How I dealt with my fear today.

My Little Man. I have a PET scan on Monday. It is my first one since being diagnosed with breast cancer Jan 2012. My tumor was Stage 1, Grade 2, triple positive. I have been having shoulder and hip pain for a few months now so my oncologist arranged the scan. I had an xray on the shoulder which showed an abnormality but my oncologist has been clear that she isn’t worried its cancer. Some blood work she ordered was also all fine, including my ALP (alkaline phosphotase) However, that hasn’t stopped me from going off the deep end. I drive myself crazy with fear. I am just a bundle of fun to be around.

Here is what I did to deal with my fear today.
1) Went to my favorite on-line support group and read some of the inspiring posts by women on the site.

2) Called my mom. She told me to get my head out of my ass and do something positive. She reminded me that I need to exercise more and eat better. So, to show the universe that I am serious about beating cancer, I took my dog out for a speed walk for 30 minutes.

3) I haven’t had an appetite for the past week on account of my fear. After my walk, I had one of my favorite things in the world – pizza. Not the greasy calorie laden kind, I ate two pieces of a thin crust vegetarian pizza.

4)I Escaped myself for a couple of hours by playing with Lego with my 20 month old little man, Nate.

5) I wrote in my journal. Specifically, I wrote down some positive affirmations.

While my hip is throbbing now, my overactive mind has calmed a fair bit. Overall, I am more comfortable and feeling positive. Tomorrow is another day. But for right now, for today, I am OK.

I hope this helps those of you who battle fear.

Time

Time Meeting The Road“Where has the time gone?” is often something I hear.  I did not realize that over a week has passed since I last wrote.  I was doing my paperwork today and wondered why the stack was so large.  Like my blog, I had not attended to my paperwork for ten days.  Time flies and work builds up.  Time always seems incredibly long when doing something undesirable.  For example, patients often tell me how long they waited in the waiting room to get care.  “Do you know that I was in the waiting room for four hours?”.  Usually I just nod and disregard the comment.  Sometimes I will spit out an “oh really?” as though I wasn’t aware.  When someone is particularly obnoxious about it, I ask them “what do you expect?  This is an emergency department!  We deal with emergencies!”.

Sometimes I wonder if patients think the ER is a deli.  “Just take a number and you will be served in order”.  I am at times appalled that people with trivial issues, an ingrown toenail for example (yes some people actually come to the ER for that) will make a fuss when a sick child who has been waiting less than them goes in first.  I suppose I will be getting a stern letter from SPIT (Society of People with Ingrown Toenails) suggesting that I am unsympathetic to people suffering with this ailment.  In the ER, time is both the most important factor and the least important factor.

Time is the most important factor when dealing with dying cells or dying people.  We try to beat time when someone is having a heart attack.  We move fastest for patients who have been waiting the least.  When deciding who is seen next, the time someone has been waiting is not considered as heavily as the seriousness of their problem.  A heart attack may be seen by an ER doctor in minutes whereas a laceration on a finger may wait for hours.  Both issues need attention.  One of them can wait.  Time seems to take forever when we are waiting.

Time goes by quickly when we are living, thriving, enjoying.  My little boy is growing up so fast.  He is 19 months old.  It seems like it was only yesterday that I carried him into the house for the first time.  I remember that moment so vividly.  Time flies by when I am playing with him.  A couple of weeks ago he started to enjoy building with blocks.  I love building with blocks.  The two of us can spend hours creating towers and knocking them down.  Knowing how precious time can be, I take in every minute that I spend with Nate.  My mind is constantly set on “record”.  The “fast forward” button for my mind is collecting dust.  That is a good sign.

Given how much all of the aspects of time play into my day to day, it should not come as a surprise that my watch is one item that I cannot live without.  I want to monitor time closely to make sure I don’t waste a second.

Waiting is a form of torture.

Stop & WaitToday I had my routine follow up appointment at the Cancer Clinic here in town. I finally complained about this shoulder pain that I have had for months now. It seemed to start after reaching down for something in my car one night.  I didn’t think too much about it at the time.  However, as time has passed, the pain has become more obvious, especially with things like putting on my bra, washing my hair, and doing anything that involves raising my arm.  Were I to get my orthopedics text book out, my symptoms would match “rotator cuff tendonitis”.  However, this “rotator cuff tendonitis” is lasting a long time.  Up until today, I Have kept putting off getting an xray because I have been afraid of getting bad results; afraid I would learn my cancer is back.  But today, I succumbed to getting an xray and am now waiting for the results.

As I shook my oncologists hand at the end of my appointment, I asked her to call me if there is bad news. She replied that she would call me either way. It is now several hours later, and still no call. Being the nervous patient that I am, naturally, I am thinking the delay is because the xray is bad and my oncologist is lining up appointments before telling me the news.  That is a common practice when giving a patient bad news. Any normal patient would assume “no news is good news”.  Why can’t I be normal?

I confess that I made the mistake of trying to interpret the xray techs body language after he looked at the images of my shoulder. I got worried when after the first xray, in a thick Filipino accent, he asked “so what is wrong with your shoulder?”. I anxiously replied “why is there something wrong with the xray?”. He lied and said that he doesn’t look at the xrays. That is totally not true.  Most techs can read an xray better than most physicians.  Next, the second and third pictures were taken. After the third picture I couldn’t take it anymore and exclaimed “look, I am a doctor who is scared the shoulder pain is cancer. Do you see anything bad?”. He made this strange facial expression where stuckout his lower lip and nodded “no” in a “I am not supposed to say anything” manner. This is a good sign, isn’t it?  Then, why am I so scared?

 

Five Types of Pain That Might Be a Medical Emergency.

PainThis is a brief article on five types of pain that should prompt a person to go to an emergency department.

1) Sudden severe pain. Pain that occurs very suddenly and achieves a high intensity almost immediately, should be evaluated in an emergency department. For example, a sudden severe headache might be a sign of a ruptured vessel in your brain.

2) Pain that is accompanied with other worrisome symptoms. Pain that causes a person to loose consciousness, even for a few seconds, should always be evaluated in an ER. Further, pain that is associated with trouble breathing, profuse sweating, nausea, vomiting, or a fever, may mean something serious is going on.

3) Chest pain. There are many life threatening causes of chest pain including a heart attack, pulmonary embolism, aortic dissection, and pneumothorax. As a result, when it comes to chest pain, coming to the ER to get it checked out is a good thing to do. Most ER physicians would far rather deal with a patient who turns out to be a “false alarm” than to deal with a patient who has come in too late and there is little that can be done to help.

4) Chronic pain that suddenly cannot be managed at home and cannot wait for a family doctor’s appointment. Any chronic pain that suddenly becomes so severe that home remedies like icing or heat, over the counter pain medication, or prescribed pain medication, aren’t working, should be evaluated in an emergency department. Pain is something ER physicians are great at helping.

5) New pain that is severe. Any new pain that prevents you from sleeping, working, or doing the normal activities of daily living, might be a sign of a serious problem. For example, abdominal pain that prevents someone from getting out of bed because moving around hurts too much, might be a sign of a surgical emergency such as appendicitis.

Most communities have a health line that people can call if they are unsure whether their symptoms are anything to worry about. If you have a health-line and are unsure if an ER visit is needed, give them a call. Another thing you can do is call your doctor if you have one. Most doctor’s offices have an on-call physician that might be available by phone. If you don’t have a health-line or a doctor, and are experiencing pain, ask yourself if you have one of the five signs of serious pain. If you do, get to an emergency department or call 9-1-1.

Taking care of a blog is like taking care of a plant.

Before I get my hands on it.

Before I get my hands on it.

Taking care of a blog is a lot like taking care of a plant.  If you don’t write often on your blog, or water your plant more than once a month, it will die.  I actually often come up with great ideas for my web page but never remember to write them down.  One of the best pieces of advice I have ever come across, on finishing a written project, is to put empty boxes in a line in a room.  This is how J.K. Rowling is rumored to have written her books on Harry Potter.  I could do the same.  Whenever I have an idea for a piece on breast cancer, for example, I could jot down a few notes and put it in a box labeled “breast cancer”.  Eventually, the box would fill up enough to write an article.  Once this happens, all that needs to occur is putting the related pieces in order and typing the assembled product onto my web page.  Or, take a lot of small steps instead of an equivalent big step.

Maintaining a blog is not as easy as I thought it would be.  Under pressure to keep my content current, I sometimes write when I am not in the mood and churn out questionable material.  There have been several times I have started a post only to delete it when finished for one reason or another.  Perhaps the better thing to do is to sit on a questionable article for a day or two, and return to it with a fresh perspective.  I may decide it is worth keeping.

The other piece of advise I have deals with finding the time to manage one’s blog.  Some days I don’t feel like writing.  However, those days can still be productive if I focus on updating the programs that are relevant to my blog’s running.  I can also do the tedious job of sifting through the comments page and delete the spam.

Boy do I get a lot of spam and it often has to do with buying high end shoes in bulk. I am not sure why my blog is target for selling high end foot wear.  What does living with breast cancer, or being an ER physician, have to do with luxury high heels?  I can assure you that I would never wear a pair to work.  Scrubs and heels.  Nope.  Not a good match.

Perhaps the biggest hurdle I have to climb over is sleep, specifically,  getting a finished piece uploaded before I fall sleep.  You see, my best ideas come to me soon after I climb into bed.  But after a couple of hours, sometimes less, my eye lids start to feel real heavy – like now for example – and I surrender to sleep.  So, I will abruptly sign off here and close by saying short articles are better than no articles.  Hope the tips I gave were useful to you.  Until then, stay well.

Grateful to be home from the eternity shift.

Today was one of those shifts that seem to never end.  Every patient that I picked up required the use of just about every resource I had at my disposal – including my bladder control.  I didn’t feel great physically today thanks to a chest cold that a patient a couple of weeks ago gave me.  That’s ok.  That happens.  Although it seems to happen a heck of a lot more since chemo.  I have to say the highlight of this shift were the many patients who had waited at least five hours to be seen and were still pleasant and understanding.  In my years of practicing emergency medicine, I have noticed that often the patients who complain the most, are the ones that are in the ER for more minor reasons.  I can understand their perspective: “my problem is small and can be seen fast so see me before the dying man in the trauma room”.  These patients are the ones who are probably pissed off that we don’t have a drive through window.  Why not?  Everyone else has a driver through window.  The bank, pharmacy, restaurant all have drive through services, why not ERs?

I am going to stop here tonight because I am

Upcoming CBC Documentary: A Day Without Cancer

CBC will be airing the documentary “A Day Without Cancer” on the CBC’s documentary channel   The 2014 air dates air dates are listed below as well as the link to the film site and the CBC documentary site:

Monday June 2 at 10pm EST
Tuesday June 3 at 3am EST
Wednesday July 23 at 7pm EST
Thursday July 24 at 1am EST
Wednesday Aug 6 at 7pm EST
Thursday Aug 7 at 1am EST

Link to film site: http://adaywithoutcancer.ca/
Link to CBC Documentary channel site: http://www.cbc.ca/documentarychannel/feature-programs/

Thank you Alice for sharing this information with me.

Answering Someone Elses Phone.

Random KeysWell I made it out of the hospital after a brief stay as a patient.  I can confidently say that I hate being on the other side of the stethoscope.  One evening I was having a nap and was awoken by the hospital wide code alarm.  A “Code Blue” was called somewhere else in the hospital.  That means someone has collapsed and is in near or imminent death.  It was all I could do not to run and help.  With my leg swollen up to twice its size, I wouldn’t have gotten there with any speed.  Although I have a few stories from my experience recently, tonight I feel like writing about answering other peoples phones.  This topic has been on my mind lately.

There have been a few times when a phone that I happen to be near rings and I end up getting involved in something that I wish I avoided.  For example, answering the phone from an unknown caller and then ending up taking a survey because I am too polite to hang up.  The other day I read an article written by a physician venting on this very topic.  Instead of answering someone’s phone, the writer was lamenting on heeding a nurse’s call to help with a patient.  The nurse couldn’t find the patient’s regular doctor so asked the writer if they could give an order for something uncomplicated – I think it was a Tylenol order.  Due to an unexpected cascade of events, this unsuspecting physician ended up dealing with this patient for over an hour.  Good intentions turning into negative consequences.  I am sure there are many more examples of this phenomenon – trying to do the right thing and getting wrong results.

I have had good intentions many a time and ended up regretting it.  I have learned not to answer the phone when I don’t know the caller.  However, it is tough having an instinct to be helpful because it often seems to backfire.  I am sure all of this ties into a fear of disappointing others.  People who don’t care probably have much fewer unwanted events in their lives; less unwanted attention; less drama.  I just don’t think I can be one of those people.

Starts and Stops.

Peace & a Phone CallFor a while everything was going well, really well.  I was knocking on wood because I just could not believe my life could be any smoother.  Then, as I have come to expect it, the shit hit the fan…again.  I am writing this entry from a bed on the Children’s ward of where I work.  A few days ago, I developed a nasty leg infection.  The Kid’s ward is the nicest one in the hospital.  Besides kids, VIPs – like staff members – get put here.  I guess it is part of the perks that go with working here.

Speaking of perks, I have had no appetite.  So, I have stuck to a diet of ice cream and apple juice – both freely abundant on this ward.  Who would ever want to leave?  My leg is getting better.  The worst part of all of this is that I am supposed to be at work tomorrow.  The physician looking after me put the Kibosh on that this morning.  I don’t like letting my team down, even though this is out of my control.  So what caused all of this trouble?

The best I can figure is that I got bit by a spider.  Spiders digest their pray using potent flesh eating enzymes in their saliva.  When a spider bites a human leg, like my leg for example, that saliva causes tissue necrosis in the region they chomped down on.  That necrosis becomes infected by bacteria.  The result is a nasty case of cellulitis.  At the center of the cellulitis is a crater of destruction and necrotic skin.  It isn’t pretty.

The worst part of being sick is the feeling of letting down the people that mean most to you.  My wife is now a single parent because I am in here.  My colleagues are short a doctor when they are already strapped for resources.  It is hard not to feel guilty, even though this was all out of my control.  Why these things keep happening to me is unclear.  All I know is that I am powerless and must find peace in surrendering and let whatever needs to happen, happen.  I need to let go.