Lunch date

They sat at the table next to us.  We were on a lunch date, me and Chris.  They were on a lunch date, mom and daughter.  Mom had the brussels sprout salad, daughter had the fried calamari, scrunching her face at the pieces with tentacles.  “Is that octopus?” she asked.  They both had fish for the main course. We left before they ordered dessert.  “Sociology,” the mom said. “No, he texted me! He said psychology!” The daughter corrected.  She was in high school. They had an easy banter between them, not “best friends” but clearly mom and daughter.

I know Mabel and I would never had had such a lunch date, nor easy banter with big words like sociology or psychology.  She would never had lightheartedly mentioned texting.  Yet I was envious of them.  In a different world, fifteen years from now, I could have been taking Mabel out for our own kind of lunch date. She would have been so proud to be out with her mom in a fancy restaurant, ordering from a grown up menu.  She would likely have squealed at the tentacled pieces of calamari and ordered the fried food over the vegetables.

An unexpected reminder of what will not be.

Validation at work

“You’re really good at this!” she exclaimed as we finished up her visit. I had just put in a Nexplanon in her arm (a small subdermal form of birth control that lasts 3 years). It’s popularity is growing, mostly in my younger patients, who love the idea of something easy and long acting.

I smiled somewhat sheepishly. “Thanks!”

“No really, I mean it,” she went on, with her teenaged enthusiasm. “You’re so thorough and just really friendly. I’m so glad it was you who did this. You’re really good at your job, you know. It’s so cool, finding something you’re good at.”

Her words were well timed. I often have so many doubts about my place at work. Some days I feel like an empty shell. I smile and say all the encouraging words that I’m supposed to, but then go how and stew over things people say, especially around pregnancy. It doesn’t feel good to be “faking it” all the time. But on a visit like this, it was really easy. I love my teenaged and early 20s patients. I’ve made it known in my practice that I have a special interest in the adolescents, so my staff and fellow colleagues often book patients in that age range with me.   I need these patients right now- they remind me (even without them saying so) that I enjoy parts of my job, that it can be fulfilling and that I can find meaning in it.

“Thanks,” I told her more earnestly. “I sometimes need to hear that. I do love my job sometimes.”

She jumped off the table, her arm neatly bound by the pressure dressing, and I knew she’d be back next year to see me.

A few patients later, I sat in front of one of my prenatal patients. She comes weekly for an injections that helps prevent preterm labor in those who have already had a preterm birth, so I’ve see her frequently. Last time I saw her, she had been struggling terribly with heartburn that made her vomit and caused bad headaches after. She had exhausted all the over-the-counter and lifestyle changes to try to combat her discomfort without any relief. Las time I tried a non-traditional medicine- one for nausea that helps with headaches, though not usually used for heartburn. I told her I was unsure it would work, but worth a try because the safety was well established and her symptoms were non traditional.

Now, two weeks later, I asked how she was doing. She told me the new meds still didn’t help. She had waited to talk to me about it, avoiding the topic at her last visit with a different provider.

“I think it’s time we try a prescription heartburn medication,” I said. I explained how the medication is “category C”- a category given to medications to rate their safety in pregnancy. We usually try to stick to category A and B medications and take category C medications on a case by case basis. In her case, I think its worth the risk (not that there is established risk, simply many of the category C medications there is just not enough information).

“See, this is why she’s my favorite,” she turned her head and was speaking to her husband and brother in law who tagged along to the visit. “She explains everything and really tries to help.” She looked back at me and continued, “let’s give it a shot. If this doesn’t work, then really, I’m just going to have to deal. I don’t have that much longer anyways.”

I smiled for several reasons. Her compliment, like my other patients, was well needed, especially coming from a pregnant woman. I also appreciated her attitude- she felt like she didn’t have that far to go, she could put up with discomfort if she had to. She was 24 weeks and had plenty of time to go. I know so many patients who feel like the last 3-4months are an eternity with their discomforts, and here was this woman who understood the transience of pregnancy and recognized that sometimes we just have to put up with discomfort to simply be pregnant. It was a relief for someone to understand that. I put up with many discomforts during Mabel’s pregnancy- and though I might have mentioned some of them to my providers and friends, I always tried to make the point that I wasn’t complaining, just stating- because really I was just so grateful to be pregnant. Every day I had still pregnant was a gift, considering how high my risk for loss was. Even without that risk, I do truly believe everyday being pregnant is a gift. I just wish some of my patients realized that.

What gets you through the days? Where do you get your validation?

The day my dog died

We got a dog when I was fourteen.  He was a Scottish Terrier named Trevor.  It took some debate, but we were finally able to come up with a name that the whole family agreed on- an impressive feat for a family of six.  One day my father dropped me off at home on his way out to run an errand and I ran into the house.  I wasn’t greeted at the door as by Trevor as usual, so I called out and started looking around the house for him.  I finally found him up in one of the bedrooms, convulsing on his side.  I picked him up and ran down the stairs, out the front door, trying to signal to my dad across our large front lawn as he drove away.  I ran stumbling, weighted down by the rigid body of my dog, carrying him in one arm while awkwardly trying to wave the other.  My dad didn’t see me and continued on his way.

I brought Trevor inside and lay him on the floor.  I called my friend who I knew had dogs and told her what was happening.  “Something’s wrong with my dog,” I said. “he’s shaking and biting his tongue.”  She didn’t seem to understand and suggested putting a blanket on him because maybe he was cold.  When we got off the phone I found a blanket and covered him.  I tried to dislodge his tongue from his clamped down mouth and in my efforts my finger got caught between his teeth.  A blood blister began to form.  The phone rang and it was my friend’s mother.  My friend had told her what was happening and she said she’d be right over.  When they showed up in their minivan, I walked down our front walk with Trevor in my arms, covered in the blanket.  I carried a wad of tissues with me, but was unable to reach my tear-streaked face while holding my dog.  A few steps before their car, Trevor’s body went slack and I felt a warm wetness spread through the blanket in his final release.  We continued on to the vet and I sat in the waiting room with my friend while her mom took the dog in.  When she returned, she confirmed what I already knew: My dog was dead.

Later that day my dad told us my Nana had died too.

My first experience with death.  It would not be my last.  I would later go on to lose my three other grandparents and my aunt.  I would dissect human cadavers in my college anatomy class.  I would hold stillborn babies.

But the day my dog died was the first time I held a living creature in my arms and feel life slip from of its body.  I thought it would be my only time.

Holding Trevor, I was scared, confused about what was happening.  I was alone, a vulnerable teenager trying to comfort him with a blanket as I witnessed his last moments.

Holding Mabel as we took out her vent, I was well aware what was happening.  Chris at my side, I was surrounded by family, far from alone.  I took off her shoulders the blanket we had chosen for her, so my hand could rest against her bare skin, as much of me touching as much of as possible.  I was a mom with a brave face and sad heart witnessing her child’s last moments.

I have held two living, breathing, loved creatures in my arms as they died.  If I had to do it again, I would.  I would be there with Trevor, so he would be with me, not alone, while he died.  And I would hold my daughter again and again as she took her last breaths.  I would hold my daughter forever as she died.