I can explain. (No really. Just keep reading.)

I’ve started and then just never been able to post a bunch of posts in the last year for one reason or another. I noticed that it’s been pretty much exactly one year since I’ve posted. And a year it’s been. A rough year? An interesting year? I guess I’d have to say a year, so full of terrible and good things, that I have no idea how to classify it at this point.

One year ago I found out that my Dad, my primary parent, one of my best friends and biggest supporters in life and in all things medical, had cancer. A very bad cancer. After The Diagnosis he came to live with me for awhile and sought treatment at the Big Fancy Medical Center where I’m training. Soon after The Diagnosis, I got dumped, in an email by the guy I’d been dating for 3-ish years. I was on Gyn Onc at the time. (Anyone who knows anything about an OB/Gyn residency probably knows what I mean when I add on that little tid bit. Yeah.) Oh, and my laptop broke. I was too broke to do anything about that. Aside from using the computers at work to do strictly work-type things that did not include blogging.

Since all of that happened, almost exactly a year ago, a lot more good and terrible things have happened.

My Dad died.

And it was the most terrible thing. I can’t even explain right now, how terrible and horrible it was. Watching the rapid decline, and eventually being there at the end, seeing him suffer, waste away, his pupils dilate the moment that life left his body.

It was the most terrible thing I have ever seen, and I have seen many terrible things having been in medicine for a relatively long time by now. And I won’t write about it any more, I can’t at the moment. Maybe some time when I have a little more time to collect my thoughts and write something more eloquent and appropriate.

Somehow, in the middle of the terrible, horribleness, I also met someone. For a fair amount of time, after the unceremonious email dumping, I didn’t think this was possible. To meet a ‘someone’ again. But, through the magic of many, very encouraging friends, a couple of internet dating sites, and fate (?). It happened.

And that is primarily why I say that even though it has been a terrible year, it has had some good as well. While I watched one of the loves of my life disappear in a terrible, horrible way, another swept in and has carried me through it all.

I called him my Prince the other night. And in his typical, self-effacing way, he poo-poohed it a bit. I don’t know if he knows how much I mean it. The guy might well as ride around on white horse as far I’m concerned.

Through it all, I’ve still been in residency. I was at my Dad’s funeral the day I would have been starting third year. They said a little something about it at the service, which I found embarrassing but Dad probably would’ve liked it.

Several people have commented on the Nurse to MD thing since I’ve been in silent mode, I apologize for the lack of response and promise that I will respond eventually. The middle of third year of surgical residency, after all I’ve just mentioned above, is probably really not the best time for me to objectively comment on making such a move.

So, for the moment, I’ve explained as best that I can.

I am still in residency and of course have to get up early up in the am to get back to it, but I’ve ripped of the proverbial band aid, the new laptop is ready and roaring to go, and hopefully in less than a week, and in much less than a year of good and terrible things I’ll be posting again.

In the meantime, I’ve still been taking pictures. Here are a few I managed to get in the Year of Good and Terrible……..

IMGP3052 IMGP3040 IMGP2985 IMGP2942 IMGP2650 IMGP2814 IMGP2833 IMGP2835 IMGP2646 IMGP2621 IMGP2611 IMGP2623 IMGP2565 IMGP2343 IMGP2352 IMGP2532 IMGP2562 IMGP2404 IMGP2276 IMGP2282 IMGP2285 IMGP2327 IMGP2334 IMG_0098 IMGP2183 IMGP2197 IMGP2215 IMGP2257 IMG_0097 IMG_0096 IMG_0094 IMG_0079 IMG_0076 IMG_0048 IMG_0026

The Daily Something: Working With Med Students

I love working with med students.

I remember very well what it is like to be a med student, and I cringe at all the horror stories I hear about how residents treat med students badly. Especially on L&D rotations. That is total crap. Med school is hard enough without someone taking out their frustrations and residency-related rage on some poor med student who is trying to learn, who we have a responsibility to teach, so they can go out and be a competent resident themselves soon. And hopefully not scare them out of a career choice just because we were an A-hole to them.

But I don’t love working with them because it’s my responsibility to. I actually enjoy the responsibility of teaching, of watching their knowledge expand before my very eyes, their brains soaking it all up like hungry, impressionable sponges. I love that they love that I make at least half an effort to teach, and include them as much as I can, if my evals from this year are any indication anyway. (They were awesome, literally, the biggest self-esteem boost I’ve had in my medical career to date, reversing at least some of the damage Intern Year has wreaked. Forget the diplomas, I may have those evals framed.) And fine, I love working with them because, frankly, I love having a buddy to hang out with in the trenches (so to speak). When we’re working all buddy-cop style, and I’m rambling on about how great OB/GYN is, I remember myself, and when I’m trying to make it fun for them, it always ends up being more fun for me too.

And also, of course, every time I work with them on L&D call it is invariably A Night Of Firsts. With the last med student, it was The First C-Section. I had them scrub in as third assist (this being The First for them, and all). It was a challenging repeat, the baby was (for lack of a better term) a Big Fella, and I got to be primary. So, I was too busy during the actual surgery to pay much attention to how the med student was faring (aside from the fact that they were right there with suture scissors and bladder blade at appropriate intervals, and didn’t appear to be faltering or swaying in any I’m-totally-going-to-pass-out-right-now sort of way).

Afterwards, when we left the OR to put in the post-op orders, I finally remembered my buddy and asked, “Oh yeah! Hey, So what did you think of your first C-section?!” To which my (completely reserved and apparently introverted up to this point) med student compadre replied, “What. Just. HAPPENED in there???!! OH MY GOD!!! There was just…like…stuff….coming out everywhere!!! And then, there was…like…a BABY!!! And it came out…and it was all, like……….”

(Best reenactment I could find of what the med student did at this point.)

(Best reenactment I could find of what med student compadre did at this point.)

I stopped, watching this graphic reenactment, and then I laughed. Really, really hard. For awhile.

I have done, or scrubbed on so many sections at this point, I forget what it what must look like to people who haven’t. There is a reason why it’s is my favorite surgery. Triple-bypass-multiple-transplant-sterotactic-robotic-Whipple’s got nothin’ on us. I mean, I’m always highly aware of this, but med students are Awesome for (graphically) reminding me of it.

I love working with med students.

Birth

It has been a less-than-awesome week. I have repeatedly thought that the best part of this week, is the fact that it is (Thank God) almost over.

But then, it hasn’t all been bad.

For instance, I may have mentioned that I will be traveling to South America this year on a health expedition of sorts, and just going to warn you here, I will (most likely) be ‘mentioning’ it a lot in the coming months until I go, while I am there, and (probably) for many months after I get back. Because it I am very much looking forward to it, and in stark opposition to all the less-than-awesomeness of this week, it is Super Awesome.

As a part of this expedition, I have been attending a regular lecture series on Global Health, and the required reading for the most recent lecture was an excerpt from the book The Spirit Catches You and You Fall Down by Anne Fadiman. The excerpt was from the first chapter of the book and entitled “Birth.”

Naturally, the title of this excerpt grabbed my especially OB/GYN-obsessed attention. But then I read it, and parts of it seemed to literally reach out, poke me in the brain, and then sweetly, almost painfully, squeeze my heart.

Before I explain, here are a few of the passages that particularly poked and squeezed:

[General Disclaimer: For those of you who are less especially obsessed with all things OB/GYN and The Miracle of Birth, this stuff may sound, for lack of a better term, kind of gross. #1 – Just saying, consider yourself warned, and #2 – Your Loss. Now, where were we, Ah yes…….]

“Even if Foua had been a less fastidious housekeeper, her newborn babies wouldn’t have gotten dirty, since she never let them actually touch the floor. She remains proud to this day that she delivered each of them into her own hands, reaching between her legs to ease out the head and then letting the rest of the body slip out onto her bent forearms. No birth attendant was present, though if her throat became dry during labor, her husband, Nao Kao, was permitted to bring her a cup of hot water, as long as he averted his eyes from her body. Because Foua believed that moaning or screaming would thwart the birth, she labored in silence, with the exception of an occasional prayer to her ancestors. She was so quiet that although most of her babies were born at night, her older children slept undisturbed on a communal bamboo pallet a few feet away, and woke only when they heard the cry of their new brother or sister. After each birth, Nao Kao cut the umbilical cord with heated scissors and tied it with string. The Foua washed the baby with water she had carried from the stream, usually in the early phases of labor, in a wooden and bamboo pack-barred strapped to her back.”

“When Lia was born, at 7:09 p.m. on July 19, 1982 Foua was lying on her back on a steel table, her body covered with sterile drapes, her genital area painted with a brown Betadine solution, with a high-wattage lamp trained on her perineum. There were no family members in the room. Gary Thueson, a family practice resident who did the delivery, noted in the chart that in order to speed the labor, he had artificially ruptured Foua’s amniotic sac by poking it with a foot-long plastic “amni-hook”; that no anesthesia was used; that no episiotomy, an incision to enlarge the vaginal opening, was necessary; and that after the birth, Foua received a standard intravenous dose of Pitocin to constrict her uterus. Dr. Thueson also noted that Lia was a “healthy infant” whose weight, 8 pounds 7 ounces, and condition were “appropriate for gestational age” (an estimate he based on observation alone, since Foua had received no prenatal care, was not certain how long she had been pregnant, and could not have told Dr. Thueson even if she had known). Foua thinks that Lia was her largest baby, although she isn’t sure, since none of her thirteen elder children were weighted at birth……When she was six minutes old, her color was described as “pink” and her activity as “crying.” Lia was shown briefly to her mother. Then she was placed in a steel and Plexiglas warmer, where a nurse fastened a plastic identification band around her wrist and recorded her footprints by inking the soles of her feet with a stamp pad and pressing them against a Newborn Identification form. After that, Lia was removed to the central nursery, where she received an injection of Vitamin K in one of her thighs to prevent hemorrhagic disease; was treated with two drops of silver nitrate solution in each eye, to prevent an infection from gonococcal bacteria; and was bathed with Safeguard soap.”

“It is a credit to Foua’s general equanimity, as well as characteristic desire not to think ill of anyone, that although she found Lia’s birth a peculiar experience, she has few criticisms of the way the hospital handled it. Her doubts about MCMC in particular, and American medicine in general, would not begin to gather force until Lia had visited the hospital many times. On this occasion, she thought the doctor was gentle and kind, she was impressed that so many people were there to help her, and although she felt that the nurses who bathed Lia with Safeguard did not get her quite as clean as she had gotten her newborns with Laotian stream water, her only major complaint concerned the hospital food. She was surprised to be offered ice water after the birth, since many Hmong believe that cold foods during the postpartum period make the blood congeal in the womb instead of cleansing it by flowing freely, and that a woman who does not observe the taboo against them will develop itchy skin or diarrhea in her old age.”

Now I will tell you why these passages, and really most of the excerpt (you can find the whole of it Here, if you are so inclined), struck me so deeply. Practicing in an infinitely larger, and more ethnically diverse city than I have ever worked in before, part of the reason I wanted to come here (i.e. from a place where the greatest diversity is the difference between a Northern or Southern Norwegian ancestry. With the occasional Dane thrown in to really shake things up), I have had the opportunity in the last many months to do a number of deliveries with just me, an attending hovering somewhere in the general vicinity, a woman completely dilated and crowning, and an interpreter phone on speaker on the bedside table. And/or a selected family member hidden behind the privacy curtain translating things like “Try and hold your breath when you push!,” or “Don’t push!,” or “It’s a Girl!” in a wide variety of languages.

My heart aches for, rejoices with, and is captivated by every woman whose baby I get to bring in to the world, but it in particular, it goes out to these women. With every one of them, I can’t help but wonder what it must be like to deliver your baby in place where you can’t even speak to the person who is doing one of the most personal things one person can do for another. I know I that feel frustrated by the wall that is essentially, metaphorically, linguistically thrown up between us. But I think, I know, that it must be that much harder for them.

And then, even besides being robbed of the ability to speak for themselves in such a situation, I wonder, and I worry about any number of their taboos, customs, or traditions I might be breaking or clumsily, unwittingly stomping all over. I wonder how different, maybe frightening, and maybe offensive it must be to deliver a baby in the rather sterile, authoritative, Western way that we are accustomed to, as opposed to whatever way they may have experienced, envisioned, or understood.

I can’t help but wonder and worry, and these passages in particular gave me some insight into how it must feel, and as to what sorts of beliefs and customs I might be clumsily trompling all over.

As with any soon-to-be new mothers, I do try to show them in ways that, I hope, transcend any walls, that I care. In whatever ways seem to be necessary at the time, encouraging nods and smiles, or a 5 second you-can-do-this-and-I’m-not-going-anywhere-until-you-do look, or with gentle hands that lay a baby on their belly with the sincerest saying of “You did it. And your baby is so beautiful.”

That last of which, I wish I could say in every language, because every last one of them, even if they don’t speak any other words of English, always looks at me and says “Thank you Doctor.”

Just slays me. Every time.

Therefore, I will get up, very early, and go back to work again tomorrow. Because those moments mean more than any amount of less-than-awesomeness.

And I suppose at least, in preparation for my South American health expedition of sorts, I am attempting to learn Spanish. Very quickly. So far I can say things like “The cat has water,” or “The horse drives a bicycle.” Don’t know exactly how helpful those phrases will prove to be on a health expedition, but I still really enjoy saying them as often as possible, to as many people as I can.

And, on that yes-I-am-obviously-over-tired-and-should-go-directly-to-bed note, Buenas noches amigos!

Golden Weekend

Golden Weekend.

A resident’s favorite two words. Right up there with “sleeping in,” “good job,” “free food,” or “free [insert pretty much anything here].” Yes, Golden Weekend sort of sounds like something from a Bob & Tom song, that could be kind of dirty (fine, that’s probably just me), but actually (in the context of residency anyway) it means A Whole Weekend Off.

[Cue Choir of Angels Singing]

Last weekend I had my first Golden Weekend in a very long time. Sure, I ended up working on work-stuff for most of it, and a fair portion of it was devoted to making sure I have a healthy supply of clean clothes, a (somewhat) clean (-er, -ish?) apartment, and stocking up with Pop Tarts and Diet Coke – normally menial activities that are transformed into Simple Pleasures Of Life when one never usually has the time or energy to do them, and is regularly forced to wear their most last-ditch, wedgiefying of undies due to a lamentable lack of clean, comfortable granny panties, live in an apartment that appears to be occupied by a small horde of (very messy) squatters, and to eat stale whateverisleftinthecupboard surprise at 4-5 am before they shower (And, okay, sometimes while showering. It’s a whole Time management strategy/Way to sleep in for five, blessed more minutes thing I’m perfecting) and leave for work.

But, by God, I did it all when I darn well felt like it, usually after 12-14 hours of beautiful, beautiful IhavetheWholeWeekendOff sleep (the very best kind).

Of course, I also made time to combine my now quarterly exercise routine (Not counting running around Big Giant Hospital every day with a very heavy back pack and/or bag ‘o gyn supplies, which does totally count as exercise btw. Because I make a point to take the stairs and/or the long way. Usually. Usually because I am lost. But still.) with a photo expedition.

Which sounds really exciting, except it was just walking up a hill and then around the historic cemetery that is just a couple blocks from where I live. Which sounds less exciting and more weird now, I know, but it was still rather exciting.

Erm, let me explain.

First of all, this activity was free (I did mention how virtually anything that is free is very exciting for most residents), it was an unseasonably, very nice day to be out getting a person’s quarterly exercise in the form of a very long walk, and this historic cemetery is actually sort of a giant park in the middle of the city (it has lots of trees, and even a lake). Right, still sounds kind of weird.

Well, as I explained to one very skeptical (and possibly, slightly concerned) friend, the cemetery really is a Historical Site (registered and everything) where many famous people are buried. And, in addtion to all the cool history stuff (I really like history stuff), it is chock-full of beatiful stautary, and other such memorially, monumental-type things. All of which I have really wanted a crack at taking pictures of since I first went there with The Writer many months ago, and was drug out quite unwillingly after only a paltry half hour or so of just barely glancing at very interesting things, to go eat sushi or something.

[Cue indignant grumbly noises]

So it was my chance to go back, taking as long as I wanted, to see all the fascinating historical stuff and take pictures of it to my heart’s content. In still, fine I will admit, a somewhat odd setting. But, really, it was so interesting. To read the stories of the people, or to try and construct them from what little information was available on tombs or various family plots. To try and imagine what they or their lives were like, to remember them, and pay homage in a way by taking (hopefully only good and properly tasteful) pictures of what they left behind, at least in this their final resting place, to be remembered by.

And I don’t think that is so weird. To be curious about people, to pay respects, and to want to remember them. Because, really, isn’t that what we all want in the end? For someone to think about us when we’re gone? To be remembered……….

 

016

 

 

244 245 246 247

 

 

250

 

 

238

 

 

084

 

 

087

 

 

237

 

 

236 235 234 233

 

 

228

 

 

219

 

 

209

 

 

207

On a roll…….

It’s kind of funny how life just keeps on rolling, taking you along with it, ready or not. Rolling through the events, and tasks, and days. The things that you work for, work at, anticipate (or dread) for long periods of time. You wonder how you will get through, how you will get it all done, how you will handle it. And then, Life pushes you right on through, and before you know it, instead of (perhaps a tad obsessively) looking ahead to them on calendars or To Do lists, they’re done, and you’re looking back. The To Do’s, events, and days are reduced to memories, and you look back on the mental slideshows, wondering how time moved so quickly.

I’m mostly relying on mental slideshows to review the last week and weekend, seeing as how I relinquished camera duties to my brother and The Writer, and don’t have the ridiculous scads overload of digital camera evidence I would otherwise have if I’d been at the photographic helm. My brother nailed all the important shots though, securing the necessary “evidence” that I did, indeed, complete the last four years successfully.

I made it through all the graduation hoops and hoopla. I did it my way, which made it a little easier, with the brother always at my side or in eyesight to keep me going. Heckling me or making me laugh (as only my brother can), squashing the nerves and panic with well-timed insults or dirty jokes (you don’t even want to know). I don’t know how to explain why such events freak me out to such an extent. Maybe it’s the introversion, maybe it’s the fact that the last four years were mess for me outside of the clinic and classroom, maybe it’s that those events mark the massive responsibility I am about to take on for the well-being of other human beings, maybe it’s the fact such a fuss seems silly and unnecessary to me when I’m not really doing anything that actually contributes to earning the degree.

I kept thinking, if I had to jump 16 school buses, through a burning ring of fire, on a dirt bike Evel Knievel-style at graduation before they’d give me my diploma, now that would be something to dress up for and invite the extended family to watch. (Not to mention, I didn’t even get my diploma at graduation, and none of this is going to be real for me until I am holding that paper in my sweaty little paw, tyvm.) I also kept thinking that dealing with a six car pile up right outside the hospital, wouldn’t give me a fraction of the nerves or flop sweats that walking across that stage for 10 seconds did. (Thank you prescription-strength deodorant.)

I can’t explain it. But I made it though, without unduly embarrassing myself or anyone else in the process (at least I don’t think I did, you never know), and I guess I don’t have to explain it.

It’s all just a bunch of memories now.

And I still seem to be on a roll, taking care of the endless To Do’s, rolling right on down the list like it’s my job. (Which, yeah, right now, I guess it sort of is.) Letting life push me forward, ready or not.

For the love of……

Right.

So I finally sat down to write this long overdue, take that Writer’s Block, here’s what’s going on with me post, finally got it done, hit Publish, and……Blam. It’s gone.

What the…..??? Sonofa!!!!!!!

I am just……so……

GAAAAHHHHHHHHHH!!!!!!

I don’t even know.

I am going to go drink some wine until I figure it out.

The Flu ends with U!

Have you gotten your flu shot?

Well have you?

Because according to the CDC, Influenza activity in the U.S. is currently on the rise. That’s right, it’s off to the latest start in decades, but Flu Season has arrived. I was not exactly surprised to hear this news today, as over the last couple weeks we’ve had at least two patients per day testing positive for influenza. Not that we really even have to test them because they tend to stand out amidst the usual crowd of snot-nosed snifflers. They are the ones who look like absolute H*ll.

What has surprised me is that not a one of the people who’ve presented with the flu bothered to get a flu shot this season. With rationales ranging from “Well, I never get the flu” to “I never get a flu shot, just thought I didn’t need one.” That last one was, to my horror, from another health care professional.

Wrong-O.

According to the CDC, EVERYONE from age 6 months on up, should get a flu shot. Unless one of the following applies, in which case, you should consult with your physician before getting a flu shot:

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination.
  • Children younger than 6 months of age (influenza vaccine is not approved for this age group), and
  • People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)
  • People with a history of Guillain–Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Tell your doctor if you ever had Guillain-Barré Syndrome. Your doctor will help you decide whether the vaccine is recommended for you.

So why is it so important that you get a flu shot?

Because not only does the flu shot protect you (yes, even if you are a young, strapping, healthy specimen of humanity who has never had the flu) from getting the flu and being completely miserable for an extended period of time, it also protects highly vulnerable populations like the elderly, the sick, and children who are most likely to die from the flu. You know, when you don’t get a flu shot, get the flu, and then (even if it’s inadvertently) infect them.

That’s right, this isn’t just about you.

I was on a rotation a couple months ago and the attending was particularly passionate about reminding patients to get a flu shot. Several years ago, they had successfully helped a couple who had struggled with infertility for years to get pregnant. The couple had a beautiful, healthy baby and at a return visit, as part of usual care, the attending reminded the new parents to get their flu shots. One of them refused because they just didn’t feel they needed it. They got the flu, gave it to the baby, and the baby died. The parent later came back and asked my attending to tell their story to all their patients, and make sure all their patients get flu shots. This story is tragic, horrific, and I am absolutely not making it up.

This is why it is so important for EVERYONE to get a flu shot. Not only are you potentially saving yourself from weeks of misery and adding to your immunity for future Flu Seasons, you are potentially saving a life.

If you haven’t gotten your flu shot already, you still can. It takes about 2 weeks for full immunity from the shot to be in effect, so do it now.

And while you’re at it, spread the word: CDC’s Flu Vaccination Pledge.