The C word.

I spent the past two weeks doing an elective rotation in the Hematology and Oncology clinics. I never thought that cancer clinic would be anything near "fun", but it was actually a very enjoyable experience for me. I learned so much about the physician-patient relationship.

Mr. X had skin cancer on his face. Before I went in his room to talk to him, I flipped through his chart and looked at his CT scans on the computer. I knew when I saw his scans, that this was going to be a tough interview. A good portion of his face was missing. It had been destroyed by the cancer. I composed myself before I walked in. I didn't really know what to expect, but I wasn't expecting this man to be the jolliest patient of the day. I know that if I was missing half of my face, I wouldn't be the most pleasant person to talk to. So I walked in, introduced myself, and looked him in the eye. I could tell he was smiling. Not because his lips were curled upward (because he didn't really have the ability to do that), but because of the way he looked at me with his one good eye-I could see the twinkle. I asked him the routine questions and made small talk. When I got back to my chair to write the progress note, the doctor informed me that Mr. X's treatment wasn't working. I proceeded to go back in the room and watch the doctor inform this man that there were no more options for him. Mr. X didn't seem rattled at all. It was like he knew what the doctor was going to say before he said it. He left the clinic after he signed all the paper work for hospice care. I didn't see him, but I'm pretty sure he still had that twinkle in his eye.

Cool was a young guy, still in college. When he was younger, he had two different types of cancers at different times that had been treated and taken care of. That day, I happened to pick up his chart. As I read up on him, I quickly realized that he was going to have to be told that he now had a third type of cancer. It was a rare type, and not a lot of research has been done on its treatment so know one really knows what works. I asked the attending if he wanted to do this, but he told me to go ahead and do it since I had seen him do it several times before. I went in and sat down and talked to him. I told him about his cancer, what we needed to do to see what stage he was in, and what we needed to do before we could do treatment. I don't really remember all the words I said... but I remember the look on his face. Cool's face was a mixture of fear and disbelief. I asked him if he had any questions and he shook his head now. When I got up to leave the room, he was looking at the floor and he said to me, "I've got some bad luck, don't I?" I just smiled and told him we were going to take care of him the best we knew how. Never looking up, he just nodded his head.

Reflecting back on those two weeks talking to people who battle for their lives every day... I realized that I don't know what to say to those people. I need to get in the Word more to learn comforting things to say to these patients and their families when they are hurting and hanging on to precious moments. The following verses are a few that I've found that may be encouraging to someone battling cancer or someone close to a cancer patient... and also for the doctors that treat them day after day. We must delight ourselves in the Lord... To do that we must have a unquenchable thirst for his Word. Only then may we serve him to the best of our abilities.


James 1:12
"Blessed is a man who perseveres under trial; for once he has been approved, he will receive the crown of life, which the Lord has promised to those who love Him."

Revelation 21:4
"...and He shall wipe away every tear from their eyes; and there shall no longer be any death; there shall no longer be any mourning, or crying, or pain; the first things have passed away."

John 14:27
"Peace I leave with you; My peace I give to you; not as the world gives, do I give to you. Let not your heart be troubled, nor let it be fearful."

Isaiah 41:10
"Do not fear, for I am with you; Do not anxiously look about you, for I am your God. I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand."

Psalm 34:18
"The LORD is near to the brokenhearted, And saves those who are crushed in spirit."


Galatians 6:9
"And let us not lose heart in doing good, for in due time we shall reap if we do not grow weary."



Pics:

Me and my good buddy from med school, Rob Cannon, at his wedding. I got to be the stand in bride!


Kristy and Clare's first trip to the delta... We posed with the Teddy Bear at the Great Delta Bear Affair.

Pieces behind the Mask

In my previous post, I shared that I was having trouble sympathizing with the patients on my psychiatry rotation. I couldn't connect with them for some reason. It wasn't a doctor-patient relationship. It was just a doctor and a patient. Most of the times these patients are addicts or homeless or suffer from some psyciatric condition caused by the long term abuse of drugs. Yesterday was the first time on psychiatry that I've felt like an alliance was established between me and a patient.

I'm going to call her Pieces because she is such a broken young woman. I feel so much sorrow for her. This poor girl is suicidal, homicidal, and depressed. She doesn't trust herself at home alone. She is afraid she is going to kill herself if she is ever left by herself. And I believe her.

Let me to tell you a little about her story.

Pieces was raped by her brother throughout her childhood, starting before age 10 up until her preteen years. Her parents split up when she was in junior high. Her dad said some pretty hard words to her the last time that they spoke. She blames herself for all that happened. She feels that no one in her family was ever happy with her no matter how hard she tried to please them, so she quit trying. She felt she had no value and was worthless as a daughter, sister, and friend. She was raised in a Christian home, so she says. They occasionally went to church. She never thought it was important to her parents because they never made it a priority. So when she was hurting she turned elsewhere. She started drinking and smoking in her early, early teenage years to ease the pain of rejection and to try to find a place to fit in, a place where she could feel valued. She went to partied, drank, did drugs. She lived hard. She got kicked out of high school within a few months of graduation. She was arrested twice at school for fighting and threatening people. She spent some time in a detention center for that. She told me she hasn't been able to get her GED. Because of that, she can't find a decent job. She works at a local fast food restaurant one day a week-hardly enough to live on. Her mother put her out. Her father lives far off. Her sister won't let her live with her because of her anger and impulsive issues. She doesn't have a place to live. So, she lives with her girlfriend(She doesn't trust men for the obvious reasons, so she engages in relationships with other women). Pieces drinks. Smokes. Gets high. Explodes in fits of rage. Attacks others. Harms herself. She does things and says things without thinking about the consequences. She is selfish. She does what she wants when she wants. She is broken.

She does what she has to in order to get what she wants when she wants it without worrying about how it effects others or herself. She is a product of her environment. That is the way the people acted around her growing up. Her brother raped her because he wanted sex-He didn't care how it affected her. Her parents split because they wanted to-They didn't care about the kids. Her mom put her out instead of trying a little harder-She didn't want to deal with it anymore.

The years of hard living and lack of encouragement and implementation of self worth from her family and the failures of her life have left her with no hope. She feels like she has nothing to offer this world. She says she feels like killing herself is the right thing to do. If she did that, no one would have to carry the burden of caring for her.

I learned quickly in medical school how to mask my emotions that arise while I'm interviewing patients. You cannot make your patients feel like they are terrible, weird, creepy, or gross. Patients tell doctors some of their deepest darkest secrets. They trust us because they feel we won't judge them. If they do feel like we are judging them, they clam up. We must do what we can to keep our faces neutral to the patient's situation no matter what may be going on inside of our head.

Yesterday was a real test of the face masking skills I've acquired. While talking to Pieces, I had to hide several reactions and emotions. I masked my disgust and disbelief as she told me about the time she almost fed a toddler bleach to teach him a lesson and the fact that she didn't feel bad about those thoughts. I masked my anger as she told me about her brother raping her and her father being so mean to her. I masked my disapproval as she told me about the drugs she uses. I masked the shock on my face as she told me about the plans she had come up with to kill herself and the ways she had previously attempted to do it. I listened to this strange, sad, and horrible story of a life. I masked the pity I felt for her as she told me about her living situation and her family problems.

Strangely enough, although it was hard to mask some of the emotions, I did not judge her in anyway. Maybe that is where I was going wrong the past few weeks. Maybe that is why I wasn't connecting with those patients. Maybe I was judging the patients because I thought it was by their own choices that they were in these situations. I never got to hear their whole story like I did with Pieces.

What opportunities did I miss to minister to these broken and beaten down people? I can be so ignorant in my comfortable life. Who am I to pass judgment on anyone? I am broken just like they are. I am in Pieces as well. God loves Pieces just as much as he loves me. God loves the men in detox at the VA just as much as he loves me. God loves the meth addict in the ER just as much as he loves me. Who am I to judge?

People who live in glass houses should not throw stones...

Romans 14:4
"Who are you to pass judgment on the servant of another? It is before his own master that he stands or falls. And he will be upheld, for the Lord is able to make him stand."

Romans 14:10
"Why do you pass judgment on your brother? Or you, why do you despise your brother? For we will all stand before the judgment seat of God;"

Pictures of Greenville from the Great Flood of 1927:



http://www.folo.us/2008/12/24/wsj-piece-on-the-1927-flood-and-blues-music/



http://www.dailyyonder.com/letter-langdon-let-me-spend-168-billion-and-ill-show-you-stimulus




http://mshistory.k12.ms.us/articles/230/the-flood-of-1927-and-its-impact-in-greenville-mississippi



http://mshistory.k12.ms.us/articles/230/the-flood-of-1927-and-its-impact-in-greenville-mississippi

Same white coat... New pair of shoes.

I have finished my first three weeks of psychiatry. I worked with the Detox team. I saw lots of broken and addicted people. Some wanted help, some didn't, and so many relapsed. The same people coming back over and over for the same thing. It was just not my cup of tea. I felt so frustrated. I couldn't empathize with these patients. I don't know what they feel like. Empathy is such an important thing for a physician-patient relationship. I felt sorry for these people, but I couldn't feel with them. There was a barrier there that I never figured out how to break down.

I wanted to update where I was at this point, but Psych is not the subject of this post. All the things that have happened away from the hospital is the reason for this blog entry.

I have "stepped" into a new role without realizing what was happening. In my family, I am a daughter, a fiance, a sister, a granddaughter, a future daughter-in-law, a niece, a cousin. The latest thing I have become is medical advisor. My grandmother has had 2 strokes in 2 weeks... I am a concerned granddaughter, just like any granddaughter would be, except I know more. Instead of just being worried, I'm thinking about a differential diagnosis, etiology, pathology, and running risk/benefit scenarios in my head. I am also the one they are asking the questions, "now what?" and "what should we do?" or "will it get better?". There is also another side to this... When it comes to my family's health, I don't know if knowledge is a blessing or curse. I don't know if I will like knowing as much as I do when it comes to my family's health. Sometimes knowing the reality and the survival odds can leave little room for hope. Hope is what keeps us going in those situations. It is what we cling to so much. It keeps us from throwing in the towel. It presses us to keep putting one foot in front of another. What will win the next time I am faced with this? Will my face shine hope or will it show skepticism?

This past weekend, all these questions I was pondering and the reality of all that was happening hit me hard. I felt a new weight on my shoulders. The people I've looked to for answers are now looking to me. Will I lead them astray? I found peace in the fact that Matthew 10:20 says "For it is not you who speak, but it is the Spirit of your Father who speaks in you." If I am where I should be in my walk with Christ, God will direct me to give the advice to my family that they need. The burden is not mine to carry. It is not on my back, but in his hands. If I trust in Him, he will take care of me and the health of my family.

I know my family reads this... I love you all. I am so glad that I can help out our family in this way. I am gladly embracing this role I've been given. God led me here. He has blessed me with the skills to become a doctor. None of it would have been possible without you. You've been beside me all the way. To my future family... I love you all too. You've been great cheerleaders as well. I'm so very blessed to be joining a family as solid as yours.



See you at the Great Delta Bear Affair on Oct. 23!!

A few pics for thought:

Some people... and their stories.

Two months of internal medicine. One month at UMC. One month at the VA. I loved every minute of it. FINALLY! I felt like I was actually useful...

I saw over 100 patients with many different types of illnesses. I learned so much about the clinical aspect of medicine. I also learned about the regulations and business side of medicine. I learned about the red tape we, as physicians, must work around and the hoops we have to jump through. I learned which medicines were on the $4 list and saw how doctors must work and adjust numbers and doses so that patients can afford their medications. I learned a lot about my future colleagues and current classmates. I worked with two very different teams of residents and students and I learned to gel with both.

I learned a lot in 8 weeks... but I still have so much to learn. 8 weeks in the hospital to learn internal medicine is like only putting a band aid on something that needs stitches. We need more time on this rotation in my opinion. Its the basis of everything we do. Psych and OBGYN get 6 weeks and MEDICINE only gets 8? (sorry... I had to rant for a minute)

I have so many different stories I could tell you. I took care of so many... some who were young, some who were old, some who were joyful, some who were depressed, some who were hurting, some who were numb, some who were angry, some who were alone, some who were fighting, some who had given up, some who were waiting, some who wanted to stay, some who wanted to leave, some who knew it all, some who didn't want to know at all, some who knew what lied ahead, and some who didn't have answers.

I'll name a few scenes that will be stuck in my mind for a long time to come...
============================================
I was involved in only one code blue the entire two months. It was the craziest thing I had ever seen. "CODE BLUE 3 NORTH, CODE BLUE 3 NORTH" came across the intercom, and it was a mad dash. Scrubs were pouring out of rooms and nurses stations in full sprint. I was sent to find the patient's chart ( this sounds easy, but at UMC they can be ANYWHERE!). When I came back to the room, there were 20 medical personnel standing outside the door. I made my way through the maze and finally got into the room and handed the chart to my resident. By this time, two huge men were giving chest compressions, switching out when the other got tired. They hooked up the heart monitor and were tracing the patients heart rhythm. Asystole (no electrical activity). They kept giving CPR. I was trying to recall the odds of code survival, I knew it wasn't good and this was the third time this patient had coded. I was honestly thinking to myself, "this is going to be the first dead patient I see." I was nervous. I didn't want to see that, not yet. I was holding my breath. Not two seconds after that thought crossed my mind... beep-beep-beep. Heart beat. A nurse found his pulse. All around the room there were sighs of relief and cheers. My resident got several pats on the back. As we wheeled the patient's bed out of the room towards the ICU, I saw the patient's spouse sitting in a chair outside the room with a blank stare. She looked so tired. My heart broke for her, I couldn't imagine what she felt like. Her husband's heart had stopped beating on 3 separate occasions. I'd be willing to bet her heart had stopped beating momentarily too.
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I'm going to call this guy Chuck. He was such a good ole boy. He was a Veteran. He had conspiracy theories and stories that you could listen to for days. He had jokes. He was jolly and upbeat. He also had terminal liver cancer. He was supposed to be getting chemo, but there was some abnormalities in his labs that needed to be corrected first. After several days of treatment, the labs weren't correcting. The oncologists went by and talked to him right before our morning rounds and told us that he had agreed to enter hospice care. When we knocked on the door and entered, Chuck and his wife were forehead to forehead... crying... They had to hear us come in, but neither dared to look away from each other. We quietly slipped out without saying a word. I was blinking back tears as we walked out. Chuck had decided to stop fighting. Chuck's wife loved him enough to let him.
===============================================
Bud (name change) was probably my favorite patient the entire time. He was such a funny old man. He had one of those hover-round wheel chairs that you see on the commercials and he was the type of guy that WOULD take it to the Grand Canyon. Bud was in the hospital for over 2 weeks. When he came in he was wheezing so loud that you could hear him breathing from the doorway. I could not hear his heartbeat with the stethoscope due to the congestion in his lungs. It sounded awful. We didn't know if Bud was going to make it for the first few days. One morning I went in to do my routine physical exam and check up. I asked Bud how he was, all he said was, "I wish you guys would catch whatever bug it is that you are chasing with those antibiotics." He told me he was having trouble sleeping because his wheezing was so loud. I got my stethoscope out, placed it on his chest. It was terrible. Diffuse expiratory wheezes. No improvement from the previous days. I was getting discouraged. He should've been doing better. While I was moving my stethoscope from the left to right lung, Bud started to cough. I pulled back to let him finish, and when he stopped coughing, his breathing was quiet. I put my stethoscope on his chest... clear. No wheezes. He looked at me and said, "Hallelujah, you done cured me!" I started laughing and my knee jerk response was, "Praise the Lord..." I didn't really cure him. He still had congestion in his lungs. But his breathing improved because the wheezing was gone. It wasn't me that did that. I do not have magical healing power in my stethoscope. But I do know the one who heals illnesses with only a spoken command, the touch of his garment, or by inducing a lung clearing cough.
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Since I learned so much about people these past two months... I thought it would be appropriate to put pictures of people on here.

Here are a few pictures I stole from my family off of facebook.

First: Madison by Blair Jones
Second: Hayden, the piano man by Blair Jones
Third: Madison and Hayden by Blair Jones
Fourth: A Man's Man by Nicole Cox
Fifth: Tough Game by Kyla Holcomb
Sixth: Seester!! by me

Galatians 2:20

Life has been crazy since my last post. I am on medicine at the VA hospital now and I am on call every 4th night. Since then lots of things have happened... I attended two funerals. I started wedding registries at 3 different stores. I went to the delta three times. I shopped for and picked out a new vehicle that has not yet been purchased. I picked out the suits and ties for the my groom and his groomsmen. I got my fantasy football league kicked off. I presented a patient in chairman rounds.


And my to do list seems to grow faster than I can mark things off...

Sometimes I get so bogged down with all I feel that is required of me. Being a student doctor, being engaged and planning a wedding, being a friend to friends just as busy as I am, being a sister and a daughter and a cousin, being a good neighbor, being a part of different committees and school groups, being a church member. I have so many identities and titles... and I want to be the best I can be in all I do.

Sometimes I need to be reminded of where my true identity lies, and that is in Jesus Christ. The basis of all I do is fixed on the cross. I am a CHRISTIAN student doctor. We are a CHRISTIAN engaged couple. I am a different creation in Christ and it is him who lives in me and through me. I forget this when I get busy, but when we are busy is when we need this the most. If we rely on Christ, we won't get as bogged down because we realize that it isn't all on our shoulders to carry. Christ is carrying our burdens for us. Our duty is to live for him in all we do and he will bless our efforts.

The only thing that is required of me is to live for Him. He takes care of the details for me.


These pictures are by the famous Mississippian author Eudora Welty. She's one of my favorites.
1.) "Home by Dark"
2.) Ruins of Windsor
3.) The origin of bottle trees...

Strapping on the gloves

The time period between when you find out you or someone you love has a lesion that is highly suspicious for malignancy and getting the biopsy results back is super stressful. When you get the call that confirms your worst fear and dashes your highest hopes... It’s hard to hear. You heart races, your body goes numb, your thoughts trail off. It is really happening. What you hoped your family would never experience is meeting you head on. After the initial shock, your mind switches gears. You begin to strap on the gloves and get ready for a fight. My mom was diagnosed with thyroid cancer last fall. I can vividly remember standing next to her as she got her biopsy done. I can remember exactly where I was and what time it was and where I was going when my dad called me back to give me the pathology results. As a medical student, I had access to tons of academic papers and resources. I had done my homework. When I read the path report, I immediately knew the prognosis, the 5 yr survival rate, the 10 yr survival rate, and the treatment and its side effects. Mom’s cancer had a straightforward treatment with little to no side effects and a low metastasis rate. Her 5 year survival was 99% and her 10 year survival was 95%. But those numbers finally hit me across the face. 95% doesn’t mean that someone was just 5% dead and 95% alive. It meant that out of 100 people, 95 were 100% alive and 5 people were 100% dead. Statistics don’t mean a thing when it’s your mom. The statistics don’t care who that 5% is.

God worked in and on me a lot last fall. I learned to trust in Him for outcomes. I learned that He creates the statistics. I learned that He does indeed hold us in the palm of His hand. I learned how powerful prayer is. I learned how He provides peace in a storm. I learned how He turns fears into triumph. I learned from my experience, and I didn’t forget.

Mrs. Babydoll (I’m going call her that because I can’t use her name that is what she called me) was a sweet old black lady with a voice that was deepened by 55 years of smoking. She was THE BEST patient I’ve had this month. She was so nice and cooperative, except for when we were telling her she had to quit smoking. Mrs. Babydoll had a grandson that was tall, strong, and built to play football. He was tough on the outside, but you could see the pain in his eyes of seeing his grandma lay in that bed and not being able to do anything about it. It’s a man’s intrinsic nature to want to fix things and protect their family. He could do neither in this situation. He was helpless, and he was very uncomfortable with it. He begged me to make her stop smoking. I did my best. I told her what it was doing to her lungs. I told her the cigarettes were the reason she was going to be wearing an oxygen nasal cannula from now on. I told her that if she lit a cigarette while she was on that oxygen that she would blow herself up. She laughed, said “Well, we wouldn’t want that to happen would we baby doll?”

We fixed the problems Mrs. Babydoll had when she came to the hospital, but there were some additional weird findings on her physical exam that just weren’t adding up. The diagnosis and treatment did not explain these symptoms or their spontaneous resolution. Cancer does weird things and given her smoking history, we decided to do a CT scan of her chest, abdomen, and pelvis just to make sure there wasn’t something we were missing.

The next morning, I went to the hospital and did my morning routine. I checked all the imaging, tests, and labs on my patients. I saw the report had been finalized by the radiologist and my heart sank as I read it. I knew, given her history and the size of the mass, that the odds were stacked against her. We went in to visit her and tell her that she was going to go home that day but she had to get a biopsy before she left because we had found a mass. Her expression went flat. I could tell she knew. She knew it was probably cancer. She knew it was probably from the cigarettes. She knew that her days might be numbered. I bet you that her heart was racing, her body was numb, and her thoughts were trailing off. The smiling, jolly lady I had gotten to know was sitting fearfully facing an uncertain future. As we walked out of the room, I smiled and gave her hand a squeeze and told her it was a privalege taking care of her. She winked at me and told me to be good and thanks for everything.

That was about a week ago. Her biopsy results came back today. The prognosis is not good for her, but I bet you she already strapped on her gloves.

I can’t help but ask… Does Mrs. Babydoll have Jesus to carry her and her family through this?
That question raises other questions…. Why do I have to wonder about that? Why don’t I already know? Did I miss an opportunity?


Highway 61 blues...
I miss home.

A Voice for Misses

Neuro rotation has come and gone. It was only two weeks, thank goodness... It was not my favorite rotation by any means. The stories were so sad. Stroke patients. ICU. Severe brain injuries. Brains aren't like bones and muscles; they don't heal quite as well. These injuries are debilitating and permanent. There is some recovery, but its slow and frustrating.

I wanted to tell the story of a patient I had. I can't use her name, so lets just call her Misses. Misses was such a sweet lady. I was on call during the week, and she came into the ER with stroke symptoms. I did her exam and helped admit her to the hospital for observation and tests. She was my first patient in the hospital to follow from the begining and I followed her the whole time I was on Neuro.
The exams and tests showed that Misses had a stroke that left her paralyzed on one side and unable to speak. She was fully aware of what was going on. She knew she couldnt talk and she was frustrated. She answered yes or no questions. She could write her name on a piece of paper for you, but thats it. She couldn't write anything else. She couldn't get her brain to communicate information the way she wanted. Misses knew what she wanted to write and wanted to say, but she couldn't make it happen. The tears on her cheeks were evidence of frustration and fear.

The doctors really irked me when they were taking care of Misses. They talked across her bed about her like she wasn't there. I wanted to tell them, "SHE CAN HEAR YOU! Just because she can't talk, doesn't mean she is deaf!" When they asked her to do things she didn't cooperate with them like she did with me. She wouldn't smile her shy, toothless (but beautiful) grin for them, but would for me (that is a test for some of the cranial nerves for all you non-meddies).

Why did she cooperate with me? I didn't talk over her. I knew Misses could hear me and I acknowledged it. I saw her every morning before the doctors came in and in the afternoon before I left. I talked with her family on the phone, got to meet them in person. I adjusted her bed for her. I covered her up. I put on her socks. I turned up her tv. I got her some water. I asked her questions about her granddaughters. I treated her like a person, not a patient. Like family.

One morning during rounds with the attending (the boss doctor), we went in to see Misses and when they left, I realized that her tv controller/call nurse button was not within reach, her feet were uncovered, her tv was muted. I went back in and covered her up, she smiled, as in to thank me. I put the controller in her hand and showed her how to work it. She nodded her head and grinned again to thank me. I don't know why, but I asked her, "Misses, are you a church going woman?" She nodded yes. "Do you pray?" Yes. "Would you like me to pray for you outloud?" She grabbed my hand and squeezed and shut her eyes. I prayed over Misses. I prayed for her tongue to be loosened. I prayed for her healing. I prayed for return of strength and function. I prayed for her family. When I said amen and opened my eyes, Misses was crying. I wanted to say something, but there were no words. I wanted to stay, but I couldn't. I just smiled and said I would be back later.

I tear up thinking about that experience. Misses is basically locked in her own body, unable to efficiently communicate. She has no voice. That day, I got to be her voice.

The idea of "voice" has stirred my mind greatly. What am I using my voice for? How many of my words every day are useful? How many are pointless? Do my words tear down people? Do they help build people up? Would I be better off with no tongue? I think some days I would. Since I have the privalege of having a voice, I should probably just learn to use it properly as Solomon describes all throughout the Proverbs and James describes in James 3.

Proverbs 21:23
James 3:5-10

A Favorite Picture of mine:

Complements of My Aunt Kyla Holcomb.
Old Highway 1