Just Be With It

Yesterday was a bad day… It’s a really long story, the kind that requires knowledge of the background situation and a good handle of what my day-to-day job entails.

Originally, This blog entry included all the details of what happened. I decided to delete it all though, because it just made me feel so bad and I don’t want to give the situation that much power over me.

Ultimately, I received a poor evaluation for my last rotation before El was born. This shocked me for a number of reasons, but mostly because I felt that the rotation went very well and was no different than any other rotation I’ve done.  Also, at no point during the rotation did anyone tell me that they thought I was acting or performing so far below their expectations that I deserved to fail. In fact, I only ever got positive feedback from people.

I know this evaluation is inaccurate and untrue. I have my beliefs as to why this may have happened and I have started the process of appealing the evaluation. Regardless, it made me feel horrible about myself and it made me feel completely helpless in the face of the guy who seemed more than satisfied to give me a failing evaluation.

In light of my recent feelings of inadequacy at home, this certainly didn’t make me feel geat about myself at all.  I am trying to do a good job of everything in my life and I feel like I am falling short everywhere (even if I’m technically not). It just constantly feels like I’m doing something wrong.  This meeting completely ruined my day yesterday, and it ruined my night. I am trying hard not to let it ruin my whole week.  While this situation does need to be sorted out and rectified in some way, I’m going to try hard to just “let it be.”  There has to be something to learn from this situation.


(Thanks to a wonderful blogging friend who posted this image on that other big social networking site… I needed to see this today)

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Start From What You Know

b0446333f9307d0fc1fb22570b6c6885Over a year ago, when A. was diagnosed with autism and I took a month off work, I bought a puzzle because it “spoke” to me.  It was my goal to finish the puzzle that month.  Unfortunately, it didn’t happen: The puzzle was more challenging than I anticipated and I just didn’t have enough time. I stored the partly completed puzzle under my bed and worked on it when I had time.  A few months ago, though, the kids had some friends over and they were playing hide and seek – and under my bed was a perfect hiding place.  The puzzle was ruined.  I packed it up, preserving the assembled parts as best as I could and stashed it away.
A few weeks ago I decided to re-start the puzzle.  I started by counting pieces and I was disappointed to realize that I was missing 10 pieces.  I counted again.  Still missing 10 pieces.  How could I possibly think they would all be there?  I was saddened, as the message of the puzzle spoke to me and there was something inside of me that felt a sense of disappointment that this puzzle would never be completed and eventually hanging on a wall in my house.  I remembered buying it at a local bookstore, so I set out for a walk with baby El to see if they still carried it… but they didn’t.  I eventually found it on their website, on clearance for $10, so I snatched it up.  That small part of my inner being felt satisfied.

The puzzle arrived yesterday and I was eager to start working on it.  I began sorting the pieces and I immediately remembered how challenging the puzzle is.  I felt disheartened thinking about all the work I had done before that was now wasted:  There was the actual assembly of large chunks of puzzle, but there was also the immense work of sorting pieces.  There are only 2 colours: black and off-white, so sorting came in the form of the size of print.  Hours of sorting – gone.

With the new puzzle, I knew there was only one place to start – placing everything out in the open.  I proceeded to filter out the edge pieces… the only pieces that have a definite position in the puzzle, and the only pieces that are almost predominantly black.  And so, I put all the sadness of what I had done and lost previously behind me and I started again.  I started with what I knew to be true and I will only work forward from there.

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Looking at the Stars

“We are all in the gutter, but some of us are looking at the stars.”
~Oscar Wilde

From The Old Blog, November 18, 2015:

This quotation makes me think of the scene in “Forrest Gump” where Forrest asks Bubba to lean up against him so they could support each other while they slept: “you lean against me and I’ll lean right back up against you and that way we don’t have to sleep with our heads in the mud.” After a few of these nights of sleeping upright against each other, the rain suddenly stopped, the sky cleared, and the stars came out… And Forrest thought of Jenny.
I couldn’t find a great image of that scene, but I found this small collage of pictures from the torrential rain during movie’s rendition of the Vietnam War. One day it just started raining and it never ever stopped. There was sideways rain, and downwards rain, and rain that even seemed to come from below. But no matter how much it rained, it did finally stop and since his head wasn’t stuck in the mud, Forrest was able to see the stars.

Last year I wrote about how I was stuck in the gutter – not necessarily looking into it, but stuck in it.  As a result, I was not seeing, or even looking for, the stars.  This year I am happy to say that I am not in the gutter.  I don’t even feel like my feet are dragging in the gutter.  I may not always be looking at the stars, but at least I am closer to them this year than I was last year.

On additional difference from last year, as well, is that I focussed much of this post on telling my friend that I admired her for always being the one looking at the stars.  Knowing what I know now, I don’t know if I would say that is always true.  I’m not sure exactly what I mean by saying that; perhaps I just don’t necessarily think that this old friend was always doing the right things or making the right choices.  That could just be my hurt conscious talking after she decided to delete me from her life, but I think it’s more than that.  I think I used to admire her and set her on a pedestal that was unrealistic.  After having time to reflect on everything that has happened and what her role was in my life, I realize that I had many ideas about her that were unrealistic.  Anyhow, this is again, a digression from the point.

The most important fact here is that I have spent much more time in the past year out of the gutter and looking at the stars.

The Story of Ms. Jones

“Life isn’t fair.
It’s just fairer than death,
That’s all.”
~William Goldman

We were about to round on Ms. Jones (not her real name).  I admitted her the other night after she fell and was found in her bathroom by the aides at her assisted living complex.  She was lucky: she didn’t break any bones despite the grapefruit sized hematoma that was forming over her left hip.  I learned from the emergency room chart that she was a relatively healthy 95 year old lady with a history only significant for hypertension and atrial fibrillation.  I tried to go talk to her and do a physical exam, but she was grumpy and drowsy and wouldn’t cooperate (in her defence, it was maybe 3am and the emergency physician had just given her some dilaudid).  I filled out all her admission paperwork and scanned her home medication list.  I opted to continue her medications for hypertension and her aspirin, but since her hemoglobin had dropped during her stay in the emergency room from 108 to 86, I thought it prudent to hold her anticoagulant (blood thinner).

When we walked into the room that morning, I was pleasantly surprised to see a well groomed, alert, and very proper English woman sitting up in bed and eating her breakfast.
“Good Morning Ms. Jones,” my staff said.  “We are your team of doctors and we are here to see how you are doing.”
“Well, if you want to know about my pain, it is okay.  But if you want to know how I’m doing, well I’m rather upset that the nurses won’t give me any hot water for my tea.”

It turns out there was a communication error and the nursing team believed that Ms. Jones was on a thickened fluid diet to minimize the risk of lung aspiration.  As this diet is quite common in our patients, we continued to explain to Ms. Jones the rational behind why she wasn’t allowed to drink her tea.
“Well, that just ridiculous!  I was just drinking tea the other day and I certainly didn’t choke on it.  I don’t see why it is any different today.”
We offered to place Ms. Jones on an “at risk diet” if she insisted on drinking her tea.
“Well doctors, I am 93 years old.  What do I have left in my life if I don’t take risks?”

She had a point, I guess.  We proceeded with our rounds, ordered the necessary tests and continued on with the day.  We thought about re-starting Ms. Jones’ anticoagulation, but her hemoglobin was down to 80, so we held off and sent her for a CT scan instead.  The results came in later that day and there were no identified areas of internal bleeding.  We decided we were going to restart the medication the next day.

When we rounded the next day, we visited Ms. Jones again.  She was happily eating her breakfast and drinking her tea.  She complained that she had been feeling increasingly weak over the past month and attributed her fall to that weakness.  She commented that it was just part of getting old.  Regardless, we asked for a physiotherapist to help Ms. Jones with her mobility and assess if she needed any aids.  As planned, I wrote an order in the chart to re-start the anticoagulation.  It was all ready to go, but we all suddenly felt uncertain: She had only been off of it for 3 days.  Why not wait one more day and make sure her hemoglobin remains stable?  It is a delicate balance trying to decide how to manage these medications for a person with atrial fibrillation who is also at a high risk of bleeding.  Without the medications, there is a chance that the heart can throw off blood clots that can cause a stroke.  With the medications, however, it becomes difficult to control andy sources of bleeding.
Later that afternoon, I passed by Ms. Jones walking with the physiotherapist and a walker down the halls of the unit.  She smiled at me, and I smiled back.

The next day was Friday and we started rounds in the same way we always do.  Our team was a little smaller, so we divided up the work and moved a little faster so that everything would get done.  We got to Ms. Jones’ chart.  The physiotherapist was convinced that she would safely mobilize with a walker.  Her hemoglobin had been stable over the past 36 hours, and from all other aspects, it seemed like she was ready to go home.  We walked into her room to tell her the good news.  However, Ms. Jones was not sitting up in her bed eating her breakfast.  Instead, she was laying with her head cocked to her left side, her right leg flexed and rotated to the left, and her right arm motionless by her side.  We said hi to her but all she did was moan.
“Ms. Jones, are you alright this morning?”
She just moaned again, this time louder and more persistently.  I went to her left side and looked at her.  She wanted to say something, but all she could do was moan.  She reached for the ID badge dangling from my neck and looked at it.  Then she looked at me.  And she moaned again.  My staff had already left the room and was on the phone with a radiologist requesting a STAT CT scan.  But we didn’t really need it to know that Ms. Jones had a stroke, likely sometime overnight.

By the time Ms. Jones’ sons had arrived at the hospital, the results of her CT scan were back: Large right MCA territory infarct.
We explained to her sons what this meant and that given her age and the size of the stoke, she likely had a poor prognosis.  We explained the options for her further care and it didn’t take long for them to both agree that their mother would not be happy living the way she was now.  The felt that if their mother could talk to them, she would say that it was her time to go.

And just like that, we consulted palliative care for Ms. Jones.  We discontinued all her therapeutic medications, and ordered all our comfort care measures.  She was moved to a private room.  And ever since that day, there has been a constant bedside companion from her family present.  I know this because I visit Ms. Jones multiple times a day.  She knows who I am and she smiles at me when I tell her that I’ve been thinking about her.  Every day she looks more and more like it might be her last day.  But every morning her name is still on my list.  So I go back to visit her again.

It was the day we were going to send her home, and instead it became the day that determined her death.  It isn’t fair.
Ms. Jones was such a fun. happy, feisty little English lady who probably had a few more good years ahed of her.  But our medical care failed her and now she is dying.  Life isn’t fair.
Every day she slips further and further away.  She spends less time awake and I spend more time talking with her family members.  They tell me stories about their mom and it makes them happy.  Then they turn at look at their dying mother asleep in her death bed, and their voices stop.  I let them cry and I place my hand on their shoulder for just the right amount of time.  Death is not fair.

I decided to share last year’s blog post in it’s entirety.  The remains poignant and I still think of Ms. Jones, to this day.

Everything Left Behind

 Starting from the beginning is hard to do, especially when there is so much that is being left behind.  My old blog was my sanctuary and I am bitter to leave it behind.  For three and a half years I gave everything I had into that blog and I loved every minute of it.  I wrestled with many challenges and worked through them with the help of my amazing blogging community, and I am sad to leave them all behind, too.

I am trying to offer myself some comfort in knowing that despite leaving the physical blog behind, I am still taking with me all of the lessons and experiences I learned from there.  Life is not always strong, beautiful, and fearless, but I have become better at being those things because I have experienced those difficulties that challenge those notions.  While I hope to blog in a similar way to my old style, I have made it a goal to learn from the experiences I’ve had over the past three and a half years and move forward with a new beginning.  Perhaps some snippets from my old blog will make occasional appearances here – and that’s because that blog will always be a part of who I am today