The medical adventures of Spaceman Spiff

Gunner's First Primary Talk

2012-02-18T15:44:00.000-08:00

Gunner is supposed to give his first talk in primary tomorrow. The theme we were given was Mosiah 2:22. I started to prep him for actually sitting down to write the talk, and we had this conversation.

Me: Do you remember the story of King Benjamin?

Gunner: I don't want to tell that story. I want to tell about when Jesus was resurrected.

M: Why do you want to tell that story instead?

G: Because I like it.

M: Oh, can you tell me the story?

G: I can't read it from the scriptures.

M: Can you remember what happens in the story? Can you tell it to me?

G: Well, Jesus was resurrected. That's all.

I don't know about you, but I think he's ready.

This is how a 3-year-old skis

2012-02-15T18:36:00.000-08:00

Spiff gives him a push at the beginning, and then walks next to him while Gunner slides down the hill.

I like the part when Gunner says "Bye" to his daddy.

That's my kid! He dives in head first. Spiff said that as they pulled into the parking lot, Gunner said from the back seat, "Daddy, I want to go fast down that hill by myself."

I think that sums up their experience in a nutshell. Gunner was thrilled to be there, and he picked it up so fast! Spiff took him up the bunny hill ski lift before he realized that there was a useable bunny hill. Gunner told me later that the operator had to stop the lift just after they got on. One of his skis had fallen off his foot, and it was dangling from the toe-clip, which is a little device that connects the tips of the skis in order to keep them together.

Spiff quickly realized that it was difficult to manage a 3-year-old on skis while he was on his own skis. So they headed over to the "bunnier hill", which has a "magic carpet" to transport kids from the bottom to the top of the hill. Think of a long, uphill conveyor belt, which is way better than the rope tow I had to use as a kid. I could never hang onto that thing!

Gunner made Spiff ditch the toe-clip device. Apparently it was cramping his style. Spiff said that he handled the skis really well, and that he was skiing circles around some of the other little kids on the hill who were taking private lessons. He had an amazingly good attitude about it. He fell a lot, but he hopped right up. The equipment was big and heavy for him, but he tried his best. He wasn't intimidated at all. He was a complete natural. He laughed the whole time. It makes me wish we lived here permanently so that we could foster his enthusiasm for this sport.

He has a little lift ticket hanging on his coat now. And he has to tell everyone he sees that he went skiing "today" or "last more" or "last week." He really was the happiest little boy on earth.

Winter Updateland

2012-02-14T09:38:00.000-08:00

Spiff had a great rotation in January. He did an elective in Pathology, and while he found the subject boring, the hours were great. Mon-Fri, 9:30-somewhere between noon and 3, with weekends off. We had four glorious weekends where he got to go to church with us. I also enjoyed four weeks of running without my kids. It felt quite luxurious, and the whole thing made me remember what it feels like to have a husband at home. Easy months always make it that much harder for all of us when he returns to Medicine Wards, when he's gone before the kids wake up and home after they go to bed. We miss him.

During his pathology month, Spiff studied for and took Step 3 of the board exam. We are still awaiting results, but no one in their right mind can wonder whether he passed it or not. It is exciting to have jumped one more hurdle on the road of becoming a licensed physician.

We traveled to Idaho for him to take the test. We stayed with my parents for the weekend, and then stayed with my brother's family for a couple days while Spiff took the test. I enjoyed seeing my family, and he enjoyed two fun-filled days of multiple-choice questions in a testing center on the Idaho State University campus. I also got to show Spiff a little of my college campus. It was so weird to be back there, having graduated and moved on almost 10 years ago. I felt old, but I have such great memories of my college days, beloved professors and friends, and it was a fun walk down memory lane. It feels like a different life from the one I have now, having grown and changed so much from when I was a college girl. And it was definitely strange having Spiff with me, since he was never a part of my life while I lived there.

In other news, Hobbes is walking more and more every day. He has slowly worked up the courage, and I'm sure that he will be a walking-boy 100% of the time in about a week. I love watching him hobble around. I love this milestone because it's so permanent. Unlike so many phases babies go through and skills they learn, walking is one that they never grow out of. And it seems to change them from a baby into a toddler, and they all the sudden seem so much more grown-up than they did the day before.

Also, Hobbes has figured out how to manage stairs. All on his own, he discovered that the best way to descend stairs is to go down backwards! I'm so proud of him. And I love the freedom that it gives me, not having to worry (so much) about him falling off every stair he encounters.

Gunner has started swimming lessons. I signed him up in a class with his 5-year-old cousin, neither having taken lessons before. I was worried about him not paying attention, or not respecting the teacher. I was worried that he would just run off and splash around in the pool, ignoring his group. But he is doing so well! He listens. He participates. He takes turns. He does what the teacher asks him to do. And best of all, he loves it! He is always excited to tell me afterwards what they worked on. They did "bobs" in yesterday's lesson, and he even did a demonstration for us by putting his head down and blowing into the air. I think we may have found a great outlet for all of his energy, and I love that he's learning a really useful life skill in the process.

And last, but not least, Spiff is off work today (his last day off for 10 days!!) and is up at the mountain with Gunner. He borrowed some child-sized ski gear from a friend, and is taking Gunner skiing for the first time. What a lucky little boy we have! He woke up to find ski gear in the living room, and had to immediately try it all on. Helmet, goggles, snow pants, boots and tiny little skis that have got to be among the cutest things I have seen. He was so excited. I think Spiff might have been just as excited at the prospect of taking his son skiing with him. I'm at home with the baby, anxiously awaiting news of their great skiing adventure.

Open Book

2012-02-05T18:36:00.000-08:00

I should have born my testimony today at church. I almost did, but chickened out before I stood up. I don't do it nearly often enough because it scares me. I am a back-row-sitter in classes. I don't raise my hand to make comments because it makes me nervous. Being nervous makes me blush. The most benign of comments will cause my face and neck to turn the brightest shades of red, which embarrasses me...and so I turn even redder...which embarrasses me more. So I rarely make comments in classes, and I even more rarely bare my testimony in testimony meeting.

I should have today, though. I had a great experience to share with my congregation. I was given the opportunity this week to explain the basic doctrine of our church with a member of another faith. She is a solid, faithful member of her congregation, and she asked me about the LDS church out of curiosity, nothing more. And even knowing that I wasn't under pressure to impress her by the possibility of her conversion to the church, it was an experience that almost knocked me flat. I found myself fumbling over my words, stumbling over explanations of church history, and stuttering over trying to find a concise way to explain the basic doctrine.

I came away from the experience wondering why it was so hard for me. I have been a faithful member all my life and have attended church on a weekly basis. I should know the answer to that question backward and forward. I have decided that it comes down to a lack of preparation. I have spent the last three years wrangling my children during sacrament meeting. I have also spent three years not attending Sunday School and Relief Society meetings because of my callings serving in the primary and nursery. Both of things are important, but they don't necessarily give me the opportunity to fully fill my spiritual glass during church, as it were.

I also did not serve a mission. I have never had the opportunity to teach the gospel, nor have I really been taught how to properly share the principles with others, despite the fact that we are all encouraged to be daily member missionaries. I realize that the spirit will guide us in situations like these if we are spiritually in tune, but I can't necessarily say that I'm so in tune these days. Perhaps I was guided in my answers. Perhaps I said just what she needed to hear. That is a nice thought.

But the point I want to make is that now I feel like I need to study up on how to answer that question so that I will be prepared the next time I have an opportunity to share. I should go read up on the history of the church, memorize some dates, re-memorize the Articles of Faith that I learned as a kid in primary (20 years ago!), and really have a good answer ready.

And then I will wait, perhaps ten years for another opportunity like this to come along, and by then I will have forgotten my perfect answer. I will probably no longer be prepared, and will fumble through it once again. Sigh.

The thought that ran over and over through my mind while I sat in sacrament meeting this morning, trying to talk myself into getting up at the pulpit, was that while I hope to be prepared to testify of the truthfulness of the Gospel the next time I have an opportunity, I really hope to be prepared to meet my Savior when the time comes. Since we don't know when either of those events will happen, it is up to us to be as prepared as possible at all times.

That's a high standard to uphold. And the more I think of it, the more I realize how short I'm falling of my goal. What with the demands of the children, marathon training(!!!), and Spiff's schedule, I find my spiritual preparation to be fairly low on my priority list of things to get done every day.

We are all busy, and my question to you, my faithful readers, is this: How do you do it? How do you fill your glass and prepare on a daily basis, despite your many life demands? Anyone have any awesome little tricks on how to fit it all in, in the midst of the craziness that is all of our lives?

Hobbes is One

2012-01-25T20:38:00.000-08:00

My little Hobbes is so darn cute. I love that kid. He turned one a couple weeks ago, and we celebrated by having his aunties and cousins over for lunch. I made him his own Smash Cake. It was actually a two-layer cake, and I gave him the top tier to smash, while we ate the bottom tier. I know people who think I'm crazy for making a big fancy cake for a one-year-old's birthday, but I get so excited to see the babies smash a cake that I can't help it. It's all about the cake for me. Besides that, I have been watching Cake Boss, and I really just wanted a chance to make a cake. They are not as easy as Buddy Valastro makes it look. Anyway, Hobbes did a good job destroying his cake. He didn't eat much of it, but he did happily smash it to bits.

Most of you saw the cake on FB already, but if you didn't, here it is. This picture makes me wish that I were actually good at making cakes, like all the bakers at Carlo's. My sister and I also wished that we had a team of sculptors at our bidding to make a little modeling-chocolate figurine of Hobbes to put on top of the cake. Sigh.

The day before the party, I had noticed that Hobbes was feeling awfully brave as he cruised around the house and was letting go of whatever he was holding on to in order to stand on his own, for just a moment. He'd do it with a smile when he noticed me looking at him. So I decided to show off his new skill to my sisters at his little party. I stood him up in front of me...and he walked to me!

Yes he did! He took his first steps at his first birthday party, with me, Spiff & Gunner, my sisters, brother-in-law, and my nieces watching him! What a great moment! I just filled in the section in his baby book about the baby's first steps, and it asks how we celebrated that moment. I think it's a weird question. I hugged him. And we cheered.

I took him to see the doctor for his one-year check-up. When the doctor walked in, he told me, "Well, they didn't send you home from the hospital with the wrong baby." I have heard people say that he looks more and more like me, although his stats prove that he takes after certain members of Spiff's family. He is in the 22nd percentile for weight, 80th for height, and the 98th for head circumference! He's not a very big baby, but he has a HUGE head. It's just room for lots of brains, I guess.

Also, he is a terrible eater these days. He's so so so picky! Gunner is finally eating decently well, and I had hoped for an easy eater with my second child. Not so. Apparently we raise picky eaters somehow. My cousin has reminded me of what a picky eater I was as a child, so I'm sure that this is just pay-back. But if it is, I don't think it's necessarily fair. I wasn't being a picky eater as a child out of spite, or hatred of the world, or of anyone for that matter. Why do my children have to follow in my footsteps by taking pickiness to the next level?

The kid won't eat rice, noodles, beans, meat of any kind, potatoes or any cooked vegetables. He usually eats bananas, but not always. He usually eats yogurt and applesauce, but not always. Oh, and he Will Not drink cow's milk. Will not. He gets excited to drink it when he sees the cup, but goes stiff when it gets in his mouth. And then it all dribbles out. Again and again. He won't even eat Cheerios with milk on them. What baby doesn't like milk? Seriously.

After going through food struggles with Gunner, I'm not terribly concerned about Hobbes. I know he will grow out of it. Either that, or he will eventually be old enough to reason with about food consequences. But it is still annoying every time I open a banana or a can of pears that all gets thrown on the floor because he doesn't want it This time. And I really don't like the question I always end up asking myself, "What in the world am I going to feed my baby?" This is one of those times when I wish I had a cook. It would be so nice to not have to worry about feeding my children sometimes.

Besides the eating thing, he is truly such a joy. He is finally sleeping well. He sleeps like a champ, actually. It was such a struggle to get to this point that I don't feel bad at all for bragging about it. He is sweet, curious, happy, goofy and cuddly. He is also very quiet. He does babble a bit, but he keeps it to himself mostly, which is quite a change from Gunner. I sure do love him, and I can't quite believe it has already been a year since he joined our family. My, how time flies.

FM in the AM

2012-01-18T18:48:00.000-08:00

Do you ever drive around in the morning with the radio on in your car, wishing there was more music, less talk, while you listen to the DJs and their silly commentary? Ever wonder who would care what the morning DJs have to say and who would laugh at their jokes?

I have. And now I know.

Gunner, that's who.

He has really started listening to things lately. In sacrament meeting, he'll perk up during a talk and say, "He said Jesus loves us." When we're listening to music, he'll say, "He said Love in a hopeless place." When we're at the store, he'll hear the guy in front of us at the check stand and tell me, "He said How's your day."

We were listening in the car this morning, and the DJs were doing a prolonged joke. I missed the story behind it, but it was a whole bunch of ending to "The Last Time." The last time you walked your dog. The last time you fished for a boot. The last time you got smacked in the head by a shoe, etc. He was laughing so hard I thought he might cry. He requested "the joking one" on our drive home in the afternoon.

I guess the intended audience to morning talk on the radio is a three-year-old boy.

While We're Talking About Church Music...

2012-01-15T20:50:00.000-08:00

This post exposes my music snobbery. Please look away if you're going to judge me, or if you're a lover of "LDS music" as a genre. I don't want to offend anyone. But...

I have been asked to play a piano solo in Sacrament Meeting next week. The lady asked me a couple weeks ago, so I have had a while to think about this. I have such a hard time playing piano solos in church because I can never figure out what to play. Every time I am asked to do this, I wonder why I don't have a collection of appropriate music in my personal music library to choose from. As I have thought about it this time, I have come to this sad conclusion: there is none.

I am a Classical pianist, so my library includes Classical piano music. This music is generally secular, even though many of the composers wrote fantastic sacred choral, vocal, or other instrumental pieces. Bach's life was spent as a church composer, but most of his keyboard music (including the Well-Tempered Clavier, the French and English Suites, and the Partitas) is secular. Handle wrote The Messiah for choir and orchestra, but wrote nothing sacred for the keyboard. Beethoven and Mozart were kings of the sonata. Chopin, Schumann, Schubert, Debussy, Poulenc...all wrote fabulous secular piano music, none of which I think are appropriate for sacrament meeting, since it is a sacred meeting of worship, and not a recital.

That leaves my choices for sacrament meeting limited to arrangements of hymns. I think that there are many lovely vocal and instrumental arrangements of hymns, but for some reason, it just doesn't translate well to the piano. The LDS Church Pop Genre has had way too much of an influence on "Mormon Composers", and they end up arranging hymns for piano by arpeggiating the accompaniment and modulating as a form of emotional manipulation. I can't stand it. To me, it screams "Hey, I'm a fraud of a composer, and I'm desperately trying to manipulate you into feeling something!"

I have tried to put my sadly negative feelings on this matter aside and pick something out that will do for this meeting. I even found a decent arrangement of a primary song that I don't hate. In the end, I have decided on one of Mendelssohn's Songs Without Words. It's a bit risky since it's not a hymn, but Spiff assures me that it will invite the spirit. I wonder if anyone will ask me afterwards what hymn I was playing?

If you know of any great piano solos to play in sacrament meeting, please enlighten me. I would love to have a nice library of beautiful, spiritual piano solos in my library. It would sure make this process easier for me the next time around.

Let's Talk About Primary Music

2012-01-08T19:31:00.000-08:00

I am the Assistant Primary Chorister in our ward. Yes, I did say "Assistant." This ward we live in is lucky enough to have two primary choristers. It makes sense to me because the primary chorister job is a big one. One where you have to entertain a varying age-group of kids, and one that you're "on" every week of the year. It's also one that you have to basically pull off a primary program by yourself. Well, that's not so fair to say, since the presidency and the teachers do so much work. But really, a whole lot of it is on the shoulders of the chorister. So, it's nice to have a partner so that we don't have to teach singing time every week.

I have had this calling for about four months, teaching about every other week. It's a fairly natural calling for me, since I am a musician and was basically born to be a music teacher. That being said, coming up with interesting lesson plans for the group of kids is difficult. I want to be able to pull something together that is simple and reverent, yet fun and entertaining, in a reasonable (i.e. short) amount of prep time. But finding such an activity that will appeal to both young and older children alike is difficult, and I stress way too much about it every time it is my turn to teach.

For example, today I taught the new 2012 Primary Song, which is printed in the little handout booklet the general presidency gives to every ward. I found an idea on a blog that sounded easy, but found out that prepping it took waaaaaaaaaaaaaaaaaay too much time. Then the more I did of it, the more her idea didn't make sense, and I wanted to do something else but had way too much time invested in it to start over. Super frustrating. I may or may not have stormed around the house at one point bemoaning the fact that none of the flashlights in our house had working batteries. (editor's note: the author did in fact have a snit re: batteries.)

This was my first Sunday teaching the junior and senior primary kids as separate groups (they had previously been combined). The lesson actually worked pretty well with the junior primary, although I found out that I had some pretty gaping holes in my lesson. I filled the holes before teaching the senior kids, got all geared up, and started my lesson. And do you know what? It is HARD to get senior primary kids to sing. The all stared at me with that look in their eyes that said, "You have got to be crazy if you think I'm going to sing this song." I continued with my 20-minute lesson with a huge fake smile on my face like it was the very best lesson anyone has ever done. At one point, one kid actually asked me, "Did you make this song up?" I showed them the printed music. No. I did not make up this song. Now sing! With a smile! And like it, dang it!!!

Now, I have two other problems. First, I don't like this new song. Here is a simplified version of the sheet music. I am not a fan of Janice Kapp Perry's music. This song, like many of her others, is uninteresting, the lyrics don't rhyme (how do you get away with rhyming "choose" and "too"?), and the melody is unmemorable, which will make it difficult for the kids to learn. I wish I liked it. I guess all children's songs are sweet when sung by our sweet little kids. But it's hard to be genuinely enthusiastic about teaching a song that you don't like. The kids sense it, and they call you out on it, and then eat you alive.

My second problem is that Gunner is now in Primary!!! He had his first day as a Sunbeam today. And he did okay. He didn't cry until (I heard later) he got to his classroom with his teachers and wanted his mom. Apparently he knocked over a chair in his anger. Yikes! How in the world do I teach that kid that it's okay to be with other adults than just me? And that it's never okay to just, oh, I don't know...Knock Over Chairs because you're mad!!! I'm a bit mortified about that.

But anyway, he's in Primary with me now. And I'm trying to lead the kids, keep all of their attention, get them all involved somehow, give turns to as many as possible, AND have my three-year-old hanging off of my arm now. During the 20 minutes of junior singing time today, Gunner was out of his chair no less than 20 times. "Mommy, I want to help you stick the paper up!" "Mommy, I want to help you lead!" "Mommy, I want my toys!" (I borrowed some of his toys as props today. I knew it was a bad decision when I did it. Putting the lesson together was a pain in the tookus, you see, so I did it anyway.) I'm surprised that my arm didn't fall off because of the amount of time he spent hanging off of it.

And that was week #1.

I guess I know what I'll be praying for in the weeks to come.

Not Enough

2012-01-04T15:29:00.000-08:00

One of the nicest things about this one-year Intern Year is that we live in Utah long enough that I have been able to spend time with my family and some time with some of my oldest and dearest friends. In the last six months, I have:

Reconnected with my family. I have a weekly playdate with my sister and her daughter taking our kids to the zoo. I have had my nieces over for a sleepover. I have spent a couple weeks at my parents' house. I have enjoyed a holiday season filled with the best family traditions.

Seen my oldest friend. We met when we were five years old, and now she has five! children and is an amazing mom and dance teacher.

Had play dates with my favorite college roommate who's two boys are so much like Gunner that it kills me that we don't live next door. They could wrestle and play Lightning McQueen and Angry Birds together every day and be the happiest kids in the world.

Driven to CA to see some our favorite people from our medical school years.

Spent time on a regular basis with my favorite cousin and her awesome kids.

Made a new friend who is awesome enough to run an upcoming marathon with me.

Spent time over the holidays with friends from St. Louis who are visiting family in Utah. Our kids feel like they have gone home with each other. And it makes me miss the community of awesome people we lived with while Spiff was in medical school, who have now mostly scattered themselves around the country.

I feel so blessed to have the time and opportunity to spend some good and honest time with my family and with so many of my closest friends. It is truly wonderful to rekindle these relationships that have been long-distance for so long. (I moved away from this area nine years ago.) But as I think about this blessing, what I realize is that this year is not enough. The few short hours I get to spend with friends who are visiting, or with friends while I'm visiting Idaho, or the days I spend with my family are never going to be enough.

The more time I spend here, the harder it is going to be for me to move away again in six short months. In the back of my mind, I knew it would be this way when we moved here in June. I had been away for so long that I was used to long-distance. And now that I'm settled here and feel slightly at home, it's going to be so hard to turn these relationships back into long-distance ones.

So, I have this idea. It's a pretty good one, too. When I die, I expect that my own person Heaven will be a giant suburb where all of my favorite people, my family and all of my friends who I have known and loved throughout my life on earth, will all live by me and be my next-door neighbors. We will either all have connecting back yard gates, or whoever you need to be next door to you can be at any time. It will work because it's Heaven and because all things are possible in Heaven, right?

I sure do hope it's like that, or something equally awesome. I love my family and friends dearly, and since it's not possible to be with them always on earth, I hope to be able to earn the privilege to be with them always in the eternities.

Simple Sports

2011-12-18T19:01:00.000-08:00

I love the simplicity of running. Good running gear is nice, but I love that all you really need to run is a good pair of running shoes. Compared to Spiff's other beloved sports, including biking, rowing and skiing that require a bare minimum of a large investment in order to get started, running seems like the most lovely, simple thing of the athletic world.

These days, however, here's what it takes for me to get out on even the shortest of runs:

My own running gear, including sunglasses, warm winter running pants, jacket, hat and gloves.

My two children, since Spiff is working all hours and they come with me, who both need to be fed and clothed before setting out

Double jogging stroller

Weather shield for the stroller

Coats and gloves for the kids

Blankets

Warmed rice bags for a little extra warmth in the 20 degree weather

Toys and occasionally food for the older one

And my awesome running partner, her little boy (with accompanying equipment mentioned above), and her Magic Garmin Watch to tell us how far and fast we're going.

That's a lot of stuff. It takes me at least 45 minutes to get ready to go for a 30-60 minute run.

Besides that, I have a wish list. I want my own treadmill. I want my own Magic Watch. I want my own Ipod (I know, right?! Who doesn't have an Ipod these days? Spiff has one that he uses at work, but I don't.). I want a new techie running cap and a strap-on-my-hand-while-I-run water bottle. I want new running shoes and socks. I want to register for a whole lot of events.

Some of these things are needs, and some of these will become needs when we move to Minnesota next year. But what this list boils down to is a whole lot of money invested into a sport that is supposed to be as simple and inexpensive as strapping on a pair of running shoes.

Very Christmas

2011-12-11T13:06:00.000-08:00

Alright, so the Christmas Season is trucking along. With two weeks to go, I feel like I have made progress, but still have so many little things to finish up that I'm still completely overwhelmed. I've got my Christmas cards, but they need to be sent out. I have presents that need to be wrapped, some packages sent, but some that need to be sent. I have neighbor gifts to make and deliver. I have a few more presents to purchase. I wish that I could be super organized like my neighbor, Kalie, and have everything done already so that I could simply enjoy the activities of the season...stuff like this:

We decorated for Christmas just after Thanksgiving, and Gunner was so sad when I took his Thanksgiving window sticker turkey down. Then some amazing Christmas elves (thank you Mom and Auntie Mhana) sent him new fancy Christmas window stickers! We have the most festive window on the block.

We went to Temple Square last night. It never ceases to amaze me. The lights are overwhelmingly beautiful, and I love it, always. I also can't help but think about the manpower and hours of work that go into putting up and taking down that display every year. Wowzah!

We tried taking the boys to a live nativity the other night, but when we got there, the area was all parked up, and there was a line of people stretching several blocks down the street. We decided not to wait in line, drove around a bit, and ended up at the zoo, where they have an event called Zoo Lights. Most of the actual animals were asleep, but we walked around looking at neon animal displays. And.........Santa's Reindeer! They have real reindeer there! Very cool.

I had a small wrapping party at my house the other night. I got two whole presents wrapped, but a whole lot of talking to friends in.

We attended my sister's ward Christmas party, where Gunner got to sit on Santa's lap. When asked what he would like for Christmas, Gunner replied, "Christmas." Well, who wouldn't?!

Gunner is so excited about Christmas this year. He's enjoying all of our little family traditions. He wakes up every morning asking to open a box from our Playmobil Advent Calender. Then we have to turn on all of the Christmas lights. Then he wants to pull out an ornament on the felt advent calender my mom made for us. Then he has to find the stuffed Tomten, which is a Scandinavian folk character who guards our tree and hides every night. He loves it all so much that I'm sort of dreading the day when Hobbes cares about doing these fun things, too. Who would want to share such fun activities?! But that's a problem for another year.

Also, I finally have a few presents under our tree, and they are killing Gunner. Just killing him! He asks about 15 times a day if he can open them, and he just doesn't get the benefit of waiting and the concept of anticipation. We got a package of presents the other day from our Aunt, and he was so upset by not being able to open them that he stormed off saying, "I Hate presents. I want to throw the presents in the garbage!" So you see, I was incredibly grateful to Spiff's mom when her package arrived, and there was a present labeled, "To Gunner, Open Right Away." Best words ever! It was the Three Playmobil Wisemen and a Camel, an addition to our excellent Nativity Scene. Grammy, you really won Christmas this year!!!

And last for today, Gunner accompanied me to tithing settlement today, while Hobbes and Spiff were home sleeping. As we were leaving, Gunner wished the bishop a "Very Christmas!"

Very Christmas, everyone!

Turkey Trot

2011-11-26T20:24:00.000-08:00

I ran my first ever Turkey Trot on Thanksgiving morning. I can't believe I have never done it before! There couldn't be a better way to show my gratitude to Heavenly Father for my healthy body than by running, just before cooking all day and then shoving it with tons of delicious food. Yes, I am grateful for food and health this season.

I'm also grateful for my 5K PR!!!
My time: 25:18 (Sixth in my age group). I think this is a 6-minute PR!
I ran with my sister, who came in at 25:45 (seventh in our age group). Very cool!

I loved it, and I think I'll finally join the masses and make this part of my Thanksgiving traditions.

Sunday Afternoon Agenda

2011-11-20T18:52:00.000-08:00

Today was a long Sunday, with Spiff at work all day. The Sundays Spiff is working seem to drag on forever, and I have a hard time figuring out what to do to entertain my kids when going to a park or a store is out of the question. I got lucky today, though. I had a really awesome kid to keep me company. Here's how we spent the afternoon.

I started to play the piano, and immediately had two boys wanting to play along.
Then Gunner wanted to dance to the piano music, so he danced. Then he wanted me to dance with him.
Dancing led to him getting his dancing dress-up on (which is a "pretty dress" that is really just one of my old shirts).
It also led to me turning on some old clips of Dancing With the Stars dances, me "lifting" him gracefully off the couch (this kid has got some moves, let me tell you!), and him putting on his Robin (Batman's sidekick) suit on, so he could look like Helio Castroneves in a suit.
Dressing up as Robin led him to dressing up as Batman himself, which led to him driving a Batmobile he created from a diaper box.
Then he dressed up as a Super Fireman, which is a Fireman who sports a Red cape. He saved Hobbes and me from many a fire.
But then there was the fire he couldn't save me from, and I got "sick". He made me lie down on the floor so he could nurse me back to health He was the sweetest care-taker. He gave me shots, medicine, and all of his most special toys to help me feel better. He also came to the hospital as a visitor to help me not be lonely.
Having me sick on the floor led to him getting out all of the pillows in our house so that I would be comfortable. (Hobbes liked that one. He rolled around on the pillows laughing, like he was a millionaire rolling around on a pile of money.)
When he helped me feel better, he got "sick" himself, and I was instructed to "feel him better." Good thing I had a great care-taker to teach me how to take of a sick person.

And that's how we spent our afternoon. He's a fun little kid to play with. Hobbes spent the day following him around, and there were some times when the two of them were both rolling on the floor laughing together. Goodness, I love seeing his imagination develop, and watching the relationship between these little brothers grow.

This is what I call Joy.

Fix-It Christmas

2011-11-17T20:16:00.000-08:00

Okay, so I'm skipping the Thanksgiving post for now, and heading right on to Christmas. If you refuse to acknowledge Christmas until Thanksgiving is over, then I'll see you next week.

I will first admit that I'm not looking forward to buying gifts for my loved ones this year because I (once again) do not have any great ideas for any of them. I feel like this always sneaks up on me, and I always end up procrastinating it until I end up spending too much money on shipping right before Christmas. Either that or getting into a losing battle with a post office worker. Gift buying ends up being a big stressor for me. I don't know how to quickly come up with something great, that doesn't seem chintzy on a small budget. I'd love to get awesome things for the people I love, or do something lovely, heartfelt and homemade. But I don't have the time, money or talent to pull off anything great like that. Sigh. I guess I'll be praying for some inspiration.

Second, Spiff and I have decided not really to buy each other gifts this year. With a move coming up in June, and in an effort to keep the cost down and the level of "stuff" in our house to a minimum, we have come up with what we are calling "The Fix-It Christmas."

Instead of buying new things, we are spending any money we would spend on gifts fixing things that have been on a To-Fix list for months/years. We are upgrading things. And we are replacing things.

It's not elaborate. Little things, like my watch battery that hasn't worked for about a year and half. Spiff's heart-rate monitor battery that needs to be sent out to a special place to be replaced. New running shoes that I need for my upcoming marathon. Parts for the Yakima rack that we'll need for the move. Etc.

It sort of takes the surprise out of the gift-giving and receiving side of things, and it does seem sort of lame to get/give a watch battery for Christmas. But I feel a whole lot of peace with our little plan, knowing what's coming up in our lives, and knowing that we did something to minimize the chaos in our home. Besides that all of it will be done with money that we will need to spend anyway, so we might as well wrap it up and put a bow on it. Don't you think?

My Shadow

2011-11-10T18:10:00.000-08:00

I have a permanent shadow these days that follows me around all day, in sunshine and rain. It is about three feet tall, talks constantly, and is named Gunner.

Seriously, I don't know what it is about this phase of his life, but he cannot seem to be more than two feet away from me at all times. If I am sitting on the couch, he is sitting next to me, asking me to read to him. If I am looking at the computer, he is on my lap asking me what I'm looking at. If I am making dinner, he is playing on the kitchen floor. If I am folding laundry, he is sitting on my bed. If I am interacting with Hobbes in any way, he is right there next to me, getting involved. If I am not carrying Hobbes, he wants me to carry him.

The funniest part is when I am doing chores and am moving from room to room. He sits at my feet on the bathroom rug while I do my hair. Then when I go downstairs to do some laundry, I hear, "MOM?! Where are you?!" I call back, "I'm downstairs," and the next thing I know, my shadow has found me and is resuming his game, again at my feet. We repeat this situation in every room all day long.

It is cute, albeit exhausting having him constantly under my feet. He has to win me up the stairs. He has to get to the door and open it before I do. He has climb out my car door and pop the trunk whenever we go anywhere. And did I mention the constant talking? This boy does not know how to be quiet. He has a constant stream of words, dictating the narrative of his life. Even the rare occasion of him "quietly reading a book to himself" is narrated. No wonder sitting quietly in church is such a struggle for him!

I keep wondering when he will get more independent, and if I will miss the days of my little talking shadow. I probably will.

...But not much. :)

Home Again, Home Again, Jiggity Jog

2011-11-05T09:06:00.000-07:00

We had a great trip to California. I loved seeing our friends, although seeing them makes me freshly miss them all over again. They are such good friends, and I love seeing our children together. Gunner played guns and wrestled with their 5-year-old the entire time we were there. He loved it. He also hugged their two girls any chance he got. I went running with my old running partner, we made cookies, took the kids trick or treating, carved pumpkins, played games, ate BBQ Ribs, and we even went on a date. Awesome. And totally worth the hours and hours of traveling and whining kids.

We have enjoyed the rest of Spiff's vacation week at home. He has gone mountain biking and skating, like he wanted. We have watched a lot of TV. We have relaxed, and I feel 100% refreshed, but somehow completely NOT ready for him to go back to work.

In other news:

We have experiences three seasons in one week. We have played in the Pacific Ocean and the beach, played in Fall leaves, and played in snow. Gunner has loved it. And so have I.

We came home from our trip to find that The Neighbors have moved. I guess I can check that one off the list of things to worry about.

I signed up for my first full marathon, coming up in May 2012. I'm excited to take my running to the next level, but I am also terrified! I don't know how I'm going to find the time to train, what with taking care of my kids and Spiff's busy schedule. But the good news is that my new running partner neighbor also signed up, so we'll be able to train together and support each other with our kids. So it's on to a Winter of cross-training, leading up to full-marathon training in the Spring! Wowzah!

Hobbes figured out how to sleep through the night, for approximately a week and half. He slept all night long during our entire trip! It was glorious! And now that we're home, we're sort of back to square one. Hopefully he'll remember quickly. He has learned how to pull himself up on things, to cruise around furniture, and he is getting so much more comfortable getting himself up and down and all around. It's super fun to see him be such a busy little guy.

Vacation, All I Ever Wanted

2011-10-28T15:01:00.001-07:00

Spiff's vacation starts tonight, promptly at 5:00 pm. The kids and I are picking him up from work and driving to California to visit some medical school friends. I could not be more excited! Not only do I get to see our good friends, I get to spend time with my husband when he's not sleep-deprived and stressed out! Ah, what sweet relief a little R&R will bring!

Wish us luck on the drive, cuz we're out of here and spending Halloween in sunny CA!

To the Doctor!

2011-10-23T16:25:00.000-07:00

This post is more for me than anyone else. I took the kids to the doctor last week, Gunner for his 3-year well-child check, and Hobbes for his 9-month baby check. You'll all be relieved to know that my children are growing just fine, and they're both as healthy as can be. Whew. What a relief. I know you were worried.

Stats:

Gunner weighs 33.8 lbs., and he is 39.5 inches tall.

Hobbes weighs 19.2 lbs, and is 29.25 inches long.

He's in the 28th percentile for weight, with a 90th percentile head circumference. Gunner was always in the 70th percentile, so it's sort of strange for me to have a smaller baby.

Both of the boys got shots, Hobbes a flu shot, and Gunner a Hep B booster he should have gotten half a year ago. Gunner hasn't had a shot for a year, so I prepared him by telling him he was going to feel a little poke. I expected a little bit of a tantrum or a fight. Instead, he watched the nurse give him the shot, sort of flinched, and then said, "Hmm, why do I have a bandaid?" No tears or fears of any kind. He's such a champ!

Also, this doesn't have anything to do with the doctor, but just to update you all on the doings and growings of our sweet little baby. He has a tooth and is working on another. I loved his gummy smile, but I sure do love that little tooth. Super cute! And he can pull himself up on things. Now that he can do it, he spends all day long pulling himself up and grinning from ear to ear. He's so proud of himself! He still has a really awkward army crawl where he pushes/pulls himself around. It looks so uncomfortable, but he's just as happy as can be with it. And he's Fast! He can really get around, limping and lurching like a little lizard who has a broken arm and leg. Oh well. Whatever works, right? Other than the fact that he doesn't sleep at night, he is just the most awesome, happy and pleasant little baby in the world. Simply happy to be alive. Love him!

An Hour and Fifteen Minutes

2011-10-23T13:00:00.000-07:00

That's how long my baby cries when he wakes up at night. When I hear him wake up at night, I look at the clock and know that we'll have to endure his pitiful cries for no less than an hour and fifteen minutes.

I'm so sad that I know this.

How long have we been sleep training? Three months, if I remember correctly. We have had to endure this for So Long. It's miserable every night, and I feel like the worst momma in the world every. single. time.

And I think the very worst part of it is the regret. We went through this with Gunner as a baby. We rocked him to sleep as a tiny baby, and I loved it. Only when it stopped working (around six months) did we painfully decide, as first-time parents, that we needed to let him cry-it-out. Spiff and I both decided that crying-it-out was so miserable that we would never let another baby of ours become dependent on us to go to sleep. We convinced ourselves that it was our fault that he didn't have any self-soothing skills, and that we caused that situation.

So when Hobbsie came around, we both refused to rock him to sleep. From the very beginning, we put him down in his bed to fall asleep on his own. With the help of a swaddle and a binkie, "we taught him self-soothing skills," and he was awesome at falling asleep on his own and sleeping through the night. Up until six months old, when just like Gunner, it stopped working.

And now I feel like I missed out on one of the most precious and wonderful experiences I can have with my sweet little child...rocking and holding him as a tiny baby. And it was all for nothing. And I will never get that time back.

I also have plenty of time to think about this awful regret...every night...as he cries-it-out for an hour and fifteen minutes.

The Neighbors

2011-10-03T15:31:00.000-07:00

This is a picture of someone getting arrested right in front of our house. Sorry the picture is so crappy. I was taking it from inside my house (so as not to be such an obvious creeper), and the reflections from my window are terrible. But you get the gist, right?

Notice the guy on the right who has rubber "drug-finding" gloves on? And the black unmarked police vehicles? There were at least seven of them on the street. There were police milling around the house all afternoon, and even a Drug Dog that got in that white car and sniffed all around. Interesting to watch. Exciting drama at our place today!

I have actually been thinking about posting something about our neighbors for a while. But Spiff informed me that the home teachers said that they would be moving soon, so I held my tongue. Until the drug bust today.

Gunner has made friends with the neighbor kids. One of the kids is an 8-year-old boy who is very nice and well-mannered. He comes over and brings his cool "big kid toys" that Gunner loves to play with. I don't actually mind when the big kid comes over because it keeps Gunner completely occupied for a couple hours.

I do mind it when his little sister (who is seven, I think) comes over, too. She knocked on the door the other day. I opened it. She said, "Um, is my brother here?" I said, "Yes, he is." She stared at me. Then she said, "Well, can I come in?" I let her in.

She's a decent kid, too, except that she's a big more negative than her brother. She says sort of mean things. And when she comes, her brother plays with her and not with Gunner. Then the two of them are playing with each other, at my house, with Gunner's toys, ignoring Gunner.

It's weird.

I have all these concerns, but they have mostly stemmed from the fact that I don't know the family. I worry that they'll teach Gunner behaviors that aren't appropriate for a 3-year-old because they don't seem to understand that he is a lot younger than them. I worry that he feels bad when the sister is around and he is being ignored. But mostly I worry that they will take him out of my house and across the street to their house without me knowing.

The other day, the kids were here, and I told them that Gunner, the baby, and I had to go run an errand. The boy said, "Well, can Gunner come to our house?" I said, "No." Him: "But I could ask my mom to watch him." Me: "Um, no thanks." Him: "But it's not a big deal at all. He could just come over." Me: (Letting out a little scream in my head) "No! I'm just going to take him with me!"

And then today. The drug bust. Gunner asked me, "Can I play with my friend?" I said, "Well, honey, he's probably going to be busy today." Gunner: "Why?"

Oh boy. How do I explain that one to a 3-year-old?

The kids are nice. I'm just uncomfortable with the whole situation. And I feel bad for hoping that they really do move soon.

Conference Weekend

2011-10-02T17:14:00.000-07:00

One of the things I have realized about living in the Salt Lake valley is that it's sort of tricky to make friend here because almost everyone who lives here lives close to home. That means that they already have family and old friends around, and they don't have tons of room for new people, especially new people who are here temporarily. I'm lucky that I also have a small circle of family and old friends here (and even a new one), but they had plans with other family, and I found myself a little on the lonely side this Conference Weekend as I remembered several years of watching Conference, eating yummy food, and spending time with good friends on this weekend. (I will mention that some of my family members were nice and invited me their family functions, but I didn't want to intrude.)

That's why I was so grateful to be invited to a breakfast this morning with some of our close friends from Spiff's medical school who are doing their residencies in Utah. Our four families, minus Spiff and another of the husbands, ate a delicious breakfast together, and then let the kids play in the backyard while Conference blared on the radio. It was glorious! Perfect October weather plus happy and occupied kids means that I actually got to listen to a snippet of some of the talks. Thank you, Lindsey, for putting it together! I felt like I had a little taste of "home" today.

On a slightly related topic, I have recently given Gunner a job. I got tired of him getting upset with me when I forgot his cup of water (known as "Truck Water" because of the pictures of trucks on the cup) on an outing. So, I decided to let it be his responsibility. I tell him, "If you want your Truck Water, then you have to bring it with you." I remind him to grab it, but when he asks for it, I have loved being able to say, "Nope, I don't have it. Did you bring it?" And he loves feeling like a big kid with a responsibility.

In the few minutes of Conference I was able to catch on Saturday afternoon, Gunner sat on my lap and listened for about 30 seconds. The speaker talked about church callings and responsibilities. Gunner perked up at a word he recognized.

Today, Spiff asked Gunner if he listened to the prophet speak.

Gunner said, "Um, yeah."

Spiff asked, "What did he tell you?"

Gunner replied, "He told me that it is my sponsibility to bring my truck water."

Spiritual lesson...Check.

My New Obsession

2011-09-24T12:23:00.000-07:00

Asian Cooking.

Since our move in June, my taste buds have decided that the most delicious food on the planet is Asian food. Curry, Rice, Thai food, Noodles bowls...Oh, may the Heavens open up and swallow me whole! I can't get enough. It is all I want to eat these days. And I have entered on a new quest to figure out how to make them.

I have gone to a local Asian Market and invested in new ingredients to me, including fish sauce, oyster sauce, rice vinegar, fried shallots, chile paste, Srirache sauce (my favorite!), sesame oil. I have a pile of recipes to try. I have had some successes, some failures. I have tons to learn. And I'm totally intimidated by what may be the most simple thing in the world, but seems to be an incomprehensible mystery: Asian Noodles.

If you've shopped at an Asian market before, you have seen the vast quantities and varieties of noodles they sell. It is truly impressive! Package after package of noodles that are slightly different from each other, but since I don't read their languages, I can't figure out what makes them different, or how exactly to find the one kind of noodle that is specified in a recipe. I definitely don't know enough about them to know how they will behave in a recipe, so I certainly can't blindly choose something out of the masses.

I asked for help, and the kind owner of the shop led me to all the different kinds of noodles I needed. I purchased some dried Chinese egg noodles. I have never cooked them before, and so when I got home and started making dinner, I read these Engrish instructions (click on the picture to make it big enough to read):

It made me laugh. I clearly have a lot to learn about this.

***And while we're on the topic, if you have a favorite Asian recipe that makes your mouth sing, please share it with me! I'd love to add it to my repertoire.

Unreasonable Expectations

2011-09-17T05:53:00.000-07:00

Spiff went off to work in the ICU this Saturday morning, leaving the house at 6:30 to ride his bike to work. He will probably return home tonight after 8:00 pm. He is working 13/14-hour shifts both Saturday and Sunday this weekend. This is after a week of 7pm-9am night shifts.

I mention this because, after he left this morning, I got up and read this status on a friend's facebook status:

"if grocery stores, restaurants, movie theaters, sporting events, and gas stations can serve the public on the weekends with out raising their rates, why can't doctors' offices? Seriously, they should staff-up 7 days a week, and evenings too. Because we all know that's when kids like to get sick."

I had to fight really hard to keep myself from posting a snippy, irritated comment in response. And in the end, I couldn't help myself from defending the doctors. I mentioned that doctors do work on the weekends, and they are do work around the clock in hospitals. I also mentioned that they are available at urgent-care and ER facilities. Her response was that doctor's weekend options are too expensive, so they should open their clinics on weekends and evenings at a normal rate.

In my opinion, expecting doctors to be available in their clinics at all times at normal rates is unreasonable. Should we expect plumbers, electricians, computer technicians, and all other professions to work around the clock, without overtime pay, just in case we need them? I don't think so.

Besides the fact that there are often weekend option available, I think it is important to think about the lifestyles of those providing services before demanding that they are available for our every whim.

What do you think?

Yumm!

2011-09-15T12:09:00.001-07:00

I lived in Eugene, OR for five years. I fell in love with it for many reasons, a few of which are these:

Our great family and friends.
The coast, just a 45-minute beautiful drive away.
Blackberries growing wild on every road side.
Green, Green Everything
Bike and running paths to take you anywhere you want to go.
Ducks Football
And last, but not least, Café Yumm!

Sweet Mhana just brought me this extra large bottle of Yumm! sauce:

I made bi-monthly trips to this eatery while I lived there, and I deeply miss it. This sauce is amazing, and unfortunately for me, perishable. I can order it online, but it has to be constantly refrigerated, making it way out of my shipping price range. I even tried to make it last year by replicating the secret recipe from knock-off recipes online. The result looked good but tasted far from accurate, and far from satisfying. Now, I almost feel like I have a bottle of pure, edible gold sitting in my fridge.

I can't wait to dig into my homemade version of this deliciousness!

Café Yumm! is a small chain with locations in Portland, Bend, Corvallis and Eugene, OR. Check it out if you're ever in the area. It is so very very delicious!

Vacation Crazies

2011-09-12T20:37:00.000-07:00

The boys and I visited my parents last week. It was a glorious vacation. We didn't do much but sit around my mom's house and play with her toys. It was so nice for me because I didn't have my own chores to do, no mountains of laundry, not my own kitchen to clean, not my bills to pay or errands to run. I was free to simply play with my kids. And my mom fed my baby during dinner every day. I even got a couple naps while I was there. It was a real vacation for me, although we did miss Spiff, who was working like a dog at the horse-pistol.

We returned late in the evening a couple days ago and dumped our vacation on the floor before falling into bed. We woke up in the morning to company (so fun to have Spiff's mom and sister in town!) and a day off for Spiff, which made for a fun-filled day and weekend.

Then today, I attempted to clean up the vacation that was still on the floor from two days ago. So much cleaning to do! Bills, errands, etc. Not to mention the fact that I have yet to make it to the grocery store since before I left on my trip a week and half ago. Seriously, how do people recover from vacations?

And then there are the children. Good heavens, the children! Both of them have spent the past 36 hours crying, whining, or complaining constantly. The baby refuses to sleep at night these days. I need someone to please remind him that he is not, in fact, a newborn, and does not need to eat three times a night! I'm sleep-training now (for real this time), and it's so miserable. He cries and is awake all night, so he's tired and cranky all day. This night-waking thing is baffling us. It could be just a phase, could be separation anxiety. A lack of self-soothing skills. Teething. Tummy problems. Who knows. But it's exhausting me.

And Gunner, since we got home, refuses to believe that he can entertain himself. He seriously has seemed to lose all ability to do anything on his own. I guess all that extra love and attention he got from me and his grandparents was the absolute wrong thing to do on vacation. Next time we should all completely ignore him.

Plus, he has developed this attitude. I have heard that it's common for three-year-olds to become bossy. Boy, is he bossy. And rude. He told me today, while I was snuggling him and reading him a book, that he wanted me to "shut my mouth."

That's when I put all of his favorite toys on an indefinite time out. He has to earn them back by being nice to me and by doing nice things.

That'll teach him to be rude to his momma!

Oh, boy.

It's just vacation detox, right? Right?! A few days of regular schedule, food and sleep patterns will calm them both down. Right? Please tell me we'll all start getting along again. Please tell me that the vacation crazies will go away. Soon.

I may never go on vacation again.

Nothing to Report

2011-09-07T18:43:00.001-07:00

I have posted in a few weeks because I haven't come across anything I felt blog-worthy in a while. We have had a month of nothing to report, other than this stuff:

I am still struggling with that darn oven! Since the banana bread, it ruined yet another loaf of pear bread (I decided to give up on that one), and it burned a blueberry pie. An oven thermometer has just moved up to the top of my shopping list. I don't think I can emotionally continue to try to bake and fail.

I ran a half marathon on Saturday with all my siblings and two of my siblings-in-law. This has been a tough training program for me this time around because Spiff has been so busy, and I haven't been able to rely on him to watch the kids. I also haven't been well rested because of my young baby who has decided not to sleep much these days. Because of this, my goal going into the Half was just to finish.

Then two days before the event, I decided that I felt really good after all, and I was going to try to PR. Race day was beautiful, the course was great, and I did, in fact, set a new personal record of 1:58:45, beating my time from 2 1/2 years ago by a whopping 10 seconds. I find myself actually being disappointed for not being even faster, but I have to remind myself that I didn't train for a PR, and I should be happy with my effort. I am grateful for my new running partner, Kalie, who has been there with me stride for stride with jogging stroller in tow, as we pounded the pavement over the past couple months. I am grateful for the friends and family who watched my children so that I could run. And I'm grateful to have had the experience of participating in a distance running event with my family, team SRT. When I started running 13 years ago, I never thought I would see the day when all of my siblings would run with me. I love it!

And also, Spiff and the boys and I have enjoyed some small hikes on Spiff's off days this past month. It has been a nice way to enjoy some family together time. It's free, it's out of the house, and it wears Gunner out completely. We did a 2-mile hike last week where Gunner actually walked 9/10s of the way all by himself! At a steep point in the hike, we told him that we were mountain goats, like the Billy Goats Gruff, and we were going to climb a mountain. It is the first walk we have taken with him in a long time that he didn't complain about being tired.

This is a pretty lengthy, wordy post for having absolutely nothing to say. Thanks for listening to my rambling.
Until next time!

When Your Ego Takes a Hit

2011-08-21T17:47:00.000-07:00

I love good food, and I think I'm a decent cook. (Is that a vain thing to say?) In fact, I have been told that food is my love language. Having a baby? Have a family illness? Anyone in your family having surgery? No problem. I'll provide dinner! I'm not great at providing other services for the people I love, but I can usually give food.

I enjoy cooking, and I love baking, especially in the Fall when the weather chills up a bit, and warming up my kitchen with yummy smelling baked goods is just the right thing to take the bite out of the air.

Now, here's the problem. My little house has a lovely, brand spanking new kitchen. The landlords fixed it all up, with new tile floors and new cabinets. It's beautiful! They even installed granite countertops. Problem, you say? It sounds glorious!

The problem is the oven. Right now, I'm wishing they had saved their money on the countertop and bought a new oven. The one in the kitchen is old and unpredictable. I have discovered that I have to set the temperature at least 25 degrees cooler than specified in any recipe. AND I have to bake things for much less time than recommended (think 7 minutes for 11 minute cookies).

Even then, I'm always guessing. I have ended up with crispy cookies (I like 'em soft), dry pear bread (it is HARD to turn pear bread dry), and my latest "creation", this lovely banana bread:

Ouch!

This has a big possibility of having a seriously negative effect on my reputation. I promise that it's the oven's fault. Please don't judge me.

Event Confusion

2011-08-15T15:53:00.000-07:00

I think Gunner is a little confused by time and spacial relationships. Today he said the following:

Mommy, will you get my birthday out?

I want to go to Halloween.

My birthday starts on Wednesday.

On an unrelated note, and in honor of Liz Lemon (although he has never seen an episode of 30 Rock), he has said, entirely unprompted, and on many occasions, "I want to go to there."

Me too, Gunner. Me too.

Wild Goose Chase

2011-08-15T15:29:00.000-07:00

Hobbes is a puker. Anyone who has been around him has either been repelled by his constant state of wetness, or baptized by a large volume of baby vomit. All babies spit up, but his puking seems excessive, although it doesn't seem to bother him. It bothers me with the extra laundry I have to do, and the fact that he has ruined my carpet! I brought it up with his doctor at his 6-month check-up, and he prescribed a reflux medication, Prevacid (Lansoprazole), in pill form. We were to administer it by crushing it up and mixing it with some baby food.

Keep in mind that Hobbes is only 7 months old, and at the time we got the prescription, he had been eating solid foods for exactly one day. Getting him to swallow enough of it to be effective has been challenging, if not absolutely futile.

It hasn't been working, or doing anything at all, from our perspective. My carpet is still consistently being doused by little wet orange blobs of vomit.

Spiff mentioned that the medication could be formulated into a liquid format for easier administration, so I called the doctor's office to see if we could get that done. Piece of cake, said the nurse. She'd call it in to the pharmacy of my choice.

I chose the Costco pharmacy close to my house, and because a series of unfortunate events, I was unable to go pick it up for about 6 days. At the end of my shopping trip, I checked at the pharmacy. They said they hadn't filled it because they didn't have Hobbes's name/info in the system. I gave it to them and left, to pick it up another day, feeling guilty that Hobbes still didn't have his medicine.

The Costco pharmacy called me back later that day to say that they couldn't fill the prescription because it had to be "compounded" and needed to go to a compound pharmacy that could do it.

Slightly frustrated and quite confused as to what that means (although Spiff said, "Yeah, I thought that might be a problem.), I called the recommended pharmacy. They were super helpful, and all they needed was the number of the Costco pharmacy so they could get the script transfered.

New Compounding Pharmacy called back a few minutes later to tell me that Costco didn't have the script. I was confused because I had talked to them two days earlier, and they said they had it, but hadn't filled it yet. New Compounding Pharmacy then called the doctor's office to get a new script.

The Doctor's Office called a few minutes later to say that they needed to call New Compounding Pharmacy, but they didn't have the correct phone number.

New Compounding Pharmacy called several hours later to say that the new prescription was ready. The pharmacist said that Costco had lost the script, and she was confused as to why Costco couldn't fill it because it wasn't something that needed to be compounded.

It was, in fact, a pill.

Seriously?!

I wonder how or if this pill is any different than the one we already have. I also wonder where the confusion was in the first place. Yikes!

She said that it was something I can dissolve in a liquid and give to him in some water (which he doesn't drink) or his bottle (which he doesn't use because he is breastfed). Eventually, she understood that I would need a container and a syringe in order to dissolve the pill in a small amount of water and give it to him via syringe.

This sure is a lot of work for some reflux that doesn't seem to bother him. I'll pick up the prescription tomorrow, and then we'll finally be able to give this new medicine a try. I also sure do hope that it's the end of the story.

Small Things

2011-08-10T15:07:00.000-07:00

Just a few things Gunner did today that made me laugh. I had to share:

#1:

Gunner: Can I have one of your cupcakes?

Me: Yes, as long as you give me a big hug and tell me that you love me and that I'm your favorite momma in the whole big world.

Gunner: I love zjew. I'm your big momma in the world favorite whole now.

#2: (while Spiff was attending the Tour of Utah with a buddy who picked him up from our house)

Gunner: Did Daddy go to a bike race? Who's his friend?

Me: That was Daddy's friend Sean.

Gunner: Sean the Baptist?

And #3: Here's what has been keeping Gunner entertained the past couple days. These are motorcycles made out of playdough (my handiwork. Aren't I artistic?). His hands are the riders, and they had to have helmets. I wish you could hear the dialogue that goes with it. I think I'm almost as entertained by it as he is.

Did he make you smile?

As Requested

2011-08-05T21:18:00.000-07:00

I have had a couple requests to explain the "Magic Pooping Toy." So here's an explanation, and then I promise to stop talking about poop.

My dear friend, Pulcheria, gave this advice as a comment to a previous post. (Pulcheria, I hope it's okay with you that I'm reposting it here.)

"The pooping was my biggest stress too! And Beemer had issues. She would hold it until we put a diaper on her at night for a long time. Or have accidents like you are dealing with. AT finally made her a poopoo necklace that she could wear on the potty. It was a magic necklace that would help her poop when she needed too (it was really just a button on a string) and it worked! So our suggestion is a new car that he can hold or some article of clothing he can wear only on the potty that is magic. Oh, and a diet coke for you!"

Like I said, she and her husband are brilliant. I think this type of insight is a rare and beautiful thing.

Ch-ch-ch-changes

2011-08-03T09:17:00.000-07:00

Yessir, things are changing around our little household. Here's what's happening:

First of all, Spiff started his intern year doing outpatient internal medicine. It's definitely not his favorite thing to do, but the schedule was glorious. Mon-Fri, 8-5:00, with weekends and holidays off. I knew it wouldn't last, and I told myself I knew what was coming, but I don't think I was emotionally prepared for how difficult his new inpatient medicine schedule would be. He leaves the house at 5:30 in the morning and doesn't get back until 9:00 on most nights. We knew going into this internship that it would be hard. We knew that the interns at his hospital work hard, and I told myself I was prepared for all the single-mothering I would be doing. I think I told myself a big fat lie, and that nothing really could prepare me for having him gone through the boys' breakfast, lunch, dinner and bedtime almost every day of the week. We miss him.

Second, we got our huge Double Bob jogging stroller (thank you for the delivery, Spiff's Mom!), and because of Spiff's awesome schedule, I have been taking my kids running with me. The stroller is great and handles like a dream, but it's still so so so hard pushing an extra 70 pounds of stroller and children while I run. It's a totally different kind of workout, physically and emotionally, but I'm grateful to have the option.

Also, I started running with my neighbor. For two days now, we have packed up our kids and taken them with us. It's nice to have the company, and I'm glad to have a new friend and a great way to get to know her better.

Third, I decided that it's time to start sleep training Hobbes. He's 6 1/2 months old, and up until this point, he slept like a dream. I could just swaddle him up, give him a binkie, put him down, and he'd be out like a light. He still sleeps well at night, but this week, he has been refusing his naps. I remember this point when Gunner was a baby when we realized that what had been working for us (which was rocking him to sleep) wasn't working anymore. It was time to sleep train.

Like most mothers, I have such a hard time sleep training my babies because it's so very difficult to hear them cry. I second guess myself all the time, wondering if he's hungry, cold, wet, poopy, or if there's something else I should have done to prepare him for sleep. This morning, he cried for 40 minutes, and the whole time I said my mantra to myself, "He will eventually go to sleep. He will eventually go to sleep." And I have to remind myself that it's the best thing for him to learn how to comfort himself and go to sleep. It's a valuable skill, and he needs to learn it, even though hearing my sweet, easy-going little baby cry makes me want to scratch holes in my window with my fingernails.

And last, but not least, I'll update you all on Gunner and the pooping. We have both been really frustrated. We stayed home from Sacrament Meeting on Sunday so that he could poop. It took the whole hour for success. He has been asking for diapers and telling me that it's too hard. Thank you for your advice and suggestions. Pulcheria, I have a "magic pooping toy" on my shopping list for the day. I think you're brilliant.

And now I have a triumphant story to tell. Brace yourselves, folks because this is amazing! This morning while I was stuck on the couch nursing Hobbes, I asked Gunner to go to the bathroom to wash his hands. I heard the water go on and off, but Gunner didn't come out of the bathroom. I didn't know what he was up to, and I nervously waited until he finally called out to me, "Mommy, I made some logs! Come here and see!"

Yep, my little boy went poop in the potty All. By. Himself. He decided he had to go, pulled down his pants, positioned his step stool and the toilet seat, and pooped without any assistance at all! I almost cried out of joy and pride. I really hope that this good experience is the turning point for him, and that he'll finally have the confidence to conquer this hurdle for good. Go Gunner Go!!!

Practice Makes Perfect

2011-07-29T21:55:00.000-07:00

Right?

I'm sure you're all tired of me posting about potty stuff, but it's on my mind, so this is what you get. If you don't want poop stories, feel free to skip this one.

Gunner really is doing well with the peeing. He's not 100% dry overnight, but he does okay. He hasn't really had any accidents during the daytime at all, since the first two days. I'm super proud of him for that.

And you all warned me about this next part.

The pooping!

It's horrible! He is about 50/50 on the pooping. Today he pooped his pants. We have had a few poop accidents. Boy, I really do hate cleaning that up. The pooping is the one reason that I waited as long as I did to potty train. I'd much rather change a poopy diaper than poopy pants. Blech.

I'm having a hard time knowing how to react to him about it. Today we worked for over an hour with him because he had to poop. He told us, so we rushed him to the potty, and then he immediately hopped off saying, "I can't. I can't." It was on and off the potty, coaching the pushing, reading books, pleading, bribing, etc. For over an hour! And we got a teeny tiny little poop out of it. I knew he had more, but he just couldn't do it then.

So he pooped his pants later.

I find myself getting mad at him, and later wonder why I can't show him more empathy. I think the reason is that I don't want him to ever think it's okay, so I scold, I take toys away, I don't offer treats, I make him clean up, and I tell him how disappointed I am. Negative consequences to hopefully entice him to use the potty next time.

It's just so frustrating because I know he is more than capable of figuring this out. He has done it before, and now he's acting all afraid of it. I do realize that there's a learning curve to figuring out those bodily urges. I guess I just have to remember that he's still new at it. The first day of potty training, he peed 20 times. If he could poop 20 times in one day, he'd be a seasoned pro at that, too.

Any advice out there for how to handle the poop training?

Potty Star

2011-07-21T16:15:00.001-07:00

That's my kid! He is a potty champ! Who knew?! He was 100% ready and has exceeded my highest expectations. I am seriously so proud of my little boy.

I would recommend the Potty Boot Camp, based on my one experience using it, even though I didn't stick completely to it. I used it as a guideline, and I think it was really helpful for Gunner. The book recommends feeding the kid lots of salty snacks and fluids throughout the day, and then taking them to the potty every 20 minutes. I did that, and he peed 20 times that day. 20 times! That's a lot of practice using the potty. He was a seasoned pro at it by the end of the day. He was also very very tired of using the potty by the end of the day, and if there's one negative about the program, it is that it can burn a kid out on peeing. Every time the potty timer went off in the evening, I'd say, "It's time to go potty!" And he would say, "No! I'm done peeing!"

The book then recommends continuing potty intervals over the next several days, starting at 30 minutes and working your way up to and hour or so. I could tell that Gunner couldn't have handled another intense day of timed peeing, so I decided to back off of him, and just take him every hour or so. He only had one big accident. And he successfully went #2 on the potty twice the second day! I think that's a huge success!

Also, the nighttime thing was sort of solved for us. We decided to put a diaper on him for overnights, and when we went to get him ready for bed, he said, "No. I wear underpants now." So we shrugged our shoulders, and nervously put him to bed in his underpants. He got up a couple times to pee in the middle of the night, and woke up (almost) dry. Last night, he went the whole night dry! I couldn't have been more proud of him this morning!

We ventured out to our first public place yesterday. I took him to the library for about a half hour. I took him to the bathroom before we left the house, and then I told him that the library also has a potty. We went in, picked out our books, checked them out, and then he ran down the hall shouting, "I have to use this potty!" So we did. I was so proud of him for self-initiating that one, and especially for telling me about it and having a public potty success.

So, he's doing great. And besides one small incident this morning in which he hid in his bedroom closet so that he could poop his pants (thankfully I caught him in time to get him to the bathroom with a stern reminder that "poop goes in the potty!!!!!"), I'd say that he's almost there.

I am under no delusion that our work is done. I'm sure that it has just started. But at least it has been a good start. I also think that it has been a good bonding experience for the two of us. I spent a lot of time just playing with him this week, besides working with him and praising him for all of his successes. I think it has been good for his confidence, and it has been good for me to put some trust in him, give him some responsibility, and see him accomplish some really big goals.

Lord, Give Me Strength

2011-07-17T19:41:00.001-07:00

I'm going to start potty training Gunner tomorrow. It's time. He's ready.

I'm not.

I'm pretty stinkin' terrified of this milestone. I'm scared of the messes, the constant checking, the accidents, going out in public afterwards. I don't know what to do about overnights. But I'm mostly scared of the fights.

Spiff reminds me not to let it become a fight. But I know my son. He's stubborn, and he's a fighter. And we haven't been getting along very well lately, and my patience is already worn thin. I'm praying that I will be upbeat, positive, and always patient with him as he learns this new trick.

I decided to go with the Potty Boot Camp Method. It's supposed to teach the kids how to use the potty in just a day or two, with lots and lots of follow-up maintenance, of course. I like the idea of a quick and dirty get-it-done method. I have heard a lot of success stories using this method. I'll let you know how it goes. I'm sure you're dying to know.

On the plus side, Gunner is super excited about his Cars, Incredibles and Thomas the Train underpants. I think they will be a great motivator. I'm also looking forward to all the new toys. It's like potty training and Christmas all wrapped up in one stressful, messy little package.

Now I'm off to prepare. I'm making a sticker chart, wrapping little presents, and getting lots of bribes easily accessible. Wish me luck.

***And for My information, what did you do with your kids over night? Diapers? Pull-ups? Cold turkey underpants?

Reverse Sunset

2011-07-10T20:31:00.000-07:00

This is our view from our front porch tonight. Not bad, huh?

All The Water

2011-07-07T14:18:00.000-07:00

We arrived at the beginning of June and were surprised to find the mountains still covered in snow. We had been told that it was a super snowy winter, but it was pretty amazing to see it for ourselves. Before Spiff started working, we drove up one of the canyons to do a hike with our kids which had been advertised online as "the most child-friendly hike in the area," around a little lake complete with boardwalk. When we got there, we found the trail completely covered in three feet of snow. Crazy!

I thought the trip up the canyon was still worthwhile, though, because of all the water. The creek that runs down the canyon is an all-out river. Check out these rapids!

Impressive, no? You wouldn't want to go swimming in that. I wish we had gotten a picture of some of the random waterfalls caused by the run-off. So beautiful!

Also, the boys and I also just returned from a camping trip new Yellowstone Park. I have never seen the area so green and so much water in the reservoirs and so many wildflowers. It looked like a different area of the country than the drought-condition campsites I grew up with. Truly so very very beautiful!

Take a Deep Breath

2011-06-18T20:04:00.001-07:00

Okay, so Spiff Graduated. We moved. We can breathe a sigh of relief now that medical school is over. We made it through that huge hurdle! Go us! We also made it through the move, and we're mostly settled into our new little house.

And now we can take another deep breath as we go into this week and the year that follows. Spiff started his intern year today. We have to steel ourselves for a very difficult year, followed by another move, followed by residency.

Okay. Breathe. We can do this.

A few thoughts:
I miss familiarity. I miss knowing where things are, down to the items in the grocery store.
I miss my friends. Boy, do I ever miss my friends.
I miss my running partners. I'm running alone now.
I miss my oh-so-familiar running route.

I don't miss the humidity. Dry heat rocks! I love love love this climate!
I don't miss my ancient windows. I have been sleeping with an open window, just because I can.
I don't miss pushing a make-shift bathtub around our house (our apartment only had a shower stall). Having a bathtub in our house has never felt so novel.

I'm grateful to be in a place where I know people. I love having my sisters and nieces right down the road from me. I love spending time with my favorite cousin. I love it that some of our good medical school friends live a mile away from us. I am lucky to have such a good community of people during this transition year. It would be so lonely without them. I need to remind myself to take advantage of it and make the most of it every day of this year.

So, I'm going to take a deep breath, say a whole lot of prayers, and gear myself and my family up for a lot of hard work.

Wish me luck.

Blubbering Mom

2011-05-15T18:03:00.000-07:00

Tonight during storytime, Gunner said "Yellow" clear as day. I almost cried when I realized that it is no longer "Lellow."

He made up for it by mixing up the "p" in "pitch" for a "b." And he still can't say "truck," and he still loves to "crap" his hands.

I love his little lisp. The way he says "Yesth" when he answers a question. I love they way his speech is developing. Spiff and I laugh every day about they way he pronounces things. I love his "Nocaners" (binoculars), "Newdavard" (boulevard), "Ephalant" (elephant), "crose" (close), "Fopped" (dropped), "Wink" or "Vrink" (drink).

I'll admit that I wish away certain behaviors or behavioral phases. I wish I could skip right over potty training, the rest of his terrible twos, and pretty much every meal time. But when I looked at him the other day, swinging on a friend's rope swing in his little jeans and t-shirt, and he looked like such a big kid, and when I realize that he has his own little opinions and that he has the right to voice them, and that he has the right to a good explanation about what's going on because he's old enough to understand, I can't help but wish that he would just stop growing up. That he would just be my little guy forever.

And if I cry at "Yellow," what am I ever going to do on his first day of school?

Mortification Moment.

2011-05-08T10:55:00.000-07:00

Every parent has them. Those moments when you want to crawl under a rock because of something your dear sweet progeny has just perpetrated. Today in church, Gunner had just sucha moment. He is only two and half, so his speech isn't flawless. He still substitutes sounds in words. "Truck" for instance is prounounced with an 'F' instead of a 'T'. Similarly, c-l sounds are pronounced c-r. So, imagine my dismay when Gunner who was clapping in church, responded to my shushing him by yelling at the top of his voice "I love crapping, Daddy!"

-SS

A strange symmetry

2011-05-01T12:28:00.000-07:00

Medical schools typically begin their first year curriculum with gross anatomy. Whether or not there is any actual pedagogical value in this is uncertain, but it is nevertheless true. I think that mostly this is the case because gross anatomy serves not only to teach the geography of the human body, but also to accustom medical students to death. After dissecting, cutting, scraping, sawing, and otherwise exposing a cadaver for several months, we became very comfortable with the dead bodies donated to science by their former owners.

Oddly enough, my medical school experience has come full circle. I finished the year in the city medical examiner's office. Every body that was found under suspicious circumstances, with drug paraphenalia, signs of violence, under the age of 50, or unexpectedly came to our office. These were bodies donated unwittingly. An autopsy is not quite as invasive as a dissection performed by a medical neophyte. Typically, a Y-shaped incision is made from the clavicles, joining at the sternum, and proceeding to the umbilicus. The internal organs are removed, and the incision is sewn back up. The skull is also opened to remove the brain, but again, the wound is re-approximated and sewn shut. Oddly, the cranial vault is filled with rolled up newspaper so that the bone flap and skin can be sewn shut for improved cosmesis. I imagine in 500 years, when some archeologist is digging around our fair city, they'll stumble across these skeletons and will find traces of Doonesbury or the Classifieds still in the skull. Imagine the conclusions they'll draw. But I digress. The body, after an autopsy, is still mostly intact, whereas after a medical student dissection, it is anything but.

After 4 years of medical training, I am comfortable touching a dead body, or a live one. That having been said, I am apprehensive about my upcoming internship. Gone will be the protective cloak (both legal and figurative) of being a student. Now my orders will count and notes will matter. It's odd to think that with regards to my body of medical knowledge, nothing is going to change significantly in the next 4 weeks, yet after May 21, I can legally call myself Doctor.

Also, I want my head stuffed with the Far Side, Calvin and Hobbes, Doonesbury, and Pearls Before Swine. That oughtta keep those archeologists guessing.

Because I know you've been wondering...

2011-04-23T13:24:00.000-07:00

Here we are, waiting out our time before Spiff graduates from medical school and we move on to the next stage in our lives. Spiff is completely done with classes, and it's awesome/strange to have him home with us. He's not quite sure what to do with himself, and the rest of us are not quite sure what to do with him. We're trying to be creative about our activities and have a list of things to do before we move, including family outings and yummy places to eat. We tried a burger joint last night and enjoyed our bottomless mugs of house root beer and cream soda (or "juice" to a certain little person who came with us). So, besides the obvious planning for the move, going through and sorting our belongings, and beginning to pack, here's what we've been up to lately.

Spiff recently discovered a new app for his i-pod. It's a Touch Mouse that will control the cursor on the laptop. It's handy for controlling the volume on the computer when we're watching shows on Instant Netflix, thus fixing our lack of remote control problem and making it so that we don't have to walk all the way across the room to manually push "play next episode." It's also a handy little tool for messing with one's spouse as she is trying to write a long-overdue blog post. I have found myself wondering why the cursor isn't where I left it, how I could possibly have typed certain letters that are on the screen, and why the word I just typed isn't there anymore. It's really great entertainment for someone who doesn't need so study all that much at the moment.

We have a rental contract on a house! I scoured rental listings for about a month, stressed about it, dreamed about it and got super frustrated with the whole darn house-hunting thing. Then we happened upon the perfect house for us. Hopefully. We haven't seen it in person (although my sister did), but I'm in love with the pictures. I'm super excited about the finished basement and laundry room, and our very own, brand new (well, 15-years old and used) $100 washer and dryer. I'm just so relieved to have our living situation nailed down for the next year, and not having to worry about house hunting for a whole year. Great. We get to do this again next year. I can't wait.

Hobbes is three months old already. I can't believe it! Gunner's infancy seemed eternal. I swear it took him a year to reach each month milestone, and Hobbes's little life seems to be flying by. He's still a dream baby, and I can't believe how lucky I am to have such a mild-tempered baby who eats and sleeps well. He has started to smile and laugh at us, he's ticklish, he's interested in his new little toys I hung over his bouncer chair, and he can roll over to his side. Big stuff for a little guy! His eyes are still blue, and I'm secretly hoping they stay that way. I check them for signs of Hazelization every day.

Gunner is learning how to behave around his little brother. It has taken all three months for him to figure out how to be soft with the baby, but he is finally figuring it out, with lapses in concentration, of course. Two-and-a-half-year-old Gunner is hard. He's emotional, whiny, needy, and naughty. There have been times in the last couple months that I have wanted to quit and run away. But there have also been a lot of times that I'm totally blown away by all he has learned lately. I love listening to him sing to himself, and I'm always amazed when I hear him singing a song that we didn't teach him. I love nursery at church and his little mommy co-op preschool for that. I loved the other day when I figured out that he was playing a joke on me. His little sense of humor is blossoming. I love how he can't quite figure out how to use prepositions or pronouns. I love how inquisitive he is, even if we have to answer the reflexive question "Why" about a million times each day. He's a pretty neat little kid, even if he does make me want to pull my hair out multiple times a day.

One quick story to illustrate my point: On our drive to the restaurant last night, Spiff and I noticed just how observant Gunner is to noises and sounds around him. We were listening to some John McCutcheon children's song that Spiff grew up with (which are pretty darn good and something I would recommend to anyone with kids). The songs are filled with all different instruments in the accompaniment, and as we drove along, a new song would come up and Gunner would comment. Here was our conversation:

Gunner: "What was that? That larlarlarla (with his tongue)?"

We replied, "Oh, that instrument? That was the hammered dulcimer."

On the next song, G: What was that? The huh huh huh?

Us: That the Tuba

Next song, G: What was that? Bling bling bling?

Us: That was the Banjo

We realized that he is so very observant about everything around us. I can recall countless times when we have been sitting around our living room, and he asks about sounds, always with a "What was that?!" "Oh, Gunner, that was just the neighbors going down the stairs." "Oh, that's a lawnmower going outside." "That a bird singing." Seriously, so very observant.

Except with us. He has an uncanny ability to tune us out. He has gotten to where he hardly listens to a word either me or Spiff says. We know he hears us. He just chooses not to listen.

Like I said, he's so naughty and so awesome at the same time.

Oh, and by the way, Spiff is a genius. He taught Gunner how to take bites of food and wash them down with a drink of milk. It takes some coaxing still, but we have actually had some success getting Gunner to eat his meals (or at least a couple small designated bites). It is glorious! Thank you, Spiff!

That's probably enough rambling for now. We're going to go dye Easter Eggs. Gunner is ready for it, clad in only a diaper. Happy Easter!

Morgue III

2011-04-17T14:33:00.001-07:00

Monday: 3 heroin overdoses. Most interesting tattoo to date: a lion-headed man having 'relations' with a monkey while a nude woman crawled around on all fours beneath them.

Tuesday: no cases. Gave a presentation on non-cardiogenic pulmonary edema in heroin OD.

***Warning: gratuitous physiology lecture ahead ***

Basically about 80-90% of the fatal OD's have this pink frothy fluid fill their lungs, sometimes to the degree that it comes out their nose and mouth. Why? The answer isn't fully known, despite this phenomenon being first described by Sir William Osler in 1880.

From a physiologic standpoint, there are several reasons that fluid can be in the lungs. It can come from 2 possible places, from the lungs themselves or from the outside world. If water is introduced through the airway, as in drowning or near drowning, then obviously the lungs can have fluid in them. Fluid can also come from within the lungs themselves. Blood flows through the lungs from pulmonary arteries, to capillaries, then to pulmonary veins. If the venous drainage is diminished, then the fluid backs up and leaks out of the capillaries because the hydrostatic pressure is increased, thus causing edema. This is analogous to kinking a hose, and water leaking out of the body of the hose. A situation which would cause this is failure of the left side of the heart, which normally receives its blood from the lungs. This would be an example of "cardiogenic" pulmonary edema, because it is caused ultimately by the heart. The inability of the left heart to pump causes fluid to back up and leak.

The foamy pulmonary edema seen in heroin overdose however, is non-cardiogenic i.e. does not originate from intrinsic problem with the heart. There are several schools of thought as to what causes it. First, a word as to non-cardiogenic causes of pulmonary edema. The pulmonary capillaries are where gas exchange takes place, where oxygen enters the blood and carbon dioxide leaves. By necessity, the membranes separating blood from air are thin, so that the gasses can move easily. If these membranes are damaged or rendered more permeable, then contents of blood can leak out. Blood is made up of primarily water, but also has proteins and of course red blood cells. If the holes in the pulmonary capillary membrane are small, then only water and protein leaks out. If the holes are bigger, then red blood cells themselves can leak out, tinging the fluid pink or even red, depending on how much blood extravasates (leaves the circulation).

What causes holes these holes then? Histamine is one postulated player in this little drama. Most people are familiar with the effects of histamine through allergies. With hay fever or seasonal allergies, the eyes and nose have clear discharge, and sneezing is commonly a symptom. The clear runny discharge is caused in part by histamine which makes the blood vessels in the nose dilate, causing congestion. The blood vessels are also rendered more permeable, so they leak fluid, contributing to the runny nose (not the only component of the nasal discharge however). This is why you take anti-histamines like Claritin or Zyrtec to alleviate hay fever symptoms. So, we see that histamine is able to make blood vessels more permeable and leaky. There is lots of histamine present in the lungs, so one thought is that histamine released in the lungs causes the pulmonary capillaries to be more leaky and causes fluid to leak from the blood vessels into the airway.

How does histamine relate to heroin though? Heroin is an opioid, which means that it is a synthetic derivative of morphine, which is the natural derivative of the Papaver Somniferum poppy, the source for opium. Opiates of all kinds can cause release of histamine in varying degrees. Morphine is especially known for this, histamine is responsible for the itchy sensation some people encounter when they receive morphine. Since heroin is diacetyl morphine (morphine with two synthetically added acetyl groups. I won't bore you with more organic chemistry). So, heroin, which is a synthetically modified morphine, can cause histamine release in the lungs, which increases permeability of the blood vessels, causing pulmonary edema.

(For the medical purists, I acknowledge that this is a simplification. The bulk of my readers are lay people married to medical students. For some reason, they are also afraid to post comments when I post.)

*** End of gratuitous physiology lecture ***

Wednesday: Car accident. Luxury sedan v. semi truck.

Thursday: No cases
Friday: Heroin OD, GI bleed secondary to duodenal ulcer, questionable pancreatic/ GI neoplasm.

AND FOLKS, THUS ENDETH MY MEDICAL SCHOOL RESPONSIBILITIES.

48 months of studying, lectures, clinical responsibilities has come to an end. I now have 5 weeks before we move, and begin internship in June.

Funny Conversations

2011-04-09T12:34:00.000-07:00

During lunch today I had the following dialogue with my 2 year old son:

G: Wassat daddy?
SS: That's the knife block.
G: Issa knife bock?
SS: yes.
G: Knife a sharp. Djanger. Knife for mommy and daddy, not little boys.
SS: that's right.
G: Djanger, sharp. A cutta me? I get hurt. Maybe die. Then I see Jesus and he hug me. Jesus love a me. I love Jesus.
SS: (unsure which part to respond to), uhh well, maybe. Knives are for mommies and daddies, and yes, Jesus loves you.
G: Give Hobbes a blessing? Give mommy a blessing?
SS: yes, in the past.
G: I love my noodles. More noodles please?

And with that we were off of toddler-level spirituality and back to the mundanities of life.
-SS

Morgue II

2011-04-08T13:29:00.000-07:00

Caseload:
Monday: Floater. 3+weeks old. The body was green with decomposition, and the smell was unbelievable.
Obese lady OD'ed on Xanax.
GSW to head

Tuesday: Car accident, massive trauma.

Wed: Day in court, no cases.

Thursday: Self inflicted gunshot wound to heart.
Heroin OD

Friday:
Sudden death secondary to cardiac arrest.

The Morgue

2011-04-01T15:37:00.000-07:00

I'm on a forensic pathology elective at the moment which is something I chose to do because I figured I'd never have the chance to do something like this again. Our charming city being what it is, there is never a shortage of cases in the medical examiner's office. This week's collection of cases was as follows:

Monday: Self inflicted gunshot wound to left chest with .40 caliber pistol.

Non-accidental trauma 2 years ago. Just died of complications, so this counts as murder/manslaughter even though the inciting event was 2 years ago.

Tuesday: Heroin overdose. Despite what the word on the street is, packing your friend's crotch with ice will not revive them from a heroin OD. Naloxone might, but ice-crotch will not.

Wednesday: Alprazolam OD (Xanax) in a massively obese patient. People don't wear as much clothing at home as you think they might.

Self inflicted GSW to the head. Split the mandible, maxilla, and exited through the top of the head.

Thursday: Schizophrenic with seizure, unknown cause.

Friday: no cases.

Since it's sunny this weekend, I expect that people will be outside shooting each other again.

It's been an interesting experience, but oh the smell can be so strong.

Match

2011-03-17T18:49:00.000-07:00

So today was match day. I got my number one choice for residency, doing anesthesia at the Mayo clinic. Prior to my residency, I'll be doing a year long internship at a hospital in Salt Lake City. The match ceremony was quite a rollercoaster event. They randomized the envelopes containing our match assignments, and then called us up one at a time. I was about halfway through the group, got my envelope and headed back to the group of married students. I tore it open, unfolded it and read where I was headed. One of our good friends is also heading there too, so Sweete Wiff will have someone to be with, after our year in "zion". I'm a bit of a masochist, so I deliberately chose an intern year that I knew would be hard, but rigorous and prepare me well for residency. At least I will be able to go skiing on the few days that I have off. It's a huge blessing for us and the answer to many prayers that we wound up getting our first choice.
-SS.

Throwing him a bone

2011-03-15T16:58:00.000-07:00

After fighting over dinner for the past three nights, Spiff brought a special treat home with him tonight. He got some fancy steak from a drug rep luncheon, and he was nice enough to eat the leftover chili he brought with him for lunch, and bring the good stuff home to his wife for dinner. It was delicious, and we decided not to share it with Gunner. I offered him Malt-o-meal and hot chocolate instead. You would have thought that Christmas had come early.

As he dove into his hot cereal, practically head first, he exclaimed, "I'm so happy!"

And then, "This is so yum," as he ate lemon pie for dessert.

Apparently that's how we have a happy dinner experience at our house.

Winning Dinner

2011-03-13T17:27:00.000-07:00

Gunner has always been a picky eater. I gave up a long time ago trying to get him to eat what we eat for dinner. As a baby, if he tried something he didn't like, he would spit it out all over me. I don't like getting spat on, so I gave up. He has been picky ever since.

I envy parents with children who eat. I have had an almost two-year struggle about feeding him. I decided not to make feeding him a fight. He won't eat what we eat, but he needs to eat so that he'll be happier. I have offered him foods that I knew he liked, including quesadillas, crackers and peanut butter, plain macaroni noodles, ramen noodles, and lots of pancakes. It is tiring to make dinner for Spiff and me, and then make something else for Gunner, but I have done it because it was the only way he would eat anything.

Recently, this has all changed. Gunner has recently decided to not even eat the alternative food we offer him. Dinner has become a fight over any food. He is not interested in sitting down to eat, and it is a fight to get him to sit and eat dinner with us, much less ingest anything. So, we decided that if he is not going to eat the alternate food, we are not going to offer them anymore. Like any normal and sane family, he will eat what we eat, or not at all.

I bet you can imagine how this new policy has gone off with him. It's not exactly a hit, to put it mildly.

Yesterday was pie day. I got up in the morning and made an apple pie (thank you, Mhana, for the apple peeler!) and a lemon meringue pie. Gunner helped me make the pies and we all drooled over them all day long. Then we had beef pot pie for dinner last night. Potatoes, carrots, beef, and biscuits on top. We told him that he had to eat one bite of potato, carrot and bread, and then he could get pie. Only one bite of each. We have really high expectations around here.

Gunner wouldn't touch it.

Even for pie.

And the fight that ensued lasted into the night because he was hungry and cranky. He went on numerous time outs, and he lashed out at us by hitting, kicking, spitting, and biting!!! Yes, biting! I still can't believe that one. He was so badly behaved that we sent him to bed without the usual calming routine. I can't speak for Spiff, but I sure felt defeated as he cried himself to sleep saying, "I want read books. I want sing songs!" It was so pathetic, and I felt so bad for sticking to our guns as I listened to him cry.

Let's skip ahead to dinner tonight. We had chili and cornbread muffins, which is a meal that he has actually eaten and enjoyed before. Tonight, he ate the cornbread and a little bit of cheese, but he wouldn't touch the chili. Even when we offered pie. Even when we lowered our expectations to ONE bite. Just one.

A fight ensued, which included several time outs. It went like this:

A two-minute time out on the naughty chair.
A chance to eat a choice of one bite of meat or one kidney bean. He chose not to, so we did...
A two-minute time out.
Another chance.
A two-minute time out.
Another chance.
A two-minute time out.
One last chance.

And guess what?! He ate a kidney bean. He chose the bean and proceeded to take teeny tiny bites of it, alternately with a drink of milk to wash it down. We rewarded him with a slice of lemon pie. I know that it's an unbalanced work/reward effort, but...

I win!

With one kidney bean.

I can't believe that I feel so proud of this accomplishment, but I do. I'm super happy to have won this power struggle tonight. Please wish us luck with dinner tomorrow.

The Transition

2011-03-06T12:13:00.001-08:00

Hobbes is a good baby. He's the kind of baby who makes you want to have more babies. Even in the middle of this adjustment period when I'm not sleeping more than four hours at a time, Hobbes is such a sweet, cuddly, content little guy that I find myself thinking I could have ten more just like him! (I exaggerate. There is no one on this green earth who should believe me when I say that I would like to have that many children.) But seriously, he sleeps well, he eats well, and now that he smiles at us, I find myself doing almost anything I can to get him to smile at me. It's so stinkin' cute and addictive, I just have to have more!

This adjustment to two kids is hard. On one hand, I think that the baby thing is way easier on me than it was the first time. Other than being terribly sleep-deprived, I don't find Hobbes to be that difficult to take care of. Two years ago, when it was baby Gunner, I swear he was so demanding that I couldn't find time to eat or dress myself.

On the other hand, there is toddler Gunner. This transition is hard. He LOVES his baby brother...terrifyingly so. He can't seem to leave the little guy alone. He is constantly and energetically giving him wet, sloppy kisses on his head, "helping the baby" by shoving a binkie in his mouth, giving him blankets and toys, or (my favorite) trying to pick him up and carry him. It seems that no amount of teaching, at this point, can get him to understand that some of these behaviors are actually dangerous and are better left to his parents. Gunner is also acting out for attention. Combine that with a raging case of terrible-two naughtiness and the fact that I have less patience than normal due to chronic sleep-deprivation, and we get the sad result that Gunner and I don't get along that well sometimes.

One time when Gunner was being particularly difficult, I mentioned to him that he was driving me crazy. Then later in the day, he did something that made me sigh in exasperation. He looked up at me and said, "You crazy, Mom?"

I just laughed and said, "Yes. Yes, I am."

It's sort of amazing how kids have the ability to see situations so clearly sometimes. He has given me a tool to check myself and turn the situation around when I get frustrated with him. When I feel sad about something, Gunner is the first person to look at me and ask, "You happy, Momma?" And when I lose my cool with him, he is the first person to forgive me. I am so lucky that this little person, this little child of God, continues to love me, even when I don't feel like I deserve it. It's also very humbling to realize that I mean so much to him that he continues to want and need me, even when we aren't getting along.

Rank List

2011-02-22T19:17:00.001-08:00

Spiff and I finalized the ol' rank list yesterday, submitted it to the authorities, and decided not to tweak it or worry about it anymore. Not a moment too soon, either, since it is due by tonight. Here are the top six:
1. Mayo in Rochester, MN
2. University of Michigan, Ann Arbor, MI
3. Dartmouth, Hanover, NH
4. Wash U, St. Louis
5. University of Utah
6. University of Wisconsin, Madison, WI

There are several more programs on the list, but we're hoping for at least somewhere in the top six. There are also transition year programs ranked, and it is very possible that we will be in one city for a year and another city for the remaining three years of anesthesia. There has been a lot of thought and prayer that went into ranking these programs, and we're trusting the Lord that we will be where our family needs to be for the next four years. Three weeks until Match Day sounds like a long wait.

Emergency Medicine

2011-02-12T19:08:00.000-08:00

I have just finished a rotation in the emergency departement. As a child I never went to the emergency room, due in part to the fact that I never broke any bones or had any major accidents, but also because in my mind the emergency room was for people in extremis, those having heart attacks, strokes, car wrecks, etc.. St Louisans do not, however, harbor any such notions regarding emergency care. Here are some vignettes to illustrate the abuse and waste found in the medical system.

44 year old african american male presenting to the ED complaining of chest pain. Upon further questioning he actually has heartburn. He asks for Maalox. When asked why he came to the ER instead of buying a $4 bottle of Maalox at Walgreen's, he replies "the ER is cheaper".

21 year old African American female who was in the ED 2 days ago for heavy vaginal bleeding. She was given a script for medroxyprogesterone and an appointment today with an OB. When asked why she came to the ER instead of the OB, she said "I'm still bleeding, they told me to come to the ER". When the OB is queried, she replied "that's ridiculous, she can come to clinic, we never told her that". I love being lied to.

59 yo caucasian female with history of coronary artery dz, diabetes, hypertension, and depression comes in with "high blood sugar". Apparently she ate a bag of cookies, checked her glucose which was 486 (pretty high, but not astronomically so). Took 5 units of insulin, didn't re-check her sugar, and then called EMS. Came to the ED. Sugar in ED: 187. Patient unable to understand instructions regarding sliding scale insulin, and discharged home. This patient visits the ER weekly.

34 year old lady with heartburn, came to hospital via EMS.
Multiple drunk folks admitted to ED to sleep off their booze.

21 year old with severe asthma who snorted cocaine. Cardiac arrest, died.
45 year old cardiac arrest after doing cocaine. Died. (well, technically came to ER dead, we just coded her for a while. Same with the cocaine-asthma guy).

24 year old with history of 22 (!) intubations in past 2 (!) years for asthma exacerbations. Comes in after smoking (!!!!!) a cigarette and now wheezing like an accordian. Statistically speaking, this person will die within another 2 years from asthma. The only people in our day who die of asthma are those who insist on smoking.

21 who is "constipated" and hasn't moved her bowels in 1 day. Explained normal bowel movements to an adult.

33 year old man with heartburn. Describes classic timing after meals, positional nature, sour taste in mouth, relief with antacids. Not exacerbated by activity, no history of coronary disease or angina, no hyperlipidemia. Yup, another dude with GERD coming to the ER.

21 year old male whose girlfriend told him she had chlamydia, so he wanted antibiotics. When asked why he didn't go to any one of the numerous free clinics in town, he replied that it was cheaper and more convenient to come to the ER. This was after a 9 hour wait in the waiting room.

44 year old who was bumped in the knee by a motorized wheelchair who was upset when I ran out of his room when the cocaine-cardiac arrest lady coded. Sir, your utterly non-emergent mild knee pain is going to have to wait while we try to resuscitate this woman.

UTI count: 7.
Pyelonephritis: 2
GERD: 6
Viral upper respiratory illnesses (colds): 5. Folks, the sniffles ain't emergent. No fever, no chills, no vomiting, no diarrhea,no abdominal pain, no chest pain, no shortness of breath = NO COME TO THE ER! See, a cold is a virus, so berating me for antibiotics is not going to work.

I'll post more stories of waste and abuse later when I can recall them all. Some of these are obviously not abuse of the system, but rather failings of the system as a whole. Why the diabetic lady who probably has an IQ of about 70 is giving herself insulin is beyond me.

Two and Half Weeks

2011-02-03T17:54:00.000-08:00

At this point in having a new baby, I feel like if someone were to offer me the choice between a million dollars or one full night of sleep, I wouldn't hesitate before throwing on my pajamas and jumping into bed. This realization came to me last night while we were struggling to get little Hobbes to sleep. He seemed to be having some intestinal distress (at least that's what I think it was), and he couldn't settle down. After I did the whole feed/burp/change/feed/burp routine for the millionth time, I would put him down in bed, and all he would do was grunt. All. Night. Long.

Grrrrrrrrrrrrrrrrrrrrunt. Rrrrrrrrrrrrrr. Grummmmmph. Grunt. Grunt. Grunt.

I can't tell you the number of times I finally lay down, only to get up again to burp, rock, or try again to feed the ever-grunting little man. We finally kicked him out of our room. Spiff rolled the bassinet into the kitchen at 4:00 this morning so that we could get some sleep. I think Hobbles eventually fell asleep, too. And then he had a mighty poop at one point this morning, so I'm really hoping that that's what his problem was last night. We all really need to get some sleep tonight. Pray for us, please.

Also, Gunner woke up this morning with a cold. I'm pretty bitter about it. We haven't gone anywhere for days and days, thanks to the weather. The only place Gunner has been in the last week is church on Sunday. I guess he must have brought it home from that. And now I'm terrified of him passing it onto the baby. I have us all on a strict hand-washing regimen before touching Hobbes, but as Spiff pointed out, it's probably too late at this point. Oh, but I'd really rather not have a sick baby. Please.

On a side note, a really nice friend from our ward brought us dinner the other day. However, she didn't just bring us dinner. She brought some homemade scones for breakfast the next day and some delicious banana bread that Gunner and I have been enjoying for several days. She brought Gunner his own special little sack lunch that he was so excited about that I swear he thought it was Christmas again. She also brought a couple toys she had lying around her house that she didn't need. I pulled one of them out today, on the third straight day of being indoors and the first day of his cold. He loved it and ended up taking his new cars to bed with him. This friend really went above and beyond with this act of service, and it has been a life-save for us this week. I will have to remember these special things she did and pay it forward soon.

Baby!

2011-01-25T18:09:00.001-08:00

We have our new little boy! Little Hobbes was born on January 15, 2011 at 2:58 a.m. He was 6 lbs. 14 oz., 20 inches long. He is awesome! So sweet and precious, and I'm completely in love with him. For those of you who don't already know it, the birth story goes like this:

My water broke around 7:15 on Friday night. We took Gunner to a friend's house to sleep while we headed to the hospital. I was started on pitocin after a couple hours because I wasn't having contractions and wasn't progressing. Once the pitocin was in my system, things really seemed to happen fast. I was given some pain medication at some point when I thought I couldn't stand the pain anymore, and it worked so fast and was so nice and strong that I had one little moment of insanity when I thought I could go through the whole process without an epidural. And then the Stadol wore off and I begged the people for the epidural, which I didn't receive until I was dilated to an eight. I had one nerve line in my belly that didn't take to the epidural so I had one spot of really focused and intense pain. But I was able to feel all I needed to feel in order to push (which wasn't the case with my super strong epidural when I had Gunner). My nurse was amazing and super helpful. Spiff was the perfect coach. The OB intern, resident and attending were all attentive and supportive as I pushed for about 20 minutes until the little guy popped right out.

The whole labor and delivery process was so different this time than with Gunner. Gunner's birth was sort of strange, with the hospital being so busy that the nurses couldn't pay any attention to us, and with my epidural being so strong that I couldn't feel anything, turning the situation into something emergent that probably didn't have to be. This time, my labor was shorter and more focused. Spiff and I both felt like we were in good communication with the nursing staff and the doctors. Hobbes's birth was calm and really special, and I was allowed the time and attention directly afterward in order to bond with my sweet new baby.

I am feeling very grateful right now. I loved my labor and delivery nurse so much that I wanted to take her home with me. I had two incredible mother/baby nurses that took really good care of Hobbes and me for two days. Spiff was the perfect coach and is a wonderful daddy to our two little boys. Hobbes is healthy, he's sleeping well, and he has already gained 11 oz. over his birth weight! My parents are here helping us with the transition to a four-member family. I also feel overwhelming gratitude for our friends who took care of Gunner while we were in the hospital and for my friends who visited me while I was there. So thank you to everyone who made our birth experience so wonderful this time around. We couldn't have done it without you!

Whew!

2011-01-06T17:11:00.001-08:00

It's pretty sad that these things count as exercise as a 38 1/2-week pregnant lady: 20 minutes of pregnancy Pilates, 10 minutes of cutting my own toenails (wow! what a workout!), a walk around the zoo with Spiff and Gunner, and a 10-minute walk to the salon. What a strenuous day! Also, I finished all of this "exercise" looking better than I did before I started. That's what happens when you end your workout with a trip to the salon.

The Match

2011-01-01T18:25:00.000-08:00

Well the interviewing process is nearly over for me, though most of my friends still have the bulk of their interviews coming up. I deliberately front-loaded my interview schedule in order to minimize the probability that I will be out of town when little Hobbes comes to the world. That having been said, I will be traveling for 5 of the 15 days before he is officially due, so we'll be crossing our fingers.

I know there are readers of this blog who are not directly related to a doctor, medical student, or resident, and are thus unfamiliar with the Match. (For those of you who are, please skip and go here for something more diverting) I will offer a brief explanation of an event which will determine our location and fate for the next 4 years.
During the fourth year of medical school, students interview for various specialties. Some hedge their bets and interview in multiple specialties, but most interview for residency spots in what they want to do for the rest of their professional lives. For me, that would be anesthesia. I don't enjoy clinic and rounding, so being in the OR with sleeping patients is great.

At the end of the interview season, both applicants and programs draw up a list of who they want or where they would like to go, based solely on personal preference. The Match (yes, it is capitalized) is administered by the NRMP, which is a subsidiary of AOL Time Warner Disney Microsoft Halliburton. Programs rank applicants and submit that list electronically to the NRMP. Similarly, applicants submit their lists to the NRMP. Sometime between Feb 23 and Mar 13, a computer crunches the lists and assigns applicants to their respective slots. Here is an example of how the match algorith works:

Rajiv has applied to 5 different programs for general surgery (he is a nut for doing so).

Rank List:
1. Stanford
2. Hopkins
3. Yale
4. Mass General
5. Mayo

The computer looks at #1 stanford and compares it with stanford's list. Let us pretend that Stanford has 4 spots and Rajiv is ranked at number 5. Initially he does not get a spot at Stanford, so the computer proceeds down the list to Hopkins. Rajiv is 4th of 6 on Hopkin's list, so he has a tentative match. So why don't programs only rank the number of slots they have? simple, because not everyone who interviews at Hopkins or Stanford wants to go there. So, lets look at Stanfords list:
1. Ron
2. Joe
3. Bill
4. Kyle
5. Rajiv
6. Heather
If ron and Joe don't want to go to stanford, then really Stanford's list is:
1. Bill
2. Kyle
3. Rajiv
4. Heahter,
5.etc....
Since Rajiv was only tentatively placed at Hopkins, if Bill and Kyle wind up elsewhere, then Rajiv can actually wind up at Stanford, despite not being in the initial top 4 applicants on their list.

The match is allegedly skewed to favor the applicants, if they rank strictly according to preference. For some reason it takes a month from when the match lists close for applicants and programs until when they finally announce the verdict on March 17, 2011.
I'm not sure why that is, because I would think that even a computer with modest capacity like my trusty MacBook could crunch all those numbers in a matter of hours.

Your homework, dear readers, is to make my rank list for me, based on whatever criteria you choose:
Here are the candidate programs, in no particular order:
1. Michigan
2. Medical College of Wisconsin
3. Dartmouth
4. Washington University
5. Virginia Mason Hospital
6. Cleveland Clinic
7. Case Western Reserve
8. University of Utah
9. St Louis University
10. Mayo Clinic
11. University of Wisconsin

Happy New Year

2011-01-01T11:59:00.000-08:00

Christmas was great after all. Thanks to those of you who shared some Christmas cheer with me. I was able to put my scrooginess behind me and focus on fun things. I made lots of yummy food. We attended a great Christmas Eve party with a lot of our good friends. We Skyped with Spiff's mom on Christmas morning and were able to watch each other unwrap presents, even though we're miles apart. Gunner and I have also been able to fully enjoy Spiff during his last ever long Christmas vacation. It has been great!

And now just a few random thoughts and stories:
1. My favorite thing about Christmas this year: New Toys! I do realize that saying that makes me sound like I'm five years old, but it's true. I love Gunner's new toys. I love the fact that he loves them and happily plays and plays and plays with them for hours. He has been content and busy for a whole week, with the promise of lots more entertainment to come. The most successful toys of the season are Playmobils, hands down. He fell in love with our nativity scene and packed Mary and "Baby Jee-us" around for days. He also loved the donkey ("horsie") and the ox in the manger scene, whom he named "Otis." He absolutely loves the "Pilots" he received from Spiff's mom, and the accompanying helicopter and race car. I have loved seeing develop his skills for imaginative play, and I'm telling you, I love love love the hours of entertainment these toys have provided! I think I will need another Christmas next month.

2. I'm having a baby sometime in the next 2-3 weeks. The question I really don't like answering is, "How much weight have you gained during this pregnancy?" I know that my very nice neighbors mean well, but describing how much weight you have gained isn't something anyone I know likes talking about. It's tempting for me to answer in explicit detail about how I have gained the weight, what sweet and fatty foods have tasted the very best, where I keep the weight, and how I feel about it. It's great that I already feel like an overstuffed whale. Thanks for drawing attention to it and for rubbing salt into that wound.

3. My two-year-old is cool. Gunner has memorized several children's books, including the original Madeline. He has also started asking for specific bedtime songs. He asked for the Daddy song one day, so I sang the "I'm so glad when daddy comes home" primary song. He asked for the Mommy song, and since I couldn't think of a mother's day song, I sang "My Heavenly Father Loves Me." He asked for the Boy Song, I sang the first song that came to my head, which happens to be a song the primary just sang in their recent program. "If you don't walk like most people do, some people walk away from you, but I won't, I won't." He asks for it almost every day these days, but I didn't realize that he knows it as well as he does until Spiff pointed out one day this week that Gunner was singing to himself, "I will, I will."

As we drove home from the grocery store yesterday, Gunner started singing this little song to himself. We decided to see how well he knew it, and we started from the beginning. He filled in almost all of the blanks. There could not be anything cuter! And just as my heart was about to melt right onto the floor of the car, I looked back at him. He had quietly taken off his shoes and socks and was in the process of stuffing his entire foot in his mouth. He innocently looked up at us and said, "I taste my toes."

Happy New Year!

Scrooged

2010-12-17T18:45:00.000-08:00

I love Christmas. It is by far my favorite holiday. I love the lights, the food, the music, giving presents, and the general happy spirit of the season. And although I love the holiday, I feel like I have had to work a little harder than usual to feel festive this year. And now, a week before Christmas, and because of a series of unfortunate events, I feel like all of the Christmas spirit I was trying to have has been squashed out of me.

Last Saturday, I dragged my good friend and her two kids out with me to do a 5K walk. I signed up weeks ago for a "Gingerbread Walk," a 5K where we would walk around the main street of a little town, collecting cookies along the way. It sounded fun and festive, and would have been great, had it not been December and raining. We made the best of it, but our kids were cold and wet, and they lasted through 6 (out of 35) cookie stations and about 1 mile, the last half of that being on the way back to the car after calling it quits while the two young boys screamed their poor little drenched heads off. We dried the kids off and took them to McDonald's for lunch. And then Gunner and I came home and ate our six cookies. I think that cancels out any exercise we got in that day.

Yesterday, I dropped Spiff off at the airport for his millionth interview trip of the season, and then I dragged Gunner all over the city in order to finish up my Christmas shopping. We had to wait an hour for a store to open, so as we hung out in the childrens' section of Borders, he pooped. As I went to change him, I realized that I didn't have a spare diaper with me. "There goes the rest of my shopping trip," I said to myself. But determined not to have to drag us both out of the house later in the day, I cleaned him up, pulled up his pants over his bare little bummie ("My pants fall down, Mommy!"), and carried him to the neighboring Whole Foods store to buy some organic, chemical and dye-free diapers, just praying that he wouldn't pee on both of us. He was a real trouper, and with the help of some animal cookies and dum dums, we made it through the marathon shopping trip.

Then I stayed up way too late last night finishing up some homemade Christmas presents, and wrapping and packaging gifts to send off to family members. I told myself that the sacrificed sleep was worth it because everything was ready to go, and all gifts would be to their recipients on time, as long as I could make it to the post office today. A friend even stopped by my house unexpectedly today and volunteered to watch Gunner for me while I ran to the post office! Gratefully, I took my large box and several small envelopes to the post office, where there wasn't even a long line. All good signs, right?

The lady behind the desk worked through my stack of packages quickly. And then she got to my large box, which weighed in at a whopping 6 pounds. It came up on the computer as an $18.40 package, which was more than I had hoped, but I sucked in my pride and kicked myself for procrastinating Christmas, and I swiped my debit card to pay for it. Only then did the desk lady say, as she got out a measuring tape, "Oh, gosh, wait! I don't know where that number came from! Your dimensions are all wrong. It's not $18.40. It's $32."

Excuse me?! $32?!!! To send a package that weighs six pounds?! Because my dimensions are wrong?!?!?!?!

What does that even mean, anyway?!?!

I told her that I was in no way willing to pay $32 to send this package, so I immediately grabbed some flat rate boxes and proceeded to move and repackage everything, trying desperately to get the various items to fit in a box. Two items had to be unwrapped and shoved into the box, and will have to be re-wrapped by kind family members on the receiving end of things. One item didn't fit and will not be sent for Christmas. And as much of a bummer as that was, I figured that it was okay because I would not be spending $32 to ship something that cost me only $13 to begin with.

So, I placed my newly repackaged parcel on the counter for her to work on. It was a flat-rate box that cost a blessed $10 to send. All is well.

Except that I had already swiped my debit card and already paid the USPS $18.40. And this is how the rest of our interaction went:

Desk Lady: "You have 8.40 left on your purchase. Can I sell you a book of stamps?"

Me: "No, I don't need stamps. I have plenty of stamps. Can you void that last transaction, please?"

DL: "We can't refund debit card transactions. But I can sell you a book of stamps."

Me: "I don't need stamps! I just want to pay for the package, and that's it."

DL: "Well, I can't refund the money, so you either buy a book of stamps, or pay $18.40 to send this $10 flat rate box."

And that's about when I blew a gasket, melted in to an embarrassing pregnant, hormonal puddle on the floor, gave in, bought the stupid book of stamps, and stormed out of the post office, while the desk ladies laughed as I walked away.

I'm still seething about how it was her mistake in the first place to measure the package incorrectly, how she basically forced me to buy a book of unwanted postage stamps, and how she was utterly unwilling to do what any other cashier in the country is trained to do and void the transaction.

Then when I got home, I found Gunner crying uncontrollably at the door, where he had been since I walked out of it 25 minutes earlier. My poor, generous friend was calmly making lunch and feeding her two boys in my messy kitchen while my kid screamed uncontrollably in the entryway. I walked in feeling so bad for putting her through that, and for being hoodwinked by the USPS, and she soon had two crying people on her hands.

Now besides having a new resolution to boycott the US Postal Service for the rest of time, I'm having a hard time feeling the Joy of Christmas. I'm sure that I will feel differently in a day or two. I will be happy when Spiff is finally done traveling and home for the holidays on Monday evening. I will be happy to spend Christmas with my little family and my good friends here in town. I will be happy to bake and eat yummy food, play games, and watch Gunner's excitement over Christmas presents. But at the moment, I'm just not feeling it.

So, please tell me something to cheer me up. Share a Christmas story, or a successful shipping story! Or just something to help me bring the Christmas spirit back into my hardened little heart. I do want to love Christmas this year.

Loving My Boy

2010-12-09T19:33:00.000-08:00

We put our Christmas tree up on Sunday. Gunner was so excited about decorating the tree, and it was so much fun to watch him hang the "guys" (little Scandinavian people) and "tubas" (bells) on the tree. He loves his tree so much, and he calls it his "Christmas". He even made Spiff and me sit down on the floor with him in front of the tree and "Watch Christmas". Who knew that a Christmas tree could be such an exciting show?

Gunner and I made a batch of Jiffy blueberry muffins today, and then he licked the batter bowl. Seriously, Jiffy Muffin mix is really that good!
And just as a side note, notice the box of Wheat Thins on the table. Gunner refers to them (and Chex Mix) as "chicken". They are the only meat products he's willing to eat.

Tonight, my baby had the hiccups. I put Gunner's little hand on my belly so that he could feel it, not really expecting him to feel anything or get it at all. But he felt it! I explained that the baby had the hiccups, and he smiled and pressed his little hand in closer so he could feel them better. Then he kept asking for more hiccups as I put him to bed. Pretty awesome.

The best part of my day these days is bedtime. I love reading books and cuddling with my little boy before his nap or bed. It gets better every day as he gets better at talking. He remember phrases from his favorite books and quotes them throughout the day. And he almost always asks for more books, which is almost always irresistible for me, and I almost always cave and read him just one more. Especially when he asks for them by content, like tonight when he asked for the peanut butter ("beanut buttet") book, which turns out to be a library book where a dog eats some butter off the kitchen counter on one of the pages. I think the only thing I love more than reading him stories is singing his bedtime song while he cuddles on my shoulder. He's old enough to pick his song these days, and it melts my heart to hear him ask for "the daddy song again." Like I said, it's the best part of my day.

The interview trail and duty hours

2010-12-05T15:56:00.001-08:00

So the interview trail has been a busy one for me. I have been trotting all over the midwest, and I'll share a few thoughts on the strengths of the various programs that I've been to:
Mayo: Amazing physical facilities. Dozens of different kinds of marble in the waiting rooms alone. Also, the truly bizarre cases come to Mayo
Michigan: A lot like Mayo from a pedagogical standpoint, Ann Arbor has a little more going on than Rochester
Case Western Reserve: Sweet moonlighting possibilities where you can make $65/hr doing anesthesia after hours. Level 1 for children's trauma.
Cleveland Clinic: Very strong in hearts, lots of pump cases and congenital cases. Very strong ICU
University of Wisconsin: national leader in transplant, very livable town.
Medical College of Wisconsin: Strong peds rotation
Washington University: Has everything, knife and gun club.
SLU: lots of penetrating and blunt trauma.

I have two more anesthesia interviews and three more prelim or transitional year interviews before I'm all done in January.

So, now my rant about duty hours. Residents are currently able to work no more than 80 hours a week, averaged over a month, with no shift lasting longer than 30 hours. They must also have 8 hours off between shifts. I think this is reasonable and allows for sufficient exposure to ensure a balanced and adequate post-graduate education. The Institute of Medicine, a think-tank (if they in fact think there) which makes recommendations to the ACGME, which is the accreditation body for residencies, recommended that interns not be allowed to work more than 16 hours at a time. This recommendation becomes codified into regulation next summer, when I become an intern. Great! I hear you cry. Interns won't be as tired and will be alert and less prone to make errors. Right? Wrong.

Here are the problems with that line of reasoning. Yes, there will probably be fewer fatigue related errors. The flip side of having shorter shifts is that there will now be more hand-offs of patient care between residents. Would you rather have your ailing father be cared for by someone who had seen and monitored his care continuously for the first day he was admitted? Or would you rather have 3 different hand-offs?
Remember playing Telephone as a kid? the same problems with garbled messages and discontinuity will now exist in medicine. In essence we're trading fatigue for the problems engendered by frequent pass-offs of care. I think it will also turn the newest generation of physicians into clock-punchers who will be ill-prepared for the real world where doctors don't have duty hour restrictions. I would rather work hard as a resident and emerge a well trained physician who is competent and has seen and cared for a wide variety of illnesses than emerge a well-rested but half-trained doctor.

There are also changes for upper level residents, who will only be able to work for 24 hours straight. This will not be any change for anesthesia residents who only work 24 hours at a stretch when on call anyway, but will be devastating to surgical residents. If you shorten the amount of time a resident can be at work, you limit the number of procedures he does. Would you like to have your knee replaced by new surgeon who has done it 350 times in training? 200 times? 100? 50? 10? It is a mathematical necessity that in order to be competent in a procedure, you have to have a baseline minimum number of repetitions to be good at it. Surgical residents are going to be doing fewer cases and emerging from training with less experience than their predecessors.

Bravo, institute of medicine. That's some strong work.

Thar she blows

2010-11-09T19:39:00.000-08:00

As previous posts have noted, we have been subject to an invasion by Mus Musculus Domesticus, or "el mouso"as the Spaniards are wont to say. 3 spring traps, 3 sticky traps and 5 pieces of anti-coagulant bait were to no avail. Our bold little nemesis would spring forth in the evening to scuttle across the kitchen floor or race across the dining room floor. We would rise, anger boiling and driving us into a killing rage, only to be frustrated as he scampered arrogantly beneath the baseboards. This evening, Mindy noticed the enemy as he darted behind a bookcase. Surely this is a dead end, I thought. The baseboards seemed to close to the floor for even a mouse to scuttle beneath, yet when I looked behind, there was nothing. I even prised the bookcase away from the wall a few inches for a better look, but there was nothing.
We sat on the couch, thoughts of vengeance filling our hearts. Lulled by thoughts of another failed attempt at extermination, I was unprepared when Wiff cride "Oh! Mouse" again. He was running across the dining room and hid under the piano. Aha! I though, we will drive him out with music, like the Pied Piper of Hamlin. Wiff hastily improvised some 20th century atonal riffs, since rodents hate Schönberg, this seemed a logical choice. Nothing. No hasty retreat from his musical abode. I peeked under the piano with a headlamp, hoping to spy the dreaded beast. Nothing at the bass end. I moved upwards in register, and still nothing. Finally, beneath the plinky little notes at the high end, I thought I saw a robust looking dust bunny. Upon closer inspection, the dust bunny had moved a little.
Quickly, I outlined the plan to Wiff, who reluctantly agreed to cooperate. Would she prefer to be the Coaxer, or the Smasher? Coaxer she quickly replied. Her job was to use a wooden spoon under the piano to drive him out where I would quickly reduce him a lifeless paste with a hiking boot. As I refined the plan in my mind, I recalled that deep in the recesses of my stored camping gear, there was a blow gun. I ran downstairs, leaving instructions with a very hesistant Wiff to prosecute the rodent with extreme prejudice, should the occasion arise. I tore into my boxes of camping gear, and at the bottom, was able to dig out my blowgun.
Hastily, I assembled the 4 pieces, and pulled a dart out of the holder. I checked under the piano to ensure that my target was still downrange. I put the muzzle of the blowgun up to the edge of the piano, drew in a breath, and expired swift death to the mouse waiting 6 inches away.

We now have a very small addition to our trophy room wall.

Unwelcome Houseguest

2010-11-07T17:40:00.000-08:00

We have a mouse in our house. It's so super gross to admit it, but there it is. The little creature came in on the first cool day of the season, about a week and half ago, on a day when we happened to have some contractors working on our bedroom wall. Since they were walking in and out of the house and up and down the basement stairs, I blame them for letting the little mousie in. That first day, just after we finished eating dinner, it scuttled across our kitchen floor and ran into a crack between the cabinets and the dishwasher. I was so grossed out I couldn't step foot in the kitchen for the rest of the evening. Spiff thinks I overreacted. Gunner now walks around periodically scolding the mouse, "No, No, Mouse is yutty!"

Spiff found it several days later scurrying around the drawer under our stove among the baking dishes. I can assure you that we have washed those dishes several times! I can also assure you that if it had been me who had found him there, I would have had a heart attack, and then run screaming from the house, just before moving into a hotel for the rest of the winter.

Later that night, our bold little mouse scurried into our living room. Spiff saw it run behind the couch. He got all excited by the thrill of the hunt, handed me a work boot and said, "Okay, when I move the couch, it's going to come running your way. Stand on that vent and smash it before it gets away! Great. Ready.......Go!!!" He practically picked up the couch and threw it two feet into the room, leaned over it and yelled, "Ha!", while I squealed "Aaaaaaaaaaaaaah!" from my post on the vent with the boot dangling tentatively from my girlie little fist. The mouse must have found another exit because I thankfully didn't have to try my hand at boot-mouse bashing!

A couple nights later, we watched him scuttle around the house. He appeared at random places without any kind of indication as to how he got there. We'd see him at the stove, then by the TV in the living room, then scurrying under the baseboard across the room, without having run across the room. It was like a gross version of Jack Jack Attack, when Jack Jack is floating around the house through walls, while Kari was chasing him from room to room, never quite knowing where he is going to surface. Spiff occasionally tried to "catch" him by waiting stealthily on a kitchen chair with a small frying pan in hand. He never did.

We have set all kinds of traps around the house. Sticky traps, snap traps baited with peanut butter, and mouse poison. I have had dreams of catching him. One night in particular, I woke up and heard noises in the kitchen, which I then convinced myself were the sounds of the mouse getting caught by the snap trap behind the fridge. I even thought that I posted "Got Him!" as my facebook status. I couldn't quite believe that the trap was still empty in the morning. Even more unbelievable was the fact that the peanut butter on the trap had been licked clean, and the trap was still set.

We haven't seen him for a few days. We're hoping he got some of the poison and has now gone somewhere to die quietly. But if he's still around next weekend while Spiff is away, I'm borrowing a cat.

And that's how I broke his heart...

2010-10-31T19:01:00.000-07:00

New words for the week: Church (turch) and Nursery (nursy).

Gunner has been asking all week long to go to church. Seriously, all week long! I didn't know that he knew or cared that we go to church, other than that it's the place we try to make him sit still and be quiet! He even asked to take one of his friends to church.

As it was Sunday today, we went to church. We planned to only stay for Sacrament meeting because Gunner has a cold and we couldn't send him to nursery. I was actually happy because that meant that he would get a Sunday nap, which hasn't happened for months. So we headed for home.

And when he realized we were walking out of the building, and not into the nursery room, the tears began. I can pinpoint the exact moment when his heart tore in two. (Anyone remember that episode of the Simpsons when Lisa breaks poor Ralph Wiggum's heart? It was like that.)

All the way home, I got this, between the tears:
G: "Nursy, please, Mommy!"

"Please?!"

"Nursy!"...

"Please?!"

He didn't stop until he had cried himself to sleep in the car.

I didn't realize that it meant that much to him. You can bet that he will be asking me about church all week. You can also bet that as long as he's healthy, we're taking him to nursery next week.

In other news, Spiff's residency interview season has started. He traveled to an interview over the weekend. While he was gone, I hung the plastic on our two living room windows. I will happily accept the Best Wife Award for the month of October. Thank You.

Nervous Confession

2010-10-27T18:38:00.000-07:00

I know a whole lot of pregnant women these days. A whole lot! It's that time of life for us, and most of our friends are having babies and expanding their families. If someone isn't pregnant, it's probably because they just had a baby, or are somehow in that wonderful in-between stage when your baby is still a baby and you haven't yet thought about the next one. I just spent a few minutes looking at blogs of some friends who are in the just-had-their-baby category. I love their birth stories and pictures of their sqwudgy little newborns, but reading their stories had an unexpected effect on me.

In short, it made me nervous.

Don't get me wrong. I'm already nervous out of my mind about having another baby. How will we make it through labor & delivery again? How will I handle having two small children? How will I survive the newborn stage? How will Gunner handle things? Etc. The nerves are in no way a new thing.

What I didn't expect was realizing with intense sadness that I am coming up short of my alone time with Gunner.

I remember visiting a friend in the hospital 18 months ago to meet her second child. Things went great for them, and their new little boy was a dream! I asked her the details of their hospital stay, and she replied that she was hoping to go home sooner rather than later. She stated, "My girl is there."

I remember being sort of shocked by this opinion because of my own experience being at the hospital with newborn Gunner. I didn't want to take him home. I liked being at the hospital. I liked the food. I liked the nurses. I liked being able to send Gunner away to the nursery, get some sleep, and see him again with a diaper that had been magically replaced for me! Home meant that we had to care for this foreign little demander all on our own, and I had no idea what to do with him!

I think I understand what she meant now. While I read my friends' experiences, I imagined our upcoming stay at the hospital, with Spiff going back and forth from hospital with me to home with Gunner, leaving me to get acquainted with our new little boy. I feel a bit jealous of him. I'm feeling that I would rather go home to the little boy we have had two years to know and love, than stay at the hospital by myself taking care of a stranger and missing my sweet toddler.

I'm also imagining baby #2 reading this post someday and thinking I'm a horrible mother who didn't want or love him. That's not the case. Of course I want this child, and I imagine that I will love him and Gunner equally. All I'm saying is that I have loved having my one baby. I have loved giving Gunner my undivided love and attention. I will miss that.

The windows.

2010-10-23T13:37:00.001-07:00

"Honey, I think it's time that we put up the plastic," Mr Thrimbly's wife exclaimed chipperly one clear October morning. Gerald Thrimbly thought himself a rather stolid and unflappable chap, not given to easy starts or fear of any kind. Yet his wife's bright announcement sent his heart sinking and the erstwhile cheerful Saturday had suddenly taken on a gloomy timbre, a funerary pall now hanging in the air. Gerald dreaded the annual autumnal ritual placement of plastic over his windows. Secretly he hoped that his wife wouldn't think it necessary, that the baggy sheets of clear cellophane loosely festooning their living room would somehow suffice to keep winter breezes at bay. Realizing that his wife was still awaiting a reply, he answered "Isn't it a bit early?""No," came the stern reply. Gerald's heart sank even further, knowing his one stalling tactic had failed him again.

With dread-laden steps he trudged to the basement. The chipped plaster in the stairwell looked to him as the dank walls of the Bastille, closing in on the foppish French aristocrat. Soon, the tumbril would take him back to his cackling Madame Defarge with her maniacal fascination with weatherproofing. Mentally crossing his fingers, he hoped that the basket with sheets of plastic would somehow be empty, that he could forestall the dreaded operation by making a trip to Home Depot, which might take place some indeterminate day in the future. Sadly, the basket was full, boxes of unopened plastic from the last winter leered at him, mocking his fear. "It's not so bad", they seemed to say, "all your friends are able to hang plastic without the final product looking like a blind chimp placed it". Gerald knew the lie, and had once told himself the same thing. Now, after several years in his centenarian house, he knew the sheets of clear plastic were deceitful. Not only would the final product look like some grotesque parody of a window, but that he would be confronted with his own inadequacy every day he spent in his own home. There could be only two solutions. Either Gerald could hang the plastic and stare his incompetency and incoordination in the face for six months, or he could kill himself. Death seemed a welcome alternative to the incessant barrage of mockery, lies, and poor craftsmanship.

Knowing that flight through the locked basement door was impossible, and realizing that his 2 year old son needed some kind of father figure, but fearing that his son's affection would forever be tainted by disdain for his father's poor handyman abilities, Gerald Thrimbly decided suicide was out of the question, and shambled back up the basement stairs. "Honey, we need to hang the plastic before it gets too cold for the tape to stick", said Mrs. Thrimbly brightly. She too knew of the duplicity of the plastic, but was somehow inured to its lies. Gerald masked his dread and presented his wife with a basket of plastic, like some trembling Aztec priest offering the sacrificial knife to a homicidal shaman. Suddenly, Buddy ran in, distracting Mrs. Thrimbly. Quickly Gerald put on his shoes and said "Let's go, we need to get to the store" He knew that if he could get the family moving, his sentence would be commuted, and that perhaps in the interval, some miracle would intervene on his behalf. Vaguely, he thought hopefully of flames licking the side of the building or a smoking pile of rubble greeting the family on their return from the store. Calmly, he walked out of the house, leading his family, his aplomb and nerve restored. No coward he, he thought bravely of himself.

Gunner's 2nd Birthday

2010-10-17T06:14:00.000-07:00

Our little boy is two! I can't quite believe it! We celebrated by doing things he likes to do. We took him to the zoo, where we rode the carousel, visited penguins, the red rock animals, and the bird house. We got splashed with penguin water (gross!), he said Hello to an owl, chased peacocks, and bounced like a kangaroo. Then we had two of his favorite little friends over for dinner and birthday cake.

Some funny things about our little two-year-old boy that I want to remember:
All musical instruments are "tubas," including all brass instruments, drums, a piece of rubber inner tubing Spiff pulled out of his bike toolbox, and his new kazoo that he got for his birthday. Exceptions to this title are violins and guitars, which are "la la's," and the piano, which has no name.

All tools are "hammers," including tape measures, screwdrivers, bike pumps, and my iron.

He has picked up new names for me. From the other room, I have heard him calling me "Honey" (which is what I call him sometimes), "Hottie" (which is what I call Spiff), and "Mindy."

He is ecstatic about his new Richard Scarry books he got from his Grammy for his birthday. He searches for Goldbug and squeals when he finds him, and he walks around the house saying, "Go Go Dinno!" (Dingo is the bad driver character who is running away from Officer Flossy, who is trying to give him a ticket.)

He received some new matchbox cars from his auntie and uncle, and he has already named one of them his "Noon Car." I have no idea what he means by that, but at least I know which car he is referring to.

He is also ecstatic about receiving a new Lightning Mcqueen car from his other Grandma. Now he has his beloved Blue Car, and his new beloved Red Car.

He is such a talkative little guy, and I love hearing what's on his mind. I also love hearing his speech develop. Just the other day, he started putting the final syllable on his words. Instead of "Duh" for Duck, he says, "Dut." Dump Truck used to be "Dump Fwuh" and is now "Dump Fwut." Garbage/Cement Trucks are now "Dahder Fwut." He also answers questions with a crystal clear "Yes" or "Nope," emphasis on a listpy little "s" and the "p". Love it!

He is generally fairly polite, asking for things by saying please (mlee?!) and Thank You (Day dyou).

"Blue" has become a term of endearment for him. He has his beloved Blue Shoes, Blue Car, and "Blue Blank", which refers to two different items, neither of which are blue. One is a baby quilt he got from his Grammy before he was born. It is orange and brown with monkeys on it, and quite gorgeous. Gunner found it one day and decided that the border is a great place to drive his cars around. The other is his Gunnerville. He sits on the with "Blue Blank" on his lap, driving his cars around for hours. And he insists on going to bed with one or the other of these Blue Blanks and falls asleep playing with his cars.

Whenever Spiff gets home from work, Gunner asks to "Mar Daddy." Spiff turns on a playlist of "The Hall of the Mountain King" from Peer Gynt Suite by Grieg, "The Ride of the Valkeries" by Wagner, "The Imperial March" from Star Wars, and the "Indiana Jones Theme." Then the two of them march around the living room, getting faster and faster as the music gets louder and faster.
Spiff has also taught Gunner to hold his hand to his ear when the music is soft and whisper as they listen to hear it. It is a Daddy/Son game, and he loves it!

So Happy Birthday, Gunner! We love you more and more every day!

Grab Bag

2010-10-02T13:04:00.000-07:00

Here's the stuff that's been on my mind recently:

Things I learn from patients:

If you have a subarachnoid hemorrhage, don't leave the outside hospital against medical advice. You will come to my hospital obtunded with minimal brainstem activity.

Don't inject "shake and bake" homemade meth synthetic product into your arm, it will give you cellulitis.

A dead liver cannot be fixed by changing ventilator settings.

Things I learn in General Conference

The word "even" can be used as punctuation, in lieu of a comma. Consider the following example:
"We are thankful for the prophet, even Thomas S. Monson, who leads us...."

Alternatively: "We are thankful for the prophet, Thomas S. Monson, who leads us.." This is another instance of why we need Victor Borge's phonetic punctuation.

"Indeed" is three words. "Indeed" becomes "in very deed". Indeed is not the same as "in deed". Indeed is an adverb, expressing incredulity, or to reinforce the credulity of a statement previously asserted. Etymologically, I believe this tendency to embellish words stems from the King James version of the Bible, as seen in very deed in Exodus 9:16, 1 Sam 25:34 and other places. From a literary perspective I think it's fine, but in oral speech it is somewhat stilted and contrived.

Backfire

2010-09-30T12:30:00.001-07:00

Gunner loves the movie, "The Incredibles". It is one of my favorites, and I'm happy that he likes it. Recently, he has been commenting on the show, asking me what the characters are doing (Doonat guy?). He likes it when Dash runs away from the bad guys (Wunning!). I think it's cute how he has woken up to the action on the show.

Yesterday, I decided to show him "Jack Jack Attack" on the second disk. I turned it on and left the room to finish up some dishes. I returned four minutes later as the short was finishing to find my sweet little movie-loving guy on the couch, shaking from head to toe, pointing at the TV, saying, "Baby?!...Baby?!!"

He was terrified!

And I felt terrible! I immediately picked him up and he glommed onto me like a wet shirt. I turned the little show back on and tried to talk him through it, saying things about how funny the little baby was for flying or disappearing, or bursting into a flaming monster. See, Gunner, isn't that hilarious?! Please, please think that it's hilarious! Mostly, though, I comforted him and told him over and over that the baby was okay.

G: "Baby?!"

Me: "The baby is okay."

G: "Baby K?!"

Me: "Yeah, the baby is just fine.

And then we got out our newly acquired library books and read about planes (Cop-ter!), trains (joo joo), and automobiles (Bus, Mommy!) to try to distract him.

I never thought that it would scare him, and I feel just terrible for putting him in into such a scary situation. But I'm glad I was there for him and realized quickly what was going on. And I'm grateful for the glomming cuddle time, since I have to take the cuddles when I can get them these days. I also guess I have learned to be a little more careful about what I expose him to. Although, really, who would have thought that it would have been scary?!

*Several days later, Gunner is still assuring us that the baby on the show is okay. Out of the blue, several times a day, he declares, "Dac Dac fine. Dac Dac fine." And we reply each time, "Yep, Jack Jack is just fine."

Residency App

2010-09-25T16:16:00.001-07:00

I've had my application in for about 3 weeks now, and have heard back from several programs. My application strategy is to apply to 16 anesthesia programs, 10 medicine prelim years, and 10 transitional year programs. Of the anesthesia programs, 3 are in the pacific northwest, 2 in the mountain west, 2 in Ohio, 1 in new hampshire, 2 in Boston, and the remainder are scattered around missouri, michigan, minnesota, and wisconsin. I don't know if 20 is enough preliminary years, I hope it is because I don't want to have to scramble into a prelim surgery year somehwere, that would be pretty awful. For the readers who are not intimately involved in the drama of ERAS and the NRMP (electronic residency application service and national residency matching program, respectively), the difference between medicine and transitional years is that medicine programs are just that, medicine, and the transitional year is a mix of medicine, surgery, ER, and elective time. There are some pretty nice transitional years that I would love to go to, although interview invites have not yet come for those.

Mid-night Heart Breaker

2010-09-22T03:26:00.000-07:00

Gunner crying in the middle of the night:

Momma!...

(pause)

Blue Car!!!

Gunner Speak

2010-09-15T06:42:00.000-07:00

Love how this kid talks! If you're ever around him, here's a translation guide to some of his more obscure phrases:

On, On--Means, "Give me your hand (yes, "On" means Hand), and come here, now, please."
Lul You--Love you (usually accompanied by a kiss on the cheek and followed by a melted heart)
Cop-Ter--Helicopter (this is something he exclaims every time he sees or hears an airplane or helicopter in the sky)
Uh, Yah!--(accompanied by smile and bright eyes), means Yes
Huh?--UhHuh, also means Yes
Wuddy?--This means that he wants to play with the cardboard race track Spiff made for him, meaning, "Ready, Set, Go!"

Morchee--More please

Beenoon--Balloon

Beenoon-a-beenoon-a-beenoon-a-beenoon...--means there's a balloon over there that I need to run across the room to get.

BlueWhiVreen--Blue, White, Green

LellowWhi--Yellow, White

Blue Car/Car Blue--his new Dinaco Blue Lightning McQueen car. He has seen the movie but doesn't really get the whole character thing. He just loves the color, size, shape...everything about this little toy. He carries it everywhere with him, and sleeps with it at night.

The Next Few Days

2010-08-30T18:32:00.000-07:00

So, it turns out that this surgical procedure actually bothers the patient more than the doctors and nurses say it will. It also turns out that a toddler who has just undergone a surgical procedure, and who is feeling terribly sore and awful, is very very cranky. Also, I feel horrible when I'm taking care of his wound site and he is saying, "Ow. Ow. Ow." and then hobbles away in obvious pain. It also turns out that even though I feel very badly for him, and I am very sympathetic towards him and what we made him go through, my patience unfortunately has its limits when dealing with the cranky child.

Today was a very very long day. I'm looking forward to the end of the week when the wound isn't so fresh.

Also, Happy 29th Birthday, Spiff!

Post-Op

2010-08-28T16:01:00.001-07:00

Gunner's surgery went well! The surgeon was very pleased with the results, and he said that Gunner handled everything incredibly well. I was impressed with the staff at the hospital, and the nurses and doctors were all great. The first patient of the day didn't show up, so they were able to get us in early, so we didn't have to make Gunner fast for so long. And since it was an outpatient procedure, we were done and home before 1:00 in the afternoon.

Gunner did great with everything, although the longer we were there doing pre-op stuff, the more wary of everything and everyone he became. He was absolutely terrified of the scale, and he absolutely refused to sit in the crib. They gave him some medication to help calm him down, and he was hungry enough to ask for more of it. The meds worked like a charm, and the nurse told me that he was asleep before they even put the anesthesia mask on him.

The procedure took slightly less than two hours. I went back to the PACU to be with Gunner after he woke up from the anesthesia. As the nurse took me back, she told me that he woke up great, just quietly opened his eyes, which was a relief since I was expecting hysterics. When we entered the room, I glanced around the room and saw several little babies on stretchers. There was one in particular who looked especially small, and I was amazed at how young the baby was to be having surgery. Then I realized that particular tiny little guy was mine! He looked so small on the stretcher, and so pathetic lying there so placidly, hooked up to an IV.

I was very grateful when they let me hold him, and when we got back to the recovery room, Spiff and I took turns holding him and helping him come out of the effects of the anesthesia. Amazingly, after that wore off, he perked right up, and was running and jumping around the house just a few hours later. Today, he acts like nothing happened at all. Amazing!

I'm so glad it's done, and that it went well, and I am incredibly grateful for the great doctors and nurses who helped him yesterday.

Gunner's Surgery (Pre-op)

2010-08-26T16:53:00.000-07:00

Our little boy is having surgery tomorrow. It's an outpatient thing, relatively routine, and I'll tell you the details if you ask. (I don't want to post them on a public setting.) But even though it's supposedly a common thing and the recovery is supposedly not bad, I am insanely nervous. Spiff is cool as a cucumber, and I assume this is because he has seen countless procedures and sees this as no big deal.

But it is a big deal. Poor little Gunner has no idea what's coming, and I guess that's a good thing. I am mostly worrying about the logistics of the whole thing. He can't eat breakfast in the morning prior to the surgery, nor can he have anything to drink past 6:30 in the morning, which means that he probably won't get anything at all since he'll still be asleep at that point. This also means that we will be dealing with an incredibly hungry and cranky toddler who is in a strange place and dealing with strange things and people. Not a recipe for success. And then there are the logistics of taking care of my post-op toddler. I don't know what to expect about how he will handle it, what he will need, or how he will feel.

I just hope that he responds well to the pain medications, and that he doesn't really remember the whole experience. I also have to deal with the guilt I am feeling about putting him through this in the first place. It needs to be done, but I still have horrible guilt about taking him to the hospital to "be hurt". And I feel so badly for him and his sweet little self to go through something like this.

Please say a prayer for us.

Stake Conference In Utah

2010-08-16T07:10:00.001-07:00

I went to Stake Conference with my sister's family yesterday. Russel M. Nelson was in attendance because their stake got a new presidency. I'm sure he gave a wonderful talk at the end of the session, but I'll have to take it on faith since Gunner was a crazy person yesterday morning and was absolutely not in the mood to sit through a two-hour meeting. (Who ever is, really?) I walked the halls as he ran them, and I was able to catch a few sentences of the talks here and there.

But, here is the cool part...

I took my niece to get a drink before the meeting started. As we were walking down the hall, Elder Nelson was standing in the hallway with just one other guy. I said Hi to him. He looked right at me and said, "Good Morning."

Aaaaaaaaaaaaaaaaaaaaah! He practically said Hi to me!

I didn't have the guts to ask him to shake my hand, but I did drop down to my knees after we passed him and explained to my 3-year-old niece (who couldn't care less) that "That guy over there is Elder Nelson, one of our apostles! Can you believe he's standing Right There?! Isn't that neat!?"

So, that's what you might get for going to stake conference in Utah, where apostles still attend the conference in person instead of attending via satelite. Very cool. Sure wish I could have heard his talk.

Away rotation

2010-08-03T14:41:00.000-07:00

So I'm going to go into anesthesia, and I'm currently doing a rotation at my number one choice, Major Medical Center in the midwest. The trouble is, as a newcomer, I don't know who anyone is or where anything is. Major Center has a rigid dress code of suits and ties all the time, but the residents still show up to the OR in regular clothes, change into scrubs, and leave in regular clothes. Should I do the same? or should I be the sore thumb who stands out in a suit when the residents go to lecture in mufti? I err the side of formality. The whole point of doing away rotations is to see if the program is a good fit, if you like the area, and if training there will help you accomplish your professional goals. I like being at Major Center, it's got world class resources and faculty. The problem is that I have no idea where I stand. I don't know if I"m doing the right things to impress the right people. I hate being 'on' all the time. Who should I ask for a letter of recommendation? I hate all the ambiguity. I will probably rank Major Center #1, but doubt very much that I will match here in March.
-SS

The poll Part 2

2010-07-31T04:49:00.000-07:00

For those of you who don't know, we are expecting another addition to our clan. We don't yet know if it's a little man or a tiny little woman, but we will be finding out in a few weeks. Since it worked out pretty well last time, I think I will again have a weekly poll with our name options for you to vote on. Just so that there's no ambiguity, I will posting facetious names. Again, these are not real. Mindy and I have already decided that Zeal-for-the-Lord will be his name if he's a boy, and Taquandafaqweyah if it's a girl. So look on the banner to the side every week and cast your vote for names.
-ss

Small Truths

2010-07-23T20:53:00.001-07:00

I am in Utah with my family while Spiff is getting ready to head to a month-long away rotation. Gunner and I miss him. I still can't imagine being away from him for that long, and I am hoping that he has a good experience at this new hospital and new rotation.

Gunner and I traveled on Wednesday, and I learned a few things on this trip:

1. Southwest is hands down the best airline company I have flown with. Their employees are generally friendly and helpful. I enjoyed my experience with them, and they even just changed their policy to allow people to check two bags for free, PLUS a carseat as a free special item. Awesome. I also enjoyed the layover since it was a chance for Gunner to get off the plane, run around, and use some of his energy. I no longer think that the best way to fly with kids is non-stop.

2. Traveling with a 21-month-old lap child is not fun. Never never do it.

3. When your child is throwing a screaming tantrum on the airplane 30 minutes before you're scheduled to land, no one looks at you. No one makes eye contact. No one offers to help, not even the flight attendants. They put their heads down while occasionally send vicious glances your direction, and make you feel like there is something else that you should be doing in order to control your very very very loud, bored, overtired, uncontrollable child. And yes, it is very embarrassing to be the mother of "That Child".

4. While I was being so very embarrassed by my tantrum-throwing one-year-old, I noticed that people were throwing the nasty looks. And while I desperately wanted Gunner to stop screaming, (Please Just Stop Screaming!!!), there was also a vindictive little part of me that thought, "Well, if no one is going to look at me or say anything nice at all, then he might as well scream! Scream, baby, scream!" I apologize to all the people who may be on future flights with me. I also promise not to pinch my child or make him cry on purpose...as long as you're nice to me.

5. It is much nicer to fly when the toddler falls asleep during take-off and wakes up during landing at the destination. I would love that to happen every time. Hopefully Gunner will read this post and behave accordingly when we fly home in a month.

6. I love love love the West. It's gorgeous. The mountains are so very beautiful. The dry heat is tolerable. It cools down at night. There is sometimes even a nice breeze! When I sweat, it actually does something to cool off my body! I am a Western Girl, and I am made for this type of weather. It is going to be very difficult for me to go home and back to heat plus humidity. Spiff might have to do some major convicing in order for me to go back. (Not really, Spiff. We love you and will be with you wherever you are. All I'm saying is that I want you to eventually bring me back...for good.)

Now it's off to a week-long camping trip and a visit to Yellowstone Park. I'm hoping to see some wild life, and I'm looking forward to cool weather. (It's supposed to get down into the low 40s at night. Doesn't that sound glorious?!) I'm sure you all wish you were me right now.

MICU part 2

2010-07-21T15:48:00.000-07:00

I have learned a lot on this subinternship. I thought I would learn a lot about the administrative stuff, writing orders, all that crap. I have, but I've also learned a lot about thinking about disease. Consider the following comparison: treatment of disease is like hiking through the forest. At the beginnig of my third year, I was barely able to recognize anything abnormal, to notice that there were trees in this forest as 'twere. I was too focussed on walking along the path and getting the motions of a physical down. By the end of third year and where I am now, I can see trees, and occaisionally discern between types of trees. I can now recognize when something is abnormal and know what to do about it. But I still see a lot of individual trees. What my attending does which I cannot, is to stand back, and say "this is a 3rd generation mixed forest of deciduous and coniferous trees, typical of the pacific northwest, most specifically the costal region between latitude 35 and 50 degrees north. I can say "this guy is hypotensive, hyponatremic, hyperkalemic, is covered in non-blanching livedo, and has 2+ pitting edema of his lower extremities. He is also anuric." This pt does not immediately scream SEPSIS to me, although he does more now than he did 2 weeks ago. It's really hard to put all the pieces together and parse between the important,the urgent, and the less-important, and identify a unifying diagnosis and come up with an appropriate treatment plan. I guess that's why I'm still a student, huh? At least watching my brand new interns, I can see myself doing what they do and being able to at least function at that level.
SS

Bad things happen at night

2010-07-13T18:00:00.000-07:00

It's true. I'm on my medical ICU rotation right now (MICU) and I'm on overnight call every 4th night. I usually sleep for 2-3 hours a night when I'm on, and then go home at 12 or 1 the following afternoon. That adds up to about 30 hours on at once, which happens every 4 nights so I work about 75-80 hours a week. This is a foreshadowing of internship. I have had two firsts for my medical career during this rotation.

Last tuesday night, we got a transfer from an outside hospital. It was an 84 year old lady with a history of small bowel obstruction, dementia, and coronary artery disease. She arrived on a levophed drip (powerful vasoconstrictive medication for maintenance of blood pressure), and intubated. Her family had allegedly retracted her DNR status and now wanted a full court press. We were barely able to get a femoral arterial line in, and when we checked the CT from the outside hospital, it confirmed our clinical suspicion that the bulk of her bowel was dead. Surgery was reluctant to take her to the OR, for the obvious reason that she would likely not survive her operation. We contacted her family and they informed us that they wished us to withdraw care, which we did. She expired about 10 minutes later as we watched.

Four nights ago we received a call that one of our patients was seizing, had probably aspirated, and was now becoming bradycardic (her heart was slowing). We ran upstairs, started bag masking her, and had to begin CPR. After several rounds of vasoactive drugs, her heart actualy started beating again and she returned to her baseline, which was incredible. This was my first experience in a code and I'm glad that I did 6 weeks of anesthesia to practice bag masking pt's, since that was my job.

MICU has been quite intense, that's for sure. I do enjoy the complexity of these patients, but caring for them is like trying to replace the transmission in a truck, at night, by flashlight, at gunpoint, when you're a bicycle mechanic. It's really hard for me to see the big picture, I can spot many of the abnormalities, and piece some of the parts together, but placing all of them together as part of a coherent whole is far beyond my current knowledge base.
Spiff.

What's On My Mind

2010-07-10T18:48:00.000-07:00

We're back from a much-needed and great vacation to Michigan. We saw some family and spent time with some wonderful friends. We left the cabin with mixed feelings, being ready to be off of vacation, but not ready to leave our friends who live far from us. We were not quite ready to start life again, and were wishing for a few more days to decompress at home before Spiff started into 4th year.

But, we got home, and he started right up. Starting 4th year is sort of a strange thing. For the first time, he isn't starting up the same big thing as the rest of his class. Everyone picks their own schedules for 4th year, and so everyone has something different to start off the year. Some of his classmates are studying for and taking Step 2. Some are doing research electives. Some are out of town. Some are doing dissection with a very flexible schedule. And some, like Spiff, started off the year with a bang by doing an intense sub-internship. He is in the MICU (adult intensive care unit), and he is on a Q4 overnight call schedule for three weeks. The means that he has to spend the night at the hospital every fourth night for three weeks. It's pretty intense, he has to do a whole ton of rounding (like 8-12 hour each day!), and he's tired. I know there are residencies that do this kind of schedule for several years in a row, so I can't complain, but it's still a tough thing to start up with.

And then in just two weeks, Spiff heads up to Rochester, MN for a 4-week anesthesia away rotation. Gunner and I will be leaving to visit my family for those four weeks, and while Spiff is enjoying a nice, month-long interview process, I will be enjoying my family. We will be camping and visiting Yellowstone (which I haven't seen for 11 years). I will also be running this event with my sister. I'm not in very good shape, so I'm a bit nervous to tackle the distance and altitude. But as long as the team doesn't care that I'm super slow, I'm just excited to do such a cool event with one of my favorite running partners ever!

Also, we're enjoying Spiff's sister, Mhana's, adventures while she researches doctoral paper material in France for the Summer. Check out her blog here. She writes good, that one.

I also recently found out that one of my good friends from college has breast cancer. It has spread to her bones and is incurable, although the doctors say it is treatable. She is only 33, has a wonderful husband who loves her, and has three little kids. I can't stop thinking about her and how unfair the situation is. I keep praying that her treatment will give her years with her children, but it even that doesn't seem good enough. I want her to grow old with her sweet husband. I want her to see her children to adulthood. I feel so helpless. And I am already grieving for her.

Spiff and I have discussed many times recently how we seem to have so many good friends who are going through terrible trials in their lives. My friend with cancer, another good friend who's pregnant wife had cancer on her tongue (thank goodness it was taken out and she is cancer free for now), good friends with infertility problems, friends who's children have been diagnosed with serious health problems. They have all been on my mind and in my prayers. While I am so grateful for my own family's current health, I find myself feeling guilty being grateful that it's not me. At least for now.

I feel so helpless. I wish I could do more for these people I love so much, and each and every one of them have been shining examples of how we should handle trials that come our way. They rely on the Lord. They share their experiences with those who love them, so that we can all at least pray for them. I'm sure they suffer more than they show, but they certainly do seem to handle things better than the way I imagine myself handling similar situations if I faced them.

And that is what I have been thinking about lately. Now I'm going to bed. Hopefully Spiff can get a few hours of sleep in the on-call room at the ICU tonight.

OB-GYN part 1

2010-06-19T18:46:00.000-07:00

It seems fitting that a specialty which refers to itself with a five letter abbreviation is one that is chock full of abbreviations, to the point that our syllabus was annotated with a glossary. I imagine this is some subconcious throw-back to the days when physicians spoke in latin both to impress their patients and to conceal their thoughts. Here's a sample:

CC: VB for 2hr
HPI: HC is a 38 yo G4P3103 at 37w5d c/o spontaneous VB this afternoon after waking from a nap. She denies any LOF, d/c, and has postive FM. Pt denies pain, no h/a, dizziness, RUQ pain, or VC. Pt only c/o BRB with dime sized clots. Denies any dysuria, pyuria, hematuria, no n/v/d.

Gyn Hx:
Pap-no hx of abnl pap
STI: neg trich, GC, CT, HIV.
Sx: LTCS for FTP

OB:
G1: 2001 IOL for dates at 41, F 6#7
G2: 2003 SVD at 33 F 4#1
G3: 2005 LTCS a 38 for FTP F 6#9
G4: current, pt desires TOLAC.

Med Hx: none
Sx: LTCS
Rx: PNV and Fe
Allergies: NKDA
Fmhx:
BrCA: mother, maternal aunt, MGM,
CAD: PGF
DM: mother, MGF

A/P
Pt is 38 G4P3103 c/o VB.
1. U/S
2. FFN, CBC,
3. consider MFM consult.

For the medical purists out there, I know that this is an incomplete H &P and that the assessment and plan are incomplete, but I'm illustrating a point. Here is a prose version:

HC is a 38 year old female with a history of 4 pregnancies, 3 deliveries, 2 term and one premature. She has a complaint of vaginal bleeding. She denies any loss of fluid, vaginal discharge (i.e. purulent discharge), and has felt fetal movement. Patient does not complain of a headache, right upper quadrant abdominal tenderness or vision changes.

Gynecological history:
patient has never had an abnormal pap smear
-no sexually transmitted infections like gonorrhea, chlamydia, trichomonas, or human immunodeficiency virus.
-Her only procedure was a low transverse cesarean section
Obstetrical history:
-G= pregnancy
SVD= spontaneous vaginal delivery
IOL = induction of labor
x#y= lbs and oz
TOLAC= trial of labor after c-section

Family history:
MGM= maternal grandmother
CAD: coronary artery disease
DM: diabetes mellitus.
BrCa: breast cancer

NKDA: no known drug allergies
FFN: fetal fibronectin a test than can help predict the probablility of labor or rupture of fetal membranes.
MFM: maternal fetal medicine: high risk OB doctors.
U/S: ultrasound.

A lot of these abbreviations are very standard, but the OB specific ones can be challenging, especially since they can be interpreted multiple ways i.e. VB could mean vaginal birth, or vaginal bleeding. Mostly there has been a movement towards the standardization of abbreviations in medicine as well as a decrease in their use overall, but OB is a lone holdout.

My Portable Fomite

2010-06-17T19:28:00.000-07:00

I wear a short white coat that I loathe. I have had it since my first day of medical school and have worn it nearly 6 days a week for the last calendar year. Sometimes I'm better at washing it than others. It has some ring around the collar, numerous ink stains in the breast pocket, and two pockets that are in the process of being torn off, and stained cuffs. It weighs between 6 and 7 pounds.
Contents:
Breast pocket: 1 cracked cheap-o school logo pen.
1 stolen Bic pen.
pocket lint.
Maxwell's pocket guide.
2007 Tarascon's Pharmacopia
1 pen light.
2 ID badges in a semi-opaque holder.
1 monofilament in badge holder.

Left inner pocket:
2009 Sanford Guide to Antimicrobial therapy
Pocket Medicine 3rd edition.
2 old H&P pages with notes.

Left outer pocket:
1 Littman Cardio 3 stethoscope with freebie Army light attached in the likely event that the penlight craps out.

Right inner pocket:
1 FACTS card (little card that I have to get signed periodically during a rotation)
1 gestational age wheel
1 old tongue depressor still in wrapper
2 procedure cards (similar to FACTS card)
2 scholarly papers
4 old H&P's
1 bandaid in wrapper.

Right outer pocket:
study book du jour, in this case Case Files for OB-GYN
2 current H&P's
1 more scholarly paper
1 page of notes from lecture
Sometimes a reflex hammer and tuning forks, depending on how likely I think it is that I'll do a neuro exam (usually these stay safely in my bag or even more safely in my locker 7 miles from the hospital).

Sleeves: miscellaneous dirt, MRSA, VRE, cruddies.

This little gem is my friend for another year, after which I can swap it for a longer version. After I graduate I am going to dowse this one in kerosene and set it on fire, both for sanitataion and catharsis.
-Spiff.

Gunneropolis

2010-06-17T18:38:00.000-07:00

Gunner loves cars, and he has recently taken to driving them around on little "tracks". He uses anything that makes for a good road, including the circle on a See 'n Say, the straps on Spiff's school bag, and the tiny little loop on the base of a stacking toy. He's actually pretty creative. It has made me want to buy a new toy for him, a race track or road, something that would probably cost $20-70 that we shouldn't spend on a toy.

Today, my awesome friend, Maggie, helped me make this:
If you can't tell, it's a cuddly little felt town with roads for driving little cars around on, complete with red fire station, blue police station, gray library, pond w/ park benches, and a gazebo in some lucky person's backyard (lower left). I'll call it Gunneropolis. He loves it. I love it. It was fun to make, and it cost about $3.

Thanks, Maggie! Drive on, Gunner!

Lightbulb

2010-06-17T18:20:00.000-07:00

Okay, two things before I tell my story:
1. I recently got out some toys for Gunner that I had kept hidden for a while. It is a set of pretend food and dishes. I got them for him for Christmas, and I hid them for a while because I was tired of picking them up off the floor.

2. Gunner loves helping me when I cook and bake. His job is to dump cupfuls and spoonfuls of ingredients into a bowl. He is always right there by my side when I make cookies, dumping in the salt and baking powder. Sometimes he doesn't get the dumping action quite right and gets a facefull of flour, to his great dismay, and my great entertainment! Of course, he enjoys the perk at the end of mixing of licking the beaters.

Alright, on to my story. I made dinner rolls the other day, and as usual, he was right by my side on a kitchen chair, helping me out. As I was rolling out and shaping the dough, with my rolling pin and pizza cutter, he gasped, climbed off the chair, and ran out of the kitchen. I thought he was just tired of baking or just excited to play with his long-lost toys. Then he returned with this:
I gave him his own little piece of dough to cut. Man, I stinkin' love watching him figure things out!

Potty Talk

2010-06-12T22:01:00.000-07:00

Let me begin this little discussion by stating that I have no intention of potty training my son for a long while, so I'm not really looking for actual potty training advice at this time. That being said...

Gunner has been very interested in the potty lately. He plays "Pretend Potty" by having us help him sit on the potty and go through the motions with him. He runs to the potty after doing some business in his diaper to show us that he knows relatively what it's all about. He also runs up to me after I have done my business on the potty to help me pull up my pants. (Is this too much information? I don't know since I have forgotten what it's like to have any privacy.)

The other day, Gunner and I had a 10-minute conversation about the potty. He initiated this discussion by pointing at the potty, turning around, scooting his little tushy up to it, and the swinging a leg up, like he was saying, "I'm going to sit on this thing, now." So I helped him on, he sat there for a few seconds, and then hopped off. Then he sat on the floor with me and told me lots of baby-babbled stuff about the potty. Then he stood up, backed up to the toilet, swung his leg up, and sat back down on it. He continued this routine for several rounds. The whole thing was very endearing.

He is very obviously interested in the potty. I would like to fuel his interest and keep him excited about the potty, without actually potty training him yet. We have talked about getting him his own little potty, but a friend suggested getting a toddler-sized seat that connects right to the actual toilet seat instead.

So I am wondering what people's opinions and experiences are with their little ones. How did you fuel any existing interest? What devices/products did you use? And where do I find these gems?

Countdown

2010-06-03T05:59:00.001-07:00

Wowzah, it's been hard to think of something to blog about lately. It's the end of 3rd year, and I'm really feeling it. My patience is low, my creativity is almost nonexistent, and I can hardly wait the two weeks for Spiff to be done with his OB/GYN rotation which marks the end of 3rd year and the beginning of a two-week vacation!!! I feel like a kid who just can't quite wait for Christmas. Maybe I should make a paper chain.

Before this turns into a total whine session, I'll write about some of the things we've been up to.

Spiff participated in his first triathlon a few weeks ago. It was a mini-tri, with a 200 yard swim, 9 mile bike ride, and 2 mile run. He said that the pool was very warm and the bike/run route was very hilly, and it was hot and sunny. But he had a good time and finished in 52 minutes, which put him at 5th in his 20-29 age group. Not bad for a first try!

I am amazed at how grown-up Gunner is these days. He is becoming so independent, and he knows what a big kid he is. He knows his body parts, he loves reading with us, and he loves, loves, loves being outside. He is also coming up with a whole bunch of new words. My favorite new ones:

Larli (Charlotte...his very best friend in the whole world)

Gah gahn (all gone)

Lellow (yellow)

Gaing (again)

Mmbomeh or Bubby (bummy/bum/tushy)

Our primary class is going well. Thank you for all of your fabulous suggestions! We have some great kids in our class, and I've actually been enjoying it. The 4-5 year olds are a whole lot different than the 2-3 year old nursery kids. The main differences are their capacity to color for a long period of time, and the fact that they want to tell us all kinds of stories. They ask over and over again if they can tell us something, and if we tell them to wait (for the sake of some kind of continuity in the lesson), they completely tune us out while they hold onto their thought. They wait for a pause in the lesson and then say, "NOW can I tell you something?"

Their stories are cute but hard to listen to. They ramble, and there is hardly ever a point. One time last week, we tried to wrap up a little girl's story by saying, "Alright, thank you." And she yelled at us, "I'm Not Finished Yet!!!"

Okay! Sorry to offend. Go right on and finish. We're all ears.

My favorite quote of the class so far:

Spiff asked, "Why should we obey our parents?"

One kid responded, "So we can get stickers."

Anyway, we're one day closer to the end of 3rd year. I can't believe Spiff is almost a 4th year! I'm going to go make my paper chain now.

Primarily Primary

2010-05-16T16:22:00.000-07:00

Spiff and I are the ward's newest primary workers (CTR4). When I was released from the nursery, I found myself surprisingly broken-hearted by the loss of my coworkers, my wonderful class and the familiarity of something I felt like I finally had gotten the hang of. As I prepared the lesson for today, I became less and less excited to try my hand at something so new. Spiff on the other hand is looking forward to a change of pace. This is the first time he hasn't been in the Elder's Quorum presidency since he returned from his mission six years ago.

Our first day went quite well, considering that we both felt like fish out of water. I also think we both enjoyed it. I had to hide my face several times to hide the fact that I was cracking up at the silly things the kids were doing. And as an added bonus, the kids listened really well! They participated, and we ended in about the right amount of time, so we didn't have to scramble for boredom busters at the end of church.

The highlight of the day was singing time. The chorister is a genius and brought a game for the kids that she made at home by cutting eight holes out of a large cardboard box and covering them with pieces of tissue paper. She calls it "Singing Time Punch Out". Like a game on the Price is Right, kids are called up and they punch out a hole, which has the name of the next song behind it. Not only do the kids get to take turns participating, but they get to legally punch the crap out of something! Pure genius!

Anyway, we're in new territory, and we need your help. My question to our faithful readers and anyone who has experience teaching primary classes:

What are your genius ideas? What do you do to make your lessons interesting? Do you have any awesome tricks or games that engage the kids?

Swing

2010-05-07T18:30:00.000-07:00

"Life is difficult. This is a great truth, one of the greatest truths. It is a great truth becasue one we truly see this truth, we transcend it. Once we truly know that life is difficult-once we truly understand and accept it-then life is no longer difficult. Because once it is accepted, the fact that life is difficult no longer matters." Thus wrote Scott Peck in his work The Road Less Travelled. I would not say that my life is particularly difficult, far from it really. Like you, I have friends and aquaintances who have survived or are currently living through hellacious trials. In particular, I have two friends whose children are sick with diseases which may them within the next 6 months or 16th birthday. I cannot conceive of the grief and pain that such a burden must be for them. Obviously, life can be punctuated with periods of great pain and anguish, which are tempered by periods of joy and elation.

As we raise little Gunner, I see just how much inner dampening of our emotions happens as we age. He has no filters or coping mechanisms to suppress rage, fear, grief, sadness, joy, and exuberance. As a consequence, he throws tantrums, and two minutes later gives us a hug while belly laughing. He feels the full spectrum of unfiltered emotion. I think he is acutely aware of how vulnerable he is in the world, because to be 18 months old is to be utterly powerless. I recall as a child my mother would tell me that adolescents think they are immortal. As a teen myself, I recalled those words, but never felt myself immortal, but perhaps invulnerable and supremely confident in my own strength and intelligence. As a parent myself I realize now that nobody is spared heartache and pain and that my invulnerability of adolescence was an illusion founded in ignorance. Now that I have friends who have survived tragedy the fact that Bad Things can happen is more real than it used to be 10 years ago.

Though there is pain and hardship in life, there are occaisionally moments of perfection as well. In popular psychology this is known as "flow", but as a rower, my coaches identified this concept as "swing". In rowing this would be those all too rare moments when the boat was perfectly balanced, when everyone was concentrated on their technique, the boat was surging smoothly through the water and bubbles from the bow-wave were audible under the hull. Time slows down, physical pain may be present but is irrelevant, and for a few brief minutes, there is perfection. Inevitably the spell is broken and we return to the real world where things break and don't go according to plan. As Scott Peck elucidates in The Road Less Travelled, these moments are the exception, rather than the rule, although we frequently lead our lives as though the reverse were true, and that any deviation from perfection is the aberration.

Where do I find swing? There are times when biking when my feet turn effortlessly despite intense exertion and the pedal stroke is smooth and perfectly round, the bike is rolling as though pushed by a tailwind. Downhill skiing is the perfect mixture of danger and concentration that allows me to swing. Recently I have found it in brief moments while inline skating. And professionally, I have experienced during my anesthesia rotations. I am not a very emotive person, but there have been times during these last two rotations where things felt as "right" as they did when my lightweight men's four man shell was perfectly balanced and slicing through the water. Since I have never yet felt this way during any of my other rotations, I can say that anesthesia is definitely for me, without reservation.

Editor's note:

2010-05-07T18:09:00.001-07:00

It has come to the attention of the editorial staff that there was an erratum in the previous post. Windy did not in fact have an accident after her prolonged journey.

PB4UGO

2010-05-07T17:47:00.001-07:00

Spiff often tells me that when he is an anesthesiologist, he wants a personalized license plate that says N2B8R. He also wants one that says PB4UGO. I thought of that today when I was stuck in bumper to bumper construction traffic on the highway and I regretted my decision to just hold it until I got home.

I went to a mall with a good friend today so she could retrieve the purse she left at Cabela's last night. It was supposed to be a short trip, there and back, with a stop at the play structure so the kids could run around. Out and back, before lunch and naps.

But it wasn't.

We missed our exit on the way there and had to call a friend to give us directions. My friend's camera was dropped and broken on the way into Cabela's, one week before her son's 1st birthday. We stopped to play at the structure only to discover that all three kids were ravenously hungry and weren't up to playing. We went in search of food and missed the entrance to the food court. By the time we got them all fed, they were tired, and we were in a hurry to get them back in the car and home before a meltdown occurred. I thought about visiting the ladies' facility, but in my need to avoid critical mass, I decided to hold it for the relatively short drive home.

And then we missed our exit on the way home (purely because we weren't paying attention) and ended up across the river and into the neighboring state.

Since we had gone so far from our missed exit, we decided to keep on going and go home on a different highway, which turned out to be 12 extra miles. After finding that highway, we turned homeward and got stuck in construction traffic, 15 more miles from home. At which point both younger kids woke up from their way-too-short naps. Sigh.

It was a terribly funny day, and we got a good laugh. And when I got home, I was oh so happy to see my bathroom, though naturally it was too late.

So it begins...

2010-04-30T10:37:00.000-07:00

There is a story in Spiff's family that is told again and again. When Spiff was a young child, he found the slots on the dishwasher (the vent) to be the perfect size for coins. He proceded to fill the front of the dishwasher with various pennies, nickels and quarters which then lived inside the dishwasher door for the rest of its existence. They never retrieved the cash.

This morning, while I was doing laundry, and going up and down the stairs to our treacherous unfinished basement, I noticed Gunner playing with the doorknob to the basement door. Months ago, before he knew how to descend stairs safely, I turned around from doing laundry downstairs, and I found him sitting as quiet as a mouse at the top of the stairs. We immediately put a doorknob cover on the door.

As he was playing with the doorknob this morning, I thought for sure that he was figuring how to open it with the cover on it. I imagined him tumbling down the stairs onto the concrete basement floor, and dread filled my heart until I took a closer look and found this:

It must be a boy thing. And cute or not, I fear for my dishwasher.

New Hobbies

2010-04-17T17:11:00.000-07:00

I've decided to take up speedskating. Why? Because there's spandex involved. Well, not really, but it does seem like all my other sports do involve an inordinate amount of lycra. Swimming-speedo, Cycling-shorts and jersey, rowing-unisuit (think modest wrestling suit), and now speedskating which involves essentially more cycling gear. Why speedskating you ask? Hmm, again, true to form it's a relatively obscure endurance sport rewarding technique and stamina and filled with lactic acide and pain. It's fast and graceful. My real wish is to do long-track speedskating like the olympics, but there are only a handful of 400m ovals in north america, and none of them are here in town. Short track can take place on any regulation hockey rink, so that is a possibility. There is a speedskating club here in town, but I'm not sure I can justify the club dues and the equipment on our student budget. So, that leaves us with off-ice speedskating, which is inline skating.

In the good ol' days of 8th and 9th grade, I used to skate frequently on my trusty Bravoblades by Rollerblade. Since I no longer sport a men's size 7 shoe, those skates are long gone. I have instead decided to work my way into speedskating from the ground up, using cheap-o recreational skates until my legs are ready for more advanced skates. Craigslist was good to me on thursday, and I got a pair of skates, pads, and a bag all for $60.

I tried them out in the park that evening and fell back in love with skating. It's like running only faster. I went to the larger park here in town and managed to skate the 5 mile circumference in about half an hour. At least now I have a baseline to compare myself with.

Since there don't seem to be any local inline clubs, I have been using Youtube for technique and tips, although I might have to spring for a book and maybe try to find some real people to work with as well. My current goal, pending a match at my #1 in Minnesota, is to to do the North Shore Inline Marathon near Duluth. We'll see...

Gunner

2010-04-07T04:43:00.000-07:00

Gunner has been doing some very cute new things that I don't want to forget about. Here's a small update of our almost-18-month-old.

He jumps. He can get both feet off the ground! He stops just about anywhere at any time of the day and jump, jump, jumps. He knows he's cool. And I'm pretty proud of my little athlete.

He started singing! I will say to him, "Can you sing, La La La?", and he will respond, with a curled up tongue, "daa, daa, daa", or stick his tongue way out and say "laaaa, laaa, laaaaaaaaa." And of course, he has to applaud for himself.

He nods his head when he wants something. For example, if he sees you with a cookie, he will come up to you with his head nodding, like he's saying, "Yes, you will give me some of that, please, now, thank you."

He likes to knock on doors. He likes it so much that he will start "knocking" as soon as we pull up to someone's house, while he's still in his car seat. And of course, he keeps on knocking all the way to the door.

He plays the piano with us. He sits next to us on the piano bench and adds his contemporary flavor to any piece we play. When he gets tired of me playing, he grabs my arm and hooks his around it...and holds me captive. It's so cute, but it sure makes it hard for me to get any real practicing done while he's around.

He loves balloons. We brought two helium balloons home from a party a couple weeks ago, and he loved them so much that he would not let go of the string they were attached to. We had to pry his hands open to get him dressed, which sent him into hysterics until his arm was through the sleeve and we could give the balloon right back. He even went to bed with them one night (don't worry, we took them away just after he went to sleep).

He also loves little cars. He clutches them almost as tightly as he clutched the balloons, and won't let go until he's asleep. He is also starting to play imaginatively with them. So fun!

He grabs my hand and takes me places. If he wants to go somewhere, he'll grab my hand and pull me along. He even does it when I'm holding him, although it doesn't work very well.

Some of his words:

Dad "Da"

Mom "mommy"

I Want That "mommymommymommymommy"

Car "car" (he said "car" about five times one day, but hasn't said it since.)

Usually car, truck, train, plain, helicopter, or any vehicle is "brmmm brrmmm"

Airplane and helicopter are "brmm brmm" with a flying hand motion.

Duck "duck duck duck duck" (always with a head bob)

Bird "bir"

Dog "doggie" or "dah"

Cat, a high pitched squeal

Fish "whish"

Ball "ba"

What is that? "Thisisthat"

No "nah no" (or when he's tired, it's a whiny, "Noooooooooooooo!" to everything.)

More, not a word, but a hand motion (think "milk" in baby sign)

I'm loving being his mommy. He's so cute and fun, and I love his happy personality and enthusiasm for live. He makes me happy every day.

Deepest Desires of My Heart

2010-04-03T13:43:00.001-07:00

I am not a garage sale-er. I have been to a few yard sales, but I generally don't go out looking for them. I have friends who find amazing things at amazing deals at garage sales, and I sort of wish that I would do it. Apparently, my subconscious thinks so, too.

I have had my eyes on a few items for Gunner. I have looked in stores and online a bit, but haven't purchased anything since they seem like such a luxury. And what are these items? A tricycle and outdoor play equipment (namely a water table) for Gunner. I didn't realize how much I desire, want and covet these things until I had multiple dreams where I find happen upon a garage sale and find perfect deals on these toys. And then I wake up and realize that it wasn't real.

And Gunner is still without a bike. A bike which I thought I bought for him, but that he can't yet figure out how to ride.

I can't tell you how disappointed I have been when I wake up from these dreams. Or how strange I have felt to have dreamt them at all.

I guess I want these things so badly because my boy would love them so much. He loves loves loves other children's bicycles. He's not big enough to actually ride them, but he sure does love to climb on them, sit on them, scoot around on them, and it's an extra special treat if someone will actually push him around on them.

The water table is just an extra. We don't own our back yard, so I don't feel like I can put a kiddie pool out there. A water table sounds like a super fun and easily-storable Summer Fun option for us. I know he would love it.

It's funny that my apparently-very-deepest desires revolve around the potential commercial happiness of my son. I wonder why I'm not dreaming about a month-long vacation with Spiff, say...in Hawaii...without Gunner. Imagine the sleep we'd get! That sounds like a better dream to be having. But I sure wouldn't see Gunner's amazing little smile and hear his contagious laugh if I left him with Grandma and went off to Hawaii without him.

I guess that's why I dream about garage sales.

Easter

2010-03-29T19:16:00.001-07:00

I taught my nursery class our Easter lesson on Sunday. All seven 2-3 year olds were so excited to learn about Easter, and they asked me to tell the story over and over. I told it at least 4 times. We talked about how Jesus died, was put in a tomb (Me: say Tomb. Them: "Tooooom!"), then was resurrected three days later. They especially loved the part about how the stone was rolled in front of and then away from the tomb. They are cute kids, and it was a fun lesson to teach.

Then during coloring time, I remembered that one of the kids had just had a birthday. So in order to highlight the birthday girl, I asked her, "What did you do on your birthday?"

She replied, "Well, I was resurrected on my birthday."

I obviously got the meaning across very well. Happy Easter!

Close Call

2010-03-17T05:34:00.000-07:00

This is my dad's plane...

And he loves flying it. Flying makes him so happy that his wife and four children don't really mind his risky hobby. In fact, my mother has worked through her fears and has embraced his hobby. Because Dad is a good, safe pilot, Mom often goes flying with them, and they take small trips together in their little plane.

It was on one of these small trips, just last night, that my dad was forced to make an emergency landing. They lost power, landed on a snow machine road (thankfully not too far from home), and Search & Rescue went to pick them up. The landing was perfect, so my parents and the plane were uninjured. Search & Rescue responded quickly, and their big concern was that Mom & Dad were without heat on a cold evening on a snow-machine-accessible road. They think the plane lost power because the carburetor iced up. This has happened before, and they have taken preventative measures to keep it from happening again.

I spoke with my mother late last night, and she seemed chipper, energetic, and unconcerned. This reassured me enough to be able to fall asleep.

I was at a party when I found out. It was late, and I checked my phone only to find that I had missed two calls from my siblings, who never call that late. I knew something was wrong. The first message I received from my sister informed me that my parents' plane had "gone down", but that they were fine. The second message was from my brother who said, "Why aren't you answering your phone? Pick up your phone! We have news."

These messages left images in my head of balls of flaming metal careening to the ground from the sky, and images of my parents barely escaping the burning wreckage. Of course I was grateful to my siblings for letting me know what happened, and I am so very grateful that Mom & Dad are okay. It doesn't do much to slow my imagination, though.

Ever since our family has embraced my father's passion, we joke that my parents will die together in a plane crash. And quite honestly, for them, I don't think it would be a bad way to go. My dad would probably be smiling all the way to the ground, and my mom would be happy to be holding his hand. And neither of them would be left behind to live life alone.

On the other side of things, anyone who is familiar with Stephanie Nielson's story knows that dying in a plane crash maybe isn't the worst thing that can happen. I have bigger fears than that now.

And last night, when I received those messages, my thought was, "I'm not ready." I quickly found out that everything was fine, but I was still shaken. I'm not ready to live without my parents. I'm not ready for them not to be in Gunner's life. I'm not ready for them to not be a phone call away. It sounds petty, but I'm not ready to go without my mom's cooking advice and Dad's computer, car and building knowledge. I'm not ready to deal with the loss of my parents in any way, and I feel for those people who are dealing with that.

Today I'm grateful for the safety of my parents and that my dad is a good pilot.

Next project: Figuring out how to get their plane off of that snowy road and back to the airport.

Interference

2010-03-14T05:54:00.000-07:00

Gunner is a Long Hugger. He is one of those people who goes in for a hug and just doesn't know when to quit. I have had him in nursery a few times and watched him chase down some of the younger kids (older than him), tackle them to the ground with a hug, and continue to hug them while they are begging anyone to help get this kid off them! He hugs babies, and he's mostly soft with them. He hugs older kids, and mostly they just want him to leave them alone. I can tell that he has good intentions, but he just doesn't know when to quit.

Besides that, he is very enthusiastic when he is around other kids. He wants to be involved with them, but they generally don't want to have anything to do with him. This means that when we are together with other kids, I spend my time running interference. I try my best to teach him how to behave around other kids, and to keep him from hurting them (feelings or otherwise). This means that I spend this time keeping him from pushing, taking toys, pulling hair, knocking down towers, and especially tackling with love.

It is exhausting.

I babysat a good friend's 2 1/2 year old for most of the day a month or two ago, and she and Gunner spent the entire day fighting.

I get together for play dates with friends, and I spend the entire time chasing him around, trying to keep him from doing any of the above things. By the end of the play date, I am so tired, frustrated, and stressed that I have wondered if it is worth it for us to get together with other people at all.

But not yesterday. Yesterday I babysat two children. The older one is 3 1/2. I'm not sure whether it's an age thing, or a combination of age and the fact that she is a big sister, but she was amazing! He did his regular tricks, including tackling her with long hugs.

And she just laughed. She hugged and wrestled him back. She played soccer with him. She encouraged him to play with her. She and Gunner actually played together all day long. It was actually easier for me to be at home yesterday while babysitting all day than it normally is because Gunner was being entertained, and I didn't have to constantly referee.

Really what it comes down to is the fact that Gunner should have been a second child. He needs an older sibling. I don't know how we're going to accomplish that, but in the mean time, I'm going to insist that he play with this little girl. A lot. Which is extra good for me since I love spending time with her mother.

"Illness"

2010-03-08T20:45:00.000-08:00

I had an intersesting patient this week. JM (we'll call him) is a 43 yo male truck driver with history of asthma, depression, and alcohol abuse who was admitted from clinic after a pulse oximeter (hand held device that measures O2 in the blood) read his oxygen saturation as 78% (normal is 98-100%). At home he has been prescribed multiple inhaled bronchodilators, inhaled steroids, theophylline, and 5 L of 02 via nasal cannula. He was taken from an oustide clinic to the ED, treated with albuterol inhalers, his pulse ox checked again, and it was decided that he should be admitted. His past medical history is significant for numerous admissions for asthma exacerbations, but under names with different demographic information (eg birthday).

The story gets interesting when the pt is admitted to the unit, a blood gas is done which showed a respiratory alkalosis. This means his blood was basic (high pH) with respect to the physiologic norm. Asthmatic patients in crisis are generally unable to sufficiently expel all of the accumulating CO2 due to their constricted airways, and treatment is aimed at opening those airways so that efficient ventilation and thus gas exchange can take place. In the absence of good ventilation, CO2 builds up in the lungs and makes the blood acidic. This patient had the opposite problem, however, which called into question the diagnosis of acute exacerbation of the asthma, which would typically present with an acidosis, rather than an alkalosis.

A respiratory alkalosis can be seen in the case of hyperventilation. When the respiratory rate increases, more CO2 is blown off, decreasing the amount of CO2 in the blood, thus increasing the pH (rendering the blood alkalotic or basic). Why would the respiratory rate increase? In the case of an acute, pure respiratory alkalosis, panic attack is high on the list of possible causes.

The patient was dishcarged to be cared for by us on the floor team after a brief stay in the unit. We checked his blood levels for some of his home medications which showed that he had not been taking them at all. While staying on the floor, the patient rested comfortably, but when visited would complain of chest tightness and would have very poor respiratory effort, shallow breaths, and appear to be in moderate distress. At night and during the day, the patient could be seen to be napping or sleeping comfortably without any evidence of shortness of breath, difficulty breathing, or increased respiratory effort.

The clinical picture I have painted you led us to suspect that his current condition was not an acute exacerbation of asthma. The tricky thing about taking care of patients such as this is parsing out how much of their illness is organic (i.e. deriving from diseased lungs), and how much is psychogenic, i.e. what components of his symptoms were derived from his mind. Despite being psychogenic, the symptoms the patient complained of and the signs he demonstrated on exam are nevertheless real, just not fully explainable by an organic process localized solely to the respiratory tract and consistent with a diagnosis of asthma.

The real challenge is also trying to differentiate whether the pt is conciously faking, i.e. malingering, in order to get some secondary gain i.e. time off work, disability, drugs, or something else, or whether the psychic gain is unconcious. In patients with conversion disorders, a psychic stressor manifests itself through physical symptoms. It is possible, then, that our patient has some stressor in his life that is so profound that his body manifests physically what the mind is feeling psychically. Alternatively, our patient is faking his symptoms or exaggerating them in order to recieve care and to be placed in the dependant role of "patient". What makes this kind of patient especially trying is that it is very tempting to disregard all of their complaints as being psychogenic, when of course they may actually be genuinely sick. It's the old problem of crying wolf. In Aesop's fable, the villager's eventually turned their back on the boy who was eaten by the wolf in the end. The same thing can happen to patients with factitious disorders who every now and again will be genuinely sick, but have cried wolf so frequently that they are disregarded. Trying to sincerely engage a patient in whom you are questioning the legitimacy of their symptoms is very challenging. Those who have cared for a factitious patient will know what I mean, those who haven't may think I am callous for even entertaining the possibility of considering that a patient may be feigning illness. What do you do when this patient comes back to the ER short of breath?

*Editor's note: the patient presented is a composite and the information presented does not reflect the clinical course of any one person for whom I have cared. JM is a pseudonym.

It's all in the details

2010-03-07T18:48:00.000-08:00

I played for the high school solo/ensemble festival yesterday. I am very happy that it's over, and the kids did very well. I even managed to talk people into switching their schedules around so that I was done before noon. It was a pain for a lot of people to switch around the solos, and I feel bad for being demanding, but I couldn't justify being gone from Gunner all day long. It worked out in the end, and even the parents ended up being happy about things.

I have grumbled a lot throughout this experience about learning the music and about scheduling issues. And they really are issues for me. But after rehearsing with the kids and their awesome teacher, I remembered how much I enjoy it. Not all of the music is horrible, and even the horrible stuff is sort of exciting when it's played well. These particular students are fantastic. They're smart, they work hard, and they're talented, and I love being their coach/accompanist. I thought at one time of pursuing a career in coach/accompanying. I don't think I could ever do it for professional musicians, but I do love doing it in the student to teacher/coach situation.

One of the things I love about it is the attention to detail. I remember a piano lesson in college when my professor pointed out to me that I wasn't holding a note long enough. I was completely shocked that I hadn't noticed the full note value. Or that it even mattered that I notice that particular note value. And then I went to grad school and realized that everything about music is about the nuances. Every little note has to be held for a precise length of time, every rest released at an exact moment. There must be attention paid to every accent, staccato or slur. Not to mention the numerous musical directions slathered around the pages.

These are things I didn't pay attention to as a high school student, and like I said, I was shocked to find out that they were important. I enjoy teaching students about these things and watching them figure it out. I enjoy coaching them on ensemble issues, including cues, transitions, tempos, rhythms, especially since most of the kids haven't played with an accompanist much, or at all.

Anyway, this is a long way of me saying that I'll probably do it again next year. I will most likely go to the state festival later this Spring to play for the five kids who scored high enough. And I have told their teacher that I will accompany for his middle school students in their solo festival coming up in April.