On second thought...

There will be no additional entries for my child advocacy elective journal.

Child advocacy is sad, depressing and I have cried enough tears these past three weeks without reflecting and writing about it. This will be all.

But I do want to say that I have the utmost respect and appreciation for those who work in the field day in and day out.

To the 18 full time detectives in Brooklyn whose sole job it is to investigate child abuse cases (both physical and sexual), I raise my glass to you.

To the medical doctors and nurse practitioners that act as consultants, giving up their nights and weekends to review pictures, talk to the detectives and perform physical exams and complete rape kits for forensic evidence when needed, I applaud you.

To the lawyers and judges that sit in court and review the cases and sentence the perpetrators, my thanks.

To the social workers and others that visit the homes and interview the parents, my hat goes off.

It is a difficult, sad, situation when a child is abused. Sometimes these children have no one else, their parents have failed to protect them and so they require an advocate. I don't know that we always get it right, the entire field is shades of gray to me... but to those who spend their careers as advocates I am grateful.

I suppose I am glad for the opportunity to witness these dedicated individuals hard at work. It has been educational and enlightening to meet and talk with them.  And while it is heart-breaking to meet the children and hear about the cases I am glad to now know a bit more about what happens once a mandated reporter call the state registry.

It has been a good but emotionally difficult elective. I won't be sad when it ends... I've cried enough tears already. I cannot wait to go back to the hospital and the smiling happy children in clinic.

My crying/scared patients...

Waking up from surgery can be scary. I have never had major surgery but I imagine that waking up in an unfamiliar room with what seems like a million people staring at you musts be a little unsettling. Today my patient woke up and she looked scared. I met her last week in clinic when I did her H&P and I had talked to her before the surgery so she knew that I would be present in the OR. She was having an elective surgery and the complication rate is low. She did well during surgery but it was slightly more difficult that anticipated and so her lengthened surgery status earned her an overnight admission. I held her hand as she woke up and her eyes told me she was scared. I went with her to recovery and told her that we would be keeping her overnight for observation. Or maybe the nurse mentioned this to her, but in any case I had to explain it to her. She didn't want to let go of my hand so I offered to stay. For half an hour I stayed by her bed and answered questions about her surgery. I tried to reassure her and I offered the only thing I could think of my time and my self. Eventually I tracked down the attending to come reassure her and I continued to check on her throughout the day. She will be fine. I was told by a resident that I wasn't acting like a surgeon. But you know- I am okay with that.

Being newly diagnosed with cancer. Being alone in the the hospital over a Holiday weekend. Being in pain. These are depressing things. So understandably my patient was minutes from tears when I entered her room this morning. She felt forgotten about. A simple procedure and biopsy of her mass were put on hold over the long weekend. As she talked and cried I offered her a tissue and she said they were bigger and softer the the hospital issued ones. She most likely has terminal cancer (and she knows this) and yet she thanked me for giving her a kleenex and listening to her. As a medical student I don't have much power, I can't make decisions and my knowledge of actual important medical information is tiny. But I can provide kleenex, hold a hand and lend an ear. Maybe these aren't behaviors of surgeons but they sure make me feel like I'm doing something.

Today was one of the most fulfilling days I've had in surgery. I went to the OR but it wasn't what I did in the OR that I am reflecting upon, it is all of the stuff I did beforehand and afterwards. Patients by their very nature are going to be scared, anxious, neglected. Isn't it our job as physicians to notice this and do our best to help them cry, accept and move on? Isn't it our job to comfort them?

The Anatomy of Tears

I cried today.... it was part sadness: I miss my husband, this term has been long and I am ready to go home. He graduates from residency tomorrow and I won't be there to share it with him. His Birthday is this this week but I'll be here, studying for my path final. Sometime things don't work out like you want. And I know that I'll be home soon but right now it just doesn't seem soon enough.... and so I cried.

It was part anger: we finished pathology with forensics and there is something despairing in how humans treat one another. The last two days have included lectures on child abuse, rape, homicide and suicide, all complete with pictures so I started to doubt the humanity left on this earth. ( I expected forensics to be fun, like solving cases on "CSI", but the problem is they are all true cases and pictures of real people.... It was the opposite of fun. It was emotionally draining and terrible and I have ruled out Medical Examiner, Forensic Pathologist and possibly ER based upon how I've felt these past two days.) 

I tried to turn my day around, I ran out of class and came home for lunch but found myself looking at pictures of the oil spill, haunting, sad, heart-breaking pictures. The highlight of my day was an actual mid day conversation with Dr. Boyfriend and skype let us both be on video for the first time in forever, so that was nice. But then I had to go to lab and hear more about terrible, horrible things that humans do to one another. I tried to redeem my day again and went for a swim at with a plan to watch the sunset, but locals kept bothering me, peddling their necklaces, mangoes and company. I escaped to IGA and stocked up on a few things for the final two weeks I'm here.... But when I got home the new iphone Facetime video flashed across my computer and the music and the orchestration was just too much, so I cried. Tears of sadness and disappointment in mankind. 

I know that I will see things and do things that will make me feel this way again. Medicine does not always provide a happy ending and that is a reality I have chosen by coming to medical school and embarking on the life a physician. I just hope that the sun comes out and the encouraging days outnumber the heart-breaking ones. And when they don't or when I need to, I'll cry....