The Migraine Mausoleum

interior of church in Philadelphia

A not so innocent comment,
Twisted daggers and misplaced hate,
Duplicitous and malicious.
Forced open doors long ago closed
By fate’s heavy, unbalanced hand,
Waking whispered ghosts not yet dead,
Hurting the one you claim to love.

Honor the memory of love,
Even if it is not your own. 

Risen up from dying embers,
Unintended consequences 
Spiraling out of your control.
Come hither says Love’s crooked finger,
Beckoning from darkest shadows.
For nightmares of my flesh and blood
Will share your bed each night.

There is no healing, only remission.

Sharp edges peel the layers back,
Reveal the skull still lying there.
Grief does not die so easily.
Auras remain, halos of pain,
Making even the strongest weak.
Because despite a brief reprieve, 
The aching will always return.

Respect the memories of love,
They do not belong to you. 

Did you taste my cold lips on yours?
A kiss, my sharp wooden stake through
The heart, just moments before.
Waging a war against your dark
And blackened soul. What is light now?
Naught but emphasizing shadows.
You should have left the dead in peace.

Honoring the presence of love,
Even if it is not my own. 

*****************************

Please enjoy today’s Mediocre Medical Poetry while I work on posts to answer the questions you all gave me this past week! 🙂

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AFTER DEATH, WHAT?

I have been reading Nina Mishkin’s posts at her Getting Old blog for some time. I have read some truly beautiful and thought provoking posts there. Yesterday she wrote a heart wrenching post about what happened after her partner, Bill, died of pulmonary fibrosis a few months ago and I could not resist reblogging it. Everyone in healthcare must remember that our duty to the dying does not simply end when that patient’s life ends. It must extend also to the individuals left in that hospital room.

The Getting Old Blog

This is not a philosophical question, or a religious one. It’s a question about what happens to the person sitting by a hospital bedside when the occupant of the bed, someone who was loved and cherished, becomes (suddenly or at last) “the deceased,” dies perhaps even while the sun is still shining brightly through the clean hospital windows, mocking the dark ache in the heart of the solitary survivor.

In the hospital where Bill died early in May, a four-year-old state-of-the-art hospital in upscale Princeton, New Jersey — home of a world-renowned university, of the Institute for Advanced Studies (where Albert Einstein found safe harbor after fleeing anti-Semitism in Europe during World War II), and of Westminister Choir College, whose graduates grace stages in many celebrated opera houses – in this spiffy new hospital, the person blinded by tears who holds the still-warm hand of a new cadaver…

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The Fast Lane

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Barb Taub asked: Parenting, doctoring, partnering, blogging… My question is how? And I don’t mean in smile modestly, Superwoman kind of way. But more in a what do you get back that makes it worth it to do all those things?We are the lucky ones—your readers/patients/admirers. But what do you get out of all of it?

I am going to start with blogging. What do I get out of blogging? Sanity. And craziness. But mostly sanity. If I did not have a place to put my words where someone would read them, I would go stark raving mad. I was close once. Writing for me is like cutting is for others. The tension builds until I cannot stand it and then I open the wound and bleed all over a page or two. You all save me. Sometimes life hurts so much you have to have somewhere else to put some of that hurt so you can walk away from it. Once I write something here, my fictions or my truths, I can let it go and set it free…. then bury it in other posts until it suffocates and dies. 

I also started blogging to see if I was any good at writing. People close to you will pile all kinds of flattery on you to keep you happy, but strangers? If strangers liked what they read, then maybe I was actually good at it.

I read a post at Barnraised this morning that started off with this: “Have you ever hit a wall? Wishing it could be a mirror that would reflect back into the world everything you know to be true in your soul?” Blogging is my mirror, so I don’t have to hit the wall. 

Parenting. Once you have a kid, as it turns out, you are kinda stuck raising them. The alternative is jail. Avoiding jail is very rewarding in and of itself, but to be honest, my kids have saved me on more than once occasion. The well placed hug, the “I love you, mommy!”, and cuddles…. They are salves for the wounded soul. I dread the time when my kids no longer want to do these things. 

Partnering is a matter of survival. Love aside, I cannot do this alone. I don’t want to do this alone. I have been alone. Alone terrifies me. Also, partnering makes blogging possible. So does a housekeeper.

Doctoring. I love medicine. I love patients. I do NOT like the non-medical and non-patient parts of medicine. Fortunately all of the crap has not crowded out all of the joy. Yet. Yesterday was a particularly tough day at the office. I’ll blog about that soon enough….

So, there it is in a nutshell, folks! Thank you so much for reading and for sticking around. 

Calling Names

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Porter Girl, aka “The Juice” asked about my nickname.

I will tell you. 

My nickname is…. wait for it….

Code Red.

*gasp*

I know. It was given to me in residency. Makes me sound a lot more bad-assed than I ever was.

Why this name, you may ask?

First thing you have to know is that I have red hair. Is it real? Is it fake? I have posted the answer to that elsewhere. Do you remember? For this story, though, that doesn’t matter. It only matters that it is red.

The next thing you need to know about is hospital “Code” talk.

If a baby is stolen, it is called a Code Pink. Don’t worry. That didn’t happen very often…

If someone poops where they should not have, it is called a Code Brown. Interestingly when someone pees where they aren’t supposed to, we never called it a Code Yellow. I wonder why…

When someone was crashing in the hospital, though, it was called a Code Blue and was announced over the intercom. Everyone would run to the patient room announced with the code. The first doctor to get there got to run the code. CPR, intubation, and everything. I was a fast runner but those codes terrified me. I thought if I could get more experience it wouldn’t scare me as much. Didn’t work. It still scares the ever livin’ bahjeses out of me.

I had a reputation for being tough. No nonsense. Mainly that was because I could somehow find a common ground with some of the most difficult patients. Someone was making problems? They sent in Code Red. At times that meant cussing someone out. I was pretty good at that. I could do it in a nonthreatening way with a smile on my face that eased tension and made patients laugh. It was like magic. 

Sometimes it meant hugging or crying with someone. I was pretty good at that, too. 

More so it meant listening. I was extra good at that. Listen long enough and everyone will tell you what is going on.

Soon, the difficult patient was not difficult anymore. I am not sure anyone cared how I was doing it. They all assumed it was simply extra swagger and bravado. It wasn’t. I didn’t share my secret. It is good to have a reputation. But the truth was, I just really love prickly people. 

So there you have it. My bad-ass nickname.

​Who Knew — A Broken Blue Sky

Last night I read a post, “It’s All An Act,” on the blog site Behind The White Coat Beats A Real Human Heart. I love her blog and she is an amazing writer, doctor, and human being. Please go check out her site. I went to bed late and then couldn’t sleep. My mind kept thinking about this post. How bad-ass she is as a woman and as a doctor. I thought about how all of my life I have been made to feel weak and insignificant. How do women get to be this determined and strong, I […]

via Who Knew — A Broken Blue Sky

It’s All An Act

colorful canal in Burano, Italy

“It is better to know some of the questions, than all of the answers.” – James Thurber

In medical school the first thing you want to do is look smart. Hell, that all any of us want no matter what our walk in life, right?

How to accomplish this while surrounded by 100-150 other brilliant academic and social high acheivers? This is the dilemma. 

My strategy was this:

Only ask second or third order questions and ask them only if you already know the answer. Even more importantly, know when to keep your mouth shut.

Here is the scenario:

You are a third year medical student assisting the most bad-ass vascular surgeon in the hospital during an abdominal aortic dissection repair. This guy is scary. He has kicked other students out of the OR for simply looking at him the wrong way through their face shields. You have to be on the top of your game.

The Prep:

You knew this was coming because you checked the surgery list before you left the night before, read all of the scheduled patients’ charts, and stayed up half the night reading up on everything in text books.

Over coffee on your hour long drive in the next morning before the butt crack of dawn (enough caffeine to stay awake but not so much that your hands shake… it is a fine line) you plan out and memorize your questions.

Act One:

As you are holding retractors, trying to keep the small intestine from sneaking over toward the clamps and bovies, you ask, “So this fellow had a 7.5cm aneurysm. That puts his annual risk of rupture at about 20-40%, right?” You don’t look the surgeon in the eye, though. Never move your eyes from the operating field….

“Yes…” Is his gruff, muffled response. He knows the game you are playing and can appreciate it for what it is.

He then starts to pimp you on the anatomy and you ace it. Thank you, Netter’s Atlas of Human Anatomy…

Act Two:

“Oh, shit!” 

You can see the aorta is dissintegrating in his hands. 

The scrub nurse stands up a bit straighter while the resident surgeon standing next to you kicks your ankle hard, shooting you a warning look as beads of sweat form on his brow. Your own heart is pounding.

Act Three:

The next several hours are tense. You don’t say a word. Your arms are killing you from hold the retractors so hard for so long but you don’t dare let go or even intimate by body language that you are in pain or tired. 

All of those extra questions you carefully planned out? You don’t use them. Instead, you keep your mouth shut because you know that at a time of crisis the last thing anyone needs is a showboating med student trying to make a good impression.

The Grande Finale:

The graft requires two re-sews. You are dangerously close to the renal arteries….

Somehow, though, it holds. No leaks. Everyone stands back and watches for a few minutes just to be sure.

Instruments and sponges are counted.

As a reward, you get to practice sutures. 

“Nice knots,” Dr. Bad-ass says as he looks over your shoulder after scrubbing out. The resident will handle it from here. “I am doing a bypass tomorrow. You are welcome to come hold a retractor.”

Yes!

Curtain Call:

It is well after 8PM when you finally get to your car only to find that you have a flat tire. You blink the tears from your weary eyes and swallow down the lump in your throat as you get out the car jack and tire iron and set to work. 

The universe has a perverse sense of humor.

As you are screwing on the final lug nut the OR scrub nurse drives past, rolls down his window, and offers to help. You decline, smiling to yourself as he drives off. You now have a witness that you, a girl, sat in the dark parking lot and changed your own flat tire.

Tomorrow you will be legend.

My Request:

Questions. Ask me a question. What do your inquiring minds want to know?!?!??? Silly questions? Thought provoking ones? I don’t care… Bring them on! 

Just please don’t ask for medical advice. And NO, you cannot send me a picture of that rash you have “down there.”

*If you have been with me for a while, you may have recognized this post from last year. I thought I would recycle it, hoping to get some blog posting ideas from your creative minds!

Septicemia

interior of a log cabin, black amd white

Her eyes are bloodshot, burning from the lack of sleep, but she cannot stop. The pressure renders her unable to breathe until she gets them all out of her chest. 

Words.

They weigh so heavily there.

They multiply. The pressure builds again until she can no longer process anything else, crowding out every other thought she might want to think, every other feeling she might want to feel.

So many words.

Such heaviness.

Her hand trembles as she writes with his old fountain pen. Ink now runs black through her veins.

I will read them when you are done, he said. 

A promise.

So all she can do is bleed onto the page again and again and again and again while her sanity slips farther away.

Writing has become her disease.

He is her infection and her elixir.

Words written in the dark, flowing so fast she cannot catch them all. 

Hemorrhaging.

There is only one cure. Just one.

He holds his hand out to her. This time, she takes it.

Outside

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 “What do you know about OxyContin?” He asked. I could see pain written all over his face as he spoke.

I knew he had chronic back pain. Multiple surgeries. Injections. Physical therapy. More surgeries. A back stimulator. Nothing had worked.

He was family. 

I always tried to avoid talking about medicine at family gatherings and I especially tried to avoid talking about narcotics with family that was taking them, but something in his eyes made me answer.

“It is a pretty strong pain medication,” I answered. “Supposed to last twelve hours. You’re taking it?”

“I just started it a couple of months ago. I don’t think it’s working.” He paused as the waitress put down his food in front of him, a burger and fries, then placed a salad in front of me, making her way around the rest of the table. “I mean, sometimes it does. But when it wears off, the pain is worse than ever before.” His hands shook as he reached for the burger.

He was suffering. 

His face was gaunt. He had lost weight.

I didn’t know what to say. If OxyContin wasn’t helping, then there was nothing left for him. Nothing at all. I had no idea how to help. So I told him to follow up with his pain specialist pronto and changed the subject.

Several weeks later, he shot himself in the head with a rifle. It was in the early morning hours after a sleepless night, in the shed in his back yard. His wife woke up to the sound of the gunshot and found him there. 

Dead.

Now, it is known that the manufacturers of OxyContin knew it did not last for 12 hours. It wore off much earlier. The withdrawals were terrible. They deliberately hid this information from physicians, using their drug reps to tell doctors to push the dose higher rather than dose more frequently, exacerbating the highs and lows. Read about it here.

How many other people, faced with this nightmare, also chose to die?

He was a good man. 

He was the victim of a botched back surgery and a greedy pharmaceutical company and it makes me angry. This is one of the reasons I don’t speak to drug reps that come by my office. They may have the best of intentions but they are still just pawns in a bigger game. 

In fact, perhaps we are all pawns.

Hospitalization

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“The ER doc says he remembers you from when you used to work there.” She laughed. “He liked you a lot, said you were a really good doctor, that it didn’t matter what time of night, you were always dressed up, with flawless make-up.”

It’s true. 

I would sleep in street clothes and make-up when I was on call so if I had a critical patient and had to go in, I was ready. 

Minutes count.

So do appearances, especially if you are a woman. People notice. It affects how they respond to you.

Much of healing has nothing to do with tests and procedures and drugs, as it turns out. A lot of it is showmanship, portraying confidence, treating patients with respect.

The thing is, and I never thought I would say this, I miss the hospital. Her comment made me think and I realized that I was having wistful thoughts. Somehow my hospital work felt more important than what I do now, only outpatient clinic. I feel like I spend most of my time pushing buttons, signing papers, attending this meeting or that meeting, trying to meet various measures. I miss being a stronger advocate, the firecracker spitfire who fought for her patients. I miss the adrenaline. I miss feeling like the sacrifices I was making were worth it.

That part of my life is over, though. There is no going back. It was a necessary thing at the time, stepping back. Now it has been too long. Things are too different. Hospitalists, dedicated inpatient physicians, save hospitals money so there is no role for me in that model anymore.

But I still look back on those good ole days from time to time… And think wistfully.

Charlie

old tombstone in Bostom cemetary

We were sitting in the dark after the bedtime story and prayers. I typically hold his hand and check blog stats or write the next day’s post while he drifts off to sleep.

“Mommy, I like dreams. They’re nice,” he said sleepily.

“I like dreams, too. Most of the time. Do you ever have bad dreams?”

“Yes.”

“Like what?”

“Charlie.”

“Charlie? Who’s Charlie?” Goosebumps rose on my neck and arms.

“Charlie is my bad dream.” He was matter of fact, no fear in his voice.

Charlie was my own bad dream as a kid. Terrified the hell out of me. I had never told this to a single soul.

“What does Charlie look like?”

“He has red eyes and no pupilaries. Like Deadpool’s but red and not black. He has a bushy beard and one eyebrow that stretches over both eyes. He’s old.”

How can it be possible for your child to have the same, identical childhood nightmare?

“Did I tell you about Charlie?” I asked, my heart pounding, hopeful that he would say yes and I had just forgotten.

“No. But he says he knows you…”