The Most Wonderful Time of the Year

I think I’ll go ahead and blame my recent return to the dreaded WARDS for my lack of blogging as of late. A lot has happened since two weeks ago when I last breathed life into this place.

Best Christmas ever? Hardly. But not all together terrible, either. Residency has put a new spin on the holidays. For most years of my life before residency – all years to be honest – the holidays were a time of rest and reflection, of comfort in the familiar, of returning home (or at least to wherever my parents lived at the time). My parents have moved a few times since leaving San Diego. And though those new places were never home to me, there were always aspects of being in a “house that belonged to my parents” which brought with it a certain heartwarming sensation of being steeped in the familiar. Papa Stup sitting on the couch and yelling at the Giants. Mama Stup going way overboard on the Christmas thing – from extravagant wrapping paper to multiple ornate Christmas trees to holiday cookies. Little Mal being little Mal (but bigger each year). I always enjoyed going home.

With residency there has been a shift in the paradigm, a certain step up in the magnitude of the holiday season. My intern year, I was in the midst of my well-documented depression. I was on the cardiology service over the holidays. I worked on Christmas eve until 6 pm. Then I went to the movies, ate popcorn for dinner, and saw a very dreary “Gangs of New York”, alone. I worked Christmas day, from 6 am until 7 pm. Then I went home, opened some presents my family had mailed me, had a beer, stared at my tree for a little while, stared out the window for a little longer, then went to bed. And then got up and went back to work the next day. It was a bad time.

During my second year of residency, I was a resident in the ICU. I was on call overnight on Christmas eve. I wasn’t sure what to expect, but other than a drug overdose and a septic old man, the evening was unusually quiet. On Christmas day, I left the hospital at about noon, went home, took a nap, and then got up and went to my cousin Cynthia’s for dinner. It was nice to have some family around for that. The next day, I went back to work. Better than intern year.

This year, I found myself on the wards. I rolled into work at about 7 am and took the infamous MOD pager. I had some coffee, sat back, and prepared. I thought it might be quiet again. On holidays such as Christmas, the only people who tend to come in are the very sick and the depressed. And the very sick tend to go to the ICU.

The morning was quiet, and some other residents and I tooled around and shared some laughs about “the most wonderful time of the year”, indeed. (All can relax, for jukebox Mick was in full swing with the Christmas carols while working that day). Good old Pete’s Taint was the ICU resident for the day.

At about noon, things started heating up. I was consulted on a couple of patients and then the ER started calling. By 3 pm I wasn’t able to stop moving and it turned out to be a very busy day. At about 9 pm, I had missed dinner and kept circling between the ward, the resident area, and the emergency room. As expected, most of the patients who came in were either really sick (I admitted 3 people to the ICU) or mildly ill with some depression (the so-called “social admits”). There were plenty of those. By 2 am, the ER had calmed down and I began catching up on paper work. At about 4 am, I was too exhausted to keep typing and I went and laid down. Up at 6 am, worked until 1 pm, then drove home and took a nap.

Gwen was waiting at home when I got back. I took a nap, and then we got up, exchanged gifts, and went to Cynthia’s again and had a nice dinner with the gang and some red wine. We stayed probably later than we should – I had to work at 8 am on Sunday morning as well. I was tired, and despite the workload, this was the best Christmas of my residency. And that’s basically because of Gwen. It was a good feeling – to come home to her now familiarity after a long night at the hospital. A very good feeling. Like coming home.

But not all was rosy. My ward team was kind of a mess this weekend. We see a lot of tragic things in the hospital setting, but they can carry a special weight around the holidays.

There is a 21-year-old kid on my team. He is in the hospital for his second recurrence of leukemia. This new onset was accompanied by a brain tumor, which he had excised surgically. The neurosurgeon also left a CSF reservoir in his head, so that he could receive intrathecal chemotherapy (intrathecal = directly into the cerebrospinal fluid). So he has a small bump on his skull – under the skin there is a reservoir for CSF that taps into his “brain case” and therefore the spinal cord. He has received several treatments of powerful and toxic chemotherapy. As a result, his blood cell counts are garbage. He is anemic, unable to fight off infections, unable to taste anything, unable to clot his blood effectively, and more. He’s a mess, but he keeps in decent spirits. Being 21 years old is a bonus when trying to fight cancer (and when trying to fight cancer therapy, for that matter).

He has a playstation 2 in his room. I went and saw him on Christmas eve. We talked about his fever curve, his latest antibiotic issues, and some other medical things. Then we talked about video games for a while. He likes RPG’s and first person shooters. When I walked out of the room, I thought about how crazy it was – this kid was like anyone else. He liked video games and DVD’s and sports. Only, he has this horrible cancer and has undergone neurosurgery for a brain tumor and now has this what can only be described as sci-fi device essentially in his brain. And oh yeah, it was Christmas. And by next Christmas he may not be alive. Sad.

Another patient I have is worse. She is 35 years old. Back in June she found a lump in her breast. She had a surgeon look at it and had an Ultrasound. Apparently, it looked like an “inflamed lymph node”, so they decided to watch it for a while. In the late summer, she began having back pain. While shoveling snow in Alaska (where she and her family lived), she fell backward and fractured one of her vertebrae. The reason? That bone was full of metastatic tumor – it had crumbled like paper. It turns out the breast lump was cancer, and it had metastasized to her bone. She was flown to our medical center from Alaska for emergency spine stabilization surgery (again with our neurosurgeon friends). Afterward, we biopsied her breast mass and did a full body CT scan. She has breast cancer, and it has spread to her spine, liver, jaw, ribs, and skull. The prognosis is terrible. Now she is on my service undergoing daily radiation therapy to shrink some of the tumors and help reduce the pain. The treatment is palliative.

On Christmas eve, I walked in the room and she was there with her husband and her three kids. The oldest child is 5. The tone was hard to describe – like a subdued somberness. The patient and her husband were trying to feign joy for the sake of their children on Christmas while suppressing a near overwhelming sadness because of the inevitable. Man, was that a tough scene. Her kids are adorable. And this is very likely the last Christmas they will even spend with their mother. Fucking brutal.

I suppose that’s how crazy my job can be sometimes. Very satisfying and rewarding at its best. Emotionally crippling and incredibly stressful at its worst. And occasionally with that extra sense of being unreal. Like in that room on Christmas eve. Hard to believe. And harder to prepare for.

And despite that, and despite the crazy near-sleepless night that ensued that Christmas eve, and despite the depressed people that rolled through the ER that night, there was some joy there.

There is an energy to Christmas for me which is palpable. Similar to one’s birthday, there’s just an under the surface feeling of something reassuring and powerful. I suppose I can trace it back to elated memories of childhood – running downstairs at dawn or earlier on Christmas day, tearing into presents and then spending the day just happy as a clam with my family. I was euphoric. They were happy to see it. Good times. There is a residual power to the holiday that I hope never goes away. And despite the craziness I had witnessed in the hospital that day and night and following day, that power was still there on this Christmas. I still felt good driving home – even though I was tired as hell.

Happy Holidays.