From Comment to post, January 2013

"Hold up! What post did you read that got all these synapses firing away from patient care? Not knocking the decision. . . just curious. . .

Most important, you are listening to your spirit. Good for you!"


Talk about irony, LOL!! I had literally just finished reading an article about Hospice and Palliative care choices among Blacks, when I logged into my blog to see a comment by the one and only, GradyDoctor herself!! Man, am I pleasantly surprised!!!

Here's the article: http://www.divinity.duke.edu/initiatives-centers/iceol/resources/last-miles/papers/08

I mentioned some of what I do NOT like about patient care in my last post. But for the last several months, I'd been reading the blog of an amazing author named Nancy Stephan, about the last months of her daughter's life which has me pretty undecided about patient care if I'm honest with myself. Her story about her daughter's care who was diagnosed with diabetes in elementary school, was rife from my perspective, with what's so wrong with how medicine is practiced and how so often, people of color get disparate care. And with every post I read, I became more and more angry about situations which to me, reeked of racism. So as not to just focus on the negative, her blog also opened my eyes to other disease processes, in this case diabetes, which like many other chronic diseases, strikes Black folks at significantly higher rates than Whites. And that was a good thing for me, because I think it's good to keep my options especially now where I'm ardently looking for suitable research positions using Informatics tools. One thought lead to another, and I ended up reading an article in the NYtimes about end-of-life care:

http://www.nytimes.com/2009/12/27/health/27sedation.html?pagewanted=5&_r=0

Unfortunately, I know from experience that when it comes to the distribution of pain meds, I've gotten the short end of the stick, no doubt due to the belief of some in the medical community, that many Black folks have "drug issues". So when I read something similar in Nancy's blog regarding her daughter's care in her last months, I got doubly mad. But anger isn't an emotion that usually results in getting things done OR in developing good solutions, so I turned all that anger into something useful by educating myself journal wise in Diabetes and in the field of Hospice and Palliative care.

I've briefly mentioned the fact that I've been dealing with "death issues" since I was about 13 which seems too damn early to attend the funeral of a close relative. In this case, it was my Cousin who died from cervical cancer at 16 (her mother had taken DES while pregnant with her). Three years later, my neighbor was brutally murdered and 3 years after that, one of my best friends from high school died under circumstances which have never been explained. Those experiences were the impetus for me double majoring in Arts and Science, with the arts degree in Religion and a thesis on death and dying issues among young adults. I also completed training as a hospice volunteer during the same time.

So after thinking things through over the past couple days, I think it's my fear that a patient will die over some disparate care BS that bothers me the most about patient care. I also worry that so much of patient care is about patient compliance, and the fact that I'd feel like I made more of a real difference in my patients lives if they were compliant. And that puts fields like Internal Medicine and Oncology near the top of my patient care possible lists, because the ability to meet new people in variety of diseases states, and the fact that no two days would be the same, combine with the fact that there's also a TON of interesting medical science in both specialties. And THAT sounds pretty interesting, professionally speaking!

More recently, it was Nancy's blog post about her daughter's hospice care that got me rethinking patient care again in ways I don't think I can properly articulate except that it made me think about my Father's last days in Hospice, my own training as a Hospice volunteer, and the idea that death is a "tough subject" in Black communities. Thus, this field could provide an almost ideal way to make a difference in the life and in this case death of a patient, and there also appears to be a SIGNIFICANT need in this reasonably new specialty.

Anyhoo, I say all that to say that I will keep all my options open as EVERY future medical student should.