Random Boy messages me on Yahoo!, which I think is the only medium I don't have limited to people I know. He asks how things are going. I tell him I'm studying. He asks if I live in FW random_boyhe's read my Yahoo! profile, which says I'm married). I say sometimes, sometimes Indy. The conversation continues; he's obviously looking for a good time either in person or online. I'm frankly not interested in the conversation from the get-go, and particularly not when he uses 'oic' in the conversation. But I give him one-word answers, hoping he'll take the hint. Then he asks the 'I've read your profile and don't know what world you live in' question:
[21:47] random_boy: pic?
[21:47] carydhuin: Sorry, don't have any.
[21:48] random_boy: o ok
[21:48] random_boy: so you're into that kinky role-playing shit?
[21:49] carydhuin: Nah, D&D is more my kind of role-playing.
[21:49] random_boy: What's D&D again?? I forget.
[21:50] carydhuin: Dungeons and Dragons.
[21:50] carydhuin: I'm a certified geek.
The conversation came to an abrupt and screeching halt; he never messaged me again. On a whim I looked up his profile on Yahoo!. That was when I nearly fell off the couch laughing.
Yahoo! ID: random_boy
Real Name: Random Boy (Duh)
Nickname: Big Poppa Pump
Location: Auburn, IN
Marital Status: No Answer
Occupation: Aspiring Professional Weightlifter
Hobbies: I love to lift weights, work out, tan, just try and stay healthy. I love heavy metal music, a whole bunch of other shit too.
Latest News: Well, I bought a new car and I LOVE it!
"Your best? Losers try their best...winners go home and fuck the prom queen."
This is the boy that messaged me. A 19-year-old aspiring professional weightlifter who loves to work out, tan, and listen to heavy metal music. The (misquoted) Sean Connery quotation in his profile wins him only the tiniest of redemption points, as I hardly think he understood what made The Rock such a lovely piece of film. I should've sent him a picture. I should keep some around to send.
And on to more - or, in this case, less - mundane things.
I forgot my pager this morning. To be more specific, I lost my pager this morning. I couldn't find it in my car or my room; I even paged it my secret pager code - 123 - and it failed to go off. Finally, realizing that I was (a) late when I left the first time and (b) doubly late now that I'd turned around and gone back to the house to find my pager, I gave up and resigned myself to a short-call night with no pager. I drove to the hospital in silence.
The day was interminable, O Best Beloved. Neuroradiology conference at 0800; I couldn't keep my eyes open through half of it. Cerebral Palsy clinic at 09:30. R, our senior resident - the man who's doing a combined neurology-psychology residency, looks like a burlier version of Robin Williams, and has decided that my nickname will be "Kitty" completely unaware of the fact that I've been called "Cat" off and on since seventh grade - R took Brendan and I to CP clinic while PGY-2 L took Lindy to the ER.
R loathes CP clinic; he doesn't feel that we're doing many of the children a service by forcibly maintaining them, increasing the levels of drugs that attack the liver and sedate the conscious mind until we can batter a child's brain into submission and force it to stop firing off misshapen patterns of electricity - aberrant thoughts that take the cortices by storm and savage the body with their force. We are guided, in these children, by the side-effects of the drugs; we continue to pour poisons into their bodies until not only the abnormal but the few remaining normal functions begin to be suppressed. And our goal is not - cannot be - to eradicate the seizures, not even with this horrific endpoint to attain. Our goal is only to reduce them. To make life, such as it is, more bearable.
I wonder, too, sometimes. I wonder if it is a failure of modern medicine that we have become so obsessed by healing and curing that we lose track of the reality of life. We extend life by almost-magical means, with our potions and our wands and our tubes and our needles and our vials full of peculiar poisons. We give quantity of life. Do we, sometimes, steal away the quality of it?
I think Hospice was invented by an angel in human guise, an angel who knew that the best gift of all is perhaps the right to die, free of pain and interference, in a place where one is loved and comforted and surrounded by the things that make for peace.
I didn't mean to go on that tangent, O Best Beloved. I meant to tell you about the heartbreak of opening a folder and reading the words on the previous visit's note. "We had the pleasure of seeing Joe Smith in Cerebral Palsy clinic today with his foster father. As you know, he is a three-year-old boy with spastic paralysis, visual blindness, and seizures secondary to shaken baby syndrome at two months of age." I almost just put the chart down and looked for a different one. Shaken baby syndrome. Someone, O Best Beloved, took a two month old infant and shook him so hard that his brain slammed into his skull and was damaged permanently. Someone broke this child. He will never be able to run around playing cowboys and indians, he will never watch cartoons on Saturday mornings, he will grow up and if he's lucky someday he will have the coordination to feed himself. Someday he won't require medications to prevent him from gnawing the skin off his fingers. If he's lucky. And someone, somewhere, held a baby too young even to support its own head fully and shook him.
He is beautiful, brown-haired and hazel-eyed and his pupils do not constrict when I shine my flashlight into them in a darkened room. The Prozac is working; he doesn't mutilate his hands, there are no new bite marks. The Depakote not so; he still has seizures. We'll turn it up, he's not on a very high dose.
CP clinic. Neurology sees them for their seizures. Developmental Paediatrics sees them for their growth and learning. Orthopaedics sees them to fit splints and custom wheelchairs and reposition bones and lengthen tendons. We inject Botox - the toxin formed by C. botulinum - into them to relieve the spasticity. They get pumps implanted that deliver constant muscle relaxants. We prescribe Depakote and Dilantin and Neurontin and Tegretol. It's a whirlwind of doctors who see patients seemingly at random, names on a board that are circled when they arrive.
My second patient, Alex, comes with her transporter from the facility she lives at, comes with a packet of nursing notes and a few letters. "She's having trouble with spasticity. Please start Baclofen." There's no note for Neuro; the transporter doesn't know Alex from Adam nor does she really care. She sees so many children who break her heart after all, who can keep track of them? No seizures in the three hours she's been at the clinic, good enough for us. We renew her prescriptions, search the stack of papers for the reason this golden-haired child with the tiny misshapen teeth is visiting us today, find a piece of familiar H&P paper. Congenital CMV. Staff dictates a note. "We had the pleasure of seeing Alex in Cerebral Palsy Clinic today. As you know, she is..." I catch an error in the dictation, correct her. She thanks me and fixes it.
R catches me. "Go, get out of here, there's no more patients to see. Go find L before someone comes in late."
I go. Branden is in with someone still; R promises to tell him to catch up. L is in the NICU, sacred bastion that it is. NICU nurses are battleaxes; we fought in peds surg over who would have to see the patients there. They're so fragile, so delicate, and the nurses require you to scrub for three minutes and change your disposable outfit between every patient. It's a nightmare. Fortunately, she's wrapping up, and as I catch up to her she leads Lindy and I out toward another hospital. Wednesdays at noon, it appears, the Neuro residents get to cut brains. We talk on the way, get to know her better. She's easier to read now that we understand the way she thinks. And she's nice, not scary.
Brain-cutting is cancelled; we walk back to our hospital, sit around the batcave, eat lunch, talk about review comments. L says we're all high-pass students right now, and she says it candidly. You have to really stand out to get honours in her book, and that's okay by me. It's just as okay as being scolded for not writing a neurological exam on my neuro note, a criticism she follows by telling me that she forgot to write a physical exam at all on an admit note today. I like L, more than I thought I would.
We round, eventually, spottily, interrupted by a lecture on multiple sclerosis during which I play NetHack and take notes, in an effort to stay awake. Exhaustion is kicking in. I don't remember whether I had one chai to stay awake or two today, perhaps just one. And then at 4 PM - the earliest we've ever finished an afternoon, we're done. Except that all three of the students are taking evening call with R. \We regroup in the batcave. He gives us the plan: we'll stick around for the evening, get dinner, study, whatever. When a patient call comes in he'll page us and we'll see them, then page him to staff with us. Sounds good. If nothing happens by 8 or so, he'll do a lecture and then ship us home. Kitty, you stick with one of these two and you'll get the first patient.
I stick with Lindy as she goes outside to study. Meeta stops by to chat, so do a few other friends. At 5:30 I get dinner and we go back to studying. At 5:45 Lindy looks up at me. "Do you want to talk through some of this stuff? I know you don't like just reading, you get distracted easily...would that be something you'd want to do?" I know what she means; I've heard her and Rachel talk through before. It's a pimp session disguised as a dialogue, conducted bilaterally between two people, neither of whom have all the answers. Yes. I'd like that.
If I had had my pager I would have been online, talking to Angel, then trying and failing to read my text. Instead, Lindy and I spend the next two hours going over high-yield facts, laughing, talking, coming up with mnemonics, reminiscing.
"Well, now, Lindy, I see here that Rachel's concerned that you might have dementia. She says you went to the grocery store for milk and eggs and came back with bacon and lard."
"I like bacon and lard. I could get milk and eggs if I'd wanted them." Pause. "Tell me about dementia...what does she mean?"
I studied tonight, because I didn't have my pager, and I learned a lot. And I like Lindy, as different as we are, despite the way I feel big and clumsy and loud and awkward around her. It was a good experience - a blessing.
We met up with Branden at 8. No pages. I paged Rod. He told us to go home.
I walked out to my car, got in, turned it on, and there was a beep. A familiar beep. A "you missed a page" beep.
My pager was on the passenger's seat, in plain sight. It had been there all along, but I hadn't seen it - nor had I heard its once-minutely beep on my drive to the hospital this morning. And because of that I had a wonderful evening and didn't resent being on call at all.
Whenever I pause and open my eyes, I find there the subtle orchestrations of a power greater than I. Things happen, O Best Beloved, for a reason. All things happen for a reason.