Social rounding

 social rounding

i had some time so i peeked in

on my patient on the wards.

he'd been having a rough go of it - 

in and out of the hospital,

his conditions getting the best of him.

in clinic, we usually focus in on 

these health issues that have

decided to make life difficult.

but today was different. 

we sat together for some time,

talking about our families,

the holidays, what's next in life.

we talked about what makes life hard 

and what makes life worth living.

i saw a bit of hope glimmering 

in those half closed eyes.

my heart swelled.

"thanks for the visit, doc,

you really helped me, mentally"

no, thank you, sir.

i needed this just as much as you.

a hazy arrival

"she’s anterior lip"

the words from the phone line
shock me awake
as i clumsily shimmy on some scrubs

it’s been a long few weeks 

peppered with sadness and heartache

coming off wards on the holidays 

in a pandemic surge.

i’m tired, but i need this.

“i have a baby to deliver!” 

i exclaim to an amused lyft driver

then take a few breaths. 

no rush, no stress

she’s a nullip, after all

she sleepily lights up when i arrive

epidural simmering

she’s labored down

let’s practice pushing

we talk about baby names and the weather 

in between contractions

it’s foggy on this uncertain morning

pairs of nervous eyes watch the fetal strip

from afar

the late dips give me pause, too

but i breathe, and i feel the progress

and i trust her process

with some more coaching, 

the pushes gain power and 

she rounds a corner

a student joins me for her first delivery

nervous but excited

hand over hand, we deliver the package

just as the fog starts to clear-

birth by fire

so many docs miss the beauty of this 

second stage

but i absorbed it all that morning 

with husband, student and nurse

cloaked in awe of the magic

a beautiful birth

a new family

a fresh chapter

a perfect antidote to so much grief

this is the power of our work

to attend to so much pain

but also connect in joy

this is family medicine.

Empowering Empathy

“Mama, Ember’s breathing funny…”

My daughter’s small but worried voice made me bolt up in bed. Ember had been breathing a little fast before bed and his lungs sounded a little coarse, but he was comfortable. Between wrapping gifts, I checked in on him several times in the night before finally collapsing in bed after the last package was wrapped.

So much for letting my guard down.

They teach you in medicine to watch out for sick kiddos. They can be hanging in, seeming just fine, and decompensate in a matter of moments.

 

Ember, my resilient fire-child, did just that. Hearing him audibly wheezing, tachypneic and with accessory muscle use filled me with absolute horror. Please, not my child. 

It was pouring rain in the wee hours of the morning as we carefully made our way to the hospital. Looking back constantly to make sure he was still hanging in there, and hoping for safe passage on the slick roads, it felt like a bad dream that one longs to escape. 

The emergency department was eerily quiet - I guess that’s how it is in the pediatric ED on Christmas Eve. Thanks to the miracle of modern medicine (aka nebs and steroids), Ember improved quickly enough that we were able to be discharged from the ED and enjoy Christmas at home together as a family.

In summary, it was a simple short-stay in the ED for presumed asthma exacerbation secondary to bronchiolitis. Bread and butter. No biggie. But it was an absolutely horrifying and stressful experience. Had this happened to one of my families I care for, would I have been able to grasp what a toll this would have taken on them, considering how much it strained me, even as someone who works in medicine?

It’s amazing how stoic and unencumbered we can feel as physicians about these everyday conditions. Carrying for a wheezing pediatric patient in my clinic generally would not throw me into a tailspin of worry like I felt that harrowing night with my own child huffing and puffing. But sometimes, certain patients will trigger us. They will remind us of something in ourselves, or our loved ones. They will pull at our heart strings, creep into our psyche in the night, and sometimes cloud our judgment. I can’t help but wonder if I will maintain my same cool the next time I’m caring for an acutely ill child with asthma.

See, the beautiful thing about doctoring is that we can bring our humanity to it. And it can deepen our work and impact in incredible ways. But it can also blur boundaries and adversely influence our decision-making.

This is the difficult balance we strike as physicians. Be humane, but strive for objectivity. Be caring, but don’t care too much. Empathize with the fact that being ill can be damn hard, but don’t overly feel your patients’ emotions and burn out.

What a fine line we walk in this doctoring game. We sure never get it just right, but I’ll lean into the humanity of my profession on the regular. And it can sometimes tax the empath in me, but it can also replete me in so many ways. So maybe I’ll worry a little more the next time a wheezy child comes through my door. But you better believe I’ll take an extra beat to comfort that worried parent, too, and we can work together to find answers and healing. 

Tearing down inequities in medicine

How do we treat the often forgotten, overlooked, or easily chastised members of our society in our healthcare system? The homeless, drug addicts, sex workers.. do they receive equal care?

I once walked into a code for a man whom we knew was going to die. This was a man with no family, no resources, and shackled with drug addiction. He had failed a few rounds of resuscitative medications and was still in asystole (flatlined). The nurse lifted the arm of the lifeless patient, and dropped it, as if to say “he’s gone, let’s call it”.  It left me in shock, horrified by what I considered a blatant disrespect for this man’s life. Some would argue that he had already thrown his life away by succumbing to drug addiction. In fact, one physician said just that. When I was later reflecting on this and stating what a sad case this was, he said, “No, it’s not. You live by the needle, you die by the needle.” So empty and so cynical. It added a little extra weight to my shoulders that night.

I understand why health care workers can become so cold about these things. They have seen people at their very worst, people who have experienced such pain and hardship that they seem to lack an ounce of humanity. How can we express compassion for people like this? How can we bridge what seems like such a vast divide and still give the very best of ourselves as health care providers?

What helps me banish away pre-judgments and treat each patient equally is starting out with a clean slate. I can’t help but think, this person was someone’s baby once. Strip away all the bad, the onion layers of hopelessness, darkness and despair.. And we are left with the core of a being, a hurt soul with little reserve to heal. For it is people like this who often need and deserve that extra bit of care and compassion even more than the rest. A little bit of grace can go a long way. 

It is not our job to judge others. It is our job to treat everyone with the utmost respect and  preserve their dignity in the hospital, a place where dignity is often stripped away in the storm of illness, weakness, and powerlessness.

This isn't life-altering stuff, people. It's walking into the room of the homeless man that's been admitted three times in the past month with just a shred of extra patience. A smile, even! Be a beacon of hope, the exception to the rule-- the person who actually steps up to the challenge with humanity. It isn't easy, but that's what makes it all the more important. Just as these patients might feel nourished by genuine kindness, we, too, gain perspective and deeper compassion by hearing their stories, acknowledging their struggles, and supporting their perseverance.

The "Art" of Obstetrics

As a resident constantly striving to do right by my patients as I learn the practice of medicine, I've recently become keenly aware of a major source of frustration in my training-- there is something so maddening about constantly being told different ways of practice. Never has this become more self-evident to me than on OB.

Now don't get me wrong, I absolutely love delivering babies. The joy! The beauty! The pride and excitement on parent's faces! I wouldn't trade it for the world. But with the good comes the bad. And working at a county hospital where extremely high-risk patients come through the doors every day, OB's learn to anticipate the absolute worst. And of course, that influences our practice.

Here's a little taste of the ping-pong of different approaches that I am confronted with every day...

lactivism

my name is julie, and i'm a lactivist.

lactivist  

-n. 

1. a portmanteau of "lactation" and "activism", used to describe a breastfeeding advocate.

why, you ask?

because i believe in the crazy idea that the breast is best for baby.* breastmilk is a free, eco-friendly food source for our babies. and hey, who doesn't want a boost for baby's immune system and innumerable other health benefits? not to mention that it is a sweet way to promote bonding and can be an incredibly empowering experience for moms. words can't express how wonderful it feels to help a new mom learn how to breastfeed her child!

i've taken it upon myself to learn more about the ins and outs of breastfeeding, so that i can really help parents get comfortable with the process, working through some of the common pitfalls, and feeling confident that they can provide this for their baby. in general, i think as physicians we don't do a great job with this. we simply don't talk to our patients about it enough. as health care providers, helping to maximize breastfeeding rates for our patients is a process with several points of intervention:

1. prenatal care (starting the conversation early during OB visits, breastfeeding classes, etc.)
2. labor & delivery, mother-baby hospital stay (kangaroo care, hands-on support with nursing)
3. postpartum care (close follow-up, support groups, newborn clinic visits)

so often on the mother-baby unit, my new moms are seriously deer-in-headlights, scrambling to nurse but unprepared, exhausted, and overwhelmed. overworked nurses, with varying levels of experience and enthusiasm about breastfeeding, are often shouldered with the bulk of responsibility of trying to play "catch-up" and help mothers get competent with breastfeeding in the hopes that they remain successful after discharge home. this isn't right, and this isn't enough.

the postpartum period is a very vulnerable time, and it is EVERYONE's job to help women feel supported in their breastfeeding efforts. family docs, ob/gyn's, pediatricians, nurses, lactation staff, and family/friends need to all be on board. we need to send a consistent message to mothers that they CAN do this, that they ARE enough and that they are doing an incredible job.

this deserves a whole other blogpost (stay tuned!), but full disclosure that i have taken it upon myself to reignite the lactivism flame at our hospital and people are, no pun intended, PUMPED. i sense a sea change, and amazing things are happening that are supporting a more breastfeeding-friendly culture and dare i say, possibly a baby-friendly hospital designation in the long-run?! a girl can dream, can't she?

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*as a lactivist, i want to make it clear that i am not a "bottle basher". every woman has the right to choose for herself whether she wants to breastfeed or bottle-feed her child, or both. i simply want to help encourage society to learn about the benefits of breastfeeding and to help women feel supported in their decision to nurse their children if they wish to do so.

"being with"

how many times a day do i tell my patients, 
take some slow, deep breaths.
as i listen to their lungs
and how many times do i tell myself to do the same?
not often. 
physician, heal thyself.