My Last Words

The other day I had an admission/transfer from the ICU. It was this 8o+ year old lady with pancreatic cancer who was found down and nonresponsive admitted for severe hypotension requiring multiple liters of IV fluid boluses. She had other multiple comorbidities and a CT scan of her abdomen showed catastrophic findings likely related to her cancer. She was admitted to me because her family had moved her to comfort care status, meaning that they wanted to withhold any further treatment and keep her comfortable until the inevitable came. I went to see her and she was not responding to anything but noxious stimuli. I tried to talk to her and she groaned without any purposeful movements. I wrote orders for some morphine to keep her comfortable and went downstairs to type out my history and physical (H&P) so that I could present her to my attending. Ten minutes later, I got a page from the nurse that said my patient already passed away. My resident and I went up to confirm her death by listening for no heartbeat or breath sounds. Quiet. Then I realized that I was probably the last person to have interacted with her or to have seen her alive. Not even her own daughter, who was on a plane from NYC, shared that experience with her. I've seen a lot of people die already, but this was the first time that I felt like someone died directly under my care because my resident or attending had not been involved yet. We notified the family and then I went downstairs to finish the H&P on my patient that already died.

My Fall Back

Well I'm on my internal medicine inpatient wards month now and I must say, it's pretty challenging. I'm lucky to be part of a great program with very supportive residents and attendings who are patient advocates. Medicine is so much more humane that way. Now that I'm working pretty long hours, it's hard to find the time to do anything fun outside of work. I basically come home, eat, and sleep. Once in a blue moon I go to the gym but with the rain I find it harder and harder to drag myself out the door to make the 5 or so blocks down to the 24 hour fitness.

Fall always makes me reminisce of the past. For example, with Thanksgiving coming up, I think about going back to Macon to my parents house to my old familiar room. Sleeping in and calling up old high school friends that I've lost touch with. We used to have a tradition of playing tackle football with a ton of people every Thanksgiving break. A few times we even had huge Thanksgiving pot lucks at a friend's house in the boonies. I miss you guys if you're reading this and I wish we kept in better touch. Those were the days. I miss the smell of the Georgia autumn. I miss college in the fall too. I can still see the UGA buses coming over the hill packed out with students wearing red and black while walking to my favorite dining hall to indulge in 3,000 calories post Ramsey Center work out with my buddies. I miss watching the football games at Sanford Stadium and making the trek down to Jacksonville, FL for the great throw down between our bitter reptilian rivals. I even miss my parents farm, waking to the smell of my mom's cooking and going outside to play with Google or watch my dad tend to the horses. Although I hated Augusta, I do appreciate my nice cozy house and having so many of my friends close by. Seattle is great and all, but Georgia will always on my.....thoughts.

I will leave you with a taste of a Seattle Fall sunset from the roof of my apartment