Still Here...

I'm in renal module - physiology and diseases of the kidney, acid/base balance in the body, genitourinary system, and some other fun stuff. I LOVE the kidney. I have Dr. Paul Heideman to thank for that. His animal physiology class back in 1998 (Oh, dear; has it been THAT long? Renal physiology has probably CHANGED since then!) got me thinking about kidneys. I actually remember explaining renal function to Richie when we met because I was so excited about it. That's weird. But Dr. Heideman loves physiology as well as the process of teaching/learning so much that he made animals' nitrogen excretion quite compelling. That was a great class. It was the first class that got me thinking that maybe I LOVE PHYSIOLOGY. And I do. I actually STILL do.

The kidney contains about two dozen plot twists and quiet ingenuities. So cool. AND, now I've held a kidney in my hands. We cut it in half so we could see the renal pyramids, the cortex, the medulla, all the vasculature, and the calyces. It's as discreet and tidy as you can imagine. Who could think that something so small gets an amazing 20% of our cardiac output? Without kidneys, we're toast, and sadly I knew only the vaguest of information about them before animal phys. Oh, I knew that they are more or less where urine comes from. Otherwise, my only information was that: a) you could allegedly awake in a tub of ice with your kidneys missing, the victim of the black market organ trade, and b) it hurts to get punched there (I owe this knowledge to Pete, who thankfully never gave me the dreaded Kidney Punch, but who referred to it enough that I knew it was mystically disabling).

Anyway, I'd like to give a little primer of kidney function, but I'm afraid I'd fall miserably short. I would be telling a story with incessant diversions. I will say only the following: It keeps your body cleared of stuff you don't need, keeps your blood pressure steady, keeps you in acid/base balance (which keeps you alive), and performs a number of other important functions such as regulating the number of red blood cells you make and your vitamin D levels. It's truly AWESOME, and that's without mentioning anything about countercurrent exchange mechanisms, filtration, secretion, urea cycling, tubuloglomerular feedback, or any of the kidney's other tricks of the trade. I am shocked it all fits into these two modestly-sized bean-shaped organs.

Ahhh. And it's summertime, so the windows are open and I get to sleep at a balmy 80 degrees. No cold feet. No goosebumps. Ice in my water. Outdoor sounds (which presently include the sound of hair-drying, I think). The girls and Richie have been going to the pool every day. Usually I use the time to study since I know they're all happy without me, but today I went swimming with them. So fun! Mazie can swim completely unassisted in the deep end. She's not freestyling yet, but she's proficient at underwater swimming. Vivian is more of a tadpole right now. She's getting the hang of it, but she tuckers out too easily to be left alone in the deep end. She can toodle around the edge of the pool and make it across the deep end if given a shove at the outset. But they both love it (Richie, too!). We do underwater teaparties and Attack Daddy and touch the bottom of the deep end together and all sorts of fun things. I was glad I went today.

Spring/early summer

Now posting has become a seasonal event. That's the way right now. If I have free time, I'll be darned if I'm going to spend it inside. And lately I have had little (Saturday mornings are family mornings for us).

We just finished our GI module and anatomy. By the end of anatomy, we have so thoroughly dissected every body part (I sort of want to use a Native American analogy about using every part of the body; but I'll resist) that the cadaver is really really discombobulated. We can't help it; we saw everything and figured out exactly where it was and what nerves, arteries, and veins supplied it, etc., but in so doing separated so much from so much else that some things are no longer recognizable to people who didn't participate in the dissection. We were meticulously respectful of our cadaver, but you just can't learn the dissection without getting between the parts and taking apart what was together in life.

I will be relieved for the cadavers to be cremated, as they will be this week. They have given us a learning opportunity that is probably more profound than it feels right now, which is pretty profound. I have HELD a kidney, heart, lungs, spleen, GI tract, etc. I know what nerves look and feel like. It's amazing. Even as I write this I'm thinking about body parts I wish I'd gotten to know better. Our cadaver was male, so I wish I'd gotten to see a few more uteruses and ovaries because if I practice OB/GYN, I'll need that. Now I'll have to wait until the brief window next year between the dissection of the last body parts and the closing of the lab for the year. In all, I saw and understood much more than I expected to see and understand. I am really thankful for that.

I am also really eager for these cadavers, these bodies that are now thoroughly asunder, to be ultimately disorganized. I want them to just finish their entropic journey and become ashes. It may be less organized in a way, but right now they're in a disturbing state of purgatory between organization and disorganization. Resolution will be good. There's a memorial service that I'll be attending.

Anyway, I have to go to bed. Renal module day two awaits in the morning. I like kidneys. PS Vivian and Mazie finish their school year on Friday!!! I could just go on and on, but the cork will have to stay in the bottle tonight, per the usual. Peace.

So, in no particular order, these photos are from a day at Stone Mountain, Mother's day at Kennesaw (we used physical sunblock so all the photos from that day look like phantom of the opera), my friend Laura Jane who fed us dinner taking pictures of M and V clamoring for sweets, Vivian doing dishes (she loves this), and me studying at my favorite study spot.

So much for observing National Poetry Month.

National Poetry Month, I have failed you. I'm sorry. The days have been SO busy, even during spring break. I have been attacking other things I need to do in the times that I'm not studying. Still, only half the list is done :(.

Love to all.
B

Moveable Feast...

The timing of Easter is as follows: The first Sunday after the first full moon after the Vernal Equinox.

Odd superimposition of Christian observance overlaid on the Jewish Passover and then again upon the Rites of Spring (or something). But who cannot help rejoicing at the newness of the vegetation and the return of warm days and the Morning Chorus (I adore the LOUD morning chorus outside our apartment in the morning. Everyone is singing to beat the boat: Chicka Dee Dee Dee! Piri piri piri!"

We had a delightful Easter. I'll post pictures when Richie uploads them - morning egg hunt, afternoon egg hunt, and Easter dresses.

Richie and I were picked to "hold the elements" today at church. This responsibility entails walking up at the appropriate time and taking the pre-poured grapejuice and the bumpy bread and standing at the head of the aisle (Richie on his side and me on mine). We don't even have to say words over the elements, although I prefer when people do say words for me. It was my first time, so I settled on just standing steadfastly with my thumb buried in the end of the bread so it would hold tight when congregants tore pieces off. I figured I'd work words into the routine next time. But...there may not be a next time.

Everything went seamlessly at first. We caught our cue, we got the elements, we stood. We managed to keep the bread on the plate (so it was not a moveable feast today har har har). Just as I was beginning to get cocky and think this was not so difficult after all, things started to get dicey in my line. One of the people filing through my line is a man named Tom. Tom has been so incredibly nice to us since we started attending this church that when I saw him all smiley on Easter Sunday about to take the Lord's Supper, I just felt very emotional. And I started crying. My lip began trembling at the person after him, but the tears didn't start to pop out until several people after Tom. And, with my hands occupied with the elements, there was no wiping my tears away or hiding the fact that I was overcome with emotion. So I just stood there...crying and smiling and doing Lord's Supper.

I don't know what the people in line, most of whom I've never met or seen before since we are new to this church (and Easter turns out all the people who never come otherwise). Either they thought I was just like Imogene Herdman crying at the end of "Best Christmas Pageant Ever" or they thought I was unstable and possibly dangerous. I should feel embarrassed, I guess, but I don't. I have always cried a lot in church because I cry when I'm happy or sad or feel strongly about anything at all. Maybe there was a fellow crier in the line who was just glad it wasn't them.

Then, at the end, the Lord's Supper servers serve each other. So Richie and I went up and started to serve each other but we couldn't work out who would do what, and whose cup and bread we'd use, so there was a lot of shuffling and some holding dishes between belly and arm and at least one loud clink. We finally accomplished the task and took our seats. I have never seen anyone else get so discombobulated serving the Lord's Supper.

Then it was over and we left right away because we had to take Mazie to Nana and Poppy's for spring break. So we got no feedback, bad or good.

Richie's folks had made a lovely Easter meal, so we ate lunch and celebrated birthdays with a cake and then we dyed eggs and had an egg hunt. I say "we" loosely, because although I didn't actually take my flash cards to the table with me, I managed to study most of the time. I was present, but aloof with stuff in my hands. More on this strategy later when I have more time...there's another boring study methods post waiting in the wings.

We had a change of plans late in the game today. Mazie is on spring break with Nana and Poppy. We were taking Vivian home with us because her spring break was weeks ago, but then, when we were 10 minutes towards home, we felt wrong about separating the two of them. We decided to take Vivi back so they will both be with Nana and Poppy. It would have been okay to separate them, but they both looked relieved that they'd be together. They are often adversaries, but they adore each other and take great comfort in the other's presence when the chips are down.

No kids tonight and we feel weird. I worry about them compulsively, but I know they're in good hands...

So, now it's time for bed 15 minutes ago! I hope everyone had a delightful Easter!

Sorry about the typos!

HA! I just re-read some former entries. Instead of going back to edit them, which would take more time, I'll just apologize for those past and those I have yet to make...I haven't been proofing. I usually type the entries standing up while brushing my teeth or something like that - one day I hope to return to a life that permits rechecking my work, but this month is NOT it! BEST!!!

Season of Poetry.

Favorite Justin Moore quote: "God didn't make ice cream so we could sit around not putting it in our coffee.)

Favorite Justin Moore flourish: "Clap! Clap-clap-Clap Clap CLAP!"

Favorite Justin Moore tradition: Observing National Poetry Month.
In honor, I will be checking Justin's blog to see what he has to bring to the poetry table and I will be posting some poems that I love as well.

In other poetry news, I just found out that a friend's poems have just been published in the New York Quarterly, and that's reason for celebration.

So, here's the meat and here are the bones:

Haiku by Basho:

Husking rice,
a child squints up
to view the moon.

General school update

So, I'm in my cardiology module, which is why no blogging has happened. Some cardiology surprises: holding human organs is always really fun, but the heart is pretty amazing. It's sort of spatially complex - more complex than the 2-D diagrams of the four chambers can portray. it's as though someone took a 2-D diagram and gave it a squeeze and a twist. The aorta is huge. It shouldn't become TOO huge, which is, clinically, over 4 centimeters in diameter!!!. It can be really big. I am functionally deaf, as usual, and that is a problem in cardiologist. I think I have an actual handicap that will preclude me from becoming a cardiologist because my ears just don't hear a lot.

Then there's the obsessive listening (with these poor ears) to anyone who will let me at their chest, which means my husband and my kids, but mostly myself. I have a weird heartbeat because it is abnormally slow and I have an - er - thin chest, two factors that conspire to make every little heart sound much more audible. It's really fun to listen and be able to (roughly) imagine what's going on in there. Now (and I mean right this very minute) I need to remember what EXTRA sounds are what. Dr. F has warned us that his test will be made of questions for which you need to implicitly figure out points 1-3 to answer each one. He's an efficient man.

Of note, Grandma was here for the girls' birthday (thank you, Grandma!!!) which made it special for everyone. I'll post pictures soon.

Meanwhile, I'm working hard and exhausted. I almost had a hissy fit yesterday because the bus I was on idled for too long for my taste (and I saw another one I could have taken departing just as I got on the idling one - rrrr). I think I need to ramp down a little bit :).

Fun Day at the Park. Note: paper airplanes supplied by Grandpa Pete.

Our buddies came to town! What a great visit!


The above two shots are Vivian and Mazie at a pool party - indoor pool, of course :).

I am not left-handed either.

We are watching The Princess Bride after a week of successful chore-charting. There is homemade pizza cooking in the oven and some ice cream in the freezer for later. They earned it! I'm enjoying it, too...

I just finished the unit on pulmonology. It was difficult, but rewarding. I like lungs and I certainly understand them and their pathologies a lot better now than I did before this month. I've been doing some thinking about this thing that I'm trying to do. It requires absolute focus. Getting sick, family drama, a sick family member, or having unplanned events pop up can really mess things up. I have to stay on top of my school work ruthlessly, which means:

• Reviewing every lecture the exact same day


• Not just reviewing but also memorizing that exact same day. Keeping my running lists of keywords, drugs, and diseases...that same day. EVEN IF I'M DISSECTING.


• Absolute attention in class. For this means the front row because I get distracted by others' computer screens.

Special needs I realize I have:

• at least six hours' sleep. If I miss more, I get sleepy and can't do the above list.


• Exercizing hard each day. Again, I can't focus with the level attention I need and I get too stressed out if I skip it. I have learned this the hard way. Luckily, exercise does the trick. It takes time but it makes up for itself in productivity gained.


• NO CAFFEINE. I adore the taste of coffee. But if I have it, even decaf, I get all batty. And, again, I lose time being batty.

It really helps me to have something to look forward to. Whether that is a jar of hot tea that's cooling or the fact that I'm going camping over Memorial Day weekend, it's enough. Usually, it's just food and my family that I'm looking forward to or going to bed or a weekend where I can take a break on Saturday morning. That's one thing: working super-hard makes family time so rich it's unbelievable.

Anyway, the pizza's done now and I'm going to eat and enjoy the poison in the cup scene.

Photos soon! (Unfortunately, Vivian crashed today while skipping down a hill at the nature walk at Fernbank Science Center. It was the worst crash she's had this year. She scraped her elbow really badly and hit her face and forehead...so prepare yourself for pictures of a very banged-up kid. Also, our car broke bad this morning :(. And our vacuum broke and it's not the belt :(. And I pulled a muscle in my back :( that is now on the mend :). But it will be okay, right? Right. After all, spring is coming!) Here is an emoticon of spring sprining: iiiiiiii #0o0# iiiiiii That's a cross-section of eggs in a nest among a field of budding (though rather homogenous) flowers. I don't know why the nest is on the ground. Maybe it's a quail nest.

And here's something else really cool. Heart muscle is wrapped around itself helically. It's sort of a double spiral.

Okay, now I'm finished.

Why we still have quiet time on weekends

A New System

The System:

The girls need a well-enforced reward system, so tonight we made one.

They have nine expectations for the day that they do without putting up a fuss:

1. Follow table rules, which are general manners - Nix: potty talk, ugly talk about the food, though saying you don't want to eat it is okay.
   
2. Follow house rules - no destroying things, etc
3. Follow car rules - nix: shouting in the car, running into the parking lot when you get out of the car, using the power windows, etc.
4. Get dressed
5. Brush teeth
6. Use a positive tone of voice (no whining)
7. Do homework (include math facts practice)
8. Clean room
9. New today: obey right away. We've had a problem recently with incessant stalling...

Each expectation is noted on a chart with a spot for their magnet for fulfilling it. They start with all their magnets in hopes they won't have to hand over too many of them. Finally, they get one star at the top for the WEEK that they lose if they strike or fight with one another. It's the shining star of peace.

Reward system:

• a nickel for each magnet regardless.
  
• $0.25 for maintaining the shining star of peace for the week. Also, you must maintain the shining star of peace for the following to large rewards.
  
• no less than 5/7 magnets in each category: Movie on Saturday morning (while Richie and I clean...see the logic here?)
• no less than 6/7 magnets in each category: Movie and dinner of choice picnic-style plus a dessert on Saturday night.

Ahhh....Now for consistent enforcement. It occurs to me that this is really elaborate.

The extra pictures are robots Mazie and Vivian and Richie designed and built. Also, tonight I heard a very brave if not outright insane cricket...for about 8 well-spaced chirps.

I'm in study mode

I just wanted to say that I am hunkering down and studying which is why I'm short on words right now. I've been a little more irritable than usual. I'd give details, but they're not fun.

My partner and I did our demo for our eye dissection (above) yesterday morning. We were supposed to demo (which takes 10 minutes) sometime between the hours of 8 and 9 a.m. I had been in lab late Monday night, which was when we rehearsed and got everything in our demo down pat within the required amount of time (we have a strict 10 minute time limit). Then I was in again at 7 just to brush up a few times before we actually did our presentation. I ran through once and got totally discombobulated on all the words I had to keep straight - lateral rectus, medial rectus, inferior rectus, superior rectus, superior oblique, and inferior oblique and then each of their motions - each has three. This is not unusually complicated, in fact, it's one of the easier demos so far. That one section just had so much overlap that it was hard on the tongue.

Anyway, I got nervous...and thus spent a good deal of time in the bathroom....and came back to lab at 7:45, ready to run through it one last time to get everything straight again in my head and on my tongue before our presentation.

Each of six preceptors hears and grades our demos. They all have different expectations and different reputations. Who should arrive just as I returned from the bathroom but Dr. X, the preceptor with the most - ahem - difficult - reputation. Surprise! He was ready for us to do our presentation for him! So, I buckled into business mode as best I could, but I was shaking so badly I could barely hold the probe to my ciliary ganglion. I said everything I needed to say, very shakily. David did beautifully on his half, though, and in the end we missed no points. But I could feel the adrenaline rush for the next hour and a half.

Demos are difficult. While one can learn the structures and their relationships perfectly well without a demo at the end, the demo adds the elements of performance and muscle memory to the equation. While it seems really weird in some ways to have to do a song and dance now (some people literally sing their demos), I suspect this won't be the last time I'll be performing and relying on muscle memory to do my job. I just hope I lose the shakes by the time I'm doing the real job.

Mazie and Vivian and snow...no pictures ;(

No pictures because I forgot to send the camera.

It snowed about 3-4 inches here last Friday. Mazie and Vivian stayed with their Nana and Poppy and made snow angels and drank hot chocolate and played with Reuben (the Staffordshire terrier). They tried to make a snowman, but the snow was too powdery so it ended up being sort of a snow pile. Mazie, ever optimistic, exclaimed, "Hey, Vivian! We can sit on it!" Pragmatic. Herman Miller snow chair. Now available in...white.

Going to Nana and Poppy's is fun. They did a ton of fun things, watched no small amount of television, and ate as they pleased. I asked them what their favorite thing was on Saturday, expecting it to be something snow-related. Vivian's favorite thing of the day is almost always dessert-related, by the way. Mazie tends to choose activities or special events. Anyway, Mazie's favorite thing was, emphatically, making snow angels. But Vivian enjoyed making Valentine's cookies (courtesy of Nana) more than she enjoyed making snow angels.

It's been a fun winter. I'm glad dissection coincides roughly with winter because, as surreal as it is to be in the basement with cadavers, there would be more opportunity cost if it were also gorgeous and warm outside. As it is, it's sort of fitting in a dark night of the medical student's soul sort of way.

(Those with a weak stomach proceed with caution. What follows is not meant to be disgusting, just frank reflection...)

Today we started dissecting the orbit and eye. This is by far the lightest dissection, workload-wise (hence, the time for a blog post about it), but also by far the most tedious and delicate. The nerves we're finding are like hairs in some cases (although some others (optic) are quite large). We begin the dissection from the brain side of things. The team before us dissected the brain and face, so the brain and calvarium (skull cap) have been removed and now tidily reside in a plastic bag within the larger blue body bad that holds our cadaver. The brain-ectomy paved the way for us to chip through the floor of the anterior portion of the skull (imagine a shelf just behind your eyebrows) so that we can have access to the eye socket from "above" (though our cadaver is obviously horizontal, so it's more like the side). We do this because this point of access allows us to dissect the muscles of the eye and most of the vessels and nerves without actually removing the eye...one gets a good sense of relationships that way.

Lab was a little cacophonous today. None of our dissections have involved bone power saws (other teams have had to use them), but in this dissection, everyone was looking around for a spare mallet or chisel. I haven't used a mallet and chisel much, but I think I could definitely get used to it. In this case, we had to take care not to damage the soft tissue underneath the bone as we chipped through. The lab was a chorus of "Tink. Tink. Tink-tink." Girls and boys alike looking a little bewildered with their tools. Then there was some scrape scratch scrape as we used...whoops forgot the type...long toothy hand saws to cut slices through the skull roughly at either end of the eyebrow to chip this portion of skull away for the sake of better access.

The actual eye structures are embedded in a lot of fat. It's really fun to get through the fat to the structures hidden within. It's like candy in Easter grass. ("Oh look, another jelly bean!") The only problem is that if you're too cavalier with your grass, you destroy your candy forever. A miracle of development, growth and function plucked into obscurity. That raises the stakes a little, I admit. My shoulders ache at present with the effort of it, and my right hand is sore from tweezing. But it was really, really cool!

All the basic structures are our old friends by now, found on a miniature scale in the orbit. Arteries are round, firm, and squiggly. Nerves are like wet strands - fibrous and discrete. Veins are tired, limp versions of arteries (owing to having much less smooth muscle in their walls). The muscles of this dissection are amazingly sensible. For example, the muscles on the superior aspect of the eye contract and, voila, the eye looks up. There are six, total, and their functions are very intuitive - some are even pulleys!

Anyway, I could go on and on. Today was what I imagined anatomy dissection to be: intense, revelatory, and detailed. No queasiness (actually, the first two minutes that I'm in lab require a mental shift, but it keeps taking less effort). And now I'm on to review Interstitial Lung Diseases. Tonight will definitely be one of those nights where half-sleep is littered with brightly lit, burned-on images of picking through fat. It happens to about half the people I've talked to. For most people, myself included, the anxiety is somehow related to cadaver fat getting on your face, in your hair, or on your skin. Weird but true. Luckily, the troubled sleep disappears when we stop dissecting :).

Theme: Medical school is intense. Lots of responsibility, lots of challenge, lots of privilege. Who gets to dissect an eye? Most people wouldn't want to, most of the rest never get to, and those who do probably do it once in their lifetime. It's very cool and I feel very lucky.

morbid curiosity

The title sounds worse than it is. It's my job right now to have morbid curiosity. I came home on the shuttle yesterday afternoon. I had been to an anatomy lecture to which we were instructed to bring our skull from our bone box. Back up: for anatomy learning purposes, each of us shares with our partners two boxes of human skeleton - one containing the skull and the other containing the remainder of the skeleton. So I was transporting my skull box with skull back home. It's a the size of a generous lunchbox but is made like a black plastic instrument case and has stenciled on the outside: Anatomy Dept.

I was walking home from the bus stop, past a line of stacked-up traffic, when I realized I was walking past what appeared to be a freeze-dried squirrel on the sidewalk. I was immediately interested: it wasn't squished, so how did it die without getting squished (Acute respiratory distress syndrome? I crack me up). How come, if it wasn't squished, it didn't get scavenged? But I thought, for the sake of adhering to social norms, "Ignore the squirrel, Brandi. Just keep walking...".

But I was holding a human skull. And when you're holding a skull, you can inspect a dead squirrel, by golly. So I stopped and peered. I turned it over with my shoe. Hard to say what happened to that squirrel to land it in the state it was in. It was just dried-up and hairless, yet not flat. This was primarily an act of getting closer to what my role will be. Fascination is supplanting disgust. Surprise!

Also, I cleaned vomit on Super Bowl Sunday. That's always a little challenging. I'm not complaining because I wasn't the one vomiting...Richie was. He got a stomach bug that's been sweeping Decatur. While I was cleaning up, I was wondering where (in which body fluid, I mean) the greatest concentration of microbes would be. Of course, every surface received maximum disinfection, no matter where I estimated to be the germiest. Our house still smells like bleach and the girls are getting dishpan hands from washing them so often. Poor Richie felt awful. He was gray and wobbly and soooo sick. But now he's walking and talking and no longer vomiting. Yay!

Off to memorize the skull bones and all their features!

med school has done some things to me

I read the word "infraction," and I thought it was "infarction" spelled incorrectly.

I am no longer weirded out by the idea of seeing a dead body.

I can't talk to someone without noticing details of their skin texture, any visible lesions, posture, gait, etc. I don't necessarily know what all I'm seeing means yet, but I know that it connects with their health history some way or other.

It occurs to me that I will have to actively stop myself from approaching people on the bus and telling them they should have so-and-so checked out if they haven't already.

I am starting to see people who are down and out as a collection of medical problems...and now I can imagine in more detail how miserable those dysfunctions make that person.

I am on the cusp of being useful in the medical setting. More on that and on something we call "OPEX" when I have more time...

Biking

So...biking. It's something most Americans learn to do at some point, and some of us love to go really really fast. Richie and I share a love of speed that I hope our kids don't share because it's dangerous. Just kidding - I want to ride roller coasters with them. Mazie has been a proficient cyclist for about a year now. She has recently taken to riding down the hill in "back" (we use that side of the apartment almost exclusively, so I think of it as the front) of our apartment building. She goes peeling down the hill at an angle, then makes the quick right-hand turn to just miss crashing into some concrete steps at the bottom. The first time I saw her do it, I almost peed my pants with fright. I realized she'd been doing it for a while; I had been out of sight range of where she'd been finishing her descent. (Bad mom; I know). She always wears a helmet and seemed to be pretty good at her maneuver. Plus, "Hill" is a generous term for the area in question. It's more of a "grade." Mostly, she LOVES going down the hill. So I let her continue to do it.

I remember last year when she was learning to ride. Mazie attacked the task of learning to ride a bike with the intensity of a fighter pilot. She was somewhere between "I-can't-do-this" and "Mama-I-can-do-this-myself" for about three months. We had a long run behind our last apartment, so I'd run beside her, steadying her bike and calling, "steer, steer, pedal, pedal!" She sort of loved it and sort of hated it. She was absolutely focused on the goal, but incredibly frustrated with the slowness of achieving it. Every session ended in tears of frustration. I finally learned to limit the sessions to about 7 minutes (both for emotional preservation and for the health of my lower back). Mazie would scarcely let me quit the session unless she had gotten to the crying point, and even then she'd want to keep going. Oh, man, was she tough. She was committed but sensitive, 100% focus. Eventually she graduated to a hand on her back, then to just a push-off. At last it was time to learn to start herself, which she accomplished entirely on her own when left by herself one afternoon.

And now she's careening down hills and biking ALL THE WAY around the lake with me.

Enter Vivian, stage left. She is learning to ride this year. Vivian, predictably, could not be more different than her sister. If Mazie is a fighter-pilot, Vivian is a surfer. Today she waited a full 45 minutes to receive help while I finished making chili and cleaning up the kitchen (Richie is at a computer class for his job)...no pushing. When I went out to help her this afternoon, her attitude is just the same as it's always been about biking: avid but relaxed. She'd bike along, wobbling her front tire crazily so that it almost went off the sidewalk on one side, then on the other, and then the bike peeled out and I caught her as she tipped to the right. She exclaimed, as she let out a deep breath, "Huh! That was fun!" And, yes, she wanted to try again. We looped around the apartment building. On the opposite side a family with little kids had left out at least 70% of their toys for the neighborhood to take a gander at. They're all spattered with mud and I think some haven't changed positions since we moved in last July. As Vivian rode past, she rubber-necked like crazy at their toys and veered off the road completely gawking at them. She does this a lot. When we went to the lake, we could barely keep her on task because she kept gazing: at the lake, at the birds, at dogs, and at other people. She'd gaze to one side and then veer off in that direction. Then she'd crash and laugh a sweet goober-ish laugh. But she's getting it...I think as fast or faster than Mazie did. She's at the needing a push-off, accompaniment, and occasional stabilization phase. I don't remember her ever crying about the process unless she falls and hurts herself. She is just a completely different person than Mazie.

I love them both so much! I really think I would not know who one is without the other and vice versa! They each make me a better parent to the other. Amazing.

Richie is so good to me.

The comment I get the most when I tell people that I have returned to medical school after nine years out with two children and a husband in tow is something like, "Wow. Brave. You must be very busy!" Right away I feel guilty because I know that my husband has absorbed 100% of what I no longer do. Last night, I came home a little late because I'd been practicing for my lab dissection demonstration (my "demo"), and he was in the middle of making a double recipe of lentil-chickpea stew. He told me to go into the living room and play with the girls. Not set the table, not help out in the kitchen; go enjoy our children.

After we had eaten the delicious meal of stew with bread and cheese, he took the girls upstairs and did bedtime routine with them so that I could study. Then he went to the gym and told me to leave the dishes for him. He came home and did the dishes. Then he stayed up until I was ready to go to bed - 11:45. This from a man who prefers a bedtime of 9:45. He stays up with me because one of the pillars of our marriage has always been to go to bed at the same time. It's like pressing the reset button on our connection for the day. Plus, and I am the luckiest person in the world because he reads me to sleep. (We are still working our way through Animal, Vegetable, Miracle.)

But last night I was extra-stressed because my demo was at 8 a.m. this morning and I have a test on Friday (that I am about to start studying for). So I was sad and I cried a little once I got into bed, mainly because of tragedy in the world and feeling inadequate and out-of-control. You know, the usual. Richie massaged my hair and told me it will be okay. Then he read me to sleep. He was so tired that he fell asleep in the middle of a sentence.

I assert that I am THE highest-maintenance wife this side of the Mississippi. Richie has served me extravagantly over the past several months; last night was one of many (most) where he bends over backwards to make things easy for me. I am so thankful.

So when people say, "Oh, you must be very busy," I immediately reply, "Actually, my husband is the one who really makes it possible. He does all the work." The more accurate answer would be that I am more well-cared-for than any other med student on the face of the planet. This is a team effort. Although I am the one actually enrolled in school, Richie is Team Captain. I love him. I LOVE him.

Brief update; pictures to follow

This morning is mostly typical of my weekend mornings. I tried to wake up at five to study, but since I stayed up til midnight studying, I got up at seven instead, when the girls woke me. Vivian was the first one out of bed. She had an accident this morning, a twice-a-year event that worries me about her continence and stress level, but not unduly. I think sometimes she just decides to go pee in bed. That's what she told me the last time she peed in bed. Anyway, this morning she shuffled into our room at about 6:30 to let me know she had had an accident. I was in denial, and asked if she could see well enough by the night light to change her jammie pants. Duh. I forgot, somehow, that the bed would need to be changed as well and that moral support is required after an accident. So soon I was up changing the bed and getting Vivian settled. The second, obvious level of denial was that at 6:45 there was any hope of snuggling in and sleeping more.

And now Mazie was awake. She woke up smacking her mouth sleepily and yawning. I thought we had woken her, so I said, "It's okay, Mazie, you can go back to sleep" (note denial). She replied, "I know it's okay; I was having a GREAT dream!" Well! That's great! Sometimes I think their moods upon wakening are temperamentally determined and other times I think it's developmental. I think four is a difficult age for everyone. Both my kids have been more negative and more volatile at age four than at any other age. Five is liberating because, finally, their independence and capability are catching up to their intentions. But four is a doldrum year in our experience.

Basically, I returned to bed only to retrieve my bathrobe (I spread it over my side of the bed for extra warmth). The girls and I came downstairs because our neighbors, whom we love, sleep on the other side of a thin wall from the girls' room so that I'm pretty sure that every little bump from the girls' room translates directly to their eardrums. The girls brought down their dress-up arsenal and began playing "historical girl" while I booted up my laptop to start reviewing powerpoints. Also, I started a pot of half-caf. ("Half caf double decaf with a twist of lemon..." props to anyone who can call the movie that's from :).

First, historical girl. Mazie has been reading the American Girl series, the Little House books, and a different but similar series called "My America." Historical girl combines storylines from these three sources with certain favorite dress-up items. They repurposed their cook's hats as bonnets and they wear their dresses in confusing layers.

And studying. I have been through several permutations of trying to get the material as well and as efficiently as possible. We learn mostly from powerpoint slides and talks, so that's where the beef is, so to speak. I started out trying to honor the paperless goal of my school, but that failed immediately. Then I decided to take notes on paper in class, noting the slide number so I could use a combo of my written notes and the saved powerpoint file. FAIL. It didn't integrate things well and still relied on my learning mostly digitally. Next, I decided to use paper liberally because this is important, darn it. I commenced the longest-term studying solution so far: printing out slides before lecture, taking notes right on the paper printout, then having a hard copy to study from. The problem here... lots of font sizes or figures are too small to make the handouts practical. Plus, my hurried scrawling captured detail but made the finished product both visually and conceptually confusing (ppt provides little hierarchy of ideas). I decided what was lacking was logic and overview, which is still lacking in the printouts because they follow that exasperating ppt. format.

I have now gone all the way back to my tried-and-true study method of copying out notes longhand in outline form. The advantages: First, processing the concepts into a logical framework from which to build. Second, my own handwriting gives me some visual latitude to underline, star, all-caps, box, diagram, and arrow to my heart's content. Finally, taking the time to make a lovely handwritten study sheet is perhaps the best learning time I have as I mull over the concepts. The drawbacks: TIME (this may be fatal; we'll see) and my handwriting, which gets buck-wild with fatigue or caffeine or really anything less than an ideal situation.

Thanks for suffering that explanation. Booorrrrrinnnnggg; I know, but it occupies most of my waking hours, so it's important to me.

So, this morning. I outlined for as long as I could, inervening in disputes and, when "Historical Girl" had played itself out (largely because Vivian didn't know the story lines and kept wanting to do things the characters did not actually do), suggesting games other than "Let's play that I am the most beautiful fairy in the whole world." I exhorted them that beauty is subjective and ultimately disappointing. Yeah, they totally got it.

Then I played for a while (we made salt-rising bread and then stew), then made breakfast. Then Richie woke up (he's been getting less sleep than I have because he usually wakes up very early and can't get back to sleep)...and then I blogged. Now I am back to outlining....