Sadness Revisited

The last two days I have encountered worrisome laboratory findings waiting for me when I logged onto my computer in the morning. Yesterday, there were abnormalities in the bloodwork of one of my prenatal patients. After discussing her case with the OB specialist affiliated with our clinic, I had to send her straight to the hospital for a potential induction of labor even though her baby is only 33 weeks along. One of the sweetest parts of providing prenatal care is how one patient gets wheeled into the labor room but two, hopefully healthy, individuals emerge. However, one of the scariest parts is that both individuals are in danger when crises occur with the pregnancy or delivery. Hopefully, this time all will turn out well for both mom & baby.

Today, I pulled up the labs from my patients yesterday on my way into our weekly staff meeting. At the top, was the blood panel I'd ordered on a 7 yr old boy with a nosebleed. Mom mentioned that he seemed to bruise easily, more easily than his older brothers, so I'd ordered the blood counts to reassure both of us. Unfortunately, this little boy's labs were severely abnormal with low values of infection fighting cells, red blood cells and platelets (they help the blood to clot). As a first year intern, right out of medical school, I'd seen numerous cases of abnormal blood counts like these in children before they were diagnosed with leukemia. We seemed to have at least one case of new leukemia each week, as doctors from rural and far away areas sent their sick patients to be evaluated and treated by the Pediatricians specializing in childhood blood cancers. I felt a sinking feeling in my stomach as I realized all that this patient and his mother had ahead of them. Though I had only seen the boy once, the previous day, I had to call his mom and deliver the bad news. And I had to send them immediately to UNC to be evaluated by the pediatric specialists in hematology/oncology. I tried to remain calm and reassuring on the phone even though I felt a dumptruck load of sadness raining down on me. By the time our staff meeting started, tears were rolling down my face. My colleagues were comforting, of course, but I couldn't hold back the tears. I suddenly felt so overwhelmed with pain and darkness for them, for their impending suffering. Childhood blood cancers are (now) 95% cured. But that road, well known to me from my own leukemia 2 yrs ago, is a tough one. Needless to say, I was never able to recover fully from the difficult start to my day-alternating between feeling so, so sad for them and reliving how hard all of that was for me.

Even now, hours later, I am still resonating in the sadness of what is to come for them. Though I feel especially lucky to have survived my own "major death scare," I feel uncertain and vulnerable. That is the hardest part of "sitting with it" . Tomorrow will be a bit better I do feel certain of that.

Flustrated

I try to let my patients tell me how they are feeling or describe whatever symptoms brought them to see me. Every once in a while, I hear a really good word that isn't, in fact, a word. When I was working in the rural countryside outside of Asheville, my patients often told me that they were "flustrated" by this or that. As I write it now, my computer's spellcheck is underlining it in red to let me know that it's not a real word. Well, let me say that it may not BE a real word but it IS a real feeling. I suspect the word originated when someone combined the words "frustrated" and "flustered," probably in some agitated state of mind.

Yesterday, my patients flustrated me (there goes that red underlining again). I had the middle aged, heavy woman who argued with me when I said I wouldn't write her out on disability from her Walmart greeter job. There was the young diabetic man with foot pain and whopping high sugar levels who doesn't take his insulin (which would lessen the nerve damage and subsequent foot discomfort). There was the 5 yr old just discharged from the Psych hospital, who screamed at his momma the whole time he was in the clinic. Regardless of what you personally believe about the value of psychiatry, some people really do need the help & expertise they provide. Suffice to say, he is one of them. Then there was the new patient who needed forms completed to renew her driver's license. After many roundabout questions, I finally learned that she needed to have an eye specialist evaluation and a psychiatry follow up for her schizophrenia. Whew! Am I helping these people at all? Some days I wonder if all of those years spent studying biochemistry and physiology should have been replaced by psychology and social work. I was completely undone by the end of the day, flustrated for sure.

Holly asked me what I planned to do for myself this morning before I head to the clinic. I decided to go to the Sportsplex and swim laps. I haven't been a swimmer in over 20 yrs-honestly. I used to swim quite a bit during college and graduate school. But I haven't been in a pool in decades (it's more scary to write that I haven't done something in DECADES than to actually do it. But there you go in middle age). I really had a great time. It took about 10 minutes to feel comfortable and get some semblance of form back. Then I swam for 50 minutes, which seemed long enough for a good workout and to chew up some of the anxiety and frustration from yesterday.

My mom left this morning, after staying with us for the past week. She was here to get a second opinion and another surgery on her eye at Duke. She'll be back in another month for her next evaluation. Hopefully she'll regain some sight in that eye. I'll say more about that later.

Grateful to be here. Thank you Holly for all of your help with my Mom's visit.

We watched Cherry Blossoms, a German movie, recently. Very lovely and bittersweet. I recommend it. Also saw an older movie, Diva, which was excellent as well.
Photo: My Mom and me at the beach house a few weeks ago (on my birthday).