Here it is.
My husband has cancer.
Though we've known now for almost 2 months it is still blowing my mind. The worst part was the two weeks of waiting for a diagnosis. See, he woke up one morning and his armpit was sore. He was worried it might be something bad (always the optimist, that hubby of mine), and I made fun of him and told him he'd over-used his arm. A week later he called me from the kitchen.
"Hey, honey... wanna check this out?"
I sighed and put down my book.
"Look at this," he said, holding down the collar of his shirt.
On left side of his neck, right above the collarbone, was visibly swollen compared to the right. My stomach dropped.
"Feel this," he said, pushing around with is fingers.
I was almost shaking as I did to my husband what I've done to probably hundreds of patients--palpated for lymph nodes.
I've never felt a left supraclavicular node on a person before, but I've answered lots of test questions about what a firm, non-tender node in this area usually means: cancer. And there it was. A firm, non-tender left supraclavicular node.
On my husband.
My heart started pounding.
Strangely, at this point, he got more optimistic, while I began sinking into despair. "Maybe I have a weird infection," he said. "I've been taking care of a lot of dudes with TB, maybe I have that."
"Maybe," I said. I didn't mean it.
"Or Cat Scratch Fever."
"Yeah, maybe."
I wanted to go to the doctor right away, but this was a Friday afternoon, so we had to wait until Monday. We were there when the office opened Monday, but as he was a new patient, they wouldn't see him until Tuesday. Those days were awful, but they weren't anything compared to what was coming. Tuesday morning the resident examined him and said he probably had an infection. A trial of antibiotics, he said.
"I'm worried about cancer," I said, trying to sound like I was wondering if it would rain or not. "Specifically, lymphoma or testicular cancer."
The resident shrugged. "Well, we could do a chest x-ray just to be sure."
"Great," I said. "Thanks."
The report came back showing a mediastinal mass, a large one. Just like how, though most people might have blown it off, I knew that his node was bad news, I knew what this meant. I had been sort of rooting for testicular cancer, something that had a pretty darn good prognosis. But a mediastinal mass meant lymphoma, and that was the kind of diagnosis that could carry less than a 50% 5-year survival rate.
It was another week and a half of CTs and lymph node biopsies before we had a diagnosis. Each test looked more like the diagnosis was lymphoma, and it was more wide-spread than we had realized. The problem is that there are lots of types, and some are pretty OK, prognosis-wise, and some are horrific. So I tried to hope, but it was hard, knowing that it was more likely he had a horrific kind (they are more common) than a pretty OK kind.
And that's what life was: hoping for the least horrible kind of cancer.
Finally, we got a diagnosis. Hodgkin's Disease. It was the best diagnosis I could have hoped for given what we knew. His labs came back--again, the best labs we could have hoped for, given his stage. They started Chemo the following week.
I never even really had much time to think. How did this happen? He's 31 years old! Healthy! Never smoked, excersises, eats well, hardly ever drinks, and then only one or two beers. This isn't right. It isn't fair. I take care of people all stinking day who have abused their bodies maliciously for 50, 60, 70 years, and they are still hanging around, complaining that they cough (You're kidding, Mr. 100-pack-years? You COUGH??).
I'd find myself thinking a lot when I had to tell people, "My husband has lymphoma." Husband doesn't really say it. It's not right. It doesn't mean to everyone what it means to me. I wanted to say, "The love of my life, my best friend, my soul mate I never thought I would find, has cancer. He could die. And I'm supposed to keep showing up to clinic, keep doing laundry, keep eating and sleeping like any of it matters."
I would overhear people talking about their problems and want to cry. "My wife got in a fender-bender, my computer died, and I lost my wallet," I heard one person lament. "Could my life get any worse?"
For your sake, buddy, I thought--I hope not.
That's all I can write for now. Things are going as well as can be expected. He's tolerating the chemo okay. Having to watch him go through so many horrible procedures, tests and therapies is torture. Waiting for his PET scan, where we find out if his cancer is responding to the chemo, is hell.
But I am still doing my rotations (on his insistence... he always makes me do the right thing). I am studying for Step 2, which I take in two weeks--just days before his PET scan. I'm still going to clinic, and doing laundry, and eating and sleeping, because I guess that stuff does matter, somehow.
Just not as much as it used to.
Sunday, October 12, 2008
Sunday, September 14, 2008
Life throws Dr. VonB a big ol' curve ball to the face
You know, I casually throw around words like "survive" around a lot on this blog. It seems kind of silly now.
Unfortunately I can't tell you a lot about this curve ball except that it is basically one of my worst nightmares come true, and I probably won't be writing much for a while.
In the future I may, however, be in a position to talk more about real survival, and being on the other side of medical care.
Until then... keep believing in wondrous advancements in medicine. For those of you in med school/grad school/mudphud adventures, keep believing in what you do. It matters, and it changes people's lives.
Thanks for reading, everyone, and please send Mrs. Dr. and Mr. Dr. VonB all the positive vibes you can spare. I'm off to face my nightmare.
Unfortunately I can't tell you a lot about this curve ball except that it is basically one of my worst nightmares come true, and I probably won't be writing much for a while.
In the future I may, however, be in a position to talk more about real survival, and being on the other side of medical care.
Until then... keep believing in wondrous advancements in medicine. For those of you in med school/grad school/mudphud adventures, keep believing in what you do. It matters, and it changes people's lives.
Thanks for reading, everyone, and please send Mrs. Dr. and Mr. Dr. VonB all the positive vibes you can spare. I'm off to face my nightmare.
Sunday, August 24, 2008
It's graduate school that sucks; not research
Yes, I honestly believe that. Research does not suck like graduate school does. Here's why:
1. Hordes of minions. This is something I've been looking forward to since before I came back to school. I worked for a biotech company for a while, and I went from being a minion to having my own minions. I can't begin to tell you how awesome it is to do research when you have your own minions. All that drudgery, all those banal things you hate can be tasked to other, often more capable, people. You can focus on the best things about research: thinking about data. Coming up with theories. Designing experiments to test those theories. Communicating your ideas to others. Personally, I also really enjoy writing grants and papers, as that really boils down to doing all of the above. In any case, this one is easy: in grad school you are a minion; in research, you get to command minions.
2. Having some small measure of power over your own destiny. I've always felt that, in graduate school, you have all of the responsibility, but none of the power. You are expected to produce, but all you can bring to bear is your own blood, sweat and tears. Others control everything: lab space. Equipment. Supplies. Manpower other than your own. You have to wait for your boss to edit stuff, which can take years. Wait for him or her to submit papers. Ask permission from your committee. Obviously, some of these requirements make lots of sense; after all, you're only learning. However, as a very take-charge person it was a relentlessly frustrating situation for me to be expected to produce, on a schedule, but have so little ability to ensure that could happen. Now, I am not so naive to think that at some point you are magically no longer beholden to anyone; no matter how high you climb you can't just do whatever you want (ahem, recent NIEHS Director badness). But, no one, and I mean no one has a more deranged power-to-responsibility ration than a graduate student. As a full fledged MD/PhD, at least you get a little leverage and a little say in your own little lab-verse.
3. Did I mention minions?
4. You can have a life outside of the lab. In my ideal career, at least, I will also have clinic, and patients. I won't live and die chained to my bench. I will be able to be out, teaching, seeing patients, speaking, hearing talks, going to conferences. Yes, I got to do some of this in graduate school, but I think that when you are a PI this whole new world of freedom opens up for you--I can't wait.
5. Minions.
Okay, I'm sure there are more, but for now I must return to the luxurious weekend. I have but a few precious hours to do whatever I want (I've been reading fun books like a madwoman--it feels like forever since I've read fiction) and I'm going to dive right in, baby. Also, I am already working hard to secure my horde, and I have a pile of applications to go through.
1. Hordes of minions. This is something I've been looking forward to since before I came back to school. I worked for a biotech company for a while, and I went from being a minion to having my own minions. I can't begin to tell you how awesome it is to do research when you have your own minions. All that drudgery, all those banal things you hate can be tasked to other, often more capable, people. You can focus on the best things about research: thinking about data. Coming up with theories. Designing experiments to test those theories. Communicating your ideas to others. Personally, I also really enjoy writing grants and papers, as that really boils down to doing all of the above. In any case, this one is easy: in grad school you are a minion; in research, you get to command minions.
2. Having some small measure of power over your own destiny. I've always felt that, in graduate school, you have all of the responsibility, but none of the power. You are expected to produce, but all you can bring to bear is your own blood, sweat and tears. Others control everything: lab space. Equipment. Supplies. Manpower other than your own. You have to wait for your boss to edit stuff, which can take years. Wait for him or her to submit papers. Ask permission from your committee. Obviously, some of these requirements make lots of sense; after all, you're only learning. However, as a very take-charge person it was a relentlessly frustrating situation for me to be expected to produce, on a schedule, but have so little ability to ensure that could happen. Now, I am not so naive to think that at some point you are magically no longer beholden to anyone; no matter how high you climb you can't just do whatever you want (ahem, recent NIEHS Director badness). But, no one, and I mean no one has a more deranged power-to-responsibility ration than a graduate student. As a full fledged MD/PhD, at least you get a little leverage and a little say in your own little lab-verse.
3. Did I mention minions?
4. You can have a life outside of the lab. In my ideal career, at least, I will also have clinic, and patients. I won't live and die chained to my bench. I will be able to be out, teaching, seeing patients, speaking, hearing talks, going to conferences. Yes, I got to do some of this in graduate school, but I think that when you are a PI this whole new world of freedom opens up for you--I can't wait.
5. Minions.
Okay, I'm sure there are more, but for now I must return to the luxurious weekend. I have but a few precious hours to do whatever I want (I've been reading fun books like a madwoman--it feels like forever since I've read fiction) and I'm going to dive right in, baby. Also, I am already working hard to secure my horde, and I have a pile of applications to go through.
Wednesday, August 13, 2008
Whatcha, whatcha, whatcha want?
You've survived almost EIGHT YEARS of intensive schooling and, dare I add, intermittent torture. You are possibly mildly in debt, or at least way behind saving for retirement. Most of your friends make more money than you, and ALL of them have more spare time. BUT, up ahead, you see a light... blazing more brightly with each passing day: graduation.
What's next? Disneyland? Rampage of revenge? Huddling in a ball and crying for days as though you just survived a plane crash? Perhaps. But the biggest question for most mudphuds is:
What the heck am I gonna do with the five years of employment I have before I retire?
It's very fun to see where your friends end up. Some you expect, some come out of left field. It's even more interesting to hear why they choose what they choose.
For me, it's peds because they are a lot of acutely ill patients that you can actually make almost or completely better. And it's derm because, well, dermatology is the awesomest thing ever.
A lot of people think of derm as lots of acne. I think that in some private practice settings that's true. But what I want to do--academic derm--is very different. There is a huge variety in patients and conditions, lots of research, surgery... it's heaven. I love that people come from hours and hours away to see you, and that often you are able to help them when numerous previous doctors have not been able to. I love seeing them come back better, and happy. Also, don't discount how horrible some of these conditions can be. I have seen many patients that are physically debilitated, and that isn't including the ones who don't date because of embarrassment.
Anyway, enough about my choice. The thing is to figure out yours. From what I've seen you need to answer an important question:
Do you want to do research? It seems a lot of mudphuds end up burned out on research. It's very sad. I can't blame them, but I wish we could figure out why this happens. I mean, yes, graduate school is often hellacious. But a lot of what makes it so is intrinsic to graduate school and not research in general. In any case, be honest with yourself, and decide if it's for you. I think it's important to choose this before you settle on a specialty, because some are much more amenable to research than others. It's good to find an example--someone who is in your field of interest who is doing what you would like to do, and--this is important--doing it well.
For me, I was trying to decide between peds rheum and derm, and what it came down to was research. Peds rheum is a very under served specialty, and the clinical aspects would always be so demanding that doing research would be very difficult. And here's the thing: research is hard enough without adding extra crap.
Anyway, those are my nonsensical ramblings. Now that I've chosen my field my full-time job is arranging meetings to try to be admitted to said field, and it's time to get back to that. Please share your thoughts on field selection below, and with luck your 4th year schedule will allow you, as mine has, to mull these things over at some length. And also to have days where you don't have to change out of your pj's.
What's next? Disneyland? Rampage of revenge? Huddling in a ball and crying for days as though you just survived a plane crash? Perhaps. But the biggest question for most mudphuds is:
What the heck am I gonna do with the five years of employment I have before I retire?
It's very fun to see where your friends end up. Some you expect, some come out of left field. It's even more interesting to hear why they choose what they choose.
For me, it's peds because they are a lot of acutely ill patients that you can actually make almost or completely better. And it's derm because, well, dermatology is the awesomest thing ever.
A lot of people think of derm as lots of acne. I think that in some private practice settings that's true. But what I want to do--academic derm--is very different. There is a huge variety in patients and conditions, lots of research, surgery... it's heaven. I love that people come from hours and hours away to see you, and that often you are able to help them when numerous previous doctors have not been able to. I love seeing them come back better, and happy. Also, don't discount how horrible some of these conditions can be. I have seen many patients that are physically debilitated, and that isn't including the ones who don't date because of embarrassment.
Anyway, enough about my choice. The thing is to figure out yours. From what I've seen you need to answer an important question:
Do you want to do research? It seems a lot of mudphuds end up burned out on research. It's very sad. I can't blame them, but I wish we could figure out why this happens. I mean, yes, graduate school is often hellacious. But a lot of what makes it so is intrinsic to graduate school and not research in general. In any case, be honest with yourself, and decide if it's for you. I think it's important to choose this before you settle on a specialty, because some are much more amenable to research than others. It's good to find an example--someone who is in your field of interest who is doing what you would like to do, and--this is important--doing it well.
For me, I was trying to decide between peds rheum and derm, and what it came down to was research. Peds rheum is a very under served specialty, and the clinical aspects would always be so demanding that doing research would be very difficult. And here's the thing: research is hard enough without adding extra crap.
Anyway, those are my nonsensical ramblings. Now that I've chosen my field my full-time job is arranging meetings to try to be admitted to said field, and it's time to get back to that. Please share your thoughts on field selection below, and with luck your 4th year schedule will allow you, as mine has, to mull these things over at some length. And also to have days where you don't have to change out of your pj's.
Monday, August 4, 2008
Entry for Most Disturbing, Strange, Offensive, and Yet Amusing Patient Quote Ever Contest
(it's a very specific contest)
From a pretty old, gnarled southern dude, said to me for reasons that, even on very careful and repeated reflection, are still not clear:
"There's two things a man lies about. The gas mileage of his truck, and how many women he's bent over."
Huh.
Any other entires out there?
From a pretty old, gnarled southern dude, said to me for reasons that, even on very careful and repeated reflection, are still not clear:
"There's two things a man lies about. The gas mileage of his truck, and how many women he's bent over."
Huh.
Any other entires out there?
Wednesday, July 30, 2008
Dumbass Medical Student Move
Okay, so I'm in this low-end procedures room, helping to do an excisional biopsy. I'm the non-scrubbed in person, grabbing non-sterile things, moving the table up and down, etc. etc. Then I offer to adjust the procedure light, the one on the arm. Now, the OR lights I am used to having a handle in the middle--which hardly ever actually positions the light the way you want--and very nice handles on the sides. So, first I try the handle in the middle. Then, making the ridiculous assumption without actually looking that this piece of crap light has the same side handles, I grab the side where the other handles usually are, firmly, to swing it around.
All I can say is I am damn lucky that I was wearing gloves, because even then I manged to burn the living @(*$%& out of my thumb, which I planted directly on one of the exposed bulbs. Then, being that there was a (conscious) patient and three residents trying to close up a giant wound about six inches from me , I had to pretend I hadn't just done that and it didn't hurt like a sonofabitch and I wasn't really, really embarrassed. I don't know how I managed to casually finish adjusting the light, pull off my gloves, and examine the giant blister on my thumb.
I quietly excused myself, taking my glove with me, to curse under my breath and find an ice machine and create a makeshift ice pack.
Which brings me to my next point: latex-free gloves are not very waterproof, and the only thing more embarrassing than burning your thumb on the overhead light during a procedure is dripping water from your makeshift ice pack onto the patient and the electrocautery plate during the procedure.
And I thought being a 4th year meant most of my bonehead moments were behind me...
Final side note: my favorite personal 3rd year bonehead moment was when, on my first day in the OR (actually, my first day of 3rd year!), the scrub nurse asked what size glove I wear (you have to know what size surgery glove you wear so they can pull the sterile gloves out for you). I said, I don't know, it's my first day. She said, hey, why don't you go next door to the other OR and ask Cindy to give you the glove sizer? I--and the other medical student--said, oh, okay! Sure! And like the pair of gullible brand new 3rd years that we were, went next door and asked for the glove sizer.
Well. The entire OR just looked at us like we rode in on goats. Then the circulating nurse kind of smiled and said, oh, yeah, the glove sizer. No, I think that's back in the other OR.
I'd like to say that we knew before the moment that we walked back into our OR and the ENTIRE OR--scrub nurse, circulating nurse, intern, resident, attending... hell, I think the anesthesiologists--were laughing heartily, that we had been had. But we didn't.
And they say doctors don't have a sense of humor. No one, of course, says that medical students aren't boneheads most of the time.
'Cause we are.
Okay, I am, anyway.
All I can say is I am damn lucky that I was wearing gloves, because even then I manged to burn the living @(*$%& out of my thumb, which I planted directly on one of the exposed bulbs. Then, being that there was a (conscious) patient and three residents trying to close up a giant wound about six inches from me , I had to pretend I hadn't just done that and it didn't hurt like a sonofabitch and I wasn't really, really embarrassed. I don't know how I managed to casually finish adjusting the light, pull off my gloves, and examine the giant blister on my thumb.
I quietly excused myself, taking my glove with me, to curse under my breath and find an ice machine and create a makeshift ice pack.
Which brings me to my next point: latex-free gloves are not very waterproof, and the only thing more embarrassing than burning your thumb on the overhead light during a procedure is dripping water from your makeshift ice pack onto the patient and the electrocautery plate during the procedure.
And I thought being a 4th year meant most of my bonehead moments were behind me...
Final side note: my favorite personal 3rd year bonehead moment was when, on my first day in the OR (actually, my first day of 3rd year!), the scrub nurse asked what size glove I wear (you have to know what size surgery glove you wear so they can pull the sterile gloves out for you). I said, I don't know, it's my first day. She said, hey, why don't you go next door to the other OR and ask Cindy to give you the glove sizer? I--and the other medical student--said, oh, okay! Sure! And like the pair of gullible brand new 3rd years that we were, went next door and asked for the glove sizer.
Well. The entire OR just looked at us like we rode in on goats. Then the circulating nurse kind of smiled and said, oh, yeah, the glove sizer. No, I think that's back in the other OR.
I'd like to say that we knew before the moment that we walked back into our OR and the ENTIRE OR--scrub nurse, circulating nurse, intern, resident, attending... hell, I think the anesthesiologists--were laughing heartily, that we had been had. But we didn't.
And they say doctors don't have a sense of humor. No one, of course, says that medical students aren't boneheads most of the time.
'Cause we are.
Okay, I am, anyway.
Monday, July 21, 2008
Whole New Scene
Well, today was my first day of 4th year medical school. It was great, and also scary. It was great to say out loud, "I'm a 4th year." It was scary to have people assume that somehow that means I know what I'm doing.
It's also great and scary because I'm no longer at my home base. I am doing a rotation at a somewhat nearby (also, major rival) school. In a field, which I love and want to enter, which I have not done, ever. With my limited, one-day experience, I have to say it has been pretty great. It's always scary for me to try completely new things, but I'm trying to focus on the positive, exciting parts of trying completely new things. Like, for example, it's nice to have new things to suck at, when all the other things I suck at start to get old.
No, but really, everyone was very nice today, and I think I am going to have a good month, which is followed by a super awesome two more weeks off. So, overall, I'm very pleased. Except...
Well, here's the thing I can't stop thinking about.
Vacation was awesome. You know what I really liked about it? The part where I don't have to do anything. It is actually making me feel kind of conflicted. Like, shouldn't I have been more excited to get back to things? Shouldn't I have at least been less depressed to be done with my vacation?
Here's the thing. I think that whole "Do for a living what you would do for free" thing is real nice in theory, but it hardly ever works out like that. I think that finding that job is like winning the lottery. I think that you are pretty damn lucky if you don't hate your job, and even luckier if you sort of like it.
I don't know... how many people do you know who would keep their job if they won the lottery? I'd like to say that I would, but I don't know that I would. I am trying to chalk some of this up to the fact that we are still not really moved in yet. The place is a mess, which I hate, but I hit a wall, and with the hubby on night float I'm not sure how much more I can do. I'm telling myself that if we can just make it through this damn night float that things will be better. And that's a whole separate post... how many times I've said that over the past 7 years of training. "If I can just make it through (insert whatever phase I'm in at the point), things will be better". But there's always something new.
But those are thoughts for another day. Today it is time to start some reading, and here's another reason to cheer: I'm reading to try and look like less of an idiot, but NOT FOR A SHELF EXAM. If that's not a reason to embrace novelty, I don't know what is.
It's also great and scary because I'm no longer at my home base. I am doing a rotation at a somewhat nearby (also, major rival) school. In a field, which I love and want to enter, which I have not done, ever. With my limited, one-day experience, I have to say it has been pretty great. It's always scary for me to try completely new things, but I'm trying to focus on the positive, exciting parts of trying completely new things. Like, for example, it's nice to have new things to suck at, when all the other things I suck at start to get old.
No, but really, everyone was very nice today, and I think I am going to have a good month, which is followed by a super awesome two more weeks off. So, overall, I'm very pleased. Except...
Well, here's the thing I can't stop thinking about.
Vacation was awesome. You know what I really liked about it? The part where I don't have to do anything. It is actually making me feel kind of conflicted. Like, shouldn't I have been more excited to get back to things? Shouldn't I have at least been less depressed to be done with my vacation?
Here's the thing. I think that whole "Do for a living what you would do for free" thing is real nice in theory, but it hardly ever works out like that. I think that finding that job is like winning the lottery. I think that you are pretty damn lucky if you don't hate your job, and even luckier if you sort of like it.
I don't know... how many people do you know who would keep their job if they won the lottery? I'd like to say that I would, but I don't know that I would. I am trying to chalk some of this up to the fact that we are still not really moved in yet. The place is a mess, which I hate, but I hit a wall, and with the hubby on night float I'm not sure how much more I can do. I'm telling myself that if we can just make it through this damn night float that things will be better. And that's a whole separate post... how many times I've said that over the past 7 years of training. "If I can just make it through (insert whatever phase I'm in at the point), things will be better". But there's always something new.
But those are thoughts for another day. Today it is time to start some reading, and here's another reason to cheer: I'm reading to try and look like less of an idiot, but NOT FOR A SHELF EXAM. If that's not a reason to embrace novelty, I don't know what is.
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