I refuse to order bereavement cards. I never even thought about this as being a part of my “package” – business cards, white coats, bereavement cards. I’m a surgical oncologist, almost all of my patients have breast cancer. I realize that some of them are going to die. It just never occurred to me that I have a job that requires a box full of bereavement cards at the ready. Cookie cutter, pre-printed tangible reminders of a major fallacy in of our life’s work.
I learned that our administrative staff orders bereavement cards for the faculty because one of the new faculty, less than one year into practice, wanted to customize her cards. Just 10 months was all it took for her to have her first patient die of his disease. When I asked our administrative assistant about it, she schooled me on the process and asked me if I wanted to go ahead and order some for next year. I declined.
So, for now, I have decided that I will not order any bereavement cards. I will not have the box in my desk. I have a craft desk at home. I make jewelry, cards, paintings with my daughter all on my craft desk. If I ever need a bereavement card I will make it at that desk. I will craft it with my own hands – on the same desk where I make thank you cards, earring gifts, and paintings of the sun.
Assault with a deadly weapon (def):
physical actions that cause serious bodily harm or an assault made with a dangerous weapon (e.g., gun, knife, etc). A felony crime punishable by time in prison.
I cut people for a living. I violate their bodies and see them in their most vulnerable state. The difference between me and the definition above is that assault requires and intent to cause harm. Assault is without consent. Assault is not sterile or ordered or evidence based. Assault is violent. Some of those whose bodies I violate are indeed victims of assault; my job is to try and reverse the harm. Despite this knowledge, despite the oath there are still days when my work feels violent. With the cut of the knife/scalpel blood is shed. Evisceration is grotesque and promiscuous. Death still lingers and just like the shot from a gun, my actions sometimes are simply one act along the road to death. Death often occuring at some point after days, weeks or months of prolonged poisoning and poking and prodding and overinflating in an ICU. Somedays my work feels violent.
Most days my work feels like purpose. Most days it is fullfilling. Patient care is an art I cherish and feel honored to be a part of. The OR is a place when the use of delicate techniques are executed with precision that has be honed and perfected with years of practice and dedication. Most days I see the OR, the patients room, the hospital as hallowed ground. But every now and then my resolve is shattered – a baby dies, a person can not be “fixed, ” a mass casualty occurs – and on those days I feel powerless and this work feels like
I originally posted this on the MiM site, but decided to also share this on my own site as well…
The first year after my daughter was born, my end of year evaluations digressed into a lot of talk about whether or not I was mommy tracking myself. The criticism was not about my work ethic or my skills. Apparently, there was an extensive discussion about how overly preoccupied I seemed to be about my daughter. I mentioned her too often. The suggestion of part-time residency came up and the sentiment was that I would no longer reach my full potential. These meetings are supposed to be confidential-ish but I was told afterwards that perhaps I should try to hide my kid.
The instructions to hide my daughter came from a good place. It came from an attending who had my best interest in mind. He mentioned that in this world even though I was working just as hard, family issues were going to be looked down upon. I would be stereotyped. People aren’t used to mom surgeons, especially not as residents. He told me a story about sneaking off from work as a fellow to pick up his sick son by making up some elaborate story to hide the reason that he had to leave. “It is more respectable to meet friends for beer than try and pick up your child from daycare,” he told me. My response…I would talk about my child incessantly!
So, I did. I figured, if the world wasn’t ready for women to be both surgeons and moms, than I would help to make them ready. The end result is that I feel this has brought me a lot closer to the other hospital staff who are sometimes more open about recognizing the importance of family. Being closer to the hospital staff makes my job easier. I chat with the nurses, scrub techs, office managers about our families. I feel like it gives me a sense of legitimacy and realness which means we are all on the same team. Also, an unexpected result was that I became the “mama hen” of the residents. There are a few more junior residents with kids or husbands and the associated stress. I try to keep an open door policy for them. And we have real and frank conversations about how hard this can be. The supportiveness of being able to have this dialog goes both ways! Also, I find that many of my attendings take an interest in my family life as well as my surgical development.
This past year’s evaluations had no mention of mommy tracking. In fact, I was made chief resident. Last night, as I sat finishing up work in the chief’s office while my baby girl bounced around watching Dora and coloring, I felt I made the right decision. She knows all the names of the other chiefs and incorporates them into her world. She loves coming to the office and is well known throughout the department. She chats with me at night about her day and asks about my day. She tells me she wants to be a doctor like me when she grows up (well, a doctor and a cowgirl of course). I’ll never hide this beautiful girl!
cross posted on www.mothersinmedicine.com
I’m one month into chief year. Savvy is 2 weeks into pre-school and we are both loving it!
After 2 years of daily morning struggles to convince Savvy to go to school, suddenly she’s actually waking Shane up in the mornings and telling him she has to hurry and get to school. I think we both sort of love learning.
Pre-school is all about turning daycare from more passive learning amidst play into a commitment to learning new things, solidifying old things and constant academic and social growth. Pre-school is the pre-lude to real school. Its one year to get them ready to go to Kindergarten. Basically, its chief year for babies!
As one of my attendings put it, I’ve entered the “big leagues.” And to whom much is given, much is expected. The independence, patient ownership, opportunities to teach junior residents and the constant operating are all amazing parts of this year. But, along with this comes the responsibility when things go wrong or when patients don’t progress as you like. Along with it comes increased accountability to these patients who have trusted you with the care of their bodies while they have surrendered control.
Savvy and I are enjoying experiencing these amazing journeys together. Every evening we trade stories – counting to 100 by 10s, learning about the animals in the sea, taking something bad out of someones belly, helping the sick girl feel better. And, when we’re done, we’ll celebrate the end of this leg of the journey together as we await what is to come!
I haven’t written poetry in many years. This is what resulted from my last call:
Mothers in Medicine
We self-medicate with colors and sound
Suppressing every trace
until it’s gone
Only to emerge the next time when we are
Creating new nightmares
Flashes of faces
Breeding deeper and deeper layers of hypervigilance
For our own
Then we step through the threshold, into the light