full circle friend

The recent weeks have found me reunited with my first friend. Yep. The first one.  Elisa and I shared a nanny growing up, Mama Marlena, and then attended pre-school together.  Holy Trinity was not only a church but the home of every preschoolers dream.  Outside the beautiful old church was a gigantic playground filled with every imaginable accoutrement....a chain link gated heaven for all those under the age of 5.  We were inseparable...me with my bossy loud mouth and her with the soft spoken beauty.  I was such a little monster back then....always making her play the boy when we played house and even going to far as to push her from the monkey bars because it was "my turn".  That little fiasco ended up in me getting my turn and Elisa suffering a broken arm.  Yet, still she loved me and was my best friend.  That cliche quote, you know..."Friends are the ones who know everything about you and love you anyway" most definitely applies.  Thankfully I've done a little maturing since then ;) We parted ways during grade school, each attending different schools on different sides of town.  We would bump into each other occasionally during high school and college but mostly heard of each other through our parents.  I heard about how she decided to move to Miami to go to PT school and I know she must have heard how I finished college and moved to D.C. only to return to Gainesville for medical school.

The past couple of years have been a rollercoaster for me....finding where I fit hasn't exactly been the stroll in the park we all dream of.  I might go so far as to say I've officially suffered and recovered from my quarterlife crisis (maybe this means I'll be spared one in midlife!).  Sparing dramatic details...I've dealt with the dissolution and subsequent bottom-up reconstruction of an almost 10 year relationship, lost friendships I thought were true, and the realization that the career I had thought for so long was so right was really, in fact, totally wrong.  Through all the ups and downs....the end of this year has brought me full circle in every definition of the term.  I am getting married to an amazing man in a little under 4 months.  Finally I can say that I have never been in a relationship that not only nurtures and supports my being but that also allows me to flourish independently at the same time.  It's wonderful and through all the struggle has turned into one of the brightest spots in my life.  I am proud of the way that we have fought and worked for this, have made it work for us individually and as a couple, and for the commitment we both have towards the work we will continue to do in the future.  He is the love of my life.  I have taken inventory on the friends in my life and while it certainly has not been easy - losing friends is never ever easy - have finally surrounded myself with a group of individuals who I am proud to call friends.  People to make a real difference in the world and who love and respect me for being unabashedly me, whatever that entails :).  Even the career thing panned out.  I've realized that my calling lies in Oncology.  I have a deep emotional aspect to my personality and I believe that I have the reserve to give to a career like oncology.  I have never met a patient population to rewarding to work with.  There is always beauty and gratitude in my encounters.  Moreover, something magical happens when faced with a potentially terminal illness....you become grateful for the little things, you live in the moment...and something about that mentality, that life, is inspiring to me.  I just wish more people could find that place without serious illness.  The moral of the story is that all of these things, these discoveries, add up to something more valuable to me than gold. I finally found Martina.  

Last month, I got off the elevator on the 11th floor of Shands, eager to start my rotation on the Heme/Onc service.  I walked excitedly towards the nurse's station contemplating the experience this month would bring.   And there she was. My first friend.  A sort of symbol in my mind for the full circle discovery of myself that this past few years have entailed.  She had moved back to Gainesville and gotten a job as a physical therapist at the hospital and just so happened to be working on the 11th floor.  The remarkable thing to me is the way that after years and years of distance....certain friendships can pick up right where they left off.  While we have taken very different roads to get there, we meet again at similar stages in life with similar stories and experiences to share.  I am astounded at how after all this time, we can be so different yet so alike all at the same time.  It's equally as strange to me that in talking with her, at work, at the mall, at the gym, how I feel like we haven't missed a moment in each other's lives.  She is just as amazing and talented as the way I remember her and I am proud that she will still call me a friend.  Just to be safe....next time we find ourselves on a playground....it's her turn on the monkey bars :)

beautiful day - a reflection on year three

I prayed with a patient and her family today and it was one of the single most gratifying moments I've had throughout all of medical school.  She is a lovely elderly woman whose time is being cut short as she is dying of metastatic pancreatic cancer.  Day by day her health escapes her and she suffers with horrible diarrhea that we have yet to assign a cause to.  We've sent test after test...tests for bacteria and parasites, various imaging studies...you name it, we've ordered it and it's come back negative.  We fear that her symptoms relate to the progression of her cancer and worry that it heralds the need for her medical treatment to stop.  Her family is always by her side, and every day despite her dismal prognosis, she greets the team with the warmest smile she can muster.  Her voice is soft but her spirit is as strong as the 6'4 250 pound man, her husband of 46 years, who sits by her bedside and holds her hands for hours at a time.  I remember the day we showed up for rounds and were greeted doorside by the cutest little ball of black hair you'd ever laid eyes on.  Her husband had brought her beloved poodle, Tasha, in for a visit.  Being quite the little performance artist, Tasha spun around in circles, laid down on the hospital floor, and then jumped up on the bed and drenched her owner in a wealth of kisses.  It was the best I'd seen her look since starting on the service...her pale skin almost as white as her hair, always brushed and styled to perfection and her blue eyes sparkling with the fleeting feeling of being home.  For some reason, it was in that moment that I knew we wouldn't be performing any medical miracles here.  We wouldn't be writing new orders, prescribing fancy medications, or laying our hands on her and magically curing her of the raging disease inside.  We would be praticing a different kind of medicine...one that I've come to realize is every bit if not MORE important than what we've spent years learning in class...one that can't be captured via elaborate PowerPoint presentations or small group sessions...one that I've come to know as the ultimate reason I can think of no job for myself more satisfying than that of physician.

We sat with her family today, her son and husband, and answered questions about hospice and about just how long we thought she had left.  Some things get easier with time....physical exams, taking histories, writing orders....but never this.  Forever a difficult question to answer, we told her honestly that she was probably looking at 6 months to a year and that our main priority now as to keep her comfortable and symptom free.  Our white coats melted away as we talked and it was clear that she had known all along what we were just now telling her.  As we spoke, a member of her spiritual family walked in the room, a brother from her church of Jehovah's Witnesses and he listened intently along with the rest.

When we were done explaining the intricacies of her medical situation and all the questions had been answered....the world stopped for a moment.  We all joined hands and listened as the brother shared a prayer with us.  As her husband wept beside me, I fought to hold back my own tears.  Tears for her time lost, tears for the future of her family and the pain her loss would bring them, tears for the heaviness in my own heart, and tears for the simple beauty of the moment.  I stole a glance at her as we prayed and the peace on her face brought a smile to my own.  Raised in the Christian church - Methodist by trade- I have never been a truly religious person.  As I grow, I struggle with my own conflicts with organized religion.  I see tremendous beauty in many different religious teachings but have never subscribed myself to one in particular.  I find great comfort in the personal belief in something higher and greater than myself - a God if you will - and I believe that this god has a plan for all of us.  Most of all, I believe that we each find God in everyday moments and within ourselves and others.  A good deed done for no particular reason...God is there.  A family gathered in a hospital room comforting an ailing loved one...God is there.  This simple prayer circle...God was definitely there.  I walked out of that room more whole of a person than when I walked in.

Throughout this year, I have been struck by the way that our patients are constantly thanking us for the smallest of things.  I am continuously amazed at the appreciation a simple 5 minute visit can bring.  But in this particular moment, I was met with the overwhelming feeling that it was I who should be saying thank you.  In all honesty, though, "Thank you" doesn't even begin to capture the gratitude I feel for having been a part of that moment in her life's journey.  Words truly fail.  All I can say is that what happened in that room is the best tangible example I can present for why I chose a career in medicine.  I think all any of us can hope for career-wise is to find one that is not only intellectually stimulating but also gives us the daily opportunity to make real and positive impacts on other people's lives.  For me, moments like this one represent a reason to get up and come to work in the morning and a reason to be proud of the work that we do...not just as medical students or physicians...but as human beings.

My patient will go home tomorrow under the care of home hospice.  She will leave this earth before the year is up and her family will try and pick up the pieces that are left when she is gone.  I pray that her transition is completely pain free and that her time is filled with the love and presence of her family, both spiritual and personal, and with lots and lots of kisses from Tasha :)