Tuesday, August 7, 2012

Day 52 - day 4.5 of 5 for consolidation #1

Some of my long time readers (ok, my family) are finding the numbered days hard to keep track of so I will try more lively titles and see how that feels. I could also try sprucing things up with more pictures, too.

This little masterpiece was painted just today by me and is of the view of my window, bookshelf and outside. It's sort of recognizable, but it turns out the whole perspective thing is a lot harder than it seems intellectually. Here's a photo taken a couple of hours later of what I was trying to paint.
One can kind of see the similarities. Kind of. I guess I'll keep the day job.

So that is an interesting question: what is my relationship to my work right now? As I am starting to get a little distance on it, I can see that I have been curled up around myself, protecting myself, just doing my leukemia stuff. Now, I'm a little better and I feel a little more out in the world, no longer like the only thing I can do with myself is to protect and heal myself. But I am not ready to be out in the world completely. I think when Cara asked if I could see the light at the end of the tunnel, part of why I couldn't is because it is too scary to. It's really nice to be in this place where I am monitored closely, my bone marrow is constantly peaked in at and the leukemia is beat back repeatedly. At some point, I'll have to turn my orientation around, face outward, and trust that the leukemia only needs occasional monitoring. I have felt badly because I'm not really all that interested in going back to work yet, but I think it is not reasonable to expect myself to be interested yet as I am still actively involved in killing leukemia cells.

In my mind, I started out June without leukemia. Then I spent June and July integrating "I have leukemia" into my view of myself. Perhaps August will be about turning down the volume on "I have leukemia" and finding the knobs that say other things.

Wanna hear some thoughts about teaching rounds? I thought so. I have had a whole bunch of attendings round on me by now and they all do it differently. They also do it differently during the week and on weekends and I have had lots of both kinds of days. Some round with the whole team (intern, resident, fellow and attending) which can be really overwhelming; not much chance for an intimate conversation with anyone if there are three other people standing around. Also, hard to find four chairs so everyone just stands around, looks awkward, does their thing quickly and gets out. The advantage is that it's quick for everyone--none of those pesky conversations need be had. Also, if people are really good at patient interactions or if a patient has a really interesting physical finding, this method maximizes the chance that everyone gets to see it, and increases the modelling opportunities for learnees with good attendings. Let me stress, however, from the patient's point of view--unless everyone on the team is devoid of personality and one wants to get the team gone as soon as possible--it's not the nicest method or at least not exclusively.

On the other hand, having each team member visit individually can be kind of wearing too. As noted above, there are four team members and having each one come in separately and ask the same questions, do the same exam can be a little tiring. This method makes for really nice conversations usually and it often feels sad to me that no one is able to learn from them besides me and the person I'm having them with.

It is almost always the person with the most seniority who speaks to the patient and this should also be varied. It is good for the junior people to get some supervision interacting with patients while it's also good for them to see the more senior people who presumably are better at it interacting too.

Some teams will round with two small groups: attending/trainees; attending+intern/fellow+resident; etc. I think mixing it up frequently so that the advantages of all the different methods are available is the best plan. I think that having people round in whatever format makes them least comfortable is probably a good experience while in training too. The quiet one who prefers not to lead the conversation should be getting the practice leading, the chatty one who doesn't like so much to listen should be getting some practice there.

Two doses of consolidation #1 left for me. This dose I get to sleep thru and tomorrow's dose I get to go home after. I'm off to brush my teeth and get my benadryl. I hope you have pleasant dreams.


  1. So, being a painter I really liked your water color. I see a very friendly castle with a winding entrance with a beautiful pond with lots of foliage. It's very serene. There is a reflection in the pond.

  2. I'm glad you like it. I do, too. It did not come out the way I imagined/planned, which was to look like the view out of my window, but I like it better the way it did come out.