Death

Today I watched the huge maple across the lane
It’s leaves falling to the ground, the colour of flames
A few days ago it was a ball of fire, now death has crept over it
Beginning at the top, the branches are undressed of their glory
And stand like skinny naked sticks defying the gray sky
It is so complete, this death.

A few days ago my patient died in the hospital
I was with him before he went, sitting on the edge of his bed
In front of my very eyes I watched him diminish
I asked a question and he looked up at me once
And I was shocked to be confronted with the yawning pools
of blackness that were his eyes

Some deaths, I have heard, are noble and fine
The pain is no less, but there is some measure of hope
To sustain the one who is confronted with his own end
But this one was like watching him being sucked into a dark abyss
He had no family, not even one, and he knew it
I couldn’t hide in my eyes that he was dying

I wrapped my arms around his emaciated frame
As if I was trying to shield him from his death, his shame
But I cannot keep the leaves from falling from the skies
I cannot quench the scent of death, that pours from his eyes
I cannot soothe the cold finality that tears away his soul
And look inside, and speak of life, when death is knocking at the door

Forced to be real

Life is ironic and strange and humbling. Yesterday morning I had a deep discussion with my Dad and it wasn’t all that great, in fact I was extremely upset, and I went down into my room and closed the door and lay on my bed and was pretty unhappy. I heard him leave for work and I heard my mom leave and I was thinking how I didn’t want to talk to either of them, I was pretty upset and I didn’t want to be vulnerable and let them know how upset I was. I was thinking how I could possibly avoid them for the next week or so. Sometimes having someone close by who will bring up issues you don’t want to talk about is a pain. Not to mention painful.
I decided to go for a walk with my ipod, for several hours. I have a set of lectures on mp3 files and I love walking anyway so I put them in and was listening to them while I walked.
What is the nerve that is affected in winged scapula? The woman’s voice asks. There is a pause, not quite long enough for me to come up with an answer, and then the man answers, the long thoracic nerve. And on and on.
I walked for an hour. Listened to the lecture, talked to God, looked at the orange leaves falling off of trees and tried to settle my soul. Maybe I would walk all day and come home just before dinner but then leave with my sister without talking to them. Maybe I would stay out late and stay out the next day and then the next day I was working and maybe by then I would be calmer.
I was an hours walk away from home and I heard this loud noise and coming down the road towards me was a massive front-end loader with a huge scoop in the front. I had my headphones in and was in the zone but it was pretty noisy.
My parents were driving the front-end loader. I couldn’t believe it. There was no avoiding them.
“Hi, Heather!” They pulled over. “Where are you going? Do you want a ride?”
No, I don’t want a ride. In fact, I was wondering what kind of parents show up in the middle of nowhere driving a front-end loader just when their daughter really doesn’t want to talk?
“Hop in the shovel!” My Dad said.
I felt like laughing or crying, I’m not sure which. Maybe just punching something. I got in the shovel and my mom got in too and my Dad lifted us way up and started driving.
“So…. How are you doing?” My mom asked.
I am fine, I thought. Just fine. I was trying to avoid talking to you because I didn’t want to face my emotions and here I am stuck in a giant shovel with you driving down the road.
Later that night I went with my sister to a young people’s group but I was feeling sick, maybe I had a migraine, and when I got to our destination, went into the bathroom to throw up and then sat on the couch trying to massage my headache away. We had a good bible study and then afterwards everyone wanted to go make a fire on the beach but all I wanted to do was crawl into bed.
I lay in the car and tried to sleep and not think about throwing up and not think about how crazy my life is and not think about how upset I am about things and all the things that aren’t working out.
Our friend Leonard dropped me off at his house, which was near the beach, and showed me a ratty looking futon in the basement I could sleep on. He gave me some ibuprofen and water and turned out the lights and I lay on the dirty futon in the dark, so cold that I was curled up in a ball with my hands inside my toque to keep them from hurting. I was right next to the water boiler and all the pipes, and every time someone in the building flushed a toilet or something, it sounded like a waterfall next to me. I lay there drifting in and out of sleep and thinking about things.
What is the name of the liver fluke that has it’s intermediate host in a water snail?..... Clonorchis sinensis.
Why is it so hard to be vulnerable?.... Why is everything in my life not working out?.... there is a long pause, and there is no answer. Go to sleep, Heather.
I woke up this morning and the sun was shining in the window and I read in the bible, Cast all your anxiety on him, for he cares for you.
I bounced out of bed (grrr I hate that I’m such a morning person!) and went upstairs and there was my family and I didn’t really care anymore about not talking to them, my Dad had a sore knee and I took a look at it, and made waffles and did Hannah’s hair and drank coffee. Everything is going to be okay.

Helplessness

One of the things I find the most difficult about nursing and medicine is the feeling of helplessness. Today I was working (as a nurse!) and had some pretty sick patients. I went into Ben’s room sometime in the morning to find him half-way between his bed and wheelchair, about to fall on the floor. I ran over to help him and was shocked to find he weighed as much as a little child. I helped him back into bed.
“What’s wrong, honey?”
He stared up at me with dull eyes sunken into his emaciated face and didn’t answer.
“What’s the matter? How are you feeling?”
“What do you think?” He gasped between labored breaths.
Later I found him slumped over in his chair and I squatted down next to him, trying to see if I could rouse him. Had he had a stroke? I put a hand across his shoulder and felt every single bone across his back and shoulders protruding out. He was literally nothing but skin and bones. He was dying. I adjusted his oxygen mask and turned it up a little, smoothed down his shirt. I counted his irregular pulse and ragged breathing, and I wrapped a blood pressure cuff around his skinny arm. I couldn’t get a reading; it was so thready and weak and his arm was nothing but paper-thin skin stretched over his fragile bones.
“What should I do?” I asked the charge nurse.
“Do you think he had a TIA?” She asked me. (A mini-stroke.)
“Maybe….. I think he’s just wasting away.” I said.
“The doctor will be back soon.” She said. “You can get him to take a look at him.”
The only thing was, I knew what the doctor was going to do. Nothing. What could he do? Maybe some protein shakes, but Ben wasn’t eating. Maybe some pills to keep him from being agitated, but that wasn’t really his problem. He was dying, that was the problem.
Another patient that morning, Richard, had a dose of morphine due and I went to bring it to him. He was completely stuporous and I couldn’t rouse him no matter how hard I tried.
“Is he usually like this?” I asked another nurse.
She sighed. “Sometimes….. He’s up and down.”
Morphine has the effect of depressing respiratory function- in the case of giving it to a completely stuporous patient- you have to make sure the benefits (pain control and decreasing agitation) outweigh the possible risks (respiratory depression leading to death).
“I’m not giving him his morphine.” I said. “You let me know if he gets agitated and I’ll decide then.”
I wasn’t feeling well all shift and when I came off and reported to the incoming staff I felt pretty low about the whole thing. I drove home in my car thinking about Ben dying and not being able to do a single thing for him. No matter what I did, I was just prolonging his inevitable suffering. The same with Richard; nearly comatose, hardly breathing- what could I do for him?
By far the biggest thing, though, that makes me feel helpless, is my sister Hannah. Since I came back from Antigua she has been having trouble swallowing periodically, leading to choking episodes. It kills me to see her getting worse. I would do anything for her, there’s not even a question in my mind. But what can I do?
The only thing I can do is love her. Be her sister, pray with her when I tuck her in bed at night, listen to how her day at school went, be patient with her. Love her.
And that’s the only thing I can do for patients like Richard and Ben and so many others. I can give them their medications and try to treat them, but in the long run, it is the love I give them that matters.
Richard can’t respond but I like to think he can hear me when I talk to him gently as I dress him. Ben stares at me with hollow eyes but I rub his gaunt shoulders as I give him oxygen and I point out that the sun is shining outside the window and it is a beautiful day.

Talking to myself, again

This week I found myself surprisingly blindsided by the goodness of God. I don't know why I should be surprised, but I was.
I feel like in the last few months I've had quite a few knocks and I guess I was sort of expecting more, not that I think God is mean and likes to hurt me, but I've learned that his training is painful and even though I have been fighting to pray and seek him every day, to be honest, I didn't expect much in the way of answers. Oh, theoretically, I expect them. But realistically? In those dark quiet moments by myself when it's just me talking to myself? Do I honestly believe that these situations are going to work out? The answer was probably no.....
Well, this week I was praying about my financial situation (which is dismal, by the way). I asked God to provide for me and specifically, I prayed about a person who owed me a large sum of money and I asked God to cause them to pay me back. I'd already contacted this person and not heard back from them and was wondering if I should just let it go. So I prayed, and I wrote down my prayer.
The next morning I had an email from her. I bet you thought I forgot, she said, and then explained what the hold-up had been and assured me that the money was in the mail. I was shocked.
I also prayed about my practicum this week. I had called to see about my license for this semester and was told that 3 days before, the provincial regulations had been changed to prevent me from getting a license. No license= no practicum= can't pass the semester. Oh great, I thought, another roadblock. Do I always have to fight them? Again, I wrote down my prayer. God, will you work a miracle?
On Friday I met with the doctor I was supposed to work with, and I explained that I was unable to get the license I needed. Oh, that's no problem, he assured me. I'm the director for all the medical students in that area and I will just phone them up and let them know to give you a license. Again, I was shocked.
And then I was praying about another situation with a friend, that I just didn't know how to approach. I prayed and asked God for direction. Sure enough, the friend phoned, and told me exactly what I needed to hear. I was so filled with relief when I got off the phone.
Last night at about 4:30 or 5, my little niece Kiara climbed into bed with me and fell asleep in my arms, her breathing settling into that familiar rhythm while I lay awake thinking. I got up this morning after not sleeping much and was studying hard all day (Today I reviewed how to perform an abdominal and rectal exam, and I badly need some patients to practice on, so if anyone wants to volunteer.....) and I found myself getting pretty discouraged.
I was thinking about school, relationships, life in general, and feeling desperately like nothing was going to work out. Am I just fighting away at this, trying to seek God, working hard, and nothing is going to come of it? Sometimes I feel tenuously close to the edge of giving up.
I went into the bathroom and looked at myself in the mirror. “I trust the Lord.” I said to myself in a loud voice. “I trust the Lord! I trust he will give me everything that is good for me! I trust he is good! I trust that he loves me!”
I'm pretty sure that if anyone had come in the house just then and seen me yelling at myself in the mirror, they would've thought I really had gone over the edge this time.
All kidding aside, though, can we trust in God's goodness? I find it hard enough to trust in the goodness of another human, let alone a God I can't see. Does he really love me? Is his heart towards me really full of compassion and goodness?
Yes, I'm telling myself in the mirror. Yes, he is good.
Sometimes we need to speak truth to ourselves, because we forget it, or we get discouraged. Why should I be shocked by God's goodness? Why should I be so afraid that it is all a joke that he loves me and has my best interests at heart?
Get a grip, Heather! And while you're at it, get off the computer and go to bed, you silly girl!

Swallowed up in intestines

I enjoy what I'm studying and I enjoy learning in general, so a few days ago I did one of my favorite things to do and made an amazingly organized schedule for the next 12 weeks. Since I'll be in Vancouver for about another 12 weeks, and since I have a lot of studying to do, I planned out every single day and made this big spreadsheet dividing up all the topics I needed to cover for all my courses. Each reading selection for each class is in a different color, and I wrote out all the page numbers and exactly what days and weeks I would be doing them.
It didn't take long for my world to fall apart. I realized that I had forgotten to calculate Thanksgiving, Christmas or any other holidays or days off. I also forgot to calculate in my job and my practicum. Oh well, I thought, I can just work a little faster.
This week is my week to study the gastrointestinal tract and by last night I was supposed to have made it to the rectum, but I was still at the esophagus and not progressing very quickly. Did you know that it's possible to get a stone of the salivary glands that is just like a kidney stone? Did you know that 12% of European Americans and ~100% of Native Americans are lactose intolerant and can't drink milk? Did you know that the first sign of stomach cancer spreading is an enlarged lymph node in your neck?
There are so many little peripheral things to learn that it is overwhelming and I am beginning to realize just how much my schedule might need revamping.
It's a parallel of life, really. My philosophy is sort of divide-and-conquer: I like to break things up into manageable pieces and then I feel like I have a semblance of control over them and can accomplish something. It's just an illusion, though. My color-coded schedule might help me be organized in my studies, but is it really going to help me be a better doctor? Is it going to help me be a better person?
Sometimes one can get too focused on the task at hand, that it is possible to miss all the peripheral things that are actually more important than the primary object. For example, keeping to my schedule this weekend was actually not as important as spending a bit of time with my siblings from out of town. And if I'd stuck rigidly to my readings I would have missed learning a lot of things.
I am not advocating flaking out and just doing what you want, learning what you want. But schedules need to be prepared to be shaken up a bit. I've spent a lot of my life being very disciplined about studying. But I have the feeling that 20 years from now I'll wish that I'd taken an evening off and gone to see a movie in the theater or hung out more with my sisters or slept in once in a while.
Haha. To be perfectly honest I'm actually procrastinating right now. I'm sort of discouraged that I don't know everything there is to know about the intestines. But give me time. I still have 3 more days this week!

Bulbous bouffant

You seriously have to watch this crazy video. The more you watch it, the better it gets.
http://www.youtube.com/watch?v=0uuCNAwXGaQ

From a tropical paradise to the North pole

Wow, I haven’t written for a whole week!
In the exciting and sad interim I had my white coat ceremony, in which I stood up and recited the Hippocratic oath with my classmates and received a white doctor’s coat, and gave a speech in front of everyone. I also danced for more hours in a row than I ever have before; including dancing on a table in the bar during our after-party. (You should’ve seen it!)
It is bittersweet. I told myself that I would return to Antigua some day on vacation, but I know that even if I do, it won’t be the same. I said goodbye to the campus I’ve spent so many long days and nights at- the bushes heavy with pink flowers, the goats on the hills staring at me, the little white bungalows and the mango trees- a place that has stolen part of my heart.
My last morning in Antigua I got up early with my roommates and we drove to Half moon bay to watch the sunrise. We watched it come up over the ocean and streak the sky with pink and the huge waves crashed all around us and the salty spray mingled with the happiness and sadness that was so heavy in the air.
I said goodbye to the dear friends I’ve made. My professors, who have been more than just teachers; my classmates who have walked this journey with me, and saddest of all, my roommates. When Burton and Asa pulled out of the driveway and waved goodbye I stood there feeling tears pooling in the corners of my eyes.
“Goodbye, little bit!” Asa shouted at me (that’s one of his nicknames for me).
Burton didn’t say anything, I think because he was feeling too emotional as well. We’ve walked this path together and there have been ups and downs and even if I see him again some day it will be different. I don’t know quite how to express how empty it makes me feel inside.
But it isn’t all sad, of course. I spent my last day on the beach soaking up the sun and I flew to New York with three of my classmates who live there. I slept most of the way on the plane and then went to Marina’s house in Queen’s. Her family is warm and welcoming and they invited me to share Yom Kippur with them. Marina took me to Long Island and we went shopping and sat in a little salon and had manicures and pedicures (which I’ve never had before but it was FUN!) and ate sushi and talked and talked.
I stayed up late with Marina’s family and her husband tried to get me to drink shots of vodka (how those Russians can drink!) and her brother-in-law tried to introduce me to cognac (yuck.) I ate some strange things I’ve never had before and went out with some friends for dinner to a fancy Italian restaurant. (I highly recommend going out with doctors, they always want to pay for everything.)
Now I am back home. It is freezing cold; I think I went from 40 to 0 degrees in two days. But it is so good to be home and I’m feeling happy at the thought of the adventures that are awaiting in the near future.
My focus in the next few months is going to be studying for my board exams- and studying, and studying. I am planning to eat, breathe and sleep it. Well, maybe not sleep….. I figure I have a backlog of about 150 missed hours of sleep from this month in Antigua, which probably explains why I lost weight and have some gray hair and every muscle in my body hurts all the time- but it is okay. I will catch up.
I woke up this morning at some ungodly hour because I have jetlag, and I lay in bed and thought about God and his plans for our lives and how they are not easy and straightforward, but when we have our eyes fixed on him, he shows us the next step, just before we’re ready to take it.

Cutting and dicing

The highlight of my week was being in the anatomy lab helping dissect a cadaver. The first module class was working on the lower extremities and abdomen of their cadaver, and since I had only practiced on female cadavers and this one was a male, I was interested in taking part. Not to mention the fact that Dr. Rust had managed to get a perfectly preserved dead fetus for us to examine.
A new lab is being built on campus and it is 100 times better than the old one- except for the fact that the air conditioning units aren’t hooked up yet, so it is smoking hot, and leaving the doors open just invites the clouds of mosquitoes in. At least there are no rats, the floor isn’t collapsing, and we have running water to wash in. We struggled for some time to move the body onto the dissecting table and then began to unwrap him.
The unfortunate gentleman had the normal pattern of bodily decomposition- after death occurs, all muscular sphincters in the body relax- which means that a dead body will urinate and defecate- as well as the hair keeping on growing. He was a little worse for wear after having been lying in his own waste for a while and as we unwrapped him Dr. Rust looked at me sternly.
“Whatever you do, go slowly so you don’t splash!”
DHBF (dead human body fluid) exposure is the most disgusting thing that can ever happen to a medical student. It happens when you forget to put on your face mask and you are leaning over with your mouth open and someone’s knife slips and stuff sprays up into your face….. or you get a hole in your glove and suddenly realize that your hand is swimming in liquid…. Or you are rushing to get a new scalpel blade and you slip and put your hand out to steady yourself and your hand lands on the edge of the table and it comes up wet….. There are not too many things that gross me out, but getting DHBF sprayed in my face that day was one of them. I was fully gloved and there was nothing to wipe with so I went up behind my housemate Asa who had a clean spot on the back of his shirt, and I rubbed my face off.
The little baby was cool, though. I took some pictures and I was telling Burton about it and saying how the baby was so cute I just wanted to take him home and put him in a little jar of formaldehyde on my shelf so I could look at him. Burton looked at me blankly.
“Heather, it’s not cute. It’s a dead fetus.”
“He’s a perfectly formed and beautiful baby.” I protested.
“Heather, it’s a dead fetus.”
Whatever. He was still adorable.
As a senior class we took our professors out for dinner this week, and we sat in a little restaurant called Trappas and talked and laughed and ate and took pictures together. Good memories. After dinner most people went out dancing but I was too exhausted from not sleeping that I stayed and had a drink with Dr. Gilbert and then he took me home. I sat at my computer screen for half an hour but I couldn’t keep my eyes open and my mouth closed and eventually I collapsed onto my bed. I slept 10 hours and felt amazing.
10 hour nights don’t last, though. Last night I was studying for this morning’s pathology exam and I only got about 2 hours sleep. I’ll catch up later, I guess.
I’m sort of paranoid about coming out of medical school with gray hair from not enough sleep. But the fact is, I love what I’m learning.
I gave a presentation this week on De Quervain’s syndrome (which is a type of tendonitis of the thumb) and instead of being asked questions by the instructor, I ended up engaging the class and asking THEM the questions. There is something so satisfying about teaching, about explaining to people how something works and seeing them understand and put it all together.
I think if for some reason I don’t manage to get a residency or I can’t license anywhere, I think I will come back here and apply to teach the anatomy lab. I think it takes a certain person to get excited about cadavers- Dr. Rust is a real trooper- but dissection is a necessary skill and what you cut on a real body, you remember.
This week I was deeply engrossed with removing the skin from the lower calf of the unfortunate gentleman, and I looked up to find a couple of my classmates laughing at me.
“Heather, you look like you’re having way too much fun there.”
I was. What can I say?