how large?

The hills behind Castle Hill in Budapest are large.

In the previous post, I mentioned having large stretches of time where my leukemia is not relevant to the conversation. That got me wondering: exactly how large are these stretches of time? How long do I go between mentions of my leukemia in conversation on a day to day basis and how long do I go between telling someone new about my leukemia?

For the first question, replaying my day in my (somewhat foggy, post-chemo) brain, I come up with the following times leukemia came up implicitly or explicitly during the workday:
1. I brought my old port into the office and showed it to my nurse (long story involving cleaning out the place it used to be kept)
2. I was sitting in the doctor's dictation room at the hospital (it is a very tiny room where we doctors shoe horn in to do our charting) and one of the other doctors is a few months older than me. We talked about how we are both turning fifty next year and I mentioned how pleased I am to be another year older. Further conversation ensued about mortality and my experiences.
3. One of the nurses who knew me pre-leukemia told me how much she likes my curls.
4. I explained ports and PICCs to a patient who may need long term IV access. Everyone in the room but the patient and their family knew that I knew exactly what I was talking about
5. A patient mentioned that her hair was darker now since having chemo and wondered if it usually comes in darker. "Yes, it does," I answered, "and curlier." She did not know that I and my nurse both knew the answer to this question was personal.

There were certainly many other times when I thought about it or touched on the "I had leukemia" factoid during the day and I bet there were other times someone made reference to it during the day that I just don't remember because I cannot recall everything that goes through my head in a day (thank heavens). As I go through my day tomorrow, I think I will try to be aware of when I think of the leukemia or when someone says something that alludes to it and see what I get. Anybody want to guess?

Day 249 - navel gazing and self-improvement

In yet another twist of February, Emily may not be able to come home this weekend because of the forecasted snow. I was, of course, really looking forward to seeing her. WMUR seems much more bent out of shape about the storm than weatherunderground or NOAA so hopefully it's just an attempt to sell advertising time. I want to see my daughter! and I don't want any stupid snowstorm standing in my way!
These days I'm working about 24-28 hours / week and it's going pretty well. I'm still tired often at the end of the day, but not every day and I can't figure out why a particular day makes me more tired than another. It doesn't seem to be intensity or amount of work or patient contact versus admin stuff. I'm just not sure, but some days (yesterday) I am really tired and some days (today) I am not. Now that I'm working more, I'm having a harder time getting myself to go to bed on time. I think it's because I have less time for myself and it makes it hard for me to stop doing something fun (usually goofing around on the internet) and go to bed and then--here's a surprise! sometimes I haven't had enough sleep when the alarm clock goes off. This was a problem I identified last week and I've been getting myself more disciplined recently, but I'm so used to having a lot of time that I feel deprived at bedtime now that I am getting less.
I remember when I was first home from the hospital thinking of all the things I could do, for instance, driving to Portland to visit my friend Jodee. This was in July/August after induction when I was home for a month after spending a month in Lebanon. I remember thinking that I would go to Portland later in the course of chemo after it had killed off more of the cancer because then I'd be feeling better. I realized fairly quickly that that was not a very realistic way to think about it because actually I didn't have any symptoms so I was really only going to feel worse as the chemo went on. I've wished that since I had "all that time off," I could have done something useful with it: restarted playing viola, improved my Spanish, whatever, but it was a vain hope because when I was recovering from chemo, I was actually doing a lot of recovering and recuperating which is, it turns out, mutually exclusive from practicing viola a lot or studying Spanish intensively. Drat! It is a good thing that I understand so thoroughly intellectually that I could not embark on a self-improvement plan while I was recovering from chemo because otherwise I would be berating myself for not having made better use of the time. I remember thinking pretty hard about this at the time that I was recovering because I knew it would be an issue for me down the road. Fortunately, in the 48 years that I have lived with my mind I have learned a little about it and can predict some of its idiosyncrasies so that I can protect myself from, well, my judgmental self.
OK, self-congratulatory self, can you develop a self-improvement plan to make you a little kinder and gentler towards yourself? Or is this all too much navel gazing? The thing is, of course, different people respond differently to being sick for six months--both at the time and in retrospect. Not everyone would view leukemia as a missed opportunity for self-improvement, but you better believe that the nuns who taught me third through eighth grade would have. Sorry, Sister Bernadette, but I think I did OK.
For me, for tomorrow, I hope for the wisdom to be a little gentler on myself. For you, for tomorrow, I hope for the wisdom to see your own self relationship and to make positive adjustments.

Day 242 - new world record

So, today I set my new world record for post leukemia work. I worked 7.5 hours in a row. I'm a little tired, OK? Not too far over the edge, but tired. My knees and hips even are tired and a subject and a verb that match seems like a bit of effort. I thinks I'll just relaxed them a little biddy bit. OK, maybe not.
Today was the kind of day at work that seems best described as wooly, as in: wild and wooly. Everything came out OK in the end and only involved two calls to the ED, one impromptu family meeting and a single call to the fire department to rescue a single small animal. OK, I'm joking about one of those three. Good luck figuring out which. Actually, you know how sometimes people surprise you by suddenly pulling out devotion or kindness or generosity you didn't know they possessed? It's especially nice when it's someone you thought had it in them, but who has acted for a long time like they didn't, then suddenly they do and you were right all along. It's also especially nice when it's someone you thought was just really not a nice person and wow! you were wrong and the world is a better place than you had thought. I had both experiences today so that made it a good day although it contributed to the wooliness by making me a little off balance a lot of the time. Happily off balance, but a little less sure that I understand how the world works.
I also got to spend some time today at CMC on E200 where I used to spend most of my time. It was just like old times and people are still coming up to me who haven't seen me since I've been back and saying how happy they are to see me. It's really such a nice feeling to have someone, often multiple someones, tell me how good I look and how much they missed me every day. I wouldn't recommend leukemia, but there are some nice things about it.
Now, I'm home, having fed myself, listened to Ellie sing every word of every math problem as well as about half the steps in every answer and will soon be rolling into bed happily.
For tomorrow, I am hoping for a cottony day instead of a wooly one for myself. I'm not sure what a cottony day might be like, but it sounds nice. For you, I hope you get the fabric of your choice, too.

Day 235 - some milestones

Today had another milestone in it. I had to call a pharmacy to coordinate a patient's meds and for the first time in seven months, I pressed "2 if you are a doctor." I've been calling pharmacies a lot in the past few months--a real lot--and have had to press the patient number. I always hear the doctor number, taunting me, reminding me that I am not doing my profession, but have behaved well and not pressed it when I was calling as a patient. It was very exciting to press the doctor number again.
Another milestone is that I watched a patient of mine get on a gurney and get loaded up in an ambulance today. I have seen patients on gurneys since being back, but the last person I saw get on a gurney was me. He did much better than I did both times as he was able to stand and pivot for transfer. I realized as I watched him get in the ambulance that I was a little sad that both times I'd been in an ambulance, I was too sick to enjoy it. I suppose that would be the definition of a wasteful ambulance ride: if you are well enough to enjoy the scenery and the cool technology in the rig, you are well enough to get in a regular car.
The 1/31/13 NEJM has the article about myths, presumptions and facts about obesity that has been widely quoted. Sadly, it's not a free text article so I didn't link. I really think we know very little about obesity and weight loss, but we like to pretend we do.
Last night, I had a really nice conversation with my friend, Rob, about patients who are DNR having to reverse their DNR status before they have surgery or procedures. Several years ago, I had a patient who had reversed his DNR status for a procedure code during said procedure. I got to thinking about that day and how I had had 15 or so other patients to care for even though having a very nice, highly functional patient die, have attempted CPR and then have to talk with his elderly wife (who fortunately was not at all surprised) was a fairly heavy duty day, emotionally speaking, I had to keep going: admit, discharge, evaluate differential diagnoses, talk with patients and families, adjust meds, call consults, etc. for hours more. As I told Rob about it, I noticed my hands were shaking. There is so much stress to how we have to handle things sometimes--just shove them aside and keep going. I find it really a pleasant change that in hospice, as a more team oriented specialty, there are more people who understand the emotional situation I might be in with the patient in room E507 and who can then offer me some support. I think hospice providers are also trained more in providing emotional support and can offer it to fellow staff more effectively than non-hospice trained folks. I am very happy to be where I am. (Unrelated, but I do really find I miss hospitalist work.)
Today is day #3 of a so far 18 hour week. I am glad I will not be working tomorrow as I'm pretty excited about my bed tonight.
For me, for tomorrow, I hope only for restoration. For you, for tomorrow, restoration if you need it, otherwise, whatever you need instead.

Day 227 - OK labs

Dr. Hill just called to let me know my labs, while still not perfect, are moving in the correct direction. My platelets were 30 too low last check, now they are 15 too low so--progress. We're going to recheck in 10 to 14 days and hopefully they'll be all back to normal.
I had an interesting experience at the POLST training session yesterday that I wanted to get your opinions on. We were role playing and a pretend patient asked me how likely it was that I would not be able to get his symptoms under control at the nursing home he lived at, how likely it would be that he would have to transfer to a hospital for symptom control. I told him that I had only had one patient in the ten years that I worked there who had had that problem. Afterwards, he told me that that method of expressing a very low probability (which is what I was trying to do) was actually anxiety provoking and that I should find a different way. I thought that was interesting because I have used that method a lot and have not noticed anyone seeming to be made more anxious by it. What do you think?
We also talked a little bit about the studies that have shown people have a harder time understanding 5% than "1 in 20." People who study these things say that your average person gets what 1 patient of every 20 means better than they understand 5% and that it is not obvious to many (most?) that they are the same. For this reason, people recommend that you give numbers as proportions rather than percents. For events that are much less than 1%, it seems that saying "one tenth of one percent" or even "one in one thousand" are hard to wrap your head around. My "happened once in ten years" was an attempt to say essentially, "it happens, but is pretty rare." How else could I say that?
Otherwise, today was a fairly normal day. I was not as tired from eight hours of education yesterday as I feared I might be, but I felt not quite 100% today. Sorry, I felt not quite 1 in 1. I felt more like 4 people out of 5 people. (as long as all five were silly)
For me, for tomorrow, I will hope for back to normal energy. For you, I will hope for the energy to do what you want to.

Day 226 - smarter by a bushel

Today I went to an educational event where I learned how to help people fill out a POLST form. If I were not so tired,  I would tell you more about it rather than link lazily only. The funny thing about being tired is that I didn't realize I was tired until I noted that I could not focus on a popular science article about bird migration on the BBC website. I realized when I was skimming pleasure reading that I must be tired. It's the old eight hour day again. I'm still not quite ready to be a normal person. Drat it!
I enjoyed the education and feel a bunch smarter and way more prepared about helping people do advanced care planning. I also enjoyed getting to see a bunch of hospice and palliative care folks from all over the state.
I am going to go to bed as soon as I have helped Ellie get to bed so more details will have to wait until tomorrow.
I am going to hope for good labs for me for tomorrow. For you for tomorrow I will hope for good news too. If you're not expecting any news, even better: good, unexpected news.

Day 196 - dogs a-walking

The big activities today were breakfast with Terry and a walk with Ana, Maggie and Ana's dog, Rykka. I forgot to take pictures, but they were cute tromping around the PEA forest in the tiny bit of snow we had.

After our walk, we went to lunch at the Good Karma Cafe which was delicious, but you can't mind the snake oil salesman at the cash register. We heard about the purported health benefits of many things he sells, among them vibrating pads you stand on to "open up your lymphatics" and an infrared sauna that is more effective than regular saunas at allowing your body to "cleanse itself of toxins." If you analyze your sweat after a regular sauna, "it's 7% toxins and 93% water; after an ultrsound sauna, it's 20% toxins and 80% water, because it's a deeper sweat." I know you come here to get the latest medical information so that is why I'm telling you this. It was all new to me, so I thought you might not know it either. We split a plate of nachos which were well-loaded. The beans, guacamole and salsa were perfect and even the vegan cheeze was tasty although not as tasty as real cheese would have been. For my meal, I had a vegetarian reuben which had flavors reminiscent of a "real" reuben, but was better as a thing on its own. Emily and Ana were happy with their lunches too, although I had Emily's salad. There were lots of raw sesame seeds on the salad and instead of having the nice taste and texture of roasted sesame seeds, they had no taste and the texture of fine sand. Next time, I'm getting my salad with extra dressing and no sesame seeds.

In the afternoon, I hung out with Emily, read a bit of the most recent Annals and generally goofed around. Tomorrow I think I will generally goof around and finish the Annals, just for variety. I was a little more tired this morning than I would have expected to be; I assume because of Friday's work. It is hard to tell for sure what my level of tiredness is now, however, because I had a nice walk which I haven't in a while. If the snow continues, we may be able to break out the cross country skis tomorrow! We live about three or four blocks from the entrance to the Phillips Exeter Academy grounds where there are maybe fifty acres of woods and fields we can make tracks on. We used to live one block away, but they closed the entrance closest to our house. The gate opened just beyond the outfield of their baseball diamond and I think some dog owners did not clean up after their dogs. It probably doesn't take too many piles of dog poop in the outfield to make them close the gate, sadly.

For me, for tonight, I will wish to wake to good cross country conditions. For you, I will wish that you will be happy with the weather where you are.

Day 195 - a long work day

Locals will remember the storm of earlier this week where I decided against driving as slush fell from the sky. The downside of that was that today was an eight hour day. It was pretty interesting and fun which is a lot to say about a day largely spent with paperwork. At the end of the day, I went to CMC and signed my documents and visited with some of my pals. I happened to run into one of the same people I saw last week. She told me that I looked less tired today than I had last week. That is funny because wow! I'm tired. The last thing I did was to meet with Lisa, who will be the social worker in the outpatient palliative care clinic. We had a nice time chatting and I think will really enjoy ourselves in the clinic.

The very last thing I did as I was leaving was to watch a man on a gurney go out to an ambulance. It made me think of the times I went by ambulance from Manchester to Lebanon. The second time I was kind of sick, but the first time I was really pretty sick. There is a photo of me that is not quite shocking, but certainly disturbing where I am lying in bed and get cold if I take off my neutropenia mask. When I got to Lebanon, I let them transfer me from the gurney to the bed. I did not insist on doing it myself or even helping. Yikes! I must have been quite a sight. I'm not sure what level of comprehension of my last six months experience I am at. That sounds stupid because of course I understood really well what happened to me in real time as it happened, and I really did understand--I'm a doctor; I had AML and chemo and neutropenic fevers and..., but I didn't totally understand it, like I'm not sure I understand that I was actually kinda sick some of the time. I think about that I understood my technical details really well and am always ready to guide the conversation there.

I've never taken care of a psychotherapist. I wonder if they always try to bring the conversation around to the underlying significance of things. "Yes, an antibiotic would be a good idea, but tell me, what in your childhood has made you so aggressive towards microbes?" A novelist: "An antibiotic would heighten the tension between my immune system and the bacteria. I'm not sure I've fully explored the frustration my immune system is experiencing right now. Can we wait until tomorrow to start it?" There's probably a whole line of silly jokes in there.

For me for tomorrow, I will wish for a restful night of sleep because I need it! For you for tomorrow, I will wish for a restful and relaxing whichever time period you need most.

Day 187 - work again

It's amazing: four hours of work, plus a commute, plus a little email about work adds up to nearly a full day. There was just a little time left over for weaving and dinner. Tommie discovered The Ipswich Shellfish Fish Market and if you like scallops or shrimp or probably just about any other kind of seafood, it might be worth a trip. We had delectable cold, grilled shrimp while we watched Tommie cook the incredibly fresh scallops. I cooked the salmon, but something had gone wrong with it and it tasted very odd (not old, more like chemical-y) and then we all tried some flounder at the end (I was underwhelmed by its delicate flavor). However, the shrimp or the scallops were so fabulous that there was no need for anything else to make an outstanding meal. Tommie also brought salad stuff over and it was surprise! dinner.

As for work, all the HHH providers got together today to talk about how things were going, what I had missed, what we were hoping for in the future. We hardly ever get to spend much time together because we are always going off in our individual directions. I also spent some time with a patient and her family. We were not really planning on me doing direct patient care yet, but it just worked out that way and I'm really glad it did. If I had had a particular day set up as The Day that I was going to start doing patient care again, I would have tied myself in a knot about whether or not I would still be able to do it. This way, no problem, it was very natural for me to do it and I did. It seemed like it went well, so I guess I can cross that worry off before I even begin to worry it; I do remember how to talk with families.

An interesting thing that happened was that while I was talking with the patient, I felt a couple of times "I so understand what you are saying; I felt exactly that way, too" and I felt the impulse to blurt out my story. Of course, it's not about me and it would not have been even remotely useful at this point so I reined myself in. I can see that I will have a little processing, as they say, to do before I go back to doing lots of patient care.

For me, for tomorrow, I will wish for eloquence and skill to convince my boss of the wisdom of my ideas and plans. For you, for tomorrow, I will wish for eloquence to ask for and get what you need from the important people in your life.

Day 185 - first day back

Back to work went well. Everyone was happy to see me, there was useful stuff for me to do and I felt like I knew what I was doing. My anxious worries that I even knew ahead of time were stupid did not come to pass. I managed to do OK even though we were out of coffee at home (it's coming in the mail tomorrow), I got there right at 8, I remembered my snack, it didn't leak or have so much condensation that it was a huge nuisance, I actually wasn't hungry midmorning anyway, there were enough computers to go around,  etc., etc. I am more tired than I would have been after a morning at home, but not outrageously tired. I got out on time. I stopped at Swann's for coffee with Eva on the way home and I was even able to walk downtown with Emily in the afternoon. So, I think back to work is going to be OK, but will build up my hours slowly.

On my commute, I listen to a lot of different podcasts and continuing medical education lectures. I don't really mind my commute because I feel I get a lot out of the time I spend in the car. Today I was listening to a lecture on "communicating bad news" and I was surprised to discover that I felt I really had info to add to the lecture. There were several points, but the most notable was when she was talking about how a lot of doctors don't like to deal with patient or family emotions and how if you brush them aside, they'll come back and bite you later anyway and how the family may not remember any information you give them, like prognosis or where the mets are or which labs are goofed up, but they will remember how you dealt with their emotions. I actually felt like a related issue was that at the times I was feeling a negative feeling towards my doctors (usually abandonment because that is my specialty), I didn't really want to talk about chemo or fevers or meds or symptoms. I wanted to talk about whether or not they were going to abandon me and how they better not do it again. We know that sometimes our patients come to us with very negative feelings about other doctors or often doctors in general. I have had the experience more than once where the family will want to talk about some prior situation and will need to recount the story with me being a sympathetic ear before we can move forward into the next step. I think it is the same phenomenon as I describe above.

Another talk that I listened to was "Zencast" which I highly recommend to everyone. Gil was talking about how being grateful is a good habit to get into and how people who were grateful and appreciative were happier, slept better and had a whole bunch of other benefits I don't remember. It made me think about how I close each post by hoping for something for the next day. After listening to him talking today, I considered instead of wishing for something, listing off the things I'm grateful for. That seems kind of sappy to do publicly and besides that, I really like the way I end the pieces. I think Gil would ask if I were living in the future because I think every post of how the future could be improved compared to the present. I wonder if he would say that this sort of thinking encourages me to be dissatisfied with the present because I have made it a routine part of my day to think of a way in which the present is not as good as I would like it to be. And, yet, I do not find it to be so. I think of it as "hopeful." How does hopeful fit with satisfaction with/acceptance of the present? Should I consider changing my practice of closing with wishes?

For myself, for tomorrow, I will wish for a sense of gratitude for all the gifts in my life. For you, for tomorrow, I will wish exactly the same.

Day 184 - more snow

A little bridge over the Exeter River

As I write this, I am actually kind of tired. It was a snow day in Exeter and Ellie had a friend over. They built a snow fort a little ways from our house and I was invited for a tour and then put to work providing the raw materials--snowboulders. I stayed out with them for maybe an hour moving snow around and trudging through the snowy fields. We arrived home later: cold, wet, and very pleased with our handiwork.

A little later, we walked downtown to find out if Emily and I like Orange Leaf frozen yogurt and to demonstrate that Ellie's friend does like it. Ellie doesn't, so we stopped at Stillwell's for her. In general, I really like Stillwell's, but haven't since chemo as it *still* doesn't taste right. Some sweet things taste OK, but most still taste "off" to me. I am not sure how long this will continue, but I'm kind of tired of it. It is a very funny feeling inside when I see some delicious treat and think "I'd like to try that" and then my brain says, "you won't like that. Not for you." The dissonance between part of my brain saying "Yes!" and part saying "You don't really want that." is very weird and unsettling. I will be glad when it's over. To answer the question, I did like Orange Leaf OK, Emily felt similarly.

The new shower head came in the mail today and Terry and I spent an alarming amount of time trying to get it in place without leaking. It is pretty extravagant--two shower heads.

Tomorrow I go back to work. I am happy and excited, but there is a part of me that is inexplicably anxious. I found myself worried about getting there on time (as if anyone cares if I arrive at 8 or 10); worried I won't be able to eat my mid morning snack (again, as if anyone cares if I am eating while we are talking) and worried that there won't be a place for me to work (there are plenty of people who aren't around every day--there will be a computer for me somewhere). I can absolutely recognize these as the sorriest and most bizarre set of worries I've seen in a long time, but there you have it. I am not sure if it is progress that I have moved beyond worrying about if I'll remember any medicine to worrying about minutia which is not even problematic. Clearly these weirdo worries must be stand ins for something, but what? and why not just worry about the real worries?

For me, for tomorrow, I'm hoping for a good first day back: to feel useful, competent, happy. For you, I will wish being happy in your profession or education as well.

Day 182 - palliative care

On the other six month anniversary (June 15 to Dec 15), I pretty much just had a nice time. This morning Kate, Terry and I took one of her dogs and Maggie out for a walk at her family's Christmas tree farm. It was nice weather, nice company and nice dogs. We had a good time. A while later, after a little bit of general hanging around, Emily and I went out to get our Christmas tree. A little more general hanging around and then it was dinner time. Tommie took us to Blue Moon to celebrate her art show being successful--yum--and then home to decorate the tree. Not much to the day, but quiet fun.

Sunday, Monday and then my first half day back at work. I will go back to Home, Health and Hospice first and the work I do there will be the same as before I got sick.

I have not been able to talk about what work I will be doing at Dartmouth until now, so let me do that. After a lot of thought, I have decided to stop being a primary care doctor and instead to help Dartmouth start an outpatient palliative care clinic in Manch. I have loved being a primary care doctor so much and am really sad at not being able to do it any more, however I can't do both and right now I feel palliative care is calling. Some of my patients have been with me all eight years I've been in New Hampshire and I have been through big stuff with most of my patients by now. They are attached to me and I, to them. I will miss them very much. I do feel, however, that a palliative care clinic will be a tremendously helpful thing to have in Manchester and I am thrilled that I get to help start one. I think there are a lot of patients we can help in such a clinic and thinking about that mission helps me feel a little less sad about my clinic patients.

We sent a letter to my patients last week. Dartmouth had not told my patients why I was out so I told them I had leukemia, chemo, etc. ; I was sure they would like to know. I also told them I was starting a palliative care clinic and that I would not be able to do both palliative and primary care, that I would miss them and tried to explain why I felt it was important for me to be doing a palliative care clinic. I was expecting to get some negative feedback from some of my patients, but it has not materialized. I got my first patient feedback today in the form of a Christmas card from a patient who said she was shocked to find out why I had been out and was hoping for the best health for me and then continued to say some embarrassingly nice things about me. Once again, I am blown away by the kindness and good spiritedness of my patients. I have been and continue to be extremely fortunate.

My wish for me for tonight is that my good luck continues. For you I wish for similar good fortune.

Day 170 - ETA for work

If you were to look at Maggie, you would be able to guess one of the things I did today--take her for a long walk. Ana and her beautiful shepherd came over to accompany us through the PEA trails and wallow in the muddiest gullies (to be accurate, Ana did not do any wallowing). A good time was had by all and, as everyone knows, a tired dog is a good dog. Other activities were a little weaving and cooking some more of the delicious Greek bean recipe. I also got my xkcd volume 0 collection of webcomics in the mail. I got one for a present for a non-reader of the blog and, well, one for myself too. I also went to an unnamed location to finish my shopping for Terry.

I was a little tired after our walk; I feel like I'll sleep well tonight and that I am building some leg muscles. Walking three miles in PEA on trails is much more tiring than walking three miles in town on sidewalks. It's also more tiring than riding the exercise bike at Planet Fitness although I don't think it's as good for getting my heart rate up.

The topic I'm thinking about most these days is timing of going back to work. Dr. Hill thinks I should go back in January and I feel ready to go back in a couple of weeks. I think the difference is that I am planning on going back very part time and building up and perhaps he is imagining me working more hours initially. It is interesting to talk with my medical friends about this issue: some of them think it will be fine for me to go back, even good, and some of them think I should stay out longer. I like my job (OK, I love my job) and really miss it and the people I work with. My team at HHH has been working super hard and will be glad to have an extra set of hands (so to speak) around. I also feel like an incredible slacker to be on disability for a single second longer than I need to be. I am grateful for how generous my Dartmouth benefits are and don't want to take advantage of their kindness either. On the other hand, I don't want to be stupid, to exhaust myself unnecessarily or to risk having to go out again two weeks after I go back in. Let me know your thoughts on the subject.

For me, for tonight, I'm hoping for the wisdom to choose the correct path for me. For you, I hope you are able to make good decisions too.