I'm taking a study break

I have a date with the girls at 4:30 (that's 18 minutes ago, by this clock). They're late. They're out with Richie, taking video and getting a cookie. We're going to make Christmas cookies, decorate the Christmas tree, and listen to Christmas music until 6:30. Then it's back to the grindstone for me.

I have a test on Tuesday. It's the biggest test I've had in med school so far, covering four weeks and three anatomy dissections (one mine, two of the other teams') total. I'm nervous about it and I feel like my brain is swimming in info that is still sort of half-baked. I hope it rises and sets if I add equal parts "diligence and patience" (Dr. Churchward's encouragement phrase). This has been a difficult holiday, but not nearly as difficult as it could have been. It's difficult because I absolutely do not have time to do the holiday things I love doing or spend as much time with the girlies as I'd like. But it's less difficult than it could've been in the sense that I have gotten to read a chapter of The Best Christmas Pageant Ever to the girls each night and Richie is taking care of the rest.

This year Richie's making a Christmas website instead of us sending Christmas cards. That's why I haven't been posting photos; I'm saving them up so they'll be a surprise.

My fam is home, so it's off I go! And I actually showered just before sitting to type this, so I'm even clean.

Merry Christmas!

some pics

Here is one of the last opportunities to see Mazie with both top front baby teeth. She just lost her left one a week or so ago. She's very snaggly-toothed now, almost overnight. Just a month ago or so she had the perfect baby tooth smile (though she'd lost the bottom four already, it didn't seem to make much difference.). Now she has the top left blank space, the top right is crooked because it's on its way out, and the bottom far left is showing it's grownup tooth - but it's growing in sort of sideways. She's still so little; I guess she'll have to grow into her teeth.
Here we are at the corn maze. Richie took the picture. It was really fun. I felt addicted to finding the way. I was SO GLAD that the map was accurate. I was getting all ready for the map to be crazy, but it was really very good and made for a fun time.


So...Here's the most pitiful picture I have ever seen of Richie. Except one of him sleeping that Iwouldn't dare post. Of course, he's just coming off of general anesthesia in this one, so it's really not fair to post it. But he did take the photo himself (I was driving him home). He had just gotten two teeth extracted. Sad day. Here's one of the girls. They're wearing Skeledog tee-shirts. Our friends make them.

Halloween '09

Halloween was rainy but really fun. We trick-or-treated in our neighborhood. Mazie was a witch again - she loves the hat - and Vivian was a mermaid again, despite the outfit being size 2T. We tried to talk her out of it and suggested alternatives, but there's something so attractive about that costume that she would settle for nothing else. They carved the pumpkins (okay, Richie did the knife work but they drew the faces) at Nana and Poppy's house. And the baking hats are from Grandma and Grandpa and have been in steady use since we received them. We also have a freezer full of waning glow sticks. What better to put in your freezer?

I'm studying aging and dying this week. We have a lot of hands-on activities - competency workshops for screening older peoples' gate, balance, cognitive status, etc. It's a lot more interesting to me than I thought it would be. The module director is really good.

Richie is enjoying work. He got to design/draw a safety deck for a fuel delivery platform today. He was very excited. He has also gotten to do a fair amount of field work (measuring, photographing) so far.

Trip to Kennesaw battlefield...SuperFun

I knew this would happen.

I have no time to blog! I'm currently studying renal function. I'll have time to post photos and a little more content at some later date...TBD.

Best,
B

General update

We have an owl in our neighborhood that makes the wildest whooping sounds at night. I don't mean "whoo-whoo-whoo" but something else entirely more creative. I'll have to listen more closely next time it calls in the middle of the night so I can relate its sound here - I'm afraid I couldn't do it justice right now. It sounds a little like a monkey. Richie thinks it's a barred owl, but I'm not sure.

The girls are drawing with chalk on the sidewalk with their friend from three doors down, Ceja. Mazie stayed home today because we think she has H1N1 and Vivian hated having to go to school when she knew Mazie was staying home. Their school is going pretty well, although Mazie's class has just last week broken into reading groups even though school has been in for almost 6 weeks. Besides, all the reading groups are reading a book called, "Hop, Frog, Hop" or something equally beginner-level-sounding, and Mazie is - er - not being challenged. I have no idea what to do about that, but Richie and I are going for a conference with Ms. Johnson on the 22nd, during which I'll ask gently about challenging Mazie if her ability level is beyond the classwork.

Vivian goes into her pre-K every day with no fuss, according to Richie. It starts at 8:30, so I'm already in school by the time she goes in. Her pre-K is at a school for autistic children. 1/3 of her classmates are autistic. The teachers are highly trained, really energetic, and there are a lot of them. But I'm getting the idea that school for Vivian is 99% social - which is wonderful for kids with autism who really need help developing socially. Vivian's not complaining, either.

I still feel like I see a lot of them. I am able to keep the times that are ritually important - dinner and all meals on weekends. Bedtime. Church, most weekend outings, special events. But all the spaces between (the interstices) are full of school for me. The only movie I have watched in the past 2 months has been The Pink Panther in 2 installments. No T.V. because we don't have one. Basically, I'm busy and sometimes pretty brain-tired, but functioning like normal in the family, except that Richie has taken on 90% of my domestic responsibilities. I'm like a roving helper and he runs the show. (Thank you, Richie!)

And he's just putting chili on the table. :)

Explanation of pictures: Mazie and Vivian playing with giant balloons in the yard with our neighbor, Maria. Vivian and Mazie with storm troopers at a local parade. They were overwhelmed and a little worried; that's what their facial expressions are saying.

Okay, so we actually got H1N1

And it's rather old news now.

On Tuesday and Wednesday, I had two days of increasing cough - it felt almost painful. That "specialness" of the cough was the only warning sign that it could have been flu, but I honestly thought it was a cold because there was no fever (I know 1/3 of H1N1 cases have none...but still) and there were no other symptoms. By day 3, Thursday, I was feeling crummier than I had and was beginning the wild aches, so I got a reservation at student health. They were awesome; they put me in a room with other masked, puffy-eyed people and then they violated my nose. No, really, I adore student health and it was actually a very efficient visit with lots of good care from an NP named Molly who handed me tissues because I was still weeping from the flu test. She was one of those practitioners whose clinical presence I'd like to emulate. Anyway, I had a 101 fever at student health (no prior fever noted) and felt horrid the rest of that day. ( I was in denial about not being able to do my last-minute prequiz sprint, but I just...couldn't...think.) Then, Friday, I felt pretty lousy, but a little better. No fever control necessary. The past two days, I've felt modestly crummy, no body aches, cough resolving. No fever. Now I'm wondering, can I go back Monday morning? I am.

I'm feeling pretty badly about taking my germs into my grown-up school, but there's also the public health crime of the century that I've just committed: sending Vivian to school with the same cough for the entire week. Unlike me, Vivian never ran a fever (we checked), but I'm pretty sure she has what I have. I immediately kept her home as soon as I was diagnosed with H1N1 and that she probably has it, too, but she was at school for long enough to spread it to every child and teacher there.

Alas. I really didn't know :(. Sorry, everybody!

It's a miracle!

Vivian got better overnight and nobody else has gotten sick. YAY!

H1N1

Today my small group leader was on vacation (at Disney World!) and so we got to meet with Dr. Helinski. Dr. H is a pediatric infectious disease doctor. Naturally, the conversation flowed to its inevitable terminus: H1N1. Documented cases have increased rapidly (like, 5-fold) in the past week at one of the hospitals nearby, so we were discussing the ramifications of this early surge in Influenza A (H1N1 is technically an influenza A - just one we've no immunity for because of its porcine origin).

August is quite early for a surge in influenza. Usually the surge begins around November and cases begin to peter out by February. My question for Dr. H was, does this mean that this is the surge or could a second increase in infection rate be superimposed on this prior high infection rate, creating a super high infection rate in November. He said he didn't know but it's certainly possible.

Here are some other little things about Influenza A. They think this one will require two sequential vaccine shots to confer resistance. If the vaccine isn't ready until October and this Flu A is surging now, the vaccine will be too late to make a big difference. You have probably heard that this flu isn't particularly virulent, which is great. It does have the potential to mutate into something more virulent. If you get the current, milder form of this flu, the immune reaction you generate will protect you from even a mutated virulent strain. All this points to go ahead and get sick and don't worry about it.

However, the more human hosts the virus has, the more opportunities it has to mutate into something more virulent. So from a host-limiting perspective and from a population productivity perspective, it would be helpful for people to get the vaccine to stop the spread of the flu.

Those are just the things we discussed.

I will add that when we went to Vivian's ice cream social at her pre-K classroom on Friday, they informed us that one kid had gone home after throwing up and there were ominous rumblings of upset stomach from Vivian's best buddy, Beatrix. Beatrix looked positively peaked, draped on her mother's shoulder. Tonight Vivian complained of an upset stomach. Then, during sing and pray I noticed she felt warm. She had a 101 degree temperature. And now Mazie and I both feel a little queasy. Ohhhhh, boy....here we go!

Finally, pictures!

Okay, this is disorganized.
Brace yourself
for an asynchronous jaunt through recent history.
In no particular order:
At Mimi's 80th...
Mimi and I mug shot,
Vivian with a smile,
and Grandpa and Mazie playing tictactoe.
The back door at our apartment, including corn plant that was here when we got here. Last (chronologically), but not least, Mazie and Vivian all dressed up for their first day of school - Mazie to 1st grade and Vivian to Pre-K.

I have noticed that I keep having to explain how cool my stepdad is. Pete, you're cool. I keep having to tell people all about Pete and I wish I could just show him off. December, maybe?

Learning secrets

I often have the feeling that I'm learning secrets - Deeeeep Secrets of embryonic and fetal development. What we (think we) know is pretty amazing. The body of research supporting a single finding such as "We used to think the nerve cells told the muscle cells whether to be fast- or slow-twitch, but now we know that the cells' fates are determined significantly before the nerve cells ever reach them" represents one study, maybe more. The embryology book is filled with such statements. I won't go into the more esoteric of them, but basically when an embryo is growing and the tissues are differentiating, the cells tell each other what to do in a precise pattern that depends on the signaling cells' history and gene expression. And the cells instructed ("induced") by those signaling cells go on to make their own signals for cells further downstream and so on. The point I'm making is that EVERY step we (think we) know had to be teased out from all other steps using the scientific process.

And I get to learn about it.

(Powerpoint is not presenting nearly as profound a problem as it previously had. I print.)

Girlies and Richie await, so adios!

It’s been three weeks since I have last posted anything substantial. That’s because I’ve been doing only the things that need to be done for the past couple of weeks.

At this phase (Healthy Human), we have a quiz every week. I’ve had a quiz the last two Fridays in a row. The first week was really difficult. The content was less challenging than the adjustment to the style of learning. At the beginning of each module of healthy human (modules last between 1 and 3 weeks), the module directors give us a list of reading and learning objectives for each lecture. I read the corresponding material before lecture. It turns out that our lecturers are often whatever experts the module leader could scrounge up from among Emory’s faculty and affiliates. We’ve been really lucky to have people teaching us who are not only familiar with, but who also engage in, the most recent literature on the topic we’re studying. This situation subverts the paradigm of “The book is the expert and the professor follows the book.” In our case, our lecturer gives the last word (at least as far as our test is concerned J. Their emphases may depart significantly from the book. If a student asks a question, the lecturer is usually familiar enough with the topic to discuss the limits of knowledge about the answer.

So, obviously, this is a really neat way to learn. It means that the Powerpoint slides the lecturer shows are of primary importance to us. That’s the crux of my remediation for the last two weeks: for me, the transition from paper-learning to screen-learning has been challenging. I learn best if I can touch or “own” the material. A lot of the way I remember when I’m taking a test is visual. I remember context (where I was when I read the bit) and I remember position on the page. I remember diagrams and pictures really well, but the words also form a sort of diagram for me in the topography of a physical piece of paper. The great thing about typed text, a consistent graphic design, and a glowing screen is that they make things easy to read. The bad thing is that it’s all the same and you can’t draw circles and arrows and flip through it. Info on a screen is a lot harder to own.

It took me about three days to get out of frank denial that I was going to have to Do Something about the info on the Powerpoint slides. The solution seems to have worked for me: I print out the slides six-to-a-page before lecture so that I can scribble right on the slide and take notes directly on the page. I didn’t have this system worked out week-before-last, and so I was exquisitely uncomfortable with the way I had been learning. There were tears and no small amount of fussing. But I did fine on the exam and also developed my system for owning the material. This past week has been easier for me. I am an old dog learning new tricks.

The material, by the way, has been pretty cool - human development, embryos, and tissue types. We’re also learning to do the patient exam. I got to feel my friends’ abdominal aortas and they felt mine. It’s pretty easy: one of you lies down on your back, relaxed, and the other presses quite firmly (it doesn’t hurt) deep into the abdomen (near your belly button). You’re feeling for the pulsing aorta. It’s big and strong, so get ready for a surprise. I’m learning percuss a chest to listen for consolidation (junk that should not be there) in lungs and for the position of the diaphragm. I’m also still learning to use my otoscope/ophthalmoscope and my blood pressure cuff. A healthy ear drum LOOKS healthy. So cool.

Stuff is happening

So quickly that I can't get it all in this blog AT ALL.

An amazing patient presentation brought home the necessity of caring how we interact with patients - the subtle things - from the patient's perspective.

We had a talk on violence today.

I got my medical equipment in the mail today!!!! If only I could figure out how to turn on the otoscope! But I have to admit, I'm getting pretty decent at taking blood pressures :).

And a wonderful M.D./professor talked to us about health care reform today. I understand more than ever, though I wouldn't call myself an expert on the subject.

Finally, Richie has gone to bed, so I better get there too or I'll not get read to!

Best!

Hello! Right now it's naptime at my house. That means the girls are listening to Kids' Sing and Dance - a maddening CD that is exactly what it sounds like it is. The singers have British accents, which makes me miss Paul Musselwhite reading in church :). I got off early because today we just did a debriefing session about Week on the Wards with other people in our small groups.

I'll go ahead and explain small groups. One of the goals of the new curriculum is to give medical students a longitudinal exposure to great clinicians. To that end, we are divided into four "Societies" and further divided into small groups of about 9 each. Ours has nine: Jenna, Shiva, Emily, Laura Jane, Steven, Jonathan, Jonathan, Robert, and me. Our leader is Dr. Mary Jo Lechowicz, an oncologist who does bone marrow transplants. Our small group does lots of things together and is the principle venue for discussing everything from medical ethics to unexpected squeamishness. We'll learn physical examination techniques from our leader and will practice on our fellow small group members. We are told that we become quite close with our small groups whether or not they're people we naturally group up with.

So, on the clinical side of things... What did I learn this week? I learned how wonderful it is to be taught any little thing by someone who knows more than you do. Our upperclassmen med students were very helpful on our week on the wards, taking every opportunity to explain what they were doing and how it fit into the larger picture. Thank goodness, because for all my clinical experience, a lot that I saw was new. One of the frustrating things - no, THE most frustrating thing - about scribing was my mandate not to ask questions for fear of interrupting the flow or slowing down the doctor. It's 180 degrees different now that I'm being trained. We have to ask questions. The catch is, when I'm in the position of the medical students and residents, I'll have to have all kinds of knowledge on the tip of my tongue.

For example, here's an approximation of a back-and-forth between the attending teaching physician and a fourth-year med student (who is, for all intents and purposes, Medicine Superman):

Dr. J: And so when you look at these lab values, what can you tell about the patient's thyroid?
4th year: It's underactive.
Dr. J: We don't have the T3/T4 breakdown, but if we did, what would we see?
4th year: Normal is between (??) and (??) (he knew); hers would be somewhere around zero.
Dr. J: Exactly right. Does anybody know what the first thing we need to do for this patient is to make her more comfortable before the thyroid replacement therapy has a chance to kick in?

They knew. Some knew faster than others, but they all knew.

Internal Medicine is really cool. I didn't witness a single procedure, but the team thought through every complaint, lab value, possible drug interaction or side effect, coordinated care with social workers, consulting physicians, nurses, and therapists VERY carefully under the expert guidance of Dr. J. I liked the thinking-through. Dr. J. was very current with the research and was constantly bringing the available evidence into the decisions she was making. She also did something I haven't seen much of outside of Dr. Heideman's classes - that's critique scientific literature for sample size, question asked, holes in the methodology, etc.

This was a very cool week. I loved the things I got to learn about. I added an image of one of the symptoms of OVERactive thyroid - Graves' ophthalmyopathy. That means eyemuscleproblem. One of our patients had bulging eyes. She eventually came to the clinic because her thyroid gland was so large that she couldn't swallow normally and couldn't sleep on her back because the huge thyroid gland (goiter) compressed her airway. She ate all the time and couldn't gain weight. She was extremely irritable, hot, and shaky. We also had a patient with hypothyroidism who had slowed down to the point that she could no longer care for herself. Her symptoms were exactly opposite of those of the lady with hyperthyroidism. Both problems are very fixable, but deadly if left untreated.

I saw other patients with problems that weren't fixable. Those were very sad, but everyone was doing their best to help.

Grady is old and tech-slow (which don't make a huge difference), but was difficult for the providers for two related reasons: volume and slow response times from staff. I'm not sure how it got this way, but tests and imaging studies got performed slowly on average and sometimes not at all. There seems to be a culture of expecting the worst. One lady complained of getting her pain medication too frequently and the medical team exchanged an incredulous look among themselves. The resources and/or oversight are simply not there to make sure things run in an ordered fashion. Sentara, by contrast, had a huge system of checks and balances that irritated the heck out of the nurses who felt they were jumping through hoops but which I suppose ensured that things would run smoothly and quickly.

Anyway, I'm home early today! We're trying to get the house cleaned early so we can have fun (and finish the final things on my list) for my last weekend before classes officially start.

I made it!

Week on the Wards (at the giant hospital shown) is finished. We go to school (the smaller building with grass) tomorrow to debrief.

Okay, it was really cool. My biggest problem was GETTING to and from the hospital. I got there every day, but rarely in the way I planned. The first day, as I described, was golden. Shuttle there and shuttle home with no hitch. The day after (Tuesday) was great in the morning because Richie and the girls drove me. But Tues was a problem in the afternoon because I didn't have a great understanding of the shuttle schedule and so missed the shuttle from Grady to Emory and had to wait almost an hour for the next one. Then I waited a long time at Emory for the connection home (should've walked at that point- 20/20 hindsight), making my entire trip about an hour and a half. Blech.

Wednesday was probably the biggest morning foible. I was determined to know the route and timing and spent considerable time on the internets the night before trying to get it all worked out. Long story shorter, I tried to take the shuttle but got as far as school before I realized it would never work. So I called Richie, who picked me up. On the way, we parallelled my attending physician on Dekalb Ave, so I switched cars and rode the rest of the way in with her. Lucky break. In the afternoon, I actually got out just in time for a shuttle and had to wait just a little while.

Now we're up to Thursday. Wednesday night I was again determined to make it work a better way and save gas and Richie's time. So I decided to bike. It's about 6.5 miles from here to downtown, where Grady is. I planned my route carefully according to roads and neighborhoods I'm familiar with. Only some of the trip is through a rough neighborhood. Those of you familiar with Atlanta or good on Gmaps, it's North Decatur to Oakdale to Euclid to Edgewood. This morning I had no idea how long it would take me accounting for road quality, hills, and traffic. Specifically, here, I thought about hills, but hadn't really considered hills that well.

I had fantasized (while waiting for the shuttle at some point, I'm certain) about a flat, straight shot to Grady where I could control my departure times. I forgot entirely about hills when I budgeted time. So, this morning, imagine my surprise when I hit the first hill and started to huff and puff - slowly - up it. I started to get reeeeeally nervous that I hadn't budgeted enough time to account for hills, so I started biking just as hard as I could - pushing up every hill and getting up tons of speed on the downhills. I kept checking my watch's tiny hands to see how I was doing. I really couldn't tell because I didn't find a halfway point in advance or anything helpful like that. I could tell when I was getting fairly close, and I seemed to be in good time. All told it took 35 minutes at a dead sprint the whole way.

AND! The bad neighborhood is situated close to Grady, so that on the way there it's downhill and I can ride fast and on the way home I've just gotten on my bike so I can sort of zoom uphill.

In all, today was the most successful travel day I've had. I looked silly walking into the hospital in my mom's exercise shorts and a bike helmet, but I changed quickly and nobody could tell I'd looked so silly just moments before.

More on medicine in a little bit. Thanks for reading that long long account of my travel experiences!

On the Wards

Hi, everybody!


Emory SOM provides an immersion experience for the week after orientation called "Week on the Wards". It's meant to be a taste of what you're looking forward to. It grounds you in the reason you're learning all you learn in the next 18 months. It also, I've heard, gives you a benchmark so that later when you've had tons of experience and you actually understand the pathologies being discussed, you can say, "Wow, I sure have learned a lot since that first week on the wards."

Every M1 (first-year medical student) goes to a different rotation at one of five different Emory-affiliated hospitals. There's Egleston Children's Hospital, Emory Midtown (AKA Crawford Long), Emory University Medical Hospital (???), The VA, or Grady Hospital. So, today I received my marching orders for my Week on the Wards: Grady Internal Medicine Team 6. (Go team 6.) I'm joking because this has been the farthest thing from a competitive experience.

There's a shuttle from Emory SOM to Grady Hospital. It's about 5 miles, so it takes around 15 minutes with no traffic. The shuttle is a little like a roller coaster ride. My spacial awareness is poor enough that it looked to me like the shuttle was going to collide with every car we passed. The words "barrelling" and "careening" come to mind. I like the shuttle, though. I'm fairly certain I'd survive a collision and I basically give up care for life and limb and allow the shuttle driver to perform her drive. I did get fussed at for eating grapes, which I should've had the good sense not to do. Plus, since I hadn't realized I was breaking a rule, it took awhile for me to catch on that it was me she was fussing at.

(Resumed next day while at Grady Hospital computer lab on the top floor with the wraparound balcony and well-used lounge.)

This is FUN! I am on a team with (in order of descending responsibility) an attending physician, a head resident, an intern, a third-year med student, and a fourth-year med student. (And another M1 like me.) They are AWESOME. The attending physician is an excellent teacher. She's incredibly well-spoken and seems not to let a learning opportunity slide by without snagging it. The head resident is also neat...but I think he's currently in survival mode. He appears to be bleary-eyed, and we didn't see him at all yesterday because the clinic was busy. (I have no idea how this relates to his hospital duties or if he happened to stay up all night last night.) But he's definitely wry, direct, and good-natured. The intern has only been in her internship for three days, so she's brand-new and had her first (?) night of call here last night. She seems operable today, amazingly, though she said last night seemed busy to her.

Internal medicine seems to me to be medicine for adults, general, complicated. It's not a specialty (like neurology, oncology, dermatology, etc.). The patients we've seen have ranged from very, very sick to on their way out of the hospital. I actually am not quite clear on what I'm allowed to discuss in public, so I'll err on the side of safety and not discuss any specifics. I will say that every time I've been invited to listen or feel something on a physical exam, I've accepted with joy. I have also had to resort to my coping tactic of "You're about to cry; don't cry, don't cry, don't cry" which seems to be enough to distract me from the tragedy at hand.

I have to go, but I'll write more when I can. :)

I watch the ripples change their size / but never leave the stream - David Bowie

Time may change me. But I can't trace time.

Time got funky on me this week. It's the third day of orientation, and I'll try to describe the experience of these first three days the best I can.

M1 Orientation mixes business with pleasure. They've done a great balancing act - really. So, here's a list of things we've had to get done/ have had to learn about before getting the solemn privilege of exposure to a single patient:

• Online HIPAA training and quiz
• Read a chapter about professionalism and the physician's role
• OSHA training lecture (wonderfully informative. I was on the edge of my seat listening to Dr. Amazing Woman talk about blood-borne pathogens, MRSA, and hand-washing frequency. Those of you who know me well know I am not kidding one bit).
• Vaccines: for me MMR, HIB, and a PPD (negative; woo-hoo!). My shoulder hurts.
  

And some other things:

• student ID's
• Lockers
• Parking Permit (wonk wonk; I'm not getting one!)
• Health insurance waiver
• Learning a litany of online platforms for communication with our lecturers, administration, and fellow classmates. Seriously worse than the truffle shuffle. They swear we'll love it in a little while, but at present I just feel like I'm wiggling my belly and sticking out my tongue. BTW, we had to solemnly swear in writing that we absolutely would check these platforms for new info every day. So if I'm not Facebooking or Tweeting, that's why!
  

But, hoping you've stuck with me, here's the great part: This school is AWESOME. The deans - Dr. Schwartz and Dr. Eley - have taken such care to articulate the values of the school. I wish I could tell you the entirety of the ethos they have worked to build at that school, but that's why I'm so impressed with them. They explain in honest, clear detail exactly the types of challenges physicians face, exactly what our mission will be to our patients and communities. I listen to them with an adult mindset, but recognize that they're addressing a group whose average age is 23.4 (and I am a curve-throwing geezer). I LOVE to hear what they have to say. All of it has reinforced that I am in the right place to be learning this career.

Umm...how can I say? Dr. Schwartz set aside his well-timed humor for a few minutes while he explained solemnly that we are not to where clothing that advertises any unhealthy substance or lifestyle. His point was that our opinions will be taken seriously. We will be exposed almost on a daily basis to people whose lives have been severely altered by controlled substances and that it is not only deleterious to their health but also supremely inconsiderate of their struggle to advertise these things. The point: care and respect for the patient. Everything here has a patient-centered outlook.

Dr. Eley went to great lengths to argue for us to set limits and really do the things that, in his words, "make our souls sing." He argues for our balance and stability. He has named the temptations and named the struggles people deal with in medical school and has reiterated many times that we must maintain balance by continuing to do the things we love doing and being with the people we love being with. They give us tons of resources to help us if we falter, and make it clear that many of us will need them. They've created a rigorous program, and then built all sorts of pads and safeties into the system because, historically, they've been necessary.

I am so lucky.

No matter how delighted I am to be there, I am always thinking of what my three compadres are doing a mile away on Myrtle Lane. Are they swimming? Are they doing school? Are they having snack? Is Richie okay? So far, they've had three good days. Tomorrow is a half day for me, then I'm free on Friday. Next week will be "Week on the Wards", an introduction to clinical medicine immersion-style. I'm excited.

Oh, yeah, I've met a bunch of neat med students. Our class has a lot more women than men, plus, I tend to go for female friendships these days. These are some super solid women. I won't name names, because I'm sure I'll miss somebody or meet someone tomorrow who belongs on the list, but all I have to say is, wow. I can't wait to get to know them better.

On every level, Emory's leaders "get it" about being humane to others and to yourself. We are going to work our tails off, but I am proud and excited to have the privilege of working so hard here. Impressed, delighted, hoping I can hang.

I miss so many people!!!! :( But I'm so busy that I can't dwell on it!!!

So so busy!

Today was day one of orientation at Emory School of Medicine. I would love to write and write, but I have so much to do that I can't right now. Also, Richie needs this 'puter. But here are some pictures of our Traverse City trip. We had a wonderful, beautiful week filled with easy going family time and lots of nature. Loved it!

Rainy Night Where?

In Georgia. It is storming to beat the boat right now. This may be an entire-Eastern-Seaboard thing, but I speculate that it just plain storms more here than it does in TWV (Tidewater Virginia). I have missed these storms. Of course, maybe I think it storms more here because when I last lived here I was in high school. The timing is significant because then I was still in what I'll call my Cool Woodnymph phase, where I felt it was my obligation to defy logic and run around in the rain expressing my appreciation for all things Natural. College saw a natural attrition of such poetic extravagances, and now I am loathe to get wet under any circumstance where the water is under, say, 85 degrees Farenheit. Adulthood.

I still think it storms more often here. The storms are impressive and productive and I like them.

It's sinking in that I'm going to medical school. My first assignment has helped it sink in somewhat. I am to read chapters 2, 3, 4, 5, and most of 6, 15, and 21 in a book called Molecular Biology of the Cell. So far, I have loved it...but I'm only mostly through Chapter 2, so we'll see. But, so far, this book is more than review; it seems to see things from a perspective that has always really excited me. The authors have taken care at every step to generate an image of exactly what cellular processes LOOK like. They give careful attention to scale and multitudinousness (that's the best word I can find for envisioning thousands of reactions per second). I am excited to get back to reading (right in the next minute or so!) and encouraged that my future teachers have chosen this text with these authors because I really really like it.

Meanwhile, some practical things:

• There was already a raised bed and a corn stalk at our apartment when we moved in
• We sang "Blessed be the Name of the Lord" in church today and I cried like a dignified baby.
• I hate driving in a car with a permanently-up driver's side power window and no A/C. My irritation has matured into pure, unadulterated hatred.
• There are a ton of kids in our complex, and they run in packs.
• We can walk to the grocery store in 5 minutes or so.
• Candler Woods is the Emory equivalent of College Woods...and we can go there to get our fix of woods and lake. That's a mercy, because I think we might all shrivel up without our woods/lake fix.
• Richie needs this computer to get interactive mapping!

Love to all, b

The Eagle has Landed

Vivian and Mazie are taking a cold bath right now, washing off the itchy grass feeling they got from playing in the yard we share with approximately 12 other units. They really like it. This neighborhood (apartment complex if you like) is like Little Brooklyn in the sense that it's multicultural and family-ish. We also have some artsy neighbors with an absolutely amazing garden (will upload photos when I can).

I was in interpersonal lock-down for about 48 hours after we moved here - not really trusting my surroundings or myself in them enough to correspond with the outside world in anything more than a cursory way. I can't think of any good reason for me to have taken so long to warm up to the idea of relaxing in this new place, but it did.

From start to finish, we have had an incredible amount of help with this process. I thank everyone who has moved our boxes, hefted our furniture, tetris-ed our moving truck, fed us, and lifted our spirits at every step. WOW, have we had help.

In the past couple of days, we have taken care of some practical issues:

1. returning Penske truck to Penske place across town
2. Returning hand truck separately because we forgot the hand truck in our living room
3. Cleaning kitchen thoroughly
   
4. Shelf papering all shelves
5. Getting "as-is" bookshelf to substitute for our pantry
6. Introducing ourselves to the pool
7. Learning our way around this part of town while on various errands

I have to say that, in general, we live in a family-friendly place with an abundance of cool places to eat, interesting places to visit, and tons of events (Tomorrow, for instance, is the Peachtree Road Race at 7:30 a.m. We plan to watch the finish line, which is 2 miles from our house.).

The key is, our kids make this a home. They necessitate and create a home base. Gotta go read them to bed.

b

Michael

I don't usually care about celebrities. Michael Jackson is different. The kids on my bus played the Thriller album on a boom box that they had gotten special permission to use after most of the other kids had been let go for the afternoon. The coolest kid on the bus had a red leather quilted jacket just like Michael's. My life marked pace to the rhythm of his hits. Mimi's and Pop-pop's house was Thriller, the Anguilla Avenue house was Man in the Mirror, etc. I remember watching the videos for Thriller, Billie Jean, and Dirty Diana on VH-1. I was crushed when I found out that Michael Jackson, as well as Kenny Rogers and Dolly Parton (this shows where my musical repertoire gathered from) didn't write many of their own songs. Michael was my first introduction to the stark reality that showbusiness is business.

Of course, Michael fell out of vogue - at least for me. I was way beyond pop music. How could a highschooler who dressed in only shades of black, brown, and army green be caught dead enjoying the King of Pop?

In college, a friend adored Michael and this let me realize I did, too (I also first believed in God as a "thinking" "adult" because someone I admired did, so it made it okay for me. So shallow.). By then, he was way down plastic surgery lane and no longer looking very human. It was in college that I began to respect his profound talent. It's unmistakable in his little kid songs like ABC 123. But then to be able to move like he did - he's a phenomenon of pop talent. Amazing.

Anyway, I was struck by these comments about Michael, particularly the last one by Usher. The sadness is that Michael was ultimately a tragic figure. I feel badly for him. Who knows what cocktail of exposure, vanity, plastic surgery, and pop genius got him where he ended up. He just peeled out in slo mo over the last couple of decades. As sad as his untimely death is, the sadder part was the demise leading up to it. I can't help thinking that Showbiz did it to him.

My kids want to watch the video for ABC 123, which I am inclined to let them do.

Illustration and Yorktown Visit Pictures

A friend just told me, after finding out that Richie DID the illustration below, that she had thought I posted it because we were really "into" 18th-century dinner scene illustrations. That is a logical conclusion, since I've given no explanation. I think Richie did a great job on this project that was way out of his art comfort zone!

Happy Memorial Day!

Why I'm Spoiled Rotten Today.

I got to:

1. Get up and do yoga with Ali MacGraw and her soft-spoken yogi who tells you at the end, "For love is what's left when you let go of everything you don't need." The girls didn't get up until I was finished.
   
2. Cuddle with Vivian and play groundhog nest.
   
3. Make bacon and pancakes for my family.
4. Color George Washington with Mazie and Vivian. (Richie printed out one for everyone.)
   
5. Check to see which seeds have sprouted. These seeds have sprouted astonishingly early and, in some cases, against all odds, as the seeds are several years old. This Memorial Day, I see: Anaheim pepper, black beauty eggplant, Louisiana red tomato, Pritchard tomato, teeny tiny oregano (vulgaris), Cardinal tomato, Carantan leek, Thymus vulgaris, Sweet basil, Musselwhite bell pepper, Burpee Big Boy Hybrid tomato, Michilli Cabbage, Roma tomato, Brandywine tomato, sorrel, Muskmelon, french green lentil, and castillo lentil. Now to figure out what to do with the sprouts!
6. Take Mazie and Vivian to the pool for its opening day. It's cloudy with fits of rain today, so the intrepid swimmers only stayed in for about ten minutes.
7. Play the game of Uno that WOULD NOT END with M and V. V forfeited about ten minutes after I started drawing and playing for her because her activity had degenerated to the point that it was necessary to do so.
8. Make rockin' sandwiches that involved garden greens and melted mozzarella.
9. Later on I'll go to a cookout and see some of my favorite folks.

Yay, Memorial day. While I have been living it up, Richie has been doing this very cool, but very involved illustration. This is a sneak peek.

Best for your Memorial Day!

Vivian and Mazie

This morning, Mazie and Vivi were eating breakfast and we were listening to the radio. A local add came on saying something about, "If you're interested in technology on the radio...blah blah blah." The ad passed, Vivian finished her bite, and then said, "I'm interested in technology on the radio." And she sounded really serious, as though that ad guy had been addressing her in particular. That was cute enough to crack up Mazie...and me, of course.

Vivian waited another minute and said, "I know what technology is. It's when people dig in the ground to find out what happened a long time ago." Sweeeet baby.

Mazie has learned enough that she rarely makes these cute juxtapositions. The thing about her that is so fun right now is just listening to her go. If she has a mind to, she'll talk about every detail of her day. She is very aware of what other kids say and how they act...what they like, if they're acting "off" from their normal behavior. She's sensitive to getting bossed around, and tends to avoid bossy people. She likes Ian, Grayson, and Jackson - anyone else who's consistently nice to her.

Mazie likes doing math in her head instead of on her fingers, but she's better at getting the right answer if she uses fingers. It's fun to hear her describe how she comes up with the answers she gets in her head. For instance, I quizzed her on 7 + 7. She told me 14 because she remembered it. Next I asked her 8 + 8. She thought at length and said, "Okay," at intervals. Finally she said, "16!" When I asked her how she decided on 16, she said she imagined two columns of seven and she added one to each one and then she reasoned she had to add 2 to the previous answer because she could "see" them. Next I asked her 9 + 9 and she quickly said, "12!" She finally worked that one out on her fingers to get the right answer. It's hit-and-miss right now, but I think she's dying to memorize sums to make it quicker for her. I'll have to get on that...without overburdening her.

Off to the bus stop.

I love jogging in the woods (from a few days ago; waited on photos)

I love to call what I do jogging because that word connotes moving around, even jiggling, but more up-and-down than forward. And that's how I roll. Our apartment is less than a mile from 5 (or so) miles of woods trails.

I was pure ebullience this afternoon. I had a difficult jog, less easy than I'd like it to be, but I absolutely have to rave about the following aspects of jogging in the woods:

1. Green sunshine. Filtering through leaves. It's so bright and so lacy.
2. Smells of leaves and flowers and dirt.
3. Skittering animals. All the animals do the wave as I jog past - squirrels, birds, deer, unseen slitheries in the leaves.
4. Very Few People. I like people, but I crave running in solitude. The others I meet seem to share my tastes.
5. The single-file path has hills and turns and little ledges. I get that zooming feeling fairly frequently without having to go fast.

God meets me in the woods. The end.

Day-to-day

It's the first hot + overcast day of the year. Before today, if there was cloud cover, it was cool cloud cover. I'm just hoping the humidity doesn't decide to consolidate and rain down on the clothes I have hung on the clothes line. In other news of the neighborhood, the pool area (just behind our apartment) has been buzzing with activity for a week solid. The dedicated maintenance personnel are scurrying to de-debris, chemically zap, and filter the pool before Memorial Day weekend. Mazie and Vivian have taken note of each stage:

"Mommy, they're using the leaf blower!"
"Mommy, I can see the water!"
"Mommy, what's in the water?"
"Mommy, the pool is bright green!"

And, today, "Mommy, I think we can swim now!" Yes, and then we can put you in quarantine for decontamination protocol. The truth is, I'm pretty excited, too. Looking forward to donning my wetsuit to brave the - gasp - 70 degree water. I never thought I'd be so "sensitive to the cold." But it seems that as years fly by, I am on a steady path towards more closely resembling my mother in every detail, including cold intolerance.

I'm blogging about nothing to avoid writing about the fact that we are MOVING IN FIVE WEEKS. Good grief, how the time flies. I guess I'm lucky to have waited until the passage of time has approached light speed to begin medical school. At this rate, I won't notice I'm in it until I'm half done. Today's preparatory activities include but are not limited to (and I am, officially, a "doer"):

• Trying to find e-mail about preschool programs in Decatur (Fail.)
• Putting Vivian on wait list for Fernbank pre-K (Pending. Can only do in person.)
• Researching moving truck rental rates (check.)
• Scheduling check ups for immunizations for Mazie, Vivian, and....me! (THREE Checks.)
• Delivery of brownies and thank-you note to kind dentist who treated my dry socket pro bono (Check.)
• Purchase of stamps (pending.)
• Sorting of the birds' nest of hand-me-down electronics in the top drawer of Richie's desk (check.)
  
• In hopes of finding the charger for the camera (fail. It's at work with Richie) that I need to use to...
• Transfer peoples' wedding videos onto DVD. (pending) (Y'all probably thought I forgot. But not ONE day has passed that I have completely forgotten that I promised some footage...and I secretly believe karmic bliss waits on the other side of completing this task.)
• Find and print physical evaluation form for check-up. (check. Discovery: my doctor will be asked to respond in writing to the question, "Do you know of any physical or psychological reason why this student would not be able to withstand the rigors of medical school education?" The next seven years of my life apparently hinge on this.)
  
• Purchase plastic bags for sorting small things. (pending)
  
• Hang dry two loads of laundry. (in progress.)

I just want to give a shout out to my season. I love running in hot weather, dressing for hot weather, being hot. I love that I'm less ravenous in summer and that my shoulders can stop creeping up near my ears and relax into the warm atmosphere down by the rest of my torso. I love being able to dry laundry on the line where the sun is free free free. I love that my oregano is finally coming into its own.

Finally, I'd like to explain the Hunter drawing I posted. Mazie was listening to a CD that has a song about camoflouge. This is the picture she drew while listening. The deer is saying, "Run."