I do not suffer from a low self esteem. In general I consider this to be a good thing, as it makes me confidant and willing to challenge myself, because I "know" I will be successful. I have high regards for myself partly because things have come relatively easy in my life. I have had many successes and few failures. I am good at a lot of things, and the things that I am not so good at I simply choose not to do (gymnastics, for example, since I have the balance and flexibility of a toothpick). And I'm funny to boot!
However, thinking that I am all that does have it downsides. It makes me too cocky to see things the way they really are. I makes me unwilling to challenge some of my thoughts and behaviors because I KNOW I am doing it the right way. It makes me lazy, because I often don't have to work very hard to do a good job.
In the past few days, my self esteem has been taken down a few notches. And I had the gall to actually be surprised when faced with failure, or when it was made very clear to me that I can be a big f**k up.
And I am not, I repeat NOT, writing this because I am looking for people to tell me that I'm a great person. I am not looking to be propped up now. I have already been made well aware of my awesomeness, and now it's time to take a look at the un-awesome me.
I don't know what to do with myself. All this talk I've been doing lately about self-discovery or finding inner peace might be fine and dandy when I thought I was perfect, but it all changes when I find out I'm not. I don't need to find myself. I need to FIX myself. I have flaws, and not just the cute flaws that make me so endearing either.
I will be 42 next month. A fine age to realize that I have a lot of growing up to do. And that my way isn't the best way after all.
I guess admitting that is the first step, right?
Saturday, May 19, 2012
Tuesday, May 15, 2012
Can't always be a hero. Damn.
Even though I've been a veterinarian for almost 16 years, I still have cases where I am surprised, or get bit in the ass, or both. Last week I saw one of them.
"Mac" (not his real name) was a middle aged large breed dog, a long-time patient of ours. He had been seen a couple of times recently for intermittent vomiting and lethargy. My associate vet saw him both times, and the second time (after x-rays were taken), we jointly diagnosed free fluid in his abdomen. Abdominal fluid is never a good thing. It could be blood (indicating internal bleeding), pus (indicating bacteria in the abdomen, or septic peritonitis), fluid containing cancer cells, or a clear serum-type fluid (most commonly seen with liver or heart disease). Anyway, I called the owner and even though the dog was feeling better, I told him to come in so we could work the problem up further. The dog had a 1:30 pm appointment.
On exam, Mac was fairly bright, but his gums were pale and his heartrate was elevated. I tapped his abdomen (basically a quick procedure where I poked his belly with a needle and syringe) and easily pulled out a syringeful of blood. In a dog of his age and breed, a bleeding tumor was most likely. I discussed Mac's condition at length. Statistically, most of these tumors are on the spleen and successfully removing the spleen can solve the problem. At least temporarily. A large percentage of these tumors are malignant and will come back. However, unless we see evidence of metastases during surgery, we cannot tell a malignant tumor from a benign tumor without sending it in to the lab. In addition, I told the owner that if he wanted to do surgery, today was the day. Mac could crash and bleed out at any time and now he was about as stable a surgery patient as he could be. We discussed doing an abdominal ultrasound to make sure the tumor was in fact on the spleen, but I didn't think I could get one done that day. His chest x-rays were clear and his bloodwork showed only mild anemia. So we took our chances and headed for surgery.
As I opened his abdomen, I was stuck by how much blood there was. In fact, I was a bit surprised that he was as stable as he was! I suctioned out at least a liter of blood from his abdomen, and there was plenty more in there. I had a hard time visualizing anything, but my heart sunk when I pulled out the spleen. No tumor. Damn! Where is it??? Finally, deep in the right side of his abdomen, I felt it. an orange-side mass on his liver. LIVER! Not a common area for this type of tumor, but I have seen it before. Once. That dog did not make it. You see, removing the spleen is one thing. Just tie off a bunch of vessels and you're done. The liver lobe, especially the right caudate lobe, is best left to a specialist. In fact, should only be left to a specialist. I pulled out all of my surgery books and none of them had very good instructions on how to remove this liver lobe. In fact, one book only said that it was rarely performed. Thanks. So helpful. In the region is the pancreas, the portal vein, the vena cava, and the gallbladder, among other things. And in this case a mess of blood made it even more difficult to see everything. Plus, it's all deep in the abdomen and cannot be pulled out for better visualization.
And, from what I did see of this tumor, it had started bleeding again. Alot. Perhaps I dislodged a clot when I was suctioning the abdomen or feeling around. Who knows. But the blood! So much bleeding! I had to do something so I placed a big clamp right at the base of the lobe. The bleeding stopped but I was certain that my clamp contained many delicate things that were not supposed to be clamped. Plus, now what was I going to do? I had no idea. So I scrubbed out and called a surgeon. Can I send the dog to you with the clamp inside the abdomen, so you can clean up my mess? Or can you talk me through the surgery here? Hmmm. He said. The surgery is too difficult for me to be able to explain. You could send the dog to me, but it is very risky (duh!).
So I called the owner and explained everything. It didn't take long for them to make their decision. Euthanize Mac on the table. I admit that even after hearing those words I did try to remove the liver lobe. Well, for about 30 seconds. But then he started to bleed so profusely that I just slammed the euthanasia solution into his IV line. Nobody wants to see an animal bleed to death, even if they are under anesthesia.
We all want to be heroes. And in this profession, I am sometimes given the opportunity to be just that. However, this profession is also very humbling and often reminds me that there are problems bigger than I can fix.
A week later, I am still a little upset about the outcome. However, today I called the owners to see how they were doing and they were actually doing pretty good. They figured that it was meant to be. And they are getting another puppy this weekend! Nothing like a puppy to heal the soul, right? After last week, maybe I need a puppy too...
"Mac" (not his real name) was a middle aged large breed dog, a long-time patient of ours. He had been seen a couple of times recently for intermittent vomiting and lethargy. My associate vet saw him both times, and the second time (after x-rays were taken), we jointly diagnosed free fluid in his abdomen. Abdominal fluid is never a good thing. It could be blood (indicating internal bleeding), pus (indicating bacteria in the abdomen, or septic peritonitis), fluid containing cancer cells, or a clear serum-type fluid (most commonly seen with liver or heart disease). Anyway, I called the owner and even though the dog was feeling better, I told him to come in so we could work the problem up further. The dog had a 1:30 pm appointment.
On exam, Mac was fairly bright, but his gums were pale and his heartrate was elevated. I tapped his abdomen (basically a quick procedure where I poked his belly with a needle and syringe) and easily pulled out a syringeful of blood. In a dog of his age and breed, a bleeding tumor was most likely. I discussed Mac's condition at length. Statistically, most of these tumors are on the spleen and successfully removing the spleen can solve the problem. At least temporarily. A large percentage of these tumors are malignant and will come back. However, unless we see evidence of metastases during surgery, we cannot tell a malignant tumor from a benign tumor without sending it in to the lab. In addition, I told the owner that if he wanted to do surgery, today was the day. Mac could crash and bleed out at any time and now he was about as stable a surgery patient as he could be. We discussed doing an abdominal ultrasound to make sure the tumor was in fact on the spleen, but I didn't think I could get one done that day. His chest x-rays were clear and his bloodwork showed only mild anemia. So we took our chances and headed for surgery.
As I opened his abdomen, I was stuck by how much blood there was. In fact, I was a bit surprised that he was as stable as he was! I suctioned out at least a liter of blood from his abdomen, and there was plenty more in there. I had a hard time visualizing anything, but my heart sunk when I pulled out the spleen. No tumor. Damn! Where is it??? Finally, deep in the right side of his abdomen, I felt it. an orange-side mass on his liver. LIVER! Not a common area for this type of tumor, but I have seen it before. Once. That dog did not make it. You see, removing the spleen is one thing. Just tie off a bunch of vessels and you're done. The liver lobe, especially the right caudate lobe, is best left to a specialist. In fact, should only be left to a specialist. I pulled out all of my surgery books and none of them had very good instructions on how to remove this liver lobe. In fact, one book only said that it was rarely performed. Thanks. So helpful. In the region is the pancreas, the portal vein, the vena cava, and the gallbladder, among other things. And in this case a mess of blood made it even more difficult to see everything. Plus, it's all deep in the abdomen and cannot be pulled out for better visualization.
And, from what I did see of this tumor, it had started bleeding again. Alot. Perhaps I dislodged a clot when I was suctioning the abdomen or feeling around. Who knows. But the blood! So much bleeding! I had to do something so I placed a big clamp right at the base of the lobe. The bleeding stopped but I was certain that my clamp contained many delicate things that were not supposed to be clamped. Plus, now what was I going to do? I had no idea. So I scrubbed out and called a surgeon. Can I send the dog to you with the clamp inside the abdomen, so you can clean up my mess? Or can you talk me through the surgery here? Hmmm. He said. The surgery is too difficult for me to be able to explain. You could send the dog to me, but it is very risky (duh!).
So I called the owner and explained everything. It didn't take long for them to make their decision. Euthanize Mac on the table. I admit that even after hearing those words I did try to remove the liver lobe. Well, for about 30 seconds. But then he started to bleed so profusely that I just slammed the euthanasia solution into his IV line. Nobody wants to see an animal bleed to death, even if they are under anesthesia.
We all want to be heroes. And in this profession, I am sometimes given the opportunity to be just that. However, this profession is also very humbling and often reminds me that there are problems bigger than I can fix.
A week later, I am still a little upset about the outcome. However, today I called the owners to see how they were doing and they were actually doing pretty good. They figured that it was meant to be. And they are getting another puppy this weekend! Nothing like a puppy to heal the soul, right? After last week, maybe I need a puppy too...
Monday, May 7, 2012
Small Group Ministry - or Learning How to Listen. Or Eat Lice.
A few months ago our minister started up a Small Group Ministry program. He asked for volunteers to be part of the inaugural group, with the expectation that those members would be facilitators of future small group ministries. Since I don't have nearly enough on my plate, I decided to try it out. To be honest, I had no idea what small group ministry is. All I knew is that I am still trying to "find" myself and I thought this would be a good place to continue down the path of self-examintion.
I am now the veteran of 6 small group ministry meetings and this is what I can tell you. There are about 8 of us (we started with 10 but a couple of people dropped out), including the facilitator (who in this case is the minister). We sit in a circle. We are not allowed to talk unless we are holding the "talking stick" (or talking figurine in this case). Because we're UUs, we start by lighting the chalice while the facilitator reads a reading. I assume that in other religions, there might be an opening prayer or something. Then there is a "check-in", where we go around the circle and one by one answer a check-in question, which usually pertains to "How are you doing?" Last week it was "How is your soul?" (To which one person answered - "I am trying to lose my soul. So I don't think I have a soul right now." Remember, we're UUs.) Each person gets a few minutes to answer the question, as deeply and honestly as they feel comfortable doing, while the rest of the group just listens. We can't talk back, make judgements, or give advice. It's a beautiful thing!
OK, I admit that initially I was a little confused by that format, but it is becoming clear that it really does serve a purpose. By answering these deep questions without fear of interruption or judgement, we find our own truth. It's an interesting phenomenon. And by being forced to listen, we are learning something about the person speaking. And about life. Because everyone has something, some viewpoint, some experience to contribute. And we are also learning the very-important-but-not-often-used skill of LISTENING. Just sitting there and listening. And not offering advice, or a smart-ass remark (a I am prone to doing), or an anecdote. This is someone else's story and I can wait until it's my turn, for crying out loud! At first the speaking part was challenging. How do I answer? What if I'm way off base? What if I am JUDGED? But as we have beocome more comfortable with each other and with the process, I no longer have anxiety over that. Then it was the listening that was hard. At first I would spend the time where others were speaking just daydreaming, or formulating what I was going to say when it was my turn. And that's ok. But it started to shift a couple of sessions ago. I gave up thinking and just listened. Because that's what we're there for. To be there. The presence of the other small group members acts sort of like a silent sounding board. And just the act of sitting in silence and paying attention to what someone else is saying is powerful. Try it some time. Just listen to someone tell a story or complain about their day. Don't say a word, but make it known that you are paying attention. It is a mighty good skill to have!
After the check-in question, there are 2-3 further questions, usually revolving around a theme. Last night the theme was our gifts - what energizes us, what we are good at, and how we can use our skills for the church. It was interesting that it took us all awhile to be comfortable speaking out loud about our gifts. Like we we didn't want to be accused of bragging. But we can! That's the question! And no one can judge! As you can imagine, I had no trouble listing some of my many skills and talents. I could have talked for hours! Actually, the most interesting thing about that question is that even I immediately wanted to answer it with some of the things I am NOT good at. Why is that?
Anyway, after a total of 3-4 questions and a closing reading or prayer, we're done. The session starts on time and ends on time - 90 minutes later. There are no breaks, no food, no small talk (except for before and after). And, after 8-12 sessions, when we're finally starting to get really tight as a group, we are supposed to break up! And form new groups! Sad. I will miss my new friends, but I can see how doing this for 3-4 groups per year allows one to form really close bonds with a whole bunch of people. OK, you may think this is weird, but I have an anaolgy for this. A few weeks ago we saw the movie "Chimpanzee". In it, the narrator talked about how important grooming each other (you know, going through each other's fur and eating the little insects that are crawling around) was in maintaining the bonds within a pack of chimps. In a way, small group ministry is a lot like that. We meet every few weeks and figuratively pick off insects from each other as a way to bond the group. Just sayin'.
OK, I admit that initially I was a little confused by that format, but it is becoming clear that it really does serve a purpose. By answering these deep questions without fear of interruption or judgement, we find our own truth. It's an interesting phenomenon. And by being forced to listen, we are learning something about the person speaking. And about life. Because everyone has something, some viewpoint, some experience to contribute. And we are also learning the very-important-but-not-often-used skill of LISTENING. Just sitting there and listening. And not offering advice, or a smart-ass remark (a I am prone to doing), or an anecdote. This is someone else's story and I can wait until it's my turn, for crying out loud! At first the speaking part was challenging. How do I answer? What if I'm way off base? What if I am JUDGED? But as we have beocome more comfortable with each other and with the process, I no longer have anxiety over that. Then it was the listening that was hard. At first I would spend the time where others were speaking just daydreaming, or formulating what I was going to say when it was my turn. And that's ok. But it started to shift a couple of sessions ago. I gave up thinking and just listened. Because that's what we're there for. To be there. The presence of the other small group members acts sort of like a silent sounding board. And just the act of sitting in silence and paying attention to what someone else is saying is powerful. Try it some time. Just listen to someone tell a story or complain about their day. Don't say a word, but make it known that you are paying attention. It is a mighty good skill to have!
After the check-in question, there are 2-3 further questions, usually revolving around a theme. Last night the theme was our gifts - what energizes us, what we are good at, and how we can use our skills for the church. It was interesting that it took us all awhile to be comfortable speaking out loud about our gifts. Like we we didn't want to be accused of bragging. But we can! That's the question! And no one can judge! As you can imagine, I had no trouble listing some of my many skills and talents. I could have talked for hours! Actually, the most interesting thing about that question is that even I immediately wanted to answer it with some of the things I am NOT good at. Why is that?
Anyway, after a total of 3-4 questions and a closing reading or prayer, we're done. The session starts on time and ends on time - 90 minutes later. There are no breaks, no food, no small talk (except for before and after). And, after 8-12 sessions, when we're finally starting to get really tight as a group, we are supposed to break up! And form new groups! Sad. I will miss my new friends, but I can see how doing this for 3-4 groups per year allows one to form really close bonds with a whole bunch of people. OK, you may think this is weird, but I have an anaolgy for this. A few weeks ago we saw the movie "Chimpanzee". In it, the narrator talked about how important grooming each other (you know, going through each other's fur and eating the little insects that are crawling around) was in maintaining the bonds within a pack of chimps. In a way, small group ministry is a lot like that. We meet every few weeks and figuratively pick off insects from each other as a way to bond the group. Just sayin'.
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