Friday, September 02, 2005

Take a Breath

Friday morning, a day off from work, elongating the Labor Day weekend to four days. Hallelujah.

What a week. The Gulf Coast disaster has engulfed the national consciousness as New Orleans seems to slide into absolute chaos. Mary has approximately fifty family members in the New Orleans area, thirty of whom are first cousins. We did not have word from any of them until last night and we're thankful that they're all safe, although several homes appear to have been lost. Another good friend escaped to Austin and thinks he'll remain there permanently.

Aside from the tragedy in New Orleans, Florida, and Mississippi, the stampede and scores of unnecessary deaths which resulted in Baghdad earlier this week is also fuel for despair and a desire for change in the world. One could see why certain segments of society might see this as the beginning of "the end times". I don't know about the end of the world, but I sure would like to see an end to needless suffering in the world.

Closer to home, the biopsy of my dear patient's chest mass was inconclusive other than to say that there is necrotic tissue in there, underscoring the notion that the spots on her lungs are very likely malignant. The next move is a trans-tracheal or trans-esophageal exploratory biopsy, basically a tube with a camera snaking through the trachea or esophagus into the chest to take a real-time peek at what's happening in there. I stopped by for a visit to my patient's hospital room yesterday, prior to leaving for my four-day weekend. Her depression and loneliness were palpable, and we sat on her bed holding hands. I noticed that she hadn't touched her lunch, and for the second day in a row I encouraged her to drink an unopened can of Boost to keep her energy up and receive at least some nutrition. She agreed to do so only if I shared it, so I poured the lion's share into a cup for her, and drank the remaining 1/4 can of thick vanilla liquid after a quick toast to her health. (I thought to myself, "If doctors I know have taken AIDS medications just to see how the side effects feel, I can stomach a bit of Diet Boost".) It wasn't bad really, though I bet the chocolote is better.

The gentleman with metastatic stomach cancer who I've recently written about is beginning to fail. Although he is still home, he's now taking almost nothing by mouth due to his almost constant nausea and vomiting. This does not bode well for him ever being able to tolerate chemotherapy, so I've begun the difficult conversation about end-of-life issues, such as resuscitation status, health care proxies, funeral arrangements, etcetera. Due to the family's insistence and my encouragement for them to explore every option, we're now researching putting in a "J-tube", a feeding tube which would bypass the stomach by going directly into the small intestine. It is an easy procedure in which a small incision is made in the central abdomen and a small tube is inserted into the jejunum, the first section of the small intestine which attaches to the outlet from the stomach. Specially prepared food is then injected through the tube directly into the intestine where the majority of nutrient absorption occurs. Many people don't realize that it is altogether possible to live without a stomach since very little happens there in terms of digestion, other than the breaking down of foodstuffs into what comes to be known as chyme. Granted, the stomach assists in the absorption of Vitamin B-12 and several other nutrients, but its lack of involvement in the digestive process can be replaced by other therapeutic means.

With both of these patients in tenuous situations, and one of them at home in need of daily checking in and symptom management, it was very difficult for me to let go and tell them I would be back in 5 days. There's a certain "ownership" of a patient's care that one can begin to feel, and one can often experience resistance to entrusting these tasks to others, no matter how trusted and skilled they are. There is also admittedly an ego-level attachment to not "missing out" on some turning point, something perhaps akin to what a parent might feel when their young child experiences a developmental milestone while at day-care. ("Oh, Mrs. Smith, little Sallie took her very first steps today! I wish you could have been there!"---I imagine many daycare providers are sensitive to this post-modern parenting conundrum and perhaps refrain from telling a parent everything a child does, for fear of the parent feeling utterly destroyed that they missed a child's first step....) But I digress.

Anyway, as you have surmised, attachments can hinder a healthcare provider's ability to "let go and let others". For now, though, I sign off from both work and blogging, preparing instead for a 48-hour trip to lovely Cape Ann, Massachussetts, where we will visit friends and frolic with my brother and his family who are vacationing there. Having lived in Gloucester, MA for several years as newlyweds, there's a nostalgic feeling to our visits to the other side of the state, and the weather looks promising. Our son and his girlfriend will also be there for the weekend, so we look forward to some needed family time. Even as we rest and recuperate, we'll of course bear in mind the suffering of others, and remember that there but for the grace of God(dess) go we.

Signing off til Sunday or Monday, giving thanks for the Labor Movement, the kind folks who brought us the weekend.....
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