Nervous Confession

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

In short, it made me nervous.

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

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

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

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

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

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

The windows.

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

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

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

Gunner's 2nd Birthday

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

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

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

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

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

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

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

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

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

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

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

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

Grab Bag

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

Things I learn from patients:

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

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

A dead liver cannot be fixed by changing ventilator settings.


Things I learn in General Conference

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

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

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

Backfire

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

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

He was terrified!

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

G: "Baby?!"

Me: "The baby is okay."

G: "Baby K?!"

Me: "Yeah, the baby is just fine.

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

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

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

Residency App

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

Mid-night Heart Breaker

Gunner crying in the middle of the night:

Momma!...

Momma!...

(pause)

Blue Car!!!

Gunner Speak

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

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

Morchee--More please

Beenoon--Balloon

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

BlueWhiVreen--Blue, White, Green

LellowWhi--Yellow, White

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

The Next Few Days

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

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

Also, Happy 29th Birthday, Spiff!

Post-Op

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

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

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

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

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

Gunner's Surgery (Pre-op)

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

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

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

Please say a prayer for us.

Stake Conference In Utah

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

But, here is the cool part...

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

Aaaaaaaaaaaaaaaaaaaaah! He practically said Hi to me!

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

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

Away rotation

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

The poll Part 2

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

Small Truths

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

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

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

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

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

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

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

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

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

MICU part 2

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

Bad things happen at night

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

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

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

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

What's On My Mind

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

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

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

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

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

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

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

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

OB-GYN part 1

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

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

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

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

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

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


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

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

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

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

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


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

My Portable Fomite

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

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

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

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

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

Sleeves: miscellaneous dirt, MRSA, VRE, cruddies.


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

Gunneropolis

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

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

Thanks, Maggie! Drive on, Gunner!

Lightbulb

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

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

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

Potty Talk

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

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

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

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

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

Countdown

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

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

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

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

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

Gah gahn (all gone)

Lellow (yellow)

Gaing (again)

Mmbomeh or Bubby (bummy/bum/tushy)

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

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

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

My favorite quote of the class so far:

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

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

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

Primarily Primary

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

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

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

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

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

Swing

"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.