Salvage

Generally speaking it's never a good sign if the word salvage is associated with your medical treatment. Whether salvaging a limb, salvaging heart muscle, or using salvage chemotherapy, things can only be kind of desperate and the outlook can only go from bad to worse. In hematology, salvage chemo is usually not well established, there aren't many controlled trials and even fewer good outcomes. Not saying it never works...just that working is usually defined in terms of extra months or weeks of life, rarely anything close to a cure. And sometimes just stopping and making the most of what's left is the best move. Our patient with fungal sepsis decided to marry her boyfriend and spend the last weeks of her life at home. I find it hard to fathom that turning point, where you're ready to give up on life, but at the same time rationally I think it's a completely reasonable decision when all remotely useful treatments have been exhausted. Grey's Anatomy actually had a really moving scene in the most recent episode, Suicide is Painless. A patient with terminal lung cancer describes how hope can be extremely damaging when you are ready to die. She's living in pain and there's no chance of a good treatment or cure...she wants physician assisted suicide and is happy with that choice. However, the thought of what if (what if there was a new cure, what if something had been missed and she's not really terminal) keeps her from being completely at peace with her decision, even when there really, truly is no hope. Insightful. There was also some annoying talk about Whoville...which as much as I love the Grinch Who Stole Christmas seems like a desperate attempt to start a catch phrase. I mean, SERIOUSLY. I miss the glory days of Grey's.

Speaking of salvaging. I spent the past week trying to salvage what remained of my medicine rotation. I definitely suffered for serious burnout right around the time I would normally be having spring break instead of working 13 days in a row. Now it's on to neurology which has it's own depressing set of problems and even less effective treatments. But at least it's spring!