Admissions

I’m halfway through my Gyn Oncology rotation, which explains why I haven’t been writing. Like many other things in the second half of the year, it is not as hard as it was last time around. It is a lot of work, early days, sick patients, daylong sessions of time in the OR, but it isn’t as intimidating as it was last time. I’m MUCH better at presenting patients, which I kind of sucked at last time. And I’m faster enough with the process of seeing patients in the morning that I can come in a little bit later than 5am unless our service is expansive. Unfortunately we had a record-breaking increase in our census at the beginning of this week - 5 admissions in one day and NONE of them from the OR.

There are a few different ways you can become a patient in the hospital. One is to come in for surgery and stay for recovery. The length of your stay will depend on the complexity of your surgery, how sick you were beforehand, what they found when they surgerized you and how your body recovers from the process. If we went into your abdomen, chances are your bowels will stop working for a time and we will have to wait for them to wake up again. If it takes a long time, then you have something called an ileus. If this is all you have, and not a bowel obstruction, then the only thing to do is keep you NPO (nothing by mouth) and give you IV fluids and wait. We had someone recently who took 8 days for her bowels to wake up. We’ve also had people who take 2 days for the same result. There’s really no telling which it is going to be.

Another way is to come in through the ED. If you are a cancer patient, are undergoing chemotherapy, have some sort of complication related to your cancer or are showing signs of recurrence, then you are likely to end up on our service. We see women who have anemia, thrombocytopenia and pancytopenia, who have partial bowel obstructions, who have new metastases, failure to thrive, wound infections and a myriad of other complications. There’s a pretty low threshold to admit a cancer patient who comes in through the ED.

If you are a patient of our oncology attendings, you might live very far away from Asheville. So instead of coming to our ED, you might go to your local hospital, which will either transfer you directly from their ED or admit you for a few days and try to tune you up before they decide to transfer you to us. Direct transfer from an outside hospital (OSH in our lingo) is another way to get to our service. This can be a little confusing because your OSH may not share electronic health records with us so getting the details of your stay there has to wait until you show up with the paper records and a CD of imaging for the radiology department to upload. Then you may be very sick or you may not need much. But likely we at least know you from a previous admission or surgery so we have some sense of who you are. There are times that we get new patients through an OSH who have a diagnosis of a new complex pelvic mass (pretty clear sign of a Gyn oncologist appropriate surgery if not actually cancer) then we don’t know anything about you. It is kind of a mystery.

Between 3:30 and 5 in the afternoon, I might get a page from the staff at the Gyn oncology outpatient office telling me they are direct admitting a patient (if it happens earlier in the day, they usually go directly through the attending who is there that day and they end up telling us about it before the page comes through). Often we get patients who are having complications from chemo this way. They go into the office for an outpatient check up a week or so after a chemo treatment and are found to be intractably nauseated or frighteningly anemic or in a lot of pain. Often chemo makes things worse before it makes them better and that can be hard for someone who wasn’t very healthy or who’s cancer was quite advanced on the outset.

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I’m doing pretty well with my sweet-free dietary changes. I continue to be able to stay away from bags of chocolates passed around during didactics, the desserts in the cafeteria, the many, many options at the grocery store and even the ice cream in our freezer. I’ve also started doing a 30 minute yoga workout I have on DVD twice a week. I had aspired to 3 times a week, and a 10 minute ab workout at the same time, but I have decided to move the finish line and call this a victory! I am doing the abs about once a week and even with working overnight this weekend I did the yoga as well. By doing the same workout over time, I can measure my progress. It is starting to get easier! I’m in my 8th week of the diet changes and my 3rd week of adding exercise. Taking a long view is easier now than it was a few weeks ago, when I felt like I needed to add rules or changes to what I was doing. Now I’m at peace with the idea of these two small, lasting changes being something I can stick to. Maybe in May or June (at 4 or 5 months) I will consider adding one more small change - maybe an addition instead of a subtraction. Maybe adding a trip to the salad bar at work or something. We’ll see. For now, I’m content with the idea that I’m making lasting habit changes without spiraling into disordered eating.

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It’s really lonely to be in a bad marriage. My friends & family in the know couldn’t really help. Most of my local friends didn’t know how bad things were. I had too many “we” friends. Now all the friends are MINE (mwahahaha!) and I can be however I want with them. I’m still lonely but now it’s more like the quiet solitude of a rare weekend afternoon alone. Before it was like being alone in a crowd, screaming but no one noticed. This is another area of my life where I’m exerting patience. I am making friends, bonds are building, but it takes time. I will have a full and vibrant social network here in town before too long. Hopefully long before it is time for me to leave!

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I had a great conversation with 2 co-workers today that helped us get to know each other and I hope, will help me relax a bit around them. I was telling stories about myself and realized that I have been reconnecting with parts of me that have been long dormant - like the little girl who cold called the neighbors to see if there were any other girls to play with when we moved to a new house when I was 5. She’s the same kid who struck up conversation with two strangers who came to take free moving boxes off my hands this summer. “I feel like we should be friends” were actual words that came out of my mouth. And now we are. Wow.

While we were talking (my co-workers, not the Craigslist friends, I recounted the 4 (at least) friends I have made in town. They are all busy people and we don’t hang much but they are great and I’m happy to have them in my life. Al & Rebecca - of the random Craigslist meet cute, Bridget - a friend of a friend who proves that awesome people know awesome people, and Raven - who is as busy as I am but throw regular international travel into the mix, so we don’t see each other often. And maybe a couple of others brewing: Sam, who I met randomly on a neighborhood walk, who recently moved to town and used to be a photographer with National Geographic. and Byron: a local pagan leader/author. We know a lot of the same people in the broader community but haven’t managed to connect socially outside of ritual space yet.

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There are a lot of people who changed me for the better and made me feel good about myself because of their contribution to my life. I’ve been thinking about two of those people recently and felt they deserved a “shout out” even if I can’t find a way to get the word to them myself. Maybe the universe will hear and it will echo back to them somehow.

• Mrs. Majeski: My 3rd grade teacher, she tried to motivate me with carrots, and I think that was the first time in my life someone tried something other than a (figurative) stick. She noticed me. Granted, it was usually for not being able to do my work or having a frighteningly messy desk, but her efforts were kind and stick with me to this day. I remember my report on Jane Addams and Mrs. Majeski incentivizing my performance in school with a special prize: lunch with the teacher. Again, carrots. 
• Ms. Hayden: My freshman year drill team coach. I know that we aren’t supposed to tell women & girls to smile, and that was Ms. Hayden’s primary message to me my freshman year of high school when I was on her JV drill team, but again, she seemed like the first person to notice that I was quite miserable as I was moving through the world (also, as it happens, I have quite a resting bitch face and had no idea how it was affecting my social interactions but that is another issue). Ms. Hayden seemed to care that I was unhappy, she was nice to me.

I’ve actually tried to find these women out there in the world, but my google-fu is weak and I couldn’t afford the PI I approached. Maybe someday I’ll be able to tell them that even though they were only in my life for one year, they made a difference in my life. Until then, telling you will have to suffice.

Whatever the opposite of a “shout out” is, here’s one of those:

• My sophomore geometry teacher who’s name has been deemed unworthy of memory by my mind: He was a jock, he was a dick, he thought it was really funny to call me “Larry” (short for Larissa, like Lari, get it?). And he was a great demonstration of the kind of grown up I did NOT want to be. I was an awkward, socially anxious self conscious 14 year old. The attention I got from him made me dread math class. Like I needed another reason to dread math class.