Gastrointestinal today

So, for those of you who are wondering, I have had halting success sticking to my study schedule. I wish I were robotic, just for these 8 weeks. Our family's bouts of frequent illness haven't helped, but aside from that, sticking to the schedule is about
1) Staying in the chair. (I wiggle like a pre-K'er)
2) Having my brain on task. (Look! a tube of chapstick!!!)
Both have challenged me so far (usually, there's class to break up the sitting), but I've gotten better at it over the course of this week. My biggest problem right now, schedule-wise: having budgeted about 2 hours per 46-question block for both answering Question Bank questions and then reviewing them in detail, when in actuality, they take me about 4 hours to go through (so far). I'll have to massage that one a bit to make it fit. Or take away from some other area...

Finally, guilt. Plain and simple: guilt at not being with my family in more quality ways. I am mommy-in-the-tower. It's better than being deployed, or a refugee, or working this hard at something I didn't truly want to do...but it's hard at Christmastime! I usually craft and cook, but this year I have thrown up lights on our neighbors' 4-foot fake tree that they let us borrow. It's short but festive. And we put it on top of a cardboard box, so it's less short now, too.

But Richie has Vivian making cornbread and Mazie is reading. I think everyone is okay without the scent of pine needles this year.

Working on renal today...

Today is blustery and sunny. Well, it was sunny while the sun was still out. It's dark now and I can hear the wind all around our apartment and feel it whooshing through the windows. The pictures I put up are, in mysterious order (I can never tell based on the code) are: Nephron art of which I am particularly proud. Richie listening to Vivian read. Mazie reading. Vivian with her Playmobil setup - the gift that keeps on giving :). I hope everyone on the Eastern Seaboard and parts northward is staying warm. Brrrrr!!!! BTW, Goljan = my BFF.

Lovely Thanksgiving afternoon

A beautiful Fall Tree Trunk
And we got to see eWeb (Mazie is dressed as the green hornet)
And we got to feed the geese...
And we got to go biking!
Make that re-bicycling, courtesy of Richie's make-a-bike skills.

Everything is beautiful

Everything is beautiful and touching right now. I believe it's that time of the month in that time of the year.

I flossed my kids' teeth. Mazie has another loose tooth. Vivian learned to ride her bike a while back, but is re-learning on a bike Richie pieced together out of two used ones we bought (long story; the important part is that there were enough good parts to make one good bike...it just has a funny color pallette). So Vivian is all banged up - legs covered in bruises. I've been eating too many cookies. We cooked big pots of food last night and the night before. First, cream of vegetable soup; second, pinto beans that turned out pretty good.

It is TIME to start studying for boards. I feel nervous and excited and impatient. An expanse of time spreads before me: a landscape obscured by fog. I'll be feeling my way through each day - my stamina, my ability to focus in my surroundings, my retention. I plan to keep in touch with my scattered, solitary compatriots. Marco! (Which resource are you using for biochem?!) Polo! (I have Lippincott, but I found First Aid to be sufficient!)

Meanwhile, Richie is awesome. Cindy the Cat won't stop climbing our screens. Mazie and Vivian are obsessed with my bathrobes. There are three - all from the thrift store - which works out to one for each of us. And, as shown here, everything is beautiful.

Whoops - forgot to mention that that is Mazie in her dandelion costume. Her part in the second grade musical was to be a weed. She chose dandelion in the flower phase of its life cycle. Later, I'll post a picture of the inscription on the tee shirt that we used to make the yellow headdress. Priceless.

Wow.

So, I've been looking at this blog, reading a bit of what I wrote. I think I haven't written at all over the past six months just from being flat overwhelmed by the day-to-day. I think about all the stuff I've learned, finishing up with anatomy, the weather getting so hot and then changing to cool again. I think about seeing patients in clinic, about the changes Richie and I have gone through to adjust to our new roles. I think about my friends doing the same things I am doing and about my friends and family who are far away.

How I am feeling right now can be summed up by the AA meeting I went to for our latest module (Psychiatry/Neuro). It's predictable, yet profound: One Day at a Time. Every day is a gift, and has its own work. God is good. That is all I have right now; Lord may it be sufficient.

Fall!

Explanation of photos: Vivian on the phone with Grandma, at dusk, near halloween. "Passport-style photo" FAIL. Mazie jumping for it. Vivi and Mazie getting Crazy-haired at Fall Festival. (This was a very cool idea that I plan to co-opt for my own purposes except I will not use RUBBER bands!)

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.