Paris - Day 2

Day two of my trip happened to be Palm Sunday. I woke up early, determined to make all the sights on my list, and took the Metro toward location #1: The Museum of Natural History. I'm embarrassed to admit, but I had a little hiccup on my way there thanks to some of the more old-fashioned Paris Metro cars. With these older cars, in order to get out at the station you have to flip the door handle up...but the sign is in French and the diagram is really not as self-explanatory as it seems. Anyway, I was supposed to get out at my station but fumbled the handle, couldn't get the door open, and the train continued on. Luckily there weren't too many people on the train. I tried to play it cool -- no, I didn't REALLY want to get off there -- but thankfully at the next station someone else was getting off so I was able to follow them out the door. I doubled back and got to my intended destination.

I've been to Paris a few times but the Museum of Natural History was a brand-new stop for me. I entered through the park gates and had a pretty walk up to the main building. Surprisingly, there were all these French people in the park -- jogging, doing aerobics, stretching. In spandex and gym shoes and ratty old t-shirts. If you've ever been to Europe -- especially Paris -- you NEVER see Europeans "exercising" and wearing gym clothes. I was pretty amused by the whole situation. I thought that Parisian girls stayed skinny by walking everywhere and smoking a pack-a-day, but I guess they sweat it out too. I'm a little surprised that there's no Lululemon in Paris, especially since it's a Canadian company...but I digress.

My real goal in going to this museum was to see the Hall of Bones. I'm not sure how I missed it, I think it was in a different pavillion, but I was pleasantly surprised by a huge hall of taxidermy! I'm kind of a weirdo in that I love taxidermy -- the taxidermy section of the Chicago Field Museum is one of my all-time favorite exhibits. I was also introduced to taxidermy at an early age by my pediatrician who is a family friend of ours. Despite being an easy-going guy and care-giver to small children, he went big-game hunting in Africa during the 80s when it was still legal. As a child, I spent many a Christmas and New Year's Eve in his study/trophy room, watching cable on a tiny TV while the adults were celebrating. This room consisted of a stuffed full-grown male lion, two leopards, a zebra rug, an elephant foot table, elephant tusks flanking the fireplace, and about twenty hunting rifles behind a glass case. I was always afraid that the animals would come back to life and exact some kind of revenge upon me. Anyway, this is an amazing museum (they have a special little room dedicated to the Dodo bird) and it's free if you're a student! The biologist in me was fascinated :)

Not too far from the Natural History Museum is one of my favorite places in Paris, the Ile Saint-Louis. This little island is right behind Notre Dame, and its winding streets are the epitome of French charm. I walked along the Seine, passing lots of little waterside gardens along my way, an entered via the island's east bridge. Again I was looking for something from the past -- a little mysterious chocolate shop that I visited with Jess a few years back. This place was straight out of the movie Chocolat. The owner was an older woman and definitely could have been a witch or at least a gypsy. The hot chocolate she served was a rich, dark and creamy drinking chocolate, and since it was pretty cold outside I was hoping to buy a cup and warm-up inside the cafe. Alas, the shop was nowhere to be found. I walked up and down the main street a few times but it wasn't there anymore which makes me very, very sad. It was a magical shop.

I settled for a Nutella crepe from a little stand at the west end of the island and made my way over to Notre Dame. The church service was just getting out, and I passed lots of people with little green branches in their hats and coat pockets. I wasn't about to climb to the top of the church alone, but I did want to make a stop at the famous Shakespeare & Company bookstore. It was definitely filled with tourists but I didn't really mind. Check out that first edition copy of Lord of the Rings they had in the window! (awesome) I picked up a few gifts and then headed toward my next destination, the Musee d'Orsay. 

The church courtyard above is at Saint-Severin, and this pretty tile is something I saw at a nearby Metro station. More on my afternoon in the next post.

Paris - Day 1

This past Spring Break, I went on an adventure. I had an amazing opportunity to visit some family friends in London and decided that on my way over I would stop in beautiful and charming Paris. This was actually not my first solo trip to the continent (I did a summer camp in Cambridge, England when I was 16) but nonetheless I was excited to go exploring on my own. I jumped on a flight basically right after my Family Medicine exam was over and settled in. My seatmate was a middle-aged Spanish teacher from Colorado. She proceeded to have several free Heinekens. I proceeded to have a few free glasses of white wine and we got along famously.

Eight hours later we landed, and I hopped in a cab to my hotel (later figured out that I could have taken the train and saved 30 euros but whatever). I was able to check in early (score!) and despite being pretty exhausted forced myself out of bed and into the boulevards. First stop, The Louvre.

I've always been obsessed with all-things Egyptian and spent a fair amount of time in the antiquities wing. Honestly, I find the Louvre to be pretty overwhelming so after about three hours of walking around I got claustrophobic and left. A few years ago I was in Paris with my friend Jess. It was freezing. We were starving. We stumbled out of the Louvre and into a delicious tiny bakery -- I think we had a fig tart -- and I was determined to find this little hole in the wall. I managed to track it down...

That pink pastry? Probably the most delicious thing I've ever eaten in my life. In Paris if you're dressed nicely and walking alone it's not too hard to pass as a Parisian. But as soon as I opened my greedy mouth to order I revealed who I really was -- a dumb American that can't speak French. Well that dumb American got that delicious baked good and sat down on those moss-covered church steps next to this gorgeous, fashionable French girl. Upon sitting down I realized that I did not have the proper utensils to eat this thing and was forced to use my fingers. Luckily the French girl was absorbed in her phone conversation and didn't see me stuffing it into my mouth. The outside was this strawberry-marshmallow fluff and it was filled with delicate lemon custard. Mouth watering...Also glad to see that cupcakes have caught on in the city of lights. After devouring my treat I walked around a little more, snapping pictures of beautiful things, which is not hard to do in Paris. I ate steak and pomfrittes for dinner and fell asleep soundly.

Losing a Patient

Something I've been meaning to share for a while, and a school assignment finally made me put it down in words.

The weekend before my first month of surgery, I got into a terrible fight with my family. We were celebrating my dad’s 69^th birthday, and as usual, my parents and my brother started spouting their opinions about my future medical career. I told them that surgery was simply, just not going to be my thing. I had no interest in the specialty and just wanted to make it through the next two months relatively unscathed. They insisted that I shouldn’t write it off, that I would make a great surgeon since I have small hands, that it would be a better specialty option than anything else I had in mind. When corned, I become defensive, and amidst our steaks that evening I lashed out at my family. I told them to mind their own business. I was going to hate surgery and there was nothing they could do about it.

As these things usually go, I would later eat my own words. I ended up really liking the rotation and even contemplating a general surgery residency. Although I’ve now decided to pursue another path I have to admit that I learned a lot on that rotation. I grew as a medical student and as a person. I interacted with a lot of patients that I will never forget. And this is the story of one of those patients, a man named Russ.

In reality Russ wasn’t really my patient. He was assigned to one of the trauma surgeons and the surgery residents put in all his orders, but I followed his progress my entire month on the SICU (surgical intensive care unit) so let’s just call him my patient. Russ’ story is one of those bad-luck stories that reminds you of how fragile and cruel life can be.

Russ was a perfectly healthy 72-year-old man who was out walking his dog one weekend afternoon when he was hit by a car. The car drove off and Russ was left with a broken pelvis, broken left femur, ruptured left iliac vein and crushed bladder. The first time I saw Russ he was on his hospital bed, intubated and sedated. He had metal scaffolding screwed into his pelvis to help stabilize it during the healing process. His entire left leg was covered in a wound-vac (pretty much fancy Saran wrap that helps protect exposed tissues). His limbs were swollen, yellow, covered in little scabs. His lips were cracked and bloody.

During my first week on the SICU I went about my duties, collecting Russ’ vitals, listening to his heart, feeling his pulses, peeking under the sheets and checking his wounds for any overt signs of infection. Every morning when I walked into the room around 5:30, I would say, “Good morning Russ. It’s me, Kat, I’m just here to see how you’re doing”. I did this for about a week without any response. My greeting went unanswered, and I was able to poke and prod without any objections from my patient. On September 10^th, the day before my birthday, I walked into the room as usual and said hello. Russ opened his eyes and turned his head to look at me. I jumped. I ran over to Russ’ bedside, my eyes quickly getting misty. He looked at me and I asked, “Do you know where you are?” He shook his head no ever so slightly and I started telling him about what had happened. Whether he truly understood me I don’t really know, but he was awake and communicating, and I was pretty much over the moon. As I drove home that day I truly felt like Russ’ awakening was an early birthday present, and I was really optimistic about his recovery.

I wish this were otherwise, but Russ did not continue to make much progress. Although he was awake and alert, he constantly fought the intubation tube down his throat. He struggled so much that he had to be sedated, since he wasn’t strong enough to breathe on his own yet. Over the next week or so Russ had to face a string of different challenges on almost a daily basis.

The ICU is such a scary place because it tends to be home to “super bugs” that infect the patients trapped, and often strapped, to their hospital beds. Russ had one line infection after another. I remember during my first week of the rotation, I expressed some distress at morning report that Russ’ white count was elevated. I was a little upset when the residents didn’t seem to pay much attention to it, but I quickly learned, the only reason they didn’t look surprised is because they knew he would eventually get an infection.

Russ also required a lot of trips down to the OR with the orthopedic and plastic surgery teams. Ortho was trying to fix his femur, but this was complicated by the fact that he had almost no skin left on that leg. Plus it was swollen to four times its normal size. Anesthesia would wheel Russ down to the OR almost every other day. When he came back he was always doing poorly. The surgeries to repair him would literally almost kill him – after the OR his blood pressure would be extremely low from all the blood loss he had sustained. We would pump him full of pressors (to get his BP up) and lactate ringer (to keep fluid in his arterial system). Needless to say, I did learn a lot about fluid resuscitation from Russ. Somehow, we managed to bring him back to life each time, but overall it was a terrifying cycle.

Through all this running about, I got to know Russ’ wife and daughter. This may sound horrible, but the first time I met Russ’ wife I really wanted to ask her what had happened to his dog, but I restrained myself. You see I adopted a dog when I started medical school, and he is pretty much the center of my world. When I heard Russ’ story I knew that if I were in his shoes, when I woke up, I would want to know if my dog was alright. Somehow the topic came up and it turned out that Russ’ dog was perfectly fine. Probably the utilitarian thing to say is that it would have been better if Russ was okay and instead the dog had died in the accident. But, that’s not how things went and you can’t turn back time.

I tried to update Russ’ wife and daughter as best as I could. Sometimes things were just too fast paced in the SICU or I didn’t completely understand what was going on. When they were visiting him we would all talk to Russ together. They told him about the friends and family members that were thinking about him. Russ’ wife told me that their church had been really supportive and was helping her out by cooking meals and finishing chores. They showed him videos of his dog and told me how if they said Russ’ name in front of the dog, she would cry and start whimpering, wondering where he was.

That first month went by pretty quickly, and it was time to change services. As I started my second month of surgery with another team, I was disappointed that Russ had not made much progress. His biggest problem was his left leg – to put it simply, the leg was trashed and they were thinking about amputating it. I tried to stop by Russ’ room when I could. Even though he was technically awake he was still pretty out of it, and I just wanted to check in with his wife or daughter.

About two weeks into that second month, I asked a fellow student who was now taking care of Russ, how he was doing. She told me that he had started bleeding from his rectum and that the team was trying to figure out what was going on. When I saw my old SICU resident later that day, I joked and said, “I heard Russ is doing GREAT!” because actually, bad news regarding his progress was not all that surprising.

About a day or two later, I had some free time and decided to visit Russ in the afternoon. I got up to the SICU, walked to his room, and he was gone. There was an unfamiliar woman in his place. At that moment I knew what had happened, but I was in shock and didn’t fully process what his absence meant. I stood there for a second when a fellow student sitting at the nurse’s station asked what I was looking for.
          I replied, “I came to check on my old patient but he’s not here anymore.”
          “Oh, that guy? He’s dead.”

I walked out of the SICU and took the elevator down to the first floor. When the doors opened I ran straight into my SICU attending, a young trauma surgeon that had been hired the previous year. He must have seen the look on my face because he said, “I know.” We exchanged a sad glance, but we couldn’t really talk about Russ since there were other patients around, and after a few seconds we were both on our way. I found out later what had happened. Once the bleeding started, the SICU staff called for a GI (gastrointestinal) consult. GI didn’t arrive until nine-hours later. They diagnosed a bleeding rectal ulcer but it was too late. Russ was really crashing this time. His family decided to withdraw care and he died a few hours later.

I took everything pretty hard. At first I was really angry. Why did it take nine hours for someone from GI to see Russ? Maybe if they had seen him sooner he wouldn’t have lost so much blood. I thought about how his case had been regarded by the surgery attendings and residents. What mistakes had we made in his care the past month? I also felt guilty that I hadn’t seen Russ or his family one more time before he passed. I wish I could have said goodbye or expressed my condolences.

Although some people do recover from terrible injuries, in retrospect, Russ probably started his whole SICU journey with only a slim chance of getting better. In the end it was Russ’ family who decided to withdraw care. I think they knew how much he loved life and understood that he wouldn’t want to perpetually be in a state where he was barely hanging on. I never had a conversation with Russ or his family about his end-of-life wishes, but maybe it would have helped me as a student to have done so. I know how important this will be for my future interactions with patients. Maybe it never came up because we didn’t want to consider that possibility – at least in the beginning. Whether Russ was aware of it or not, he suffered. He was not going to be able to return to his old life before the accident, and I think his family made the right choice for him.

I know that Russ is a patient who will stay with me throughout my entire career. What happened to him was unfair and tragic. This is going to sound cliché, but for me, his story really is a reminder that you never know what is going to happen in life. We should try to appreciate our blessings as much as we can, even when our worlds are falling apart. This experience also taught me the value of compassion and actually being present in a moment. Taking that extra minute to talk to a patient or family member can make a big difference in someone’s day-to-day life. You may not be able to control all the end outcomes, but you do have control over the way to treat and respect others. I wish that I could have seen Russ walk out of the hospital and back into the arms of his wife, his children, and his dog. It didn’t happen, but I am grateful to have met him and participated in his care. I hope he is at peace, in whatever place that may be.

Solar Sound

This is a very random little post. During my morning commute today I realized that many of my favorite songs oddly have a "space" or "planet" theme to them. Odd, because there is no amount of money you could pay me to go up in space. I do love a dark and starry summer sky though...

Don't judge #2 by it's appearance in a Twilight movie. 

Speaking of space, isn't this beautiful?

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a walk in the woods

This morning, instead of taking Indie to the dog park like I usually do, I decided to go for a walk with him in my local forest preserve. This change of plans was partly fueled by my desire to avoid washing his muddy paws and partly by my desire to be alone. This walk in the woods was a bit of a risk -- normally the forest preserve is pretty packed on the weekends. This isn't a bad thing, but today I was not in the mood for company. With impending rain in the forecast, I took a chance that the normal crowds would be scared away. I was right.

These camera phone picture are rather disappointing, but I hope you can get at least a tiny sense of what my walk was like today. When I got out of my car, I saw that a light and misty fog was creeping through the trees. (It was shy at first but over the last few hours it has grown bolder. Right now it's at my doorstep, pacing, waiting to be let in.) The temperature had finally hit above freezing, so all the pretty snow was melting, turning into grey, slippery sludge. My rainboots did not have enough traction, my socks were too thin, it was a sticky situation. Although the snow was slowly disappearing, it was replaced by the music of running water. The river was flowing quickly and echoing through the trees. No more icy stillness, the forest was coming back to life.

The air was different, too. A subtle whiff of smoke made it feel like I was walking around the edge of a mountain ski town. The water itself carried the scent of rotting trees, rust, and stagnation. Although I couldn't see them, the birds were singing to one another. Indie ignored the sparrows and instead focused on some fresh squirrel tracks. Where the snow was patchy I could see the forest ground. Dirt that was soft and fresh, the color of dark chocolate. Orange and yellow leaves that had somehow held on to their color throughout the frost were exposed and in various stages of decay. The ground was littered with slivers of green making their way up to the surface and little red berries were sprinkled about.

During today's walk, I felt transported to another place. With nature all around me and the signs of our Earth waking-up from its winter sleep, I felt at peace, if only for a little while. As eager as I am to move to the city, it will be hard to be so far away from this magical little forest. It reminds me that there is still a part of life that moves at its own pace, without deadlines or email reminders or expectations. It reminds me that change is around the corner, and that my friends is a good thing.

To Rome With Love

If you haven't yet, grab a bottle of wine and some gelato. It's time for you to watch Woody Allen's new movie, "To Rome With Love". What a wonderful Saturday night :)

Keep Going

Well friends, I didn't think I'd come crawling back to my blog with the attitude I've had this past week...Let me just say that I haven't felt this down in a long time. In fact, despite being on a few of the hardest med school rotations for the past 4 months, I have been really upbeat - busy of course, but happy about life in general. I don't really know what has changed in the past 3 weeks or so. I'd have to say that it was probably a combination of the cloudy Chicago weather, stressing about my upcoming career choices, and just general worry about some aspects of my personal life.

To top it off, this past weekend my dog Indie ended up in the vet emergency room. This past Saturday he started having some GI issues that we thought would resolve. But by Sunday they had only gotten worse, he wasn't eating or drinking, and he started shaking. My dad and I rushed him to the emergency vet and he was diagnosed with canine hemorrhagic gastroenteritis (HGE). That's probably more than you wanted to know, but anyway, he had to stay overnight for IV fluids and antibiotics. We picked him up on Monday morning, he slept all day, and thankfully by yesterday afternoon he looking like his old self. (By the way, we did make him some homemade chicken broth to rehydrate on). I'm so thankful that he got better & that nothing serious happened. (The main complications of canine HGE are renal failure and death -- so, so scary!)

My little trooper. He had part of his paw shaved so they could place the IV.

My current rotation is one of the easier ones, but it isn't really my thing. Less interest combined with a SLOW attending (the MD that leads our team of residents & students) is making this week much more trying. I've also started to be bothered by the gunner personality a few of my classmates have adopted. My saving grace has been my residents this month - they are kind, funny and great teachers - all in all, awesome people.

Still though, a cloud of depression has been lingering over me. I'm trying to focus on the positive and be thankful for all the blessings in my life - namely my friends and family. I took tonight off to bake my team some chocolate chip cookies, update my iPod, and of course, finally get back into blogging. Holiday break is only one week away and I know I can make it there. The quote below is by Churchill and is one of my favorites...it's been a good little mantra to keep in mind during these rough times.

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