Thursday Born

The everyday life of a psychiatry resident (who was born on a Thursday).

Archive for January 2013

“My First Death”

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I went to a special grand rounds in the pediatrics department yesterday, and the topic was “My First Death.” It was a panel of five people, plus the doctor in charge of the pediatric palliative care service in the children’s hospital. Each of the five told a story of their first patient death in their current roles,  and then the floor was open to questions, or for other people to share their experiences. I’m not an easy crier, but I admit I came close to tearing up at least once or twice.

The idea of my own death still terrifies and confuses me on some level, but at the same time I am very aware of the inevitability of death, and of the extended process both dying and grieving can become. It’s interesting to me how little we talk about death in the US. When I lived in Ghana, I was confronted with death more often, but these days I think if I wasn’t in medicine, it’d be fairly easy for me to only think about it on a very superficial level.

I feel a little self conscious sometimes when talking to people outside of my family and classmates, especially on my more bleak rotations. I feel like it’s inappropriate for me to share what I’ve been going through and thinking about, like finally writing up my advance directives and assigning at least one or two medical powers of attorney, or how interesting it is to see the variety of people who are the ones standing by someone during their most trying and difficult times (sometimes not even family or romantic partners, but people whose lives have become intertwined in unusual ways), or when the death or illness of a child precipitates the end of a marriage, was the divorce inevitable someday or would they have stayed together otherwise?

I worry that speaking my mind is being a Debbie Downer, that people don’t want to hear about these things. That the stories that I find almost uplifting in a bittersweet way, like the attending who told the fellow to stop CPR so that the baby could spend the last moments of its very brief life being held instead of being pounded upon, will simply be depressing.

What was my first death as a medical student, by the way? It depends on how you define it. Was it the patient in the Emergency Department that my resident wanted me to try CPR on (I don’t remember why exactly I didn’t “get a turn”) but who everyone was just waiting to pronounce dead? Or was it the patient I followed my entire four weeks on the general Internal Medicine rotation who we had nothing left to offer and were sending home with hospice? (Or the one I had for two days who we also had nothing left to offer and also sent home with hospice? He probably actually died first).

I’ve never had a patient die in front of me, but I’ve known quite a few patients, quite a few people, adults and children both, who either died soon after I met them, or who I know will die within another year or two.

I don’t have a specific point to this post. I think that mostly I’m wondering how much it’s okay for me to talk about these things, because they’re on my mind often, and dying, death, and grieving, are all a big part of living, as much as we really don’t want them to be.

Written by Aba

January 29, 2013 at 6:24 pm

Coping with Grief

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I think that one of the reasons I’m taking this Pediatric Palliative Care rotation is because I don’t really know what to do when people, patients or their loved ones, are grieving. I don’t know how I’m supposed to talk to them. I don’t know yet when it’s okay to keep talking and when I should be quiet, I don’t know when I should leave or when I should stay. I know I won’t be able to learn all this in just four weeks, but it’s a start.

We, people, don’t talk much about grief. And when we do, it’s mostly in the context of death, not in the context of the ongoing loss that is associated with, for example, a severely ill loved one. Today I watched a young couple grieve after learning that their baby would be incapable of even the most minimal definition of meaningful life (severely under-developed brain), but as difficult as that was, it doesn’t compare to the numerous times I’ve been around parents caring for chronically, tragically ill and/or disabled children. They did not plan for this. Most people don’t ever think of the possibility of this becoming their life. And the available resources for assistance at home (or long term facilities where their children can  live) are pitifully lacking. I know I see them at their worst, when their child has landed in the hospital, again, or when they have just learned of the enormity of their situation, but still, my heart breaks for them.

I’m hoping this rotation will give me some beginning insight for how to better interact with these families. It is not, never has been, enough to sympathize with them, if I don’t know how to show that I am thinking of them. That I am proud of them for doing what they can, for living each day, for still finding things to smile and laugh about with staff. Even if there isn’t anything I can to do fix, or even help their child, there has to be some way I can be someone who adds something, however small, to their life. And if there isn’t, then I want to do what I can to minimize my footprint, to not take anything away from them.

I don’t want these families to fall into the same category as “starving children in Africa.” I don’t want their place in my life, in my work, to be a simple reminder that there are people out there dealing with harsher realities of life than my mundane concerns. And I don’t want to minimize their lives to this one thing, however big and consuming it is, because they are more than the parents of a sick child, just like Africa is more than just a continent full of corruption and poverty.

It feels somewhat trite writing an entry about this, almost like I’m exploiting their situation to write a good blog post. But these families do affect me, and there are many I will never forget. Not all these memories are sad either; some are bittersweet, and some are actually downright pleasant.

Written by Aba

January 17, 2013 at 7:26 pm

Winding Down

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The end is in sight! 60 days till my Match Day, and exactly 12 weeks left of rotations. Today I started Pediatric Palliative Care, then I have Special Topics in Reproductive Health, and then I end with Dermatology.

I still have Step 2 CS to take (mid-February, unless I find an earlier date that has opened up), and my Dermatology rotation has a small test at the end, but I’m essentially done with the more stressful parts of medical school (minus the match, which is a different kind of stress; it’s more just disorienting).

There’s two other medical students on my current rotation, and I hadn’t realized it, but I had missed being around my peers. I’ve been mostly on my own during my rotations this entire year, with just a few exceptions. It’s nice being able to commiserate  about things like Step exams, and being behind on thank you emails, but it’s also nice for the shared joy aspect, because we’re all very excited about this Pediatric Palliative Care rotation (strange as that may seem).

Here’s to another exciting four weeks!

 

Written by Aba

January 14, 2013 at 6:04 pm

Happy 2013!

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I’ve been looking forward to and wondering about this year ever since I realized it would be the year I graduate from medical school. So hello 2013! Welcome to existence! I’m going to try to savor each day, but don’t mind me as I continue to count down to my match day (73 days) and my graduation (136 days).

I don’t have any specific resolutions this year. I think I did a good job with 2012, especially given its rampant stressors, so my goal is to just keep doing life better. Keep trying to be more mindful by continuing to do things like culling my possessions, and re-adjusting that tricky work life balance problem. Eating better. Exercising. Reading more. Spending more time connecting with loved ones. The usual. :)

I hope this is a good year for all of you, dear readers, especially my fellow fourth years! I hope we all match in places that we’ll be pleased with.

Written by Aba

January 1, 2013 at 8:05 pm

Posted in Medical School

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