oncRN

news

2009-03-11T22:08:00.003-04:00

sometimes it's simple:
your insurance just approved this treatment
your cultures are negative
your x-ray is clear

then there's the other kind. the kind that changes everything.
and as the nurse, you know.

you know the result because you've been checking for it compulsively

you know the doctor told her he would call her today with the result

you know at this moment that she is trying to casually fill the minutes of her life until he calls, checking occasionally to be sure that the phone is working, and that the ringer is on

you know that at this moment that doctor is skiing on another continent and won't be calling

you know you have to call

calling with bad news strips you of all the tools you need to humanize it. you can't lock eyes or lay a hand on a shoulder or hand a tissue. words are all you have and they are just usually not enough.

that feeling...that feeling of dialing, slowly, wishing you could be doing just about anything else, quickly sorting through in your mind what to say and how to say it, knowing your tone will be read in the first hello, knowing this call will be remembered, knowing you just have to spit it out. ugh.

it starts out well and you say hello, and state the facts , and tell her how sorry you are. all too often you then decompensate into some adrenaline-mediated mish-mash of apology or silver lining or offer of hope intended to soften the blow. it's really hard not to even though you both know the score. it's hard. it's hard to demoralize someone. it's hard to know that their life has just changed course down a path they never wanted to be on. it's hard to know that whatever we did didn't help.

after a few quesions, she'll say, 'thank you for letting me know'. and you'll say 'you're welcome', as dumb as that sounds.

soon enough it's over and you're moving on to the next chart, the next note, the next patient, the next call.

at the same moment, she's making calls too - to the people who love her and she's saying, 'the nurse called. it's not good news'.

back

2009-02-20T14:13:00.002-05:00

...to work...sigh.

alarm goes off
make sure baby is breathing
baby is
take shower
listen for baby
dry hair
listen for baby
get dressed
drink coffee
baby cooing
get baby out of bed
take long slow swig of warm baby neck
watch baby's delight that his feet are still there
feed baby
burp baby
take long slow swig of warm milky baby neck
attach baby to hip

set out jeans and t shirts for big boys
remember it's gym day - excavate sweatpants out of basket - replace jeans
get big boys out of bed
ask boys to get dressed
set out breakfast plates
slice apples and artfully display on plates
ask boys to get dressed
decant breast milk into bottles
gather breast pump parts into handy travel bag
ask boys to stop jumping rope and get dressed
safety pin strap of handy travel bag that breaks with the third use
realize i'm starving and eat artfully displayed apple slices

baby crying
change baby
suction giant boogies out of baby's nose
take long slow swig of warm baby neck
sniff ears while i'm at it
baby cooing

come down to find boys miraculously dressed
and making themselves toast
review facts with 8 year old for quiz on Brazil
remind 7 year old to take completed project to school
wrestle drum, sticks, and music stand into ill fitting drum bag

inlaws arrive
kiss everyone
drive away
drink breakfast

arrive at work
turn on computer
check messages
erect breast pump
go see first patient
document
see patient, see patient, see patient
document, document, document
spend 30 minutes looking for 1/2 gallon of urine that patient has lost somewhere between car and waiting room
break it to doctor that urine is lost and tests can't be run
doctor to me: 'did you look for it?'
me to self: 'why didn't i think of that?'

run to office
pump breastmilk while returning phone calls
tell people i'm calling that i don't know what that strange noise is
forage in desk for nuts and berrries: find nuts, no berries
down nuts
see patient and document
repeat x 4
return to office
call husband who says, 'if you leave now, you'll be home in time to feed him'
leave now

arrive home
greet all
lucious baby grin quickly fades to a 'where you been, Missy?' wail
feed baby
the next few hours: attend to the feeding, watering, bathing, and educational needs of various small people
tuck in said small people
read to said small people

take deep breath
find husband who i have pased in the hall several times in the last few hours
kiss husband
watch episode of The Office with husband
laugh ass off
shirk various domestic responisbilities
go to bed.

thank God i'm only working part-time
it's the stage of parenting that i'd crave if i didn't have,
mourn if i lost,
and will too soon be over.
but it takes stamina
which some days you have and some days you don't

i'm pretty tired.
note to self: get some laurels
so i can rest on them

no words

2008-11-07T11:01:00.004-05:00

there are no words

for the sensation of pushing a new life into the world

the life that you have cared for the last 9 months

the life that kept you awake some nights and alive some days

and there he is

the face you recognize from the sonogram

the warm bluish limbs flailing around on the very belly in which he resided 1 minute before

there is a swirl of activity and noise and cheers and tears

and all you can say is thank you. and welcome.

there are no words for the feeling of adding another member to your family

for watching the big brothers race in, throw down book bags and race to hold him

for the colossal sweetness that is newborn

for the head of thick black hair

for the general lusciousness of it all

that's a lot of words considering i said there were none

love will do that to you

prayers

2008-08-13T10:59:00.005-04:00

Mr. K died quietly last night in his sleep. he was supposed to go home to hospice today. arrangements were made. family was coming in to town. his wife had gotten to a place where she was "ready".

"I prayed, damnit!", she cried angrily. "I prayed we'd have one more week together. after everything we've been through, was that too much to ask?!" she is deeply wounded by what she sees as the final insult from an unforgiving enemy. i hug her and tell her i'm sorry. i'm so sorry.

and i am. but he had very few platelets and esophageal varices. if that means nothing to you, let me just say that his life could have ended with blood. a lot of it. blood the likes of which his family can't imagine and would not soon forget. instead his heart stopped while he slept. he shed no tears and not a drop of blood.

it was either Jesus or Garth Brooks, i can't remember which, who said that sometimes God's greatest gifts are unanswered prayers. i can't help but think they were all given a gift.

cancer is a beast. all too often one finds themselves praying for the lesser of two evils for their loved ones with no good choices left to hope for.

i suspect she is one of those who may call me in 3 or 6 months wanting to talk...looking for a few answers or a new perspective. if she opens that door, i'll tell her what i think.

for now, i'm not about to interrupt her raw state of grief with my perceived silver lining.
for now i'll just say i'm so sorry.

mother lode

2008-08-08T20:09:00.003-04:00

you eat
you move through your day minding your own business and are overcome by a craving. not a "wouldn't it be nice if i could have..." - no, this is some fight or flight primal "i need an avocado or i will DIE". mr. oncRN is sympathetic to these internal death threats i get. he'll often call when he leaves work to see if there is anything i NEED.

you watch
the metamorphosis of your own body. you're aware that all manner of flesh is being laid down. i understand the need for the weight gain. the belly? of course. the hips and breasts? sure. the backs of my arms? not so much. seems totally unnecessary to me.

you worry
what if it won't eat?
what it it won't sleep?
what if it's a republican?

you lie awake
in part because the little spleen kicker is awake too.
in part because you ate pad thai. and then m&m's.
in part because your mind races with equal parts awe, excitement, and fear

you love
the kicks
the privilege
the percentage of lycra in your clothes
your husband's hand on your belly when you fall asleep

you field questions
when are you due?
do you know what it is?
why don't you want to find out?
what are you going to do about work?
was this planned?

thanksgiving. no. we like surprises. i don't know. who cares.

you pray
for the patient you are about to meet with who had to lose her pregnancy so that she could get chemo and live. it pains me to know that my presence will pain her. she congratulates me. we wordlessly acknowledge the truth that good fortune is not distributed equitably.

you prepare
i'm no expert but this is my third, so i know a couple of things. i know that despite what the baby stores the size of airports will have you believe, you don't need much. from what i recall you need breasts, love, and patience for the first few months. i have those.
and diapers. i'll get those.

brave

2008-07-30T15:51:00.002-04:00

i think it every day.
patients are so brave.
over and over i see them gritting their teeth, sucking up symptoms, taking risks for a potential benefit, fitting in treatments on their lunch hour, being patient with the phlebotomist who is having a bad day, returning to us...even though they know, at least in the short term, that it's going to hurt...that it has to get worse before it can get better.
but, somehow it's not the right word. it sounds cliche and insufficient. most patients would say they aren't brave - that they are just doing what they have to do. but it's how they do it all...with grace and focus.
it's all so scary sometimes. and they're brave. trust me. don't let them tell you otherwise.

sometimes doctors are brave too.
this one is one of my favorite species...the doctor/scientists. the ones who see patients but also run a lab... the ones who know what the most important paper is going to be this year...because they are writing it. the ones years ahead of the FDA in knowing what might work. the ones that often forego the enormous salaries of their peers, because their heart is in science...and science doesn't pay. the ones that, as a group over time, move the whole field ahead.

this one looked at a young guy whose options have run out
who has tried everything there is
who is going to die...soon
and he said, 'hey, my lab is working on something...we think it's going to work...it's nowhere near approval...i'm telling you this because it's what i would do'
and they throw up a medical hail mary.

and damned if it doesn't work.
today i looked at them, physician and patient, celebrating this most unexpected victory and felt grateful that they ended up together. another physician would have never had the knowledge to share. another physician might have covered his ass and not shared what he knew. another patient might have been too scared to try.
this patient was beaming today.
he told us today that he had canceled his trip to europe this summer, because he thought he'd be dead.
he isn't.

i felt like i was witnessing something great.
this doctor was brave...and may have saved a life.
who knows what will happen from here.
for now, though, this young guy is living and living well.
what else is there?

dad

2008-07-15T15:41:00.002-04:00

where was i? oh right, my sanity. i have spent most of this blog examining it - the ways my work tugs at the places in me to which i feel my sanity is anchored...worrying about the potential of losing the sometimes fragile grip i have on it...questioning if, in fact, all this examining and questioning might be healthy and might be the very definition of sanity...honing my tools of the trade for preserving said sanity - learning to invest in and care for people without feeling their pain to the point that i start to think it's my pain, etc, etc.

all that, in short, gets shot to hell when your dad becomes the patient. no small part of the aforementioned storm was his new diagnosis of cancer. in your memory it's a blur of belly pain, a phone call from your mother, an ER visit, a strained attempt to understand the english as a fifth language (EFL) resident that examines your dad at Podunk Memorial in your hometown, scans, more scans, masses being measured in centimeters, nerves getting frayed, calls made to inform and placate overseas siblings, tears, worries, frustrations...all leading up to a huge surgery where the best and worst facts of it are all revealed.

people, mostly colleagues, immediately start talking to you about how it must feel to "be on the other side". you quickly learn there's no such thing. you are who you are, you know what you know, you've seen what you've seen. it doesn't turn off because it's family - if anything, it revs up. when you're seeing patients on the first floor and your dad is recovering in a bed on the fourth floor, there is no other side. the daughter/ oncology nurse /employee of same hospital trifecta benefits you all in different ways, but makes you fall asleep in a pile on the living room floor more than once.

when the trauma of the surgery wanes and physical healing begins...when the facts are all known and next-step plans are made, you exhale. you all learn that it could be so much worse - you learn that he has a diagnosis for which oncologists can't seem to help themselves from saying, "well if you have to have cancer, this is one of the ones to get" - or my favorite "you're probably going to die from something else" - reassuring facts said in ways that are not at all soothing. you resist the urge to slap any of the kind people who keep saying these things but add to your own mental list of Things Never to Say to Another Human. ever.

so he's left with some cross between a blessing and a time bomb inside and life all but returns to normal. somewhere between despair and relief you get to share that he's going to be a grandfather again and you all celebrate in the juicy cliche handed to you at this key moment - that life does go on.

you and he, arm and arm, stride out of your hospital each with radiology films under your arm - his showing a mass, yours showing a fetus- neither of you pretending to know for a minute what the future holds.

love you dad.

storm

2008-06-23T14:00:00.004-04:00

it's been an interesting stretch of life. not like any other i have ever had.
i have been lucky to live the bulk of my life without tragedy and suffering in the circle of people closest to me. i always thought that was one reason i was able to handle such an abundance of both at work. it was a different world.

it feels a bit like my worlds have collided.
there have been one too many family members, friends of the family, and friends of friends who have had a few symptoms, seen a doctor, had some tests, and gotten the worst news of their life.
and of course there is my dear friend, trying to navigate this new life she has been handed, sans the love of her life.

what has become crystal clear is that there is no magic pill, no silver bullet, no conventional wisdom, no piece of scripture or words of Rumi that can help a family face the loss of their dreams. no matter the support available, it is still a pill they need to swallow. some will chase this pill with sugar, some with bourbon, some with ipecac. as a nurse, friend, daughter, loved one, all you can do is be there and meet them where they are.

lest anyone think i sound cynical or depressed or hopeless....i'm not.
quite the contrary.
i, too, had a few symptoms, saw a doctor, had a few tests and they found this:

sometimes the joy that arises in the midst of the storm is the sweetest.

serenity

2008-03-03T15:04:00.006-05:00

you're not ready to use the past tense when you talk about him.

you don't know how to process the beautiful and harrowing truth that life just goes on.

time....patience....i know.

my friend - she's surviving. in so many ways, she is what she has always been. she's suffering, yes - she's also poised and beautiful - she's rock solid in her faith and her role as a mother.

she's jackie o.

then you see the kids and feel that all your crying isn't enough - that you should be bleeding. your boys are always asking you what super powers you would choose if you could - now you know - you'd make yourself a giant sponge and absorb all the pain and sadness and fear from these kids so they'd feel whole and safe and happy again. then it would just be a matter of finding a place to wring that sucker out.

you have a wonderfully surreal life moment when, in telling your patient that you'll be out for her next visit, you start crying because it's for the memorial service of your friend. she doesn't know that's why, but has never seen you cry and wraps you in an incredible embrace. you proceed to tell her the whole story because you have no professional boundaries whatsoever. you've provided her care and empathy and an ear for the last year and a half, and now it's almost as if she welcomes the opportunity to return the favor. tragedy is a leveling force, that's for sure.

you realize that there is nothing to say and nothing to do to make this better.
so you pray that god will grant her the serenity
to accept the things she cannot change
the courage to change the things she can
and the wisdom to know the difference.

and you ask the same things for yourself while your at it.

always

2008-02-22T22:20:00.003-05:00

you're driving home. you call your husband to say you're stuck in traffic. you see lights and a helicopter in the distance and know that someone is having the worst day of their life.

hours later you get a call. it's your oldest friend who's having that day. it was her husband in that helicopter. her husband who died. your friend is a widow at 36. with six kids. six.

you hear the words the woman on the phone is telling you, then you can't hear anything because someone is screaming. it takes a minute before you realize it's you. your husband comes running, 'what happened?! what happened?!'. you tell him and watch his face fold and his body collapse onto the bed heaving and shuddering.

you know you have to go see her, but you're hesitating. you tell yourself you're hesitating because of the snow, but really you're just afraid you won't come back.

you enter the hospital you left hours before. you feel like you're staggering and wonder if you really are. you see the waiting room and feel your heart drumming and hear it thudding in your ears. the room is full. full of women your age, heads in hands, hugging, gasping for air. full of men your age, hands stuffed in pockets, pacing, rocking, sniffing. she sees you and crumbles. you feel her weight pull on your shoulders. you feel her wails in the side of your neck. you hold and tell her you'll be here always - both of you knowing full well there's no such thing as always.

you've been in the presence of death so many times. you've held its hand and felt its breath and showed others the way the best you could. now you realize that sudden, unexpected death is a different beast altogether. it's violent and explosive. it's rip your heart out of your chest raw.

you return home. it feels like something has burned a hole in your stomach. your eyes feel swollen, like there's cotton balls shoved up under your lids. you're walking funny. you go in their room and lay a hand on each chest - feel the rise and fall for just a minute. they don't know yet. you envy their peace.

you crawl in bed beside your husband. you'd crawl inside his skin if you could. you wordlessly intertwine and press and sink into each other, but can't seem to get close enough. with puffy eyes and clenched hearts and tangled bodies, you flirt with sleep. you hear a whimper occasionally and you aren't sure if it's him or you.

the day after finds you even though you tried to hide. you hold their hands and tell them what you know and how you feel. you learn a lot about your kids this day...what they're afraid of...what they believe in...what they worry about...how their minds are organized.

'so who will be my soccer coach now?'

'who's going to help max put on all of his hockey gear?'

'how can you be so sure he's not coming back?'

'how long will your heart be heavy?'

you feel, in this moment, that you can't possibly heal...that you'll never stop crying...that pure joy is gone. and that's just us. just a filament of the grief they must feel.

dear one, i'd give anything to wake you up from this nightmare.
whatever always is, you have me for it.

skin

2008-02-15T23:34:00.000-05:00

the largest organ...the barrier...it breathes...it protects...it blushes...it gets cut and heals...it sweats...it glows...it toughens under the sun's rays...and wrinkles in water

the skin of my patients shows they've been to hell and back.

there are scars. thanks to biopsies, catheters, needle sticks, vaccines, rashes, iv's, skin grafts, feeding tubes, trachs. vivid, wordless legacies that recall suffering and fear...and healing.

there are colors. if you've never seen them, i'm glad for you. few things rattle me as much as running into a patient after a few months and seeing a sick complexion. their eyes and their smile and their hug tell one story, but their skin tells another. it's a yellowish, grayish, non-humanish hue that can bring tears to my eyes in an instant. a color that makes me want to know if they've been down or if they're going down. that makes me want to ask, 'what the hell have we done to you?"

there are messages. it turns yellow when the liver has been insulted. it gets bumpy and itchy when the immune system doesn't approve of a certain drug. it gets baggy in strange places to show weight loss. it goes numb when a nerve has been injured. it gets rather ornate when the blood is not clotting well. it lets go of heat to inform us of a fever. it's a good communicator.

to hell and back. back being the key. they are back every week. and friday nights they flip throug my mind like a slideshow. a show that i have often tried to cancel or unplug or drown out with red wine. i'm letting it play tonight - it's healthier, i know. not that there's not wine involved - which i hear is healthy also.

night

2008-01-28T21:06:00.000-05:00

sometimes i wake up suddenly for no particular reason. and even though it's the middle of the night, and i have to get up early, and i reeeeeally want to be sleeping, it quickly becomes clear that it's just not going to happen. so i reluctantly leave my warm bed and the steady even breathing of my husband. show off.

i get up and pad around quietly. i always feel like i'm robbing my own house. like if i got caught i'd have some explaining to do. i lie down next to the warm little bodies i tucked in several hours before, and do a little re-tucking. i listen to them breathe. i feel their heads to be sure they're not cold. i tuck the hippo back up under the arm and turn up the heater a notch.

i remember a time when most of my friends were single and/or living fairly carefree lives and you could call at any hour. it wasn't unusual to make or receive calls in the middle of the night. now i sit and wonder who i could call. everyone i know has kids or works early or really wouldn't want to be woken up just to chat. and since when do i like to chat? i don't . i think it's just the acute sensation of being alone with myself. so rare these days. my instinct is to reach out. sometimes it's too scary to reach in.

i think. and wonder. and worry. and read. and stretch a little. and yawn. and read some more. and get some water. and wonder about all that worrying. and worry about all that wondering.

i'd love to have a drink. but my genes aren't to be trusted with such things. plus, i don't think 'drinking alone at 2am more' was one of my resolutions. or maybe it was - right behind start smoking and eat more lard.

witness

2008-01-24T21:30:00.000-05:00

dear doctor,

for what it's worth, i saw it all. i saw the dread in your eyes, and your chest deflate when those labs popped up on the screen. i saw you squeeze your fists together and gently rest your head on them. then i saw you psych yourself up with a sip of your coffee and a deep breath.

i saw you wince at the hope and lightheartedness in the room when we walked in. i saw you greet them and eek out a smile. when you started talking, and he grabbed his wife's hand, i saw you pull on your collar with one finger tip, like someone had just cranked your tie tighter. i saw your foot, that ususally circles calmly while you talk, swinging sharply back and forth.

i watched you dig for the right words. when they didn't come, i saw you slide your chair closer, put your hand on his knee - and then hers. we all heard you say, 'we're not through fighting this". i saw them exhale for the first time - probably more from your hands than your words. i saw them sift through fear and devastation and gratitude for your care - leaving them with a morsel of hope to nourish them through this next phase.

i watched you leave and return to your desk. when i put my hand on your shoulder, i felt it sink and saw your chin fall to your chest for just a second.

then, like a prize fighter, i saw you roll your shoulders back, pull once more on your collar, pick up the phone and dictate your note.

one down, twelve to go.
it's going to be a long day.

for what it's worth, it's so important what you do. and you do it well.

thanks.
and peace.

wonder

2007-12-31T16:37:00.000-05:00

i wonder.
a lot.
about this whole life and death business.

you call because you care and you worry and you wonder.
but beware, it could go something like this:

me:
hey, did mr. d get discharged?

her:
(awkward oncologic silence)

me:
oh my god! what happened?!

her:
i’m so sorry. he died on sunday.

me:
oh my god……..anyone else?

her:
mr. c. last night. i’m so sorry. i was going to call you.

me:
oh my god…… geez……… shit.

note to self: do not call while on vacation to check on patients.
information you learn could negate the ‘vacation’ part of the vacation.

so let me get this straight. life goes on without me. and so does death. and i can’t always be there. not that i want to be or anything would have been different if i had. it’s just that i’ve sort of been assigned as their personal escort through this last phase of their life – and i should have been there. damnit.

‘what’s wrong mommy? did one of your patients die?’
‘actually two died.’
he hugged me and brought me his stuffed hippo and asked the obvious question,
‘so, do you wanna play yahtzee?’

mourning fog. you feel like banging one side of your head like after swimming – maybe the grief will leak out and you’ll be able to hear and think again.

but you blow through the grief express lane. then you roll a large straight – in one roll! you coast on your yahtzee high for awhile.

there was foreshadowing before i left and i made a special point to see mr. s. he was the one i was really worried about. the frail one. it feels like we’ve been waiting for the other shoe to drop with this guy for weeks – and that sucker just won’t drop. he keeps hanging on. more than that – he’s actually improving. that said, he’s old, sick, and tenuous. he hugged me and told me to relax. i told him how well he is doing, how well he has done, and how much i admire him. i said farewell without saying good-bye.

but i couldn’t see everyone. and i didn’t see the two that died. and now i can’t. that hurts and frustrates me in a way i can’t quite describe.

these patients…..god, they are fragile. literally clinging to life by a thread. a thread that we may be able to fortify or weave into something stronger – or a thread that could be unexpectedly snipped in an instant.

it was a glorious vacation. it was memorable in so many ways – for the blue skies and good air and fresh fish. memorable too for the loss and the book that found me afterwards. the books i need have been finding me for years. it works out great. Eat, Pray, Love fell in my lap – well, right after i bought it. it was a perfect companion to my 24 hours of soul searching that needed to take place. i didn’t connect with her story as much as her voice and the idea….eat, pray, love – what a mantra. what a mantra for grief management...or just for life. it’s one of the best i’ve found yet.

full day

2007-11-15T22:52:00.000-05:00

taking care of cancer patients every day makes me:

inspired

appreciate my body

wonder how i will die

want to get a cbc everytime my gums bleed

cry sometimes for no reason. or for every reason. depends on how you look at it.

hug excessively

a wee bit self-righteous about my work being harder than other people's

grateful

invigorated

want to snort lines of antioxidants

exhausted beyond comprehension

really bad at the whole planning for the future thing

a more sensitive parent

irritated with god

...sometimes all before 9:00am

waiting

2007-10-21T18:34:00.000-04:00

sometimes i dread the waiting room. truth be told, if i could scale the outside wall of the building and rappel down the other side to avoid walking through several time a day, i would. it's not the conversations i'd like to avoid, it's all the eyes.

everyone is there waiting for something they don't want. they're anxious. they're inexplicably bored by the Architectural Digest circa 1998 littering the end tables. they're unimpressed with the accommodations that focus on the pretentious and are a little light on comfort. personally, i say screw the hardwood floors - people need windows, skylights, plants, truly comfortable chairs, complimentary chocolate.

walking through is sometimes uneventful. more often, though, it's a series of greetings - waves, smiles, occasional hugs. it's patients giving quick updates on their cancer and their lives and the book they just read and the pictures from the wedding last weekend. i live for that stuff and the potential of it happening each day is my greatest motivation to keep coming in. if only it didn't have to all take place in the waiting room...with all the eyes...and all the ears. i hate the idea of my sad, just relapsed, sick patient seeing me laughing and celebrating across the room. i hate the idea of not being able to laugh and celebrate with my patients that are looking to me for that.

i was a inpatient for 5 days while in pre-term labor with my youngest. the unit i was on had an interesting mix of patients...some that had just delivered, some whose bodies were trying to deliver way too early, some who had just lost their baby, for one reason or another. outside each private room, the staff would place a picture - their own code to remind them which scenario was on the other side of that door - a blooming rose for the new mother, a evergreen branch for those of us scared and waiting, and a dew drop on a leaf for those grieving. i remember thinking how hard it must be to be a nurse there - to have the happiest day of someone's life in room 8 and the absolute depths of grief in room 9.

the waiting room reminds me of this unit. only there are no botanical cues - only memory and instincts to remind you where everyone is - and what they may need. everyone wants and needs something slightly different from you. it feels like a day's work sometimes to try to give it all.

regret

2007-10-18T21:51:00.000-04:00

there’s a lot to be said for being your own best advocate. for knowing as much as you can know. for standing up for yourself. for educating yourself. for questioning.

sometimes there’s even more to be said for listening to the experts. for knowing that all the googling in the world can’t take the place of the thousands of patients this doctor has treated over 3 decades and the experience she has gained doing so. a physician that has devoted her career, if not her life, to one disease. a physician that is looked at as a resource by her colleagues across the country. it’s not that she can’t be wrong, it’s just that she’s worth listening to.

i knew when i met her that her disease was bad. it was the thinning in her hair, the skin color that was indescribably off , the splitting nails, the sunken eyes, the body that looked like it had been fighting a demon for quite some time, despite just being diagnosed. she was an avid life-long athlete, a textbook go-getter, a type A googler who would arrive with printouts and abstracts and pie charts and demands. but over and over i saw her back this doctor into a corner. with her stack of abstracts and an ever subtle whiff of litigation in the air, she would dictate what she wanted, and because it was all within the realm of reasonable, it was all done. over and over i heard this doctor say, ‘there are no right answers, but this is what i recommend’, and she would invariably do something differently, all backed up with evidence of her own.

i’m not surprised her body isn’t winning this one. it almost looked defeated from the start. but i can hear the regret in her voice, and it breaks my heart. she’s doubting choices she made, wishing she had listened more, wishing she had let herself be led.

we’ll never know how, if at all, things could have been different. and quite possibly we are witnessing the best possible outcome for her. but she is regretting sitting in the director’s chair. that is a burden all its own.
that is a cross i wish she didn’t have to bear.

gray

2007-09-16T19:24:00.000-04:00

when a colleague dies, business as usual disappears and everyone walks around with their heart at half mast. there’s a fog and a confusion that is exchanged in wordless glances . there are puffy eyes, heavy sighs, and lots of tight- lipped sympathetic smiles.

when that colleague dies of cancer, it’s worse. it’s more unbelievable, more sad, more wrong. there are too many levels of tragedy and irony.

i’m glad it was gray and cool out. bright sun would have felt like an intrusion or like the skies were celebrating, and that would have felt wrong.

if i wasn’t already, i am officially the town cryer. ‘i wish i could cry freely’, one of my physicians said. ‘it’s a gift’, i told him drawing a tissue from the holster on my hip.

13 years

2007-08-13T12:24:00.000-04:00

one of the only things i know for sure is that starting and ending my days with him casts something wonderful over my life. it's a twice a day scheduled dose of warm and calm and right. i love him.

there's not much not to love. men love him because he is such a guy. he instinctively knows how to build or fix anything. he's a natural at climbing a mountain or kayaking a river. women love him because he does that and everything else without toxic doses of machismo and swaggering. when i met his work friends for the first time, the biggest and burliest stepped forward, shook my hand and said, 'hi, you must be sweetie.' now that's awesome. there are entire books written about how to 'get' a man like him - kind, loyal, supportive. and when i say kind, i don't mean nice. nice is everywhere. nice is....nice. but kind is in the blood or bones or spleen or cells or something. you can't fake kind.

he understands stability. when he built our house he would always tell me - 'invest in the things that you can't change - the things that ground the house.' so we did. we spent a lot on a fireplace and brick all over and windows - tons and tons of windows. and he was right, of course. and no matter what changes we make from here, those 3 things make it our house.

and beware of flying metaphors, but i can't help it. because marriage is the same. in a couple, you build and reinforce and put on additions and then find out that it's not to code - so you tear down and plan a little more carefully and build again, repeat, repeat, repeat. and as much as you change the look and the color and the feel of things, your supporting structure is always the same - and it's either strong enough or it's not. ours is.

i admire his life that seems to have such a quiet clarity of purpose. he loves being the husband and father of this family. and he's so good at both. the simplicity of it all gives it a sort of grace or elegance. or maybe that's just compared to the bumbling and fumbling through life of a certain oncRN who shall remain nameless. truth be told, we here at oncRN are not entirely sure why he loves us as much as he does. and it's not that i'm undeserving or unlovable - but what is it that makes someone love another so deeply, so completely, so calmly. i don't know, but it, to date, has been the greatest gift of my life.

i am deeply grateful to god or fate or the universal attractiveness of the mullet or whatever other force that drew me to him two decades ago.

cheers, baby!
i love you.

"...nor is it strange that after changes upon changes we are more or less the same."
paul simon - 'the boxer'

things i could live without

2007-08-09T13:37:00.000-04:00

realizing 4 minutes into a 12 hour shift that i've made a horrible underwear selection.

the expression 'nuff said'. i just become aware of it and i don't like it. i thought it was a little cute the first time it was written to me in an email, but i'm over that. today i saw a bumper sticker that said Hawaiin - nuff said. no, not nearly nuff said. i don't know what you're saying.

other people's phlegm. don't want to hear it expectorated. don't want to step over it on the sidewalk. don't want to wrestle into a cup to send for culture. just don't want anything to do with it.

the expression 'be that as it may'. nuff said

that zit on my chin that seems to have its own pulse

the practice of carrying small dogs in purses

that thing where you take care of a patient for 12 hours straight, spending most of it face to face doing mouth care, suctioning, re-arranging oxygen masks, feeding, etc and then come back the next morning and everyone who goes in the room needs to wear this

nurse secrets vol. 1

2007-07-19T22:14:00.000-04:00

misery

2007-06-27T14:10:00.000-04:00

she:
wasted.
starving.
cancer is leaching her body of everything it needs to look and feel well.
the eye sockets tell it all.
hollow.

he:
hands - wringing
knuckles - white
legs - wound tightly. like DNA
foot - swinging urgently
eyes - tearing
brow - furrowed
worried - sick

one cancer. two patients.
heartache all around.

she: 'can i smoke pot...for the nausea...for the misery?'
me: of course

i hope they both smoke it.
maybe i should have given them a prescription for Doritos.

thanks

2007-06-14T09:11:00.000-04:00

i love that feeling - being the bearer of good news. telling the alpha male body builder with leukemia that we can barely detect his disease - that his numbers are the lowest they've been in 4 years - that what we did appears to be working. it's worth a thousand bad days at work to see him well up, rise out of his chair and give me a big alpha male body builder hug. my feet left the ground. he hugged me so tightly that even through a pectoralis the size of my head, i could still hear his heart racing, pounding with incredulous joy. 'thank you. thank you', he kept repeating while balancing eyelids full of tears, willing them not to actually fall. he gave the doctor one of those testosterone-mediated aggressive handshake/back slap combos, but i know he really wanted to kiss him. silly men.

when things go badly, i always hear myself saying, 'i'm sorry', and patients race to say, 'it's not your fault', which of course i know. but when things go well, the same patients say thank you in such a way and with such an intensity - as if i had gone in there myself and tidied up their bone marrow with my own hands. they hold us responsible for the victories in a way that they don't hold us responsible for the failures. at least that's what it feels like. and even though i know i'm not responsible, i say, 'you're welcome'. the intense gratitude makes me feel like a superhero for a minute. that is until i go to leave and through a brief series of ungraceful events, catch my stethoscope on the door handle and almost hang myself, pretty much negating the whole superhero thing.

i love this feeling. i need to bottle it. and get a spritzer for the bottle. and apply liberally.

onkos

2007-06-11T21:20:00.000-04:00

from the greek roots index:
ONCOLOGY, from Greek... to carry... with derived noun onkos, a burden, mass, hence a tumor.

a burden indeed.
the burden of disfigurement
the burden of worry
the burden of pain
the burden of hours spent waiting for appointments and results
the burden of needle sticks and missed needle sticks and biopsies and surgeries
the burden of being told you're one of the lucky ones and wondering when you're going to start feeling lucky

quote

2007-06-01T11:12:00.000-04:00

patient quote of the day:

we are going over the consent for a clinical trial and i am reviewing possible side effects. he interrupts and says, " you know i've had every weird symptom imaginable over the last 3 years. just hit the highlights - just tell me how high it's likely to register on my Weird-Shit-O-Meter."

that makes me want to design a clinical trial to study the WSOM and see if we couldn't standardize it for all to use.