DUALITIES OF OUR MORNING | Shaleen Thakur

Patient

6:00 am Wake up with apprehension, likely thanks to—but also inducing—an IBS-D flare, cyclic. It’s chemo day.

7:00 am Coffee is brewing, let me gather my supplies for my day out. Ice capping supplies, lunch, water bottle, anti-nausea remedies, book. Apply lidocaine to my port site, maybe it will sting less this time. Texting my well-wishers back, coordinating my loved one’s schedules for those lining up as my chemo visitors today. Don’t forget my hospital badge for ease of entry. Also slap on the bandana, mask and sunglasses for an incognito entrance.

8:00 am Check in, deny current COVID-symptoms, wrist-band gently wrapping around my watch to brand me as the patient. Watching my comrades-in-chemo filing in, almost the same cohort of us weekly. The doting husband pushing in his wife’s wheelchair, the young daughter texting with identically manicured hands as her mother, the sisters with matching “Beat Breast Cancer” shirts the only mismatched item being one sister’s head-covering.

9:00 am “Ms. Thakur.” My turn to have my port accessed, labs drawn and sent stat. Weigh myself again, body dysmorphia somehow still managing to rear its ugly head in year 29, despite an immense gratitude for the chance to get better. The duality of it all.

10:00 am Sit down on the crinkly office paper. What is this called, an office chair? No, I’m not the one working right now – maybe patient chair? It doesn’t look very chair-like, more akin to if a slab of Stonehenge folded on itself. My accessed port is annoying; I feel the needle – okay, just don’t think about it. Thankfully my oncologist walks in to aid my quest for distraction. I’m surprisingly as anti-PRNs as possible – sleeping at a 45-degree angle for my heartburn rather than taking my PRN Pepcid, trialing acupuncture for my hot flashes (also known as “chemopause”) instead, mints and sniffing alcohol wipes rather than my PRN ODT Zofran (which tastes horrendous by the way, the worst-tasting grape, it actually induces nausea for me). I pass her inspection and am sent back to the infusion center – fear not, I am pro-chemo.

11:00 am The pre-medications begin their descent into my SVC. I know I’m about to feel sleepy soon – going to try and squeeze in some work emails while I can. I’ll also lose my hands to the ice bag soon, type away, type fast, scarf down some lunch. My favorite nurses stop by to give me their updates on the restaurant recommendations I’d imparted last time. The lovely massage therapist helps address my tension headache with a shoulder massage. I’m feeling nauseous because chemo has a smell, did you know? Maybe it’s the bag, it’s already in the room, staring at me, propped up against the wall. It smells of burnt plastic and cleaning solution – entering my SVC soon. Ripping open my alcohol pad for a deep anti-nausea sniff.

12:00 pm The burnt plastic and cleaning solution is being infused, will await symptoms tomorrow and report back. Napping now as anticipated.

Physician

6:00 am Wake up with apprehension, what’s my schedule looking like today. Did all my patients do okay overnight? Cyclic bowel movements to start the day yet again.

7:00 am Coffee is brewing, let me gather my supplies for my 14-hour workday. I want to be in the best shape for my patients. Protein snack, water bottle, hospital badge, stethoscope, laptop, pens, sticky notes. Let me get my glasses on so things can get into HD quality for me. Texting back my loved ones – I didn’t have a chance to get back to them after my shift yesterday. Pasting my bandana into place, my chemo-induced alopecia is becoming evident.

8:00 am Check in through the hospital doors, flashing my badge allows me ease of entry to shuttle over to my desk to review my patients’ charts. My fellow healthcare heroes file in with the same sense of purpose and intentions, as do our esteemed patients and their loved ones. But my eyes are filled with Epic and the flags to clear, the “double exclamation mark” notifications sending my fingers aflutter across the keyboard in the Orders tab. To amend, to fix, to PRN. I’m not so anti-PRN across the table.

9:00 am “Good morning, I’m Dr. Thakur.” Making the rounds, serving as the unwanted alarm clock for some patients. Did I make sure to share all the big updates? Have I enhanced their care, advanced their care? Are they doing okay? Mr. T needs ice right now. Ms. C does not look good. Oh god, no pulse, starting chest compressions right now. Life and death, door-to-door – the duality of it all.

10:00 am Sit down at the computer, in an office chair. All the patients I’m caring for swim in my head, and as I attempt to advance their care, afterthoughts pop up along with Epic chats. “I forgot to tell Mr. T this.” Ms. C’s nurse needs this order put in stat so she can be transported to the ICU. “Wait, maybe it could be HLH? Let me add-on a ferritin.” PRNs are being requested – does the patient meet the parameters their nurses want to know. Let me sign off on this, let me sign off on that, wait it’s not safe yet to do so on this other one here. My head is spinning, as if Stonehenge is folding in on me.

11:00 am I’m ordering the appropriate medications, making new diagnoses. I want my patients to feel well, in fact, I need them to. I am all too aware of the need to feel better. I’m going to go stop by my patients’ rooms again, I think their loved ones must be here. Check in, see if any new questions have arisen. Some rooms hold tears, some smiles, others hugs and yet more contain only silence interrupted by the breaths of the hospital – the clacking of keyboards as nurses draw medications, the mechanical whirring of a ventilator, the discharge of the automatic hand sanitizer dispensers, the sharp click of the light switch. But every room contains a patient waiting to go home, to sleep in their own bed.

12:00 pm All the infusions for my patients should have started thanks to the lovely nurses, I’d placed the orders a while ago. I’ll trudge down to the cafeteria now. I really wish I could nap.

Timelines Juxtaposed

6:00 am

[Patient] I’m tired. Not another chemo day.

[Physician] I’m tired. Are my patients okay?

7:00 am

[Patient] Thank goodness for coffee. Let me collect my armamentarium for the day.

[Physician] Thank goodness for coffee. I want to be at my best to care for my patients.

8:00 am

[Patient] Reporting for duty yet again. I don’t want to be here.

[Physician] Reporting for duty yet again. I am honored to be here.

9:00 am

[Patient] Doing my best. It’s Dr. Thakur, but that’s no matter here, it doesn’t protect me from chemo.

[Physician] Doing my best. “Hi, I’m Dr. Thakur, it’s nice to see you again.”

10:00 am

[Patient] Sitting down now. Wow I’d much rather be sitting in that office chair instead.

[Physician] Sitting down now. Thankful for the chance to sit for a second.

11:00 am

[Patient] I would really like some lunch now, probably should have eaten breakfast. Chemo again, necessary self-flagellation.

[Physician] I would really like some lunch now, probably should have eaten breakfast. Let me be efficient, need to provide the best care for all my patients.

12:00 pm

[Patient] Napping. I want to go home.

[Physician] Wishing for a nap. But let’s get my patients safely home first.

Shaleen Thakur is a geriatrics fellow at the Mount Sinai Hospital, having completed both her internal medicine residency and chief year at Mount Sinai Hospital. She has interests in geriatric cardiology, the equitable care of older adults and patient education and advocacy. The humanities have always brought her comfort and guided her in her journey through and with medicine.