Wednesday, September 30, 2009

Two more days

One of the best things about this program is that you can take vacation on one of your intern oncology blocks (we do two blocks). Intern onc is one of the least forgiving blocks. The hours are not actually as bad as on a couple of other rotations (OB days come to mind), but the work is painful. It's floor work: coming in an hour before the rest of the team to write the day's labs next to the patients' names on The List, writing for daily labs, repleting electrolytes, answering pages on all of the patients on the service, writing the daily progress notes even though someone else got to do the surgery, and being the brunt of everyone else's frustration whenever something is not perfect.

Luckily, the first time we do onc, we get a co-intern as a partner. The second time we're alone, but the first time we are not. My co-oncie is Cat, my Women and Infants BFF. It makes the day better. Less lonely. We can complain to each other when we feel put upon. We help each other out with the work load. And we talk about the patients.

The patients are the worst part. This is not post-partum floor work, where everyone is healthy and relatively young and really quite annoying at times because you get pages about the mundane ("I feel a little sore, you know, down there." Um, yes, you just pushed 8lbs of human out of you. What did you expect to feel?). On onc, the complaints are tragic, heartbreaking. On onc, half of your patients will be dead before you finish residency. This is where we learn about managing pain in the terminally ill, as the tumor presses on their spine or erodes the bone in their hip or compresses their bowel.

One of my patients is one of these patients. She has cancer, doesn't matter what kind, and she is not doing well. She knows it. Her husband knows it, and he is lost. And yet, she always wants to know how I'm doing, if I'm eating enough, if I'm sleeping. She offers me food from her tray. I refuse. I tell her I had pancakes for breakfast. She looks dubious. I ask her about her pain. She tries not to complain, but I end up increasing her dose every day. I don't know if we'll ever catch up to what she needs.

On Saturday, I go on vacation. Every day, driving home, some song on the radio makes me burst into tears. I live 1.8 miles from work. There aren't that many songs. On Saturday, I go on vacation.


twinsetellen said...

Oh, they are, at least, fortunate to have your care for a bit. A small grace.

Kate said...

Karen, this post brought me to tears myself. If nothing else know that it reassures me that there are people like you and Greg in the medical profession and that men and women like your patient are getting not only the medical, but emotional attention they deserve. I can only imagine how warm your bedside manner truly is. Keep on with your bad self! And stop writing blog posts that make me cry (kidding).

-Kate (the wedding photographer that just won't quit)

twinsetjan said...

We really stop living when we stop caring about others. Your patient is still living and not dying even if her death is closing in. I feel for her husband and family and for her caregivers who give of themselves. You're high on that list!