & walk to her mailbox to pick up her “paycheck”. The taxpayers who are paying for his morphine so that he won’t have withdrawls. The taxpayers who are supporting the economy run by businesses that are forced to employ workers that are less-than-qualified for the jobs they are given for fear of discrimination lawsuits.

The taxpayers who “get nervous” somedays at their jobs too…but who keep working.

the monday curse.

it continues.

despite my being in NC for the month, i just can't escape it.

i got up extra early monday morning to allow ample time for any mishaps that might fall upon me (read: injections of humility from the Good Lord Above). so at 6am i was up and going. i self-groomed (a rarity--i had to make a good impression on the first day of my new rotation), ate breakfast, drank some chai (necessity), had quiet time...and even packed my lunch.

i put on my wool coat (it was 60-something degrees yesterday!) and reached for the doorknob with purse, lunch pail, nalgene, and books in hand, and thought to myself my this morning went smoothly.

the few steps too the car was uneventful. my car started smoothly. the radio still worked, save the aliens that might have abducted it just because it was Monday. my "butt warmers" were warming. and so i backed out of the driveway.

CRUNCH.

whaaaaattttt??!?!?!?!

the nice garbage man had kindly placed the LARGE city-issued forest green garbage can RIGHT in the middle of the driveway. the LARGE city-issued forest green garbage can which was now wedged under my rear bumper at t-minus 5 minutes to my required arrival time at the hospital.

so i got out of the car, butt warmers still blazing heat & non-alien-abducted radio singing jolly carols of the HAPPY SEASON. ohhh...but i was not happy.

the only thing that my mind could muster was: SERIOUSLY??!?!

my wool coat was almost too warm as i wrassled the partly wedged garbage can from under my back bumper. but the orientation of that forest green thing was akward: the lid was splayed open on the street so that when i wanted to good grip on the can itself, i had to step on the lid--completely defeating the purpose of my pulling since my full weight was keeping the can in place. at one point i halfway fell into the can itself...

after a good 3 minutes of pulling i freed that LARGE city-issued thing from under my back bumper. the only problem was that because my car was taking up the entire width of the sloped sidewalk, i had to pull once again in order to get that monstrous thing over the curb.

good thing i haven't worked out in awhile...i was sweating in the wool coat by the time those two plastic wheels popped over the curb & onto the grass.

Thank you Mr. Sanitary Engineer. I HOPE YOU HAD A GOOD MONDAY TOO!!!

the mirror.

it is saturday. 10am. i'm home alone--jon has staff duty today (i.e., he has to work for 24 hours this weekend). and although i miss having him here (our down-time together is a rarity), i'm enjoying the quiet at home. the laundry is folded (& yet to be put away). the house is clean, albeit for our bedroom floor which magically grows clothes. cookies are baked. presents are wrapped. the tv is off. and all i can hear is the buzz of the heat blasting through the vents above the doorway to the office.

a bit of a change from the past few weeks, yes?

needless to say, i've been challenged more during the past three weeks than i have in a long time, maybe in forever. my emotions ran high & are just returning to ground-level with the quiet (& the husband) that surrounds me.

in an odd way, my ER rotation highlighted things in my own life that i haven't noticed prior or perhaps, chosen to overlook. life. death. suffering. disease. worried parents & patients & loved ones. tradgedy. joy. relief. burnout. i'd leave the hospital each day emotionally drained. because i connected with those patients. i cried when the wives cried. i was mad when the patients were mad. and even moreso i was frustrated with the often overly pathetic "cries for help". and each day when i got back to my empty apartment there was silence, which made me think harder & longer about each one of their cases. and there was a mirror that i'd have to face each morning, inevitably questioning me about how i'd handle the situation if i were in their shoes.

most mornings i didn't have answers. and the truth is that i still don't.

it's a bit counterintitive, really. i've been fed answers the past two years. certainly not without studying & stress & hours of dedication. but the goal of the past two years has been to find the answers. to look in the mirror and be confident that i know the answers. my brain has been trained. but now that i'm faced with no answers, lack of answers, non-existent answers, and ENDLESS QUESTIONS. i'm confused, distraught, emotionally torn. and because there are no easy answers, & many times no answers at all, i'm left searching.

i'm still searching. something tells me i'll be searching for awhile...

and yet again, in an odd way i'm relieved by my searching. because it reminds me that i'm connecting. that i haven't lost it--that i haven't tucked my emotions in the pocket of my white coat, that i haven't lost the ability to connect with people. i'm humbly proud of my searching. because it is evidence that i haven't unconsciously jumped on the bandwagon of medical thinking that science is god, that my knowledge trumps others' sufferings, and that my patients are subjects to be studied instead of people to learn from.

We have to ask ourselves whether medicine

is to remain a humanitarian and respected profession

or a new but depersonalized science of

prolonging life rather than diminishing human suffering.

--Elizabeth Kubler-Ross

the snail version.

guess what's in the mail?

mom, are you proud??!

i bought this fabric earlier this summer on the clearance rack (it maybe totalled $20)...and finally got around to sewing Holiday pillows last week. jon & i (well, mostly me) decided awhile ago that changing our couch pillow covers would be a very economical way to "decorate" for each season without cluttering up the house. so...here are this "seasons" pillows & coffee table runner!

i will admit that my mom was right 10 years ago when she made me take a quilting class, much to my dismay at the time (the quilt still isn't finished, by the way). the sewing machine i bought used (circa 1974) for $25 this last summer has opened up a TON of new possibilities for creativity & gift-giving. scrapbooking, although i really enjoy it, is a "selfish" hobby to me--i hesitate to give people scrapbooks because each person has their own style & preferences in how to present their photos. but WHO doesn't want a cute holiday pillow cover??!

so, thanks mom. you were right...again.

beyond my understanding {II}.

...continued...

The monitor wouldn’t stop beeping. A red warning flashed across the screen telling us, & reminding her, that her body was failing. Her heart rate was through the roof. X-ray came running down the hall. Her left lung was collapsed. Transfer wheeled her to CT. The radiologist called as the images were transmitting.

On the phone he said he’d never seen anything like it.

Tumors. On the uterus. On the ovaries. In the abdomen. Attached to the bladder. Around the liver. In the pancreas. Growing on the intestines. Everywhere. Gas gangrene was building in her abdomen. Her nurse drained 1.2 liters of stool from her stomach via her feeding tube.

Her cancer had spread. Despite the chemo treatments. Despite the hair loss & nausea, despite the desperation to live. Her cancer had spread…grown…and taken over.

And now it was killing her. Right in front of me.

She stopped squirming. Her eyes focused on her husband as he held her hand. And then they rolled back. She didn’t talk after that, except for the occasional groan. The wiggling stopped.

Her husband stood by her side. Her mom paced the hallway. Her sister dialed numbers from a black address book. And I had to turn away. It was all I could do to maintain my composure. I stuck my finger in my eye—the finger I’d just cleaned with hand sanitizer. It burned. But I didn’t cry. I saw a few more patients—people who’d come in for things that certainly were not emergencies. But I didn't cry. Phone calls were made. Surgeons were consulted. Her case was declared a surgical emergency. They wanted her transferred. She would die on the trip. Heck, she would die in the ER if somebody didn’t do something quickly. Her monitor beeped. The man in room 2 who had overdosed on narcotics hit the police officer & was restrained. Her chest heaved. The woman in room 1 wouldn’t stay in her bed. Her husband cried. But I didn't cry.

I watched her husband. I watched her mom. I watched her sister. And I peeked in on her.

Her monitor beeped. Her chest heaved. Her eyes rolled back. Her husband cried. But I didn't cry.

And I had to walk away. Out of the ER. Out of the hospital….where the tears finally came in the car. And again over dinner. And again in the shower I took just to feel the hot water on my skin—a reminder that I’m alive. And they’ll come again tomorrow. When I look into my own husband’s eyes…when I hold my own husband’s hand…when I talk to my own family…when I look in the mirror & see that I’m alive.

Yes. They’ll come again tomorrow. When I ask God for the millionth time: WHY?.

beyond my understanding.

The tears finally came in the car. After three hours of holding back emotion, three hours of avoiding room #3, three hours of straining to maintain composure, finally, I broke. It was cold--I could see my breath. It only took a couple of minutes for the rain covered windshield to fog. The fingertips of my gray fleece gloves were wet with salty tears. And still they came.

She was pale on the yellow stretcher. And when I first looked at her, the frustration I’d felt toward most of the patients earlier in the day quickly faded. This was an emergency. Her young husband trailed behind the stretcher—he’d ridden in the ambulance with her.

She was gasping for air, struggling to breathe. Her swollen belly sat firmly below her swollen face and cracked lips. The fuzz on the top of her head served as the only evidence of the brown hair she’d once had. Large purple bruises covered her elbows & forearms where needles were stuck to try to find veins. She was moaning, miserable, wiggling on the stretcher from the anxiety provoked by the carbon dioxide that was quickly building up in her body.

Transport was called for a stat transfer of the gallbladder patient in room 3 to the second floor. We needed a room for her yellow stretcher…and we needed it now.

The middle green line on the monitor said her O2 sat was only 76% on 6L of oxygen--mine would be 100% without any supplemental oxygen. Her brain, heart, & kidneys weren’t getting enough oxygen. And at the rate she was going, they’d shut down within the hour if something wasn’t done quickly.

And then we heard her story.

I’m not the same person that I was this morning, nor this afternoon. Because at 5:24pm when her yellow stretcher was wheeled through those double sliding doors, I changed. I stared death in the face. I stared down my own road ten years from now & saw myself in her, possibly. I stared at her husband by her side & thought of my own husband. I stared at her pacing family in the hallway & considered my own family. And for a few seconds, I was her. She changed me, her story changed me.

They were excited to have a baby. And probably ecstatic when they found out it was twins. I’m not for certain, but I’m going to assume fertility treatments were involved because of her age. She was a few years past thirty, likely waiting for love & contentment before bringing new life into the world. I imagine they set up a nursery, decorated it with matching cribs & blankets—one pink, one blue.

Nine months they waited to hold those bundles in their arms. They thought. They dreamed. About what the two people growing inside her would become. About the adventures they’d share—together. They dreamed about finally being a family.

The c-section was pre-scheduled, as it often is with twin deliveries. The OR (operating room) was prepped, the doctors scrubbed in, nurses gloved & dressed in blue. Double warmers were ready to welcome the twins into the world.

Iodine. Scalpel. Incision. Uterus. BIRTH.

And this is where the story of joy & triumph turns tragic. This is where the nine months of hope is covered in gray—where the dreams of being TOGETHER fade into the realm of reality this family abruptly entered:

Tumors. On the uterus. On the ovaries. In the abdomen. Attached to the bladder.

Newborns. Late nights. Soft babies. Joy.

Chemo. Surgery. Nausea. Heartbreak.

That yellow stretcher held a brand new, first time mom. A mom who, I’m sure, looked at her babies with more love than even I can fathom. A mom who cradled those little swaddled bundles in her arms & rocked them to sleep. A mom who looked into her husbands eyes with wonder & awe at the miracles they created, together.

A mom who wouldn’t live to see their first birthday.

…to be continued.

daily {pixels}

i found this interview with a professional photographer about setting up portrait shots, including clothing tips & poses. :) it was very insightful...

and--get this--this photographer has only been taking pictures for two years. she taught herself! pretty amazing!

ENJOY!!

up next....

conversation.

[knock knock]. Hello, hello Mrs. G! I’ll be talking with you briefly before the phys…

Get out of here.

What? Mrs. G I’ll be talking with you bef…

Get out of here.

Okay. You don’t want to talk to me?

Oh gawd! My back. My back. Help me. Help me. MOVE MY LEGS. MOVE MY LEGS!!!!!!

Umm. Okay. Mrs. G I don’t know how to help you. I don’t know what is wrong with you.

Oh honey. I’m hurting so bad.

Okay. Well where are you hurting?

Oh gawd! My back. My back. Help me. Help me. MOVE MY LEGS.

[reaching out to move her legs]

Get out of here. DON’T TOUCH ME. DON’T TOUCH ME!!!

Mrs. G, you just asked me to straighten your legs.

I know honey. I’m hurting so bad.

You hurt your back? When did you hurt your back?

My legs! My legs! MY LEGGSSSSS!!!!! Oh gawd! My back! My back!

Mrs. G, I don’t kno…

Get out of here. I’ll break your wrists. I'll just snap 'em. Right in two.

Mrs. G, I…

Out! GEETTTT OOUUUTTTT!!!!

I…

Straighten my legs!! STRAIGHTEN MY LEGS!!!!!!!!!!!!

You just told me to ge….

I want my doctor. I want my nurse. I want some drugs. Oh gawd the pain!!! THE PAIN!!!!

And her voice faded into the air as I walked out of the room, shook my head, and went to fetch her doctor. Patients like these I am THANKING THE GOOD LORD ABOVE that I don’t have my license yet :)

looking.

He threw back the curtain, making the patient in room #3 jump. The poor man had come for a wound cleaning & they had to kick him out of his room because a more urgent case was about to arrive at the sliding double doors.

When the yellow stretcher crossed the threshold the scared man was out of room #3 and a slightly overweight woman was wheeled in.

In a way, it was like slow motion—the bag that was breathing for her, the frenzied nurses who slapped her arms to try to get IV lines, the two techs who took turns pumping on her chest, the shuffling feet of the xray tech standing by his portable machine, and me who just stood there.

I’d crammed myself in a corner, trying to be as “out of the way” as possible. Codes can get kind of crazy at times, especially if there are changes in the leads stuck to the patients’ chest.

But we didn’t have any changes. Just a flat line.

And each time we checked & re-checked & checked again, it was still just a flat line. No heart beat. No voluntary respirations. No blood flowing through her veins without pumping on her sternum.

I think I noticed her toenails first. They were freshly painted, neatly trimmed. Her legs were shaved. Her hair was combed. She loved herself. And now she was naked, aside from her underwear, on the yellow stretcher. Surrounded by no less than 10 people. Pushing. Poking. Feeling. Moving. Sticking. Testing. Looking.

Her hands fell to the sides. Her head bumped against the hard plastic mattress with each chest compression. Her obese belly jiggled.

The bag was squeezed. The Epi was given. The leads were checked. The chest was pumped. The monitors examined. Pause. Assess. Repeat.

The bag was squeezed. The Epi was given. The leads were checked. The chest was pumped. The monitors examined. Pause. Assess. Repeat.

The bag was squeezed. The Epi was given. The leads were checked. The chest was pumped. The monitors examined. Pause. Assess. Repeat.

Five times. We repeated five times…and still, just a flat line danced across the monitor.

And once again, as if time had slowed down, the bag that was breathing for her was laid by her face. The frenzied nurses looked hopefully at the monitor one last time and then hung their heads. The two techs stepped back from the yellow stretcher. The xray machine was wheeled back down the hallway. And me, I just stood there.

I stood. And I looked. At the sheet that now covered the body that once was a woman with painted toenails & combed hair. And I looked. And I looked. And I looked until I walked into the consultation room & listened to the sobs of a husband who’d just lost his wife. And then I listened.

I listened to the “Oh God’s” and caught breaths. I listened to the wails & the crying. I listened to the nose-blowing and chest heaves. I listened. And I listened. And I listened until I couldn’t listen anymore. And then I excused myself.

The bathroom mirror didn’t lie. It wasn’t the fluorescent lights that made me blink, and it wasn’t the eyelash that had “fallen” in my eye. It was sadness and surprise and grief and “what if this happened to me”; it was “it’s not fair” and sympathy and “I don’t think I could handle this”. It was real. And there were tears. My tears...from my eyes. The eyes that had looked. The eyes that had seen life slip away as those shaven legs mottled & turned blue. The eyes that had seen the naked body. The eyes that had seen the love torn apart. The eyes that had seen the unexpected grief.

…the eyes…the ones right above the heart that didn’t understand.
…the eyes…the ones leading the faith that didn’t dare to ask why.

the monday curse.

after three weeks, i think i'm officially authorized to call it a "curse". and really, although i don't believe in "true" curses, i just might have to change that point of view. the first week, i got lost. the second week, i had an eventful day of charcoal fountains & open zippers. and now, on week three, i'm basking in the glory of my airheadedness.

i feel it necessary to insert a brief disclaimer before telling the full story that i AM quite competent. i DO take care of patients. i DO sew up wounds & cut people open. and so far, my record for the latter is an A+. not even one time (!!!) have i left gauze or sponges in people. and not even one time (!!!) have i personally caused a medical catastrophe--at least, one that i've been informed of. so despite the pure blonde that may be coming across on these stories about the monday curse, please trust me when i say that when it comes to scalpels & medications, i HAVE BROWN HAIR.

so there i was. packing my bags in NC. i'd been spoiled to be off for the entire week of thanksgiving (that monday, i will note, was flawless). we'd just decorated our christmas tree, found places for the collection of nativities, and i'd had a good cry about leaving once again.

i'm going to go ahead & blame it on the swollen eyes. i looked in my closet & grabbed by workout shoes, throwing them quickly into the hamper of clean clothes that needed to journey back to my WV closet.

fast forward four hours to my unpacking of those clean clothes into my WV closet.

i took out one shoe.

and then the other.

and saw this lovely PAIR:

and if that isn't a monday curse that happens to ruin ALL the workout plans i had for this week, I DON'T KNOW WHAT IS.

stupid monday.

givingTHANKS

the Clark's came into town to celebrate the anniversary of "the feast" with us. i was lucky enough to be home the entire week (& i got to clean!!) and got to sleep next to my husband for SEVEN WHOLE DAYS!!! (which quite possibly was better than all the world's turkey's combined...)

anyways.

we walked. we ate. we read. we ate. we laughed. we ate. we watched movies. we ate. and then i stepped on the scale and fainted.

okay, not really.

but my pants are tighter, much to my dismay. and i have a few extra workouts scheduled in my upcoming weeks. which could be a big problem with my humerous shoe situation....

perhaps the cutest part of spending thanksgiving with our family was the interaction between jon & alec (my little brother). if a 10 year old boy was ever an admirer of a 24 year old man, i'm certain alec would be the poster child. their days were filled with Light Saber battles and deals struck on 30 minutes of xbox (with a pre-set timer, controlled my me). they talked army. and tanks. and airborne operations. and mostly Star Wars. which would lead to another Light Saber battle--the second of which was Alec against an invisible dude-whose-name-i-don't-know-because-i-haven't-seen-all-the-movies-nor-do-i-understand-them opponent.

they left at o-dark-thirty in the morning on Saturday & were kind enough to put us up in a hotel in Raleigh so we could enjoy the last night together before their departure. jon & i spent the entire day Saturday on an extended "date": Christmas shopping & movie-seeing & yummy-food-eating :)

in short, it was my kind of holiday.

a bad case of the monday's.

for most people, you might say that they "get monday"--you know, in other words, it is the person who doesn't like monday & goes about his or her day with a bad case of the monday's. BUT, apparently i'm special...because mondays "get me". i swear it--they are out against me.

remember two weeks ago? that monday turned out fine after an incredibly frustrating start. and then there was last week, which in the book of my history tops all other monday's ever lived by me...

as all monday's do, it started out innocently enough. i had decided the night before that my pants were getting a bit too tight this early on in the holiday season, which warrented a good workout the following morning. and since i had to report for my first day in the ER @ 7am, it made for a very early morning. with my lunch box, purse, book bag, & gym bag in hand i made my way down the slightly-snowy steps @ 5:40 am. i brushed the snow off my car window (with my bare hand because i'd forgotten gloves) and was headed to the gym in a relatively short period of time after i threw my pluthera of bags in the backseat.

once i walked through the fitness center doors, i ran to the locker room to deposit my bag in the toilet, set up my station for Body Pump in the fitness room...and waited. And i waited....and waited...and waited....and 3 other people walked into class and then we waited....and waited...and waited. we all waited until someone from the front desk called and said that the teacher forgot he had to teach that morning & wouldn't be joining us. WHAT?!??! you mean i got my butt out of my freezing cold apartment at freaking 5:40 this morning to sit on my butt in the freezing cold gym waiting for the teacher to show up??!!!?!?!?!?!?!

after a quick workout upstairs i figured i would just show up early for my ER shift so i might leave a little earlier that evening...which is when i walked out to my car & realized that my soy milk that was so lovingly self-packed in my lunch box had tipped over when i'd thrown my bags haphazardly in the backseat. And that lovingly self-packed soy milk now decorated the floor, seat, white coat, and purse of one very frustrated girl. i squatted in the semi-dark parking lot wiping out the lunch box, wiping off the seat, and sorting through the baggies of soggy food that was supposed to have been my lunch. oh, and did i mention the fact that i was almost run over by a crazy west virginian trying to find a parking spot?

i showed up in the ER with a large yellow stain down the front of my coat--caused by drying soy milk but slightly resembling wiped-off bird poop. fast forward a few hours & the ER was bustling. people were filling the rooms with ridiculous complaints...but the most exciting part was that there were a few legitimately sick patients.

one woman had a chest tube put in after developing subcutaneous emphysema--and subsequently the voice of a smurf. it really wasn't funny, but as i stood in the corner listening to someone who sounded like they'd sucked helium, i couldn't help but chuckle at the irony of the actaully grave-situation. humor gets you through everything, right?

an overdose was wheeled through the door. and after his respirations started to drop, they decided that they had to intubate. they'd given him charcoal to drink while he was still conscious (it helps absorb drugs/substances in the stomach so it doesn't get into systemic circulation) but the drugs took affect too quickly for the charcoal to work.

the P.A. handed me the suction & i immediately took a white-knuckled grip on the handle--probably from subconscious excitement at what was about to happen. and what did happen next got a little...ummm...messy. as the P.A. tried to guide the tube down her throat & into her lungs, we all realized that she wasn't sedated enough for her gag reflex to be gone--and so he was struggling with the positioning of the tube (there are certain landmarks you have to look for). as we rejoiced that he'd finally gotten it in, a huge spray of black charcoal poured out of the tube & shot at least 2 feet in the air...covering the nurse who was holding the man down, covering the P.A.'s lab coat, and soaking my pant leg. the humor of the situation peaked when i continued to stand there with a white-knuckled grip on the suction, completely oblivious to the shrieks & pokes of the nurses to put the suction on the shooting charcoal-mixed-with-stomach-acid fluid that was coming from the tubed man on the table. and perhaps even more hilarious is that it wasn't until at least 25 seconds later (which, of course, seemed like 10 minutes) when the P.A. physically yanked the suction out of my hand that I finally surveyed the black-stained nurses now soaked with charcoal colored liquid and realized what had happened.

when we all recovered--& dried off--i realized that the lunch i had eaten was not agreeing with my stomach (perhaps it was the charcoal stained pant-leg that upset my stomach so??) and so, aware that there was a gas bubble slowly making its way down to you-know-where, i positioned myself in the corner of the nurses station that is empty most hours of the day. i stood there, probably looking quite the opposite of inconspicuous, and let that gas bubble go--and the sound that came out was, quite possibly, one of the loudest i've ever signed off on. which is when i turned the corner & realized that a case worker was sitting at the desk on the other side of the wall i just farted against.

after 8-or-so more patients it was almost time to leave, & i gathered that i'd better stop in the bathroom before my bladder exploded. i walked in, turned the light on, & paused in the mirror. before me stood a frazzled, thoroughly exhausted girl....and one pant zipper that was gaping WIDE open for the world to see.

the world which included the last who-knows-how-many patients....

"...and for everything else..."

1 pack of cigarettes: $4.75

cost per week of smoking 4 packs per day: $133

money spent in 1 year on smoking: $6916

cost of smoking over 25 years of smoking 4 packs per day: $172,900

sum of annual bills for once-yearly doctor's visits in 25 years of smoking: $7500

x-rays at age 63 because of shortness of breath: $450

cost per month of Spiriva inhaler to help with shortness of breath: $85

repeat x-rays at age 63 years 8 months because of shortness of breath & pneumonia: $450

Nebulizer + Albuterol for continuous trouble breathing: $200

oxygen tank & tubing: $250 per month

cost of ambulance trip to the hospital because of trouble breathing & nasty cough: $2500

eight hour ER visit for worsened shortness of breath: $800

total cost of cigarette smoking in a 63 year old: $187,885

a real-life lesson about the consequences of smoking for the 18 year old on the other side of the curtain: PRICELESS

She came in for a toothache…because she “just couldn’t stand the pain.” The light that came from my penlight reflected against black teeth & weeks (maybe months) of plaque buildup. So she sat on a bed in room #1, because she didn’t brush her teeth.

He came in with a scratch on his face—mom said his dog did it. And under his eye was a ½ inch scab, not bleeding. He played & laughed when I asked him if he was in pain. His parents seemed more concerned about the tiny scar that would sit on his face that they did about the possibility of him losing his eye to infection. So he sat on a bed in room #2 because he was playing with his dog.

He told me he had a stuffy nose, and then got nervous & wanted medication when he discovered his stay would be more than three hours. We had to finish his lab tests (legal precautions, we said). So he sat on a bed in room #3 because his nose was runny.

Her throat hurt “so bad that [she] couldn’t swallow”. She told me she thought she’d just “pop in” to the ER to “get some medicine” because her doctor’s office was busy. It had only been hurting for a few hours. And so she sat on a chair in the corner of room #3 for five hours because it was “convenient.”

She didn’t have a fever, no infection, no change in attitude or appetite…just a runny nose. Her parents called the ambulance—maybe because they were scared at the clear fluid coming out of her 3-week-old-nose. And those paramedics drove through two inches of snow to pick up that 3-week-old baby…who sat in room #5 with a simple runny nose with two overly-naïve parents.

She had diarrhea in room #6.
He had a belly ache in room #7.
A sore leg occupied the bed in room #8.
Her constipation bottom dirtied the sheets in room #9.
A fussy baby in room #10.

Her blood pressure was dropping. Oxygen saturation was too low. Heart rate was sky high. She’d eaten dinner…then slumped over in her chair. They wheeled her in on a yellow stretcher. She came in because she was DYING….and her stretcher paused in the hallway because all the beds were taken.

conversation.

from where i stood, he looked like an old man. which, in fact, he was. slumped over in his wheelchair, his bright green hat with "Lucky Dad" written across the front was a stark contrast to solemn whispers surrounding his presence at the nurses desk. they had found him in his room--his O2 sat's 86% & quickly dropping, despite increased oxygen through his nasal cannula.

Dr. W: We'd like to send you to the hospital, Mr. Smith

Mr. Smith: I ain't going. If I'm going to die, I'm gonna die right here!! [raising his shaky hand & pointing his finger downward on "here", as if enunciating his point]

Dr. W: Mr. Smith, I think you are sick & we need to get a picture of your chest.

Mr. Smith: Then you bring in the xray...we'll take the picture right here.

Dr. W: Mr. Smith, how to you think James would feel if I just let you die here? If it were James in this position, what would you want us to do for him?

Mr. Smith: Everything you can...

Dr. W: Then how do you think he feels about you?

Mr. Smith: I am 88 years old. I 'dun & lived my life. He still has to live his.

Dr. W: Mr. Smith, I am okay with you dying. But I don't want you to be miserable for a couple of days while your lungs fill up with fluid...and then die.

Mr. Smith: No, doc. I'm ready. I'm waiting. If you have to send me, take me to Dr. Taylor. He'll know what to do.

Dr. W: Well I can't make you go.

Mr. Smith: No you can't...& I'm going to die righ t here.

Dr. W: Okay we'll do what we can.

Tell me, how am I supposed to handle that conversation? How am I supposed to be an innocent bystander & maintain my composure (which I did not--I pretended an eyelash fell in my eye when the waterworks came on)? How am I supposed to be part of medicine, respect patients wishes, learn about the amazing interventions...and then let them ignore something that could save their life??!

And then again, at 88 years, how can I blame him for being ready to go?