A few firsts

There were moments during my darker moments of stumbling through the darkness of cancer when I often thought of what it would be like to return to work as a physician. I now have about two months of working back under my belt to know that sort of like riding a bike or the first ski of the year. The second of these analogies seems more appropriate for this time of year. In fact I got in a wonderful early season ski the other evening. We got a little dusting here in town but up in the Chugach foothills we received a nice early season blanket of white. Many people had been out before I got a chance to try it out but most of the eager outdoor crowd seemed to be stuck in summer mode or overly excited about the new fat tire bike craze. What ever they were into the trail at Glen Alps was packed out and the skiing was reasonable.

I remember so many years of getting out on skis and sort of flopping around for a while to get the feeling and rhythm back to make it feel right. Many of those memories are so pleasing, early days on Rabbit ears at the campgrounds, eventually at Bruce’s trail, the college days up beyond Red Lady, and the more recent years at Glen Alps. Every year the feeling of the glide comes back a bit quicker and is even more enjoyable. This year was no different and even more rewarding. Eventually I hit the end of where everyone else dared to go. Beyond was fresh snow but hidden rocks. Despite my desire to look like Ben Husaby in that old Snickers commercial (traumatizing for most nordic skiiers as that came out when we were all skate skiing not dorking through the powder on wooden skis) I picked my way further up the valley just so I felt like I had outdone all my early season diehards. I did not ruin my skis but they do have some new wounds.

The point of all this is that I have fallen back into the groove of working. Just like the early season strides the feeling of caring for people and directing the plan of care has not been to foreign to regain. Clearly, it is different now that I can commiserate with many of the concerns I hear about now. Still to be on this side of the worry is less dramatic to say the least. There is just no way no matter what my history is that I can truly feel or understand someone else’s situation. Yes I still feel the anxiety of looking at my labs and wondering when my world might crumble again and I remember so many of the feelings they have  but we are all different. So once I felt that more smooth delivery of my thoughts to patients I started wondering what would happen when I ran into someone with AML.

Well, it happened. Yesterday, I heard of an admission I would be taking from a partner at another hospital who had AML. As I have learned that simple three letters clearly does not give an adequate picture of the situation. My new patient had a lot of problems associated as most of us AML battlers do. I wondered how I would act when I walked in. Sort of like if you are called to the front of a room and you must walk through a crowd, you can’t help but think “how could I forget how to walk right now, something I do all the time?” which just makes it worse.  Well that is the feeling of walking into a room with a patient who carries the same diagnosis.

I managed to revert to my learned habits. Sit at the edge of the bed, recap the story I know, ask some open enders, narrow down to the pertinent issues, get the review of systems and start to discuss the plan. Well, I got through that and didn’t even mention my AML. I was glad I could ask him about it and not cry myself. I realized at one point though I was clearly relying on my routine when I asked in my systems review if he was depressed. I immediately knew what a dumb question that was. I got asked this many times and so many times I just wanted to say ” what do you F—ing think?” I caught myself really quick and before he could answer said “wait let me explain” and I reminded him that everything he was feeling was okay.

Depression carries this weird stigma of weakness but in so many cases it is not pathological but just an appropriate response to a horrible situation. There is clearly depression which is troublesome but his was, just like many of my patients, and my own was the right thing to feel. After explaining I rephrased, and asked how he was coping. More open ended and we started talking more. I eventually did tell him we had the same Oncologist and the same cancer diagnosis. I didn’t expect anything from him in response and we moved on. Later it made me wonder how many of my own providers through this have had horrendous disease of their own. As I drove home thinking about this I felt sort of like an ass that I didn’t take more time to think of my providers along the way. My guess is this is more along the pathological thought processing than normal. Still I think I will pay attention to them a bit more in the future.

As I seem to be wading through my feelings of my encounter today and think ahead to the next week I will have with him I realize I really miss writing. I have some many thoughts about my days. My first ski of the year, my daily encounters, my thoughts of the past, my lessons of the past come to bear on the now, my stories of my life and those of my wonderfully developing family. I wish I had some more time to write. Just like the routine of an early season ski the routine of my day’s has become hectic again. I have more joy in my days also and that makes my thoughts seem less poignant. Still amidst the wonder and struggle of life there is always so much to reflect on at the end of the day or in the few minutes sandwiched in between activities. This is better than tripping in the darkness of cancer.

Head Up, Heart Strong. I need a cure.

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