my monologue

By Jehoiada Brewer Often attributed to Major John Andre

Hail, sovereign love, which first began The scheme to rescue fallen man! Hail, matchless, free, eternal grace, That gave my soul a Hiding Place!

Against the God who built the sky, I fought with hands uplifted high, Despised the mention of His grace, Too proud to seek a Hiding Place.

Enwrapt in thick Egyptian night, And fond of darkness more than light, Madly I ran the sinful race, Secure without a Hiding Place.

But thus the eternal counsel ran: Almighty love, arrest that man! I felt the arrows of distress, And found I had no hiding place.

Indignant justice stood in view. To Sinai's fiery mount I flew; But justice cried, with frowning face: "This mountain is no hiding place."

Ere long a heavenly voice I heard, And Mercy's angel soon appeared; He led me with a placid pace, To Jesus, as a Hiding Place.

On Him almighty vengeance fell, Which must have sunk a world to hell. He bore it for a sinful race, And thus became their Hiding Place.

Should sevenfold storms of thunder roll, And shake this globe from pole to pole, No thunderbolt shall daunt my face, For Jesus is my Hiding Place.

Dr. David P. Steensma in “The Narrow Path” 

This week was a bad week. Because of the various number of stressors in my life, I haven’t been able to cope with how heavy work has been. There were two patients who had passed whose stories and memories have weighed on me. Witnessing the suffering of those who are dying is an honor. You are privy to some of the most if not the most worst experiences in someone’s life. There is an immeasurable gratitude to have trust placed in your care for another human being - this is someone’s child, partner, and friend. I’ve been reflecting on how there’s a sense of PTSD with being on an inpatient oncology unit for the past three years. There has been an unseen and unheard number of tears, cries, and moans. But, like a songbird, there have also been smiles and laughter. It’s hard to reconcile where I belong in the journey of all these people - amazing people. 

There are winding paths in our lives that go round and round, and with eyes closed, we take each step propelled in earnest by faith. The past five months I’ve grappled and wrestled with the meaning of pain and suffering in the Christian life. I’ve reflected on the experiences and trauma that I have accumulated working as an oncology pharmacist. At first, I prayed for the sadness and despair to be arrested and excised from my heart. At times, it paralyzed me.  The Father pressed into my heart and told me no. The pain and grief from the loss of a loved one cannot be undone or covered up. Indeed, it is an empty space that grows heavy and weighs on us.  During small group time, someone used a metaphor of a brick to describe the pain and sorrow of losing a loved one - that it is a weight that is carried always. At first it bears on us, even debilitatingly so, but at some undisclosed time, we acclimate to the heaviness of the burden. And at times, we fumble into our bag and feel the hardness of that empty space.  This reminded me of a quote by Bonhoeffer:

It’s absolutely no bother! The role of the clinical pharmacist varies depending on a number of factors (e.g. community hospital vs academic medical center, size of the institution).  I can give a brief overview of my day as an inpatient medical oncology pharmacist. I work with patients with solid tumors, myeloma, and lymphoma primarily. 

If you have more detailed questions let me know!

0700 – Check in with the pharmacist who worked overnight on handoffs (e.g. any clinical questions or action items)

0730 – Review scheduled inpatient chemotherapy admissions on whether chemotherapy orders and supportive care is appropriate and/or if there’s any clarification for patient’s oncologist

0800 – Pre-round (review) patients (typically census for the team whether a nurse practitioner service [18 patients] or intern/resident service [14 patients])

0900 – 1030 – Rounds with intern/resident service (e.g. make recommendations on pharmacotherapy)

1030 – 1200 – Rounds with nurse practitioner service

1200 – 1300 – Grand Rounds or staff meetings are around this time

1300 – 1530 – Following up on patient care and meetings

It’s been quite a while since I’ve sat down and written down my thoughts. Ever since finishing residency, the past months have congealed together. And the days have been so very, very heavy. 

I come to the realization of how much of a blessing it is to work each day with passionate individuals all devoted to the singular purpose of caring for patients with cancer and to support their friends and family. At the same time, I’ve been at a loss to reconcile the apparent pain and suffering with my faith.

After so many months of searching for a singular answer to the question of pain and suffering, I wonder to myself is it even realistic to ask that question? Is my question a realistic one? 

Can any amount of the pain and suffering be explained and rationalized away? But is it not evidence of just a fragment of the injustice that exists in this world? I need to tell myself that there is no satisfactory answer for a mother whose child has weeks to live. There is no answer that will erase the anguish of knowing that you won’t live long enough to see your son or daughter graduate high school or college or get married.

It’s nearly over. It’s almost over. I can’t believe it.

This past year was a blessing. I keep telling myself that in less than a month I’ll be graduated and that I’m going to be a lymphoma pharmacist.

It still feels like a dream. Even now, though I’m feeling the accumulated fatigue from the past year, I wake up grateful and humbled that I’m paid to learn. My job is to care for patients and continually learn. Even though I sometimes think to myself how much time I’ve invested these past eight years, I’m being taught to trust in the promise of every single day. 

I can’t help but be in disbelief that residency is over in 6 weeks. I still can’t believe that I’ll be moving back to the Northeast. I still can’t believe that I have a clinical position as a lymphoma pharmacist. 

These past two years of residency have felt like a decade. I’ve held the notion of being finished with residency out of reality for myself because of how trialing the past years has been. 

I’ve grown and learned so much this past year. This past year was filled with many hours pouring over trials, review articles, and textbooks. This year was filled with a multitude of patients, and it has been such an honor for me to have been a part of the care of each and every patient.

Many of the patients that I have had the pleasure of meeting when I was on the inpatient teaching service and in the clinic at the beginning of the year have now passed away. But, there are those who have triumphed and continue to triumph. 

As a requirement for PGY1′s, residents have to deliver a presentation at a conference. The topic of the presentation has to be your year long residency project. 

Ironically, I was more nervous for this than all my PGY2 interviews combined.  I think it’s because rapid infusion rituximab is so overdone and that because there wasn’t any unique spin, than that we introduced it not in the outpatient setting first but the outpatient setting, that I felt a little odd about the whole affair.