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An attending I recently worked with is a married mother of two kids (now 18 and 20) and just could not fathom what stay-at-home moms do all day. The impending doom bliss of my growing belly has prompted many similar conversations with women at work. Whether you choose to stay at home or go to work while your little one grows up, I think there are a lot of misconceptions and misinformed stereotypes on both sides of the fence.

Organized in an alphabetized list of definitions, this book by Kristin van Ogtrop is fun and funny and easy to read. Brandon picked it off the “Mother’s Day” table at a local bookstore and it’s a good little read.

One of the main themes of this book is that there is no single path in motherhood. Every mom makes her own way as she learns from her mistakes and figures out what works for her family. I like this open, non-judgmental approach. I am probably secretly envious of women that have the luxury(?) and leisure(?)* of making their kids their full-time career.

But, as van Ogtrop says: it’ll probably be better in the long-run for me to be around less because it gives me less of a chance to screw my kids up.

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*Would stay-at-home moms really call their life “luxurious and leisurely”? Not likely. But I consider the ability to comfortably live and pay down debt with one income a luxury indeed.

A kind publisher from HarperCollins sent me a complimentary copy of Katherine Rosman’s book “If You Knew Suzy”. An article by her in the Wall Street Journal received a huge response from the medical community and he figured I might be interested in her book.

He was right.

As most readers know, my experiences with death and dying on the hospital wards has been extremely personal and personally enlightening. Interactions with specific patients have brought up questions about my future place in palliative or hospice care as well as insights to my own capabilities and limitations of compassion. I think that part of the training to become a great doctor includes lessons in awareness of the feelings of others, how to read them, and how to provide what they need.

As we learned firsthand, a kind bedside manner is not merely a quaint characteristic you hope for in a family doctor. A doctor’s attitude toward a patient and the patient’s family colors every moment of a health crisis. It can help a patient to heal, keep those of us who suffer alongside her saner and healthier, and lower costs.

And yet for all the advances in medical technology and research, simple kindness from health-care providers is all too rare. A recent survey conducted by the Arnold P. Gold Foundation, which advocates for a respectful bedside manner, asked 600 people to describe their interactions with doctors. Twelve percent said they were taken care of by doctors who didn’t know their names. Twenty percent had met with doctors they found “rude or condescending.” Forty-seven percent said they had felt rushed by doctors.

~ “The Power of Compassion” by Katherine Rosman

Rosman’s mother died of lung cancer. Her book is a journey and a memoir. It’s a reporter following leads and a daughter opening doors.

I was thankful the book arrived just in time for Mother’s Day. How appropriate. I’m thankful that I haven’t yet lost my mother and this book made me appreciate the shortcomings and successes of our relationship.

It was also a good reminder that the fragile little lady in the ICU is someone’s mother, grandmother, daughter, sister, or aunt.

“Do not try to give your children all that you did not have and then forget to give them all that you did have.”
~ in an email from a friend

My belly button is looking pretty shallow these days. Perhaps more frightening to me than an array of stretch marks is the thought of having an “outie”. Ugh.

Woke up this morning feeling really loosey-goosey. My knees, ankles, shoulders, and even the soles of my feet feel stretched out of shape. All of the ligaments in the body loosen and stretch during pregnancy. This is why many women can go up almost a full shoe size and it’s extra important not to overstretch during yoga or exercise. Still, I had no idea I’d be feeling like Gumby on a hot summer day.

My fingers and feet are like fat over-stuffed sausages in the mornings too. After a walk with the dogs on a hot day, Brandon looked down and laughed, “Wow! I never thought I’d say this, but you almost have cankles!”

I’m feeling big and swollen and over-stuffed. How lovely.

Last week, when I was walking from the parking garage to meet Brandon at our prenatal appointment, some guy leaned out of his car and whistled at me. I was wearing one of my non-maternity t-shirts (aka: tight-fitting and looking extremely round) and yoga pants. I told Brandon and he said, “Oh ye-ah! Whistling at my hot pregnant wife! Sweeet.” I don’t get the appeal of pregnant married women being extra attractive. Is it the ultimate wanting of something you most definitely can’t have?

How’s the baby doing? According to online estimates, he’s now a full pound and about eight inches long. Sense of touch is developing, as is light and dark differentiation. Hair and eyelashes are growing too! I can’t wait to meet him when he’s finally ready to come out.

Oh, and I now have to tie my bathrobe on top of my belly instead of around it. Hee.

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photo: Big box of baby boy blues from Brandon’s mom. Yay!

“All women become like their mothers. That is their tragedy. No man does. That’s his.”
~ Oscar Wilde

I got this card in the mail from Brandon’s parents and am pretty excited to be joining the elite club of Motherhood.

I hope all of the hard-working moms out there are spoiled silly today by their loved ones. Breakfast in bed, dinner out on the town, mani/pedi, a big bathtub full of bubbles, or just a plain bear hug and simple “I love you.” We appreciate you! Even though we often suck at showing it throughout the rest of the year.

Overheard at Wal-Mart…

Stranger: You have a cute baby girl.
Baby Mama: That’s my baby Tequila.
Stranger: Tequila?
Baby Mama: Tekela. T-E-K-E-L-A
Stranger : Tekela? That’s a cute name. What does it mean?
Baby Mama: That’s the drink we was drinkin’ when we created Tekela.
Stranger: That’s strange. My name’s Miller.

~ from The Happy Hospitalist

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photo: We’ve received this book twice already. So it must be good! The second one (Aunt Nancy’s) we traded in at Target for another by the same author. Brandon likes to wander down the boys’ toys aisle and pick up little matchbox cars and smile, “He can get one of these every time we go shopping if he’s good!”

My response is always, “He can get a book every time we go shopping if he’s good!”

Just another gem of a quote from the woman that lost my student loan documents wayyyy back in mid-February:

“In the future, I think both the Finance and Clinical departments would appreciate it if you would pay your tuition on/before the due date.”

Yah. That would be awesome.

“Madame Michel has the elegance of a hedgehog: on the outside, she’s covered in quills, a real fortress, but my gut feeling is that on the inside, she has the same simple refinement as the hedgehog: a deceptively indolent little creature, fiercely solitary — and terribly elegant.”

At first this book scared me because I thought I was too dumbed down by science textbooks to enjoy its’ more lofty philosophical and artistic qualities.

But I’m about 2/3rds through now and I really, really like it.

A friend (thanks, Roger!) passed along this NY Times article to me the other day week. It made me think about the physician’s role in end-of-life care. More specifically, it made me evaluate my position on end-of-life care and the type of physician I will become.

While there are universally accepted protocols for treating conditions like flu and diabetes, this is not as true for the management of people’s last weeks, days and hours. Indeed, a review of a decade of medical literature on terminal sedation and interviews with palliative care doctors suggest that there is less than unanimity on which drugs are appropriate to use or even on the precise definition of terminal sedation.

Discussions between doctors and dying patients’ families can be spare, even cryptic. In half a dozen end-of-life consultations attended by a reporter over the last year, even the most forthright doctors and nurses did little more than hint at what the drugs could do. Afterward, some families said they were surprised their loved ones died so quickly, and wondered if the drugs had played a role.

Whether the patients would have lived a few days longer is one of the more prickly unknowns in palliative medicine. Still, most families felt they and the doctors had done the right thing.

~ from the NY Times

The entire article is moving and worth a read. I found it intriguing because I really like dealing with old people in medicine. And I feel drawn to some of the harder specialties like oncology and palliative care.

As such, it is inevitable that the ethics of pain management and medication in end-of-life care have a few lessons up their sleeves for me. I intend to learn a lot from patients and their families on how they want to spend their final days.

Because when the time comes, I hope someone is listening to me.

So, I got an email the other week from a publisher wondering if I’d like a review copy of Atul Gawande’s new book, “The Checklist Manifesto.”

I responded, “Heck yes”. I LOVE LISTS.

I am a big fan of Gawande’s other two titles, “Better” and “Complications” and was considering investing in his next book. Once it came out on something cheaper than hardcover, of course.

And then it showed up on my doorstep. Hardcover and all. I’ve burned through the chapters in a couple of days, but can tell I will go back and re-read most of it. It’s a simple but inspiring solution to succeeding at highly complex and unpredictable jobs: make a checklist so you don’t miss anything.

“We have accumulated stupendous know how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mentioned demoralizing and frustrating, across many fields — from medicine to finance, business to government.

… the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.”

Gawande is a surgeon. And nowhere is this more true than in medicine. In med school we joke that it’s like trying to take a sip of water from a firehose. There is just so much information to memorize. As physicians, you may not need to know tiny details of the glucose degredation enzyme pathway on a daily basis, but there are still a ton of details to manage with an emergency case of DKA in a patient.

Right now, as a student, I’m practicing an established set of checklists that were created by people who studied medicine before me: labs, reviews of systems, medications, allergies, etc. I ask a predetermined set of questions in a history & physical to make sure I don’t miss anything. I check the same CBC and BMP values every morning. Pre-rounds have a different set of questions for a patient with pancreatitis than frostbite. The checklists evolve according to each situation, but I still feel certain things falling through the cracks with my lack of knowledge and experience.

I’m curious to see how the book ends. And I’ll be sure to share the checklist I come up with to help organize my daily 3rd year med student tasks.

“It is by chance that we met, by choice that we became friends.”
~ Unknown

I wanted to thank the following ladies for upping to the holiday cheer quotient around here:

Jillian – I curled up in bed with a cuppa cocoa last night. I have been drooling over the latest homemade bottled Christmas gifts on your blog.

Laurie – The cards are beautiful. I am looking forward to thinking up occasions to mail them in the new year.

Joanne – So much oatmeal, so little time! YUM! Thank you for rounding out the food groups in our holiday snacking plans.

You gals rock. Thank you!