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....

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.