We are loved in Belgium....AND in Italy.

Anyone remember Singles, circa 1992?

I just wanted to say thanks for reading, anyone who reads this.

The first pic is Mazie dressed as John Tyler.

I am currently on my surgery rotation and loving surgery a lot. I have trauma call at Grady tonight, which is where we go in and help out in any way we can with whatever traumas come in overnight. If tonight is busy, I will start Foley catheters, staple scalps, suture lacerations, clean up trash, and scrub in on surgeries. Picking up trash isn't actually my job, but if a big trauma comes in, the trauma bay gets littered with everything under the sun. It turns out that neatness is not an issue when it comes to life-saving. But if I have down time and there are little caps and scraps of stuff to turn an ankle on (as Pop-pop would inevitably caution - my dear grandfather valued his ankles), I like to tidy up before the person with the wide fluffy broom circulates through.

That's the really cool thing about trauma call. You get the privilege of being there at the very moment that it's possible to make a huge difference in someone's life. I, personally, have a teeny role in this process...but I truly feel that every little bit helps. If I am starting a catheter, it frees up someone else with more specialized skills to do the FAST ultrasound or clear someone's C-spine or start an arterial line or whatnot. I have just finished up my week of anesthesia exposure, so I now have a couple of new skills to share: starting IV's and intubating. Likely, I will not get to use these tonight, as someone more experienced will certainly do the job if it's a hairy situation.

On trauma calls, I've seen some stuff I'm not allowed to write about. One thing I can say that won't divulge identities or mess up anything at all is: domestic violence is everywhere. If a man hits (or more creatively injures) a woman, she runs a very high risk of eventually being killed by that man. Just FYI - if you ever have any voice in a situation where domestic violence is involved, be as urgent as you feel it takes to get the job done, i.e., get the victim out of the relationship and away from the abuser. And safe, especially for the first several weeks when he hasn't yet moved on and the risk of retaliation is highest.

And I don't have official tallies, but the people I've seen come in dead or seriously injured from motorcycle wrecks keeps ticking up. Sorry; scooters, too. (Ciao...) So dangerous. I know how fun they are, but physics doesn't play. One should not partake in the fun unless one is truly ready to die or to get rearranged in previously-unforseen ways.

But, honestly, the world is just plain broken. It's a mess. I'm a mess, the world is a mess, and a small or large handful of people in the greater Atlanta area wind up a real mess every single night. That's not all there is, but that's the part of it that I know I'll confront when I go to trauma call. I don't love seeing people who have trauma for the sake of gawking. In other words, I'm not like, "Cool; his femur's poking through the skin!" I do, however, have respect for the pathologies involved. Mostly I like it because for that night, I know I am in the one trauma hub in the greater Atlanta area - the place where I can just briefly step into other peoples' trainwrecks and do a little something to help out. This is one of those times when it's such a privilege to learn.

Falling through the cracks.

Everything seems to be falling through the cracks. So many aspects of the clinical phase are so rich. Some are frustrating, some are heartbreaking, but everything is new and interesting right now. On the other hand, I'm having a monumentally difficult time juggling my responsibilities right now. I want to be a help around the house, but my ability to take time away from reading when I'm not in the hospital is patchy, and on blue moons I take a night to be with the family and vegetate. This is a new balance, involving both clinical and didactic responsibilities, all of which are new and perplexing. I would go into detail, but it would take too long, so in brief: each rotation has a different set of complicated expectations for our clinical responsibilities/communications as well as a didactic core that is basically waved beneath your nose but otherwise is accomplished by whatever we happen to run across in clinic, plus the book of our choice. It's hard to get a handle on. All that plus an irregular clinic schedule (irregular schedule but uniformly long hours) has flushed all semblance of balance and all feeling of mastery from where they were tenuously perched.

So I want to grab hold of this time in writing, to share. But I really don't have the time at all at all at all. I want to write about patients I see (with identities masked - nod to HIPAA). I want to write about misperceptions I had, things I learn, and attendings I watch. But I feel like I am strapped to a giant wheel that keeps ducking me under cold water...I just get my head clear again and under I go again. I am taking a moment to write because over the past two hours, my brain sort of stopped and I wasted time anyway. So I thought I may as well top it off with some actual directed thought, frivolous as it is.

Of note: Mazie and Vivian had their 6th and 8th birthday party, and it was really fun. I hope everyone had fun!

I have a list of thank you notes two miles long to write. If anyone who reads this happens to be owed a thank-you note, know that I thank you and it just hasn't gotten on paper and into the mailbox!

Everyone is pregnant and I officially would love to have another baby...but, o, the complexity!

Groundhogs and Gratitude

This photo is Mazie and Vivian on Groundhog Day. Mazie wanted to wear brown head-to-toe and have "Princess Lea" buns on either side of her head to make ears. Then Vivian wanted to do the same. It sounded harmless to me, so I facilitated. At the end of the day, I asked them if they told anyone they were supposed to be groundhogs. Neither girl had told a single person. I guess it was their little secret! I wonder if it will turn into a tradition. I am likely to dress as a groundhog next year, myself.

I am - we are - so so thankful for all the help received while I was working hard on board study. You know who you are!!! Many, many thanks!!!

Making Tracks

These pictures are of Vivian Tracks and Mazie and Vivian making tracks.
I took the USMLE on Monday. I could write a short book about what to do and what not to do for studying for the USMLE, as I'm sure all veterans could but, like me, lack the energy. I will say that I have such a craving for good strong housework that I have been busy with homemaking since Tuesday. I made curtains! Or, rather, finished making curtains.
I am so pooped right now that I can't even muster words of jubilation for having completed my exam. I am delighted to be done, excited to read more medicine, but not quite yet.
And our cat, Cindy, is totally nuts. She WOULD NOT LET me work on the curtains today because her favorite game is sheets, and guess what looks like sheets? Curtains. So I couldn't move my project without having a tumbling ball of sharp cat parts tearing around in the curtain. I put her outside in the rain twice; both times she jumped up about five feet and clung to the screen until I let her back in. She has also developed the curious habit of climbing people and curling up on their shoulders with her face by their face. It hurts as she's climbing up - enough to make you say YOW! - but it's sort of comforting and cute once she gets in place. The last thing about her is that she's completely recalcitrant. Other cats we've had responded to being squirted with water. After the first couple of times, Cindy became completely impervious to the water squirt. Maybe it's related to the fact that she comes running whenever she hears running water and she plays with the stream of water.
Anyway, this cat is inconvenient, as living things tend to be, but she is enormously entertaining. A cat's quirks give them their uniquenesss and are their own way of thumbing their nose at all controlling forces. This cat is uniquely good at thumbing her nose.
I'm so glad to be back to spending time with my family. I have missed them so much!

Toyota

Vivian this morning at dinner:

"On Star Wars? Why does Toyota have to look like that." The punctuation is not a mistake - it accurately reflects her inflection.

We all laughed and laughed.

Making it Count

I am told that Vivian noticed this pretty pattern in tree bark and asked Richie to do a digital capture. I think it's pretty, too.

I'm writing my boards the 31st of this month, which is in six days, not counting tonight. In the past six weeks, I've worked harder than I ever have in my life. That's a risky statement for me. I don't like to say things like that. After all, what if I do poorly despite all this hard work - then I'll look really stupid and I can never say: "Nyeh. I didn't really try, anyway." I'll go ahead and stand behind it. I worked really hard on my honor's thesis, but I don't think I was physically or emotionally capable of the sort of day-in, day-out, nary-a-break workaholism I've been enjoying over the past six weeks. By contrast, the most difficult time I have ever had as an adult was right after I had Mazie. That's the hardest I've ever worked emotionally, I think. Richie, too. I think he was fairly concerned that none of us would survive a newborn. But board study has been pure elbow-grease, emotionally simple as long as I can dull my existential noise.

The bite of this is losing time with my family. The sweetness of it is Richie taking up my slack and all the laughter that happens in the house when I'm in the office with the door closed. Speaking of the office door, I stressed it out and now the knob just unscrews instead of actually working the opening latch. I kept getting stuck in the office until Richie fixed the knob tonight. Anyway, Richie has understood when I've been grumpy and distant and absent. He has done everything this household has needed. Vivian always comes in to let me know when something REALLY fun is happening. I take dinner with the family, and I come down to say hi when they come home, but that's basically it.

I'll take another risk: the risk of being disgustingly Flanders. This has been the richest time for learning I've ever had. I occasionally become incredibly brain tired (quicksand brain), but most of my time is spent learning and elaborating on what I've learned. Something about the singleness of purpose of this time has suited my learning style well. I would be way too big for my britches if I said I was ready to go be a doctor now, but I think now I may be able to keep up in conversation regarding the care of a patient.

There's one thing that's really bothering me. I forgot BOTH of Vivian's last two Daisy meetings. I almost cried at 7:30 last night when I realized that the other Daisies in Vivian's troop were probably just settling down after their return home from their meeting. Vivian loves Daisies, and I love Vivian - that's why I got her into Daisies. The first time I flaked, I chalked it up to stress and thought we'd catch the next one. Two in a row strikes me as officially egregious. I haven't told her about it because it's not necessary and I feel awful. I know she'd be upset. But I did e-mail some moms of Daisies telling them about forgetting and asking if their Daisies would be up for a play date in February. I think I should tell Vivian, but I'm wondering if it's ethical to wait until she's eighteen.

This winter has flown by. My exposure to the out-of-doors is at an all-time low, so I haven't been exposed to this winter that much. Nonetheless, I'll be glad when February gets here for a number of reasons. One is that February is when winter starts to wane. You start to see buds on trees here by the end of February. And the rivers are made of chocolate milk and the streets are paved with gold. Okay, fine, buds happen in mid-March. But February is - statistically - warmer that January. And then spring will be here and, soon, pool weather!!!

Some Pictures:
I walked past Mazie's room one day and she was posing as the famous Fragonard painting, "Girl Reading at an Open Window."
Another: Vivian with our neighbor, Seijia. Seijia's parents speak mostly chinese and are both post-doctoral students at Georgia Tech. Seijia is good at math.
Another: Mazie and Richie on one of our snow days, happy because they've been sliding downhill on skateboard decks.
Another: Snow pic to mark the occasion.
Finally: Clay snowperson.

Totally Wiped

This is Cindy the Cat playing with fire AND standing on the table, which is a huge no-no and makes me wonder why Richie took the picture instead of shooing her away. Because it's a cute picture and he knew it would be, that's why.
I am presently totally wiped. I've been studying microbiology all day. This is a bear of a subject that our curriculum touches on, but doesn't go wild about. So now I'm learning about all sorts of disease processes and trying to do it quickly enough that there's still time for organ systems! I just took a practice test of 46 questions that took 3 hours to complete and then review, making notes in the all-important First Aid book that has become an object of extreme importance (owing to the notes therein). Oh, and I studied for the entire day, taking breaks to do essential things. This has been a long day, after several other long days. My friend recommends tearing pages out of First Aid when you get *really* frustrated. So far, I hadn't torn any out. But tonight, midway through micro, those "extra" pages in the back are looking pretty loose. Nonetheless, I do like knowing things I didn't know before.

Ha Ha; Minor Victory!

Honestly, I don't know why I bother blogging about this minutiae, but I am REALLY, even overly excited that I just finished a Qbank problem set with an average of three minutes spent per question (with review) and I am totally excited!

Windy

Tonight is windy and co-old. It's flurrying, but the snow isn't drifting down the way Georgia flurries ordinarily do. It's driving sideways and hurts when you go out. Nonetheless, it cheers me, as does the sound of people moving around the house and doing things. My mom will remember, I always preferred to go to sleep to the sound of things happening so that I felt I wasn't missing out. This is the same. If 8% of my brain is occupied by normal home noises, I can both take comfort in the nearness and normalness of it all, and still use the other 92% of my brain for USMLE-approved learning purposes.

Tonight Richie and the girls watched "It's a Wonderful Life." Richie came upstairs afterwards with damp eyes. I asked Mazie and Vivian how they liked it, and Mazie said "I really liked It's a Wonderful Life...except it ISN'T a wonderful life." I guess bittersweetness is lost on a seven-year old, as it hopefully should be. Both girls sang, "Buffalo Gals, won't you come out tonight?" at lights-out.

Handsome

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.