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Circle of Life

It's been a crazy week, or maybe two. I don't know. I've been on AM hospital duty for the past week and on call two weekends in a row.  I'm not entirely sure what day it is. But it's all good.  The hospital census - the number of patients I have to see each morning, before outpatient clinic each afternoon - went from 4 to 23 when I came on the service (we typically average 10). Why there was an explosion of activity in the hospital out of the blue in the middle of May I don't know. Last Tuesday it was wall-to-wall in the ER and not enough beds in the house for all the patients who needed to be admitted. Plus, there were about a dozen babies delivered that day. Pretty impressive for our little community hospital.  Later in the week we discharged 14 people in one day.  We had 2 people die, sent a bunch of folks home, admitted a few more, and had more than a dozen babies come and go...so now the census is back down to 4. Much more manageable, that. 

In the clinic I've had the typical sniffles and coughs, blood pressure and diabetes checks, prenatal visits, well-child checks, etc.  But I also got to cut some lesions off of one of the ER docs (sweet man who recently put me in the middle of a political battle between him and a local pediatrician and the nearest referral center...but that's another story), remove a toenail, and treat a rash of jaundiced newborns.

The two patients who died were both elderly ladies with lots of medical problems.  They had both lost a leg to diabetes.  One had a massive hemorrhagic stroke and was comatose when she got to us.  After speaking to her family, I removed life support at their behest and in accordance with her wishes. She passed peacefully about 6 hours later. The other was a patient I was very familiar with. She came in with a UTI (after a long, slow decline). After a few days in the hospital with no improvement in spite of multiple interventions her kidneys shut down and her respiratory status started to decline, so I had to discuss the grim prognosis with her family.  Her daughter has devoted the last few years entirely to her mother's care. With the help of her nieces and nephews she decided to change her mother to palliative care. About an hour after I changed her orders, and a few minutes after her daughter told her she loved her and that it was okay to go, she took her last breath.  It's never easy, even when you know beyond a shadow of a doubt that they're better off, no longer suffering.  There's something about the helplessness of not being able to fix it that is hard to take - goes against our instincts.  But at least we can make the transition easier for the patient and their family. And there's something rewarding about that. 

Well, this isn't really what I'd intended to share about the last couple of weeks, but suddenly the bitching and moaning I'd been thinking about seem a bit less important.  Reflection, perspective...hmmm, imagine that! 


( 15 comments — Leave a comment )
May. 23rd, 2012 05:10 am (UTC)
{{BIG HUGS}} I'm sending out lots of restful, peaceful vibes your way! Your strength and resilience just amaze me, as does your enormous spirit, but I do hope you get to have some quality YOU time soon just to rest and decompress. Thank you for sharing your insight with us. It's always wise and beneficial just to take a step back and gain some perspective from what we see around us in our daily lives, and not many of us do that. I feel I rarely do: I need to change that! :) :)
May. 26th, 2012 01:29 am (UTC)
You're too kind. I started typing with the intention of just venting, but the process of writing forced me to really look at what's been going on and how it, and I, fit in the grand scheme. I needed that. This journal has turned into therapy...and your sweet words are equally therapeutic. Thanks so much, dear. *HUGS!!*
May. 23rd, 2012 05:58 am (UTC)
People need compassionate, understand doctors at these times in their lives, and you sound like you're just what they needed.

May. 26th, 2012 01:33 am (UTC)
Thank you for your kind words. It's not an easy job, but somebody's gotta do it! I just hope not to make things any harder. God knows it's hard enough.
May. 23rd, 2012 11:36 am (UTC)
Those last two paragraphs remind me sharply of when my grandmother was transferred to hospice. I held her hand too, and watching her struggle for each breath was very hard. I think I told her too it was okay to go. She waited long enough for her daughter to come say goodbye before passing away. It was within hours.
May. 26th, 2012 01:35 am (UTC)
I'm so sorry for your loss. Some folks just need permission to leave - to know everybody will be okay. The human spirit and will are amazing. *hugs*
(Deleted comment)
May. 26th, 2012 01:40 am (UTC)
Missed you too, dear!

It's amazing to see folks come and go, and a privilege to be so intimately involved in the process.

Heehee! I've know of folks who developed a bezoar from eating things like that. There was a lady we treated in med school who swallowed eye glasses. I must say I enjoy taking toenails off. It's a cool procedure. Not that I'd just go around taking them off willy-nilly...

The indomitable dog is getting around pretty well. Not sure she's learned anything, but at least the hip is still in place! Thanks for asking after her. :-)

Safe travels, sweetheart! *hugs*

Edited at 2012-05-26 01:41 am (UTC)
May. 23rd, 2012 02:18 pm (UTC)
It's got to hard to lose someone even if they've lived a long life, it's just the nature of being human to be sad about it. Even when we don't know the people it tends to make you think what if that had been so and so.

Sounds like you've been insanely busy, take a bubble bath read a good book and have a glass of whatever makes you happy. :)
May. 26th, 2012 01:41 am (UTC)
Sound advice! Thanks, dear! :-)
May. 23rd, 2012 04:04 pm (UTC)
After writing and rewriting this note, getting rid of everything each revision, I'm going with saying that I'm glad that reflection has given you a more positive outlook. And I hope things become less stressful for you.

I hope you're one of the doctors who makes sure the painkiller's working right before doing anything to the nail bed. Because I've tried it both ways (I get killer splinters), and I think the painkillers are absolutely essential.
May. 26th, 2012 01:46 am (UTC)
Thanks for your good wishes. Just found out today that I get a long weekend, so I left my computer at work and am looking forward to 3 days off to destress a bit!

I'm pretty generous with the anesthetic and I always test sensation before I start cutting or poking on somebody. I know how terrible it is to not be numb enough!

Take good care, dear.
May. 23rd, 2012 08:50 pm (UTC)
It's as it ever was and always will be...and you're just helping things along at the beginning and at the end! :O)
May. 26th, 2012 01:47 am (UTC)
And what a privilege it is. Sometimes I just lose sight of that...good to be reminded. :-)
May. 23rd, 2012 10:29 pm (UTC)
Oh, my dear. Rest and breathe. I only see the outfall of all this kind of thing, and thones who pull through. Can't imagine what it must be like making, and carrying through these decisions.
May. 26th, 2012 01:54 am (UTC)
Being born is hard, living is hard, and dying is hard. I have the rare privilege of coming alongside folks during the rougher patches to hopefully help smooth things over, or at least be with them as they struggle through. I forget that sometimes. And then there are these moments when it becomes so clear...I surely needed the reminder right about now! The flip side is that it can be utterly exhausting. So I'm taking advantage of this long weekend to rest as you suggested. I greatly appreciate your kind comment. Take care, dear.
( 15 comments — Leave a comment )