Dr. M.K. said this to me today:
"You graduate from medical school,
and you think you know everything.
Until you start internship.
Then you finish residency,
and you think you know everything.
Until you start fellowship.
Eventually, you finish fellowship,
and then you really think you know everything.
Until you meet your first patient.
So the key is not to know everything,
but to know how to find out anything."
Showing posts with label patients as teachers. Show all posts
Showing posts with label patients as teachers. Show all posts
Thursday, September 5, 2013
on empathy
i was thinking today about empathy. one of our noon teaching conferences focused on physician-patient communication. our fellowship director, T.M., was talking about empathy. T. M. was an English major in undergrad and he was describing the origin of the word, from the Greek εμπάθεια, suggested "to make suffer". the word empathy itself is a later translation into English from the German "Einfühlung" first coined by the philosopher Robert Vischer (1847-1933). apparently he was referring to "sympathy with art" and how you were to appreciate an art piece by imagining what the artist was feeling at the time he was creating it.
according to Merriam-Webster, the definition of empathy:
the wording of the Merriam-Webster definition confuses me a little, but essentially i believe it means to understand and to feel for someone and even beyond this - to try to place yourself where they are and see things the way that they do. the importance of this in the medical profession is that it allows for us to take better care of our patients. it guides us to be more compassionate. it demands that we are always attentive to our primary focus - the patient - and that we continually act on their behalf, as this is what we would want if we were actually in their position.
not just in the medical field, but in all aspects of life - isn't this important? i should always try to be more considerate of others. i should always try to understand for others - because people may never really tell you the hurt they are feeling or the difficulties they are going through. they may not be able to tell you or they may not be able to admit it to themselves. or they may not necessarily be able to see it for themselves.
it is always kinder to try to protect others' vulnerabilities and help them to grow to happier places.
according to Merriam-Webster, the definition of empathy:
1 : the imaginative projection of a subjective state into an object so that the object appears to be infused with it
2 : the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner
the wording of the Merriam-Webster definition confuses me a little, but essentially i believe it means to understand and to feel for someone and even beyond this - to try to place yourself where they are and see things the way that they do. the importance of this in the medical profession is that it allows for us to take better care of our patients. it guides us to be more compassionate. it demands that we are always attentive to our primary focus - the patient - and that we continually act on their behalf, as this is what we would want if we were actually in their position.
not just in the medical field, but in all aspects of life - isn't this important? i should always try to be more considerate of others. i should always try to understand for others - because people may never really tell you the hurt they are feeling or the difficulties they are going through. they may not be able to tell you or they may not be able to admit it to themselves. or they may not necessarily be able to see it for themselves.
it is always kinder to try to protect others' vulnerabilities and help them to grow to happier places.
much scarier
i've been taking care of O.M., a 67-yo man with a new diagnosis of acute myelogenous leukemia. he received the standard 7+3 treatment and i was doing his day-14 bone marrow biopsy the other day.
he's been a difficult patient. when he first came in, he was grumpy and dirty and said rude comments to all the nursing staff. he was always complaining - about the room, the hospital, the hospital food, the neighbor next to him, the staff not answering his call light fast enough. G70 nurses in our hospital are the most compassionate and certainly the most prompt nurses anywhere - except for possibly in the intensive care units. i didn't meet him until a couple weeks later and at that point, psychiatry had seen him and they had started him on some anti-psychotics. maybe it was the medications, maybe it was that he was more acclimated to the environment, but he had become more mild-mannered by the time that i got to know him. he's actually always been very gentle with me.
his story: he's 67yo, he fought in Viet Nam. he was a medi-vac. he was carrying soldiers to his helicopter when a bomb went off. he sustained multiple wounds. he was in a hospital in Viet Nam for a period of time. he was then sent to Japan where he spent 6-8 months in a hospital/rehab facility there. then, he returned to the US and spent 6-7 months in a rehab facility here.
after that, he picked up his life again. he went back to school and he worked hard. he became a pilot. he was very functional, until about 8 years ago and then something happened...life got to be heavier again. he slipped and he's been suffering from PTSD and depression ever since. i'm not sure what the trigger was.
despite all those things that he's been through - as i was doing his bone marrow biopsy and he was talking to me about his current hospitalization...he told me this: that having leukemia was much scarier than anything else he had ever done in his life.
puts things into perspective for me.
he's been a difficult patient. when he first came in, he was grumpy and dirty and said rude comments to all the nursing staff. he was always complaining - about the room, the hospital, the hospital food, the neighbor next to him, the staff not answering his call light fast enough. G70 nurses in our hospital are the most compassionate and certainly the most prompt nurses anywhere - except for possibly in the intensive care units. i didn't meet him until a couple weeks later and at that point, psychiatry had seen him and they had started him on some anti-psychotics. maybe it was the medications, maybe it was that he was more acclimated to the environment, but he had become more mild-mannered by the time that i got to know him. he's actually always been very gentle with me.
his story: he's 67yo, he fought in Viet Nam. he was a medi-vac. he was carrying soldiers to his helicopter when a bomb went off. he sustained multiple wounds. he was in a hospital in Viet Nam for a period of time. he was then sent to Japan where he spent 6-8 months in a hospital/rehab facility there. then, he returned to the US and spent 6-7 months in a rehab facility here.
after that, he picked up his life again. he went back to school and he worked hard. he became a pilot. he was very functional, until about 8 years ago and then something happened...life got to be heavier again. he slipped and he's been suffering from PTSD and depression ever since. i'm not sure what the trigger was.
despite all those things that he's been through - as i was doing his bone marrow biopsy and he was talking to me about his current hospitalization...he told me this: that having leukemia was much scarier than anything else he had ever done in his life.
puts things into perspective for me.
in defense of the young doctor
i am often told that i look too young to be a doctor.
as a woman, it's nice to hear that.
as a doctor, i'm not sure how to take that.
how should that be interpreted?
too young to be a doctor
does that mean --
you look like a kid.
you look like you've got no experience.
i really don't want you taking care of me.
is there a real doctor in the house?
i've never personally had any negative experiences with patients being disturbed by my age or how young i look (just friendly comments), but i have friends who have a lot of problems with this. i have, however, become increasingly more aware and have tried to become more professional - in appearance, in mannerism, in conversation.
i've thought about this more recently. one of our fellows from last year (now completed), signed on as staff here. apparently, when patients call in and try to set up consultation appointments, the scheduler will sometimes advise them to be careful with this "new staff guy" because he's pretty young and probably doesn't have too much experience....he is a very smart, conscientious physician. he takes good care of his patients. he's really good at what he does - but he's young.
seeing as how i'm going to be done with fellowship in a little over a year, i'm probably going to have the same problem.
so i thought i would write in defense of the young doctor,
in defense of myself:
i am young.
i will be fresh out of fellowship.
i will not have as much experience as the older staff doctors will have.
but that doesn't mean that i don't have any experience.
hematology/oncology are very rapidly progressing subspecialties.
there are new discoveries - both in pathophysiology and in therapy - that are happening all the time and guidelines for treatment are continually being revised.
having just finished fellowship/training,
i'm as current as possible on all these new advances.
in an era of wide-spread, easily-available electronic medical information, and increasing sensitivity towards legal ramifications,
i am trained to think critically and review analytically.
and cost-effectively.
i know what i don't know.
i know when to look things up.
i know when to ask for help.
and, being young, i won't be afraid to ask for help.
i have no issues of pride or appearance that will make me hesitant about asking other staff for their suggestions. chances are likely that if i do have questions, i won't ask just 1 staff guy, i'll probably ask at least 2 different staff and that will be 3 different people thinking about you.
i'm more nervous.
and that's not necessarily a bad thing - because that nervousness is going to make me think harder about you and the decisions about your care that i'm making. and that means that - at the end of the day, after i've seen you in clinic, i'm going to go home and look things up and read several more hours about what's wrong with my patient to make sure that i'm not missing anything.
yes, it's true that there is a lot to be said about experience, but there is a lot to be said about youth, too.
of course, all this being said, if your doctor - no matter what age - is telling you something that just doesn't make sense, ask them. ask them to explain it until you understand it. or get another opinion. i am always supportive of my patients and encourage second opinions. or third opinions (at reputable institutions, of course). i would even refer them, as necessary. it never hurts to have more people thinking about a patient. especially because the patients i see often have very complicated diseases and histories.
as a woman, it's nice to hear that.
as a doctor, i'm not sure how to take that.
how should that be interpreted?
too young to be a doctor
does that mean --
you look like a kid.
you look like you've got no experience.
i really don't want you taking care of me.
is there a real doctor in the house?
i've never personally had any negative experiences with patients being disturbed by my age or how young i look (just friendly comments), but i have friends who have a lot of problems with this. i have, however, become increasingly more aware and have tried to become more professional - in appearance, in mannerism, in conversation.
i've thought about this more recently. one of our fellows from last year (now completed), signed on as staff here. apparently, when patients call in and try to set up consultation appointments, the scheduler will sometimes advise them to be careful with this "new staff guy" because he's pretty young and probably doesn't have too much experience....he is a very smart, conscientious physician. he takes good care of his patients. he's really good at what he does - but he's young.
seeing as how i'm going to be done with fellowship in a little over a year, i'm probably going to have the same problem.
so i thought i would write in defense of the young doctor,
in defense of myself:
i am young.
i will be fresh out of fellowship.
i will not have as much experience as the older staff doctors will have.
but that doesn't mean that i don't have any experience.
hematology/oncology are very rapidly progressing subspecialties.
there are new discoveries - both in pathophysiology and in therapy - that are happening all the time and guidelines for treatment are continually being revised.
having just finished fellowship/training,
i'm as current as possible on all these new advances.
in an era of wide-spread, easily-available electronic medical information, and increasing sensitivity towards legal ramifications,
i am trained to think critically and review analytically.
and cost-effectively.
i know what i don't know.
i know when to look things up.
i know when to ask for help.
and, being young, i won't be afraid to ask for help.
i have no issues of pride or appearance that will make me hesitant about asking other staff for their suggestions. chances are likely that if i do have questions, i won't ask just 1 staff guy, i'll probably ask at least 2 different staff and that will be 3 different people thinking about you.
i'm more nervous.
and that's not necessarily a bad thing - because that nervousness is going to make me think harder about you and the decisions about your care that i'm making. and that means that - at the end of the day, after i've seen you in clinic, i'm going to go home and look things up and read several more hours about what's wrong with my patient to make sure that i'm not missing anything.
yes, it's true that there is a lot to be said about experience, but there is a lot to be said about youth, too.
of course, all this being said, if your doctor - no matter what age - is telling you something that just doesn't make sense, ask them. ask them to explain it until you understand it. or get another opinion. i am always supportive of my patients and encourage second opinions. or third opinions (at reputable institutions, of course). i would even refer them, as necessary. it never hurts to have more people thinking about a patient. especially because the patients i see often have very complicated diseases and histories.
the good doctor
"The good doctor is smart, compassionate, dedicated, thoughtful, funny, and kind. He cares about all the right things - about love and honor and ethics and community. He has faith in himself, in his profession, and in those he serves."
- The Country Doctor, Life, June 1998
i first read this when i was still in undergrad and i was home, going to the doctor's office with my mom for her routine annual visit. we were in the waiting room and i was looking through the magazines. there was a Life magazine (it was still in print then) and it had an article on doctors. i remember reading this quote and i wrote it down. i've saved it for years now and i keep it written down in different places. reading it reminds me of what i aspire to be - a good doctor.
the part i've been thinking about recently is the last part - having faith in myself, in my profession, and in those i serve, my patients. in particular, i've been thinking about my patients. and people in general. being a heme/onc doctor has really taught me a lot about people.
i've been in school/training for most of my life. i work more than 12 hours every day. i don't get to sleep much. i don't get weekends off. and i hardly have any life outside the hospital. but, despite all these things, i still feel very lucky - and it's because every day, i get to meet wonderful people and i get to see the beauty of life, the depth of love, the strength of the human spirit. and so i am constantly inspired. and my faith in people is constantly challenged and constantly re-affirmed.
cancer patients are given the chance to see life differently, granted that this is not a gift that anyone would want or wish for - but it is still a gift. they are given the chance to appreciate life differently. it is true that, for many patients, cancer is an incurable disease. it is also true that treatments are getting better and the hope is that, if there is no cure, there are at least therapies that will allow cancer to become more of a chronic illness rather than a terminal illness.
still, there is a stigma associated with it and, ultimately, cancer patients feel that they are faced with their own mortality. they can fear this and they can deny this - or they can embrace the diagnosis and embrace their lives and continue to grow through this experience.
and that is my wish for my patients.
- that they embrace their diagnosis. in my initial visits (and subsequent visits) with patients, i always try to take as much time as possible to discuss the details of their diagnosis with them. i want them to understand it. i want them to ask questions. i want them to feel like they own it (and not the other way around). an interesting thing about cancer is that it only takes one bad cell (simplistically speaking) - and that the one bad cell is different from one cancer patient to another. when we diagnosis leukemia, we do flow cytometry and cytogenetic studies, looking for particular surface markers and genetic abnormalities. while some surface markers and genetic abnormalities are consistent in a particular leukemia and help to diagnosis it - there are a number of them that are unique to a patient. this is like a "fingerprint" of their leukemia. it's their "fingerprint" and it becomes their diagnosis, their cancer. they can take their time with this - but i want them to know it, own it, embrace it. we will go through their treatments together. they will find out what they're made of. and they will be surprised to find out how strong they are. and they will be surprised to discover how much love surrounds them. they just have to give themselves a chance. i believe this. i know this.
- that they embrace their lives. we often don't get a chance to see the longitudinal aspects of our lives, but when i take a medical history - i'm looking at everything that happened to a patient medically since their birth. in the same way, patients need to be able to take a longitudinal look at the other important events and relationships that they have had throughout their lives. this is the time to let go of all the fears that have kept them from looking into their past, in depth. we all have colorful histories. we all have our own crosses to carry. patients need to think about what is (and who is) important in their lives. they need to gently find their way, to not be afraid to face the sad things in their lives, the things that have caused them hurt in the past - so that they can think about what it will take to heal those wounds. they need to accept their own personal history and embrace who they are. it will give them appreciation for their own lives and help them to cherish all the people in their lives in this day.
- that they continue to grow. we are always growing. we are always becoming something greater. i hope for patients to realize that just because they are diagnosed with cancer - just because they think they are going to die - it doesn't mean that they have stopped growing. we never stop growing. their is always room for growth, and creativity, and introspection. and happiness. and peace.
this doesn't happen in one visit. it doesn't happen in a month. sometimes, it takes years.
but my wish is that it eventually happens.
63 years
i met a 90yo woman with leukemia today who was admitted to my service for pneumonia and acute MI. this sweet, little old woman who actually looked much younger than her 90 years. she is quite sick -- but also very depressed. her husband died 5 weeks ago.
we were married 63 years.
we were married 63 years.
it was a very good marriage.
we were just right for each other.
just right.
poor, dear woman. i felt so sorry for her. my staff, who is not usually someone others would describe as a warm man, sat on her bed and held her hand as her eyes started to get all wet. she was saying that ever since she was diagnosed with leukemia - her and her husband both thought that she would be the one to die first. instead, he did.
poor, dear woman. i felt so sorry for her. my staff, who is not usually someone others would describe as a warm man, sat on her bed and held her hand as her eyes started to get all wet. she was saying that ever since she was diagnosed with leukemia - her and her husband both thought that she would be the one to die first. instead, he did.
we were walking back to the cancer center and my staff told me how he has noticed this scene many, many times --
husbands can't live without their wives. even though you think one has a worse prognosis and will die sooner, it's always the one who can't live without the other that will end up dying first.
husbands can't live without their wives. even though you think one has a worse prognosis and will die sooner, it's always the one who can't live without the other that will end up dying first.
i was thinking to myself that some people don't even live 63 years -- let alone be married for 63 years.
if you are lucky, you will find the person that is just right for you.
and maybe you will be lucky enough to spend 63 years or a lifetime together.
bedpartner
i came in to see one of my patients early the other morning and asked her about how her night was. she is a sweet, little old lady who has been admitted too many times, this time for pneumonia. i asked her if she slept ok and she said -
no, i couldn't sleep well.
how come? breathing ok? coughing? were you hurting anywhere?
no, it's not that...
was it too loud out in the hallway? maybe we were waking you up to check vitals or for blood draws?
no...i think it's just because i miss my bedpartner. see, we've been married a long time and i'm so used to having him next to me when i go to bed, i guess i just can't fall asleep without him.
her husband was sitting next to her, he put down his newspaper, and put his hand on hers, and said --
yes, i miss her, too. i can't sleep well either. we've been married 46 years now, and i still can't sleep without her next to me. our dog misses her, too.
the simple, sweet things.
i love old couples.
no, i couldn't sleep well.
how come? breathing ok? coughing? were you hurting anywhere?
no, it's not that...
was it too loud out in the hallway? maybe we were waking you up to check vitals or for blood draws?
no...i think it's just because i miss my bedpartner. see, we've been married a long time and i'm so used to having him next to me when i go to bed, i guess i just can't fall asleep without him.
her husband was sitting next to her, he put down his newspaper, and put his hand on hers, and said --
yes, i miss her, too. i can't sleep well either. we've been married 46 years now, and i still can't sleep without her next to me. our dog misses her, too.
the simple, sweet things.
i love old couples.
Thursday, June 10, 2010
America the Beautiful
yesterday i went to a patient's funeral. he was a retired ICU physician, in his early 60s when we met. he had acute myeloid leukemia. he had gone through multiple treatments, including induction chemotherapy and stem cell transplant, but his disease relapsed and became more aggressive. nothing was going to work.
he had tolerated his therapy relatively well. only the last few months, things were catching up to him. his disease was worst. the treatment was harder to tolerate. he had more fatigue, lower blood counts, more bleeding problems, more infections.
several weeks ago, he had been hospitalized again with fever. his disease was getting worse. there was nothing more we could do to treat the leukemia. and he knew this. he got everything lined up in his life. he had been prepared for this. he left the hospital under the care of hospice.
he was always a wonderfully kind man. i really became fond of him and his wife. he was a physician himself and i'm sure had trained many residents and fellows in critical care. but he was always so respectful towards me. he never once treated me like i was just a fellow - always, i was his doctor and part of his care team.
he was optimistic about his disease and always tried to be cheerful. but there was one occasion, when i was getting up to leave his hospital room, when he reached for my hand and stopped me. he looked scared and that look, coming from another physician, really made an impression on me. he said - "please take care of me. please take care of me". and he started to cry. i had nothing to say at that moment. i hugged him and he cried briefly. i told him i would do everything i could.
i don't know if it's really ok for doctors to cry with their patients. i'm sure that he could often see in my eyes when i wasn't sure how things were going to turn out. i'm sure he could see my own fear. i'm not sure how physicians (or patients) feel about attending funerals. it is always a little strange. i sit in the church and i feel like i'm responsible for his illness...and ultimately for his death. although i know that nothing could have been done differently to alter the course of his disease. acute leukemia in older patients is a bad disease.
he was Filipino. came over to the US in his early years and worked hard to get accredited as a physician in the US. at his funeral service, his son went up and spoke of him. he said that his father wanted "America the Beautiful" to be his processional hymn. this was truly his land of opportunity. there was nothing in his life that he was more proud of than being an American. he always impressed this on his children.
his son started crying at that point. he had to stop for several minutes. the church was completely silent. then, he stepped to his father's covered coffin and stood there. he bent over and placed a single kiss on the cloth that was covering the coffin. it was a touching moment.
afterwards, i stood in line waiting to greet my patient's wife. she was standing there and we were all stopping, one by one, to hug her and give our condolences. she was dressed all in black, as is tradition. the image of her standing there made me think about her and her husband. over 40 years ago, when they were married, they both probably stood similarly - at the doorway of the church, she was probably dressed all in white then and he was probably wearing a suit next to her - they were probably greeting people in a similar way, except it would have been a much happier occasion. and he would have been by her side. that thought made me sad for his wife, who was now alone, and i could feel myself starting to cry.
she saw me, i was several people in line away yet, but as soon as she did - she reached towards me. she had several people to hug before she got to me, but then she hugged me tightly and said - "thank you. thank you for everything you've done". i hugged her tightly and told her - i wish we could have done more. thank you. it's been my privilege. it was hard to let go.
rest in peace, dear one.
i will always remember you.
and God bless America.
he had tolerated his therapy relatively well. only the last few months, things were catching up to him. his disease was worst. the treatment was harder to tolerate. he had more fatigue, lower blood counts, more bleeding problems, more infections.
several weeks ago, he had been hospitalized again with fever. his disease was getting worse. there was nothing more we could do to treat the leukemia. and he knew this. he got everything lined up in his life. he had been prepared for this. he left the hospital under the care of hospice.
he was always a wonderfully kind man. i really became fond of him and his wife. he was a physician himself and i'm sure had trained many residents and fellows in critical care. but he was always so respectful towards me. he never once treated me like i was just a fellow - always, i was his doctor and part of his care team.
he was optimistic about his disease and always tried to be cheerful. but there was one occasion, when i was getting up to leave his hospital room, when he reached for my hand and stopped me. he looked scared and that look, coming from another physician, really made an impression on me. he said - "please take care of me. please take care of me". and he started to cry. i had nothing to say at that moment. i hugged him and he cried briefly. i told him i would do everything i could.
i don't know if it's really ok for doctors to cry with their patients. i'm sure that he could often see in my eyes when i wasn't sure how things were going to turn out. i'm sure he could see my own fear. i'm not sure how physicians (or patients) feel about attending funerals. it is always a little strange. i sit in the church and i feel like i'm responsible for his illness...and ultimately for his death. although i know that nothing could have been done differently to alter the course of his disease. acute leukemia in older patients is a bad disease.
he was Filipino. came over to the US in his early years and worked hard to get accredited as a physician in the US. at his funeral service, his son went up and spoke of him. he said that his father wanted "America the Beautiful" to be his processional hymn. this was truly his land of opportunity. there was nothing in his life that he was more proud of than being an American. he always impressed this on his children.
his son started crying at that point. he had to stop for several minutes. the church was completely silent. then, he stepped to his father's covered coffin and stood there. he bent over and placed a single kiss on the cloth that was covering the coffin. it was a touching moment.
afterwards, i stood in line waiting to greet my patient's wife. she was standing there and we were all stopping, one by one, to hug her and give our condolences. she was dressed all in black, as is tradition. the image of her standing there made me think about her and her husband. over 40 years ago, when they were married, they both probably stood similarly - at the doorway of the church, she was probably dressed all in white then and he was probably wearing a suit next to her - they were probably greeting people in a similar way, except it would have been a much happier occasion. and he would have been by her side. that thought made me sad for his wife, who was now alone, and i could feel myself starting to cry.
she saw me, i was several people in line away yet, but as soon as she did - she reached towards me. she had several people to hug before she got to me, but then she hugged me tightly and said - "thank you. thank you for everything you've done". i hugged her tightly and told her - i wish we could have done more. thank you. it's been my privilege. it was hard to let go.
rest in peace, dear one.
i will always remember you.
and God bless America.
Tuesday, June 8, 2010
leave a light on
today, we had this patient with myelodysplastic syndrome. i did her first consult visit and she was coming back this time so we could talk about cord blood transplant. unfortunately, her disease had progressed to acute leukemia and before we could go to transplant, she would need to have induction chemotherapy (which could be a month-long hospitalization, or maybe longer). she and her husband had a lot of questions and we spent a lot of time answering them.
her husband was this quiet man. she and he are both in their 60s, both with white hair. he has a beard and long hair that grows to his shoulders. kind of hippie-ish. he was not forceful or loud or demanding. not at all. he was non-assuming. asked few, but thoughtful questions. and was very attentive. didn't say much at the first visit and he didn't say that much at this visit. but what he did have was this - a hand-written graph of all her blood tests, from the time she was diagnosed until now.
he had a graph, multiple pages taped together because it was so long - dating back to April 2009. since that time, she had had hundreds and hundreds of blood tests done. he had plotted out her white blood cell count, her neutrophils, monocytes, blast percentages, hemoglobin, and platelet counts. literally, hundreds and hundreds of data points. written in very neat writing, smudged in some areas, but carefully protected. and color-coated. crazy? maybe some would think it was obsessive compulsive? maybe it is a little crazy and maybe it is a little obsessive compulsive. but, simply enough, to me it was just a man showing his love in a way he knew how to. something about it was very endearing.
and, actually, because we didn't have all her records or lab results faxed over to us, it was very helpful to see what her trends had been like.
so she needed induction chemotherapy, either locally or at our hospital. she asked where she should have it done. we said it was a standard regimen, could be done anywhere, and then she could return to our hospital for transplant. she didn't know where to go or what to do. and at the end, Dr. K said to her - it's ok. go home, think about it. and then you can decide. you can come back here anytime. we'll leave a light on for you.
and that was enough. a look of relief. a moment to think about it. she looked so comforted. and they went home. they are going to decide and then call.
i got to thinking about those simple words - we'll leave a light on for you. there is so much meaning in those words. how nice it is to know that someone is watching out for you and is waiting for you. i think about all the times i have driven back to GR and gotten to my brother's house so late at night - and there was always a light on for me. when we lived in Whitehall and i used to drive back from medical school, lots of nights not getting in until past midnight, and the street would be dark and quiet, except for the little light at my parents' house that they left on for me.
her husband was this quiet man. she and he are both in their 60s, both with white hair. he has a beard and long hair that grows to his shoulders. kind of hippie-ish. he was not forceful or loud or demanding. not at all. he was non-assuming. asked few, but thoughtful questions. and was very attentive. didn't say much at the first visit and he didn't say that much at this visit. but what he did have was this - a hand-written graph of all her blood tests, from the time she was diagnosed until now.
he had a graph, multiple pages taped together because it was so long - dating back to April 2009. since that time, she had had hundreds and hundreds of blood tests done. he had plotted out her white blood cell count, her neutrophils, monocytes, blast percentages, hemoglobin, and platelet counts. literally, hundreds and hundreds of data points. written in very neat writing, smudged in some areas, but carefully protected. and color-coated. crazy? maybe some would think it was obsessive compulsive? maybe it is a little crazy and maybe it is a little obsessive compulsive. but, simply enough, to me it was just a man showing his love in a way he knew how to. something about it was very endearing.
and, actually, because we didn't have all her records or lab results faxed over to us, it was very helpful to see what her trends had been like.
so she needed induction chemotherapy, either locally or at our hospital. she asked where she should have it done. we said it was a standard regimen, could be done anywhere, and then she could return to our hospital for transplant. she didn't know where to go or what to do. and at the end, Dr. K said to her - it's ok. go home, think about it. and then you can decide. you can come back here anytime. we'll leave a light on for you.
and that was enough. a look of relief. a moment to think about it. she looked so comforted. and they went home. they are going to decide and then call.
i got to thinking about those simple words - we'll leave a light on for you. there is so much meaning in those words. how nice it is to know that someone is watching out for you and is waiting for you. i think about all the times i have driven back to GR and gotten to my brother's house so late at night - and there was always a light on for me. when we lived in Whitehall and i used to drive back from medical school, lots of nights not getting in until past midnight, and the street would be dark and quiet, except for the little light at my parents' house that they left on for me.
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