news

sometimes it's simple:
your insurance just approved this treatment
your cultures are negative
your x-ray is clear

then there's the other kind. the kind that changes everything.
and as the nurse, you know.

you know the result because you've been checking for it compulsively

you know the doctor told her he would call her today with the result

you know at this moment that she is trying to casually fill the minutes of her life until he calls, checking occasionally to be sure that the phone is working, and that the ringer is on

you know that at this moment that doctor is skiing on another continent and won't be calling

you know you have to call

calling with bad news strips you of all the tools you need to humanize it. you can't lock eyes or lay a hand on a shoulder or hand a tissue. words are all you have and they are just usually not enough.

that feeling...that feeling of dialing, slowly, wishing you could be doing just about anything else, quickly sorting through in your mind what to say and how to say it, knowing your tone will be read in the first hello, knowing this call will be remembered, knowing you just have to spit it out. ugh.

it starts out well and you say hello, and state the facts , and tell her how sorry you are. all too often you then decompensate into some adrenaline-mediated mish-mash of apology or silver lining or offer of hope intended to soften the blow. it's really hard not to even though you both know the score. it's hard. it's hard to demoralize someone. it's hard to know that their life has just changed course down a path they never wanted to be on. it's hard to know that whatever we did didn't help.

after a few quesions, she'll say, 'thank you for letting me know'. and you'll say 'you're welcome', as dumb as that sounds.

soon enough it's over and you're moving on to the next chart, the next note, the next patient, the next call.

at the same moment, she's making calls too - to the people who love her and she's saying, 'the nurse called. it's not good news'.

back

...to work...sigh.

alarm goes off
make sure baby is breathing
baby is
take shower
listen for baby
dry hair
listen for baby
get dressed
drink coffee
baby cooing
get baby out of bed
take long slow swig of warm baby neck
watch baby's delight that his feet are still there
feed baby
burp baby
take long slow swig of warm milky baby neck
attach baby to hip

set out jeans and t shirts for big boys
remember it's gym day - excavate sweatpants out of basket - replace jeans
get big boys out of bed
ask boys to get dressed
set out breakfast plates
slice apples and artfully display on plates
ask boys to get dressed
decant breast milk into bottles
gather breast pump parts into handy travel bag
ask boys to stop jumping rope and get dressed
safety pin strap of handy travel bag that breaks with the third use
realize i'm starving and eat artfully displayed apple slices

baby crying
change baby
suction giant boogies out of baby's nose
take long slow swig of warm baby neck
sniff ears while i'm at it
baby cooing

come down to find boys miraculously dressed
and making themselves toast
review facts with 8 year old for quiz on Brazil
remind 7 year old to take completed project to school
wrestle drum, sticks, and music stand into ill fitting drum bag

inlaws arrive
kiss everyone
drive away
drink breakfast

arrive at work
turn on computer
check messages
erect breast pump
go see first patient
document
see patient, see patient, see patient
document, document, document
spend 30 minutes looking for 1/2 gallon of urine that patient has lost somewhere between car and waiting room
break it to doctor that urine is lost and tests can't be run
doctor to me: 'did you look for it?'
me to self: 'why didn't i think of that?'

run to office
pump breastmilk while returning phone calls
tell people i'm calling that i don't know what that strange noise is
forage in desk for nuts and berrries: find nuts, no berries
down nuts
see patient and document
repeat x 4
return to office
call husband who says, 'if you leave now, you'll be home in time to feed him'
leave now

arrive home
greet all
lucious baby grin quickly fades to a 'where you been, Missy?' wail
feed baby
the next few hours: attend to the feeding, watering, bathing, and educational needs of various small people
tuck in said small people
read to said small people

take deep breath
find husband who i have pased in the hall several times in the last few hours
kiss husband
watch episode of The Office with husband
laugh ass off
shirk various domestic responisbilities
go to bed.

thank God i'm only working part-time
it's the stage of parenting that i'd crave if i didn't have,
mourn if i lost,
and will too soon be over.
but it takes stamina
which some days you have and some days you don't

i'm pretty tired.
note to self: get some laurels
so i can rest on them

no words

there are no words

for the sensation of pushing a new life into the world

the life that you have cared for the last 9 months

the life that kept you awake some nights and alive some days

and there he is

the face you recognize from the sonogram

the warm bluish limbs flailing around on the very belly in which he resided 1 minute before

there is a swirl of activity and noise and cheers and tears

and all you can say is thank you. and welcome.

there are no words for the feeling of adding another member to your family

for watching the big brothers race in, throw down book bags and race to hold him

for the colossal sweetness that is newborn

for the head of thick black hair

for the general lusciousness of it all

that's a lot of words considering i said there were none

love will do that to you

prayers

Mr. K died quietly last night in his sleep. he was supposed to go home to hospice today. arrangements were made. family was coming in to town. his wife had gotten to a place where she was "ready".

"I prayed, damnit!", she cried angrily. "I prayed we'd have one more week together. after everything we've been through, was that too much to ask?!" she is deeply wounded by what she sees as the final insult from an unforgiving enemy. i hug her and tell her i'm sorry. i'm so sorry.

and i am. but he had very few platelets and esophageal varices. if that means nothing to you, let me just say that his life could have ended with blood. a lot of it. blood the likes of which his family can't imagine and would not soon forget. instead his heart stopped while he slept. he shed no tears and not a drop of blood.

it was either Jesus or Garth Brooks, i can't remember which, who said that sometimes God's greatest gifts are unanswered prayers. i can't help but think they were all given a gift.

cancer is a beast. all too often one finds themselves praying for the lesser of two evils for their loved ones with no good choices left to hope for.

i suspect she is one of those who may call me in 3 or 6 months wanting to talk...looking for a few answers or a new perspective. if she opens that door, i'll tell her what i think.

for now, i'm not about to interrupt her raw state of grief with my perceived silver lining.
for now i'll just say i'm so sorry.

mother lode

you eat
you move through your day minding your own business and are overcome by a craving. not a "wouldn't it be nice if i could have..." - no, this is some fight or flight primal "i need an avocado or i will DIE". mr. oncRN is sympathetic to these internal death threats i get. he'll often call when he leaves work to see if there is anything i NEED.

you watch
the metamorphosis of your own body. you're aware that all manner of flesh is being laid down. i understand the need for the weight gain. the belly? of course. the hips and breasts? sure. the backs of my arms? not so much. seems totally unnecessary to me.

you worry
what if it won't eat?
what it it won't sleep?
what if it's a republican?

you lie awake
in part because the little spleen kicker is awake too.
in part because you ate pad thai. and then m&m's.
in part because your mind races with equal parts awe, excitement, and fear

you love
the kicks
the privilege
the percentage of lycra in your clothes
your husband's hand on your belly when you fall asleep

you field questions
when are you due?
do you know what it is?
why don't you want to find out?
what are you going to do about work?
was this planned?

thanksgiving. no. we like surprises. i don't know. who cares.

you pray
for the patient you are about to meet with who had to lose her pregnancy so that she could get chemo and live. it pains me to know that my presence will pain her. she congratulates me. we wordlessly acknowledge the truth that good fortune is not distributed equitably.

you prepare
i'm no expert but this is my third, so i know a couple of things. i know that despite what the baby stores the size of airports will have you believe, you don't need much. from what i recall you need breasts, love, and patience for the first few months. i have those.
and diapers. i'll get those.

brave

i think it every day.
patients are so brave.
over and over i see them gritting their teeth, sucking up symptoms, taking risks for a potential benefit, fitting in treatments on their lunch hour, being patient with the phlebotomist who is having a bad day, returning to us...even though they know, at least in the short term, that it's going to hurt...that it has to get worse before it can get better.
but, somehow it's not the right word. it sounds cliche and insufficient. most patients would say they aren't brave - that they are just doing what they have to do. but it's how they do it all...with grace and focus.
it's all so scary sometimes. and they're brave. trust me. don't let them tell you otherwise.

sometimes doctors are brave too.
this one is one of my favorite species...the doctor/scientists. the ones who see patients but also run a lab... the ones who know what the most important paper is going to be this year...because they are writing it. the ones years ahead of the FDA in knowing what might work. the ones that often forego the enormous salaries of their peers, because their heart is in science...and science doesn't pay. the ones that, as a group over time, move the whole field ahead.

this one looked at a young guy whose options have run out
who has tried everything there is
who is going to die...soon
and he said, 'hey, my lab is working on something...we think it's going to work...it's nowhere near approval...i'm telling you this because it's what i would do'
and they throw up a medical hail mary.

and damned if it doesn't work.
today i looked at them, physician and patient, celebrating this most unexpected victory and felt grateful that they ended up together. another physician would have never had the knowledge to share. another physician might have covered his ass and not shared what he knew. another patient might have been too scared to try.
this patient was beaming today.
he told us today that he had canceled his trip to europe this summer, because he thought he'd be dead.
he isn't.

i felt like i was witnessing something great.
this doctor was brave...and may have saved a life.
who knows what will happen from here.
for now, though, this young guy is living and living well.
what else is there?

dad

where was i? oh right, my sanity. i have spent most of this blog examining it - the ways my work tugs at the places in me to which i feel my sanity is anchored...worrying about the potential of losing the sometimes fragile grip i have on it...questioning if, in fact, all this examining and questioning might be healthy and might be the very definition of sanity...honing my tools of the trade for preserving said sanity - learning to invest in and care for people without feeling their pain to the point that i start to think it's my pain, etc, etc.

all that, in short, gets shot to hell when your dad becomes the patient. no small part of the aforementioned storm was his new diagnosis of cancer. in your memory it's a blur of belly pain, a phone call from your mother, an ER visit, a strained attempt to understand the english as a fifth language (EFL) resident that examines your dad at Podunk Memorial in your hometown, scans, more scans, masses being measured in centimeters, nerves getting frayed, calls made to inform and placate overseas siblings, tears, worries, frustrations...all leading up to a huge surgery where the best and worst facts of it are all revealed.

people, mostly colleagues, immediately start talking to you about how it must feel to "be on the other side". you quickly learn there's no such thing. you are who you are, you know what you know, you've seen what you've seen. it doesn't turn off because it's family - if anything, it revs up. when you're seeing patients on the first floor and your dad is recovering in a bed on the fourth floor, there is no other side. the daughter/ oncology nurse /employee of same hospital trifecta benefits you all in different ways, but makes you fall asleep in a pile on the living room floor more than once.

when the trauma of the surgery wanes and physical healing begins...when the facts are all known and next-step plans are made, you exhale. you all learn that it could be so much worse - you learn that he has a diagnosis for which oncologists can't seem to help themselves from saying, "well if you have to have cancer, this is one of the ones to get" - or my favorite "you're probably going to die from something else" - reassuring facts said in ways that are not at all soothing. you resist the urge to slap any of the kind people who keep saying these things but add to your own mental list of Things Never to Say to Another Human. ever.

so he's left with some cross between a blessing and a time bomb inside and life all but returns to normal. somewhere between despair and relief you get to share that he's going to be a grandfather again and you all celebrate in the juicy cliche handed to you at this key moment - that life does go on.

you and he, arm and arm, stride out of your hospital each with radiology films under your arm - his showing a mass, yours showing a fetus- neither of you pretending to know for a minute what the future holds.

love you dad.