The price you pay

I've gotten into watching "Blue Bloods" lately, thanks to Hils. Tom Selleck's commissioner has become one of my favorite TV characters of all time. Recently, in talking to his granddaughter about the strength needed to face the emotionally draining duties of a cop, he hit on something that I think has equal relevance to being a pediatrician. I substituted in some words, but I think you get the idea.

I've cried, but I learned pretty quick that you can't be a [doctor], especially a good [doctor], if you let your emotions take over, so you sit on 'em, push 'em way down. I don't know if that's a good thing, but it's a necessary thing. I had a partner who always said [doctors] can't cry so that their [patients] can. You pay a price? I think so. But it's the price you pay for the privilege.

Just within the last week, I saw a teenager come in nearly dead from septic shock, and watched my attending have the very tough (and necessarily brief) conversation with her father that she may not make it. I had to tell a family that their son had cancer. I called a mom to tell her that her son was not outside playing anymore like she thought, but had just been brought to the ED by ambulance after being knocked out of his shoes and thrown 20 feet by a car. While each of those moments touched me, they were also routine. Pushing fluids, calling consultants, ordering CT scans. Breaking things down into English so the parents could understand them. And then moving on.

I hate having to be stoic in the bearing of bad news, being objective in the middle of a crisis, ignoring the parents while I order epinephrine and chest compressions, having to finish rounds when a patient has just died, and then not being able to process it afterwards. I would rather sit and cry, hold hands, be silent, stay and answer questions, tell them it's all going to be okay. But that's not my job (at least not most of the time).

When I was taking care of my mentor's son in the ICU, for that brief week, I questioned every decision I made, avoided going in the room because it felt like an invasion of privacy, and had to leave the room when things went downhill because it was too hard to see people I knew watch their son dying. In short, I wasn't a good doctor. So instead we sit on it. We don't let emotions take over. It doesn't mean that we don't go home and cry, because I think all of us have. But it probably means that we seem a little distant talking about illness and death. That we're overly focused on the medical details. That we often forget that it's not routine for the families like it is for us. It may not be a good thing, but it's necessary.

Declaratio

Today Pope Benedict XVI announced to his brother cardinals that he would be stepping down at the end of the month. My initial thought was "Why?" I so admired JPII's perseverance to the bitter end, when it was no longer glamorous for him to speak before an audience, when he couldn't be the outdoorsman he once was, when he received the Sacrament of the Anointing of the sick. Why would he step down when there was so much to be gained by staying put. And yet, as I read his statement, it all made perfect sense. He's not JPII. He has different gifts, a different purpose for us. I'm glad he didn't feel the need to follow in his predecessor's footsteps, that he was able to discern for himself God's will in this difficult time. I found a quote that puts it more eloquently and succinctly than I could. "Pope John Paul II remained in office so that he might show us how to suffer and how to die. Pope Benedict XVI is leaving the Papal Office so that he might show us how to live in humble honesty." (-Sr. Mary Theresa)

Because he was elected on my birthday, I'll always feel that BXVI was a special gift. In my mind, when Blessed John Paul II died, no one could fill the void. And yet he did, with a humility and faith that largely flew under the radar, but that was much needed. I am grateful for his leadership and service and sad that I didn't know him and his work better. 

"I don't need to change myself; I like myself"

According to my mom, that's her older brother's take on conformity. Since embellishment runs in the family, who knows exactly what he said, but I like the sentiment. And I like Uncle Dave, so we'll go with it. Before Lent arrives to remind me that I'm nothing more than dust, and before Valentine's Day shows up to tell me I'm incomplete without a man, I figured I'd lay it out there that I'm me and that's good enough.

Here's the thing...

I like to read, like a lot, and if the last seven things you read were all off the rack in the checkout aisle, then it's hard for me to take anything you say seriously. Likewise if anything on your bookshelf starts with "50 Shades of..." There's something to "poison in, poison out" and I don't want to spend my time pretending that romance novels (or worse) or tabloid covers are reality. And I feel the same way about movies. I never want to see "The Hangover" or any of its sequels. Or anything that relies solely on crotch humor, or on degrading the sacrament of marriage, the Church, respect for women, honesty, or good judgement. My time is too valuable for that. I pretty strictly screen movies that I'm going to watch. And I think I'm going to stop apologizing for that.

I don't like to wear makeup. I did finally decide to bring my makeup into the 21st century, but I'm pretty content not to cake something on my face that I'll just have to wash off everyday. Sorry if you don't like the way I look without it. Same goes for not highlighting my hair or spending insane amounts on haircuts. My mom cut my hair all the way up through medical school, and I turned out just fine (though still single, yes, I know). I don't want to own hundred dollar purses and clothes that I'm afraid to get baby drool on. I hate shopping (unless it's at REI or Barnes and Noble) and I'd rather go barefoot than wear heels. I hate spending money on stuff, because it's all just stuff. I don't need a hand mixer or a printer or a full-size bed or cable TV. I'm doing fine without all those things (although yes, now I own a hand-mixer, even if it currently lives in Denver).

I like sports. And talking about them. And watching them. And playing them. And I may have become very intense one or two (or a hundred and thirty seven) times while doing all of the above. Oh, well. Again, I think I'm going to stop apologizing for that. No, it's not very ladylike, but who cares?

I hate talking on the phone. I don't know any of the top songs on the radio. I'm not a good skier, and that doesn't make me a bad Coloradan. I still like Lucky Charms. And Return to Me. And Hanson.

So there.

Now, on to preparing for Lent...

ADDENDUM: Make no mistake, the above is just a rant. The truth is that I do need to constantly be evaluating myself to see whether I'm in line with God's plan for me, and that I should like myself because God likes me. Loves me, created me, holds me in the palm of His hand. But still, I'm not getting cable.

Residency 3.7: Gold Team

Gold Team (GI and Endocrine) is notorious in our program. Having kids with abdominal pain just brings out the crazy in parents. Like moms who prefer that their child get a G-tube and receive formula feeds when they're doing perfectly fine eating a regular diet. Or moms who spend 9 months seeing every specialist except GI, even though every other doctor says, "I think you need to see your GI doc" and saves samples of her child's spit which she wants tested for parasites. While we know that sometimes you just gotta play the game to please people, things often get a little heated. We had to call security twice this month ("They're gonna haul me off to jail for what I'm about to do!" -typical Gold Team mom) and stories about our patients made the rounds through Housestaff pretty quickly.

There was the kid who ate couches and had to have a huge ball of whatever couches are made of surgically removed from his stomach. The girl who ended up with part of a charm bracelet stuck in her appendix. Kids who ingested toilet paper, dryer bars, and household cleaning spray. I'm no longer surprised by what kids will put in their mouths.

And actually, we had a pretty decent month in terms of real pathology (as opposed to just the crazies). Bad ulcerative colitis, achalasia, hepatitis A, biliary atresia, pancreatitis, new diagnosis of Crohn's, etc. We also had a girl with a very severe bleeding ulcer who required 7 blood transfusions and emergency surgery which probably saved her life. The sad part about it was that we're pretty sure the situation was worsened, if not directly caused, by mismanagement at an outside hospital that does not deal with kids all that well. It makes it a little daunting to be five months from going out on my own, because none of us want to be that person that gets talked about the day--"They did WHAT???"

The Endocrine part of the rotation was good as well. Lots of new diabetics, but also some other interesting pathophysiology as well. As well as time for plenty of teaching. Yours truly won the steroidogenesis olympics for memorizing this and got a box of Christopher Elbow chocolates to show for it. We also got the opportunity to wear continuous glucometers which measure our blood sugar every 5 minutes and record it on a computer chip, which is later downloaded and synchronized with our record of manual blood sugar checks and charted. There's a site with two sensors that's injected and then taped to your body, like so. And then for three days we recorded what we ate (the massive amounts of brownies and donut holes we had to celebrate the end of the month wreaked havoc on my pancreas I'm sure) and when we exercised, etc. We'll see what it shows.

Still having no luck finding a job, since no one in Denver seems to even be hiring, which makes it hard to get interviews. Going to spend the weekend exploring new options and bugging people again. Back to the ER this next month, which should be fun. Until then!

Run down

Got a lot on my mind tonight, feeling like I need to vent. Probably just need to pray, which is next on my list.

Still having trouble hearing back anything about jobs. Trying not to let "trusting in God" mean that I don't exhaust all of my options. But really I just don't want to think about it.

Totally over being on inpatient right now. Frustrated with the fact that my decision often doesn't count for much, that I have no control over when patients are admitted and when they go home, and that I'm at the hospital 13 hours a day. Yesterday my body mutinied and slept through my alarm, leaving my team senior-less for an hour and a half. Good thing my interns are so good I'm practically worthless anyways.

Have had four codes while team leader this month that have left me feeling rather inadequate. I've had a lot of moments where I've been reaffirmed, but they don't stick out as much in my hypercritical mind.

A friend of mine was way too close to a tragic murder in Philly this week that left me feeling physically sick and I'm sure has devastated an entire community. Praying for her and not really knowing how to help. Hating that there's that kind of senseless suffering in our world.

Reading a really decent book right now--The Rook. It's like X-Men meets The Bourne Identity, and it's a perfect escape. I'd rather do that than study or work out or look for jobs or clean my bathroom or cook real food (I ran my dishwasher a week ago and still haven't emptied it because I haven't eaten real food in my apartment since).

Like I said, what I really need to do is just go sit with God and let Him reassure me, because I'm not my lack of job or my burnout at work or my imperfections or my inability to comfort a friend or my poor motivation. I am a daughter, servant, and beloved of the Father. If only I could convince myself of that.

Under the banner

In the Spiritual Exercises, St. Ignatius calls his readers to imagine themselves in a battle, with two armies. One under the standard (or banner) of God, and one under the standard of Satan. We must choose which standard we will follow. St. Maximilian Kolbe imagined himself a warrior against Satan and wanted to create an army for the Immaculata to win the world for her Son. Make no mistake, that battle is still raging, perhaps more so now than ever before. The last several months of news has caused me to give up a little, between the healthcare mandate, mass shootings, the stress of work, and the suffering of those around me. It's easy to spout words of trust and then retreat into my own corner. But God has given me just a bit of a competitive streak, despite my protests. And so, the other part of my new year's resolution is to tap in again, suit up and run full on into the battle, whatever that ends up looking like. Again, still working out the details... 

Resolution

It feels like everyone's life is moving on without me. Marriage, pregnancy, houses, new jobs. And I'm happy for them, each and every one. It's exciting to be a part of their journeys. It just feels a little lonely to not only have none of those things, but to feel like I don't have anyone to share my own journey with. And yet, I know cognitively (though my heart is a little slow on the uptake) that God has amazing plans for me. Plans for my happiness. Plans for my fulfillment. Maybe my resolution this year will be to believe in His plan. I know that's quite vague. I'm still working on the details. I want to celebrate the little things, not be afraid to reach out, show love first, be a leader, pray, focus on the positive, and accept where I'm at. Because the truth is that this is where God has led me, and that means it's where I'm supposed to be. And who I'm supposed to be. So I guess I should be okay with me.