The real deal

I'm sitting out on my back deck with Paul Simon singing to me and the mountains hidden in darkness on three sides beyond my cute neighborhood. Happy birthday to Jill who is now asleep because she's on call tomorrow morning. My sweatshirt smells like the fire I've been sitting around for the last few hours celebrating her birthday, playing hilariously dangerous dusk baseball, and sharing beers with First Hill and Cherry Hill folks at Golden Gardens, a beautiful beach overlooking the Olympic peninsula. I can't believe I live here.

OK: Learning to be a good doctor is really hard; that's now a given. What did I actually expect? I don't think I thought much about the specifics of it, which is strange. I found out where I matched on my way to Africa, a pair of months which blew my mind to such a wonderful, global awareness mind-fu@k degree that I thought about little but AIDS, the wonderful people dying of its indiscriminate reach, and the ways I could learn to help. My sense of doctorhood grew beyond any Paul Farmer dreams I had for myself into something totally UNdreamy and core-dedicatedly and life-span-exceedingly passionate. That's a lot to experience in a couple months (refer to previous posts for the blowing of my mind) and I didn't find many ways to anticipate residency while learning to treat and just BE WITH patients dying of pericardial effusions from tuberculosis or AIDS-associated cryptococcal meningitis - oh, sweet boys! I wish that learning how to dose and administer IV fluconazole had done more, but medicine is too late. Then I flew back for a whirl-wind party, packing, and graduation-filled short week in Boston, hung with my week-short-of-adolescence brother, welcomed my high school friend's baby into the world, and drove everything I thought I needed across the country in three and a half days to the other side of this massive continent to meet my future. This all sounds super dramatic... but it was. really. This is a whole lot to ingest. I was about to say, "I've been wondering if I enjoy stability or if I prefer to thrive on change" but the truth is I haven't wondered much of anything for a while. I'm a wondering kind of person, was a kid who thought too much to the point of others' nausea and my own exhaustion until I learned to temper it for the sake of functional human life. I baffle myself still, though, driving myself semi-consciously towards busy situations in which I'm forced to live in the present but yearning at all pauses for a more contemplative existance. I think this is my lot and I think I love it, find a mostly-beautiful balance of practical productivity and romantic thought, and cherish the people who can appreciate that in me.

Last night I was on call and a 55-year-old woman came into the emergency room. 2 and a half years ago she noticed a lump in her left breast. She had stopped using heroin heavily 15 years before, was periodically homeless, and was (and still is) a fiercely independent and hilarious woman. She declined treatment after receiving a tissue diagnosis of invasive ductal carcinoma. Two years later -- last October -- she was in a great deal of pain from the tumor growing in her breast and made a rare visit to a doctor. This oncologist got a PET-CT scan and saw 10 little metastases light up in her lungs, gave her a lidocaine patch for pain and scheduled a follow-up appointment to start palliative treatment which she decided not to keep. She spent this last winter and fall living with her boyfriend, occasionally hussling for heroin for pain control, and taking in homeless people to feed and house. She feels confident that, in her afterlife, she will return to be guardian angel to these people. Two days ago when her sometimes estranged but loving daughter visited her, she was house-bound with a productive cough and a 10 centimeter tumor splittling out of the skin and oozing pus onto her chest wall. The pain had become too much and she agreed to come into the hospital. It's late now, after a long week, and I don't have enough energy to give this story right now, but I'm swimming in sadness and admiration for this woman. She wants me to control her pain and her cough and allow her to die at home with sufficient lucidity to know what's going on and to say goodbye to her family. When I met her, surrounded on all sides by her family, I felt a barely-containable rush of the heat of emotion surging through me. I saw my role, saw that I could help this funny, tough woman exit life on her own terms and felt desperately sad and deeply touched that she was trusting me with this job. She doesn't have a doctor and she would love for me "more than anyone in the world" to be her doctor while she dies. Good lord.

So glad I have tomorrow off to mountain bike, try to catch a Sounders soccer game, cook a real dinner, clean the bathroom, and get a good sleep. Good night.