I've been spending a lot of time immersed in the other side of medicine. The human side. It's been a very enlightening vacation from the dirty, gritty, completely un-glamorous life of dingy scrubs full of cat & dog hair and wipeable shoes caked in excrement from all imaginable canine and feline places. It's been an interesting, albeit eye-opening foray into what I might have been if I liked people half as much as I like furri-ed beings. The differences between these two species,, me and the MD's, is stark and vivid in contrast. I did a little informal study of the attire in human medicine. They are an excellent example of how different the life of an MD is versus a DVM.
Here was my attire for yesterday: layered short sleeve shirts, short sleeved scrub top (a motif of mugs of coffee of every color floating in haphazard directions against a charcoal background... one of my favorite shirts purchased within the last decade), scrub pants, (ill-fitting, baggie, completely unflattering, which is how most of us live our entire careers), and plastic covered flowered Danskos. God are these shoes durable and professionally forgiving, but fashion vomit. And, yet, I have dozens of pairs in every shade, season, and style. There's only one style, it's that bleak. Ponytail, trademark and omni present. No time for pretty hair you are just going to get ear wax puss, or anal gland spooge in. Is there? I dress for a power wash decontamination day, well, every day. No false pretense here. I aim to serve and be peed on,, it's a crap shoot I expect.
Here was how my moms oncologist (I met her just yesterday) was dressed: Silk dress jacquard print black floral cream background. Heavy duty, almost bullet proof leggings, and heeled ankle boots black. Immaculate white, nun inspired bleached, starched, pressed, cursive embroidered multi-lined, almost paragraph form, blue lettered, lab coat. I wouldn't be surprised it if has it's own glass box it is kept in off duty. She sported a double back pony tail. Pony tail start, flip up to sky ends. I liked her for her effort. The jealousy lies in the silk and jacquard.
It's a wide divide. Want to know how wide? Well, let's measure it in this. My humble wardrobe. It keeps me smiling more than I need to. And with that I get to show off the braces, (second attempt since puberty attempt at alignment failed many decades ago), which are also a reminder that I live and work amongst the mere mortals. It's real-life at ground level. I am dressed and ready for medical detective sleuthing and slaying. She, well she talks too much and never touches her patients in any meaningful medical way.. She dresses for luncheons at country clubs. My mom is dying in the dark corner of her small room and I am prepared to clean up any mess it might make, and then still see another patient 20 minutes after. Down, dirty, real-life messes that I can diagnose, treat, and sweep up the crumbs.
My mom is back in the hospital. Again. This time it was a quick three week stay at home after a week of intensive trials to find her pain management for her stage 4 metastatic breast cancer. I have to say it like that, seems more ominous. I try to lower my bravado, enunciate like I'm introducing the sporting class entrants at Westminster, "Sir Lancelot Cumberbund of Landsley, 4 year old male Bishon. He likes long walks, and peanut butter laced Kongs".. kinda drawl. Add flavor if you can't add humor, and we all need to try to add both lately. It was a long hard discussion about where to go from the discharge instructions out of the hospital the first time. My mom chose home. In retrospect I am fairly certain she was feeding me a line of BS not even she believed. It was what she wanted, not what she needed. She needed to go to the rehab hospital to have the full time staff inflict a regiment of tasks upon her to rebuild her. She needed post hospital boot camp. She got furlough. It cost her and the consequences were realized within a month.
Among the very different way we doctors dress, (yes, grant me the use of "doctor', even if vet med precedes it), is the way we dish out the dirt. For me, in my daily practice it is 100 % honest with very little chance at a thick file full of data filled diagnostics to support it.
Veterinarians have a few big challenges to face with every patient. It has been one of the big stark observations for my days living on the other side of the tracks. MD's ask a lot of open ended questions. Vets do this too, with our human clients, our patients we just can't get honest answers out of... BUT, we take all chatter at about 60% face value. We listen, we take notes, and we KNOW that about 50% percent of the time our clients are lying, embellishing, flat out oblivious unaware, or hiding something out of guilt, shame, or overwhelming personal blindness. Veterinarians KNOW to listen to our patients responses to our internal questions far more weighted than our speaking pet parents. Here is where MDs need to spend some time in our trenches to learn some valuable diagnostic skills. Let me give you an example,, or a few..
My mom has been under hospital care for weeks, cumulatively. The doctors, the nurses, the entire staff changes every 12 hours, like shuffling a Vegas deck. The house holds the upper hand, and the player is always likely to lose. Same applies here. There needs, really, desperately NEEDS to be some consistency. There is not personal investment if there isn't at least familiarity. So that's where family advocacy plays such a vital role. For the past few days my mom has been eating better. This little step alone is immeasurable. At the vet clinic every patient is monitored for food intake. We, the collective small consistent bunch of us, provide direct oversight. My mom, nope. They bring in food, clear food, always some cafeteria dressed orderly who says "hello" and flashes away. I am very certain she could go days without anyone knowing how many calories she is, or more aptly, isn't consuming. At the vet clinic we also weigh our patients DAILY. Examinations, done at least once, usually twice a day. My mom gets a "nurse assistant" who is always too indifferently distant to allow her four times daily numbers to interrupt her after work plans.
In three days in the hospital no one gave a thorough exam. Lots of specialists chatting, and no step back use your noggin deductive reasoning.
Back to meals: In the two days she has been attempting to eat a meal she has started to cough. The progression of her disease is so abrupt that she struggles to cough well enough to clear her food obstruction. I watch her and think, "crap, if she needs a Heimlich I am going to shatter her. If I try to slap her back I will likely send her into so much pain she will need a drug induced coma." So, I watch and wait. She hasn't needed emergency intervention yet,, but,,, it's probably coming.
She made mention to her nurse. "I get a tickle in my throat when I eat."
"Your lungs are still crackly, we will add a mucolytic." Essentially Robitussin to break up the chest congestion. She was after all admitted four days ago for pneumonia.
"She has dysphagia." I added. She is also on oxygen, lying in her bed for 23 hours a day, and not getting better.
Open eyes appeared.
We called the doctors in. After an hour of conferring I told them all of the observations I had made over the last two days.
She is oxygen dependent because she has lost so much muscle mass she can no longer inflate her lungs on her own. The same mechanism causing respiratory difficulty is causing swallow inability. She also needs to be told to sit up all waking hours, walk, and work on her internal muscle function as determinedly as her external muscle function. She has had three negative cultures for pneumonia. Therefore she does not have infectious pneumonia she has aspiration pneumonia, and atelectasis of her lungs. Her lungs are shrinking and shriveling inside her chest because she lacks the ability (whether that is pain, disease, etc.) to fully inflate them. Over time, weeks to months she is further failing to inflate them so they are shrinking inside of her, and now without forced 100% oxygen she cannot breathe."
The straws were taken away.
The bed is taken away.
The food has to be monitored. It needs to be small bites, liquid more than solid, and swallowed under supervision.
The nurses need to encourage her to walk and move. Even in bed exercises will help.
But what really hasn't been given to her, and what I find most contrasting in how I practice medicine is that there are no discussions of consequences. Lots of chatter about findings, the latest diagnostic results, but no talking about what will happen. What her course, her current path, where she is and how she has migrated within the spectrum of health, freedom, prognosis, life in general has come from, or gone to, or ending up.
Am I the only one who feels like every patient deserves that? Am I just a glutton for stark, cold hard reality so I can feel like I led a life of choice?
And here is my quandary?
Does my mom want to know? Do I just sit quietly and give her quality time as it escalates to short time? DO I deny her the ability to know so she can understand what lies ahead?
My husband thinks that she just can't do what is needed. I can't possibly relegate her to "lost cause" on the assumption of can't. Can I?
The absolute torture for me is being able to see what lies ahead.. To be asked to sit quietly as doctors miss things while they lack the intuition to question their patients ability to accurately represent their condition. I can see her future and I am not sure I can sit sidelined and not yell in the warning of the linebacker about to sac her.
Mom, if you are out there you need to move, and eat, and yes, dare I say it, fight. It's almost too late to turn this game around. The coach, the vet, they all know the consequences. Aren't we here to remind you of them?
Here was my attire for yesterday: layered short sleeve shirts, short sleeved scrub top (a motif of mugs of coffee of every color floating in haphazard directions against a charcoal background... one of my favorite shirts purchased within the last decade), scrub pants, (ill-fitting, baggie, completely unflattering, which is how most of us live our entire careers), and plastic covered flowered Danskos. God are these shoes durable and professionally forgiving, but fashion vomit. And, yet, I have dozens of pairs in every shade, season, and style. There's only one style, it's that bleak. Ponytail, trademark and omni present. No time for pretty hair you are just going to get ear wax puss, or anal gland spooge in. Is there? I dress for a power wash decontamination day, well, every day. No false pretense here. I aim to serve and be peed on,, it's a crap shoot I expect.
Here was how my moms oncologist (I met her just yesterday) was dressed: Silk dress jacquard print black floral cream background. Heavy duty, almost bullet proof leggings, and heeled ankle boots black. Immaculate white, nun inspired bleached, starched, pressed, cursive embroidered multi-lined, almost paragraph form, blue lettered, lab coat. I wouldn't be surprised it if has it's own glass box it is kept in off duty. She sported a double back pony tail. Pony tail start, flip up to sky ends. I liked her for her effort. The jealousy lies in the silk and jacquard.
It's a wide divide. Want to know how wide? Well, let's measure it in this. My humble wardrobe. It keeps me smiling more than I need to. And with that I get to show off the braces, (second attempt since puberty attempt at alignment failed many decades ago), which are also a reminder that I live and work amongst the mere mortals. It's real-life at ground level. I am dressed and ready for medical detective sleuthing and slaying. She, well she talks too much and never touches her patients in any meaningful medical way.. She dresses for luncheons at country clubs. My mom is dying in the dark corner of her small room and I am prepared to clean up any mess it might make, and then still see another patient 20 minutes after. Down, dirty, real-life messes that I can diagnose, treat, and sweep up the crumbs.
My mom is back in the hospital. Again. This time it was a quick three week stay at home after a week of intensive trials to find her pain management for her stage 4 metastatic breast cancer. I have to say it like that, seems more ominous. I try to lower my bravado, enunciate like I'm introducing the sporting class entrants at Westminster, "Sir Lancelot Cumberbund of Landsley, 4 year old male Bishon. He likes long walks, and peanut butter laced Kongs".. kinda drawl. Add flavor if you can't add humor, and we all need to try to add both lately. It was a long hard discussion about where to go from the discharge instructions out of the hospital the first time. My mom chose home. In retrospect I am fairly certain she was feeding me a line of BS not even she believed. It was what she wanted, not what she needed. She needed to go to the rehab hospital to have the full time staff inflict a regiment of tasks upon her to rebuild her. She needed post hospital boot camp. She got furlough. It cost her and the consequences were realized within a month.
Among the very different way we doctors dress, (yes, grant me the use of "doctor', even if vet med precedes it), is the way we dish out the dirt. For me, in my daily practice it is 100 % honest with very little chance at a thick file full of data filled diagnostics to support it.
Veterinarians have a few big challenges to face with every patient. It has been one of the big stark observations for my days living on the other side of the tracks. MD's ask a lot of open ended questions. Vets do this too, with our human clients, our patients we just can't get honest answers out of... BUT, we take all chatter at about 60% face value. We listen, we take notes, and we KNOW that about 50% percent of the time our clients are lying, embellishing, flat out oblivious unaware, or hiding something out of guilt, shame, or overwhelming personal blindness. Veterinarians KNOW to listen to our patients responses to our internal questions far more weighted than our speaking pet parents. Here is where MDs need to spend some time in our trenches to learn some valuable diagnostic skills. Let me give you an example,, or a few..
My mom has been under hospital care for weeks, cumulatively. The doctors, the nurses, the entire staff changes every 12 hours, like shuffling a Vegas deck. The house holds the upper hand, and the player is always likely to lose. Same applies here. There needs, really, desperately NEEDS to be some consistency. There is not personal investment if there isn't at least familiarity. So that's where family advocacy plays such a vital role. For the past few days my mom has been eating better. This little step alone is immeasurable. At the vet clinic every patient is monitored for food intake. We, the collective small consistent bunch of us, provide direct oversight. My mom, nope. They bring in food, clear food, always some cafeteria dressed orderly who says "hello" and flashes away. I am very certain she could go days without anyone knowing how many calories she is, or more aptly, isn't consuming. At the vet clinic we also weigh our patients DAILY. Examinations, done at least once, usually twice a day. My mom gets a "nurse assistant" who is always too indifferently distant to allow her four times daily numbers to interrupt her after work plans.
In three days in the hospital no one gave a thorough exam. Lots of specialists chatting, and no step back use your noggin deductive reasoning.
Back to meals: In the two days she has been attempting to eat a meal she has started to cough. The progression of her disease is so abrupt that she struggles to cough well enough to clear her food obstruction. I watch her and think, "crap, if she needs a Heimlich I am going to shatter her. If I try to slap her back I will likely send her into so much pain she will need a drug induced coma." So, I watch and wait. She hasn't needed emergency intervention yet,, but,,, it's probably coming.
She made mention to her nurse. "I get a tickle in my throat when I eat."
"Your lungs are still crackly, we will add a mucolytic." Essentially Robitussin to break up the chest congestion. She was after all admitted four days ago for pneumonia.
"She has dysphagia." I added. She is also on oxygen, lying in her bed for 23 hours a day, and not getting better.
Open eyes appeared.
We called the doctors in. After an hour of conferring I told them all of the observations I had made over the last two days.
She is oxygen dependent because she has lost so much muscle mass she can no longer inflate her lungs on her own. The same mechanism causing respiratory difficulty is causing swallow inability. She also needs to be told to sit up all waking hours, walk, and work on her internal muscle function as determinedly as her external muscle function. She has had three negative cultures for pneumonia. Therefore she does not have infectious pneumonia she has aspiration pneumonia, and atelectasis of her lungs. Her lungs are shrinking and shriveling inside her chest because she lacks the ability (whether that is pain, disease, etc.) to fully inflate them. Over time, weeks to months she is further failing to inflate them so they are shrinking inside of her, and now without forced 100% oxygen she cannot breathe."
The straws were taken away.
The bed is taken away.
The food has to be monitored. It needs to be small bites, liquid more than solid, and swallowed under supervision.
The nurses need to encourage her to walk and move. Even in bed exercises will help.
But what really hasn't been given to her, and what I find most contrasting in how I practice medicine is that there are no discussions of consequences. Lots of chatter about findings, the latest diagnostic results, but no talking about what will happen. What her course, her current path, where she is and how she has migrated within the spectrum of health, freedom, prognosis, life in general has come from, or gone to, or ending up.
Am I the only one who feels like every patient deserves that? Am I just a glutton for stark, cold hard reality so I can feel like I led a life of choice?
And here is my quandary?
Does my mom want to know? Do I just sit quietly and give her quality time as it escalates to short time? DO I deny her the ability to know so she can understand what lies ahead?
My husband thinks that she just can't do what is needed. I can't possibly relegate her to "lost cause" on the assumption of can't. Can I?
The absolute torture for me is being able to see what lies ahead.. To be asked to sit quietly as doctors miss things while they lack the intuition to question their patients ability to accurately represent their condition. I can see her future and I am not sure I can sit sidelined and not yell in the warning of the linebacker about to sac her.
Mom, if you are out there you need to move, and eat, and yes, dare I say it, fight. It's almost too late to turn this game around. The coach, the vet, they all know the consequences. Aren't we here to remind you of them?
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