Wednesday, August 22, 2007

The Long Goodbye

“I can't change the direction of the wind, but I can adjust my sails to always reach my destination.”  - Jimmy Dean
I love to sail.  In fact, it was talking about sailing and the difference between windsurfing (board sailing) and boat sailing that started the relationship between myself and my fiance, Jerry.  And, when I stop to think about some of my favorite quotes, a lot of them have to do with sailing, the wind, yet unknown journeys, etc.  I came across this quote today while helping Jerry to write a farewell message to all of his windsurfing and kite surfing buddies on their message board.
I always hate this part.  I hate saying good-bye.  Because to me, it's a new journey, a new adventure.  It's not supposed to be an end, but a new beginning.  I blame my mother for instilling in me a sense of wanderlust, and she takes all the credit she can because she has the same spirit.  We always want to be "going somewhere." 
We plan vacations months in advance.  We talk about where we'll go, and what we'll see.  If it's to a new place, we'll research and read, plan for tours and find side trips.  We're the type of people who need vacations from their vacations because, for us, it's never going somewhere to relax, it's going somewhere for the sake of going, exploring, being able to say, "Yes, I was there."  There's a new show on the Travel Channel, "1000 Places to See Before You Die."  Kinda like that.
And, this sense of exploration carries over into my every day life.  If this blog is any indication, it shows that I can't seem to be in one place for any length of time before I am looking for that next place.  While most people freak out about moving and getting set up in a new town, I relish in the adventure of finding new places, trying new restaurants, and just the excitement of the new people I will meet along the way.
While packing, I came across my "personal box" which has cards and letters, postcards and scraps of paper with the namesof people that I have met in my many moves.  From college in San Diego, to pre-med at Cal State Fullerton, to med school in Wisconsin, my internship in Chicago, junior fellowship in Boston, surgery residency in Minnesota and in between.  So many hellos;  so many goodbyes.
Which brings us back to the goodbyes; this part I hate.  I've been saying a lot of goodbyes over the last week.  Getting phone numbers and email addresses;  wondering whom I'll actually really keep in touch with.  Granted, I think I have a better than average track record when it comes to keeping in touch with people.  Email has made bridging the distance gap so much easier.  Now, for the most part, at least once or twice a year I "catch up" on all my contacts, and I hear what's happening in their lives.
So for now I am off again.  Turning my sail once more to where the wind is taking me.... and, when I arrive, I am sure there will be some new "hellos" to greet me.
"A ship in a harbor is safe, but that is not what a ship is built for." - G. Hopper

Friday, August 17, 2007

Death Becomes Us

I've been thinking a lot about death lately.  In part, it's due to the fact that I just finished watching all five seasons of "Six Feet Under," but it's also due to the fact that I have been encountering death on an almost daily basis for the last 6 weeks.  One of my duties as a House Physician is to pronounce patients who have died while in the hospital.  Since I have been working 24 hours on and 24 hours off for a greater part of the last 2 months, I have had more than my fair share of pronouncements.
The oncology ward is on the 8th floor here at Fairview Southdale, so the majority of my calls are to this floor.  A colleague of mine has had up to five deaths in one shift.  My record is three.  These patients are usually in the end-stage of their cancer, and they are admitted as "comfort care" meaning, they receive pain medications and are kept "comfortable" in anticipation of their impending death.  Families are usually prepared.  They stay in the room as I do my exam.  It's often a very calm experience.
Contrast that to calls I get to the ICU.  There patients usually die of an acute process, most often, a massive heart attack or stroke.  Families are in shock and disbelief.  It is never a good situation.  But, families usually come to understand that the severity of the illness was so catastrophic that survival wasn't possible.
But, my rant today isn't for those patients.  It's for the patients for whom there is no hope.  Who've suffered that catastrophic illness and are kept alive because of medical technology.  My story today is of the two Russian ladies.  Both spoke no English.  Both lived alone.  Both were in their late 70's/early 80's.  And both fell down at home alone.
The first lady was found by her family about an hour later.  She was admitted to the hospital with severe back pain.  I was called to see her because her back pain was getting worse, and she was having difficulty breathing.  In med school you're taught that "sudden-onset ripping severe chest pain" means aortic dissection until proven otherwise.  And, she had the symptoms to go with the diagnosis.  As I watched her oxygenation saturations drop, I asked her, via interpreter, did she want to be intubated (breathing tube placed and put on a ventilator).  She replied, "No, I've lived a long life, and I don't want any extra-ordinary means keeping me alive."  When her EKG showed that she was having a massive heart attack, I asked her about doing chest compressions and starting medications should her heart stop.  Again, she said, "No." 
The other lady was found down immediately.  She was brought into the Emergency Department and found to have bleeding in her head.  She was admitted, and she was actually doing well until the morning I was called because she had become unresponsive.  She was showing signs of brain injury, and, because her family had said they wanted everything done, she was intubated and placed on a ventilator.  An MRI showed no new bleeding, but she never awoke again.  After an EEG showed minimal brain activity, her family had been asked if they felt she would want to continue doing everything to keep her body alive, they said, "Yes."  Because she could not tell us, and because she had no advanced directive or living will, her family made the decisions for her. 
This morning, on my way to pronounce a patient in the ICU, I heard that the family wanted to have a permanent airway (a tracheostomy) placed in her neck so that she could be on a ventilator long term.  I started having feelings of anger and indignation which were shared by the respiratory therapist who had told me of their decision.  I was still shaking my head as I came to the room of the patient who had died.  It was this second Russian lady. 
She was still on the ventilator, but her heart had stopped.  The family would not let the nurses turn off the ventilator until I pronounced that she was really dead.  I went into the room and did my exam.  When I nodded to the nurse, he quietly turned off the ventilator.  The family remained in the room, visibly upset.  I feel in some way, she finally made her own decision and let go.
My whole point in writing this, aside from the fact it's my blog and I can rant if I want to, is to illustrate the importance of having frank discussions about death and making your wishesknown. 
My mother and I have always had an open dialogue when it comes to her wishes.  Her only concern is that I might "pull the plug" too soon because I might be too interested in my inheritance.  But, she knows that if something were to happen to me, I want all organs to be donated.  Then I want to be cremated and separated into 5 mini urns to be taken by family and friends whenever they travel.  She knows I am going to turn a part of her into a diamond.  (  She's just jealous because she loves diamonds and won't be able to have one of her own.
My best friend Nicole wants to be cremated and have her ashes spread in Lucerne, Switzerland.  We once had a conversation that if she went first, I'd make sure they got there.  If I went first, she promised to have some of my ashes taken to be spread with hers.
Death isn't to be feared.  It's the one fact of life that we will all share.  So share your wants and desires before someone makes decisions for you.  Frank discussions and planning with family and loved ones will help so much when the time comes.  Make a plan, appoint a power of attorney for health care, make a living will. 
Talk about organ donation.  Be a part of the Green Ribbon team and sign the back of your driver's license, but also make sure to talk to your spouse and family members about your wishes.
My favorite poem:  Crossing the Bar, Alfred Lord Tennyson
Sunset and evening star,
And one clear call for me!
And may there be no moaning of the bar,
When I put out to sea,

But such a tide as moving seems asleep,
Too full for sound and foam,
When that which drew from out the boundless deep
Turns again home.

Twilight and evening bell,
And after that the dark!
And may there be no sadness of farewell,
When I embark;

For tho’ from out our bourne of Time and Place
The flood may bear me far,
I hope to see my Pilot face to face
When I have crossed the bar.

Saturday, August 11, 2007

The Mixed Tape

As I start to pack for the impending move, I am finding the usual odd and end things you just can't seem to get rid of, yet should, yet don't.  I have two shoeboxes full of cassette tapes that are those "mixed tapes" we all made in high school and college.  As I scanned the titles, I was instantly able to remember where I was, who I was thinking of, the club where I'd heard a particular song, or the situation involving this that or the other song.
I subscribe to Napster to fill my MP3 player, and I spent about 2 hours going through the tapes and downloading songs that I didn't have to it.  Most of the time, I knew the actual title of the song, but there were some that I had no idea what the song even was and had written just a few words from the chorus.  And, funny thing, I have no idea where to find a tape player to listen to the cassette to find out. 
My old "boom box" with the dual cassette players was given away in Chicago in the Summer Move to Boston of 2004.  A cassette Walkman is packed somewhere amidst old serial/non-USB computer cables, a 5 1/2 inch floppy disc drive, and a couple of CD Walkman's in a box labeled "Electronics."  So, I guessed one day I would find a way to listen to the tape, tossed it back in the box, and moved on.
Once I was done going through one of the boxes of cassette tapes, I found I couldn't bear to throw any of them away.  Again, I have nothing to play them on, most of the music is now on a CD or on my computer, and yet, there's something special about those cassette tapes.  How many hours did I spend picking out just the right music?  Putting it in just the right order so there would be a certain flow.  Carefully writing out the names, or in some cases typing out the names and making labels.  I can't get rid of them.
I think of the burning crushes and the unrequited love I had in college, the dance songs of Tijuana and Rosarito where my best friend Melinda and I danced for hours in a tequila haze.  I remembered the inspirational music that carried me through some of my teenage angst and rebellion.  The makeout music and the songs that came with the breakup.
I can't get rid of them.  I may still have them when I am 90, and I am listening to music waves directly into my brain through my implanted audio assist device.  They'll have been converted from cassette to digital to direct mind wave format.  So, I better keep that box.  For now.

Thursday, August 9, 2007

Sources of Inspiration

I found out today that a friend had died. I first met Allen when I was in pre-med trying to get the credits necessary to go med school. He was already in med school at East Carolina University at the Brody School of Medicine. We were AOL IM pals. All I knew about him was that he liked pipes, cigars and classical music. At the time, he knew I liked baseball caps and sent me one from ECU to add to my collection.

During that hard year of applying for medical school, and then sweating out the interviews and waiting for acceptance letters, he always encouraged me.
He had no doubt that I would be going to medical school. He sent me a caduceus charm about a week or two before I got my letter of acceptance. I didn't wear it then for fear of jinxing myself. Now, it is one of my prized possessions, and I'm wearing it now as I have daily for the last 10 years.

He graduated in 1999 as I was just getting started. I knew he had met and married a wonderful person, Pamela. I didn't know until the obituary, that he has a daughter, Amelia. I knew he had a brain tumor, but that didn't stop him from completing his Family Medicine residency and doing the work he loved: taking care of patients.

We didn't write much to each other over the last 3 years. Just an email every six months or so. Mostly prompted by yet another move on my part. But, he always answered each one kindly, and sent me a heartfelt congratulations or word of encouragement.

Pamela called me today. She'd received the email about my upcoming move and new job. She knew Allen and I kept in touch and just wanted to let me know about his passing on July 4th.

Even though we hadn't spoken in years, I will miss my friend Allen W. Chan.
Suddenly, today, the sky is just a little bit darker and the world is just a little bit colder.

Tuesday, August 7, 2007

Great new quote

"I am careful not to confuse excellence with perfection. Excellence, I can reach for; perfection is God's business." Michael J. Fox

Sounds like a new mantra to me, especially as I consider my new career choice. I am constantly going to have some small doubts about tests, diagnoses, treatment plans, etc. Striving for excellence. Sounds like a plan...

Monday, August 6, 2007

The long drive east

I just returned from my first trip to Buffalo, NY. It wasn't as bad as I thought. I found an older city with some great architecture downtown, up and coming trendy areas, and lots of water. Of course, it's not winter yet. And, I imagine it will be a lot like Minnesota... with more snow.

The trip took 15 hours going north from Eau Claire, Wisconsin and hitting Lake Michigan just to the north of Green Bay. From there, it was across the upper peninsula of Michigan, across the awesome Mackinac Bridge, and down to Flint at the bottom edge of Lake Huron where we turned east to go across Canada to Buffalo. With Lake Ontario to the north and Lake Erie to the south, I managed to see 4 of the 5 great lakes in one trip. Having been to Duluth, I can actually say I've seen all 5 great lakes. By the way, remember HOMES (Huron, Ontario, Michigan, Erie, Superior) as an easy way to remember the names of all the great lakes. Just a little trivia.

While in Buffalo, I visited Niagara Falls at night and saw the American Falls. I had been to Niagara Falls on a road trip east after graduating from med school and had seen the falls from the Canadian side. Definitely, a much better view. The American side was still impressive, and I was even more amazed at how many people were still arriving to see the falls at 10 p.m.

After 2 days of exploring most of the neighborhoods in Buffalo, and eating twice at a nice little restaurant called Pano's on Elmwood in the slowly gentrifying neighborhood to the south of SUNY Buffalo State College, I found an apartment in Amherst which is a nice suburb located on the northeastern edge of the city. I am sure the cats will enjoy having stairs and multiple levels again.

Over the next three years, I plan to keep a journal of my activities as an emergency medicine resident at the SUNY Buffalo program. I will be working out of Buffalo General Hospital (inner city), Erie County Medical Center (major trauma), and a couple of other surrounding hospitals. For the first time since med school, it will be the longest I've actually stayed in one place.

I hope you stay along with me on this next phase of my training. And, as we answer the question which has been bothering me since I found out I was moving: are there squirrels in Buffalo? Because, honestly, they keep telling me there are. I haven't seen one. Haven't even seen a dead one. I did see an article in one of the local newspapers about flying squirrels, and someone posted a pic, somewhat blurry, about a pair that lives in their backyard tree. I am still skeptical. So, we'll find out together.

I move on August 31st, so until then my postings will be random rants and raves, as well as sundry comments on the difficulties of packing up my life and moving, yet again.