Thursday, January 19, 2006

What I've learned so far in this rotation...

This, as I've said before, has been a much different rotation then I've previously done. The patients are sicker than even the sickest patients I've seen before and the attitude toward death is strikingly different. We're all going to die. We might not all die of cancer, but we're all going to die at some point.

- False hope can be more devistating then the truth, especially if news is delivered as though the family knows the true extent of the situation. When this happens the family can feel as though they have a double blow to think through, and as though everything they'd been holding onto is wisked away in a few minutes.

- it is possible to have a "good" death.

- A "good" death means more to the family then it does to the patient.

- Guilt comes in all shapes and sizes, and can take on any form of emotion. It's important to remember this when talking with family members and patients. People who have no reason to feel guilty will.

- Some people gain years from cancer treatment, even if they will never be "cured." Some people decide that the treatments are not worth it and live what time they have left doing what they want intsead of spending hours in the clinic. Some try everything and die knowing that they gave it their all. There's no wrong way to do it if it's what the person wants to do.

- people with cancer die from non-cancer related things such as heart attacks and accidents.

- a spry looking 84 year old can make a very ill 60 year old look twice their age. The age a person is means nothing if it's not combined with their health and activity level.

- the drug plan "part D (The D must stand for "araagagagggDhrrrrgh")" has created more paperwork for doctors and more confusion for patients. It's a mess that is very unneccessary. (doctors are now filling out even more forms then before, and all of those forms take time away from patients even though patients can't get their medication without filling out the forms.) If you know someone who qualifies, please help them to figure out what is best for them. And know that if they don't sign up for drug coverage now, they'll pay a penalty for not signing up when they, eventually, do sign up.

- the cleaning lady for this student housing house will make our lives crazy. I'm not sure how this one is possible because her job is to simply, well, clean; but somehow she gets the office staff to page me with insignificant requests that don't make any sense and then she doesn't follow our polite written notes requesting something such as leaving a door between the mudroom and kitchen closed because otherwise the house gets cold. I have a feeling that my yarn, which meets the roommate's approval, is up on the chopping block next. The fact that she has never vaccumed the carpet shouldn't stand in the way of me leaving yarn out....should it?

- hopsital coffee is awful.

- people with cancer can still have senses of humor.

- I've made so many comments about patient's socks that one of the doctors finally asked what was "up" with all of my sock questions. I can't help that he sees more patients with handknit socks then the other doctors...but I will say that nothing gains a knitting patients respect then sharing the name of the local yarn store and then mentioning that they're having a 20% off sale right now AND they have a great selection of sock yarn. Even if they already know about the sale, they can appreciate that I'm a 20something who knits socks. (best pair yet was knit out of stripes of "leftover" scrap yarn and they matched exactly. Nothing like recognizing leftover koigu, regia and Lorna's laces all knit up into one pair of socks.)

- attempting cable work, even simple cables, is a bad idea after being in the hospital all day.

- some older men won't like that I'm a female med student. I may, or may not, be able to convinence them that I'm competent.

- (if I have to pack up all of my yarn simply because the cleaning lady says I have to I will not be happy. Not happy at all.)

- The unlabed mixed cds that I put in my car will be the best part of my drive to and from the hospital as I'm never quite sure what I'm going to hear from them.


Blogger Pumpkinmama said...

I have a question about this comment: "A "good" death means more to the family then it does to the patient." I'm wondering if that seems the case only because the family are the only ones left at the end to process the death and deem it good?

I know when my grandfather passed, it was important to us all that he had a "good" death, but I also know that the only reason he did was because HE worked for so long to manage his care so that he did have a "good" death. I know every case is different, but I would think the good death is just as important to the one doing the dying, we just don't get to hear their final take on it, because they're gone.

Early morning ramblings.....

6:51 AM  
Anonymous mamacate said...

Ooh, for sure you have to comment on socks like! I bet that patient was impressed with you!

For the perspective of a tough, smart, funny woman battling ovarian cancer (who take the "I need to know I've done everything" approach), see the blog Cancer, Baby in my "Bitter Infertile Women" blogroll. She doesn't post much these days (bowel issues), but her archives are very much worth a read. I particularly like what she has to say about the mythology of "attitude" with cancer treatment (and IF is the same). It think the post is called "the mood police" and I think she talks about that theme on a few other posts around that one in the archives.

I think if knitting socks is what you need to do, well, there aint nothing wrong with that!

8:24 AM  
Blogger Theresa said...

Warm feet, warm heart.

Doing a lot of thinking, I can see - definitely a reflective rotation.

And definitely avoid the hospital coffee. Good idea.

9:08 AM  
Blogger margene said...

It's wonderful that you learn as much (or more) about life as you do medicine.
Damn that cleaning lady!

11:39 AM  
Anonymous Laurie said...

I wonder if you make the realities more palatable to your audience. I can only knit intelligent things when I haven't had to work that day. The paperwork is unbelievable, the documentation needs are getting worse and worse, and it all interferes with patient care while making health care bureaucracies, and the government, happy as clams. Health care now happens despite the system used to deliver it. I do try to keep my mouth shut in your posts. I'm not succeeding today.

9:44 PM  
Blogger Cari said...

Um...why does the cleaning lady have any say at all in whether or not you leave your yarn out? You live there. She doesn't.

9:52 AM  
Anonymous Kat with a K said...

The cleaning lady has no right to say anything about your yarn. Doesn't she, basically, work for you? (Not sure how the student housing thing works.)

(And apparently I'm too tired to say anything about any of the deeper things you mentioned...)

12:16 AM  
Blogger Nikki said...

I just finished an elective in palliative care - can't remember if I told you that I was doing that one. Anyways, I wholeheartedly agree with your thoughts here. I can't believe how gratifying end-of-life care can be. People are so grateful for the smallest things, like holding their hand for a few minutes while they cry.

4:58 PM  

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