Isolation

"The patient is in isolation".....and I groan loudly inside.

This has been going on for 30 years in my professional life. Never any easier or any less aggravating; this need to take off my white coat, find a hook to hold it, don a flimsy yellow gown, put on gloves, and maybe a face mask (depending on whether we're talking respiratory isolation in addition). Then, I go into the patient's room all decked out, find family at the bedside who may or may not be in compliance with the warning sign of the door, and do my work. Then, in reverse, I peel off the costume and pitch all in the trash, wash my hands, and put on my white coat.

Back in the day this might happen once a day and sometimes only every few days depending on the mix of patients on service. Now, up to a third or more of the patients seen in the hospital have the "IN ISOLATION" sign on their hospital room door. Damn it, I think. And then, I feel guilty for cursing the need for all the hoopla.

I suppose it's possible to prove scientifically that what we do to prepare for our interactions with those in isolation actually pays off in terms of preventing transmission of disease to other patients and to prevent ourselves, the presumed healthy, from becoming colonized with bad "beasties". In fact, I feel quite certain that this data exists. I just do what I'm told, cringing with the thought of reprimand if I'm caught out of compliance with the dreaded yellow paper gown.

Microbes are invisible. Yet, they are powerful and in some cases, deadly. It makes great sense to take precaution in hospitals where the risk of cross contamination between patients is so real. I get it. Truly, I do.

But, that doesn't mean I can't despise the process inside and curse and moan in silence for the plague of methicillin resistant staphylococcus aureus (also known as MRSA) which may have once been present in said patient but is years past but forever a "scarlett letter" around their neck. Or, the patient affected by clostridium dificil or multi-resistant enteroccocus, and on and on it goes. "Possible influenza" might be the cause for "in isolation and even though I've been immunized and am at low risk of transmission of disease....my hands and white coat, the humors that surround me, may represent the difference between safety for patients and palpable risk.

 Sigh. I wax mournfully about this annoyance because I can. It takes up so much precious time. If I had a nickel for every yellow gown I've put on, I'd be a rich lady.

But, I'm compliant with orders. Compliant  because it's the right thing to do; even if no one is looking.

"He Went to Chicago...."

During medical school and residency, slang phrases for death were inevitable, especially amongst the surgical trainees  Thinking back, I'm wondering if a certain wild and crazy resident from Argentina named Mario K might not have invented his own terminology for the act of passing on into the great unknown. I first heard the phrase come out of his mouth and then from others who worked with him. After leaving Texas and my training roots, I never heard this expression again. A Google search for synonyms for  the verb "to die" spews forth all manner of  crude expressions as well as the more generally accepted phrases that one might hear from a funeral director....like "departed", "passed away", or "left us".

Mario referred to the act of dying as "going to Chicago". I remember coming in for rounds one morning as an eager, yet terrified third year medical student and hearing him (as senior surgical resident) say of someone who had died during the night, "He went to Chicago".  I recalled thinking this an odd blend of disrespectful, weird, and funny, a not uncommon situation in Medicine when stress-busting humor commonly borders on the edge of decency, if not beyond. Medical types typically limit our not-so-professional-speak to times when we're in the company of others of like mind or those who wouldn't take offense. Discretion is key.

Yet, "going to Chicago" isn't really an offensive term for dying. The only question I had then, and still do is what happens if someone dies in Chicago?

also published at Ahead of the Wave

When Your Child is Ill

My parents owned hundreds of books, belonged to several book-of-the month clubs, and considered books worthy of display in one's home; much like art. The only books hidden away were written by Mr. Alfred Kinsey. But, never fear; I found them anyway as a naive but curious twelve year old, stashed in the back of the guestroom closet. I read fast, furiously, and frequently, always careful to put the books back in their not-so-childproof hiding place. In retrospect, those books taught me things no one else bothered to educate me about.

But I digress, wildly off topic.

If there was something or someone that started me on the path, it would definitely be the innocent looking book entitled: When Your Child is Ill by Samuel Karelitz, M.D. This hardcover book-of-the month selection from 1958 found  a prominent spot among the books in our living-room bookshelf. I don't think Mom read the book but I certainly did. Voraciously.

The introductory remarks in this book includes the following passage....
"When Your Child is Ill is a book for intelligent mothers. It is not a substitute for the doctor: it tells her when she needs him (love that); and it helps to answer the questions parents often ask themselves before and after the doctor's visit. Dr. Karelitz's object in writing for parents so fully and frankly is not to alarm but to inform and how to treat her sick child herself, but rather to tell her what symptoms to look for and which are danger signals.  This book, so full of facts, will also be of use to nurses, school matrons (huh?) and social workers--in fact to any person who may have to deal with sick children."


This book simultaneously scared me to death and pulled me back into its pages with a kind of warped fascination. I was a healthy kid but succumbed to the usual: measles, chickenpox, and croup-like upper respiratory illnesses. Whenever I was sick enough to stay home from school, I'd pull this book off the shelf and devour the pages that discussed whatever symptoms were most prominent in the moment. The problem was (and to this day); whatever complication there might be from any relatively benign illness......I figured I'd get. Meningitis, encephalitis, rabies, liver failure.....and on it went.

Mom eventually confiscated this book from me. "You get too upset when you read this.", she'd say. I'd beg her let me read just a bit more. If the book disappeared, it was never well hidden. I'd always find the book and read voraciously about all manner of horrid thing that might happen.

Did this book fuel a budding interest in things medical?  I believe so. When my parents moved from Aruba back to Texas and were packing up their belongings, I spied this book and felt a peculiar bond. Mom told me to take it, jokingly. I was just finishing up my first year of medical school at the time and had come to Aruba for a last visit home.  That was 35 years ago, 1977.

I never see this book, which resides in the back on my closet with other old books, that I don't stop and remember a very young, impressionable girl.

How We Dress Matters

Once upon a time, the Chairman of Medicine (also my mentor) practically blew a gasket when he saw one of his faculty members wearing blue jeans to work on the weekend. The doctor was rounding on the hospital wards, seeing patients on a Saturday morning.

I wasn't present to witness what occurred in the moment but there were all sorts of stories floating around. What I do remember like it was yesterday was what The Chief told us residents as we gathered for Morning Report in the conference room adjacent to his office shortly after this event. His words have stuck with me forever; they are so ingrained that conscious thought about the issue comes up only when I happen to see a colleague in jeans.. In the 30 years since The Chief imparted his wisdom on the subject,  I wouldn't dream of putting on a pair of jeans and heading into work, weekend or not.


"When you dress like that [jeans], the message you send to your patient is loud and clear; you'd rather be out on the golf course or anywhere else rather than where you are right now."

I think he was/is absolutely correct. Yesterday was Sunday and I was on call, rounding in the hospital. Standing in a patient's room with three attentive and concerned family members at the beside hungry for information and a sense that their loved one was in good hands, in walked a surgeon, dressed in blue jeans.. Was it just my impression or was every word out of his mouth colored by what he had chosen to wear?

I may be old school but, in my view, jeans of any kind have no place in a hospital except on visitors. The Chief said it best.

Bravery?

I finally learned what not to say to my patient who is battling a chronic illness whether it be cancer, recurrent strokes, kidney failure on dialysis, diabetes with endless complications or anything remotely similar.

Never (ever) say: "You're so brave." in response to their hardships, struggles, and the seeming courage they show making it through each day.

Guilty of this faux pas on an embarrassingly frequent number of occasions, a light bulb finally went off in my head. Uniformly I've received the same response from my patients to my perceived encouraging and complimentary statement. I've been told nicely by some and with exasperation by others something on the order of "Brave? I had no choice in the matter." In other words, trying to pin the word brave on someone fighting for their life is likely neither reassuring nor endearing. In fact, many who've heard these words come out of my mouth probably say to themselves, "Doc just doesn't get it.".

I suppose I'll never really know how annoying my comment, however innocent, feels since I don't walk in their shoes. What I learned was to hold back on this reflexive comment and instead, listen more deeply, respond with the squeeze of my hand on theirs and say less. For this, I'm grateful.

Intermission

I want (desperately) to post on this blog. Flooded with ideas, I'm struggling to focus. What I need to do is stop thinking so much and just write. Write.

In part I'm plagued by wanting what I say to stand up to a self imposed standard. "It's got to be good", I tell myself. An overwhelming need to produce at my peak, to write my best does nothing but push me into paralysis.

"I'll write later", the voice inside says. Procrastination is alive and well in my soul.

I find myself pondering a potential post and sinking into weariness considering all the seemingly important background facts or figures or data or proper recollection that need some research;  any one of number of other details which spoil the spirit of writing.

Here's my resolution: Begin again and ignore the background noise  that wants to disrupt what could be good stuff emanating from my screen.  Hit the publish post button. Just go with the sentences longing to be free.