It’s Geting Dark in Here

So for Christmas Duncan bought be some great books. Maybe true love is someone who knows what books to buy you.

I am currently reading The Antidote: Happiness for people who can't stand positive thinking by Oliver Burkeman and Awake at the Bedside by Koshin Paley Ellison. They are both SO intriguing and thought provoking. I am trying to be monogamous, but it's not working. These books have many overlapping themes and central ideas despite being about very different subjects. I love how they randomly came into my life at the same time.

I never really had any proper training in palliative medicine, which I feel was a major gap in my medical education. Yes, I did 18 weeks of general practice, 15 weeks of internal medicine, 15 weeks of surgery, etc etc. but zero weeks in palliative care during medical school and zero weeks in residency. Weird because, uh...we ALL die. We might dodge the nephrotic syndrome, the massive stroke, the carcinoid metastasis, the glioblastoma, the neck fracture, but we all...die. So why is this universal outcome so ignored and unexplored in medical training? It's absurd really.

I'm left trying to sort out how to manage the physical manifestations of this fact while learning how to listen, problem solve, know when it is not time to problem solve but just listen, juggle oncology telehealth appointments with finding out how to get a ramp made so my patient can get into his house with a wheelchair. It's a clash of the ultimate in existentialism, spirituality, and bowel care. The logistics of continence and difficult discussions and denial and heartbreak weave in and out of daily interactions, most of which I feel woefully inept at.

So I make mistakes. Say things I shouldn't. Extend myself in ways I won't again and retreat in times I should have been present. But I am trying to learn, LISTEN, read, think, reflect, improve.

I've learned that the Ellison book is not for bedtime reading. Unless you want to go attempt sleep with questions like "who do you want with you when you die?" or "what are the fundamentals of a good death and how would you like your death to unfold?" rolling around in your head.

I started this post before going on post-Christmas holidays. I brought so many books with me in the hopes of enlightenment and insight. I read about 2 paragraphs over the 2 weeks. So I am still here, at the same place. But now the pressing paperwork, charting, forms, follow-ups, tasks, notes and labs are pouring in and as usual I find myself mostly living in the "urgent unimportant" world.

So I will leave this for now. A poem that hit the nail on the head for me at a time when I needed it.

The Last Time
Marie Howe

The last time we had dinner together in a restaurant
with white tablecloths, he leaned forward

and took my two hands in his hands and said,
I'm going to die soon. I want you to know that.

And I said, I think you do know.
And he said. What surprises me is that you don't.

And I said, I do. And he said, What?
And I said,  Know that you're going to die.

And he said, No, I mean know that you are.

Meh.

Just can't get excited about Christmas this year. All the family is scattered to Hawaii, Australia, and Vancouver Island. I'm on call for the next 10 days here on the frozen prairies.

Shift from hell yesterday. It was like the 12 Days of Christmas Emergencies....12 colds and coughs, 11 migraines ringing....5 abdominal painnnnnnnns, 4 chest pains,  3 hurty ankles,  2 broken legs and a post arrest resuscitationnnnnnnnnnnnnnn.

We have a tree, yes. I didn't go too crazy on presents this year, mostly donated money to UNICEF, CBM, The White Helmets and World Vision. I don't know how much those donations actually help or get to the people in need, but I have to tell myself at least a fraction of a donation is better than no donation at all.

Last year Audree (other ESS resident) and I had a big Christmas Eve dinner for all the orphan docs also stuck working over the holidays. It was a blast. Any dinner party that involves two-stepping in the kitchen with one of your attending's kids while others are attempting the final lift from Dirty Dancing in the living room, is a success in my opinion.

I just can't get excited about being here, stressed about being on call, and having no friends or family around for any celebrations. And because I'm on call I can't even drink at this little pity party I'm having for myself !!!


Merry Christmas to all y'all, enjoy a heavily spiked eggnog on my behalf. xx


Popcorn

I've been thinking a lot about my own mortality lately, which weirdly manifests itself in an anxiety around popcorn. 

I think this is because of the fact that I've had two palliative patients pass away recently and because I've been reading some books on stoicism and mindfulness. 

I was falling asleep a few nights ago when I woke up my already drifting husband,

hon...we only have ONE life....ONE. THIS IS IT!!!

He acknowledged this to be true and in his pragmatic way pointed out that it didn't matter because we wouldn't know anything when it ended anyway.

So, I go to work and try to be my best self and give my best self to my patients. And it's hard and stressful and some days I want to cry with them when they are crying, and some days I do. I mean I don't sob away and use their sleeve to blow my nose, but I let myself have that emotion. And then I get home and man, all I want is popcorn. Yes. Truffle salt and cayenne and nutritional yeast, please, you haven't lived until you've tried my popcorn. But it feels gluttonous and my husband is sliding the Obesity Code my direction with monotonous regularity, encouraging me to read it. He keeps telling me about ketogenesis and podcasts and really, I just want popcorn.

HMPF.

Because, we only have one life. I should enjoy this popcorn now dammit. I could be dead tomorrow. 

But then I get up, and get dressed,  and my jeans are tight.  And I am OFF popcorn dammit. I go to work and see human suffering, and I see this crap shoot of a hand that we are dealt and I have to wonder.

What if it were me that had the molar pregnancy 4 months ago which has now metastasized to my lungs. All of my worries and all these neurosis really boil down to sweet fuck all. 

Having your own mortality pointed out to you at work on a nearly daily basis can really put things into perspective or completely out of perspective, depending on how you look at it.

I didn't have any tonight. For the record.

 

What the hell happened in June?

So this is a weird thing.

I have kind of had the blog in semi-hibernation since starting residency. I wasn't really checking in, or looking at stats at all (for readers and viewers, etc).

But, something weird happened in June. I had this crazy spike in visits in June 2016. And I have no idea why. I can't go back now to see where the source was or if there was some link or story featured.

Just this:


Just wondering if anyone out there has any ideas on where this sudden surge of traffic came from? Was Dr. Grumpy's blog featured on The Daily Show or something? Did I get a shout out on CBC radio 2 ?

Just curious.

Letter To This American Life


Sometimes you need to just take the time. 

I have very little time for reading, even less it seems, for writing. But a recent episode of This American Life was so important to me I forced myself to sit down and write a letter. My mom always reminds me that we fill our days with urgent, unimportant things instead of important, non-urgent things. If you haven't heard the podcast episode, "Once More, With Feeling" especially act two. 
I received a reply today which gave me almost as many gifts as the episode itself. I'll post it later.

I am a huge fan and have been a dedicated listener for years. I treasure many episodes and hold some very close to my heart, but this is the first time I have been so profoundly moved by an episode that I feel the need to write the show.

I don't know how to illustrate my gratitude in a way that gives justice to the insight given to me by this episode.

I have two retired infantry soldiers for brothers. One has done over 10 tours of duty, initially as a mine disarmer and then as a post-blast forensics specialist. He has served with NATO, the UN and the Canadian military in Afghanistan, Bosnia, Cyprus, Yugoslavia, Rwanda, and many places he could never tell us about.

I listened to Once More With Feeling this week while driving to one of the communities in northern Saskatchewan that I work in. It's a long and lonely drive. Several hundred kilometers with no cell reception and it's -35 Celsius right now. I drive with a satellite phone in case of a breakdown. It's dark too, so the podcast keeps me awake and keeps me company.

When it got to Act 2 I was listening with intrigue as I know my brother struggles with PTSD and integrating with normal society now that he's retired. I know that when he got his first holiday in Greece after a few months in Afghanistan he just sat on the beach and didn't speak at all for several days. I know my sister in law has found him sobbing in their closet. I know he vomited once while crossing the lawn of a friend's house in Ottawa because a flashback made him think he was walking, without care or attention, across a minefield.

I drink scotch with him when I visit and he tells me some stories, which my sister in law knows verbatim. And some mornings she'll say, "I never heard that one from last night before". I know he told a story once at a work Christmas party about shooting an Afghan soldier in battle which left everyone speechless and uncomfortable.

As Michael Pitre spoke, it was like I was finally able to see and understand a tiny fraction more of my brother's struggles and his coping strategies in civilian life. Some of what Mr. Pitre said seemed so obvious once he described it, I wondered why I hadn't understood, or picked up on those patterns in my brother before. So there I was, driving and crying and finally understanding things about someone who is so close to me but so hard to get close to on many levels.

My brother is getting counselling now, and his wife tells me he's getting better and better, slowly. But I still feel so much fear and sadness when I hear stories of Vet's who commit suicide or harm others once they are home.

It was such a powerful and important piece for those of us living with friends and family struggling with re-integration. It wasn't exploitative, or indulgent, or sensationalized. It was a beautiful, succinct snapshot.

I am deeply grateful for this episode, and for all the hard work that the staff at TAL put into their work every day. You may never realize how far reaching, truly valuable and life changing the work you do can be for listeners. I hope this shines a little light on that reality for you.

Thank you again.

Sincerely...