Archive for the ‘Katherine Ellington’ Category

Guest Blog: Recovery and Healing

Katherine Ellington
Monday, August 29th, 2011

Katherine Ellington is a medical student and writer. Her work has been featured in The New Physician magazine, at KevinMD.com and she blogs at World House Medicine. This post is the second in a three-part series; read the first post here and the second here.

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I had battled with mom the day before about going to the see her primary care physician or to the emergency room.  She instructed me drive her to her doctor’s office, but while there her chest pain became unbearable. “I really don’t want to go the hospital because they may keep me,” she lamented. I kept driving in silence.

Now, as I waited by her hospital bedside, she  opened her eyes only briefly, but she smiled. She was glad to see me.  She whispered, “I’m in the short-stay unit.  Does that mean my end is near?”  I laughed and said, “Oh no, that means you will be coming home soon, once you’ve recovered.”  She grimaced as she took in a breath that showed on her face and with a slight groan, she exhaled.  She whimpered. “The doctor did tell me that everything was fine now, but I just wanted to be sure they didn’t think I was heaven-bound.”

As a medical student, I’ve learned from my peers that parents are challenging as patients.  The reading available about this subject is sparse, but many physicians have told me an assortment of stories ranging from horrific to compassionate about caring for parents, partners, other family members and friends. My mom has at times invited me to come with her to doctor visits. On other occasions, I have insisted that I go with her.

In these situations, I’ve always identified myself as a physician-in-training. For the most part I’ve remained silent, observant and tense during these clinical encounters.  When I’ve interrupted, it has been to offer facts. I’m usually scolded by the patient and acknowledged as helpful by the clinician.  When Mom and I have debriefed after these visits, there are usually inconsistencies in our retellings. I point these out and ask her to follow-up if necessary.  Otherwise, we agree to disagree.

Time and experience have helped me find my role as a caregiver and advocate for mom. I focus on being her daughter.  I offer support with careful listening, trying my best to remain present.  My focus is on common sense advice with basic explanations about conditions and treatment plans, while urging follow-up conversations with clinicians and medical teams.  This much I can do and do well.

Once mom returned home from the hospital, we had almost daily conversations about medications. We reviewed symptoms that she should pay close attention to and talked through changes coming in the days ahead.  I was able to explain the significance of the procedure my mom would be having, but we were both familiar because my grandmother was in the same situation just a few years earlier.  Like my grandmother, Mom would have to take medicine, make dietary changes, and reduce the effects of stress in her life with physical activity and other changes.  I wouldn’t be there in person, but we could talk, text and Skype. She did her reading, talked with her doctor, prayed and set a plan for herself. 

I’ve learned that it is challenging to help patients understand that the healing process can be long and unpredictable.  Interventional catheterization, the procedure Mom underwent, is modern medicine at its best. While less physically traumatic than open heart surgery, it does require time for healing. It’s been a year now since mom’s procedure and her recovery has had some setbacks. Nonetheless, she’s made progress.

Recently, I found myself unable to take on my yearly challenge, to walk, jog, and run 100 miles in the weeks between Memorial Day Weekend and the 4th of July.  I felt overwhelmed and uninspired to get moving. It seemed too lonely. I needed a partner. When Mom overheard me telling a friend as much, she volunteered.  I was surprised and cautious.  We agreed to early morning walks at sunrise three days a week.  We’d each move at our own pace.

We decided to go to the park that I like sometimes, and at other times remain in our neighborhood. Our motivation and momentum continued with each week, to my surprise. I’m jogging more and Mom’s complaining less about incline of the hill on the path. We’re averaging about 45 minutes, 3 days a week, together.  On the drive home, we do chat about travels to places we’d like to visit. Mom’s healing and so is our relationship, and this has added to my life as well as my medical school experience.

I’ve been told to treat patients as if they were my mother, to offer competent care with empathy and compassion during clinical encounters.

But it’s become all too obvious to me that it’s complicated when a patient is a loved one. Health care professionals and their patients need help in navigating these situations, especially within real communities where people work, live and play together. In the working and lately in the playing together, Mom and I both are steadily healing and learning together.

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Guest Blog: Matters of the Heart

Katherine Ellington
Monday, August 22nd, 2011

Katherine Ellington is a medical student and writer. Her work has been featured in The New Physician magazine, at KevinMD.com and she blogs at World House Medicine. This post is the second in a three-part series; read the first post here.

Mom whispered to me from her hospital bed, her eyes bulging with urgency, “Something is not right. I’ve been in pain all night.”

Just a few weeks earlier, she had some heart palpitations and was admitted to the hospital for a routine work-up.  The news came back that all of her test results were normal. But now her body appeared tense; she looked panicked and afraid.  At her bedside, the attending physician suggested endoscopy, offering that her pain may be related to a gastrointestinal condition.  I introduced myself immediately as a medical student and quickly advocated for a consultation with a cardiologist.

I shared that a few months prior, she had been rushed to this same hospital by ambulance with idiopathic ventricular fibrillation. The attending shook his head. He started moving toward the nurses’ station and I followed behind.  He reviewed her case with me again and then he shouted, “Endoscopy!” I said, “Cardiology consult.” Trembling with fear, I left quickly, without waiting for a response.

For a medical student, learning to observe in clinical settings is a skill that comes with practice and time as well as teaching.  Furthermore, practicing medicine well involves seeing the whole patient, looking beyond the chart to examine the situation. My concerns about Mom were influenced by both my first-hand knowledge of her complaints over time but also concerns about being sure that as a black woman she received the best care.  The recently released book by Dr. Augustus White, Seeing Patients: Unconscious Bias in Health Care offers the following:

… the race and sex of patients [influences] physicians’ decisions about whether to refer patients for catheterization…If you were black, the report concluded, you were less likely to be referred.  If you were a woman, you were also less likely to be referred.  And if you were a black woman, you were especially less likely to be referred.

As I sat outside trying to figure what my next steps would be, my phone rang. It was the nurse, calling to tell me that the attending had in fact agreed to the cardiology consult. I returned to our house to care for my grandmother. In the absence of my mom, she had no caregiver.  In the afternoon the cardiologist called me to express his concern with mom’s condition. He recommended, pending insurance approval, that she be transferred to another hospital with full cardiology services for more tests and further observation. 

Mom was transferred that night. Additional test results showed significantly blocked coronary arteries. Early the next morning, she had cardiac catheterization to open her blocked blood vessels. After a short hospital stay, she returned home.

As an African American woman training to be a physician, I was glad to witness good medicine, as well as Mom’s progress.

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Guest Blog: Summer Palpitations

Katherine Ellington
Monday, August 15th, 2011

Katherine Ellington is a medical student and writer. Her work has been featured in The New Physician magazine, at KevinMD.com and she blogs at World House Medicine.

Early one Saturday morning, I was making my plans for the day. As I moved toward the kitchen, Mom’s voice bellowed from the living room, “The coffee is ready.”

Turning my head, I could see bright rays of sunshine making a path through the open front door.  I followed my morning greeting with, “Did you have breakfast?” Mom answered, “Yes,” so I sat down with yogurt, a banana and cinnamon coffee in my favorite cup.

She came to the table, pulled her chair up close and said with half-hearted laughter, “I keep feeling these flutters.”

“What have you been up to this morning?” I asked.

She said, “Well, I ate cereal for breakfast and took my medication, then I rode my bike to the bank. Now I’m getting ready to go grocery shopping, choir rehearsal and then to get my hair done, but I keep feeling these flutters.”  Just listening to her schedule made me uncomfortable. She had other unmentioned responsibilities, like caring for my grandmother and cooking dinner, but I wasn’t ready to stir up an argument. Instead I said, “Well, it’s been a busy morning, so why don’t you go back to the sofa and rest for awhile?” 

My summer break from med school had provided us with new opportunities to share our lives and experiences. I talked about interesting findings in health and medicine while she shared more stories with me about her own life experiences. I learned to listen more attentively and I began to see her rage with the world of injustices and her strength in overcoming obstacles. At the same time, I noted the way she kept her vulnerabilities hidden“with myriad subtleties” as described in Paul Lawrence Dunbar’s poem “We Wear The Mask.” As she laid in the other room, we talked about a co-worker who’d died suddenly a few days ago. She paused for a moment, admitting her anguish.

A few weeks earlier, when we spoke about the New York City Health Department’s no trans fat public awareness campaign, her question was, “What’s the big deal?”

As I grinned through a biochemistry lesson on lipid metabolism, she became irritated and puzzled. I made more progress when I talked to her about fries and partially-hydrogenated oils leading to weight gain and rising cholesterol levels, which may increase the risk of heart disease. She got it, and began reading food labels more carefully and switched out the oils in the kitchen with healthier choices. But as she rested on the couch, I realized that reducing the stressors in her life might be harder than adjusting the contents of our pantry.

By late Saturday evening, I was sitting in front of the computer with the banter of young people outside my front bedroom window and a hint of barbeque in the air. I heard rushing footsteps coming down the stairs, then a knock on my door. In a shaky voice, Mom asked, “What did you tell me to do about these palpitations?” 

I asked, “Have these continued from early this morning?”

She nodded. “I’m too uncomfortable to lie down or sleep like this.” 

I told her, “You have to go the hospital.” I reached for the phone and dialed 911. She lamented that she didn’t think her situation was that serious. I did. She urged me to take her blood pressure. I did not.

The ambulance came in less than ten minutes. Her pulse was rapid, her blood pressure was abnormally high and the portable heart monitor gave a picture of irregularities. She was rushed to the hospital while I stayed behind with my grandmother. Grandma was now awake, upset by the ordeal and demanding answers by asking the same few questions repeatedly. “Why did they have to take your mother to the hospital?  What’s wrong with her heart? How did that happen? She’s too young to have heart trouble. They took your mother to the hospital? For what?”  It was a long night.

After an hour in the emergency room, mom was admitted to the hospital.  Her pulse, blood pressure and heart rhythms returned to normal with medication. She was released from the hospital after a few days with instructions to follow up with her primary care physician and with a referral to see a cardiologist.

That summer, I finished my first reading of our cardiovascular physiology packet with a more profound interest in the advances of science and medicine as well as the research related to health disparities. I had already learned first-hand that the prevalence of heart disease among black women is twice as high as for others.

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