Swing

"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:

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

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...

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

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

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

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

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

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

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"

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

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.

Medicine

It's been a while since I've written, mainly because I haven't felt like anything noteworthy has happened. I'm currently doing my medicine rotation and enjoying it far more than I thought I would. I'm not sure where I came to the conclusion that I wouldn't like medicine, but I carried that prejudice with me for most of the first half of this year. I have done one inpatient rotation at a local private hospital, as well as an acute care rotation at the VA. I have to say, the VA rotation was pretty cush. 8-330 everyday is a pretty nice schedule. It's going to be hard to get used to getting up early and rounding all day again.
Medicine has been a pretty pleasant surprise. In fairness, however, I was at an outside hospital with residents who let me act somewhat like a sub-intern, so I learned a lot without having to spend all day rounding. I doubt that I will enjoy the endless cogitating and head scratching that constitutes the in-patient medicine at our university hospital.
We are currently in the midst of planning our fourth year schedules which is pretty daunting. All of a sudden I have to figure out what I want to be when I grow up. Since before starting med-school, I've always thought I'd be an anesthesiologist and am still about 90% sure that's what I want. There's a nagging 10% though, that is thinking hard about cardiology. We had a really cool grand rounds lecture this morning on the physiology of the heart and it was more interesting than anything I"ve heard in a long time. I'm thinking hard about putting a cardio elective early in my 4th year in order to muddy the waters. Cardiology has a few problems with it, however. It's a longer road than anesthesia by 1-3 years (depending on if I do a fellowship after anesthesia), and I have to outcompete my other fellow Medicine residents to make it in. I'm pretty tired of competing and jumping through hoops. On the up-side, however, it's really fascinating, acute, and heavy on physiology.

I have one more month of medicine before I start my two three week anesthesia electives this spring. I guess after that I should have a better idea of whether I want to spend my professional life doing anesthesia.

Drug of Choice

I couldn't fall asleep last night. For two hours, I tossed and turned in the bed next to Spiff, who was sleeping as soundly as I have ever seen him. The more I tried, the worse it got, and the madder I got that Spiff was sleeping so peacefully as I thrashed around next to him.

I finally gave up trying and in my desperation, I took some Tylenol PM, the miracle drug of my pregnancy with Gunner. During said pregnancy, I took one pill almost every night to fight off the insomnia that haunted me for 9 months. Last night, I took two. And sweet relief, I slept like a champ for the rest of the night.

The recommended dosage on the box is two pills. But Wowzah! Two pills! I'm chasing Gunner around this morning, feeling like I could fall asleep every time I blink.

Poor Gunner has an impatient, tired mommy. Oh, so tired.

A Few Things

Here are some things I've been doing and thinking about lately. Not very interesting (or positive, really, because that's just how I've been feeling lately), but here you go anyway:

I am training for another half marathon. I have been struggling with finding the motivation and a good schedule to run. Spiff has been working early in the mornings most of the year, so I have had to resign myself to running at the gym in the evenings. This is double hard for me since I'm not really a treadmill runner, and it is hard for me to exercise in the evenings. But I'm grateful to have a membership at the gym to give me a place to run. And I ran with a group of girls on Saturday at the park, and I felt like a piece of my soul that had been missing from my life was handed back to me. I guess I really do need this, and that will be my motivation.

Gunner is going through a new phase. He is finally making the transition from two naps to one, and it's a tough one. He has really been struggling with sleep in general. I think it's a combination of teething, coming down with a cold, and sleep deprivation, but it's causing some very poor behavior from an extremely grumpy child. I can't figure out what to do to help him.

Also, it is high school instrumental festival time again. I have accompanied for some students in this event for the past few years, and I have enjoyed working with the kids and their super duper nice teacher. However, I'm feeling a bit tired of it this year. I'm just not excited about doing it. I'm not excited about the music itself, which tends to be difficult for me to play, unpleasant to listen to, and difficult to put together with the kids. Plus, this is the schedule I just received for the kids' performances on festival day:

8:18

8:59

9:17

9:30

9:45

2:32

3:42

Anyone else notice the LARGE break before the last two students? I have a baby and just can't be available all day like this! And it happens every year. Grumble grumble.

I have committed to doing it this year and can't back out, but I think I'm done with this event for a while.

On the plus side, I just read a gloriously good book. It was the kind of book that is so good that I read it really slowly, just so it would take me longer to finish it. It was also so good that now I'm really sad it's over and just want to read it all over again.

I also made a really yummy dinner yesterday and shared it with some friends. Gunner enjoyed destroying my kitchen while I cooked all day, and I got the benefit of doing some service and enjoying good food.

And my sister-in-law, Mhana (for those who read her blog), is coming to visit us in a month! I can't wait!

Now I guess it's time for me to go clean up my kitchen and think about which book to read next.

Pick-Me-Up

So, I have had a pretty rotten day. My feelings were hurt in a way that made me question my abilities and spirituality. I'm dealing with it.

And in so doing, I found this blog entry that made me laugh out loud, several times. I bet that the "Voice of Reason" had no idea she would be the pick-me-up I so desperately needed today.

Make sure you read the comments. My favorites are the ones about the squirrel, Mormet, and the "recipies".

I'm sinking

Appreciating My Two Hands

Spiff and I went ice skating last night. It was pretty much an awesome night to go ice skating at the outdoor rink in town. It was snowing (a fairly wet, slippery, sloshy snow), and so there weren't a whole lot of people out and about, which means that there weren't a lot of people at the rink. But it wasn't very cold, and it wasn't snowing very hard, so it was really quite awesome. Spiff is a pretty good skater (surprise, surprise), but I have only been on ice skates a handful of times, the last time being two years ago. I was surprised last night to find that it wasn't as hard as I remembered. Plus, my rental skates seemed to fit better and were way more comfortable than the last pair I rented, and it left me feeling all empowered and daring.

So, we skated a bit, and we even tried a few tricks. For me, that includes turning around in very large, slow circles, and then feeling super triumphant. I even tried skating backwards. And as I doing these bumbling tricks, I thought, "This is so fun! And I'm probably going to end falling on my face."

Not two seconds later, I fell flat on my face. A kind rink-worker dude saw the whole thing and came right over asking me if I was okay. Sadly, Spiff missed it, and turned around to find his dear, sweet wife on the ground, and he came rushing right over. They helped me up (yes, I needed help up), I brushed the snow off the entire front of me, and sporting a nice new bruise on my chin, I tried putting on my brave face.

I wish I could say that I hopped right up and continued to skate because, seriously, how embarrassing is it to break into tears after something like that? But I did something to my left wrist when I fell, and it left me feeling like an weepy, insecure eight-year-old, for the second time in two weeks. With my newly hurt wrist, I hobbled off the rink to have Spiff take a look at it. (Somehow, hurting my wrist causes me to hobble.) We did continue to skate for a while, and it really was very fun. I skated more conservatively, and Spiff was the perfect gentleman and held my hand so I could keep up with him and so that we could skate around the rink together.

So, my wrist is not broken, but it sure does hurt a lot. Little things that I take for granted are so very difficult today. Like picking up my son. Putting on gloves. Getting dressed. Grabbing and holding on to anything. Anything that involves twisting my arm or grasping in any way.

I'm just feeling so grateful for my general health today. I'm grateful that I have two hands and two arms to help me with my daily tasks. And even though I'm frustrated that my stinkin' wrist hurts and that things are difficult for me today, I'm grateful that I will heal and be able to go back to taking advantage of that fact that I have two working arms. And then I think I just might carry Gunner all day long, just because I can.

Doing My Civic Duty

I served on Jury Duty today. I did my civic duty. I am slightly disappointed to report that doing my civic duty involved me doing absolutely nothing at all.

I arrived at the Civic Courts building at 8:00 a.m., where I was herded into a large room and given a badge. As Juror #289, I sat in my chair and waited for an hour while they got organized. During that hour, the government workers occasionally called people up to the front desk, and I thought it was going to be a busy and interesting day. Boy was I wrong! I made myself comfortable in my chair and tried to read my book. But between the TV that was spewing its inane daytime programming, the man sitting behind me who fell asleep and snored for hours on end, and the fact that my chair did super-human feats in making my buttocks numb, I found myself lacking the attention I required to get into my book. It felt like I was on a really long flight, or a bus or train that didn't end up taking me anywhere. Plus, the front desk workers stopped talking at 9:00 and didn't address us until 11:30, when they dismissed us for an almost-two-hour lunch.

When I got back in my seat by 1:15, I thought that surely something would happen. I was again disappointed. The front desk workers didn't address us until 3:30, when they finally called a jury pool of about 30 people. I sat in my seat, my little heart pumping, feeling a bit like an 8-year-old hoping to be picked for the dodge ball team during P.E. I was so hoping to be picked. I wanted to see what the court process was like. But mostly, I wanted something to end the maddening boredom that was the waiting room. My number was not called. And The Chosen Thirty received their assignment to return for court the next day at 9:00, and then they were released!

And the front desk workers, again, said nothing to the rest of us.

Just when I thought we might just end up living and dying in that soul-sucking waiting room, Heavenly Angels came down from above, in the form of a front-desk worker, and told us that we were released to go home at 4:00. And that we don't have to return tomorrow!

Hoorah! I have fulfilled my service to the court system for now. I think that as long as I will myself to think of it as SERVICE, I won't feel like it was the biggest, fattest waste of a day in my entire life. But since I haven't yet convinced myself that I did any sort of service at all, I currently do think that it was the absolute biggest, fattest waste of a day. My Jury Duty Experience= Not interesting or fulfilling in any way, shape or form.

But Thank You to my awesome friend, Angela, who took care of Gunner for me All Day Long. You are a Super Goddess Mommy!

Theme Day

Look at what I bought at Costco the other day. Notice the theme? I just love spending money on these things that we (almost) literally throw down the toilet. Sigh.

On a side note, Gunner threw a tantrum in Target yesterday. I decided not to let him make such a public display, so I picked him up and marched him out of the store. While I was thinking, "Boy, I sure taught him a lesson.", he was probably thinking, "Yes! We're getting out of this stinking store!"

Faulty Gadgets and Billowing Plastic

You may be asking yourself how we have been spending our time lately. Then again, you may not, but I'm going to tell you anyway. We have been child-proofing and plasticking. (Is there any correct way to spell "plasticking"?) The child-proofing has been a frantic and futile attempt at making our lives more relaxed at home with Gunner always two steps ahead of us. He figures something out, we child-proof it, and then he is immediately on to two more things. It is amazingly difficult. Hats off to anyone who manages to child-proof their homes so that they aren't constantly chasing their toddlers around the house saying, "No! Leave that alone, for the thousandth time!!!"

And the plasticking ("spell check" says that I should be saying plasticizing, so there you go). We have the world's oldest windows in our home. Well, probably not the world's oldest, but they are at least 100 years old. In the Spring and Fall, the windows themselves don't open, and if we do manage to get them open, it takes a 10-man construction crew to get them closed again. Needless to say, I miss having fresh air in my home during the nice seasons of the year. However, there is no lack of fresh air in the Winter. We have a healthy cross breeze blowing through our home, through the large cracks in the ancient windows during the Winter months. In an effort to reduce the amount of Winter weather we invite into our home, not to mention the reduction of the heat bill, we have spent much of our lives putting plastic on our windows. We do this again and again because the stuff keeps falling down. I am so tired of reapplying plastic that I feel like I would give my arm, my legs, and even a bit of my left brain if we could have new windows.

Here are some our recent adventures in child-proofing. We buy gadgets at $4-5 a pop, and they end up not working. My advice: do more research than we did before buying any commercial child-proofing gadget. We recently had mishaps with these items:

The toilet lid holder

This lovely gadget doesn't fit onto our tank. As you can see, Spiff added an extension (which is a couple of Gunner's blocks, artistically attached to the device with electrical tape), which makes it fit...BUT the stinkin' suction cups are weak enough that Gunner can just pop the whole thing right off without even trying very hard. We don't use this.

The sticky latch thing.

This is a product we bought to keep Gunner out of the corner cabinet in the kitchen that holds all of my baking supplies. He loves that cabinet, and he loves loves loves emptying it out. So we bought a latch to keep the baking soda and vanilla safe and sound. It works great on the cabinet so far.

We decided to try another one on the shower door (heaven forbid that we may want some privacy from Gunner while in the shower). But obviously it didn't work. Notice the sticky stuff that has detached from the gadget itself. I would feel better if the sticky stuff didn't stick to the shower surface. But, no. It doesn't stick to itself.

We have baby-gated off the bathroom for now.

Plastic Windows

This is our bedroom window. Notice how the insulating plastic is Billowing! I couldn't get it to lie flat because of the breeze that is blowing through the closed windows. It also took four strips of tape on the bottom ledge to keep the breeze from blowing the plastic right off the tape. Our bedroom got down to around 35-40 degrees during this last cold snap. The old windows are so bad that it felt like we had an open window in our room. We now have two billowing windows in our room, and thankfully it is much warmer now.

If this last re-plasticking job doesn't work, I think I may have to offer my body parts to our landlords as a sacrifice for replacing the windows. But then again, how could I ever get down on my knees and beg if I have already given them up as an offering?

Surgery Part 1

It's been a month since I last posted, and it's because I haven't figured out how to talk about my experience. The sub-rotations that I participated in were, in order: pediatrics, pediatric urology, general adult sugery, and orthopaedics. In general, I think my experience suffered from a lack of hands-on learning. Medical students generally round on patients before the team rounds, finding out how patients did overnight, what changes occured, and formulating some semblance of a plan for the day. They then present their findings to the team during rounds and any modifications or additions are added before the workday begins.

Surgery differed from this in several regards. On pediatrics we would pre-round in the usual manner, but the residents did not make any use of our information, but at least wanted to hear what plans we had come up with. The afternoons on pediatrics, however, differed from other rotations in that the medical students were not really included in the floor work. Normally students follow labs, help write discharge orders, follow up on consults and imaging studies, additionally, if there are any OR cases happening, the students would scrub in for those. The two weeks I was on pediatrics did not have very many cases, so the afternoons were often devoid of any OR time. Rather than include us in the floor work and teach us about medical decision making, the residents would just tell us there was nothing happening, and tell us to sit and study. I have nothing against study time, but if there is nothing happening for 5 straight hours, to me it makes sense to let some of the students go home or to the library if they want because there is truly nothing happening.

Pediatric urology was interesting in that it was an inpatient rotation, but we had only 2 patients who stayed overnight, so really it was more like a day surgery rotation since we never had to round on patients. I did learn a lot from Dr. P, the peds urologist. His clinic was the smoothest running with the lowest percentage of no-shows of any clinic I have yet assisted in. He also was the only attending who actively taught about how to relate with patient's families and about non-medical aspects of satisfying patients and their families.

More to follow in Part 2

-spiff.

I have a button and it's not on my shirt...

I have a button and it's not on my skirt.
I have a button. It's a part of me.
It's the button in the middle of my tummy!

It's my Belly Button, found underneath my sweater.
It's my Belly Button. And it's holding me together!

I'm sure that this is the song Gunner would be singing, if he could sing, as he eats Cheerios in Sacrament meeting. A couple months ago, I tried to entertain my wiggly little boy by sticking Cheerios in his belly button. He thought it was hilarious, and preceded to play peek-a-boo with the button-Cheerio before snatching it out and eating it.

Then two weeks ago, as we were sitting in sacrament meeting, Gunner was getting fussy. I handed him some Cheerios, and on his own, he lifted up his shirt and stuck a Cheerio in his belly button. He entertained himself, and the people sitting next to us, for at least 15 minutes. It happened again today, so apparently this is standard sacrament meeting entertainment.
Forget quiet books. Break out the Button Cheerios!

Making it Feel Like Christmas

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

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

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

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

Uncle Sam Santa?

Frontier Santa

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

5 Year Ago Today...

Spiff and I Got Married!

Our Wedding Luncheon, post ceremony:

The Winter Wonderland Reception:

Happy Five Years to Us!!!

That's what we were doing five years ago.

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

The Homeless Man

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

Fast Sunday

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

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

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

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

Ho Ho Ho

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

Pet Peeves

What is this? This is the worst doorknob that mankind has ever designed, patented, and produced.

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

It's Christmas Time!

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

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

A Happier Family

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

Voice of Experience

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

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

For example, here is an interaction we have several times a day. (I have included his actual actions and what I think he would be saying if he could talk.)

Me: Would you like a cracker?

Gunner: Throws his head back and wails...NOOOO! I Don't want a cracker! How could you think I might have ever wanted a cracker?! My Life Is Now OVER!!!

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

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

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

I am now working with Gunner on an attitude adjustment that consists of two things:

1) I'm trying to teach him to decline an offer by simply saying, "No Thank You". Any version of this will do, but I'm trying to avoid the hysterics over being offered a cracker. This already seems to be helping.

2) I'm also trying to teach him that he doesn't get what he wants by throwing a tantrum. I will understand his need to cry about it, and I will give him the space to do so. When he has calmed himself down, then we can "talk".

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

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

Up To Here

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

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

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

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

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

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Neuro Psych

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

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

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

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

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

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

Our Tiny Toddler

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

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


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

Gunner's 1st Birthday

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

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

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

Sigh.

Anyway, about the birthday festivities. We had a great time. First, my sister was in town, and so we held a little "party" before she left. Lucky Gunner got to dig in to this cake 5 days before the big day.

I must admit that I was pretty excited about the cupcake eating/smashing experience. He loved it, and he was the perfect little performer. When he figured out that he had a yummy, sweet cupcake in front of him, and it was all for him, and he had permission to actually eat it, boy did he dig in. He started by sucking all of the frosting off the top, and then proceeded to devour the entire thing, other than what he smashed onto his hands, belly, face, hair and ears.

We continued his birthday celebrations over the weekend when some friends came into town from Minnesota. We went downtown and visited some parks and the Old Courthouse. We went to the zoo, and we ate a yummy BBQ dinner. Then lucky Gunner got to dig in to this cake:

This time, he wanted to eat the whole thing (all twelve cupcakes in the stack), and when Spiff took the cake back to the table after blowing out the candles, Gunner lost it. There was too much excitement and not enough cake for him, and he cried uncontrollably for a good two minutes before he realized that there was in fact another yummy cupcake sitting on his tray, all for him. He devoured that one, too.

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