On Being Alone

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

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

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

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

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

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

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

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

Only 25 weeks to go!

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

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

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

-SS

Attack of the Tooth Fairy

One Tooth, Two Tooth, Three Tooth, Four;

Today we found a third tooth, and then One More!

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

Three Teeth

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

Parking Troubles

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

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

My New Job

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

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

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

Let's Go For a Walk

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

And then we start it all over again.

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

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

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

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

The autopilot

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

-SS.

The Strange

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

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

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

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

-SS.

Onwards to strokes

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

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

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

Discrepancy

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

Height--29 inches

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

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

Gunner's 10 1/2 month stats

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

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

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

Neuro/psych

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

Caravan of Wet Women and Babies

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

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

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

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

Little Life Lesson

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

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

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

Chores

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

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

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

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

Call

My pediatrics rotation requires that we spend every 5th night on call, and at least two of them be overnight. Being a glutton for punishment, I decided to take my two overnight calls this week to get them out of the way. Monday went as follows:

630-730: pre-round on my patients

730: huddle with senior resident and discuss any issues on the patients

800-830: Morning Report which is a 30 minute didactic conference for medical students and interns

0830-1130: rounding with the cardiology, pulmonology, and clinical medicine (general peds) teams.

1130-12: quickly do anything that needs to happen before 12, i.e. check on labs, order studies, etc..

12-1: noon conference which is a 1 hour didactic session for MSIII's

1:15-2:15 another didactic session

215-6: follow up on my patients and wait around for admissions

6-630 dinner in the cafeteria, which was some not so pleasant pizza

630-9: study and wait for admissions

9-11: admit 1 patient for potential bacterial/viral meningitis, rule out Bell's palsy

11-230: sleep fitfully in the resident lounge, missing a page at 130. Called intern to see if she was still admitting the patient, but she was done.

230: moved to a place in the hospital where I would get better cell phone reception.

230-5: sleep in 20-30 minute increments on a chair in the lobby, checking my phone for pages.

5: Get fed up with not sleeping and start rounding on my patients

5-12: repeat from monday morning.

12 (tuesday): Go home, 2 hour nap, groggy afternoon with studying

9pm: bedtime

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

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

I Run Because I Must

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

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

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

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

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

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

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

The Dumbening

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

-SS

Peds Inpatient

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

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

Tooth Fairy

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

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

Mobile

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

Minutiae

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

Cutis aplasia

Hypomelanosis of Ito (I diagnosed this one!)

Congenital adrenal hypoplasia (not hyper)

Diabetes insipidus (nephrogenic)

Gordon's syndrome

Congenital Central Hypoventilation Syndrome (Ondine's Curse)

Hypoplastic Left Heart Syndrome (in my NICU time)

4 umbilical hernias in 1 day (apparently they are more common here than elsewhere in the country.)

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

-SS

Enjoying the moment

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

Outpatient = Impatient

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

Self-Indulgence

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

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

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

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

The new stuff

I'm nearly done with two weeks of third year, but have yet to post on this here blog.  

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

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

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

Week 2: 

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

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

Cleaning house, Petunia Dursley Style

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

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

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

Gross.

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

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

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

Vacation

We had a great three-week marathon vacation.  Here's a quick summary:

• Oregon for a week, where we fit in all the family and friends we could handle (dinners with friends, wedding preparations, bridal shower & bachelorette party, the wedding, and a day on the coast, and even a could bike rides for the boys).  
  
• Utah for a few days of the other side of the family, some family pictures, and a whole lot of Wii Mariocart.
  
• Home for two days, just enough time to see Spiff's mom (who happened to be in town), and to pack for another vacation.
  
• Michigan for a week of fun at the cabin on the lake.  The weather turned out to be unseasonably cold, so there was no swimming, no boating, and mostly just huddling together and trying to keep warm.

We are back from vacation, and I am glad to be home.  Gunner is also glad to be home.  We completely wore him out, and he has spent the past few days sleeping and sleeping.  Spiff is working again.  Our three weeks of freedom were great, and I'm not sure it has hit me that he has started his 3rd year.  It still sort of feels like he's still just studying like mad for the boards.  I'm sure it will feel different tonight when he gets home from call after 10:00, and after being at the hospital since 6:30 this morning.  We have to get used to a new normal for the next few years.  

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

The happy couple.  She is beautiful!  

(And he looks great, too.  But come on, seriously, all eyes are on the bride on her wedding day!)

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

The Cake!

Seven amazing layers of deliciousness.

The Centerpiece.

Mouthwatering Indian food and fruit bar.

The dance floor before the lights were dimmed.

I took these pictures to capture how vibrant the saris were.

Turns out, the whole thing looked even more amazing when the lights were out.

Third Year

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

-SS

Vacation

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

What I am enjoying on this trip:

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

The wait

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

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

Verge

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

Inherent Flaw

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

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

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

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

Progress Report

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

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

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

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

Happy Place

I'm grumpy today.  I'm stressing about Gunner's sleep issues, Spiff's Grammy's living situation, and finding a modest and cute dress to wear to my sister-in-law's wedding.  And the baby has been crying at me.  So, I need to write about things that make me happy:

1. A competent auto repair shop located three blocks from my house.
2. The weather is beautiful today.  Sunny and warmish.  Not beastly hot and humid.
3. I went on a walk with my baby, and he kicked his little fat feet the whole time.
4. I'm making delicious turkey sandwiches for my picnic lunch with Spiff.
5. I just discovered that Gunner likes avocado.  My son after my own heart.
6. Gunner intentionally hugs and kisses us now (big sloppy drooly kisses).  As he comes in for a kiss, he pulls my hair, and it would be cute if it didn't hurt so much.
7. Spiff will be done with his big bad test in one week from today.
8. Then we get to go on vacation for three weeks, go to the wedding, and see our families.

Family Games

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

http://laclionaute.blogspot.com/2009/04/these-foolish-games.html

http://laclionaute.blogspot.com/2009/05/family-games-part-deux.html

Why Didn't I Think Of This Sooner?

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

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

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

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

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

New Preoccupation

Sick 7-month old.

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

Why?

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

An odd sort of notoriety

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

Eating My Words, and My Crutches, Too

Approximately one hour after I posted the previous post, Gunner woke up crying.  I fed him, we  rocked him, we rubbed his gums with Orejel, and he wouldn't calm down and go back to sleep.  So, in a desperate attempt to get us all back to bed, I reached for the binkie.  Spiff eventually got him back to sleep, and I assume that Gunner was still sucking on his binkie, since it was in his crib when we got up this morning.

This is what happens when daytime aspirations meet night time desperation.  Apparently, we should actually throw the binkies away if we really want this to work.  On the other hand, if he still needs them, and they still serve their purpose, I guess we might not be ready to give them up after all.  We'll see.  I'm still going to give it a shot, and we will see if we actually can give up this crutch.

Crutches

My dad had surgery on his knee a couple weeks ago.  He had a "Knee Resurfacing", in which the orthopod was able to replace the parts of the knee that were worn out.  He used a walker at home during recovery in order to steady himself, just for a few days.  As far as I know, he is able to walk around without aid now, and without too much of a fear of falling.

Spiff's grandmother recently fractured both of her ankles stumbling down the last step of a flight of stairs.  She is in a wheelchair and staying at a skilled nursing facility until she recovers.  She despises being in that chair, and wants desperately to be her mobile, independent little self again.  She has broken some of her rules about moving herself around her room, and has spent some time putting weight on her fragile and broken legs, much to our chagrin.

We are also experimenting with throwing out a crutch.  Gunner just turned 7 months old, and as I have been watching his behavior over the past couple weeks, I realized that he hasn't been very interested in his binkie.  If I give it to him while we're in the car, he will take it, but then almost immediately pull it out and play with it.  If I give it to him to help him go to sleep, he sucks on it for a while, and then promptly spits it out when he is in dreamland.  If we try to give it to him while he's crying and really upset, it only makes him more angry.  I usually find it clutched in one of his little hands, or hidden underneath his crib.

A friend of mine, and mother of a toddler, told me last year that there was a phase when her baby didn't really care for his binkie.  She wished that she would have taken it away then, so that she didn't have to try to take it from him when he was older and more attached to it.  She also mentioned that she kept it because she was attached to it at the time.  I have thought about this quite a bit, and since Gunner doesn't seem to care much for his binkie at this point in his little life, we're testing it out and seeing how we all do without his binkie.

I admit that I have loved his binkie!  I loved how it used to turn him off like a switch when he was tiny.  He has used the MAM brand, which I think look so cute plastered onto his tiny face.  I also love it when he falls asleep sucking on it, and I can hear him sort of snoring as he breathes around it.  We haven't used the binkie for a couple days now, and I can't say that I think he misses it at all.  I miss it, though.  Not so much for its soothing purposes anymore, but because taking it away only reminds me of how quickly my little baby is growing up.

His binkies are still around.  I haven't thrown them out.  If this is too hard on all of us, I'll just get them right back out of the drawer.  But if he never misses them, then I'll just figure this as one battle we won't have to fight later on.

Current Preoccupations

Spiff:
Spiff has finished his second year of medical school! It hardly seems possible that he is halfway through his medical school training! And now, he and his friends are in the thick of studying for Step 1 of the Board Exam. They are all putting in even more hours studying for this test than they did studying for any of the other classes they have taken over the last two years. When Spiff informed me of his plan to study from 7:30-6:00 six days a week for this five weeks, I had a minor emotional meltdown, and I'll admit to having a bit of a pity party as well. I have accepted it now, and we're safely in a new routine, which includes a picnic lunch with the family on the medical school's beautiful grounds, in order to break up the monotony of Spiff's 11-hour study days.

Mindy:
While Spiff is busy studying at school, Gunner and I are preoccupied with Sleep Training. I constantly worry and brainstorm about how to teach my baby to sleep. I know that I posted about "Crying It Out" a couple months ago, and we did try it at that time. But we weren't all that dedicated, and it really didn't take. Now, however, something has to be done with our sweet little baby because he refuses to sleep! He won't let us cuddle him and rock him to sleep anymore, and he cries and cries when we put him down to sleep in his bed. We are using the book Healthy Sleep Habits, Happy Child as a guideline, and it has given us some ideas about how to have a well-rested child. So far, some of the ideas have been very helpful, and some of the ideas have just frustrated me. The author gives many patients' testimonials on how his ideas have caused miracles, and those same ideas have come close to giving our little family all ulcers. I'm pretty frustrated with the whole thing. My friends keep telling me that it will get better if we just power through and do our best to teach him to comfort himself. It has actually helped to me to think of it as "sleep training", with a plan and an agenda, instead of just "crying-it-out". Like potty training, I know that sleep training will take a while and not happen over night. But I sure do feel like it's going to last forever.

Update (Sunday May 17):  We have been doing this for almost a week, and I'm happy to say that we have seen some glimmers of hope. Gunner has gone down to bed like a dream for three nights in a row! I know we're not done, and I don't expect this to happen every night, but it helps us get through the sleepless moments when we know he has his great moments, too.

Gunner's 6-month Stats

We went to the doctor yesterday, and G.A. was a champ. He was in such a great mood that the doctor couldn't help but tell me what a beautiful, perfect little baby I have. I like his doctor, not only because she always tells me how perfect my child is, but because she is very kind and supportive. Plus, she always asks me how my family is doing with a husband and father in medical school. She said yesterday that she feels for any medical student with a child because their hearts are so much in two different places.

Gunner's 6-Month Stats:
Weight: 18 lbs. 14 oz. (70th percentile)
Length: 27 1/2 inches (70th percentile)
Head Circumference: 46 1/2 cm.

If you're curious about his growth and development over the past six months, check here and here.

Scheduling update

So, I decided not to go for the anesthesia elective. There were too many people competing and the scheduling lady said it was pretty unlikely I would get it. I have 2 alternatives now, however, so all is not lost. I can take my schedule as it currently stands, and do an anesthesia elective right after third year. Alternatively, I can still postpone family medicine and do a "self-designed" elective, which is essentially the same thing as doing the original anesthesia elective. The advantage to not postponing family med is that I can complete my third year which frees up which electives I can do, since some of them require that the entire third year be completed.

Schedule

So, we've been scheduling our classes for third year, and yours truly got his schedule for next year. For the 48 weeks following July 6, here is what I will be doing:

8 weeks of Pediatrics
8 weeks of Neuro/Psych
8 weeks of Surgery
Christmas break
12 Weeks of internal medicine
6 Weeks of Anesthesia -assuming I get the elective, and forcing me to postpone Family Med
6 weeks of Ob/Gyn

2 weeks of freedom, then 4th year which will include Family Medicine which I postponed from third year. I was pretty fortunate in that I got my first choice in scheduling, though I still need to get my elective.
-SS

Monkeys

So I think monkeys are pretty funny. I bet even, that you don't find monkeys as funny as I do. In 2001 before I served my mission, I watched the "Grinch who stole Christmas" with Jim Carrey. There's a scene wherein a frustrated grinch is getting his head smashed by a mechanical monkey banging cymbals together. If there's a funnier motif than a mechanical monkey with cymbals, I defy you to find it. The theatrical denizens tittered politely for an apropriate amount of time. Yours truly, however, was laughing loud and long, well after the scene had changed. I would have thought that 8 years had tempered my love of the primate percussionist, but that is not the case. We were learning about adrenal disorders in class, and the teacher drew the comparison between an adrenal gland spontaneously secreting cortisol to an elephant running wild and trampling the bleachers (which ones? I don't know, he didn't say). That got me smiling. Then he compared a small cell lung cancer secreting ACTH which causes unregulated cortisol release to a runaway elephant with a monkey on it, whipping it. The class chuckled gently, and, remembering my experience in the theater 8 years ago, I fought hard to not laugh out loud. But I was grinning to myself with my head bowed so the teacher wouldn't see me as he changed topics. I'm still grinning as I write this. I guess this is why my sister has managed to find a different monkey card for my birthday for at least a decade.

The palpable border

For the last 4 weeks we have been going once a week to work with a preceptor. We are to work in two pairs in conjunction with the preceptor in order to improve our history taking and exam skills. The last weeks have seen me in a nursing home near school. The clinical encounters we have rehearsed at school with standardized patients and in the lecture hall were not sufficient preparation to seeing real people. Our standardized patients are all very stereotyped and presenting in a pseudo-outpatient setting with some well defined chief complaint. The nursing home however, provides quite a different experience. The patient only grudgingly will consent to talk with you, as there is a bingo game impending, and they don't have any 'chief complaint' as such. "I'm doing ok" is not really a chief complaint. I also realized in this setting that, in the absence of a stilted semi-scripted interview, I suck at taking a history. I also suck at performing a physical exam.

To learn PE we were first instructed by one of our professors who demonstrated on a standardized patient. In small groups on various days, we then all took turns learning the PE from the standardized patient. While admittedly this saves on manpower because you don't have to get 8 different MD's to come in to teach small groups, this strategy also leaves somthing to be desired. I would prefer to have been taught by someone who has actually done a physical, rather than by an actor who knows approximately what a particular exam should include. There were sometimes 4th years around to help, but they were usually not helpful, nor particularly trustworthy. Usually I felt like I was being instructed by someone only marginally more familiar with this than me.

Last week and this week, my group and I asked our preceptor to help us improve our techniques in the various exams. Last week we did heart, lungs, and abdomen on real patients and this week it was the neuro exam. It's nice to examine someone who has real findings as well, because you're not just going through the motions.

Today we were examining a patient with stage 4 colon cancer. They were cachexic, but their abdomen was protruding outward, despite the patient's emaciated appearance. After talking briefly about their abdominal surgical scars, I palpated, percussed, and auscultated the abdomen. It was definitely unlike any standardized patient. This individual's liver margin was palpable nearly at the level of the iliac crest. Normally the liver is found approximately at the lower edge of the ribcage. There were firm nodules scattered diffusely over it as well. Our patient had metastases that had infiltrated the liver and caused the massive hepatomegaly that we observed.

It was a long, but very informative afternoon. I realize that it must sound callous that this poor individual's plight was educational for me in a very dry, clinical way.

SS

Another unit down

Well, since I seem to post about once a month these days, I thought I'd update the world on my doings. I passed Skin, Bone, and Joint, our connective tissue module. As the name implies it is quite a wide assortment of subject material. This made finding a studying groove pretty much impossible since every week a totally new set of lecturers would speak to us. I have now safely ruled out dermatology as a specialty, (not that I think i'll have the board scores for it anyway), hematology/oncology, which is also something I think I would detest, rheumatology -hmm, chronic disease- my favorite!, and geriatrics. My school has the #3 geriatrics program in the country, but I don't find the material very engaging. I'm currently in the endocrine module which is refreshingly homogenous. My current quandary is how best to balance studying for USMLE step I and my coursework. If i study for classes, I have less time to review for the boards, but my courses are on the boards anyway, so it's still kind of a review. If, on the other hand, I devote some more time to reviewing material from last year like biochem and immunology, then I will sacrifice my performance in my current class. At least I will have 5 weeks to review in may/june which will be very helpful.
cheers
SS.

Poisson d'Avril

Spiff loves a good prank, so April Fool's Day is right up his alley. I, on the other hand, am not a prankster. Spiff usually doesn't act on his tricksy tendencies to me, it doesn't occur to me to be wary on a day like today.

This morning, I walked in on Spiff cutting out this little gem:
If you're anything like me, you would ask him, "What are you doing?" He would answer, "Just a project for school." And you'd sort of believe him, and promptly forget about it.

Then, when the mother of your only piano student pulls this off your back at 4:45 in the afternoon...
...you realize that your dear, sweet husband got you! He really got you! I didn't suspect a thing, and I had been wearing a fish on my back all day long! Also, my 14-yr-old piano student had to explain to me the French tradition of sticking a paper fish on someone's back on April Fool's Day, since she learned about it at school today, and I had no idea about the significance of the paper fish I had been donning.

So, congratulations to Spiff on a great little prank. Here is what he got for dinner (keep in mind that every time I ask him what he would like for dinner, he very helpfully answers, "Beans").:

Crying It Out

I have come to the conclusion that Crying It Out is another name for sheer emotional torture. Our sweet little baby has been having a rough time sleeping lately. He went from a tiny newborn who wouldn't sleep because he needed to eat every two hours to a heavenly 3-4 month old who slept through the night, mostly. However, he has recently decided that the only place he wants to sleep is in his mommy's arms. I do what I used to do for him. I feed him, cuddle him, and rock him until he is blissfully in dreamland. He is happy, and I am happy to cuddle with my little sweetie. I take him to his bedroom, and as gently as humanly possible, I lay him down in his crib, which has become an action that screams "Unacceptable" to him. He immediately wakes up, kicking and happy, and ready to play. As he has already shown me he is ready for bed by falling asleep in my arms, I know it's time for bed. I kiss him goodnight, and leave him...to cry...for 30 minutes (which is up from the five we started with). And then I die a little more inside, as it has been going on for several weeks.

We have decided that there is nothing more we can do for him. If I could make it better by going in to him, by giving him back his binkie, by cuddling him, by singing to him, by rocking him, I would. But nothing I do helps, so we feel like it's time that he learns how to comfort himself to sleep. It is the most horrible thing to hear him scream and I spend the designated time on edge, frustrated, and with the highest of blood pressure. We're doing something for him by not doing anything at all, and it's one of the hardest thing I've done. Meanwhile, none of us in our little family are getting much sleep, which also makes things difficult to cope with.

Incompetance- my own this time.

So it's been over a month since I last posted. Mainly that's because nothing of note has happened in the last month and I haven't really felt compelled to write. I did very well in GI which was surprising considering that I didn't think I had studied very hard. The skin, bone, and joint module (SBJ) has been underwhelming. It's a random hodgepodge of stuff, including geriatrics, and the material itself is not interesting. I have now ruled out oncology as well as dermatology as career options. Derm is ultra-competitive anyway, but I'm glad to know that I really have no desire to analyze skin lesions that all look the same. It seems that the derm faculty here recruits solely 28 year old tall thin women, since we have had 5/7 lectures from that kind of professor. Perhaps recruit is the wrong word. I think they all rush the derm department in the same way they rushed their sororities.

I have started studying for the boards, and it's not going very well. There's a lot of material that I have forgotten, or never really knew in teh first place. Biochem is the case in point. Looking at the Krebs cycle, it's as though I never knew it; likewise with the regulation of gluconeogenesis. This is particularly frustrating stuff to memorize because I know that it's just going to leave my brain again in two months anyway. I really don't enjoy cramming stuff that i'm going to forget anyway, because ultimately, I didn't really learn it, so what's the point? Well, right now, the point is that I need to do well on the boards before I can shuffle the urea cycle back to the dusty attic where I semi-remember metabolic pathways.

So I had my first patient enounter as a medical student in my capacity as a student, not a volunteer at the student clinic. I was paired with my classmate and assigned to get a history from an elderly nursing home resident. I sucked. It's pretty hard to take a history from someone whom you can't understand, and for whom life is as ok as it's going to get in a long term care facility. No chief complaint = hard to pursue line of questions. There was no logic, no flow, no sequence to my questions. My presenation of the patient to the attending also sucked. Since I've never really been taught how to verbally present a patient, this is to be expected. I also realized that I have forgotten what little I knew about physical exam. I realize that 20 minutes sessions with a standardized patient learning skills was really not enough. I would much preferred to have had a doctor there, with me and the standardized patient to show me how these things are done, rather than having a glorified layman actor teach me how to examine a patient. Where does my $44K go anyway?

Overall, it's been a pretty sucky 3 weeks in this unit so far. At least I have my back pain to keep me pre-occupied.

Seeing Double

I saw my double today. I know everyone is supposed to have one. The person who was made from the same mold as you. Well, this girl looked like me! She had the longish face, fair skin, reddish-blonde hair, glasses, pig tails, and the t-shirt. I sat in my car at the recycling center staring at her, trying to look like I wasn't staring at her, and probably succeeding in making her feel slightly uncomfortable. I wish I had had a camera with me so I could have snuck in a quick photo of her. I would have liked to compare profiles. I swear that her profile is the one I see when I look at pictures of myself. Weird.

Getting the Ball Rolling

I haven't posted for a while. It seems like whenever I post on the blog, I suddenly start seeing and thinking about tons of things to write about. But, when I don't post for a while, I lose the knack for writing, and I don't think that anything I think about is worth sharing. I do have several thoughts floating around in my head today, so let's just see what comes out, and we'll get the ball rolling on this blog thing again...

Spiff has just finished Spring Break, and he found himself doing quite a bit of service this week. He has unselfishly given up some of his precious free time working a the HRC and serving people in our ward. I am grateful to be married to the type of man who will do this. He is a good example to me. I love serving my friends, and I try to do what I can to help them when they need it. I like to think that they can ask me for help, or accept it if I offer. I, on the other hand, have a hard time serving people I don't know or love. I find myself avoiding opportunities to serve, or begrudgingly serving only because I have been asked, all the time thinking of how I am barely being able to hold myself and my own life together, much less help others with theirs. I pray for help to be more Christlike, and I know that this is one of my biggest challenges, and I am grateful that Spiff is my willing example.

On a lighter note, I am quitting the scrapbooking business. That is kind of a misleading statement, since I have never really been in the scrapbooking business to begin with. I was introduced to this past-time in college by several fanatic friends who were amazingly good at it and created beautiful memories. I decided to jump on the bandwagon and invest in supplies, and I tried several times to creatively display my memories. However, I found that I am not good at it. Not only that, I don't really enjoy it. While I admire my friends' beautiful books, I found that I couldn't organize the pictures, paper and journaling into something artistically beautiful enough to be satisfying to me. So I resorted to plain photo albums, and then most recently to the digital iphoto version of the photo album. So, yesterday, I made a big decision and decided to get out. I am purging myself of all of my scrapbooking supplies! I went through all of my crafty things and pulled out the stickers, cutters, templates, cropping tools, and 12x12 papers, put them in a box, and am getting ready to ship them to a friend who's mother is just getting into scrapbooking. I don't know why, but making this decision makes me feel slightly more confident in myself. I bought into it, tried it, disliked it, and instead of feeling guilty about it, I'm quitting it. Go me! On to some new, creative hobby! Any suggestions?

I have many other floating thoughts, but this post is getting long. I should break it up, lest my readers get bored. I think it has done the trick for me, though. I'm already thinking of more things to post. So, stay tuned for more exciting thoughts and stories from yours truly. Wahoo!

My, How He Grows!

I took Gunner to the doctor today for his four-month appointment. He did amazingly well, and he didn't even cry very much when they gave him his shots. I gave him some Tylenol before we left the house, and I think it helped a lot. So, thank you to all of my friends who gave me that great advice.

I'm happy to report that he is a super healthy and happy baby!
His new stats at 4 1/2 months:
16 lbs. 15 oz. (70th percentile)
26 inches long (60th percentile)
34 cm head circumference

To see his previous stats, look here.

Would you like a cookie?

Spiff told me tonight that I "offer ambiguous cookies". And it's true. I apparently don't know how to properly offer cookies to my guests, and it makes for awkward moments.

Spiff was over at my house one night, just after we met and started dating (five years ago!). I opened up a bag of some yummy raspberry-filled butter cookies I bought at the World Market. I offered him the opened bag while we were chatting, thinking he would take a cookie or two, and we could share the yumminess together. He thought I was offering him the entire bag, and being surprised by this, he awkwardly packed them up and took them home with him.

Just this afternoon, I was making a batch of cookies to take to some friends, and the home teacher came over while they were baking. It was a small batch (only 24 cookies), and I needed enough to take to our friends. However, I thought it might be rude not to offer freshly baked cookies to our guests, with the smell of deliciousness in the air. So, I put a few on a small, glass plate and offered them to the two guys. The first home teacher took a cookie. The second one took the plate and put it on his lap. I didn't get to offer Spiff a cookie. When the visit was over, the guy with the cookies asked for a paper plate so he could take them home. I retrieved the plate from him and divvied the cookies up into separate plastic bags before giving them back to the home teachers to take home.

I was so struck by the awkwardness of this situation that I can't stop thinking about it. I didn't think I was offering "take homes" tonight. It's fine that they had cookies, and I had plenty left over to take to our friends, but I'm baffled. Was I really that ambiguous? Is offering a plate of cookies, on a glass plate, to a group of people in a room, really that ambiguous?

What is the proper way to offer cookies to guests?
What would you have done?

Follow-up...Festival

My two weeks of part-time work are over. The kids performed at their festival today, and five out of seven of them are going to the state festival in May. It was a successful day, and the weather was beautiful, which made the festival more pleasant because the billions of high school kids could go outside, spread out, and practice their various instruments all over the campus.

The baby never did take to the bottle before the event today. So, Spiff and Gunner came to the festival with me. The boys hung out and waited for me, and I hung out with them in between students. One of the judges was way behind schedule, so we ended up coming home an hour later than we planned. But, the baby did amazingly well through this whole ordeal, and Spiff was fantastic to take the afternoon off to oblige me. Thanks, Spiff!