Some days you get the bear...

...but today was one of those days when the bear got me.  The whole week has been busy between seeing patients, trying to put together presentations, working on my scholarly project, etc, but today was exhausting and depressing.

It didn't start off too badly.  One of the attendings brought in hot chocolate and doughnuts, so the day had a pretty promising beginning.  And it looked like our list was fairly manageable -- just a handful of follow-ups to see, most of whom we'd seen at least a few times before and appeared to be progressing well.  We had a pair of new consults to see over in Magee, but that was it.  Seemed like it was shaping up to be pretty easy -- maybe we'd get out early!

...Yeah, not so much.  I went in to see my first follow-up patient, a woman with recurrent medulloblastoma whom I'd seen three or four times before today.  She had been cheerful and smiling the last time I'd talked with her, and had apparently been making good progress.  So I figured it'd be a routine visit, just a couple of minutes.  She still wasn't sleeping well, she said, but otherwise things were going ok.  I asked a little more about the sleep and then asked how her mood was.  She was fine, she said, but her answer seemed just a little off.  So I prodded very gently but got nothing new.  I was getting ready to leave the room, just asking my last questions, when I noticed that she seemed to be struggling to keep her face under control.  Soon she was crying.  Turns out she wasn't fine after all.  She was horribly depressed, barely finding enough energy to keep going each day, struggling with the uncertainty of her diagnosis.  She'd been trying to hide it (very successfully) because she was desperately afraid that we'd make her stay in the hospital longer if she told us, and the one thing she wanted more than anything in the world was to go home and see her kids.  There was much more to the story, but it's not for sharing.  Let me just say that the burdens on this poor woman's shoulders would have been enough to break my back ten or twelve times over.  Regardless, rather than the five minutes I had initially intended, I ended up spending over an hour in that room, dealing with something that was completely out of my reckoning.  After I had talked with her, I was drained, overwhelmed, and kind of scared -- scared enough to call the resident and basically tell him that I needed to talk with him immediately.  First time I've ever felt that inadequate to deal with a situation.  Hers is a horribly sad story, all of which came out at once today.  I was privileged to be the one the hear it, but it affected me badly for the rest of the day.

This, of course, is on top of another patient who's been in the hospital for over 4 months for a partial small bowel resection secondary to mesenteric ischemia.  The other day, one of his family members passed away before he had a chance to see her and say goodbye.  Now it doesn't look like he'll even be able to go to her funeral because he's simply not well enough.  And then there was the patient who once served in the armed forces but turned to cocaine when she fell on hard times and lost, in quick succession, her son to Child Protective Services, her boyfriend (who blamed her for the boy being taken away), and the baby with whom she was pregnant.  Also, she's been living in boxes on the street for the last couple of months because she had nowhere else to go and had been forced to turn to prostitution to earn money.  Such a horrible story...

So yeah, bit of a rough day.  And then I came home and I'm pretty sure a mouse has taken up residence in my apartment, so we'll deal with that tomorrow.  Hopefully things will get a little better from here.

Anyway, hope everyone is doing well.  Till next time, peace and God bless!