Yumm!

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

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

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

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

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

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

Vacation Crazies

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

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

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

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

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

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

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

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

Oh, boy.

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

I may never go on vacation again.

Nothing to Report

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

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

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

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

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

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

When Your Ego Takes a Hit

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

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

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

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

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

Ouch!

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

Event Confusion

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

Mommy, will you get my birthday out?

I want to go to Halloween.

My birthday starts on Wednesday.

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

Me too, Gunner. Me too.

Wild Goose Chase

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

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

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

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

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

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

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

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

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

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

It was, in fact, a pill.

Seriously?!

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

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

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

Small Things

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

#1:

Gunner: Can I have one of your cupcakes?

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

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

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

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

Me: That was Daddy's friend Sean.

Gunner: Sean the Baptist?

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

Did he make you smile?

As Requested

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

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

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

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

Ch-ch-ch-changes

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

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

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

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

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

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

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

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

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

Practice Makes Perfect

Right?

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

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

And you all warned me about this next part.

The pooping!

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

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

So he pooped his pants later.

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

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

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

Potty Star

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

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

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

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

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

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

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

Lord, Give Me Strength

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

I'm not.

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

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

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

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

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

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

Reverse Sunset

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

All The Water

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

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

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

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

Take a Deep Breath

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

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

Okay. Breathe. We can do this.

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

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

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

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

Wish me luck.

Blubbering Mom

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

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

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

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

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

Mortification Moment.

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

-SS

A strange symmetry

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

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

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

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

Because I know you've been wondering...

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

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

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

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

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

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

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

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

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

Us: That the Tuba

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

Us: That was the Banjo

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

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

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

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

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

Morgue III

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

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

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

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

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

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

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

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

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

*** End of gratuitous physiology lecture ***



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

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

AND FOLKS, THUS ENDETH MY MEDICAL SCHOOL RESPONSIBILITIES.

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

Funny Conversations

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

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

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

Morgue II

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

Tuesday: Car accident, massive trauma.

Wed: Day in court, no cases.

Thursday: Self inflicted gunshot wound to heart.
Heroin OD

Friday:
Sudden death secondary to cardiac arrest.

The Morgue

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

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

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

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

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

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

Thursday: Schizophrenic with seizure, unknown cause.

Friday: no cases.

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

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

Match

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

Throwing him a bone

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

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

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

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

Winning Dinner

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

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

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

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

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

Gunner wouldn't touch it.

Even for pie.

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

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

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

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

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

I win!

With one kidney bean.

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

The Transition

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

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

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

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

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

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

Rank List

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

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

Emergency Medicine

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

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

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

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

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

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

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

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

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

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

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


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


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

Two and Half Weeks

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

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

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

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

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

Baby!

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

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

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

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

Whew!

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

The Match

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

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

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

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

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

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

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

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

Happy New Year

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

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

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

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

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

Happy New Year!

Scrooged

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

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

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

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

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

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

What does that even mean, anyway?!?!

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

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

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

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

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

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

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

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

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

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

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

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

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

Loving My Boy

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

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

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

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

The interview trail and duty hours

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

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

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

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

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

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

Thar she blows

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

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

Unwelcome Houseguest

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

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

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

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

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

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