Goodbye, Mrs. W

Did I say that I enjoyed gyn/onc? I spoke too soon.

Mrs. W is a fiesty, strong-willed 68 year old woman who reminded me of my own mother. She had an ovarian mass that we surgically removed. Unfortunately, we didn't help her at all. It turns out that Mrs. W has a metastatic GI cancer that is going to kill her in a few weeks.

I had grown to like Mrs. W during her hospital stay. I will never forget the day she got her prognosis. The gynecologic oncologist, the medical oncologist, the chief resident and I all crowded into a small room with Mrs. W and her daughter. With a flinty stare, Mrs. W asked the doctors to be complely straight with her about what was going on. They were. She seemed to take the news rather well, considering. Her daughter, however, fell to pieces. As my eyes welled up with tears, I fought hard not to follow suit. I was suddenly transported back to my father's losing battle with prostate cancer. At that moment, my professional veneer slipped and I was no longer a doctor. I was a daughter facing the loss of a parent. I hid behind the medical oncologist and stared my tears away.

After rounds I slipped away to my call room and cried like a baby.

The very next day, as if by magic, all five of Mrs. W's daughters appeared in her hospital room. They had come at a moment's notice from all over the country, leaving jobs, husbands and children behind. That morning, the mood in the room was surprisingly light. The daughers were cracking jokes and I could see they had inherited Mrs. W's sense of humor. I did see one daughter's face crumble once when she thought no one was looking, but she made a quick recovery. When I left the room, I noticed that one of the daughters had posted a hand-written note on the door:

"Outside this door we may fall apart. But inside these walls we will be a source of love, encouragement and support."

After that, Mrs. W was never alone for a single moment. Her daughters kept a bedside vigil, even spending the night in her room. They worked shifts. I would see a different daughter every morning and several of them in the afternoon. After my daily physical examination, a daughter would follow me outside of the room and ask questions. Sometimes the daughter would cry and I would struggle not to do the same.

Today, we discharged Mrs. W from the hospital. She wanted to die in her own home.

As strange as it may sound, there was beauty in this experience. As an Ob/Gyn resident I spend most of my time witnessing birth, not death. For me, the joy of delivery is being in the presence of family love as they welcome a new member. The way that Mrs. W's daughters surrounded her with love was as moving as watching new life enter the world. May we all be fortunate enough to die in the same way.

Goodbye, Mrs. W.

gyn/onc

My current rotation is oncology. I thought I would really hate it, but truth is I love it. It's not nearly as depressing as I thought, and since the patients stay in the hospital for longer than 2 days we get to know them pretty well. They can be difficult and high maintenance at times, but if you had metastatic cancer you would be difficult, too.

One patient is this 68 year old woman with metastatic cancer and no one knows where the primary cancer is. The chemo won't start until they have some idea what they are treating so that they can choose the most effective agents. Until tumor cells are identified, she will just be waiting. She and her daughter are full of questions, and they ask the same questions every day.

Q: "What is the plan now?"
A: Same as yesterday.
Q: "What are we waiting for?"
A: The final pathology, same as yesterday.
Q:"Should we get a second opinion?"
A: If you like, but you might want to wait until there is enough information to give one. You don't have a first opinion yet.
Q: "When will I be able to go home?"
A: I don't know.

And so on.

I really like this patient. She reminds me of my mother. One of the residents on the service is named Watson, and she can't resist saying "Dr. Watson, I presume" when she sees him. My own dear mother would say something corny like that, as will I if I'm lucky enough to live as long.

It's fun dealing with older patients. Until this point, the vast majority of my patients have been reproductive aged women. Older women are cute. They are formal and polite and they love to talk. One of them insists on calling me "Brenda" (not my name) and after correcting her a few times, I stopped trying. It's kind of funny. She even introduced me to her husband as "my friend, Brenda" and I just smiled and shook the man's hand like that was what my mother named me. Hey, she's old and she has cancer. She has enough to think about without trying to remember all the resident's names.

Overall I enjoy the mature patients, but that is not to say there are not a couple of cranky old birds in the bunch. One surgical patient with vulvar carcinoma in situ took one look at me and insisted that residents not be involved in her surgery. My race paranoia flared, and I had a hunch what that request was about. I assured her that the attending doc would be doing her surgery. She then looked me in the eye with hostility and said emphatically, "GOOD!". Naturally the residents ended up doing it anyway. I told the attending doc about her request, and he said that because he was directing the whole thing it was the same as if he did it himself. It was a simple, partial, skinning vulvectomy, something that her husband could have done at home with a knife and a local anesthetic.

sex and the single resident

I'm convinced that the real reason so many people get married during residency is not because they need companionship...they just need someone at home to write out the bills! I am late with the rent for the 100th time this year. It's not because of my bank account, it's because I can barely find the time to mail the stupid check.

Doctoring is a sexy profession. Booty is everywhere, especially for male residents. Unfortunately (or fortunately), it doesn't always feel this way because of our confinement to the hospital. My male classmates end up sighing wistfully over some cute unattainable intern like Charlie Brown's obsessive crush on the little red haired girl. Or they make lame attempts to hit on the handful of nurses who are under the age of 50 and single. They don't seem to lust after our clinic patients because 1) (hopefully) they realize that it would be highly unethical, 2) many of the clinic patients have multiple social issues, and 3) no one is quite as cute when you know they have chlamydia. One of my classmates confided that he cheated on his long term/long distance girlfriend with *gasp* a medical student, which is super inappropriate. But perhaps if more residents slept with the med students we would get fewer complaints from students about OB residents being so bitchy. Just kidding. Sort of.

The female residents who are not married are also quite vocal about their lonliness. More than a few have signed onto dating services on the internet. As a group they can be anal retentive which of course prompts my male classmates to speculate about how much more pleasant they might be if they were getting some. Sexist, but occasionally amusing depending on how much I like/dislike their target du jour.

I signed onto one of those dating sites a few months ago and met Jeff, a nutty pseudo-Rastafarian. He was reasonably intelligent, but a tad bit off the deep end on the afrocentric tip. We had a few dates then parted ways amicably. I abandoned that online stuff because even that took too much effort, and most dudes online seemed to have a hard time expressing themselves in writing. All I can say is "RIF": Reading Is Fundamental. From what I've seen that campaign needs to make a comeback.

I've been getting random collect calls on my voicemail from a local prison. Maybe it's a wrong number. Maybe the guy just likes my voice. The calls sound like this:

Recording: "You have a collect call from..."
brotha's voice: "Mookie" (more urgent) MOOKIE!!!!"

My future husband, perhaps. I wonder if Mookie can pay his bills on time.

I had a good day today. I didn't screw up in the OR, my cases went well and my upper level residents behaved themselves.

diversity

Last night the residents gathered for a retreat. An intern brought up the issue of the horrible attitudes some residents have toward our clinic population. No one really heard her comment. The chiefs immediately got defensive and nothing was accomplished. However, I'm really glad she voiced an observation that has been made by many, including myself. The truth is, the residents talk about our clinic patients as though they were something less than human at times. It's true that some of our patients can be challenging to deal with because of their social issues, but there is really no excuse for the racist and elitist culture that permeates this program. I have never been in an environment where such hateful, disrespectful speech is tolerated.