This is a blog that contains: struggles, triumphs, crafts, recipes and stories to brighten your day and make you smile, laugh, and say well things aren't all that bad!

Sunday, June 12, 2011

PA Reflections: Surgical Oncology Rotation Mrs. M.

I don’t often write about encounters gone badly. But, honestly I don’t really have a lot of insight into when encounters go badly.

Mrs. M is a 47 year old with metastatic breast cancer who was sent to our office for a consultation for palliative mastectomy. Those two words seem diabolically opposed to me. Basically her disease was likely going to overtake her in the not quite forseable future. She was undergoing chemotherapy and her disease was stable, not advancing. However, it was so diffuse initially that this was not entirely hopeful news.  The medical oncologists thought I guess was that in select cases of metastatic disease removing the primary site can prolong survival. (not cure the patient was increase their lifespan).  However, in my attending’s quick and appropriate judgment the decision was no or at least not yet until further medical treatment could be employed to shrink the primary tumor further.  

Let me back up to my role in the encounter. I rushed in. Spanish speaker ok, Lo siento Me espanol es muy mal. I checked off the breast CA risk factors she had, asked about new complaints, and did my physical. I didn’t explain why I was there or ask her why she was at our clinic.

When my attending shared her assessment with Mrs. M, she burst into tears. Thinking back over the encounter I realized Mrs. M I never asked Mrs. M why she wanted the surgery or what she thought the surgery could do. What if Mrs. M. thought this surgery was going to cure her. . . We decided to wait on the surgery because it was not in her best interest, it could make her last months more painful, the surgery would be extensive due to the size of her tumor and this may be a bigger risk to her health than if the breast stayed. We decided to wait until the last rounds of chemo and further medical treatment that was planned. If the tumor shrank at that time the surgery would be a better option. However, I didn’t even understand all of this until the Doctors explained this to me. So what if she thought we were saying no we were not going to do this not because we didn’t want to… We never asked. We didn’t explain our rationale.

I just finished a book about communication in healthcare. But it didn’t sink in. I failed Mrs. M. I didn’t realize it, the sleep deprivation and stress of being uncomfortable on my new rotation let me get in the way of my strengths compassion and communication.

Saturday, June 4, 2011

PA reflections: Surgical Oncology Rotation

Monday I start my 3.5 wk Surgery Oncology rotation. From all reports it is doubtlessly going to be long hours, six/seven days a week, with people who are less that Mr. or Mrs. congeniality. I am not super excited, actually I am probably closer on the spectrum toward dreading it (the most of all the rotations this year).

But bright points are:
--It is only 3.5 wks long
--I will be ale to come home everynight, even if it is just for a couple hours of sleep.
--It will be something new and different.

Wish my luck but after monday just know I probably will not be blogging much for this next month!

Book Review/reflection: The Spirit Catches you and You fall Down.

This morning I finished this book. It is a less popular/main stream book than I normally am drawn to. However, the book was very interesting/applicable to me.

The book is a nonfiction investigation into the life for a family of Hmong refugees living in Southern california who have a daughter with Epilepsy and the doctors that are trying to cure this little girl of her disease. The book is about cultural miscommunication/ Eastern medicine vs. Western medicine.

Being in the medical field sometimes I feel pressure to be God. I don't think I am alone in this feeling, as evidence by Lia's Doctors in the book. We feel it is our job to cure, to heal, to know all the answers. But medicine like anything else is often times not black and white. Solutions to problems can be problems themselves. Lives are precious, but sometimes in an effort to save medical intervention can make things worse.

The book is a beautiful complete look into the lives of the doctors, nurses, social workers, and family involved. As a healthcare provider it was wonderful to read. Medical Education in this country teaches us to treat diseases, teaching us pathopysiology to explain to our patients how diseases affect our bodies and how the medicines we will use will restore new order. However, how does this translate to a culture where Epilepsy, a condition that called in Hmong is "The spirit catches you and you fall down,"  is caused by lossing your soul to an evil spirit.

Medicine focuses on life, preservation of life, sometimes at the expense of dignity. Not once was I ever taught about any treatments that heal a soul. Western medicine preserves life, there are many cases where without it people: life, soul and all would expire. However, I think most of us would agree there is more to life than just an EEG or EKG reading. This book is a beautiful, mind bending, heart wrenching look into these struggles. For health care professionals who deal with this everyday. It is an invitation to look over these tough things again. For people like Mr., next in line to read the book, hopefully it is a glimpse into what I struggle with during my 9-5 life.. or more like 5:30-6 life. Things that sometimes you shut out as you come home because the burden is too great.