Residency 2.3: Heme/Onc

I don't really know if it's possible to give you an idea of what the last month was like for me on the Hematology/Oncology service (blood disorders and cancer). I had heard a LOT of different things about Heme/Onc going into it (it's super depressing, those kids are sick as snot, these will be your favorite families of all of residency, etc), and had equally as many feelings about starting (mostly terror at the "depressing" and "sick as snot" parts, also dreading the 28-hour calls and looking forward to working with the great group of residents that were on service with me). It was all of the above and more.

It was not being able to sleep at night because I was afraid one of my patients wouldn't make it through until the next morning. It was blowing bubbles with one of my patients who was bed-ridden and dying, but loved swatting at bubbles. It was rejoicing at baby steps, like tolerating 2 extra ounces of formula a day or having a one-point decrease in pain scores. It was seeing bald toddlers ride Big Wheels through the halls like there was a devil on their tail, and then having the bald 17-year old wish that they made adult size Big Wheels (cause they should).

There were days when I had to cry because it wasn't fair and days when I stood in awe of the strength and grace with which many of these patients and families dealt with the unimaginable.

One thing I heard before starting that I know is true is that after this month, I know I have nothing to complain about. And I know that even though I moved on to the next rotation, these patients will continue to impact me and will hold a very special place in my heart.

Priceless

US Women visit KC...
Abby Wambach goal--check.
Priceless Pia quotes--check.
'Pinoe's Hair shirt--check.
16,191 fans chanting non-stop--check.
Cara getting Hope Solo to sign her shirt.....CHECK! (Still can't believe it!)

I love everything about this team. Cara asked me who my favorite player was and I think I listed off six names before I realized that I can't pick just one. They are all amazing examples of dedication, creativity, poise, and heart.


Pia admitted it wasn't the best soccer we've seen from these women, but she just wanted them to enjoy, and I'm pretty sure we got that down. Kansas City turned out in great form to welcome home our team. The frenzy ignited during the World Cup is still in full force as a whole new generation of fans learns the finer points of following the USWNT. I think my favorite was when a girl behind me, about eight years old, commented on a Canadian shot on goal: "You have to kick it harder than that to get it past Hope." (yeah, you do)


You know you've come a long way from "Mia who?" when Nike sells out of a shirt featuring nothing more than the outline of a certain midfielder's now-iconic hair.

Wake Up Call

Every now and then I like to sneak in a story from my childhood, just to remind you of a) how wonderfully precocious I was, b) how nutso my family is, or c) how amazing it is that I turned out as good as I did. Today's story just may fall into all three.

Most of you can probably imagine the chore it was for my poor mom to get four of us ready in the morning. I mean, hard enough getting four kids to brush their teeth (and actually hit the sink when they spit), getting us into matching clothes, getting us to all agree on something semi-nutritious for breakfast (actually, mom excelled at breakfast!), and getting us all seat-belted in to the sometimes-working Mustang...and on time. But I think the hardest part was actually waking us up. "Girls, time to get up" seventeen times just wasn't doing it, even when the bright light right by my face came on and refused to go off in response to my incessant whining. No, the 100% guaranteed way to get those Zapapas girls up and going in the morning was...are you ready...Dolly Parton!

True story. After my Dad wowed the Loveboat with his "Here You Come Again" singalong on my grandparents anniversary Alaskan cruise (another story worth telling sometime...or you can come over and watch the video), my parents purchased a cassette tape of Dolly's best, appropriately titled, "The Best There Is" to commemorate the performance. It became part of the soundtrack of our childhood.

Soon there was nothing more my mother had to do to than fast-forward to the start of "9 to 5" (a lot harder before the age of CDs) and crank the volume. Michelle and I would hear that unmistakable "Bum bum bum bum bum bum bum bum" and before the first line of the chorus, we were out of bed, down the stairs, and rocking out in the living room, belting middle-aged career disillusionment at the top of our lungs. Fortunately, I think the next song was considerably more mellow and made for a great time to herd us upstairs for said teeth-brushing and clothes-matching. And after waffles or egg sandwiches, we were in the Mustang and off for learning. On time!

If only I could somehow program my pager to go off with "Tumble outta bed and stumble to the kitchen..." it would make my call shifts a little more enjoyable.

Remembering

I don't have profound thoughts to share today, but like so many, I feel a need to say something. Ten years ago, I remember as we all struggled to wrap our minds around the unimaginable, there was this urgent, very tangible need to share where we were, how we heard, who we knew. I found myself drawn by this compulsion to take in everything I could--photos, testimonies, articles, videos, mementos. People emailed stories and reflections, trying to make sense of it all, needing to put to words the turmoil that they felt inside. I think we all knew that so many years later, as we would look back, we would need to have it all cemented, something to come back to. We remember in exquisite detail that morning, and we are still sharing. Still in awe of the photos, still proud of those who rushed in and earned the name "hero", still defiant in the face of those who try to break the American spirit. I guess what I'm saying is that in 10 years, even though everything has changed, in some ways, nothing has changed. We still need to be heard, to feel connected, to share in the sufferings of others, to capture in photographs and poems and prose the anguish and the triumph of life. To remember.

Not what you had in mind

I knew this day would come. The day when I deliver truly bad news. How do you tell a 17 year old who has everything going for her in the world that she has cancer? How do you tell her parents that the quick trip they thought they were making to the ER over Labor Day because their doctor's office was closed means they could be spending the next two and a half years shuttling her to and from bone marrow biopsies and chemotherapy appointments, praying that she's one of the ones who make it? How do you tell her she may be in that other percent that won't grow up to be a journalist, or finish gymnastics, or see her dad find the prize-winning barbecue recipe? Thankfully my fellow and attending came in at 10 o'clock at night and were the actual ones to say the word "leukemia" but it still was heart-wrenching and sickening to be there, to see their faces drop. I think I could have handled hysteria better than the teeth-gritting stoicism I got. And as much as I get that knot in my stomach when I'm in her room, I WANT to be there. I WANT to walk with her through these first several days. As much as I need my day off, I HATE that I won't be there tomorrow when she goes down for her bone marrow biopsy. I find myself in the midst of an almost constant prayer for her, for her family, for her doctors, for all those with cancer and their loved ones affected by it. Because really, to hell with cancer. Cancer sucks.

Residency 2.2: Cardiology Clinic

"Are you a hard-hearted person?"
"I'm hard-headed."
"Are you a cold-hearted person?"
"Cold hands, warm heart!"

This was the conversation between one of my attendings and one of my very astute patients during Cardiology Clinic yesterday. I have to say one of my more enjoyable experiences this month was listening to this doctor go through all of the corny "heart" idioms and make the patients and parents laugh. "What's that I hear? Is your heart carrying a tune for someone?"

This month was a blissful call-free, vacation month, so I feel like I hardly worked at all. I got to enjoy my weekends, work out, and even go home for a week. But I also feel like I learned a lot. I got pretty good at listening to heart murmurs, talking to parents about abnormal heart rhythms and passing out, and even started to be able to identify structures on echo. The trick will be if I remember any of this when I do Blue Team in June.

This month I'm on Heme/Onc (blood and cancer disorders) so it will be a lot more taxing, mentally and physically. But I have Day 1 under my belt with no issues (that I know of). Also, I have to say that it's kind of fun to be back inpatient and see everyone again (I missed my Owl Team!). Until next time...

Monkey off the back

A little belated vacation blogging. While there were many notables from the trip back to CO, I'd say the one I was most glad to check off was finally checking Mt. Evans off of our 14er list (cue "Hail the Conquering Hero"). It was back in the summer of 2005 when Michelle, Dad, and I attempted Evans for the first time. Dad being the only one who had ever done a 14er, we left him in charge of directions, planning, packing lists, etc. After (very little?) researching, he deemed the Bierstadt trail head as the place to start. It was early on in the trip when I, having read the directions, said, "It says we're supposed to cut across this field." Dad: "This trail keeps going." Me: "I know, it says to leave the trail." Dad: "No, I think we keep going." Fast forward 45 minutes, long past any hope of cutting across fields of any kind...Dad: "This is the trail up Evans, right?" Random hiker with a clue: "No, this goes up Bierstadt." Whoops! At least we bagged our first 14er.

The next summer, Dad somehow convinced not only the rest of the family, but our next door neighbors as well, to attempt Evans from the same trail head. I won't go into all the gory details. Needless to say, we hacked through tons of soaking wet scrub oak and swamp land, scrambled up a huge scree field, and then once again, failed to read the directions and tried to go OVER West Evans instead of around it, and had to turn around because of lightening--8 hours later=no summit and very cranky hikers.

Well, so you can see why we have avoided Evans or any mention of it for 5 years. But being that Michelle and I were on our own for this one (another long story) and didn't want to drive 4 hours to try Massive, we opted for the very close Mt. Evans. This time, we would go from the OTHER side, the NORMAL side. We decided to pass Echo Lake and start from Summit Lake for the sake of timing and sanity (15.5 miles vs. 5.5).

Starting out from Summit Lake

I did have a few flashes of "only crazy people climb mountains" when we looked ahead at what was to come, but we kept trucking on, Michelle being a very good hiking partner (I mean, it's practically like hiking with myself!). We successfully found the trail at West Evans (a much easier way to go) and picked our way around the back side until we could see people raising their arms above their heads on the summit. I had a hard time controlling my joy when I knew that we had made it--FINALLY beat Mt. Evans, after 6 years of having it nag at the back of my mind.

Summit Bears at the top!

Next, we'll have to re-try Colombia and Harvard so we can get those off the list too.

Looking back on the hike. The summit is on the left. West Evans on the right.