Rural Doctoring

Interferon Diary, Day #1-2

So Noo has two IV interferon treatments under her belt and here's our impressions so far:

• Pre-treatment anxiety is worse than the treatment itself.
• Sitting in an infusion center for two hours is about as interesting as it sounds.
• A small dose of lorazepam (day #2)  makes the infusion time go by faster.
• So does reading vampire thrillers (Noo) and slightly vulgar essays by John Waters (me).
• Shaking chills develop within 15 minutes after concluding the infusion, usually on the way home in the car.
• Noo says the chills are so awful that it feels WONDERFUL to feel them go away, about two hours later.
• A gnarly, throbbing headache sets in 3-6 hours after returning from infusion.
• Ditto clammy, all-over achiness.
• You will sleep like a rock after infusion. Noo, who tends toward insomnia, thinks this year promises some of the best sleep ever.
• Maybe infusion centers should provide recliners for friends and family members as well as for patients. Napping in a regular chair makes is like sleeping on an airplane.
• Note to self: Signing up for night hospitalist shifts during the first week of infusion therapy was probably not the cleverest idea I've ever had.
• It is OK to lower expectations during infusion week. (Hint: I don't have all my tax stuff pulled together yet.)

Our Girl Friday is taking Noo to infusion today, so I can take a wee nap and get some essential paperwork (damn those reapplication for hospital privilege deadlines!) done. If it were up to me, cancer patients and their families could flip a switch and go into Bureaucratic Bypass mode for the duration of their treatments.

Zippidee Doo Dah!

We're starting interferon today!  Well, Noo is, to be specific; I'm just along for the ride. However, I am beginning to understand the parallel experience a patient's family goes through whenever they confront a major illness.  I may not be receiving interferon, but I am in charge of making sure we come home to a comfortable, well-stocked house after each treatment. So I made a couple of gallons of black bean chili yesterday, and made sure we had plenty of toilet paper. That was the limit of my coping skills for the day. Let's see what this day brings.

It's Delightful, It's De-Lovely, It's Delirium!

Recently I helped take care of a 90-ish year old man who fell down and broke his hip.  He's moderately demented at baseline, and while waiting for and ORIF--our Anesthesia department was balking at his cardiac co-morbidities--he got more than a bit delirious.  Delirium is a common hospital-based problem, especially in older patients with cognitive losses at baseline who develop an acute illness or who have a condition which requires interventions such as bladder catheterization, NPO status, ICU observation, TPN, beeping IVs, and almost everything else I was compelled to order for this poor gentleman.

If Esme Were Extremely Interested in Depravity

This post is a bit all-over-the-place.  I know it already, only after writing the first few words.  Noo and I are in Ashland, OR, to see a few plays at the beginning of the season, before Interferon robs us of any opportunities for pleasure.  I drove us up here yesterday, after completing a truly awful week of hospitalist rounds, the kind of week that raises disparate literary allusions in my mind.  At one time, I wanted to be a writer and a scholar, so I'm afflicted with disparate literary allusions from time to time.  I think these allusions are the primary occupational hazard of literary scholars.  Believe me, I prefer to examine infected wounds and gangrenous feet than wrestle with renegade literary allusions.

The Quick Update

Oh dear, there is everything EXCEPT blogging going on these days in Rural:

• The master bedroom is now SPINACH GREEN. 
• Now I need to get on curtain-making duty.
• This means I have to figure out how my sewing machine works. This scares me.
• The bathroom renovation has been shelved, because my contractor fell off the face of the earth.
• Instead, I'm going to do a light renovation of my garage to turn it into a gym/craft space.
• You may be asking why a feng-shui problem in the bathroom will be fixed by a garage reno, but the idea is to shift the center axis of the house, and using the garage regularly will accomplish this AND expand my living space at the same time.
• Interferon is scheduled to begin on 2/23/09. I doubt the curtains will be sewn by then, but come hell or high water.
• Oh yes, I'm still working, but primarily on hospitalist shifts--relatively little OB call or clinics. 
• One of these days, I've got to post about the economics of providing OB care, and why it is not a breadwinner for me, but I'm not in the mood.
• My general sense of inward insanity has settled down but is still present in the form of a constant hum of activity. I'm resigned to this.

Off to the hospital. I think the moon was full last night, so in addition to discharging patients I might have to conduct an exorcism as well.

On Grim Rural Self-Sufficiency

Recently I met an internist who may be relocating to a rural community to work as a hospitalist.  When I told her our hospital has no dialysis services, she asked, in horror, "What happens if someone comes in with hyperkalemia?"  Uhhhh....I rattled off a few intern's pearls on the subject before I realized I probably sounded condescending and hastily changed the subject.

What to Expect During Your Cancer Year

Yesterday, Noo and I went to our friendly local oncologist's office.  He was great, and we weathered the tour of the infusion center (read: chemo chairs) pretty well, all things considered.

Before we left, we were provided with several pamphlets and booklets about support groups through the American Cancer Society--sort of a "Welcome to Cancer!" information packet, if you will.

Which raises the question:  How does one prepare to receive interferon therapy for a year?  The first month is IV, five days a week, two hours per session, best scheduled in the afternoon so the patient can go home, have a light meal, and sleep through most of the aches and chills which follow.  But what about the nuts and bolts of daily life with a PICC line, interferon, aches, chills, indifferent appetite, fatigue?  I don't claim to have the answer to these questions, but here's what Noo and I are going to do before she starts interferon at the end of the month:

• Make gallons of vegetarian soup to freeze and serve up on those "by golly, I've just had interferon and I don't have ANYTHING to serve for dinner" moments.
• Draft a general "movies to rent" list so she can watch one on a portable DVD player while she's stuck in the chemo chair for two hours.
• Paint the master bedroom a deep green, so at least the four walls in which she sleeps off the interferon won't be Landlord White.
• Invest in a really good mattress.  Ours are twelve years old and as bowed as backyard hammocks.
• Put our game faces on.  Most of what we're facing is the unknown, and you can't really plan for the unknown, can you?

Can you?