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photo credit: Anh Nguyen I have included a list of questions your healthcare provider may ask you during your headache evaluation:
There are several types or categories of headaches:
If you are not quite ready to seek a medical workup, you can try the following safe therapies at home:
Headaches can interrupt our daily lives and become quite cumbersome. Please do not ignore your headaches. Listen to your body. Author's note: this article should not be used to diagnose or treat any conditions. Please seek an appointment with your primary care provider for proper headache evaluation. A neurology consult may also be warranted.
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At the end of the day. At the end of my life. When I'm old and gray. When I'm free from strife. I will smile every time I remember your face. And no one can take that from us. Godspeed. One of the most common questions I am asked during a wellness visit (routine physical) is "when should I get a colonoscopy?" . I was not asked this question as often 10 years ago or even 5 years ago, but there has finally been an increased awareness among the general population with colorectal cancer. As a former med/surg nurse, I took care of countless patients after their colonoscopy or even their colon resection for colon cancer. I helped care for their fresh colostomy site and stumbled to find the "right" words to give them comfort. I have one patient etched in my heart who lost his battle to CRC (colorectal cancer) at age 27. I was only 23 or 24 myself at that time. His young wife and 2 year old son stayed with him as much as they could. He had a suprapubic catheter (one that came out of his abdomen directly from his bladder to drain his urine) because the cancer had eaten through his entire pelvic cavity. I cried on my way home every time I took care of him. But I wanted to take care of him. I wanted him to see someone close to his age. Someone that didn't pity him like a child "poor dear" and all the other patronizing words I heard some of our senior nurses mumble. He and I would talk about TV shows and popular songs, whatever we could that would help him feel a little more "normal." This post isn't about him, it's about all of my patients. That said, I couldn't write this post without mentioning him because his life mattered and my time with him touched me forever. I could not write this post without telling you about another dear friend who lost his 6-year battle with CRC in 2020 at the age of 44. Out of love for his family, I will leave his story at that but HE MATTERED and MATTERS and cancer statistics are NOT just numbers my friends! They are mothers, fathers, sisters, brothers, sons, daughters, friends, employees, bosses, lovers, neighbors, coworkers, and beyond. The next time you see a cancer statistic on the news, I hope you pause and remember reading this post. So the question remains: When should I get a colonoscopy? In the words of my beloved GI colleague, "45 is the new 50!". The earlier CRC is found, the better the 5-year survival rate. We can easily remove a 5mm or smaller polyp in the colon and prevent it from ever becoming a malignant tumor. Yes there are some other screening tests on the market that have their place and time, BUT nothing beats a visual inspection by a well-trained eye looking for colon cancer. Direct visualization - there is nothing better!
The prep is not always "a gallon of nasty stuff" anymore either. There are a variety of prep techniques, so please don't let a colonoscopy prep prevent you from possibly saving your own life. You are NOT awake during the procedure. I have had one and I can tell you with certainty that I do not remember any of it AND I had zero soreness after the procedure. It was honestly a much-needed fantastic nap and a day off work. I urge you to see your PCP for a colonoscopy referral from a GI specialist if you are 45 years old or older and have never had one. If you have certain risk factors or family history, you should have a colonoscopy before age 45. Your PCP should be able to guide you. Any bright red rectal bleeding or alternating constipation and diarrhea needs to be worked up by your medical team. Please do not hesitate to seek care for those issues! I hope this answers your questions about colonoscopy screening. If polyps are found on your colonoscopy, your GI provider may want to repeat your scope in 2 years, 3 years, or 5 years depending on they type of polyp (per pathology diagnosis). If your colonoscopy is clear and there is no family history of CRC (or other extenuating risk factors), you will probably receive a 10-year pass. Most insurance companies pay very well for colonoscopy screening, BUT most insurances have a certain deductible each year that enrollees must meet, so do not be surprised when the procedure is not 100% free like your mammogram or pap smear was. Do not let cost stop you, though! It is well worth your insurance deductible. You can always call ahead to find out what your out-of-pocket expense will be, and most healthcare facilities offer payment arrangements. Please comment below if you have any other specific questions. Jan 30, 2021- Feb 3, 2021 Red, painful eyes start with painful vision and light sensitivity (UVEITIS). Feb 3, 2020-Feb 8, 2020 Tiny dots of a rash begin on my neck- they don't itch, burn, or hurt at this point. I call my dermatologist to schedule a biopsy, assuming this must be related to my sarcoidosis. Feb 3-March 8, 2021 Rash kept getting bigger and more painful. Not responding to topical Rx creams. Went for 2nd biopsy on March 8th, the day I started my 30-day medical leave. Focused on walking, sleeping, hydrating, and eating clean. Also journaling and resting. March 8-April 8, 2021 Off work. Tried the AIP Diet. No gluten, no dairy, no sugar. Derm and Rheum also put heads together to double my Methotrexate dose. The diet was difficult but my joints and skin "felt" better even though my skin still needed lots of help! April 8- August 8, 2021 Back at work. Still working covid. Boys off for the summer during some of that time. Started Humira in May 2021 and stopped Methotrexate. Skin would wax and wane, but I would say it eventually cleared by early to mid-August. Joints feel much better on Humira. Energy level too. September 2021 Had my 2nd episode of uveitis. That responded quickly to Prednisone eye drops. Skin pretty clear, but under more stress with some work and family stuff. Delta variant of covid is ravaging my patient population and friends. Evidence of proteinuria again so will follow-up with my nephrologist (that's more sarc-related, less psoriasis-related). Still on Humira. Echo and PFT's slightly worse than last year, but lung & spleen CT's show that the Humira is controlling my sarcoidosis. March 2022 I have had at least 2 more episodes of uveitis since the last update. Skin stays mostly clear with the occasional flare in the anterior portion (front) of my neck. I wrote this piece for all of my fellow Psoriasis Warriors who are walking this painful, lonely road. It is SO HARD. One can think they are not a vain person, but when your LARGEST ORGAN (your skin) is literally on fire with inflammation, it's hard to "hide" from vanity, comparison, self-loathing, and frustration. If you love someone with psoriasis, please share this with them and with others who love them. I hope it brings someone comfort to know they are not alone and that there are those people who will love us no matter what. photo credit: Oluwaseyi Johnson Was it luck that the young mother of three bumped her head on the bed post and came in to see me? She was picking up a toy that had fallen into the abyss between the bed and the wall but I felt we better not miss an internal bleed in her brain those are rare but not good so I ordered the CT scan and we both went back to mothering our brood When the phone rang that night I can't remember if I dropped the phone It's a brain tumor, and it's big Can you call her at home? Was it luck when the car struck her from behind? Plastic and metal shredded and busted near the yellow line Her head hurt, her neck hurt to the doctor she went And the MRI that was supposed to check bones instead showed a hint of the cancerous tumor that was showing no signs it was in her thyroid, she had no symptoms God was definitely on time Was it luck when she came to tell me she was in pain? Her abdomen was cramping, her bowel movements had changed As the dutiful NP, I pulled up her old scans Has anyone ever mentioned your lungs to you ma'am? My lungs, why would they? My lungs are fine well it says on here that there's an issue - do you mind if I order a CT scan of them just to be safe? God was nudging me, directing me, showing me the way Pulmonary fibrosis? what in the world is that? Well, sweetheart, it's serious, sit down, we need to chat Unfortunately it's the same way my own disease often ends Here's my number, you can call me, I actually do understand Was it luck when she looked at me with frustration and contempt? Ma'am I'm sorry I just met you, let me see if I can help You can't help me she thought, they've already run all the tests God tapped my shoulder, I looked a little deeper, there was one thing left I'm sure it's nothing, but let's check this one last thing It's an ultrasound, I know you're frustrated, but let's do it, okay? Okay, she said, and I wasn't sure she would actually do it But days later the phone rang, there's an issue, there's fluid The young colleague who sent her to me called me for advice What do I order next? What do you think it is? I'm not sure what to try. So I made my suggestions and prayed I was wrong. Come on Lord, let's let this young patient just move along. But He couldn't and she couldn't and my colleague and I cried Another cancer, a bad one, it's not fair, it's not right Was it luck that I've found some of these things at the craziest times? Or was it God this whole time leading me with His light? I'm no saint, I'm a sinner, I get fired up, I have faults, I get loud But when I slow down and I pray and I look up to those clouds I can feel Him, sometimes it's so strong I just weep Like right now as I type this, and all those nights I've lost sleep These are a mere few of the miracles I have watched unfold in my tiny little town with my regular little folks Are we special? am I special? I don't claim any of it as mine It's His, I'm a vessel, I'm a sparrow, I'm a scribe Dear Lord, there have been so many times I have seen You. Why me? Am I doing it right? I sure do try, but I need You. When the going gets tough, and my stethoscope seems too much My alarm goes off again, and I feel Your gentle nudge You'll tell me when it's time. When my service is up. It wasn't luck, God. It's been You. Knowing that is enough. Amen. Author's note: Age and any identifying factors have been changed due to federal privacy laws. Please help support my fellow hope*writers by visiting their pieces using the prompt work LUCK:
You are Not Lucky You are Blessed by Lisa Granger https://lisamarcelina.net/you-are-not-lucky-you-are-blessed/ Luck by Dianne Vielhuber https://simplewordsoffaith.com/wp-admin/post.php?post=10672&action=edit What Does Luck Have to Do With It? By Lori Shoaf https://www.lorishoaf.com/inspiringstories/what-does-luck-have-to-do-with-it Luck of an Evacuee by Ashley Olivine https://ashleyolivine.com/luck-of-an-evacuee/ He sat down, head in hands, downward glance She looked up, tears in eyes, uneven stance I walked in, low on sleep, high on caffeine They walked by, on the street, young love, just teens He stood up, paper in hand, PowerPoint prepared She fell down, learning to walk, not nervous, not scared I walked in again, ready to listen, ready to care Do I absorb it, do I deflect it... do I share? The first one has a heavy load, family stuff, he's overwhelmed The second one feels trapped, but she's 83, where would she go? The third one is me, with my own load and I'm trying to figure it out Do I carry their burdens or give them back? I was never told... The fourth one is the big boss and the fifth one was once us While the overwhelmed man and the trapped senior unfurl It's good to remember that someone somewhere is in charge and someone somewhere is just a happy little girl The teens are just teens and I remember how that used to feel The butterflies, the headrush, the lovesongs, the thrill While I dance between empathy and boundary and pharmacy Someone somewhere is getting married or at a funeral or in the hospital nursery And so I sit here replaying today's events and my children's faces and my own dreams Do I let the man's troubles and the woman's sorrow fall off of me? Am I a sponge? A shield? Sand through a sieve? Where do I put it? How do I move it? What do I need? Dear Therapist once asked me "how do you feel? what are you feeling?" and I just stared. I ask that question, Madame. How do you dare! She brought out the preschool book and reminded me the names: anger, sadness, anxious, scared, and my favorite- SHAME! So I ask you, my brothers, my sisters, my friends Where do we put it? How do we move it? Where does it end? We are connected. Are we a puzzle? Passing ships on the same sea? I am you and you are me and we are thee. What is the answer? I need the code. I need the key. I will take today. You take tomorrow. Let's give her next week. He can do the dark nights. They can do the long fights. Let's share the joy and spread out the misery. Next time you see him. Next time you see her. Next time you see me. Remember the pleasantries are just a mask atop the real things. The real beauty of the patient-provider relationship is the back and forth. Never stop sharing with us. It's why we got into medicine. But if you love us or if you live with us and we are quiet or distant... We are simply trying to figure out where to put it. Godspeed.
Before deciding if you love me or hate me, let's look at each of these in a little more detail. If you are reading this and you don't work in healthcare, I encourage you to close your eyes. Imagine driving to work where patients are very sick and you are responsible for their health. Imagine being extremely exhausted - mentally, physically, and emotionally. Imagine having the same conversations day in and day out. Imagine wearing a mask and face shield all day every day AND if you work in certain healthcare settings, full plastic gowns (sweaty and HOT) with even more restrictive masks (n95). Think about having heart-wrenching conversations about death and dying with families and patients that you have come to love over many years. Consider praying on your drive in and your drive home because you've worked in healthcare since you were 19 years old, but you've never seen anything as dark and dangerous, cold and pointless, savage and destructive as THIS. Imagine that you, like everyone else, have also been unable to see loved ones, travel, send your kids to school without a mask, and that you- like everyone else- have your own political and religious beliefs but you cannot mention those since ALL eyes and ears are on you. Now imagine doing that every single day for 20 months in a row.
I usually wrap up my posts with some heart-swelling, tear-jerking, or funny concluding thoughts. I try to connect us as humans, mothers, fathers, daughters, sons, sisters, brothers, neighbors, and friends. I find a way to touch you, soften you, move you even if it’s only for a moment. I don’t know how to do that with this post. I’m tired. I’m sad. I’m frustrated. I’m still hopeful. I still believe. I guess I will end by asking all of us to consider the division we have all felt over the past 2 years. Consider the lost lives and energy we have all spent to prove we are right. And hug your family. Hug your loved ones. And look your “enemy” in the eye before you judge their choices. We really are all the same. Imperfect. Scared. And trying to stay alive. 🌎 Once you have decided on a planner, you will immediately start thinking of ways to use the Notes Pages in the back of the planner. Below, I show you pages from my own planners over the years. Some of the other ways I have used my notes pages include:
📝 ✍️ Happy planning!!! 📒📚
I do want you to listen to the podcast, because I think there are some big pearls in this interview, but here are a few highlights:
Find out who is in your circle:
Plan as much as you can ahead of time:
Final pro tips: -Keep a medical binder of all your paperwork -Have a designated inbox for all incoming papers (follow The Planning Woman for more on this) -Apply for intermittent FMLA with your employer -My personal pro tip: PET THERAPY! 🐶🐱 Charlie the Dachshund makes everything better!
When a patient presents with hair loss, I obtain a thorough history:
I then perform a thorough physical exam and order the following tests:
That may not “answer” your question but I hope it helps you know what a clinician will be looking for with this presentation of hair loss. 🩺👩⚕️ Personally, I have dealt with hair loss from taking Methotrexate for my sarcoidosis.
It started coming out in clumps in the shower and then in my brush. I soon had very patchy areas of hair loss all over my scalp. My hairdresser advised me to stop applying heat to my hair when possible, to wash my hair less frequently, to avoid ponytail holders when possible, and to avoid any hair color or harsh chemicals. I usually got some blonde highlights in the spring put in my naturally red hair, but I went without those for 4 years while I was on Methotrexate. My rheumatologist increased my Folic Acid dose from 1 mg to 2 mg daily, and I ordered Biotin off Amazon Subscribe and Save. I took the Biotin daily to help with hair growth. I am finally off Methotrexate and on Humira and am seeing hair growth again. Losing my hair was very emotional for me. My bright red hair has defined me for so long. I now knew what all of my patients struggling with hair loss from chemo or other medical reasons were feeling, and boy was it a wake up call. My heart goes out to anyone struggling with hair loss. Much love to you and I hope this helps. I was surprised 🧐 when the vaccine came out for frontline HCW (healthcare workers) in December 2020 and the general public started claiming it caused sterility. Let’s use common sense. 🧠 It takes 1–24 months 📆 to conceive before most providers start to investigate infertility. It takes 40 weeks to carry a baby 🍼 to term. Let’s average conception time to 12 months and add the gestation time of 9 months🤰 to = 21 months. Covid REALLY started to hit the US hard about 18–19 months ago. The vaccine was available to some of us 9–10 months ago but MOST of the women of childbearing age could not receive it until 5 months ago. How can anyone claim infertility at this point in time? 🤔 I never say never because I am constantly learning in medicine. Every day I see something I never thought I would witness. I have had pregnant women🤰contract Covid and pregnant women🤰receive the Covid vaccine. I have also seen pregnant unvaccinated women with Covid whose babies had to be delivered while mom was on the ventilator. My community just lost a 28 year-old mother of 3 who never got to know her newborn. 🥲 The American College of Obstetrics & Gynecology and the Society for Maternal Fetal Medicine issued a joint statement encouraging the vaccine for all pregnant women🤰 in July 2021. I recognize that I have the benefit of being "done" having my babies as I navigate this pandemic. That fact is NOT lost on me. I know young adults are faced with a very hard decision with such a new vaccine and their entire lives in front of them. Early in the pandemic, I even advised some of my young, healthy patients to wait until we had more long-term data... that I saw no serious health risk if they were to contract covid. 2021 changed that. I have had YOUNG, healthy patients on the ventilator and near death. I still believe it is a personal decision, but please be sure you are getting your information from reputable sources and people you trust. Much love... What can I do at home for Covid? 1. Zoom with your provider 2. Walk around as much as you can- covid causes blood clots 3. Lay on your belly when you’re resting, not necessarily when asleep. We are proning Covid patients (placing them on their belly) even when they are on the ventilator to help move mucus / fluid and drain the lungs. 4. Hot steamy showers. Even if you don’t feel good enough to shower, sit in your smallest bathroom with the steam running to help open up the lungs. If you feel lightheaded though, stop. 5. Hydrate hydrate hydrate - covid is an inflammatory virus and hydration is key! 6. Monitor your pulse and oxygen levels as I mentioned yesterday. 7. What has fallen out of favor / lacked statistical backup and/or caused harm: ivermectin, oral steroids prior to hospitalization, hydroxychloroquine (Plaquenil), unnecessary antibiotics 8. Mucinex, zinc, Vit C, Vit D, Singulair (it’s Rx though) are all in the grey zone- I don’t think they’ll hurt you but they may not keep you out of the hospital. 9. Finish out your quarantine please and thank you. 10. Chest percussion- look it up on YouTube How do I know if it’s Delta? 1. Big testing centers are batch testing swabs for variants and extrapolating that data to identify geographic variant trends. Your local urgentcare is not. 2. Whatever the variant, we treat based on symptom severity and delta may look good on you and horrible on Sally. Alpha (the original variant) may have put me in the hospital but barely slowed Steve down. 3. I equate it to flu A and B which are always swabbed and tested together each year. Every year I hear “oh Flu B is way worse than A. I’m so sorry you have B.” Etc etc etc when patients’ flu courses can vary regardless of the strain. 4. Anecdotally, my zoom covid visits with this wave seem different than in 2020. Less fevers. Less complaints of crippling headaches. Less loss of taste and smell. More dizziness & confusion (likely from low oxygen levels). Similar diarrhea complaints. Worse shortness of breath and chest tightness. Way more trips to the hospital and ICU. . My only vent-survivor told me all of a sudden they just Could Not Breathe. I should add this person is under 40 years old and is (or was) healthy. 5. Speaking of strains, did you know the Gardasil vaccine protects against 9 strains of HPV? Did you know Prevnar13 protects against (you guessed it) 13 strains of pneumonia? Strains have been around forever as have vaccines yet sudden interest persists. Just educating- no judgment on vaccine choices. I’m too tired. How many times can a child under age 12 have Covid? Will they develop immunity? Great question. I’ve seen twice so far and I expect more. Their bodies should be developing antibodies but no children have volunteered for my quantitative antibody study yet. Stay tuned. How soon should I get my vaccine after I have Covid? I’m recommending one month not 90 days IF you’re truly feeling better. Ask your PCP as they know your health situation. If I’m + today, symptoms resolve in 2 weeks, and then I’m + in 4 weeks, is it a reinfection or residual positive from original infection? I would ask if you ever had a negative test. If you did, maybe it is a re-infection but if you did not, I know we saw some folks stay + for 6 weeks or more in 2020. ***as always, consult your PCP for your healthcare. I’m trying to raise awareness. Let’s not bicker and judge over vaccine status. Let’s educate ourselves and let’s come together to get out of this public health crisis!!!***
Taking multiple medications multiple times per day can be overwhelming at best. Remembering to take them, remembering to refill them with the pharmacy, remembering to contact the provider if you run low, and remembering to purchase or pick them up can be stressful, time-consuming, and somewhat depressing. I hate filling my 2 pill boxes each month (one for morning, one for evening). It is a reminder that I am living with a chronic illness and that my body has "failed me." My rheumatologist told me 5 years ago at the onset of my sarcoidosis diagnosis, "Amy, my goal is for us to get your treatment regimen in line to the point that you only think about having an illness when you see me every few months and when you take your medication. Otherwise, I want you to feel so good that you don't even think about it." I did not know then how important those words would be to me five years later. I have FINALLY recruited my husband to help me fill these PITA boxes (they are- I spill meds every month and lose count without fail). Now we turn on Ted Lasso or Bloodline and he fills one while I fill the other. It is depressing to accept that my body depends on the very THING I shell out every single day in my profession. I can truly empathize with my patients who say "but I don't want to be reliant on a pill." A few times I have shown them a picture of my med boxes, and sometimes it has provided comfort. One patient asked "oh my goodness- what is wrong with you?" so I decided I might share a little less. Vulnerability is hard. My best advice is to have a system for managing your medications if you have a chronic illness.
I just had a funny thought as I sipped my coffee. I wish I had read this article 19 years ago in my first few weeks of NP school. I wonder if I would have kept going to class? Probably... knowing me. I'm always trying to prove somebody wrong. Alright, alright, I'm about to let you all in on a BIG secret! Those who love me, and especially those who live with me know all of these truths, but I bet many of you are about to lose all your enamor for your health care provider. I am going to tell you about the daily life of a family nurse practitioner working in primary care. In essence, my day can be broken down into a few "sessions" or time periods.
Let me laugh with another sip of coffee real quick before I proceed.
Going back to my original "dreams" of working as an NP, did any of it come true?
Check out these posts from my fellow Hope*Writers for our monthly writing challenge. This month's theme was "daily": Oh, I Try by Jessica Weaver www.rootedunrooted.com/blog/oh-i-try Kids Sleep Meditation: 6 Daily Practice Dos and Don’ts by Ashley Olivine louvaria.com/kids-sleep-meditation/ Lessons from Daily Bread by Dianne Vielhuber simplewordsoffaith.com/2021/09/01/lessons-from-daily-bread/ Daily Conversations with God by Sharla Hallett www.sharlahallett.com/daily-conversations-with-god/ Throughout my career, I have had to deliver hard news to my patients. I have had to deliver even worse news to their families. It is the LEAST favorite part of my job, but I have found some comfort knowing I am delivering the news with compassion and empathy. I usually know the patient and family very well, and I think that means a lot. These suggestions may be helpful when faced with a difficult diagnosis.
Let's look at each suggestion in detail:
I am in a unique position in that I have both delivered and received hard news. At the age of 40, when my youngest son was 4, I was told I probably have lymphoma AND multiple sclerosis over the phone by a nurse. I was told to get an appointment with an oncologist and a neurologist as soon as possible. Many blood tests, imaging tests, and biopsies later, I was finally told that "you don't have cancer! And I don't think you have MS but I'm not sure. What you do have is a lifelong incurable autoimmune disease that can attack any organ and can be difficult to treat. And by the way, nobody has really heard of it and even us doctors have to google it when we see it on a chart."
So maybe those weren't his exact words, but it was close. And there will be a lot more to that story to come in my posts. I wish someone had used tip #3 with me when delivering my news. Pros:
Cons:
I have worked as a family nurse practitioner since 2004. As with any career in medicine, I have had peaks and valleys. Burnout and frustration countered by personal reward and gratitude. Humility for sure. In nursing school, I liked every rotation. I wanted to do "all of it." My faculty advised me to go into med-surg. I guess my love for "all of it" carried into my choice to primarily stay in family practice. I have done some moonlighting in GI and Pediatrics. GI was interesting, a challenge, and a break from a full family practice panel of patients. Pediatrics was fun, repetitive, and just a different pace. I think any career in medicine comes down to a few things:
In the words of Thoreau "It's not what you look at that matters. It's what you see."
Here are 10 easy ways to support someone with a chronic illness:
I have been living with a chronic illness for 5 years now. My family and friends have been a huge source of support. Even as they've tried to love me, I've witnessed their looks of "what can I do?" or "what should I say?". Most chronic illnesses are unique and involve multiple appointments with various specialists, countless medications, and years of simply managing one's health. These concrete examples can really help your loved one and make them feel important.
How to have an effective office visit with your provider: There are some tried and true ways to have a productive, meaningful visit with your medical provider. As a patient with a chronic illness AND a family nurse practitioner, I have the inside track.
If you need more frequent office visits, ask for them. Your provider is PAID to see you. Your insurance is billed for those visits where as most providers do not bill for phone calls or portal messages. If you end up needing them before your designated 3 or 6 month follow-up and you have more than 1-2 simple questions, PLEASE schedule an office visit. As a provider with complicated patients of my own, I would much rather have that patient in the office with me to have a discussion than to do multiple back-and-forths over the portal. It’s better patient care. AND my time is used wisely in my employer’s mindset. Medicine is a business. Although so many of us really do care!!! Healing people is wonderful. It’s challenging and rewarding and exhausting and sad and scary and exciting and mundane. It’s refills and phone calls and charts and labs. It’s insurance authorizations and having the same conversations with the same patients over and over and over again.
But it’s also seeing progress and growth and determination. It’s witnessing families come together and sometimes fall apart. It’s being a steady presence in the lives of what starts as strangers and ends as friends. Can we be friends? Am I your friend? I like you. I’m cheering for you. I want you to do well! I think of you and I pray for you. I laugh and I cry with you. I love seeing your pictures of your babies and your successes. My heart hurts when you hurt. Where are the boundaries? I don’t want you to have my cell number, but I want you to tell me when you need me. How does that work? What are the rules and who makes them? I don’t want to think of you as just a name or a number. I am invested in you and you in me. Working in a small town feels like home. It’s likely that I know your mom, your neighbor, your hairdresser, and your child’s teacher. I wouldn’t want it any other way. At the end of our time together, I want you to smile when you think of me. I will always smile when I think of you. Even if you didn’t heed my advice. Even if you missed too many appointments. Especially then, because you made me work harder. I want you to know I looked forward to walking in your room and seeing you just as you are, whatever you were going through. I am thankful you put your trust in me. I know you made me laugh at least once. I saw you, all of you. I think you saw me too and I’m okay with that. |