Why Am I Doing This?

Tuesday, August 26, 2014

Before I go any further, what the heck, 200 posts? ::parade::

Okay then.

At least 27 times a day, I say to myself, "What am I doing?" or some permutation of the phrase. Not going to lie, it's usually, "What the balls am I doing?" or "What the balls is going on here?" If I'm feeling especially dramatic, I might take it to, "What is happening to the world?" because everyone knows that I can't resist a good Mean Girls quote. But as I've been studying the intricacies of the translation of DNA to proteins, 462 seemingly-unrelated genetics disorders, cramming hundreds of slide images of various tissues into my brain, and trying to memorize 628 things about muscle physiology, I found myself thinking...

WHY AM I DOING THIS???

Well, obviously, I'm doing this because there is currently one way in this country in which to become a physician, and this is it. So there's that. I'm doing this because I have no choice. 

Hrmph. Depressing. 

And yes, there's the whole, "I can't imagine anything else giving my life meaning the way that being a physician will give my life meaning, and it's basically like oxygen, and if you asked me if I'd rather someday have kids or someday be a doctor, I'd pick being a doctor every time," thing. But that isn't something you can just say to someone on the street and have them think you're a sane and rational human.

However, over the past few days, I was reminded with glaring clarity why I am doing this. I was reminded by my own health situation and my own doctors. I wasn't always as fortunate as I am right now with the kinds of physicians I have on my team. I first got sick in 2005, and it took almost 9  years for me to get any kind of reasonable treatment. I saw more than 6 doctors, three of whom were specialists in various fields, all of whom basically ran a bunch of tests and then told me that there was nothing they could do for me because my diagnosis didn't fit into one of their neat little boxes. My debilitating symptoms of joint pain, fatigue, migraines, fevers, and rashes were pushed aside because my blood work was "normal" and I was told that it was "all in my head" and that if I were "less stressed out" I wouldn't feel so ill.

Okay, true. Stress, the completely vague term that holds sway over our entire society, can and does affect physical and mental health, but telling me to "be less stressed" doesn't solve my problems. Neither does throwing a ton of SSRI's at them, in case you were wondering. There is totally a time and place for SSRI's or other mood-altering or mood-stabilizing drugs. I rely heavily on mine to keep me even-keeled and functional. I am Team SSRI, for sure. This just wasn't a problem that could be solved by their usage. I had random diagnoses made, including Lyme Disease (with no positive Lyme titer... go figure that one out) and fibromyalgia (because they ran out of things to tell me?) At various points, my symptoms went away, so whoever was in charge of my health at that time declared me a success and decided I was no longer their problem. Then when the symptoms inevitably came back, as they always did, I moved on to another physician, since clearly the last one had no interest in figuring out the actual problem.

Fortunately, starting in 2009, I started gathering my current team of physicians. I found a good primary care doctor through a friend, and his office is extremely easy to work with, especially with referrals. He and his associates have evening and weekend hours, and it's easy to get an appointment at the last minute. He also understands that basically, he's there for when I'm acutely ill and to coordinate my 900 specialists. He doesn't really try to step in and micro-manage on top of my other doctors, which I really appreciate. 

Then I found my PCOS doctor, thanks to my life-saving therapist. She's also a primary care doctor, so my insurance gets complicated because I can't see my NJ primary care doc in the same 30 day period that I see my PCOS doctor, which leads to all kinds of schedule finagling, but it's totally worth it. She was the only doctor who listened to me when I was freaking out because I had somehow gained 40 pounds in about 3 months for no apparent reason. Meanwhile, my regular gynecologist was telling me to try Weight Watchers and the endocrinologist I was sent to had decided that I definitely didn't have Cushing's, so I needed to go see someone else since she only saw people with neuro-endocrine problems. By the time I landed in Dr. Sherif's office, I was a disaster. I hated my body, I was disgustingly depressed, my hair was falling out, and I basically hated my entire life because I felt like a crazy person. That first appointment with her took almost an hour, and it was worth every second. She just kept asking, "And what else? Tell me more," as if she had all the time in the world. She made me feel like I wasn't crazy, and she apologized for the fact that no other physicians had listened to me when clearly, something was very wrong. She explained all of the medications she wanted me to try and why, and wrote down the studies she had recently read that backed them up. And then, when my insurance didn't cover the Byetta (an injectable medication used for blood sugar control) because I wasn't actually diabetic, she made sure that I got my medication, free of charge, from her office. I am not kidding when I say that this woman saved my life.
That was in 2011, and I actually went almost an entire year without seeing her, until today, when I had a follow-up appointment because I had changed some meds and wanted to talk about what was going on with all of that. I was seen by a completely wonderful resident, first, who was not only kind and friendly, but asked a lot of questions and made sure she understood everything I was trying to say. When I went out of order or back-tracked, she followed and wasn't annoyed. When Dr. Sherif came in, she immediately got right to my questions that I had brought up with the resident, and we went through my more recent medical history and medication changes. She spoke to me like I knew what was going on, but answered my questions when I had them. She made me laugh and put me at ease. When I brought up the 40 pounds weight loss, she practically threw a parade. She asked me how my life was going, and when I told her that I had gotten married and bought a house and started medical school, her face lit up and she said, "Life is really working out for you now, isn't it?" And she meant it. She was so happy for me, and I could tell it was completely genuine. When we were wrapping up, she asked again, "What else?" Never at any point did she have her hand on the door, waiting to dash to her next patient. She wanted to make sure I had her full and undivided attention for as long as I needed it, and I felt a complete connection with her for the entire time I was in the office. When we left, she gave me a real hug, and I felt like I was leaving the presence of someone who really and truly cared about my health and my life. It was wonderful. 

That is why I'm doing this. So I can be that physician for someone.

In 2013, I met my current rheumatologist, Dr. Chen. He stepped in when the rheumatologist I had been referred to by my allergist (yeah, I have a lot of doctors) left the practice. I was nervous, because even though I had only seen the first rheumatologist twice, she seemed nice and was actually willing to listen to me, so I was worried that the new guy would laugh me out of  his office (like so many others had in the past). It turned out that Dr. Chen was even better than the physician I had originally seen, which was a huge relief to me. As expected, all of my blood work was "totally normal" with the exception of one extremely vague marker, but according to my symptoms, there was something definitely wrong. 

It was July and Ken and I had just moved into our condo and were painting 2 of the bedrooms. After a few days of painting, my hands were so stiff and swollen that I could barely hold my toothbrush or drive my car, and they hurt all the time. I was practically non-functional, between the pain and the fatigue, and the NSAID that I was on was doing essentially nothing to relieve the symptoms. It was then that Dr. Chen decided it was time for methotrexate, which was terrifying to me because I only knew it as an anti-cancer therapy. He walked me through starting it and was there while I dealt with side effects, and before long, I was feeling like a human again! When the methotrexate started to not work so well, he counseled me on starting a biologic immunosuppressant; again, scary, but he gave me all of the information I needed to make my decision about which drug to start, and he answered my myriad questions I had about side effects and dosages and pharmacological functioning. I knew that I could call his office with any questions, and he always called me back, generally within the hour. I never felt like he was trying to run out of the office or hang up the phone. Again, a geniune, human, connection.

More recently, I called him a few weeks ago to talk to him about the whole "not being able to breathe" problem. Kind of serious, I suppose. He listened to my symptoms and surmised that it was pleuritis and possibly pericarditis, which means the lining of my lungs and heart were inflamed. He called me in a prescription for a Medrol dosepack (a steroid taper) and put a refill on it, mentioning that I "might need the second pack". The first pack got me through the wedding weekend and I thought I might be okay. Then a week later, my symptoms were back, so I filled the second dosepack. That was this past Wednesday. This past Friday, I woke up and felt pretty horrible, but chalked it up to not getting enough sleep. I missed my first hour of class because I overslept, and the entire time I was sitting in lecture from 9-12, I felt like I could feel my lungs straining to work. It wasn't pleasant.

When I stood up to leave, I got extremely lightheaded and thought I might pass out, but again, decided that was because I was dehydrated and tired. I drove to the harp store in Haddonfield to pick up some music for an upcoming wedding that I'm playing in September, but after 10 minutes or so of browsing, I essentially ran out of the harp store because I was pretty sure that I was going to pass out if I didn't lie down very quickly. I laid in my car for about 20 minutes, focusing on breathing, which was getting increasingly difficult and painful. I called Ken and told him that I was coming home, and then I called my mom and asked her what heart palpitations felt like... because those were happening and I didn't know what to do. I called Dr. Chen and left a message with his office staff, and then I drove home and spent the next hour lying in bed, crying because I was entirely unsure what was happening. I went back and forth about going to the emergency room, but knew that the moment I walked in there and complained of shortness of breath and chest pain that I wasn't getting out of there any time soon. I was also worried about what Dr. Chen would say when he called back, because somewhere in my mind, I am still scared of being told that my problems and my symptoms are "legitimate" because my diagnosis isn't completely nailed down. 

Fortunately, Dr. Chen called and spent about 15 minutes on the phone with me, talking with me about my symptoms, what had gotten worse, what had worked, and what we wanted to do next. He told me when I absolutely had to go to the ER, and he told me that he thought that it was still pericarditis and pleuritis. He said that because of this, he was now leaning towards my diagnosis being more of a lupus-like connective tissue disease (versus RA), and that if I didn't get better, that I needed to see a pulmonologist or cardiologist to make sure there wasn't anything else going on. He upped my dose of prednisone and set up a longer taper, and said to move my appointment up from the end of October to the middle of September. I still wasn't feeling physically better at this point, but the fact that he took the time to listen to me, make me feel less crazy, and agree that yes, this was not normal and something was wrong and no, it wasn't in my head, made me feel like I could at least get through the situation without having a total meltdown.

That is why I'm doing this. So I can be that physician for someone.

So yes, as I sit here and stare into the void of epithelial and muscle tissue, or try to remember which enzymes do what with regards to DNA synthesis and replication, I have to remember that at the end of this weird and convoluted road are patients who need me. I don't know who they are yet, and they might not even exist at this point in time (especially if I decide to go into pediatrics!) but they need me. They need someone to listen to them and to hear them, to give them a voice when they don't have one, and to remind them that even when it feels crazy, it probably isn't. I have to remember that this may feel silly and useless, but it has to start somewhere. 

I have a lot of medical experience, not just from shadowing and volunteering and working in healthcare, but from being a patient. From being passed through the system, navigating insurance kerfuffles and dealing with getting my physicians to talk to one another. It is a freaking full-time job, let me tell you. Honestly, being a patient has only made me want to be a doctor even more. I know that I deserve quality physicians who make me feel like a human who has worth beyond what they can bill to my insurance, and I know that I can be a physician like that for my patients. They deserve that, and they need that.

And yes, this is worth it.

- A

PS: Remind me this in a week when I'm studying for my first big exam and want to hide under my kitchen table, kay? 

4 comments:

  1. I feel a little bit wrong saying that I love this post (because obviously your pain/suffering is nothing to love), but the place from which the words come is so heartfelt and genuine. I'm so proud of you for going after your dream. You're awesome and you can do this!! <3

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  2. You already are that physician for someone! At least in the ability to calm someone who's having an "I don't understand what this means. Am I dying more quickly now? Should I be panicking? I don't understand!!" moment. :) <3 You're the best love. I hope you're feeling better.

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  3. Aw, thanks. It feels sappy to write it all out, but words have power and if I tell myself enough that it's worth it, then I'll remember it, right? :)

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  4. And you are the best, too! I'm glad that you feel like you can call me whenever and ask if you're dying. I'm also glad that you're not dying any more quickly than you were before. <3

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