Waking Up.

The last week has been like a bad dream. My mind has been filled with a fog that has kept me unfocused and unmotivated. I haven't slept much and that makes it worse. The funeral for my cousin was on Friday. It was the hardest funeral I've ever been to. I've been to a lot, unfortunately. But, saying goodbye to someone who was like a brother to me has left me confused, angry, guilty, and desperately sad.

I've spent a lot of time in quiet thought and prayer and today I woke up feeling a little better. I woke up feeling like I'd slept. I woke up without memories of terrible dreams. I woke up wishing I could sleep more since I finally had a little rest.

Last Wednesday evening after work I headed home to Oklahoma.  It was comforting to be home among family and friends. I just wanted to help. To do something, anything. I certainly couldn't focus on work. Thursday we spent the day finishing the funeral arrangements. Part of that meant that I spent hours and hours going through family photos. That was very hard. But, I knew my Aunt could not do it.  Photos like these.

My cousin and I about age 3

It's Oklahoma, what can I say.

There are so many more.  We went to the cemetery, the funeral home, ran some errands. There is a lot of paperwork and chores associated with death. Hard decisions to make. I've learned that you really need to sit down and put in writing your wishes so it's not so hard on your family. My husband and I are going to work on this very soon.

The funeral was.....a good service. There were so many people there which is good for the support, but bad because you almost feel like your grief is on public display. But, that is how it's done. And then there was the food.

I don't know about where you are from, but in the south death=food. People start bringing stuff the minute the news gets out and continues for days and days. It's wonderful and yet not. At least we didn't have to think about food and the house was full of people so we didn't have to entertain or prepare anything. It's just another way people can show you that they care. And if you read my blog you know how food=love in my family.

On the bright side, I learned that my new body really does have to move. I hadn't worked out all week and when I woke up Thursday, I had to. HAD to. I decided to go for a walk/jog. I did C25K.  I learned one thing. Running while crying is damn hard. Between the cool air, the pollen and the tears, it wasn't too easy and I didn't go very fast. I didn't realize how many angry and sad songs I have on my iphone. Gotta work on that.  Anyway, after I felt a little better. I did some TKD practice and stretches after.

I can't tell you how many people told me how different I looked. How good I looked. How they didn't even recognize me at first. I've gotten used to these sorts of comments. It was just weird when I felt so bad on the inside.

Saturday I drove my Aunt and my Great-Aunt to the beauty shop. Another southern "old lady" thing. Saturday morning you get your hair fixed for church the next day. I was surprised she wanted to go, but I guess routine is a comfort in some ways. By chance there was a park next door with a walking track. So I went out, in the cold, and by cold I mean 45ish, and walked. I did 1.5 miles.

I also woke up this morning realizing that this crap-food fest I've been on has to be over. For one thing I gained 4 pounds. I am bloated and just plain icky. My stomach was queasy and gross last night after the Arby's drive through we had on the way home. I can't even begin to tell you how many calories I've consumed. There's been cake, cookies, Cokes, alcohol, pies, fried chicken, baked beans, greek food, pizza, lasagna and so much more. The truth is I didn't enjoy it nearly as much I used to. I found myself eating out of habit. I'm a little ashamed about that.

So now I am getting back on track. With my eating, with my exercise, with my emotions, with my schedule. As hard as it is, life must go on. And I'll be damned if the hard work I've done to improve my life is undone by tragedy.  There are those in this world dealing with much worse than I. I will turn my thoughts and prayers toward gratitude. For the times and memories I have of my cousin. For the love of my family and friends. For the career and talents God has given me. For the things I've learned over the last year of healthy changes. For the things I can do now that I couldn't before. For the future whatever it may hold. I will focus on my blessings and that will get me through.

What are you grateful for today?  Have you had those difficult conversations with your family about your wishes?  How are you waking up on this Monday morning?

The call.

"Doctor, the medical examiner is on  the phone for you."

Words you never want to hear. Especially on a Monday morning. After being in practice for the last 12 years, I've gotten many calls I'd rather not. These calls are never fun. They mean someone has died, either at home or in unclear circumstances. It usually means that the medical examiner either needs me to sign a death certificate or provide insight on the medical problems of the deceased.

It also means I've lost a patient. This elicits a whole host of emotions. You feel sad for the family. Sad for the loss of the patient. Sometimes you feel sad because the patient was someone you liked, enjoyed, bonded with, a "favorite".  Sometimes there's relief. You know that patient was suffering and very sick. and you know that is finally over for them.

Sometimes there is shock because it was unexpected. Unfortunately this can lead to guilt. Sometimes as a physician there are patients that no matter how hard we try, we just can't establish a relationship with. You can't relate to them. Or frankly, there are patients that are just plain annoying. Either because of their refusing to follow our advice or because they are just plain an unpleasant person to be around. You find yourself wondering if there was something more you could have done or said. Some other way to break through to the patient.

And then there's the shame because on some level you are relieved that you won't have to have yet another visit with that patient that is confrontational or just plain ignores what we say.  This is usually followed by a smidgen of fear. Medical examiner=patient death=possibility of a law suit. It may seem crass or mean, but these calls always include a little fear for me. Did I do something wrong? Did I miss something? Did I document all those times I told her to take her insulin and see the specialist and she refused?  Did I prescribe the right meds? Did I try hard enough? Did I make a mistake?

It's a fear we live with everyday as physicians. And to be honest a fear that drives many of our actions. It is a fear that is healthy in some ways. We have to remember that the decisions we make have huge consequences. We have to be careful and thoughtful and educated. But, we can't let that fear be paralyzing. We can't be so afraid of making a mistake that we do nothing. Sometimes this is much worse.

Twice this week I've gotten that call. Twice too many. Luckily it's not a call I get often. And whether I like it or not, these calls won't be the last. One was a patient that was too young. It was sad, but not surprising. We tell patients that if you don't take your medicine or follow advice you will die, but I don't think they always believe us.

The other patient was old and it wasn't a surprise. But, I had just seen her last week. She seemed good, getting better, on the mend. She had a fall and with her blood thinners this resulted in a fatal injury. I was sad to see her go. And I am ashamed to admit that I was glad that I was not the one managing that blood thinner.  I was relieved that I don't have to sign the death certificate since the death included a trauma.  But, so sad that she seemed better the last time we met. Is there something I could have done differently?

It's OK to work through these feelings. We have to. We're human and we have to let ourselves feel. In my opinion good doctors are in touch with how they feel and this helps us relate more to our patients. We can't be robots. We can't be super-human either.

I joked with the guy on the phone letting him know that I liked him fine, but I'd rather not hear from him. And then I felt bad. Can't be any easier to be on the other end of that call, can it?  But that is life. We do the best we can. And sooner or later we will all be the subject of one of those calls.  Until then, I'll keep striving to be the best physician I can be. The best mommy. The best wife. The best me.

Of course all that doesn't mean I won't cringe when I hear, "Doctor the medical examiner is on the phone."

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I wrote this post a few weeks ago, long before my cousin died this week. I hadn't posted it yet as I had written it and then didn't know if I wanted to. I stumbled across it today and was struck that this week I'm experiencing that call from the family side and not the medical side. Waiting on the death certificate and cause of death and all that.  Understanding how the system works helps at least a little.   I ate dinner last night, but realized just about an hour ago that I ate nothing yet today. I had a couple of cheese sticks. I'm trying not to give in to the cravings and the old crutches of food, particularly sodas. I made myself drink some water this morning. I am trying. I will not give up.

I realized today that it was exactly one year ago today that I started this life change.  I started logging my food and such.  In that time I've lost about 55 pounds (assuming I haven't gained any the last few days. I have not weighed and really can't face doing that yet.).  I started blogging 9 months ago. It was the best thing I've done for my health. No joking. Stumbling across this blog world where I have support and can find inspiration and ideas and recipes has helped so much. Of course I had to do the work of diet and exercise.

In the wake of what's happened this week, I have been struggling. I have not worked out. I didn't go to TKD. I am honestly too tired and I haven't slept. But......I will. I will get back to balance with exercise and diet. I will move forward toward my goals. I will get through this terrible time.  I am stronger now than I've ever been, mentally and physically.  I will not quit.