Anxiety

Nearly two years ago, I sat with my younger sister at the airport in Houston, Texas waiting for our respective flights.  She was going back home to New Jersey, and I was headed back to California.  While waiting, she passed the time browsing SAT prep sites on her iPad.  Her oldest child, my nephew, was starting his junior year of high school that fall, and she wanted to make sure his summer was well spent, and that he had the opportunity to prepare for the exam which would determine his future college options.  As she talked about the merits of one approach over another—classroom instruction versus private tutoring– I felt my anxiety level rising like an uncomfortable expanding bubble in my chest, gradually cutting off my air supply.  The pressure was palpable.  After listening for a few minutes, I said to her, “Please stop talking about this—you’re making me very nervous and I’m not even TAKING the exam.”  She looked at me in surprise, and we moved to other topics.

 

On Sunday evening on our way out to dinner, I went with my daughter to take sign out from the intern who was leaving the ward service the next day, and turning the very sick patients over to my daughter’s care.  I tried to position myself unobtrusively, in the far corner of the residents dictating room, sinking as deep into the shelter of my wrinkled hooded raincoat as I could, but even from my self made cocoon I could hear them discussing in hushed tones the low platelet counts, the mucosal bleeding, the fevers unresponsive to antibiotics in these acute leukemic patients.   It was seven pm after a long weekend on call, and the interns and residents looked exhausted.  The white cubicles and the scuffed linoleum on the floor reflected the fluorescent ceiling lights overhead. The faint smell of stale fried food and sweat combined to form a vaguely nauseating aura.  Suddenly I was transported back thirty-five years to my own internship, and to my first night on the cancer service and in that instant, I felt every bit of anxiety that I felt so many years ago.  For anyone who has done an intensive medicine or surgery residency, these feelings form the impetus to learn and become competent—the overwhelming sense that a human being’s life is in your hands, and this night, and every night, you must be vigilant; you must perform and do your very best.  The end of shift can never come soon enough.

 

It’s been many years since I taught a class of high school students, or staffed an inpatient service run by interns and residents.  But if I ever do either again my recent “flashbacks” will serve me well.  It’s good to remember the fear and tension associated with being a learner in a stressful situation.  Teaching has always been a passion for me, and those are the memories and feelings which will make me a better teacher.

Weights and Measures

The sudden illness of a colleague is always a shocking surprise.  As physicians, we are trained from an early age to ignore our own infirmities in the service of others.  Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for that blessing.  In my day to day world of caring for cancer patients, I know that in an instant, by accident or by sickness, everything can change.  I think that my colleague must have felt the same—that calling, that mission to care for the stricken that leads one to suppress the rising signs of illness in order to keep that black curtain of infirmity a little further to the edge of the window frame of life.

On Monday I learned that the man I have grown to respect for his insight, his dedication to his profession and his kindness would likely not be coming back to work, ever. My entire department was devastated, especially his nurse who has worked so closely with him for the eighteen months he has been with us, and also his patients, each of them with cancer,  who asked me one by one when they saw me for their weekly on treatment visit, “I am so sorry to hear that he is ill.  When is he coming back?”  As the realization of the gravity of his illness slowly came to all of us, since he had not shared the knowledge of his disease with any of us, the weight began to descend.  Our patient load is at its highest, our working hours are extended, there are patients waiting to be seen, planned and treated.  Who will step in to consult on these patients, to plan their radiation treatments, to oversee their side effects and work the extended hours?  Right now, we do not know.

I have always said that unlike my father, I do not want to “die with my boots on.”  I want to retire while I am still healthy enough to do the things that I’ve put off for so many years—to write, to paint, to take photographs, to teach English, to travel, to play with my dogs, and perhaps, just perhaps, get another horse—an older horse, a calm horse (we grow so brittle as we age that we break more easily!) who will carry me down the trails so that I can smell the orange and lemon blossoms on the trees, up close, as they bloom in late December here.  I said this to my husband last night, at the end of a very long week.  He said, “No one ever knows what they will do when faced with a terminal illness.”

This was a very busy week in the clinic, and I had a medical student rotating with me. In the chaos that surrounded us, I had to keep reminding myself, first things first. Yesterday, together we saw a man with a life threatening cancer.  I was running very late, and he was the last new patient of the week.  My student took the reins—he interviewed the patient, examined the patient, explained the treatment and seamlessly introduced me to the patient and his wife, who were quite pleased with the care and attention he had already received. We completed the consultation together, and as I left the room I suddenly felt a deep sense of satisfaction.

When the weight of illness suddenly descends on an individual, my colleague, and consequently, his patients, his co-workers and me, his partner, we can still take comfort in the small measures of success–the satisfaction that we, as a team, are doing things right.  Sometimes it’s the little things, the small gestures and kindnesses that count.  We dust ourselves off, and we go on.