Showing posts with label grief. Show all posts
Showing posts with label grief. Show all posts

Thursday, December 29, 2016

(all is not) lost

There was a heartbeat. I saw it on the ultrasound, but I knew immediately something wasn’t quite right. Was it too slow? Yes, the ultrasound tech said she noticed that too and gave me the wise, all knowing look of a Black grandma who can’t quite tell her granddaughter that something is wrong.

And then there was none at the ultrasound 2 weeks later. I asked the next ultrasound tech to angle the screen when I didn’t see movement. Saw the look on the Radiologist's face and then the Fellow. No heartbeat. The tears began to flow. My body began to shake. I held in the sob knowing if it began here with these strangers it wouldn’t end until I was safely tucked away at home.

You were there. I saw you. You were there. And now you’re not. When did you leave me? My heart breaks. I type through my tears.

I am at home. Grieving. Surrounded by loved ones.

I cry now as I type.

“Mama, are you crying? Did you have a nightmare? Are you frightened?” I stifle my tears. Say to Zo through closed door “I’m okay. Mama’s okay.” He calls out for me and O from his room after bedtime. O goes and comforts him and calls me into his room.  I gather myself, wipe my tears, blow my nose. Zo rushes into my arms “Mama, are you okay? I was having a good dream but then I woke up. Why are you crying? Everything will be okay.” As he gently rubs my face with his amazingly soft 5-year-old hands. As he pats my back. As he rubs my belly. As our family holds one another.

All is not lost in spite of this major loss. You were there. I saw you. You were with me. Now you are not there. But my husband is here. And my Zo is here. Their hearts are strong. My heart is strong.

The stories from friends poured in over the last few years. We are all in our 30s. Gut-wrenching stories of second trimester terminations due to fetal diagnoses incompatible with life. The heartbreaking call telling us of a stillborn nephew. Friends with years of infertility. A family member with seven losses. Stories of rainbow babies after loss. Countless miscarriages. Flashbacks from medical school of being present with sobbing women in the antepartum unit when their ultrasounds showed the absence of heartbeats. I didn’t understand then how the loss of something (a baby? A fetus? I didn’t know what to call it then) not yet realized could cause these women to sob uncontrollably. But I do now. From the moment I saw the positive sign I was hooked. Head over heels. Then the heartbeat. My growing belly. Zo’s “mama, is there a baby in there cuz I think there is.”

I was so excited to tell him he was going to be a big brother but I didn’t because I knew things weren’t quite right and it was all too soon, too early, too many things could go wrong - and they did. But he knew. He knew yet we feigned ignorance.Told him I would go to the doctor to find out.

All is not lost. You were there. We were together. Our family is still here and you will always be with us. We will go on. For we are not lost.

Monday, June 20, 2016

Witnessing sorrow and grief; taking trauma home.

About a week ago, I awoke to the news of the Orlando mass shooting-that 49 people had been murdered in the Pulse nightclub--for no other reason than that they were gay, and most were Latinx. The mass shooting du jour in America. You know the rest of the story, because unfortunately we've all heard these stories repeatedly. But it made me wonder about something else, tangentially related--but related to us in our work.

I came across a Facebook post by Dr. Joshua Korsa, an Orlando resident who described his experience caring for the surviving victims. Check out his story here (original post) or here (short news story)--. The "tangible reminder" he refers to below? His blood soaked Keens. He writes (about the survivors of the shooting):

"They've become a part of me. It's in me. I feel like I have to carry that reminder with me as long as [those patients] are still under my care. So this is a tangible reminder that the work's not done. That there's still a long way to go" 

Later I read the NY Times' "Orlando Medical Examiner: ‘Take a Typical Homicide Scene, Multiply It by 50" which was just amazing (for lack of a better word)--in less than 48 hours they were able to identify all 49 victims and in less than 72 hours autopsies were done on every single one of them. That's a logistical accomplishment and an emotional....quagmire. I cannot imagine being a part of that. I cannot imagine how hard that must have been. What exceptional work-- bringing confirmation to each of the 49 families and countless loved ones involved.

But wow, logistics aside--consider for a moment about the pathologists and technicians who did this work, who painstakingly photographed each victim, prepared them for transport to the morgue, the pathologist/assistants who later performed the autopsies, cleaned the bodies--these are the unrecognized people behind the scenes in such catastrophic events. How are they doing this week? How are the police officers? The crime scene technicians? Are they ok? How do people that witness such awful mass casualties cope? 

So that got me thinking (this is how my ADHD brain works, one topic to another, bouncing along)...WE deal with some really difficult stuff.  Not mass casualties (I don't think most of us do, anyway) but day to day casualties of life. Car accidents. People losing limbs. Diabetes, heart attacks, cancer, strokes. Kids dying. Homicides, suicides, accidents. Alcoholism. Lung cancer. New diagnoses of leukemia (surprise! you didn't just "have the flu"!). Homelessness. Stillbirths. Domestic violence. And so on. It's a lot to deal with.

How do you deal with the anger, death, violence, despair, stress, grief in your job? Sometimes it isn't even the death that's so hard, it's the sorrow, the daily witnessing of human distress. Death is a separate entity, and varies in it's impact on me--some deaths leave me with a sense of calm, some break my heart and I swear I never want to go back to work again (but I keep showing up.). Some don't seem to affect me emotionally much at all, and that's ok too. Every one is different.

As I walked around the oncology ICU recently, several rooms were empty-- and I realized as I walked around that I associate almost every room with a patient I have cared for in that room--and who has since died. I often think of them as I pass by (Oh, that's J's room...oh, that was D's room...etc).

As I walked down the long hallway to grab lunch, I thought:
  • M's room-she was my age--she died in that room over there, overlooking the water. She and her husband were avid skiers and mountaineers and he shared incredible pictures of their adventures together. I swallowed back tears during rounds that day; that was the second time I'd cried that day. M died of relapsed leukemia and candidemia. 
  • D's room-she coded suddenly, and died before her daughter could make it in. The chaplain put her daughter on speaker phone so she could say goodbye to her mom as her mom underwent CPR ("Tell her she was a good mom....tell her I love her....tell her she was a good grandma"). D died of advanced lung cancer.
  • M's room-an older woman with AML, the same age as my mom. Wonderful family, with a toddler grandchild who liked to sit on the bed and who was fascinated by the sat probe on grandma's finger. That boy lit up the room. M died of a disseminated fungal infection. 
And so on. I remember many. 

We carry our patients in our hearts and in our minds--they are with us/in us, year after year. And sometimes memories of them/their deaths are comforting while at times they are heart breaking and hard to revisit--even years later. Some patients/deaths I look back on and I feel peace, and I smile at the memories that surface. Some patients/deaths I think back on and tears still come to my eyes-and the deaths were years ago. Some I look back on and my heart rate increases--because their deaths were so awful that I still have an emotional/visceral response. 

So I wonder. I wonder how the nurses, doctors, EMTs, police, pathologists-how everyone that helped victims of the Orlando massacres is doing. And I hope they're ok. And I'm grateful they were there to face such horror, to run into a scene that hopefully none of us will ever have to face. And I hope now that they've taken care of so many others, that others are taking care of them.

And last but most certainly not least, may we never forget these 49 people, almost entirely queer people of color, murdered en masse for being...themselves. 

ZebraARNP. 

*****************************************************************************


In Memory.
June 12, 2016.


Stanley Almodovar III, 23 years old
Amanda Alvear, 25 years old
Oscar A Aracena-Montero, 26 years old
Rodolfo Ayala-Ayala, 33 years old
Antonio Davon Brown, 29 years old
Darryl Roman Burt II, 29 years old
Angel L. Candelario-Padro, 28 years old
Juan Chevez-Martinez, 25 years old
Luis Daniel Conde, 39 years old
Cory James Connell, 21 years old
Tevin Eugene Crosby, 25 years old
Deonka Deidra Drayton, 32 years old
Simon Adrian Carrillo Fernandez, 31 years old
Leroy Valentin Fernandez, 25 years old
Mercedez Marisol Flores, 26 years old
Peter O. Gonzalez-Cruz, 22 years old
Juan Ramon Guerrero, 22 years old
Paul Terrell Henry, 41 years old
Frank Hernandez, 27 years old
Miguel Angel Honorato, 30 years old
Javier Jorge-Reyes, 40 years old
Jason Benjamin Josaphat, 19 years old
Eddie Jamoldroy Justice, 30 years old
Anthony Luis Laureanodisla, 25 years old
Christopher Andrew Leinonen, 32 years old
Alejandro Barrios Martinez, 21 years old
Brenda Lee Marquez McCool, 49 years old
Gilberto Ramon Silva Menendez, 25 years old
Kimberly Morris, 37 years old
Akyra Monet Murray, 18 years old
Luis Omar Ocasio-Capo, 20 years old
Geraldo A. Ortiz-Jimenez, 25 years old
Eric Ivan Ortiz-Rivera, 36 years old
Joel Rayon Paniagua, 32 years old
Jean Carlos Mendez Perez, 35 years old
Enrique L. Rios, Jr., 25 years old
Jean C. Nives Rodriguez, 27 years old
Xavier Emmanuel Serrano Rosado, 35 years old
Christopher Joseph Sanfeliz, 24 years old
Yilmary Rodriguez Solivan, 24 years old
Edward Sotomayor Jr., 34 years old
Shane Evan Tomlinson, 33 years old
Martin Benitez Torres, 33 years old
Jonathan Antonio Camuy Vega, 24 years old
Juan P. Rivera Velazquez, 37 years old
Luis S. Vielma, 22 years old
Franky Jimmy Dejesus Velazquez, 50 years old
Luis Daniel Wilson-Leon, 37 years old
Jerald Arthur Wright, 31 years old





Tuesday, June 14, 2016

Diagnosis

This is a Daughters in Medicine post.

(which really does describe me - I'm a third-generation doc. And that is and isn't relevant to this post.)

When my grandmother was in the last years of her life, she fell out of bed. They took her to the ER, where she was Xrayed, pronounced intact, and sent home (where she lived with my grandfather, the retired internist, and a full-time caregiver.) The next morning my mother called me and said "Your grandfather is upset because your grandmother refuses to get out of bed." This was in the 1990s, before digital radiology and Nighthawk came along. I said "Tell him to call the hospital and ask for the radiologist's interpretation of the film. She might have a non-displaced fracture that the ED doc didn't pick up." Mom called me back several hours later and said - in a deeply suspiscious voice - "How did you know that?" I said "You sent to medical school. I learned stuff."

It's now 25 years later. My mother is the one with dementia, living at home with 24-hour care. No retired internist in sight; my father died nearly ten years ago. Last week Mom fell. The caregivers thought she was OK; a few days later, the pain was worse and she was refusing to bear weight. I said "She needs Xrays; she might have a nondiscplaced fracture." And sure enough. She sent me to medical school. I learned stuff.

Mom doesn't need surgery, thank heavens; we'll get equipment into the house and she'll stay in bed most of the time for a while. She's not having any pain.

But I know what it means when someone with moderate to advanced dementia breaks a hip. I'm a palliative care doc. I know where we're going. She sent me to medical school. I learned stuff. And some days, that stuff breaks my heart.

Sunday, November 8, 2015

The End… and the Beginning

When I was first queried about writing, specifically for a blog like this, I was excited, nervous, surprised… would other mothers in medicine actually want to read what I have to say? Would this be an opportunity for me to reflect upon my own clinical and academic practice? Would this enable me to grow as a physician mom? 

Like many things I’m sure you all can relate to, this idea fell to the back burner, simmering. I now find myself at a critical point in which the stew that is my professional and personal life are bubbling, coming to a boil and I find this the opportune moment to jump in. This comes on the heels of a gentle reminder from KC, for which I am thankful. 

I am approaching the final stages of divorce. In order to proceed with finalization, I have been required to attend parenting classes. I won’t go into just how asinine I thought this was given he has no requirement to attend said classes. Nevertheless, I showed up with intent to learn as much as I could that I’ve not already discovered through trial and error in the co-parenting adventure. I was surprised that they started with Elisabeth Kubler-Ross and the stages of grief. I took that with a big arms across the chest eye roll, then softened a bit as I thought more about each stage and the fact that this transition does in fact mark a loss… I’ve since considered my own transition through the stages and thought back on the years we were together. 

It’s taken nearly three years. I asked him to leave almost three years ago with our eleven month old son on my hip, seething with anger and pain. Eight years of emotional roller coasters. Eight years of infidelity. Eight years of me not acknowledging my own value. In that moment, that decision, I chose myself and my child. I chose to remove myself from a relationship and marriage which was so far removed from anything I wanted to model for my progeny. I had finally come to the complete realization that my husband would not every remain faithful and tend to his responsibility and commitment to me as a life partner. I did not want my little one to watch and live in an environment where a person whom is purported to be loved is treated that way. I have come to terms with the fact that I have zero control of half of this equation (my ex), however I have full control of my own actions, behaviors and decisions. 

So, if you will, walk through the stages with me. 

DENIAL 

Every single time I found out about another indiscretion of infidelity, I refused to believe it or give it any power. I denied how devastating his actions and betrayal had been. I denied that he’d made a seemingly meaningful connection with anyone in this world other than me. I denied that he’d violated my trust. I denied that I deserved to be treated with respect, dignity, love and commitment. I denied my value. I denied my intelligence. I denied my sex appeal. I denied everything and assumed it was my fault. I stuffed my emotions and hurt into a little box and told myself he’d be better. I denied my visceral sense that his behavior would never change. I denied my better sense. I denied my friends’ pleas to remove him from my life, over and over again. 

ANGER 

This emotion is incredibly primal for me, particularly in regard to this situation. My instinctual, somatic response was long buried due to a longstanding practice of compartmentalization. The trouble with compartmentalization is that it is both protective and destructive. I put those sad, hurtful, scary, heart wrenching things in a box, I lock each box, then I dissociated from those feelings with the hope to never, ever have to feel those terrible feelings again. I felt comfortable, or at least I felt that I was well enough in control of my life to go about my day to day. Then there come times when I’ve run out of capacity in my emotional compartments and for me, that’s usually when I feel least in control of this primal behavior. On the surface, I perceive myself to be fairly calm, cool and collected. When my fully stuffed compartments start to overload, the anger floods over me, forcing my hand to process what’s in those boxes. This is also the crux of that inherent destructive nature of compartmentalization as well. 

When this happens, my transition to anger is a painfully exhausting one. Each of us experiences it differently, but I can tell you how it feels for me. I develop an ache in my chest, then my heart rate quickens, blood rushes to my head, my jaw clenches, my nostrils flare, my posture becomes more erect and inevitably, my left eyebrow raises. My hair stands on end, my pupils dilate and I coil into position to strike. If it happens too quickly, it blends with the hurt and tears well up alongside my venomous words. At the same time, the sense of power that comes with anger is intoxicating. If it happens more slowly, I can calculate my response, choose my words and actions in a much more strategic way. I feel much more in control and strong. It’s a delicate balance, however, between the primal emotion and the controlled response. My ex, whether intentionally or not, can always find ways of awakening the beast within me. I’m still learning my own triggers and how best to turn each experience into something productive rather than destructive, with particular focus on self preservation. That, however, is for another conversation. 

BARGAINING 

Anger is powerful, but it’s also energy intensive and exhausting. That adrenaline rush only lasts for so long and in general, I’m a big softie. So, let’s get to part of my own challenges with him. The mind is strong, the woman is strong, the flesh is weak. I rationalized that if I reclaimed him, I somehow won. Then I’d turn the blame onto myself. I’d make lists of the things I was or was not doing that must have somehow had an impact on his behavior. If only I wasn’t studying so much, if only I spoke another language, if only I were more exotic, if only I wore more makeup more often, if only I were thinner, if only I were funnier, if only: insert any markedly self-deprecating phrase, he wouldn’t have strayed. I’d consider what I could change about myself to keep him from doing it again, maybe if I were more shapely, or if I colored my hair, or if I wore more makeup, or if I spoke another language, or if I had perfect skin, or if I had perfectly manicured fingers and toes. I was just certain that I could do something to inspire change in him, then in my depression, he’d feed into the bargaining and do bargaining of his own: “I’ll delete her number, I won’t work with her anymore, I’ll delete that email account, I’ll go to counseling, I love you, not her, I don’t know what’s wrong with me.” On and on. Of course, this spoke to the caretaker in me as well. There must be something wrong with him and I can help him! What a poorly rationalized thought which cost me the better part of a decade and emotional scars which will eventually heal, but not disappear. 

DEPRESSION 

I spent eight years ping ponging between denial, anger, bargaining and depression. It happened so frequently that it just became the norm and an expectation. It was just a matter of time until it would happen again, then pieces of my heart would chip away, I’d become furious, buried in anger and wanting to lash out. When he, the person in my life to whom I’d given everything I could possibly think of giving betrayed my trust and discarded me as if I was worthless, I became worthless. I devalued myself. My life lost it’s color. Everything was grey. Tears ran until there were no more tears. The ache in my chest became colder, darker, then numb. I anesthetized and dissociated myself from the situation, from our life together. I ached for connection. I ached to be desirable. I drank, a lot. 

The most marked period of depression in all of this was not actually after I finally asked him to leave. It was when he told me he didn’t love me and wanted a divorce. I packed my bags. I had no idea where I was going. I searched frantically on Craigslist and found a furnished studio which fit into my budget. It was close to the subway. It was close to a grocery store. The grocery store had wine. I could get to work. I could get food, not that I had an appetite. I became a hermit, a one to two bottle of wine per night hermit. One day I woke up and realized that this was not at all in my best interests and pulled back on the alcohol, found a 10 mile race to train for (I’d never run that far in my life) and redirected my energy. Slowly, the depression lifted which softened my heart and he came back into the picture, again. In my softened state, I let him back in, of course, but that’s a story for another time. 

ACCEPTANCE 

This may sound strange to you, but the last time I let him back in, I knew it wasn’t going to work. I had decided that he was not going to change, but I was going to give it one more go. You may be thinking to yourself, “WHAT?!?! Is she crazy?” Maybe, a little bit. We all have our own pathology and demons and this was my path to take. My decision to let him back into my life and my heart was complicated, as these situations often are. As was our cycle, there was wooing and there was romance and of course there was sex. Then one day I realized I was incredibly sensitive emotionally, my breasts were swollen and sore, and GASP! I was late. I immediately ran to the drugstore, bought a pregnancy test, walked to nearest coffee shop and went into their bathroom, and melted into the bathroom stall as two pink lines showed up. Did I forget to mention that I was tapped as a chief resident for the next academic year just one week prior??? 

He never wanted to have children. I could just not tell him. I could cut him out of my life forever. I’d always wanted to be a doctor and I’d always wanted to be a mom. How in the world am I going to do this alone? I knew he was going to completely flip out. It would be so much easier to not include him. Alas, that wasn’t the right thing to do. So I told him. He was livid. “How could this happen?” Ummmmmm, I know you’re not a doctor, but seriously? Remember all those times I reminded you that I wasn’t on birth control anymore because I didn’t think it was necessary given I was alone in a studio apartment drinking my life away and maintaining solitary confinement? Well, we had many conversations about termination, so much so that I went to Planned Parenthood for a preliminary appointment. This was followed by a call in tears to my best friend in the entire world about how there was no way I could do this alone and that I couldn’t count on him for anything, so wouldn’t this just be easier. Thankfully, she talked me off of the ledge. She knew that I wanted to be a mother more than anything and that all of the excuses I was coming up with were silly in the grand scheme of things. I’m a strong woman and I thankfully have a wonderful circle of friends and I would figure it out. I would be ok. We (my kiddo and I, at least), would be ok. 

Then it became clear that he was still involved with tomfoolery with one of the many women from his past. She got involved and there were text messages and emails. I have to say, the level of class demonstrated by all parties is fodder for another time. Ultimately, he cut ties with her, promised to go to therapy for his “sex addiction” read “narcissism.” By the time I was eight months pregnant, he’d demonstrated sufficient amounts of commitment that I finally moved back in and we planned for the arrival of our baby. 

I knew it wasn’t going to work. I. Knew. It. Was. Not. Going. To. Work. I felt compelled to give it one last go for the sake of our little one. I also had an inner dialogue that was determined to figure out how to at least be a parent with this man. We made a small person. I’m stuck with him no matter what happens between us and our relationship. I have to tell my child when they’ve grown bigger and understand more of the world that I did try to make things work. I also had to give my ex the opportunity to be a father, though he never thought he wanted to do that. I wanted to be able to look into the eyes of my pride and joy when they ask why mommy and daddy aren’t together and speak frankly, honestly, that I did everything in my power to make things work… and they just didn’t. I want to say that we both love our child and have our child’s best interests in mind and want them to grow up happy and healthy. 

So, when I was in the midst of my first year as an attending, spending a fair bit of time as a solo parent with our newborn given my husband’s work related travel, and my little was 9 months old and I got a phone call from my father-in-law. He was nearly hysterical as my mother-in-law had just had a CT scan with a mass and mets EVERYWHERE. I knew what this meant. My father-in-law had an inkling, but not a full understanding. He’d tried to call my husband. No answer. I tried to call my husband. No answer. Text. No answer. Another phone call. No answer. I called the hotel where he was supposed to be staying for his work related conference. “I’m sorry, ma’am, there’s no one by that name in this hotel.” Call to his boss. “I don’t think he’s checked in to the hotel yet.” After trying to reach my husband on an emergent basis for two and a half hours, he finally called back. How do you deliver bad news to the love of your life after you’ve been unable to contact them for a prolonged period of time? You don’t ask too many questions about where they were, who they were with and what they were doing… after all, their mom is dying and they don’t even know it. You take a deep breath, tell them you have some difficult news and follow that with as much promise of support as you can. I told him they’d found a mass, it was very concerning for widespread cancer and we needed to figure out how to get him home and us on a plane to see her. I called my colleagues, got shifts covered, booked our flight, headed across the country. 

My husband stayed. I came back to work and essentially be a single parent. I facilitated conference calls with specialists, primary care physicians, hospice providers, and my husband, father-in-law, brother-in-law. I was the tele consult 24 hours a day, while caring for our infant, managing a nanny who left a bit to be desired, managing my board exams and finding my way as a new attending. My mother-in-law didn’t want treatment. She wanted quality of life. Her sons and her husband could not fathom this. My father-in-law understood her desire, but his heart was broken. He was watching his love slip away right in front of his eyes, in his own home. The boys on the other hand were going through their own grief process. My husband was distant. I expected this. I figured it was his process. At the same time, just hours after we celebrated her life in a remembrance ceremony after her death, the text message that came from his paramour, while not unexpected, her timing was audacious. “I think he’s lying to us both. I hope he comes clean with you.” 

That was THE moment of acceptance. I knew it would come. I just needed to go through the whole process. That was the moment our marriage and relationship was over. Now, don’t get me wrong, there certainly followed moments of depression and anger and a sense of loss, but there was no bargaining and there was absolutely no turning back. That was the point of no return. I am worth more than this and my child deserves to learn that I will not accept being treated this way. My kiddo deserves at least one parent who strives to demonstrate the value of meaningful and lasting relationships built on communication, openness and trust. I refuse to accept that life anymore and am moving on with my new life and my little one.

Here's to new beginnings.