I See You! I.C.U. :)

I just got off the phone with the most amazing man ever: Joshiepoo! I’m on my ICU rotation, and it has been challenging in a lot of ways. It has also been incredibly educational, enjoyable, and broadening. I will speak briefly about the challenges first. First, it has been difficult to be here at times because it reminds me of being in the ICU with Daddy during his last few days with us here in his physical form. The sights, sounds, smells, feelings are just so familiar….I have experienced a roller coaster of emotions….fear, anxiety, discomfort, sadness, but also (and more often) curiosity, compassion, peace, joy, and relief. I try to let go and be present with all the feelings, sensations, thoughts, and mind states that come up. I try to let my breath anchor me….to breathe my way back into mindfulness. I think often of Rumi’s Guest House poem, welcoming all that comes up.

The Guest House (sorry formatting a little messed up)

This being human is a guest house. Every morning a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all! Even if they're a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably. He may be clearing you out for some new delight. The dark thought, the shame, the malice, meet them at the door laughing, and invite them in. Be grateful for whoever comes, because each has been sent as a guide from beyond.

This rotation has been a gift, even after only three days. I felt really nervous and insecure about my clinical skills and knowledge having taken time off. I noticed in me a fear of being back fully in medicine, and yet I knew that the best way to get back into it was to go all the way, to dive in, to go for the full immersion experience. And this is it. I’m here. And I’m noticing how much I’m enjoying it. I get to work with really excellent, intelligent, kind, dynamic physician/PA/nurse/RT/pharmacist/etc. teachers. Everyone is sooo welcoming and goes out of their way to teach. The environment is very collegial and cooperative. I love that every day we have Multi-disciplinary Rounds to talk about all the patients in the unit. As the name implies, we have physicians, PAs (physician assistants), nurses, social workers, palliative care doctors, dieticians, (students hehe yay!), and pharmacists. It’s a form of integrative medicine for sure!

Something I’m really appreciating, too, is that this is Western Medicine at its best. What I mean is that I believe that one of the major strengths of allopathic medicine is acute and critical care. I feel that non-allopathic modalities and health systems really shine with chronic issues and preventative health. All these systems complement each other so beautifully, and I think that learning this medicine here, now, is so very important. With some of these patients, the only thing that can help them might be Western Medicine. Now some may argue that all these interventions aren’t natural or that they shouldn’t be done in the first place. I respect their views too. This is valid. Still, in our day and age, and to be a truly integrative, holistic physician, I feel it is imperative that I learn this medicine well. Keeping this in mind and thinking of my larger goals really drives me. And I have been so humbled and inspired by my interactions with my teachers here already. For instance, this morning, my colleague gave a presentation in which she quoted her attending physician, a surgeon. He stated that “You make your money by what you do to patients. You make your reputation by what you don’t do to patients.” I love this! Contrary to some stereotypes, most surgeons I’ve met have not been “knife-happy” but have been incredibly thoughtful and only operate when indicated. In fact, on the first day of surgery, my chief resident said, “98% of the care we do takes place before and after the OR. Only 2% takes place on the operating table.” I digress somewhat, but this quote spawned a whole conversation on favorite doctor quotes, and my course director shared this quote:

“There are three kinds of languages for physicians:
1. The language of anatomy, physiology, and pathology (in other words the language of the basic sciences and the pathophysiology of health and disease).
2. The language of clinical medicine (all the terms we say in clinic and in the hospital, the language spoken between physicians and other health care workers as we actually practice medicine).
3. The language of patients. How we convey what’s going on to patients and their families.”

My course director stressed that he believes this third language is the most important and is unfortunately, often overlooked in our education. How insightful of him to share this!! This is especially important in the ICU where patients are so sick. I feel thankful that at OHSU, this third language has been very intentionally taught to us, both explicitly and implicitly. We had sessions on practicing translating complex medical jargon into “lay speech.” More importantly, we are surrounded by soooo many amazing role models who really embody this aspect of the practice of medicine. This is the true art of medicine, and I feel so blessed to have worked with so many artists! :) I’m thrilled that here, too, in Bend, there are so many insightful, communicative, thoughtful, socially intelligent physicians and role models. Especially in the ICU, patients and their families are so vulnerable and really look to their medical team to support them and provide them with information. In only three days here, I’ve learned so much about the art and science of medicine thanks to my wonderful teachers.

Why am I writing all this on Joshie and Stephie’s blog you ask? Well, I felt inspired to write this after speaking with Joshie. He is my daily inspiration, my light, my love. I feel his presence all the time, and I am constantly thinking of him in MN, picturing what he might be doing in each moment. It’s been so amazing: several times now one of us will call the other and the other will happen to be free in those exact moments! It’s gotten kind of uncanny and crazy beyond coincidence...specifically because I’m on ICU and he’s on surgical pathology! We have about 10 free minutes the whole day. It’s wild, and yet not that surprising at this point hehe. :)

I’m just so thankful for you, Baby. I love talking to you, thinking of you, holding you in my heart and mind. Seeing photos of you (thanks for all the wonderful photos and vids throughout the day!). Seeing photos of your scrumptious food hehe. I’m so excited to see you in two days! Okay sorry for anyone else who’s reading this. I realize that it’s kind of strange to be writing a love note publicly like this. Forgive me? :)

Really though, I am ever so grateful to have Joshie in my life and to be able to talk about anything and everything with him. As I described above, certain aspects of this rotation are challenging for me, but Joshie gives me strength and helps me find the opportunities for learning, growth and transformation in this experience. Thank you, Darling!

I’ll end with a cartoon that I found online today. Someone had a photo up of a Notre Dame cheerleader holding a sign upside down. I cringe whenever I see it. Loyal Irish fan that I am, I covered it up with this new image. :)

I’ve also posted this quote at my desk.

Finally, here’s an image of the office in which I work (with the other physicians and PA):

Hard to read but it says, “Doctor. Walk In. Man or Beast” and to the right, “Bona Fide Physician with Degree. Animals doctored when time permits. Elixirs, splints, remedies, trusses. House calls only if needed.” I love it! Such a great group with which to work! :)

Goodnight! Here's another one of the above Mary Oliver quote. :) Quotes are so lovely!

Addendum: I forgot to mention that one thing I really appreciate about this rotation is the opportunity to be working with these patients, many of whom stand at the threshold between this world and the next. It's such a privilege just being here...this work is remarkable, sacred. This is true out of the ICU as well. Patients teach us so much about grace, bravery, fearlessness, and our own humanity.