Graffiti Broom Cute Gnat Autumn

1. Graffiti on an long-decommissioned waterworks near our house
2. Vivian learned to do Witch's Broom!
3. Mazie is sweet.
4. I was running and got a gnat in my eye that stung and interfered with my vision. I was using the camera on my phone to try to see the gnat so I could pick it out. I accidentally took this picture. FYI, the camera also did not help me get rid of the gnat. I ended up rubbing it out.
5. Autumn Richie.

swear words

I just explored online and found something that I wrote that had swear words in it! Not mild swear words! The heart was mine but the words didn't feel like mine anymore. I felt embarrassed. When I wrote that, I had naively believed that only about six people would read it - six people who think it's weird if you don't use swear words. Ten minutes ago, if you'd typed my husband's name into Google, the fourth result is me yakking on with swear words. That's far more public than I had intended - but such is the internet. I went in and took out the swear words just now...and already my blood pressure has improved. But what damage is done when someone types in poor Richie's name and hears the voice of a crusty old sailor wife? I'm sure I've already messed something up. May we all learn from my mistake!

Helloooooo, Fall!!!!

So these images are, in no particular order:
Vivian and Richie and Mazie playing in a rocky stream north of here.
Vivian and Mazie with faces painted from the apple festival (courtesy of Nana and Poppy)
Vivian and Richie and Mazie doing a helmet jog (rode bikes and jogged on this outing).
Cindy in Mazie's bobcat habitat for her bobcat report...like a REAL bobcat!
Presumed bear poop. I couldn't get Richie to put his hand beside it for scale. So I did the honors. It did occur to me that it *may* not have been bear poop. But it was full of berries and other bear food. So it's either bear poop or vegetarian poop :).

Stamping this on my brain...

I am putting this here mainly to remind myself later down the road. Mom, remind me! I overheard some attending physicians discussing residents today, and what they said needs to be stamped on my brain. Here's what they expect:

#1- A resident needs a get-it-done modus operandi. YOU are responsible for the patient, and you need to follow through all the way every day. A resident cannot be passive. If your patient has a problem, get up and go see them. If you order an intervention for your patient (transfusion, for instance), watch them during, after, and check them periodically YOURSELF. In general, do stuff YOURSELF. Don't ask the nurse to do it. Don't tell another resident to do it. DO IT.

#2 - Really an extension of #1 - Get your skills under your belt (checkoffs done EARLY) and use them whenever you need them. This means: blood draws, lumbar punctures, rectals, pelvics, paracenteses, and the rest. If your patient needs it, JUST DO IT. No getting someone else to help you/ sort of do it for you and then saying "can I check it off?" Do it yourself.

#3 - Have your clinical reasoning down pat. We follow algorithms sometimes, but we think it through...that's our ROLE. Thinking, reasoning, knowing why we do A not B. Knowing why A didn't work and when to switch to B. If you can't reason it out, read until you can. Again, take responsibility for your ability to think it through.

#4 - If you think you are 4's and 5's out of 5's on any self-assessment, you may want to re-think that. Look for areas to improve rather than thinking you've arrived at a "5". Ask those senior to you: How could I have done _________ better?

#5 - (This was my own observation): Communicate about expectations very clearly with examples and concrete terms. Do this for your interns' and students' sake.

Family pics

In random order, these are:
a) Richie at the Varsity (downtown burger joint for non-Atlantans). We were a one-car family for a bit, which gave Richie a chance to bike halfway to and all the way from work.
b) Mazie holding a doll quilt she made, materials supplied by Nana. Vivian is thinking.
c) Daisy Campout: Happy Vivian and me
d) Mazie (yellow shirt) on the hayless hayride (therefore a "Hey!" ride) at the Daisy campout.

Happy Days

Just some happy days!

Video from Talbot Taylor's Intro to Linguistics 1999

Here is a video clip from American Tongues, a documentary that my linguistics professor thought was important enough to spend class time on. I loved this film because there's not much editorializing by the narrator. The subjects say their piece, share their attitude, then the film moves on. So the medium is the message. Also, this is a subject particularly well-suited for video. You couldn't do the same thing with a book. Maybe a radio piece, but it would be missing something.

This is just a bit of it, but as the film goes on, people reveal more and more of their attitudes about others' accents - regionally speaking. This, together with research about the way people differentiate themselves linguistically...perhaps not consciously, but nonetheless actively, is food for reflection.

I wonder what this documentary would look like re-made in 2011 instead of 1988. The old-timers are dead now - I suspect we'd be missing a lot of old-timey richness because today's old-timers are thirty years farther from a pre-radio or pre-TV era. I think about Pop-pop and his sturdy Oklahoma drawl. My mom, the accent chameleon. My midwestern stepdad, who got made fun of for talkin' funny when he moved to The Deep South as a six-year-old (or thereabouts). And, of course, my husband, whose accent is so Southern that it seemed exotic when we first met. He truly is a rare bird, but in a houseful of Forest Park natives, I can't tell him apart from the rest if there's a closed door between us.

Poor Kitty.

There is a meme in my family of origin called: "Poor kitty. Pooooor, poor kitty." We usually had a cat around the house. The cat was well-loved but also known to exist in a state of mutual tolerance. Cats invariably take themselves too seriously, and in so doing, set themselves up for good-natured taunting. This is how "Poor kitty" works: the cat pines away for some small luxury ("Meowwwwww!"). We reply: "Pooooor kitty. Pooor, poor kitty" with tragic expressions on our faces. It's fun! The fun comes from the fact that we feed this animal, give it the best spot in the house to sleep, let it in and out pretty much whenever it wants, and take it to the vet periodically, adore it liberally - and it has NO idea how good its life is. We know it has limited perspective because it's irritated about being in when it wants to be out or vice versa.

I can't help adding that the reason this is satisfying is that I, myself, AM a Poor Kitty. What's the matter, kitty? You can't fit in a jog? You're having car trouble? You don't get to vegetate tonight? Poor kitty. Poooor, poor kitty.

Rainy Day Women #9

These ladies love to cavort in the rain. In rural locales, they have been known to run out in the rain in their unmentionables (if there's no thunder). I let them do it because I love to run around in the rain, too!

Motherhood and med school

I think when I started this blog I had in mind to document a path of what it's like to be a parent (of the female sort) and be in medical school. As I actually go through the days, clarity is elusive and nothing feels done. I don't really feel on top of anything, only thankful to have completed another step or to be in the middle of a step I'm completing. I enjoy the time...but it doesn't feel clean. A good friend of mine said to me a long time ago that I don't really talk about things I haven't figured out. I think a little of that is showing as I go day by day not writing about the things that really come up that are difficult. Number one, usually they're mundane. Number two, if they're not, I've become too private to really say much in a public forum, although I'd gladly have an open face-to-face conversation with the readers I know of. I guess that's the nature of the blog format.

The pervasive theme has been that I can't micromanage. That sounds very zen, until not-micromanaging causes some sort of large responsibility to slip through the cracks (because none of us is perfect). Richie doesn't really get adequate backup from me. I mean, we throw out leftovers when they go bad and we still flush the toilet, but less immediate things are more difficult to wrangle. Gymnastics? Hasn't happened. Birthday party RSVP's and gift-buying? Almost un-doable - between figuring out whether it's me or Richie who's available, convincing Richie (bless his heart) of the worthwhileness of attending said celebration, then getting a gift that fits into a budget that has no allocation for gifts...very tricky.

So, we sort of hobble along, smiling mostly, and mostly patient with our shortcomings. I'm sure we've blacklisted ourselves as poor respondents and giftgivers, and probably a few other bad things, but honestly? I have to not worry about it and do the best I can. I guess the complicated stuff that I could write about in this forum is a mixture of boring and embarrassing. Life is good, better when we concentrate on controlling our irritation levels, working hard when we're working, being fully present when we're physically present, taking small failures in stride, etc.

There are some great joys (besides stuffing face with cookies, which is usually the urge I'm fighting) that don't take long. Planting things is surprisingly quick to accomplish, then yields joy and a feeling of connectedness. Doing hair in the morning is pretty fast, then the girls are properly coiffed and a joy to behold. Jogging need only take 15 minutes - once upon a time, I'd pish posh on such a quick jog, but now I recognize how vital it is to get moving if only for a quarter hour. Dancing through some songs is always fun. And there's dinner every night and every night (lately) I've read a chapter from the Chronicles of Narnia to the girlies. We're finishing The Magician's Nephew. I look forward to that time all day long.

Nightswimming moons are here.

It's that time of year when summer wanes but fall isn't quiiiite here yet. We've been making the most of it...not actually nightswimming per se (except Richie, who always jumps in the neighborhood pool after he runs or bikes) but definitely making the most of the end of summer.

These pictures are a series from visiting a spot at Lake Lanier 10 minutes from Richie's folks' house and 5 min from the church where we got married (that's us in front of the church as a fam...10 years later). We swim across the lake about 1/4 mile - really don't know the distance - to an unpopulated island. The girls paddle across in inner tubes and Richie tugs a big truck inner tube behind him as he swims. The island gives us a very Robinson Crusoe sort of feeling. There's a ton of mica on the shore, so we imagine we've found a deserted island with gold on it. We admire the heron nest. The girls play on "Stingray Point," which has some real sand that must have been imported at some point. We walk all the way around the island, then swim back. Next, we eat snacks and some of us read while others play in the "sand." That's our day. We've been lucky to have this handy stay-cation practically in our back yard.

I love ambulatory (outpatient clinic) medicine. I like hearing about peoples' lives. My family medicine preceptor is a really wonderful person to learn from. He does a lot of small procedures and tests in-house, so we get hands-on experience doing really simple low-hanging fruit medical stuff that lots of people outsource, like drawing blood, giving vaccines, interpreting x-rays, ekg's, doing small procedures. I am a master ear irrigator. That's a satisfying job. It doesn't hurt the patient and you see/hear immediate results. Small office procedures are really interesting middle ground between thinking and doing. My preceptor's attitude about referring to specialists is: not if we can do it here. It's a fun practice model to see in action.

Of note, I lost my International Year of Chemistry 2011 pen today at my afternoon clinic. I'm pretty sure it got folded into a fat chart and will not see the light of day until that patient comes back.

Secrets, secrets.

Patients tell me secrets that they keep and I keep. I don't think I've ever been told a really harmful secret. There are rules: You have to tell the secret if the person divulges abuse or neglect of a child or elder. You have to tell if they're thinking of hurting or killing themselves. Otherwise, it's in confidence. I like to hear what's really going on with them. I hope it helps them feel better, too. Lots of times there's an opportunity to ask a question: What do you think about that?

Cindy the Cat is boodling on my bathrobe right now. That bathrobe instantly turns her from Fearless Hunter of the Night into Mushy Kitty.

photos

This is Richie and the girls at Lake Lanier and all of us at Happy Family Chinese Restaurant. I missed the day at the lake :( but will be on ambulatory (normal people hours) in a month!

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.