Bad News.....

it's tough to give to patients, this is one of the most difficult things I've had to do here in prison. I've been out in the world treating patients (true it's only as a student, but still..) for almost 10 months and this is the first time I've had to give people bad news. Not, "yep you have a broken bone" or "looks like you have pneumonia" ... or even "you're a diabetic now". Nope I'm talking about telling people chances are they will soon die. It's a lot harder than I thought... and I didn't think it was gonna be easy in the first place.

The first time was the worst, giant tumor in the middle of their chest, Anaplastic Thyroid cancer, the invasive kind = Not good. I gave myself the pep talk and tried to remember... "go slow, don't use medical jargon, don't forget to talk about DNR (do not resuscitate) and for God's sake don't say anything stupid! It was so hard to do, I remembered once you say the word CANCER you just have to stop and let that sink in, cause anything you say after that falls on deaf ears. You have to give them time to process what that means and it's really hard to watch. I could see it in their eyes... they went all glassy and distant, the brow furrowed and they looked away, seconds felt like hours and it's all I could do to make myself keep quiet. I wanted to ramble about "what type of cancer it was on the pathology report, the most common treatment, the 5yr survival rate based on age and health factors and blah, blah, blah, shit that wasn't going to mean beans to the patient.... but oooohhh how I wanted to fill up that horrible silence!! When the patient finally came back from thought and began asking questions I fell into the medical jargon trap.... I rattled off a bunch of statistics and half way through realized I need to stop and make sure the patient understood. I managed to only put my foot in my mouth once, and unfortunately that was one of the things that stuck with the patient cause they repeated it back to me.... twice Uuuuggghhh! why oh why did I say "worst" even though it was true ( it's really rare and less than 5% of patients have a 5yr survival rate) I still shouldn't have said that. But I got through it and I'm sure it wasn't the best but it couldn't have been the worst "you have cancer" talk ever.

I guess I was just kinda surprised by how affected I felt coming away from that talk. I really didn't know the patient it was only the second time I'd ever met them and after it's not like I'm the one who has cancer.... It was a weird feeling.... I guess the closest I can come to describing it was a feeling of guilt... like I was somehow responsible for giving them cancer and there's nothing I can do to make it better. Usually when I give not-so-good news to people I always get to say "now here's what we're gonna do to get you better". But not being able to say that just leaves me with this unfinished feeling, like a job you left incomplete. Then as if to add insult to injury it's a virtually necessity to let it go and move on to the next patient! I'm telling you it was a really difficult day to get through. Afterward my fantastic preceptor Robert told me " you can't carry it with you... you gotta let it go or it'll drown you. It's good that you feel it, just don't take it home with you."

The last patient I had the talk with has the wicked combo of TB and AIDS, unfortunately this combination of diseases is pretty awful. The dangerously low CD4 count (T-cells) means they're susceptible to opportunistic infections and because her immune system is low it's like a free pass for TB to start acting up and rampage through her body. I was much better this time around and I thought the patient took it amazingly well... until I left the room. As I started to walk away I heard them break down and begin to sob, and that guilty feeling came gurgling up from my gut.

I know I said it was great to see all the super sick patients, with their complex diseases and super rare conditions... but I don't know how I'll ever get used to giving the truly bad news. but unfortunately I'm pretty sure someday I will.

The Big Easy..

New Orleans... jazz and jambalaya, hurricane drinks and voodoo... I wish I had had more time with this amazing city. Guess I will just have to go back, the sooner the better :)

Life in PRISON...

Well not so much for me but those are the people who's care I am now responsible for. So here I am on my Internal Medicine rotation at the Carole Young Medical Facility (CYMF). So I figure I should start off with a little about the prison itself. CYMF is a minimum security prison facility for inmates with chronic diseases, terminal conditions or post-op wound healing. It also houses 300 female inmates most of whom work in the hospital doing house keeping, janitorial and kitchen work. There are 5 "pods" or wings of the hospital with roughly 50 - 100 inmate/patients per pod. I was surprised to learn that most of the patients are men, there is only 1 pod for females and most of them are post op for some kind of surgery or are cancer patients in between rounds of chemo/xrt (radiation treatment). I was a little apprehensive knowing that most of the patients I'd be treating were going to be male, until I saw the patients. Most of the male inmates are seriously sick, 70+ and look emaciated, amputee's or can barely walk... needless to say they aren't very intimidating. However that doesn't mean I'm not uneasy or stay vigilant while in the room with them. When I see patient's I always have a guard with me and the door is always open. I have never felt unsafe, threatened or really had any trouble with a patient at all. According to our Preceptor staying at this facility is highly coveted, apparently its one of the nicer facilities and so inmates don't act up for fear of being transfered. So now you know a little about the place, here's a little about what I'm doing.

This place is FANTASTIC! I'm getting to see all kinds of crazy stuff!! These people are really, seriously ill and dying. A little morbid and kinda sadistic I know, but you have to look at it from where I'm at... I've never seen any one with Hep C in liver failure with a gigantic belly that needs to be tapped, and then I get to help do the paracentesis! I have seen Myasthenia Gravis a disease so rare only 10 in 1 million people have. I have a patient with Schizophrenia (and you all know how much I love the crazies!!) a patient with TB and AIDS another with Hodgkins lymphoma. It's amazing to see so much pathology, every patient I get has some kind of seriously horrible disease. Most family med practitioners, in their entire career might see, if their lucky/unlucky enough, one or two of the patients I've seen just in the two weeks I've been here. I'm learning soooo much, how to treat really sick people, rare diseases, how to admit, discharge and some of the outrageous ways our tax dollars are spent on inmates. Like the illegal alien who is basically a vegetable. When prisoners are brain dead, terminal and close to death they are paroled to hospice and the family takes over care and fee's for their end of life stage. However since the patient is an illegal he is not eligible for parole and the state will have to pay for his comatosed ass until he dies. Moving on.. There's also lots and LOT'S of wicked, nasty wounds to clean and dress. Now I'm a freak for the gross stuff, but there are a couple wounds here that made MY stomach churn, mostly it was the indescribable foul stench that got me. However I still loved it ;)

Well we have a long weekend coming up and I'm not sure what I'll be doing ( Austin? New Orleans? Oklahoma?) but I'll be sure to post when I get back.

Break, Road Trip and New Years.

Break...

It was soooo nice and yet over so soon, my 2 week winter break was all too short. Unfortunately before break had barely begun I got some sad news regarding a family member and spent a few days visiting in the hospital. But my family is a tough bunch and we don't go out without a fight, so decisions were made and the fight has kicked into high gear! I love my family and I'm very glad they are such good and wonderful people it makes it soo easy to love them more and more every day. I did manage to cram time with lot's of friends and family into Christmas festivities but the whole week just left me feeling like I needed more time just to take a break from break! I think it felt even shorter because 1/2 way into it I left for my next rotation. Yes my boyfriend Ryan (aka Billy ) helped me load up my nimble little versa for a 3 day road trip to Texas. Ry has a friend from his Army days who lives in San Antonio so we decided it would be fun to come down early and visit.

The Road Trip was loooong we drove from 3pm to 9am non-stop before getting some breakfast at Denny's and taking a 2 hour cat nap in the parking lot. The pass between La Grande OR and Where ever ID with snow and ice and big semi truck was not fun! I was so happy Ry was with me and even happier when he took over driving in that crap! After we crossed over into Utah it got pretty boring until we drove into Salt Lake City but at 3am we couldn't see any of the landscape or the city itself, what we did see was several cops riding our bumper. I'm assuming it was because they could sense we weren't Mormon ;) We drove past Archs National Park, but by then I was so delirious that when Ry woke me from a half sleep I couldn't get the words out to ask him to stop so we could go see the famous giant rock arch. Later after our nap, when I was more coherent I got to drag him to Four Corners ( AZ, NM, CO and UT). Not much to see there but worth the 6$ for me and Ry to take a few pics get a snack and use the porta-john. Roswell NM on the other hand was not worth it. I can't tell you how jazzed I was to roll into a dusty small SW town filled with Alien themed everything.... which is what I had imagined. What we found was Walmart, Applebee's, 4 Sonic's and less than a block of Alien nick/nack shops..... what a disappointment. The most amazing thing about the drive through Texas..... I only got pulled over once, and I even though I was going around 90 in a 65 (at night) I only got a warning :)

San Antonio was great! Ryan's friends David and Anita are amazing, Anita was off work the entire time we were there and insisted on cooking for us, which was really sweet of her and delicious. They took us to a Brazilian restaurant of meat on New Years Eve (sooo delicious I'm kinda drooling just thinking about it) and then went back to their house to play games and light off fireworks at midnight. Oh yeah and I don't think anythings illegal in Texas (haha) the boys got big mortar fireworks like in professional displays, it was like being in downtown Portland, only this was just random suburb neighborhood. It was one of the best New Years Eves I had, good friends, good food lot's of fun and spectacular firework show.