Tuesday, December 15, 2009

Making it Feel Like Christmas

As I have mentioned previously, I have had a hard time getting into the spirit of Christmas this year. Christmas shopping was a bit stressful this time around, Spiff was very busy in his surgery rotation, and our vacation with my family has seemed so far away! But I have finally managed to catch the Christmas Bug, and I am very excited about the upcoming festivities. I realize that I am responsible for making it feel like Christmas. I also realize that this will be more important to my family as Gunner gets older, so for future reference, here are a few things we did this year that helped me get into the Christmas Spirit...

My friend, Maggie, gave me a Christmas tree! Pretty awesome gift, huh? They bought a new one last year, and she gave us this great little, pre-lit(!!!) tree, which Spiff and I decorated, and which I am completely in love with! I love the lights, and they have been on every waking hour since we put it up. This little tree has been a great centerpiece for our family this month, and was the thing that really helped me oust my humbug. Thanks, Maggie!

Apparently, it's very important for me to decorate my home in order for it to feel like Christmas. We put up the tree, an advent calendar on the wall, and our fabulous Playmobile nativity scene, and it makes me giddy to go into our living room!

We also attended a Christmas festival in the historic district of a local suburb. We got bundled up, braved the cold, and walked among the festive streets. We tried chestnuts roasted on an open fire for the first time. They're very good, but oddly taste a bit like potatoes. And we watched the Santa Claus Parade, filled with all kinds of Santas, carolers, and even the Sugar Plum Fairy. Very fun!
Uncle Sam Santa?
Frontier Santa

So, Merry Christmas! We wish you all have a wonderful holiday season!

Friday, December 11, 2009

5 Year Ago Today...

Spiff and I Got Married!

Our Wedding Luncheon, post ceremony:
The Winter Wonderland Reception:



Happy Five Years to Us!!!

That's what we were doing five years ago.
Spiff's sister was defending her BA Honors History Paper (well, that...and attending our party). What were you doing?

Sunday, December 06, 2009

The Homeless Man

Gunner is apparently aspiring to be a hobo when he grows up. He has a diaper box which he pushes around the house, filling with various and sundry articles of interest. Currently the rather weighty contents include: 1 empty 2 liter soda bottle, 1 24oz parmesan cheese container, 6 boxes of easy mac, 1 empty box of wheat thins, 1 tupperware full of cheerios, 1 3/4 cup measuring cup, 1 jumbo Lego, 1 Power Ranger cell phone, 3 floating bath animals (a whale, a polar bear, and a starfish), a container of hand lotion, a rubber spatula, an aluminum trivet, a Kitchenaid serving spoon, 12 board books, and a silicone oven mitt. I guess wherever he decides to settle he'll be well fed (assuming he can get into the easy mac), and entertained.

Fast Sunday

I'm having a first today. Well, not a Real first, but a first-in-a-long-time kind of first. I'm not pregnant, and I'm not a nursing mother anymore, so I'm fasting. And oh, boy, I forgot how difficult fasting is. First of all, I forgot about the blessed occasion until after I had already cooked oatmeal for Gunner and me for breakfast. Just as I was about to spoon it into our bowls, Spiff reminded me that it is, indeed, Fast Sunday. So I replaced my bowl into the cupboard, fed Gunner, and listened to him hum away as he enjoyed what was Going to be my breakfast.

Also, I am in the nursery, and snack time was slightly torturous for me today. I do enjoy the fact that we nursery leaders get to enjoy snacks with the kids. It is a small, but delightful, perk in such a difficult calling. But since I couldn't have my Craisins and animal crackers today, at least the kids were well behaved.

Now I'm home, waiting around for dinner time, and I'm having to fight the strong urge I have to be crabby with my family. My body thinks that my belly button is well on its way to merging with my spine. My stomach thinks that I have betrayed it, and it has absolutely convinced my mind that I might Not Ever Eat Again.

I will admit that I was able to listen to and absorb more of the testimonies in Sacrament Meeting today than I have in a long time. Whether that was because of my renewed efforts in fasting, or because Gunner was actually a good, non-temper-tantrum-throwing boy, or a little bit of both, I'm grateful to have felt the Spirit today. I guess that's why we do this to ourselves. Right?

Thursday, December 03, 2009

Ho Ho Ho

Gunner met Santa in the mall yesterday. He was walking the halls during a break, drinking a Mountain Dew. Gunner looked at him like he looks at all strangers, with a uncomfortable stare that I know as, "Mommy, someone is looking at me." He was otherwise unfazed by Jolly Old St. Nick. And no, I didn't get his picture taken with him.

Thursday, November 26, 2009

Pet Peeves

What is this? This is the worst doorknob that mankind has ever designed, patented, and produced.
Unfortunately, our house is equipped with five of these masterpieces. As you can see, it readily separates into at least two pieces. The metal rod that you can see doesn't quite fit the hole it's supposed to fit in, so even when the whole miserable assembly is in situ, it rattles around. It rattles around in the lock, and it works its way loose from the horrible glass knob as well. Basically, there could not be a more annoying doorknob. I actually prefer using a screwdriver which fits the hole and, despite being removable, doesn't have to be adjusted twice a week.

Tuesday, November 24, 2009

It's Christmas Time!

Yeah, yeah, yeah, I know that Thanksgiving is in two days. And I'm very excited to spend the holiday with friends this year! But I have spent all day working on Christmas gift projects, and it has gotten me all "in the mood for Christmas Cheer". Well, sort of. I have finally started my shopping for the season (hooray for me!). However, I am feeling a bit like a humbug this year because I have no great gift ideas. None! For any of my family or friends. Add that to the fact that we're living on a student budget, and my inner Scrooge starts grumbling.

On the bright side, we get to spend Christmas with my family this year! I'm so excited about that that I can hardly stop myself from packing tomorrow and camping out at the airport for the next month. I know that once we get on the plane, all of the stress of shopping, the Christmas parties and concerts, and the Christmas cards will be mostly over, and it will be time to party! Family, prime rib dinner, egg nog, pie, games, and lots of people around to entertain Gunner for the entire vacation! Let the countdown begin!

Sunday, November 22, 2009

A Happier Family

So, it turns out that Gunner was sick for about three weeks. First with a cold (that Spiff & I had, too), and then his "lingering cough" got worse and we realized that he was really quite sick with something else. Poor little guy. He was so whiny and awful for the past month, and I thought it was just a behavioral phase. Oh well. At least he is feeling better and is back to his cheerful self, and at least we now have a frame of reference for what he is like when he feels like poo.

Monday, November 16, 2009

Voice of Experience

My other sister came to visit me last week. For a whole week. It can hardly get any better than that, and I am very grateful to her and her family for their sacrifice in making that visit happen. It was, again, so nice to have my sister around for the companionship, the familiarity and comfort. Most of all, although it was not her intention to come and give us parenting advice, I appreciated her sharing her experience with us.

Gunner is at a difficult age for me. He is so interactive, cute and fun, and I love him, BUT he is whiny. And he throws tantrums. And he whines while he throws tantrums. And then he whines because he threw a tantrum. And then he throws another tantrum because he feels like he didn't whine loudly enough. So I feel like I am fighting him all day long. Things that used to thrill him now throw him into hysterics.

For example, here is an interaction we have several times a day. (I have included his actual actions and what I think he would be saying if he could talk.)
Me: Would you like a cracker?
Gunner: Throws his head back and wails...NOOOO! I Don't want a cracker! How could you think I might have ever wanted a cracker?! My Life Is Now OVER!!!

That's right. All the drama, over a cracker. Or a drink of water. Or a toy. You name it, and he overreacts about it. There is definitely a learning curve for both of us here. He is learning how to handle all of these new emotions, opinions, and preferences. He is learning how to push my buttons. I am learning how to deal with a person w/ opinions, and how to deal with a person who won't let me comfort him.

That's where my sister comes in. She has three daughters, age 10, 7 and 2. She has dealt with her fair share of fits and temper tantrums. Her philosophy about temper tantrums is this: If you're going to cry, you're going to cry in your room, or on the floor, or wherever, but basically you're going to figure it out. Her two-year-old goes to her room to cry, and if my sister checks on her and she's not "done", she'll say, "I'm Crahying. Geet Out!"

One day during my sister's visit, Gunner threw a tantrum, and we tested her philosophy. What happened was a lot like this kid from youtube. Although not quite as extreme, Gunner did follow us around the house for about five minutes, crying when we could see him, and calming himself down after we had left the room.


I am now working with Gunner on an attitude adjustment that consists of two things:
1) I'm trying to teach him to decline an offer by simply saying, "No Thank You". Any version of this will do, but I'm trying to avoid the hysterics over being offered a cracker. This already seems to be helping.
2) I'm also trying to teach him that he doesn't get what he wants by throwing a tantrum. I will understand his need to cry about it, and I will give him the space to do so. When he has calmed himself down, then we can "talk".

I know that he is very young, and that these may sound a bit harsh, but if there's one thing I learned from my sister's visit, it's that my little son knows exactly what he's doing, even at this young age. And if he won't let me comfort him anymore, then he has to learn another how to comfort himself.

She also taught me that I take myself and my son too seriously. It's difficult for me to be goofy and have fun with him when I'm tired, but it's very important to mix the fun with the rest, and I had forgotten about that. I hope I don't forget it again.

Tuesday, November 10, 2009

Up To Here

We are fed up. Gunner wakes up at 5:00 a.m. What do you even do with a baby at five in the morning?!?! I am not a good mommy at 5:00 in the morning. I can do 6:00, but I cannot to 5:00. I can't even think about being a decent mommy until six. Last week, I decided to concentrate on teaching him that the day doesn't start until at least 6:00. But in order for me to get a few minutes of extra sleep, I have been nursing him in the morning. So, when he wakes up (always screaming!), I take him into bed with me, nurse him, and make him cuddle me until at least 6:00. The result is that he sometimes snoozes until around 6:30, but usually he and I just end up fighting and I end up getting up in a bad mood. And I have had it up to Here (my neck, my eyeballs, highest reach...take your pick) with starting our day this way.

I read that some babies wake up early when they expect breakfast right away, so we should delay feeding them until a "normal" breakfast time. So, we don't sit him down for cereal until 7:00. Does this mean that that I need to delay (or just cut out) that early morning nursing/cuddle, too?

Also, I hear everywhere that we need to push back his bedtime about 10 minutes each night so that he gets used to a slightly later bedtime, which might then convince him to sleep a little later in the morning. I am hesitant to do this for two reasons. 1) He seems to always wake up at generally the same time in the morning, no matter what time we put him to bed. 2) He is so tired in the evening after being awake since FIVE, that it's all we can do to keep him up until bedtime. And generally, it's a miracle if he's still alive at bedtime since he is so tired and cranky that we can hardly stand him!!!

I have talked to several moms who say that they nurse their babies around 5:00 in the morning, and then put them back to bed. It works for them, but I don't think Gunner would ever go back to bed. Especially since bedtime is between 6:30-7:00 at night, and by 5 a.m., he has already been asleep for 10 1/2 to 11 hours!

So, what do we do with him? Does anyone else have early risers? What have you done that works for your family? And how do you cope with them?

Wednesday, October 28, 2009

News.

We are changing the way this blog is administered. As of 11/1 this will blog will be by subscription only.

If you would like to continue to follow our drab little lives, email us and we'll put you on the subscriber list.

Sunday, October 25, 2009

Neuro Psych

So I haven't posted in a while, but not because I haven't had anything to say. I have spent the last 4 weeks doing inpatient psychiatry at our inner-city hospital. Daily, schizophrenic patients abstaining from their medications would report to the ER or were brought by the police after being found cursing in the street or doing other disorganized behavior. We had a gentleman with multiple personalities, numerous heroin addicts, an anti-social personality, a borderline personality, multiple suicide attempts or gestures, and of course generic psychosis and delirium. I live a very sheltered life, it turns out. I never really realized how well off I am, despite living on a pittance from student loans, until I saw the effects that devastating mental illness had on these folks. You never really think twice about being able to evaluate the world realistically and act accordingly until you meet people who can't. It was disheartening, really, to help bring a schizophrenic patient down from his floridly psychotic state to a less psychotic, but still rather disorganized condition, discharging him, and knowing that in 2 months or less, he would have stopped taking his medication, or not followed up or been lost to follow up, and likely be gracing our ER again.

The downward drift hypothesis of schizophrenia certainly holds true in the city here. This hypothesis posits that schizophrenia is more common among lower income echelons of society, either because of their low income status, or more often because their schizophrenia causes them to lose employement and become a marginalized member of society. Most of our patients drifted from group home to group home, and living intermittently on the street until they were sick enough the police found them and brought them to the hospital. Dante outlined concentric circles in Hell, and presumably there are analagous realms in Heaven, the more exalted of which are occupied by Social Workers. The social workers on 4 West Psychiatry Service found these people homes and case workers who would follow them and ensure, to some degree, that they recieved and took their medication. Their tireless efforts ensure that, at least on discharge, our patients at least had a roof and food.

Depressing as the schizophrenic patients were, the heroin addicts were worse. They would come to the ER either having OD'ed, run out of dope and detoxing, or allegedly wanting to go to rehab, which usually happened mostly on cold nights. If they only wanted a roof, they left AMA (against medical advice) when the weather warmed up, or when their cravings got bad enough, usually after 36 hours or so. The really sad cases were those who wanted, or at least convincingly acted as though they wanted (drug addicts will make you cynical very quickly) to get clean, but would then leave as soon as the craving for heroin overpowered their higher cortical funtion. The ol' limbic system is pretty powerful compared with the puny little cerebral cortex. One trio went so far as to stage a little drug reunion in the parking lot after leaving AMA. Sadly, two of them were at a point when they really could have changed, gotten clean, and moved on in their lives, but instead chose to piss away what little meaningful trappings of life they had left.

I can never practice Psychiatry because there is so much of the patient's social environment that factors into their illness but that lies outside the realm of any intervention I can make. It is arguable that this is true in all medical specialties, but I contend that it is to a lesser extent. So much of psychiatric illness stems from problems in childhood, abuse, poor education, low income, poor housing, poor mobility, poor literacy, poor parenting, that a psychiatrist can only do so much to ameliorate. Combine the underlying socio-economic problem with a pharmacological arsenal that is rather limited, and psychiatric illness becomes a daunting and frustrating thing to manage.

I never fully understood the logic behind giving a patient SSRI #1 v. SSRI #2 , and then why schizophrenic patient Joe took antipsychotic X which we then switched to Y , thinking of perhaps combining with Z and W as well. Perhaps that's my fault as a medical student, but as I have alluded to in other posts, psych meds are difficult to understand because of the combinations of receptors that they interact with, as well as the fact that the underlying disease is very poorly understood from a molecular biological standpoint. Take my patient "Joan", who took: Seroquel (quetiapine, an anti-psychotic with anti-dopamine and anti-serotonin properties), Modafinil (an atypical stimulant type medication whose mechanism is unknown), Celexa (a selective serotonin re-uptake inhibitor (SSRI)), and a few other non-psych meds. It would be extremely challenging, based on the known mechanisms of those drugs, to predict how they will interact with one another, let alone the underlying psychiatric illness, which in this case was a personality disorder more than depression, and thus more likely to be refractory to medication in the first place! (take that, grammar snobs! 'twas a run-on sentence!)

I bid adieu to neurology/psychiatry and will now enter the cut-throat world of surgery (no pun intended). I have the following rotations: pediatrics, pediatric urology, general adult, and orthopedics. At least I will be back in children's hospital which is much nicer than the adult hospital next door. As I know that there are surgeons who read this blog, I will be diplomatic in my analysis of this rotation. I fully expect to be the low man on the totem pole, in this case the little raccoon-man who is parked 2 feet underground holding up the rest of the totem pole so that admiring tourists can gush about the woodwork.

Our Tiny Toddler

Gunner is getting so good at walking. We had such a beautiful Fall day one day last week, so I took him on a little walk outside. He loved it! He walked a block in about an hour. He liked all the leaves on the ground, and he was absolutely fascinated by each set of stairs we passed. He's a pretty good climber, too. He doesn't know how to get back down safely yet, so I spent my time heaving him off the landings and redirecting him back down the sidewalk.

This is a video of my view as I walk behind him. He's a pretty stinkin' cute tiny toddler!


The title of the video is a reference to our friend's little boy who couldn't remember Gunner's name, so he called him Baby Jones. In their family, we are now called Spiff, Windy and Baby Jones.

Friday, October 23, 2009

Gunner's 1st Birthday

Last week, we celebrated Gunner's first birthday. I can hardly believe that he is one already, but watching him talk and talk (babble is more accurate) and walk around the house leaves me with one conclusion... Yep, we have a toddler! And I have to deal with the initial shock of that realization, and the terror that grips my heart when I realize that I have no idea what to do with a toddler, especially a toddler boy. It is seriously a different beast, and it happened almost overnight. Since he started walking and "talking", he has decided that life is just too fun to ever ever slow down for a nap. And those teeth and the shots from the 12-month doctor's visit just clinched things for him, and not only does he think that napping is now optional, he also thinks that morning starts at 5:15 in the morning.

Yes, I did write 5:15!!! In the morning!!!

And remember, naps are now optional. Which means that he usually chooses to opt out.

Sigh.

Anyway, about the birthday festivities. We had a great time. First, my sister was in town, and so we held a little "party" before she left. Lucky Gunner got to dig in to this cake 5 days before the big day.
I must admit that I was pretty excited about the cupcake eating/smashing experience. He loved it, and he was the perfect little performer. When he figured out that he had a yummy, sweet cupcake in front of him, and it was all for him, and he had permission to actually eat it, boy did he dig in. He started by sucking all of the frosting off the top, and then proceeded to devour the entire thing, other than what he smashed onto his hands, belly, face, hair and ears.

We continued his birthday celebrations over the weekend when some friends came into town from Minnesota. We went downtown and visited some parks and the Old Courthouse. We went to the zoo, and we ate a yummy BBQ dinner. Then lucky Gunner got to dig in to this cake:
This time, he wanted to eat the whole thing (all twelve cupcakes in the stack), and when Spiff took the cake back to the table after blowing out the candles, Gunner lost it. There was too much excitement and not enough cake for him, and he cried uncontrollably for a good two minutes before he realized that there was in fact another yummy cupcake sitting on his tray, all for him. He devoured that one, too.

He also got spoiled with lots of fun presents from his aunties, grandparents, friends, and us, of course. And I have loved having some new toys around this week. He is in heaven, carting his new soccer ball, cars, fishies, books, and stacking cups around the house. That's just all part of the fun that is this new life called Toddlerhood.

Wednesday, October 14, 2009

On Being Alone

I have an adorable little two-year-old niece who, like me, has two beautiful older sisters. I think she is a very insightful little girl because she feels lucky to have sisters. As I was visiting with her family not long ago, she walked past me, and in her sweet sing-song voice said, "I go play with my sisters!" As she rounded the corner to the play room, she sung out to them, "Hello, Sisters!"

I adore my own sisters, and I miss them every single day. One of them came to visit me last weekend. We had a great time together, and I'm so glad she came. But then, as I drove up to my house after dropping her off at the airport, I felt my heart sort of sink into my stomach with the thought, "I'm alone again."

I don't mean to sound depressing, or in any way ungrateful for my circumstances. Of course, I have Spiff, and I am so grateful that he loves me and comes home to me every day after his long, hard days of school/work. And of course, I have my little Gunner, who is with me almost all of the time. I have a constant companion who loves me so completely that I hardly dare ask why. So I'm not really alone. But I feel like it sometimes when I find myself facing daily life and my mountains of chores.

I bring up being alone because having my sister here was so refreshing. It was so very glorious to have some company. We ran errands together. I carried the bags, and she carried the baby. We cooked dinner together. She chopped, I stirred, and the food was finished and on the table in half the time. We talked, and she gave me an outlet for my insatiable need for conversation. We watched movies, hung out, and laughed until we cried, all in a way that only sisters can.

So when she left, I admit that I felt sad and a bit incapable of facing those mountains of chores...alone. Now imagine the big sigh, and me trudging up my large front stairs, head down, with the sad Snoopy song playing in the background.

And then a friend called me up and came over for a visit. We hung out together with our kids, talked, and ate lunch together. She probably didn't see it as an act of service, but it meant the world to me. For a few hours, she took my mind off of the fact that I'm not going to see my sister for months. She kept me company, I hope she knows how much I appreciate her friendship.

I feel like I am a fairly independent person. I enjoy running alone. I do most of my errands and shopping alone. I can eat alone at a restaurant. I have even gone to movies by myself. I enjoy having alone time. (Doesn't some time alone, without a baby crawling all over you, sound just divine?) I think that independence is an important quality to have. But I can't help feeling that sometimes, things are just better with some company.

I have great friends here, and I hope they don't mind me leaning on them when I feel lonely. They make it possible for me to be okay about being so far away from my sisters. They make it bearable to say "Hello, Sisters!" from thousands of miles away. They make it bearable to face the mountains of chores "alone".

Tuesday, October 06, 2009

Only 25 weeks to go!

I was finally able to schedule my anesthaesia electives for the spring, and they're in only 25 weeks! All I have to do is make it through 3 more weeks of psych without tearing my hair out (trichotillomania), 8 weeks of surgery, 12 weeks of eternal medicine, and then the promised land! For the mathematically inclined, I have a two week christmas vacation during which I will sleep.

Psych/neuro has been the nadir of 3rd year thus far, which they will hopefully remain as I would like to enjoy the rest of the year. I don't enjoy the pigeonholing arbitrary nature of psych. Everything has to fit into a neat little DSM IV rubric. If your patient has been depressed for only 3 weeks and 3 days, they aren't technically depressed yet ( or somesuch crap, I don't care to look up the criteria right now), but it doesn't matter any way because they still get an SSRI. What if your patient is 86% of her ideal body weight, but is still binging and purging? Well then she's not anorexic, she's bulimic! (binging and purging are found in both anorexia and bulimia, percentile body weight is actually used to distinguish the two.) But if she loses 500 grams, then she's anorexic! These categorizations are totally arbitrary and more or less pointless because they don't really affect therapeutic decision making.

Psychopharmacology also sucks. The names of the drugs are all confusing, and the trade names sound like the generic versions of other drugs. That, and they're all very dirty drugs which act on multiple receptors and have about a dozen effects and two dozen side effects. These drugs are not like blood pressure meds, for example, which have well understood mechanisms and a relatively straightforward effects. Additionally, there doesn't seem to be any rhyme or reason as to why one patient gets SSRI X while another gets SSRI Y. 2.5 weeks left until I prostrate myself on the shelf exam and hope to heaven I pass.

-SS

Friday, October 02, 2009

Attack of the Tooth Fairy

One Tooth, Two Tooth, Three Tooth, Four;
Today we found a third tooth, and then One More!

We discovered his third tooth today, and then just before we put Gunner to bed tonight, I thought that his gums were looking awfully swollen. Plus, he has been a complete bear for several days. We were sure that the fourth tooth was going to be following that third soon, but I didn't expect to find that it had also broken through today! No wonder he has been having a rough time lately. Two new teeth in one day!

Three Teeth

Gunner has his third tooth! Today he added his upper left to his collection of two bottom teeth. We're so very excited!

Thursday, October 01, 2009

Parking Troubles

I got a parking ticket today for forgetting that it was street-sweeping day (darn first day of the month snuck up on me). And then a parking meter ate my quarter!

Is that bad luck? Or did I anger the Parking Gods?

Monday, September 28, 2009

My New Job

I have started a small part-time job as a choir accompanist. I was not looking for a job, and didn't really want to start working, since I have Gunner at home and Spiff is a busy 3rd-year bee. And then an opportunity jumped out at me from out of nowhere, and I couldn't turn it down. A voice teacher I knew while working as an accompanist at a local university called me a few weeks ago and offered me the job. I hadn't spoken to him in a year and a half, and I am quite surprised that he remembered me. He told me that his former pianist quit at the last minute, and he practically begged me to take the position. The choir is a "class" at a pharmacy school, made up of students who want a form of artistic release in the midst of all of their scientific studies. They meet twice a week, and usually only half of the choir is present at each rehearsal. He assured me that it is a very low pressure, low stress gig. So after talking to Spiff and convincing many of my friends to help watch Gunner, I decided that it was a good opportunity for me, and I took the job.

I have been doing this for about a month, and so far it seems to be working out. I think it is nice that Spiff has a scheduled evening to be with Gunner. It is also nice for Gunner to spend one-on-one time with daddy, and to get out and play with other moms and kids during the weekly rehearsal. It's so much fun for him that he thinks he has died and gone to heaven for two hours a week.

It is also giving me a chance to play the piano and exercise my brain. I am so badly out of "piano shape", and I can feel my fingers and my mind being stretched like taffy while I play warm-ups and parts, and sight read. This is pretty easy stuff, too, and I'm surprised at how much I find myself working at it, considering that accompanying (sight reading, sight reading and sight reading!!!) was what I spent the majority of my time doing while in college and grad school. So, I am grateful for this new tiny job because it's giving me a small chance to get back some of what I have lost over the last few years of ignoring the piano.

Thursday, September 24, 2009

Let's Go For a Walk

Big news around here. Gunner is walking! Well, Gunner can walk. He normally chooses not to. We practice with him in the usual way. We stand him up and coax, encourage and plead with him to give it a try. Because "we know you can do it!" "Come on, little guy!" "Come to Mommy!" And then he gets his balance, lets go of our hands, takes that little step, and then another one, and pretty soon, he is hobbling around, with his arms flailing in every direction. He has absolutely zero control over his direction. In fact, if we send him in a straight line, when he is aimed right at his daddy, his body just veers its little self a completely different direction, and pretty soon, he finds himself landing on his nose. Again. And then we cheer, and we act like there has never been a more exciting event, ever. And no one has ever been more proud of any accomplishment. And he smiles.

And then we start it all over again.

He is getting better at it, and he knows it. Little by little, he becomes more daring. This morning, I left him cruising around the kitchen chairs while I puttered around the house. I walked in on him standing in the middle of the kitchen. I could tell that he had a goal, and he was getting up the guts to go ahead and walk right on over to it. He was concentrating so hard. And then, of course, I interrupted him, and I had to cheer and praise him, and rush right over to him and tell him how awesome he is. So he never made it to whatever it was that was exciting enough to let go of the kitchen chairs and walk across the room on his own, with no coaxing and pleading.

I'm loving this. It is so much fun to watch him discover, and to see how he learns so quickly, and to see how independent he is becoming. It will take me some getting used to. I remember when he was learning how to sit up from his army-crawl. He would be crawling around the room, and then I would look over at him, and all the sudden he was sitting up. It surprised me every time for a good week. Especially those times I walked in on him when he was in his crib and he was just sitting there in the corner, looking at me like, "Hey, Mommy. I'm sitting here, and I can't figure out how this happened." I seriously almost tripped over my own feet when I found him standing in the middle of the kitchen this morning.

I'm sure I will get used to it quickly enough. And then I'll probably be pining away for those days when he not only didn't stand or walk, but didn't run all over the house. Like I already pine for my sweet chubby 4-month old who was just happy to see me, and happy to be held, and happy to play with any toy I happened to throw his direction. I really loved that stage. I love this one, too. There really is almost nothing more exciting than watching my baby take his first steps.

Gunner's first steps: Sept. 18 (the day after his 11-month day)

Thursday, September 17, 2009

The autopilot

When I was a phlebotomist, I used to have a set schpiel that I would say as I entered a patient's room. I would knock on the door and say "Good morning, this is Spaceman Spiff, I'm here from the lab to draw a little blood today." Every single patient was greeted this way. This morning, as I walked into my patient's darkened room, I knocked on the wall and said "Good morning, this is Spiff from the la-....medical school, I'm here to draw- examine you this morning." I guess I have a pretty deeply ingrained pavlovian reflex.
-SS.

Wednesday, September 16, 2009

The Strange

My sister and her husband were fascinated (well, fascinated might be too strong a word) by some of the stories of neurological disease I had to share with them, so I thought I'd pass along a few.

Neglect syndromes: After a lesion to the parietal lobe of the brain, patients can have what is known as neglect. This can be limited to 'not seeing' parts of their visual field. This would manifest itself if the patient were to draw a clock, it might only show the numbers 1-6 and be drawn in a semi-circle. Alternatively, the patient could no longer recognize a part of their body as belonging to them. We had a patient whose arm was limp after his stroke, and when the attending brought his arm over within the patient's sight, and asked whose arm it was, the patient replied that it was the attending's. Curious.

Amok: I learned what amok was today. Doubtlessly you are familiar with the phrase "to run amok". Well, now I know what the etymology is. Amok is a psychotic disorder found primarily in Malaysia. The patient suffers from persecutory delusions, procurs a weapon, and attacks everyone and anyone he sees. The episode usually ends in the death of the patient, either by suicide or by perishing in the frenzy caused by his attacks.

Koro: I have not seen a case of this. Koro is a delusional disorder in which a man believes that his penis is disappearing, and that when it does in fact disappear, the man will die. Don't believe me? Check out this abstract. Be careful, however, not to confuse Koro with Kuru, an encephalopathic disease similar to Mad Cow, but which is caused by the cannibalistic consumption of brain. It is found exclusively within the Foré tribesman of Papua New Guinea.

-SS.

Sunday, September 13, 2009

Onwards to strokes

Today was my last day of pediatric neurology. We only had two patients on our census, so rounds went quickly. On psych/neuro we have afternoon lectures during the weekdays which, while necessary didactically, really detract from the patient care portion of neurology. I would rather be working up a patient and learning about their disease first hand than hearing a lecture about it and trying to remember a presentation rather than a patient. A more efficient system would be to have a noon lecture series like we had in pediatrics, that way we still get the lectures, but we aren't tied up for 90 minutes in the afternoon.

My next assignment is the stroke team at the adult hospital. I've been at the pediatric hospital for 10 weeks now, it'll be strange working with adults. Also, I won't know where anything is or how things are done, so I will yet again enjoy the clueless newbie feeling. I'm sure that just as I'm getting comfortable with finding my way around the neuro-ICU I'll be on my next assignment in psychiatry.

This year is going very quickly. I still haven't found something to fill the three week hole in my spring schedule that was left when I deferred Family Medicine in favor of anesthesiology. I'm considering a critical care elective, but I'm not sure if it's better to do before I do anesthesia or not.

Discrepancy

Gunner was weighed and measured again on Friday, two days after his doctor's appointment. On the same scale, with the same measuring system. Here's what we got:

Height--29 inches
Weight--24 pounds (which puts him in the 75th percentile, instead of 60th)

I almost had the lady do it again, just to see if we could get a different third set of results, but I didn't. I guess it doesn't really matter. He's still as healthy, sweet and cute as can be. But I am curious about why there was such a discrepancy.

Wednesday, September 09, 2009

Gunner's 10 1/2 month stats

Gunner's doctor was out of town most of the summer, so we are a little bit behind schedule. Instead of seeing her at 9 months, we went today, a week before Gunner's 11-month day. We had a whole long list of questions for the doc, since we haven't seen her in five months. And then we have to go back in six weeks, after Gunner's 1st birthday, when he is scheduled for a whole slough of shots. He escaped today's appointment without any shots.

10 1/2 month stats:
Weight: 22 lbs. 9 oz. (60th percentile)
Height: 30 inches (70th percentile)
Head Circumference: 48 cm. (80th percentile)

If you are curious about how our little man is growing, you can check here (2 months), here (4 1/2 month), and here (6 months).

Sunday, September 06, 2009

Neuro/psych

I am now one week into my neurology/psychiatry rotation, having just completed a week of pediatric neurology. Last year our first block was neurosciences, and I detested it. It was a well taught and well organized unit, I can't fault the administration of the class. I just really didn't like neuroanatomy. I currently am not enamored of the clinical side of neurology either. Maybe it's because I hated neuroanatomy so much that I can't remember the basics very well so I struggle to diagnose people on the clinical side. I think it's the patients with intractable illnesses like cerebral palsy and refractory seizure disorders which by definition are untreatable that get to me. I don't think "success" is putting a kid on 5 different seizure meds so that he's so gorked out of his mind he can't seize, but he can't do anything else either. I don't like how the only tools at our disposal are physical exam, EEG, and MRI. If those don't turn anything up, you're out of luck as to the etiology of some child's seizures. As the old saw from The House of God says "they can always hurt you more, but they can't stop the clock." So, in that very unenthusiastic spirit, I have 7 weeks left.

Saturday, September 05, 2009

Caravan of Wet Women and Babies

I mentioned in a previous post that I have recommitted to running. I'm happy to report that it's true and going well (for now). For the past five or six weeks, I have once again been a regular at the park early in the mornings, with Gunner in tow, tucked comfortably away in the jogging stroller. What is the secret to your success, you might ask? Well, faithful running partners and a goal, of course! My running partner and I decided that we needed a new goal to kick our bums into gear, so we decided to train for a 10K this coming October. We sent out a general invitation to people we know here, and we are so very pleasantly amazed at the response. Usually when I invite people to run with me, the response I get is "Are you nuts? I only run if I'm being chased. Why would you even consider asking me?" So, amazingly, we have about 15 women now training with us, some experienced runners, and some completely brand spankin' new.

We don't all live close enough together to train as a big group during the week, so we train in small groups during the week, and then get together for Saturday Long Runs. This morning's run was scheduled as a 6-miler, and I was awoken early by a healthy thunderstorm. As I lied in bed, listening to the rain and thunder, my mostly-still-sleeping brain contemplated how on earth I could make my baby "run" with me in the rain. Thanks to the years I lived in Oregon, I enjoy running in the rain, as long as it's warm enough outside. But I can't say that I was all that excited to experience Gunner's opinion of a rainy run...for six whole miles.

But we packed our little selves up, and we met our group. We had nine girls and four running strollers, and we set off in the drizzle that rapidly turned into Rain. You know, the kind of rain that makes you say, "Man, it's really coming down out there." And we ran. We ran through the puddles with rain dripping down our noses into our mouths. We ran past a group of middle-aged men who couldn't help themselves from commenting. Could you help it if nine women caravaned past you in the pouring rain, pushing four babies? After hearing them tell us that we were "torturing those poor babies" and how "those babies are going to hate us for this", I decided that I was proud of us for being tough mommies. And I'm mostly sure that Gunner is going to be happy to have a mommy who not only isn't afraid of the rain, but will be happy to go out and run right through it with him.

The babies all did amazingly well. In fact, two of them slept right through it. Gunner seemed to thoroughly enjoy himself. His blankie and feet were completely soaked, but that didn't stop him from singing to himself and (I'd like to think) cheering me on. We did cut the run down to three miles. We figured that we should probably quit while we were ahead. And although my shoes are soaked now, and the stroller is going to take days to dry off, we got our run in for the day, and I'm feeling like I have a bit of a rainy runner's high.

Tuesday, September 01, 2009

Little Life Lesson

Earlier this morning, I was thinking about some of the blogs I read for fun and about the funny stories people share about their lives. I got thinking that I haven't had an amusing story to share for a long long time. I then decided that my life just isn't that amusing, and that I've got things so under control that funny and embarrassing things just don't happen to me.

And then my little Gunner pooped on the floor. I decided to let him run around in the buff for a while to give his poor little rashie bum a chance to air out. The next thing I knew, there was a little pile of poo under the table.

Maybe I shouldn't wish for my life to be more entertaining.

Thursday, August 20, 2009

Chores

Yesterday, I started a project that I have been procrastinating. I began putting together our revised budget for this school year. Since it is seven weeks into the school year, that says something about how much I've been looking forward to this project. The more I put it off, the larger of a project it became, and the more I didn't want to do it. But now that I'm in the middle of it, I have embraced it, and I'm up for the week-long challenge of organizing and catching up on our finances. Like most chores for me, once I get the motivation to start them, I'm okay with the work involved.

There are some chores that are more enjoyable for me than others. I like cooking. I don't mind doing the dishes, as long as I don't let them get out of hand. I don't mind doing laundry, as long as I keep up on it. I don't mind grocery shopping, besides the fact that I always spend way more money than I want to. I don't think anyone likes cleaning the bathroom (myself included), but I don't mind it too much because I like having a clean bathroom.

However, I do have a few chores that I just don't like. Apparently I'm pretty vocal about them because when I asked Spiff to guess my least favorite chores, he listed them off to perfection without hesitation. I really don't like dealing with our cars in any way. I don't like gassing them up, washing them, getting the oil changed, and especially dealing with mechanical issues. I also don't like doing the budget/checkbook, or cleaning the floors.

Of course, I do them anyway. They're chores, and there are always things I would rather be doing. But it's life, and they have to be done. And I'm curious about other people's favorite or least-favorite chores. I bring this up because I was surprised to discover recently that one of Spiff's least favorite chores is emptying out the clean dishwasher. That's not a chore that I mind at all. I guess now that I know that, I'll try to be sensitive to his dislike of this chore and empty out the dishwasher more often. Maybe he'll take care of the cars for me.

Sunday, August 16, 2009

Call

My pediatrics rotation requires that we spend every 5th night on call, and at least two of them be overnight. Being a glutton for punishment, I decided to take my two overnight calls this week to get them out of the way. Monday went as follows:
630-730: pre-round on my patients
730: huddle with senior resident and discuss any issues on the patients
800-830: Morning Report which is a 30 minute didactic conference for medical students and interns
0830-1130: rounding with the cardiology, pulmonology, and clinical medicine (general peds) teams.
1130-12: quickly do anything that needs to happen before 12, i.e. check on labs, order studies, etc..
12-1: noon conference which is a 1 hour didactic session for MSIII's
1:15-2:15 another didactic session
215-6: follow up on my patients and wait around for admissions
6-630 dinner in the cafeteria, which was some not so pleasant pizza
630-9: study and wait for admissions
9-11: admit 1 patient for potential bacterial/viral meningitis, rule out Bell's palsy
11-230: sleep fitfully in the resident lounge, missing a page at 130. Called intern to see if she was still admitting the patient, but she was done.
230: moved to a place in the hospital where I would get better cell phone reception.
230-5: sleep in 20-30 minute increments on a chair in the lobby, checking my phone for pages.
5: Get fed up with not sleeping and start rounding on my patients
5-12: repeat from monday morning.
12 (tuesday): Go home, 2 hour nap, groggy afternoon with studying
9pm: bedtime


Last night was very similar, only instead of sleeping fitfully in a chair, I made sure the intern had the phone number to the wall phone in the lounge, which was very loud, so I wouldn't snooze through a page. We had one admission at 7pm, but after that it was very quiet. I fell asleep at 11 and slept pretty well on the couch until 530, when I began rounding. I forgot, however, that medical students don't have to round with the team in the mornings on the weekend, so rather than going home at 12, I was able to come home at 8 and go to church.

Overall, my two overnight calls were pretty easy, all things considered. Since I don't have the authority to write orders, or answer questions regarding orders, I don't get paged frequently for those reasons, unlike the interns. The interns on our team work about 80 hours a week, which is the ACGME maximum. Last week I think I worked something like 75 hours, which includes my two overnight calls.

Wednesday, August 12, 2009

I Run Because I Must

Since I ran my half marathons in the spring, I will grudgingly admit that I have been less than motivated to run. I have been lucky to make it out once a week during the past several months. And while my body is imploring me to run, to stretch, to work, to be outside, to breathe in fresh air, and to enjoy the early-morning Summer weather, I have been all too willing to ditch out of a run for a variety of valid reasons ("It's storming." "I went to bed too late." "Gunner kept me up all night." "My running partners are all out of town." "Spiff has to be at work early, and Gunner is still sleeping."), all under the assumption that I would try again tomorrow. Tomorrow would come, and I would be all too happy to stay in bed, or lounge around my house in my jammies, getting less and less in shape by the minute.

Well, and of last week, I have recommitted to running. My partner and I went out three whole times last week. Impressive, I know. I realize as I'm writing this, that one of the real reasons I haven't been as diligent in my running lately is because of the sacrifice involved. It is difficult sacrificing sleep, time, and comfort for some voluntary hard and painful work.

In fact, this morning's run was a huge sacrifice. I actually woke Gunner up to take him running with me, since Spiff had already gone to work, and I had to make it to the meeting place on time. I never realized before I had Gunner how emotionally difficult it is to wake a sleeping baby. Knowing that he'll probably be tired and grumpy at me all day because I chose to wake him up, makes it the very last thing that I ever want to do. He wasn't super happy about it, and although he was pleasant during most of the ride, he got very upset about a mile from home, causing me to push that stroller faster and get a more intense workout than I bargained for.

So, I find myself asking the question, "If it's so hard, and you have to sacrifice so much, and now you're making your son sacrifice along with you, why are you still doing it?"

I just have to remind myself that I know I love it. I have already started, and I don't want to ever have to start over from scratch, so I can't just quit. It is one of very few actual hobbies I have. I feel healthier when I do it, and it's good for me. I love being outside. I love the social time with my running friends or with Spiff, but I also love running alone with just my thoughts. I know that Gunner also enjoys being outside, so it's good for him, too, even if I have to wake him up occasionally. I also have a huge respect for runners and the sport in general, and I think that running makes me a better person. Even with all the sacrifice, it's a good thing, and I'm glad I still running.

On a side note, this week marks the 2-year anniversary of my running partnership with my awesome, dedicated running friend, Angela! Here's to two years of sweatin' in the elements, training for and running two half marathons, and running through most of our latest pregnancies, and meeting new running friends along the way!

On another side note, I stopped a stranger in the park today and got her phone number. We have seen this girl running in the park for the past two years. I have also seen her walking in my neighborhood, and we always smile when we pass each other. I recently decided that the next time I saw her, I was going to stop and meet her. Turns out that she lives a block or two away from me. She seems nice, and I got her number so that I could get in touch with her. I can't really decide what to do with it now that I have it, and I hope she doesn't feel weird that this stranger in the park has her phone number.

Tuesday, August 11, 2009

The Dumbening

When I was an undergrad and on the crew team, I used to wake up at 450 am to get to practice. I combined this pre-dawn awakening with a late bedtime because of my job. Needless to say, I was severely sleep deprived, and intimately familiar with the cognitive deficits caused by lack of sleep. I recall a severely impaired short-term memory, so much so that you could ask me to do something like vacuum, I would walk out of the room to get the vacuum, and in seconds not even be aware that I was supposed to be doing something. Besides impairing my ability to do household chores, my grades naturally suffered as well. Currently, on in-patient pediatrics, I have been sleeping less than I have in many years. Slowly I can see the onset of the memory deficits that plagued me a decade ago. As an undergrad I was pretty blasé about my grades, but now I need to learn information in order to apply it for the treatment of patients and my porous memory is not helping. It doesn't help that by the time I get home in the evening, I don't really feel like studying, even if I have the energy. I think that the impending shelf exam will change my motivation, however. I'll write about my first overnight call in my next post.
-SS

Sunday, August 09, 2009

Peds Inpatient

I just finished my first week on the peds inpatient rotation. I'm on the Red team which means we cover the pulmonary, cardiac, and also general peds patients. Aside from the specialty patients, the clinic-med (general peds) patients we have fall into two categories: the mysteries, and cellulitis. There was a rash (forgive the expression) of Staph skin infections this week, but none under my care. My patient was in the mystery category, and since he was completely non-verbal, it was pretty tough to figure out why he was in pain.

It's surprising how little we contribute as 3rd years. I hadn't realized just how little we actually do. There are 4th year students doing sub-internships who are in charge of admitting patients, writing orders, etc, and I though that the 3rd years would be doing things more like that, but we really just do H&P's, and fill out oceans of paperwork. It's not for nothing that 3rd year rotations are called clerkships. Our children's hospital doesn't have an EMR, so everything is done in paper charts scattered all over creation. I really don't care for writing things out longhand, and I can't read half of what the attendings write. If you're going to take the time to write something, why not make it legible? If you don't, you might as well not have written it at all. Generally, I do enjoy the inpatient side of things better, even though my role is less useful than it was in outpatient.

Friday, August 07, 2009

Tooth Fairy

Gunner got up at 5:30 this morning. He was just too excited to sleep. The Tooth Fairy brought him a tooth last night, and he couldn't wait to show it off this morning. His bottom left tooth has popped through the gums! Pretty exciting! Crawling and a new tooth. That's a lot of work for one week. I can understand his excitement, but I cringe to imagine the timing of our wake-up on Christmas morning in a few years.

By the way, why is it that kids only get a prize for loosing a tooth? Isn't it much more work to get one than to loose one?

Monday, August 03, 2009

Mobile

Gunner is crawling! He just figured it out a decent army crawl a couple days ago, and just this afternoon, he decided to go exploring. As of 4:00 this afternoon, he refused to stay in one place, and he refused to go anywhere he is allowed to go. In other words, he explored the less baby-proofed areas of our living space, including three bookcases where he pulled books on top of him and tried to eat the paper. He crawled over a barricade of pillows I put up. He explored the area behind the rocking chair, crawling over the large air intake vent on the floor to get there. He crawled towards the garbage can before I grabbed him. He pushed a rolling chair around the hardwood floor and enjoyed crawling around underneath it. He found the pointy cable hook-up wire that is sticking out of a hole in the floor. He also crawled under the computer desk because he was enthralled with the vast number of wires. I pulled him out several times, gave him a stern look and a "No, Baby!" He proceeded to think that my reprimanding him was hilarious. Maybe he will respond better to my very hardest of stares.

Thursday, July 30, 2009

Minutiae

During the first two years of medical school, we are taught volumes about disease, pathogenesis, presentation, and a little about treatment. Often, the diseases we learn about are obscure and rare, but illustrative of a particular physiological principle. There are certain vanishingly rare metabolic diseases which every student learns about, but will never see because only a few dozen people in the world have them. I used to groan and gripe about how these obscure diseases were worthless, that I would never see them, why should I learn about them? Well, I am now formally eating those words. Here is a list of the unusual conditions that I have seen on outpatient pediatrics, usually in the specialty clinics.

Cutis aplasia
Hypomelanosis of Ito (I diagnosed this one!)
Congenital adrenal hypoplasia (not hyper)
Diabetes insipidus (nephrogenic)
Gordon's syndrome
Congenital Central Hypoventilation Syndrome (Ondine's Curse)
Hypoplastic Left Heart Syndrome (in my NICU time)
4 umbilical hernias in 1 day (apparently they are more common here than elsewhere in the country.)

Bonus points for the readers who at least look on Wiki what these things are.
-SS

Saturday, July 25, 2009

Enjoying the moment

We are having a Saturday night at home. Our baby is ready for bed and in his jammies. I wish you could see how happy he is right now. He is thoroughly enjoying this evening's pre-bed activity: dancing with Mom & Dad. So far, we have bebopped to "Sing Sing Sing" by Benny Goodman, waltzed to "So She Dances" by Josh Groban, rumbaed to "Fallen" by Lauren Wood, and we're currently swaying to "Anything You Can I, I Can Do Better" by Bing Crosby and the Andrews Sisters. He especially loved the slightly awkward three-person waltz and the big twirls under his daddy's arm. I hope that I can play this scene back on my life-reel when I die and remember my sweet little 9-month-old baby, his fat dancing body, and my happy little family.

Thursday, July 23, 2009

Outpatient = Impatient

So going into medical school I had a suspicion that I wouldn't care for outpatient clinic very much. I didn't ever have anything to base this on, but it's what I thought would happen. Sure enough, it's true. At least based on my 3 weeks of outpatient pediatrics, I don't care for clinic very much. The most excited I got for school this week was the morning I spent in the cardiology clinic reviewing echocardiograms and following up on catheter procedures. Outpatient peds interventions are just much more long-term and lifestyle oriented. Vaccinations, lifestyle, diet, safety, and prevention are the mainstays of successful health, but they just don't get me fired up. I'd much rather be the guy guiding a cath or anesthetizing someone. I'm a pretty control oriented kind of guy, and I'd rather have the outcome of a patient depend more on my own skill and knowledge than on their willingness to follow through on my instructions.

Monday, July 20, 2009

Self-Indulgence

Spiff and I went on a date on Saturday. An actual date! We went somewhere, the two of us, just for fun. My awesome friend, Maggie, watched Gunner so that Spiff and I could go to the new Harry Potter movie. We haven't been on a date since we had the baby nine months ago. Well, we did go for a twenty minute walk while we were on vacation in June, after Gunner had gone to bed and my parents had agreed to listen for him. Can we count that?

I had a great time, and Spiff cooks up a great date. We went to a really cool theater that was originally a Shriner's Temple and has been converted to a single-screen venue. There is a balcony, ornate decor, chandeliers, and a dome in the ceiling. The crowning glory of the place is the floor seating...rows and rows of plush leather couches! Yes, we watched Harry Potter cuddled up together in front of the big screen on a comfy leather love seat. Very cool! I liked the movie a lot, and I loved my time with husband.

The weird thing is that while I enjoyed my time with Spiff, and some freedom from mommy responsibilities, I found myself missing Gunner. After being engrossed in the movie for a bit, I found myself looking around, expecting to find Gunner rolling around on the floor in front of me. Or I would look at my watch and think to myself, "Gunner should be up from his nap any moment," and then I would prepare myself to pause the movie so we could go get him...before realizing that he wasn't with us at all. I guess that's what happens when you spend almost every moment of the last nine months with a baby attached to your hip.

It's also strange to me that something that was so commonplace to me for so long, such as spending one-on-one time with my husband, has become so foreign. We do spend time together, after Gunner has gone to bed. But we haven't been outside of the house together, without the baby, and I admit that it felt strange to have an empty car seat in the back of the car. I also felt strange about asking my friend to give up her Saturday to watch my son, along with her own two sweet kids. I'm so grateful to her for giving Spiff and me the time together, but since the movie was so long, I felt like I was taking advantage of her. She has definitely earned some brownie points, and some IOU's of babysitting with me.

Thursday, July 16, 2009

The new stuff

I'm nearly done with two weeks of third year, but have yet to post on this here blog.  
Week 1 was spent in the healthy newborn nursery at one of our sister hospitals here.  The day started at 0630 and lasted until 3-4 if we weren't on call, or until 9 if we were on call.  We would do exams on any babies that had been born during the night, write up the H&P, and write progress notes on any babies that we were following from previous days.  At 0830 we would round with the attending, giving him a brief synopsis of the infant's pre-natal history, any significant physical findings, and discharge plans.  I have to admit, we were pretty spoiled because our intern had a sheet that spelled all this out in the order in which our attending wanted to hear it.   The one night of call I had I spent in the NICU.  There was an infant born at 29 weeks gestation who weighed about 2 lbs, and there was another infant born with hypoplastic left heart syndrome. 

 This is a relatively rare congenital heart defect in which there is almost no left ventricular tissue.  In lay terms, that means the heart is not really able to pump blood to the systemic (as opposed to pulmonic) circuit.  As a result, the child can only receive blood from the right ventricle via remnant of fetal circulation.  In the fetus, there is a connection between the left and right atria, known as the foramen ovale as well as between the pulmonary artery and the aorta, known as the ductus arteriosus.   In this infant with a hypoplastic left heart, we keep these open with a substance called prostaglandin E2 (PGE2), until such time as the infant is able to survive the three open heart surgeries necessary to enable life.  Without the PGE2, the ductus arteriosus will close in a matter of days and the infant will die.  

 As an MS3, my role was simply to stand in the background, ask questions, and not contaminate anything.  We resuscitated these infants right outside the C-section room, and prepared them for a brief trip down the hall to the NICU.  It was pretty hard for me to see the dad of the hypoplastic heart baby because he was filming his brand new baby with his iPhone because I knew we were both aware of the fact that those seconds of video could very well be the only keepsake these parents get to have of their baby.  Being in the NICU in general was challenging emotionally because I mentally place Gunner in the little isolettes and had little daymares of terrible illnesses that could have befallen him.  I don't know why we were blessed with a baby who didn't have any problems, but I am grateful. 

Week 2: 
I've been in outpatient pediatrics this week.  Outpatient clinic is a combination of general pediatrics as well as specialty  clinics.  I've spent about half the week in U Peds, our general peds clinic, and about half in specialty clinics.  I've been in the cystic fibrosis (CF), asthma, diabetes, and allergy clinics.  Generally I enjoy the specialty clinics more, since there seems to be greater emphasis on the patient's disease and its management, rather than in Upeds where there are a lot more social issues in addition to any pathology.  I don't consider myself to be anti-social, I do enjoy being with patients and talking with them.  I just don't relish trying to fix all that is wrong with their lives that is not health related.  I realize that there are social workers who can bear most of this burden, but trying to find a car seat for someone or help them get WIC or TANF (welfare) isn't very gratifying.  Thus far, actually, I haven't seen very much pathology, at least that is grossly visible, our work has mostly been well-child visits and maintenance checkups for chronic conditions. 

In other news, I got my board scores back yesterday and I was very pleased with the result.  There should be no difficulty, from a scores standpoint anyway, pursuing whatever it is I choose to do. 

Thursday, July 09, 2009

Cleaning house, Petunia Dursley Style

"The kitchen door had opened, and there stood Harry's aunt, wearing rubber gloves and a housecoat over her nightdress, clearly halfway through her usual pre-bedtime wipe-down of all the kitchen surfaces."  (from The Half-Blood Prince, p. 46)

I used to think that Petunia was obsessive and overboard with cleaning.  I used to think that a daily wipe-down ritual was crazy and time spent on something far too unpleasant.  That's what I used to think...

Until I got home from my three-week vacation to find ants in my kitchen.

Gross.

Spiff thinks that I over-react to the teeny, tiny little insects I found marching over my kitchen floor.  However, I remember all too well the ant infestation in a house I shared with roommates, that centered around the kitchen sink.  I remember the sight of thousands of little insects constantly framing the sink.  I remember thinking that the kitchen sink was moving, if I caught a glance of it out of the corner of my eye.  I also remember feeling that if I consumed anything that came from the kitchen, the food must also be crawling with little marching creatures.  It still makes my skin crawl and my stomach turn to think of it.

This is why I no longer think that Petunia Dursley is crazy, at least about kitchen cleanliness.  I have taken to wiping down all kitchen surfaces and mopping the floor with bleach water every night.  I also spray any little beast I find swarming over dropped pieces of ramen noodles with Lysol, and then I mop, mop, mop my cares away.

So, if you drop by my house around 8:00 in the evening, you might find me donning my housecoat and my rubber gloves, with Lysol in one hand and a bucket of bleach in the other.  We're aiming for an ant-free kitchen here!

Vacation

We had a great three-week marathon vacation.  Here's a quick summary:
  • Oregon for a week, where we fit in all the family and friends we could handle (dinners with friends, wedding preparations, bridal shower & bachelorette party, the wedding, and a day on the coast, and even a could bike rides for the boys).  
  • Utah for a few days of the other side of the family, some family pictures, and a whole lot of Wii Mariocart.
  • Home for two days, just enough time to see Spiff's mom (who happened to be in town), and to pack for another vacation.
  • Michigan for a week of fun at the cabin on the lake.  The weather turned out to be unseasonably cold, so there was no swimming, no boating, and mostly just huddling together and trying to keep warm.
We are back from vacation, and I am glad to be home.  Gunner is also glad to be home.  We completely wore him out, and he has spent the past few days sleeping and sleeping.  Spiff is working again.  Our three weeks of freedom were great, and I'm not sure it has hit me that he has started his 3rd year.  It still sort of feels like he's still just studying like mad for the boards.  I'm sure it will feel different tonight when he gets home from call after 10:00, and after being at the hospital since 6:30 this morning.  We have to get used to a new normal for the next few years.  

The highlight of our trip was Spiff's sister's wedding.  She was stunning, the wedding was beautiful, and the party was fabulous.  Check it out:

The happy couple.  She is beautiful!  
(And he looks great, too.  But come on, seriously, all eyes are on the bride on her wedding day!)

Sister Sassy (the bride) herself made these stunning cut-paper centerpieces.  This is only one of four sides, and there were about eight(?) designs.  They were lit from the inside, and absolutely stunning!  My sissy is so talented!

The Cake!
Seven amazing layers of deliciousness.

The Centerpiece.
Mouthwatering Indian food and fruit bar.

The dance floor before the lights were dimmed.
I took these pictures to capture how vibrant the saris were.
Turns out, the whole thing looked even more amazing when the lights were out.


Sunday, July 05, 2009

Third Year

I start my third year of medical school tomorrow.  My first rotation is pediatrics, and the first week will be spent in the neonatal nursery.  Since this year will be unlike any of my previous schooling, I am a little apprehensive.  As the previous post mentioned, I was able to spend a day in the OR with my friend back home. While there, she let me intubate a patient, put in an LMA ( which is another airway device), and start an arterial line (analagous to an IV, only intra-arterial).   I have to say, it was way cool.  Anyway, not much more to say other than hopefully this blog will become exponentially more interesting now that I'm doing more than just studying day in and day out. 
-SS

Thursday, June 18, 2009

Vacation

We are in Oregon for Spiff's sissy's wedding! We're on vacation...finally! And what is Spiff up to today? He is at the hospital, shadowing our anesthesioligist friend in the OR. It's great experience for him, especially since she is the doctor who really inspired him to be interested in anesthesia in the first place. So, he's taking a working vacation today.

What I am enjoying on this trip:
  1. Spending time with Spiff.
  2. Seeing our family.
  3. Seeing our beloved friends.
  4. Fabulous Oregon weather (it's cool, breezy, and I don't automatically break into a sweat when I step outside).
  5. And of course, I'm excited about the wedding! I can't wait to see what Connie has cooked up for the reception!

Sunday, June 14, 2009

The wait

Well, I took the exam on friday. It took just over seven hours to complete. The exam is administered in seven blocks of 48 questions which you have an hour to complete. There is 45 minutes of break time as well, that can increase if you finish a block early, as I am prone to do. My strategy was to do four blocks, take lunch, do two, break, and finish the last block. By the end of my fourth block, I was pretty tired and my brain was starting to feel fuzzy. Block 6 was really difficult, either because my brain was foggy or because it truly was tough. There were many times when I could narrow it down to two answers, and would just have to take a semi-educated guess. The difficult thing about Step 1 of the USMLE is that there are 336 questions, but not all 336 are graded. The exam draws from a random assortment of questions from a huge question bank. In order to deem a question worthy of being included, it must be presented as a trial question for several years, which means it is included in the exam, but not scored lest it be an unfair question. Consequently, I could kill myself for several minutes on an insanely hard question that may not actually be part of my grade. The challenge lies in not knowing how many and which of my questions are not "real" questions.

I really don't have a very good feel for how I did. During practice exams I could usually tell how I did based on the inverse of my emotions. If I finished a practice block feeling good, then the score was usually lower than if I finished feeling apprehensive. All of the questions are blended together in my head though, and I really don't have a good feel for how I did. I would really like to do as well as my practice scores at the end of my studying, but I'm not too sanguine about that. Again, I don't know if that's realism or if I'm just psyching myself out in case I don't do as well as I would like. Here's a graph of my progress that I made using my practice scores.
As you can see, there is generally an upward trend, at least if you look at the lowest scores. Overall I improved significantly from my beginning scores, but who knows if that bears out in the real thing. I'll post in July when I finally find out my score, and that will settle things once and for all.

Thursday, June 11, 2009

Verge

I take the boards tomorrow. Step 1 of the USMLE will, to a great degree, determine my options for residency. It is doubtful that I will score well enough to do dermatology or plastics, which fortunately do not appeal anyway. It is also doubtful that my score will consign me to the least competitive specialties. I've worked my butt off for 2 years, and doubly so for the past 5 weeks. Like many hard workers, I think that medical students are prone to overestimate the time they actually spend working. However, for the last 5 weeks, I have spent between 10-12 hours a day, 6 days a week reviewing and learning what I spent 2 years studying. That means conservatively, I spent 300 -360 hours studying for this exam. I'm not boasting or bragging, just recounting what I have done for the last 5 weeks. Board studying is an insatiable beast. I can never "be done". Everyone always says "oh, you'll be fine, just take a break, you know everything you need" etc... Nope, there's always some cytokine that I've forgotten, some immunodeficiency syndrome to review, some drug side effect (thank you very much, psycho-active drugs) to learn and re-learn, and re-re-learn. At some point, which happened at 9:30 this evening, I admit that the time for preparation is over.
-SS

Inherent Flaw

I have done a little clothing shopping lately. I don't usually shop for clothes, due to lack of funds. In fact, the last dress I bought was my wedding dress 4 1/2 years ago. My wardrobe is full of old, worn, dated clothing, and with my changed post-baby body, I have found that some of it just doesn't fit me anymore. So, I am trying to find some items that will give my sad little wardrobe a small boost to get me through the next few years. I have a few requirements, and I don't think I'm picky. I still can't find what I need.

Dresses: There are about a zillion dresses for sale. I would say that 80% of these are of the sleeveless/spaghetti strap variety. The others are too short, too low, too old, too young, or just too expensive. The dress I found for my sissy-in-law's wedding is cute, but it had to be altered just a bit to make it modest (Thank You, Maggie!).

T-shirts: I believe that these requirements are simple. I want something that is comfortable. Not too tight, too short, too low, or too wide in the neckline, or expensive. Am I asking too much?

Here's the flaw, as said sissy-in-law pointed out: Most women don't actually have the bodies that fit the clothing that is being sold. Most of us don't have fabulous upper arms, so why are all the dresses sleeveless? Also, I would say that the majority of women don't want to dress like skanky chickies. So, why are all of the shirts tight and low?

Progress Report

The Binkie:  It seems as if we have gotten rid of our crutch.  Gunner hasn't taken a binkie in three weeks.  I still have them around, just in case, and I have reached for them in times of desperation.  But, he doesn't suck on them anymore.  He chews on them, and them takes them out of his mouth and waves them around in the air.  He treats them like a little chew toy.  And now I know that he no longer needs them at all.

Sleep Training:  Gunner is sleeping better these days.  I don't want to jinx it by announcing it to the world, but I have to acknowledge that he has done very well during this past week.  We have changed our bedtime routine a bit, and he has been responsible for putting himself to sleep at bedtime.  We have also decided that it is not hunger that wakes him up before midnight, and instead of rushing into him to quickly rock him back to sleep, he has to figure it out on his own.  I think that we had been over-stimulating him at these wakings, and the effect was hours and hours of crying (for all of us!) because he just couldn't get back to sleep.  This hasn't happened in over a week!  Nap times are getting better as well.  He has taken some good naps this week, and it usually doesn't take him too long to settle himself down for a nap.  Also, if he's asleep and wakes up while we're transferring him to his crib, he knows how to get comfortable enough to go back to sleep.  That has been a good good thing.

Again, I'm not trying to jinx anything.  Nor am I blowing my own horn by saying that we have done something spectacular that has solved all of our problems.  I am completely aware that this could be a week-long phase.  Maybe his problem was that he was teething (he doesn't have any teeth  yet), and it hasn't been bothering him this week.  Maybe he's in a growth spurt and he needs to sleep more.  Or maybe...just maybe...he is figuring out how to comfort himself.

Whatever the case may be, we have had a good week of sleeping.  It seems that this long, difficult five weeks of sleep training has done some good.  It couldn't have come at a better time because Spiff's big test is tomorrow.  And it sure has been nice to get a few good nights of sleep!  I sort of forgot how it feels to sleep for more than three consecutive hours.

Friday, June 05, 2009

Happy Place

I'm grumpy today.  I'm stressing about Gunner's sleep issues, Spiff's Grammy's living situation, and finding a modest and cute dress to wear to my sister-in-law's wedding.  And the baby has been crying at me.  So, I need to write about things that make me happy:
  1. A competent auto repair shop located three blocks from my house.
  2. The weather is beautiful today.  Sunny and warmish.  Not beastly hot and humid.
  3. I went on a walk with my baby, and he kicked his little fat feet the whole time.
  4. I'm making delicious turkey sandwiches for my picnic lunch with Spiff.
  5. I just discovered that Gunner likes avocado.  My son after my own heart.
  6. Gunner intentionally hugs and kisses us now (big sloppy drooly kisses).  As he comes in for a kiss, he pulls my hair, and it would be cute if it didn't hurt so much.
  7. Spiff will be done with his big bad test in one week from today.
  8. Then we get to go on vacation for three weeks, go to the wedding, and see our families.

Thursday, May 28, 2009

Family Games

I think my sister-in-law is funny, and I laughed out loud while reading her post today.  These two posts are about games she & Spiff play with their family.  The games are definitely more entertaining than the Alphabet Game my family played on long car trips.  Check them out.  I think you'll laugh, too!


Monday, May 25, 2009

Why Didn't I Think Of This Sooner?

We have a musical mobile hanging on Gunner's crib.  It's cute, jungle-themed, and it has little animals that rotate with the music.  I received this excellent item from a friend while I was pregnant.  I remember thinking how cool it would be to be able to lullaby the baby to sleep with Classical music playing right from the baby's crib.  In fact, I was quite taken by the picture on the box that had two parents lovingly gazing at their sleeping baby from the door of the nursery.  Gunner loves the animals, and he likes to play with the music box.  Occasionally, he has successfully pushed the buttons that turn the music on.  It hasn't really ever worked to lull him to sleep.

This music maker is battery operated.  And just like most battery operated toys, the music gets slower and more artificial sounding as the batteries run down.  I don't like buying batteries.  I feel like it is a huge waste of money, and so the batteries in the music box haven't been replaced in a while.  Spiff often asks me if we should turn on Gunner's "Bongy Music" if he's having a difficult time settling down for sleep.

The other day, while the baby was crying in his bed, furious at me for having laid him down for a nap, I thought about turning on his "Bongy Music".  But as his cries got more and more hysterical, I decided to try to overpower his loudness with my own.  I started playing the piano.  And as I played a Bach prelude, the strangest thing happened.  He fell asleep!  Today, it happened again, this time settling down to my favorite Poulenc Improvisation.

I am baffled as to why I didn't try this before!  If the manufacturer of the music box mobile realized that babies might fall asleep to fake Classical music, why wouldn't he fall asleep to the real thing?

The fact is, I have been afraid that it would be too loud for him.  The piano is situated directly opposite Gunner's bedroom, with only a hallway separating them.  Maybe the music is overpoweringly loud, and it's lulling him into submission.  Whatever the case, it has worked twice now, and I'm completely surprised!  Don't get me wrong.  He still only naps for about 30 minutes at a time.  But at least I have a sufficiently loud lullaby to get him to sleep in the first place.

Saturday, May 23, 2009

New Preoccupation

Sick 7-month old.

Spiff and I needed something to take our minds off of the boards and sleep training. This oughta do it.

Friday, May 22, 2009

Why?

Apparently the unanswered question is "why an armadillo?  "The long answer is " I don't know."

Wednesday, May 20, 2009

An odd sort of notoriety

So I got a peculiar email on Facebook today. A classmate of mine directed my attention to a website called Awkardfamilyphotos.com and said she thought she'd found a picture of me on there. I cruised through the site, found some truly terrible photos like this on the site, but didn't see any of my own family pictures. I emailed her for clarification, and she provided a link which proved definitively that someone out there furnished a copy of our family photo. It's pretty weird to see my family photo on a site that mocks bizarre family photos. I'm just curious who put it out there, since there are a limited number of people who have this photo and even fewer with the technical savvy to put it online. So, dear readers, if any of you have direct knowledge of this, shoot me an email and let me know. I'm not irritated, more bemused. Since I know you're dying of curiosity, here is the link in question.