Sun-avoidance

There are a number of things I have become obsessive about since learning a thing or two about bodies and disease and I wish I could say sun avoidance was one of them. I am horribly conflicted about the sun. On one hand (the more sensible of the two), the sun ages your skin, suppresses your immune system, and contributes to/causes a variety of skin cancers. I have already had one basal cell carcinoma removed from my neck - we're not talking pre-cancer; we're talking full-blown all-out it had gotten cancerous. Luckily, basal cell is the least dangerous and least likely to metastasize of all skin cancers. NONETHELESS. That was a setback. On the other hand, there's the warm feeling of the sun on your skin, the inner peace that only comes with lying in the sun and waiting to get too hot, and the lovely pink or brown glow you get when you're sun-kissed.

I have never been an avocational "tanner." Okay, that's not entirely true, but I have spent a total of ten minutes in a tanning bed in my entire lifetime and that was because I was good friends with the lady who owned it and she gave me the session for free. It was bright and seemed to do nothing to my skin. I think I was too reflective-white to absorb radiation. My skin's current problem is that I was nut-brown all summer (nine months long where I come from) from ages 2 to 13. Seriously, I should post some photos of me looking like Sheena of the Beasts. My dad thought it was an excellent idea to get in my first couple of burns so that I would just tan after that. Several times every summer I'd get burned so badly I'd run around naked saying that I had on a white bathing suit - the shape of my bathing suit was perfectly imprinted on my otherwise lobster-red body.

ANd now? Well - no kidding - my skin has aged MUCH faster than my peers'. My hands and face and arms and legs (but not my belly - I rarely wore a two-piece) are all wrinkly. Now, hear this. Additional sun exposure will absolutely suppress my immune system. Our immune systems are one of our biggest allies against cancer. They find the cancer cells and kill, kill, kill them. Sun will also cause additional damage (DNA fried, helpful proteins demolished, etc.) to my skin and its repair mechanisms.

So, fine, I officially swear off laying out. Not that I actually did this very much in the first place after age 21. BUT. I cannot stay inside in the summer. I refuse to completely avoid the sun. I think protective clothing is part of the answer: hats, sunbonnets, zinca, sunglasses, long flowy shirts (problem: long, flowy shirts have an SPF of about 2). But I have to figure out how much I am willing to risk and how much I am willing to avoid. I think I'm shifting over to the sun-avoidance side of things...gradually....

My kids? Sunscreen and hats. I think Vivian has gotten one pink sunburn in her life and I almost cried. I am obsessive about sunscreen for them. I think back to days at Yorktown beach rubbing gritty sandy sunscreen into their skin for the two-hour re-application. They're excellent sports about being chased down and coated. Yes, they both wear long-sleeved sun bathing shirts when swimming. they have dedicated sun hats that they're outgrowing. It's difficult because Vivian is much fairer-complected than Mazie is, so she gets attacked by me twice as often. I know her skin has less than 0 protection of its own.

I guess that's part of parenting - you pass the torch. I am passing the good skin torch. My skin is announcing that it's on its way out. I will do the best I can with what I have and keep the rest of me in ship-shape (as soon as I have time - right?). But my girls still have a shot at skin health, and I'm going to give them the best running start I can.

I think I'm done being rebellious about the sun. I love the way it feels and I love the way a "healthy glow" looks. But I know for certain that it's not actually healthy. My Uncle Terry once called my mom's winterized legs poking out from shorts, "white sticks." Here's to white sticks for me.

Most Illingest.

We are sick! We all got the flu, it turns out, sometime around Monday. Mazie and Vivian have been home all week and Richie is so sick he can't do ANYTHING. The poor man is so ill that doesn't even want to eat - those of you who know him may find this shocking. It turns out, that's because he has PNEUMONIA. That explains the -er- colorful coughing and 102 fever. And, I suppose, could explain his reluctance to eat. Don't worry; he went to the doctor and got on a Z-Pack today.

Wouldn't you know that what was supposed to be my first week of big-time study for boards has been neatly absorbed by 1) being so sick I couldn't learn 2) caring for a family too sick to go about their business. I have shed tears over lost time, but now I am trying to right my emotional ship and take stock of the time I have left, which is ample. I padded my study time because I expected interruptions. I just didn't know they'd be so profound and come so early. This doesn't leave me much wiggle room for the remainder of the two months before January 31st, though.

This flu has been bad, but not as bad as The Infuenza of '07. That one was so bad that all our fevers (adults included) were over 102. I almost passed out in Food Lion trying to buy Motrin and Gatorade. The flu has become almost unrecognizable to me because I compare all illnesses to that horrible horrible incapacitating flu. Now, as far as I'm concerned, if I can stand, then it's not the flu. We had actual positive flu tests - so it's "the flu" (but still doesn't hold a candle to '07's).

So some of us are not nearly as sick as we could have been. Richie, on the other hand, has fared much worse. We started out neck and neck. Then I got better and he didn't. Then he started to feel worse. He has taken up a cozy residence on the couch, among blankets and slanting sunlight. He's overheating, but he's old enough to control his own thermostat so I try not to say anything about it. My main job is to deliver liquids and dose him appropriately with fever-reducing and phlegm-disrupting medications. It sure reminds me how much he does around the house and for our girls when he isn't able to do any of it.

Lots of times, being a mom in med school is fine - I just wish I had more time for my family and more time for medical school in a wouldn't-that-be-nice sort of way. This week, though...this week hurts. Because the stakes are high (boards are very very important) and because the time I'm spending isn't really quality time (although I'm trying my best to make neutral time into quality time). I'm about to rely heavily on Christmas movies and early bedtimes to get us through the rest of this illness, though. We had big plans for Christmas cards and stuff...but those plans are definitely in jeopardy now. It is what it is.

Meanwhile, there's nothing like a good meal and some Christmas music to keep the spirits high. I am thankful to have a basic quality of life that's really very good. I think about Grady and the guys milling up and down Edgewood. The people with shopping carts, talking to themselves. If you have nothing, not even a hope or prayer of dragging yourself out of it (as in no family to fall back on, no education to leverage, possibly a criminal record around your neck like an albatross), you grab at comfort or escape. I think it makes perfect sense.

On a lighter note, Mazie and Vivian are listening to a Magic Treehouse CD, "Pirates Past Noon," on which there is a chapter entitled: "Vile Booty." (Insert snickers) Really? What was Mary Pope Osborne thinking? No matter, we all think it's hilarious.

Advice

I wish I had pictures to post, but all the people I run into at our school building who are in my class are studying every bit as hard as I am. It's really quite lovely: 23-year-old Adeolu, in the computer lab from dawn until long after dusk. She has an entire environment set up there. She has special hiding places for her stuff so that she doesn't have to transport it back and forth for the brief amount of time she's home - to sleep and shower, I guess. But she always looks so fresh and kempt - you'd never guess she's working so hard to see her in passing. But she is...and she's going to do great!

There's also Mina. Mina is young and lovely as well, and gregarious. But she's an absolute workhorse of study stamina when you give her a challenging test to prepare for. She keeps similar hours to Adeolu - long. She is incredibly focused, shunning social contact. I see her friends come by and in reply she proffers a quick wave and half-smile and that is IT, folks, so just walk on. Nothing to see here.

This time is really weird. On one hand, I can't imagine doing this level of engagement (stopping only for the essentials and getting up and doing it over again) lasting a day longer than it has to. We're all sacrificing balance for this period of time. On the other hand, I feel like I'm just hitting my stride...and I think I'm not alone in feeling this way. There's something simple about knowing what you're going to do and knowing that everything else comes second (for these few weeks).

The class above us has offered advice and help generously. Lots of people told me lots of different things. I have taken the advice that I think works best for me. One person said to me, "I'm not going to lie. Studying for boards was the worst thing I've ever done in my life." Well, to make that positive, she must have been studying really hard. I feel more like the person whose advice was: this is a chance to put it all together. The stuff you've learned begins to link up into something cohesive, and that's pretty fun.

I'm trying to keep my head down and push through these next three weeks. I'm a little scared that something very disruptive will happen, or that I'll do all this studying and then not do well on the boards. I have other more existential concerns as well. Everything seems sort of bittersweet when you're spending all day alone, sorting the mystery. Accepting the mystery is difficult: Will my work bear good fruit? Will my family be okay? Will I get to see the people who are dear to me but far away? Will Vivian and Mazie one day have to DRIVE? I can't handle sorting it. I have to accept the mystery; there is no choice.

How does sphingomyelin accumulation cause hepatosplenomegaly again? At least I can answer that one. It may take five minutes...but it can be done. Very clean - easy in comparison. The trick is to stick to the pathophys and pharmacology, etc., and stay away from the bigger mysteries for now.

Sweet time

Richie and I have been married for 10 years today. I think back to the excitement we felt 10 years ago, how exhausted I was but how full of adrenaline. I think about the people who came together to see us/help us get married. I think about all the people who drove a long way: Jason, Sara, Beth, Brian, Alexis, Brian, Lauren, Uncle Chip, Aunt Judi, Sherri and Hunter, Chris and Annie, Mimi and Pop-pop, Polly and Jan, Patti and Jeff, Carter and Evelyn with little Merina, Dan and Wendy. Not to mention all the other people who came from around the state. Now that we've had kids, I understand what a huge sacrifice it was especially for those with small children! I think about the lovely women and men who stood up front with us. I think about Jim and JoBeth Kee-Rees and the Bauers, who counseled us through it all. I think about our dear parents who went along with it probably in spite of their misgivings regarding the speed with which we decided to get married.

But mostly I think about Richie, the loving, patient husband and father he has been...and I think about Mazie and Vivian, with whom we have been blessed. Marriage becomes something different after a good number of years have passed and when kids are in the mix. It requires a lot of communication, a lot of compromise, and then more communication and compromise. But mostly, it's a working love. I love my husband and he loves me. Which is to say: when money's tight, we work it out. When a kid has problems, we work it out. When one of us drops the ball, we work it out. It's not easy, but it is beautiful.

For those who don't tolerate mention of God, read no further.

God is at the center of our marriage, and it is from this center that all the beauty, the humility to compromise, the love, love, love.

Hemidactylus frenatus and gorgeous light

A new pet introduced itself to our family tonight. I had just finished tucking the Sweet Breads into their beds when I came downstairs and saw a little creature scuttling across our wall just beneath the chore charts. It was the size of a large bug, and the way it moved looked like one of those really disturbing (though apparently harmless) house centipede things (I found this website called what's that bug? to help me name those shaggy-legged crawlies accurately). Sadly - maybe for lack of time - I am no longer the devout bug humanitarian I once was. It was heading for behind some furniture, so I reflexively grabbed for a shoe to squish it. But (thank goodness) I looked a little closer and realized it wasn't a bug at all! It was some sort of little lizard! I called for Richie, and he came bounding down the steps with Mazie and Vivian on his heels. As it turned out, we needed Mazie's speed and skill to capture it because it was so fast and, truth be told, we're just not as fearless and nimble as our 8-year-old. She had gently captured it in no time flat.

We put it in a tupperware and began speculating about what manner of lizard this was. It's about an inch and a half long from nose to tail tip. Its body is mottled and its tail is banded. The most striking things about it are the way it moves - more articulated then a normal old lizard - and how transparent its body and head are. If you hold it between you and the light, you can see the outline of its digestive tract! I had held a gecko back in college, and of course had oggled geckos in pet stores. The shape of its head and feet...is just so gecko! It turns out this is a House Gecko - Mediterranean or Asian or whatever, now they're pretty much everywhere warm - including the southern US, according to Dr. Wikipedia.

The whole family (except Cindy and Skiplo) is super excited. We put it in a bug box with a damp clod of grass and furnished it with a mosquito and a moth for snacking. I don't know if we'll keep this thing or what (it depends on whether crickets and their stinky selves fit into our budget), but it sure is cool! It makes me glad I saved the aquarium we got for free back in Williamsburg.

Surgery followed by Internal Medicine was a slog. It wouldn't have been so hard if it were JUST 80-hour weeks. But on top of that, there was studying to get done in the interstices of time, which barely existed - especially on my last 3 weeks of medicine. There are a number of factors that go into making your schedule, and it is very team-dependent. I worked more than any person I knew during internal medicine...it was just the luck of the draw. My team was wonderful at patient care (hence the long hours) but worked super late compared to other teams. No time to study makes for a feeling of being stuck between a rock and a hard place at all times. I was realistic from the beginning about not being able to see much of my family for this chunk of time, and Richie was fully on board. But being brain-dead at the end of a 14-hour day is something I found if I tried to fight, I just ended up wasting time staring at a book and going nowhere mentally. It was tough - I hate being under prepared. In this case I had no choice but to get through the best I could, make the most of my days off (all of which I spent trying to catch up with my studying). My anxiety has ratcheted way way up in the past month due to this hours-in-the-day issue. I find myself clenching my hands in normal conversation, having a hard time sleeping at night, and with racing heartbeat intermittently throughout the day. I am glad for a break.

After surgery and medicine, this whole doctor thing feels different to me. These rotations are very difficult but very empowering. You begin not just to practice your physical exam skills but to use them to gather data and fit your mind around how a patient is doing...based on your own ascertainment. I had patients whose physical exams (which is to say how their body was faring as can be perceived from the outside) I knew better than anyone else. I could trust that I knew because I did the physical exam over and over again day after day. I went from "I think I may have heard a split S2" to "There is a late-peaking high-pitched systolic murmur heard best at lower left sternal border, grade 3 / possibly 2." Confidently. I can see a retina pretty well now, even non-dilated and with a normal (as opposed to pan-optic which magically gives you an eye-max view of the retina) ophthalmoscope - which is a good thing because it's what I have. Dr. Hardison has taught us to look at hands very carefully, and I will never forget that lesson. You can see an amazing amount of stuff on hands alone. Diabetes, chronic hypoxia, endocarditis, connective tissue diseases, arthridities, anemia, vitamin deficiencies, certain cancers, and lots of other stuff. Dr. Hardison's so full of physical exam pearls and so experienced (I think he's in his late seventies) that looking at a hand is like literal palm-reading for him.

The light was beautiful tonight after a heavy rain and just before dark. Things are beginning to feel normal-ish again. Once more, it doesn't take long to get back to normal-ish. We all went to church together this morning. I made meals for my family and cleaned up after. I read a chapter (The Bell and the Hammer) from The Magician's Nephew to the girls. I got to listen while Richie coached Vivian through her first at-home writing assignment (How she got her name). We worked together on adjusting our budget. Very nice.

Just in case you don't know, we really wrestled to find the right fit for Vivian's middle name. Vivian was first named "Vivian Augustine Gunn." But she was so little and new...and that name sounded so heavy and old...we switched the middle name to Faye, and we're so glad we did! It fits her just right!

I love EKG's

I have to admit it. They can tell you so ridiculously much about a hidden organ. And they're so simple. I mean, really really low-tech. I had a patient with prolonged QT. That means that inside his heart muscle, the cells were taking longer to repolarize (get ready to contract again). And we could tell that by sticking little tapies to his skin and recording the electricity that moves across the skin on a little tracing and voila! Long QT. It can mean: drug interaction, familial syndrome, ischemia, electrolyte imbalance...but the EKG gets us started.

I have an old EKG of my own (from the time I passed out while working in the ER, hit my head, and accidentally bought the Workman's Comp system a lot of tests). That EKG is dog-eared and fuzzy on the edges from wear. I have to say that I can learn about quirks of physiology in a book forever, but there is an emotional punch to receiving a much-sought lab on a patient whom you've gotten to know. When I know what someone's high school sport was, the names of their kids, and their first job (things I usually find out in a patient interview), I CARE what their white blood cell count is. Because high WBC's could mean an infection that I am (a little bit) responsible for protecting them from.

A point of personal growth: I have never trusted my ears one little bit. I don't trust them to hear my kids when they're whispering upstairs, not to discern the nature of the ruckus outside my home, not to differentiate Schumann from Schubert. But tonight I was the first person to diagnose a heart murmur! This was AFTER a senior doctor listened and missed it! (It's easy to miss because it's the kind of murmur that radiates to the lateral chest wall, so you have to be really thorough to hear it way over there.) I got confirmation from a third person. Go, EARS! (It's probably mitral regurgitation - the patient has too much else going on health-wise for the diagnosis to matter a hill of beans to her in the long run).

Work hours have been right at 80/week on internal medicine at the VA. Today (Saturday) I worked from 7 til 9, and that's how almost every day has been for the past week. I work again tomorrow starting at 6 a.m. Today, Richie took the girls to get a new mattress (Vivian was literally hanging out of her toddler bed which has a crib-size mattress). He made tater tots for dinner, the aroma of which hung in the air when I arrived home tonight. Ahhhh, cold tater tots! I like tater tots so much that (don't tell) I have gnawed away at them in their frozen state. I'm getting slap-happy in a public forum, and so will bid the internet Adieu...to you and you and you!

One last thing: I have a patient with tattoos that label his nipples "hot" and "cold." You'd think this would be scrawled or written in Victorian parlor font, but it's actually in clean architectural lettering. I found this among the more odd and interesting of the tattoos I've seen. I won't mention the more profoundly disgusting tattoos I've seen, but Mr. hot/cold is, I think, fairly PG. I always want to ask people about all their tattoos. Less "what the heck were you thinking?" (although some may feel that's appropriate), and more "What does that piece mean to you?" Dr. Gillespie, the psychiatrist who leads our psych module, mentioned that approach and I liked it. I've only asked about specific tattoos a few times (not Mr. Hot/Cold), and I learned about peoples' loved ones who have died and about their military service. One must work that question in artfully, preferably after the initial interview...maybe during the physical exam. I don't know. But I certainly don't lead with that question.

Almost all my patients are nice people. People who are addicted to things have, in my experience, been among the nicest ones. I think they usually feel pretty sheepish about their reason for being in the hospital. I have seen a lot of really physically miserable, crying, shaking detoxing alcoholics who were the most contrite people on earth. I don't know. I know when I meet a patient, I initially feel standoffish (really just like when I meet any new person), but it takes about 2 minutes to warm up to each other and then I just really love them (usually). Even if they don't smell so good and I want to give them a buzz cut and a shave so bad I can't stand it. I wonder if there is a role for hospital grooming consultant. I think people wouldn't fare nearly so badly in life if they only had short hair. Okay, now I've really got to sleep. But I think short clean hair is always a step in the right direction.

In the hospital, people have access to showers, but I think that in some cases they've forgotten that hygiene is important. I think street culture is like camping only without the gear and without the wildlife. And without the s'mores and the thermarest and a good deal of other things. Nonetheless. I think some people get so far into street life that they literally need re-teaching. Maybe an 8 1/2 by eleven sheet that says something like: "In our culture, it's important to bathe. If you've been on the street for a length of time, it's easy to forget what you need to do to fit back in to non-street culture. Even when you can't smell yourself, other people will begin to smell you after a day or two of not showering. Bathing also helps rid your skin of germs that can make you sick. It gives you a chance to examine your entire body for any changes that may have occurred. It's easy to forget places like feet if you keep them inside socks or boots all the time. You may not always be able to get to a shower, but we have one here for you to use, along with this complimentary soap. If you have any questions or if you need any help that we have not provided, please ask. Go ahead and shower - your body will thank you!" And then one for haircuts and shaving. I really don't mean to be flippant or simplistic. I feel for these people, and I think that the urge to keep clean simply acculturates right out of them. I have wanted to have this talk about a dozen times in the past month, but it's tricky territory. I have had some patients who have detoxed in the hospital, and then we let them go looking and feeling and in the same clothes as when they came in (only not drunk). I feel like a haircut and a shave and set of clothes that fit well would go a long way toward helping them stay clean substance-wise, too.

I love Grady.

I have discovered that I love Grady Memorial Hospital. I didn't want to make a snap judgment. At first, the sheer complexity of the layout baffled me, as did the uncanny locations of different services. Also, lots of people hang around the front entrance along the city block of Jesse Hill that's cordoned off between Armstrong and Gilmer for foot traffic only. People of all ages are in various states of disarray, colorful array, intense cellphone conversations, out-loud yelling throw-downs, random-talking, rummaging, smoking, etc. At first I found myself on-edge in the Front-of-Grady gauntlet. Now I rather enjoy it, especially in the morning when things are just beginning to stir.

Now that I've done a few rotations at Grady (actually the transition happened around my second week of surgery), I find the layout less baffling and more interesting. I love the fact that it's a historically rich hospital, though I don't know the entire history. I enjoy the strip out front of Grady: you never know what you'll hear, or what outfits you'll see, or which of your former patients you'll bump into. I've personally been loudly complimented on my appearance a couple of times out in front of Grady :). The things I love most about Grady are the views from its generous old-timey windows. Okay, a lot of the windows look directly onto brick walls, or are completely encrusted with oxidized A/C drip, or are tinted a dingy sort of gray so nothing looks good out of them. But many offer sweeping vistas (see above) of city and sky. Imagine: walking into a patient room, realizing they lucked out with their view, and letting them know: Hey! You got a great view! Will you pretty please keep your blind up? I feel so sad when the blinds are broken in the down position.

I like Grady because it has flava. Up one side and down the other: flava. People in turbans, people in neon, people with intentionally-torn clothing. Friendly people who will talk to you. Crazy people who will talk to you. People who have not taken care of themselves who will talk to you. They haven't taken care of themselves less out of stubbornness and more because they have NO model for doing so, no resources to draw upon, no cultural value assigned to healthliness, etc. They eat what they eat and they do what they do to kill the pain of: loneliness, indebtedness, sadness, guilt, anger, poverty. For instance, here's a van that says a lot:

I can't believe this thing still goes. It may be younger on the inside than it is on the outside, which is actually what I'm hoping for my own self. Apparently, when this minivan does muster up the courage to go, it goes to Grady.

Lots of people really need help - more help than Grady ever will be able to give. On one hand, most of Grady's clientele will flout doctor's orders faster than you can say Jack Robinson. On the other hand, what choice do they have? Realistically, I mean. They're making something work that just barely works. Ingenuity beyond pride. There's something to it. John Ector used to say about Cheetos (my very favorite trash food): they'll keep you alive. I'm not saying these modes of living are good, but I am saying it's good to be there at Grady and in among it. It's good to shake hands with my patient and see him imagine a brighter future with fewer COPD exacerbations...or maybe no more lengths of limb amputated.

It's up to me, in that moment, to believe against rationality that they can do it. I don't know how much this really helps...which is why public health is where the money is. I don't have any good way in mind to relieve the ATL from the larger evils: coca cola, cheez doodles, little debbies, vienna sausages, 40 oz beers, and crack. I don't have any suggestion that will handily do away with black-on-black violence, motorcycles, prostitution, child sex trafficking, or intimate partner violence. Education that somehow doesn't work (no finger pointing; teachers are awesome people). We are so screwed, as a whole. But we have GOT to start somewhere. Why not the DASH diet?

Link to Amazing post by Dr. Kimberly Manning

Hey, everyone. I have to share this. I found it riveting and beautiful, even the comments. It is high time for someone to write well about this topic, and Dr. Manning is clearly the One to do it. Enjoy!

From Domesticity to...Something Else

This is a blog post I began on another blog (Keep it Human). I am also a med student, and I am also a mother of two (shown above with their daddy in the background). ***First, to give you a sense of where I am in life: I am at the dining room table. It's 9:30 p.m. I'm eating one of the fudge-sicles I got for my daughters - Mazie, age 9, and Vivian, age 7 - at the grocery store today. It's 80 degrees outside and our windows are open to the crickets and the hum of neighbors' air conditioners. In this apartment, papers aren't crisp. My tongue is sore from today's choice of foods: cheddar potato chips, a whole pint of cherries, a large decaf, cuban beans, and the popsicle. I am sitting in front of a laptop computer that has become the one non-living item I would grab first if the apartment caught fire. For it is the embodiment of a lot of work I probably haven't backed up adequately. On this computer: ideas, spreadsheets of anonymous data, copies of letters I've written, meticulously-made notes on lectures that have blended into one item in my memory. Around me, the apartment I share with my husband and kids is disheveled with various stacks of paper...under furniture, beside the table, atop the table, trailing over to the stairs (that's the cat's fault). The papers are almost all mine. ***When I started med school, I asked my stepdad for advice. I always ask my stepdad for advice. He went back to professional school when he was the same age I was at the time, 31. He told me this: "Do not waste a single minute thinking you shouldn't be there because you're older, or that you need to apologize for yourself in any way." He said he felt in retrospect that he wasted time and effort second-guessing himself instead of just plowing forward and doing the work (don't get me wrong - he definitely did the work ALSO). ***Three years later, I have a much better understanding of what he meant...yet I am just beginning to take hold of that sense of belonging that he urged me toward. I have spent time worrying that I am in the wrong place. I have often felt inferior because I took a different route. Those feelings of inferiority weren't anyone else's fault. In fact, fellow students, preceptors, and administrators alike have welcomed me and have been 100% accepting of my nontraditional status. ***The only way I have to frame the difficulty I've had just-working and not worrying about whether I should be working in this particular way is a matter of identity. When I walked through the doors of EUSOM on the first day of orientation, heart aflutter and puffy-eyed from having cried my goodbyes in the car a moment before, I was a MOM. And a WIFE. I knew I wanted a career, and physician seemed outwardly like a good fit, but I had busied myself for the previous five years with a hard-won old-school domesticity. If anything, the domestic phase was the one that didn't fit my personality at first. But by the time I got to med school, I was in it and it was in me. I had my routines down to a science, laundry cycles established, folding rituals, menus, recipes memorized and cooked by muscle memory. I used cloth diapers and liked it, I could recite the contents of the fridge at any time (literally), and I knew where everything in the house was. Tape measures, business envelopes, pants hangers, chrome spray paint, garden shears, spare drier sheets...you name it. My linen closet was a vision, and my floor was free of paper piles. ***Once med school began, I spent a lot of time in class worrying about the contents of the refrigerator, or my kids' teachers, or their safety, or their arrival to and from the things they had to do that day, or their reading development or apprehension of math facts. I told my husband which spatula to use. I cried about mold in the bathroom. I developed a mental tic wherein if I heard a siren, as I often did because the med school is directly across the street from Children's Healthcare of Atlanta, I spasmodically entertained the idea of the ambulance bearing one of my children. The urge to call my husband and make sure it was not our kid would rise until I called. I wouldn't ask him directly for fear of seeming crazy, but I'd find out what was going on, you know, in general, and listen for signs of panic in his voice. He eventually began to ask when I called for no apparent reason, "Did you hear an ambulance?" He had figured me out, and after that it was clear how crazy I was being, so I forced myself to stop. ***But let's face it: I had lost control and I hated losing it. I had to hand over the daily care of my most precious softies to other people. As simple as this sounds, and as much of a relief as it could seem in the abstract, actually losing the control of the workings of my household felt like a small death. ***In med school you have milestones: Your first didactic phase test, your last didactic phase test. Step I, your first shelf, last shelf, Step II, etc. As I progressed through these mile stones, I kept expecting to fall flat on my face and be proven to have been badly mistaken about choosing med school. While I had my share of private ignominies, the catastrophe never arrived. And here I am with one year remaining and...my floor is a mess. ***My floor is a mess, my bathroom has mold, my husband put the kids to bed tonight. But something else has happened. As I am bleary-eyed, I'll pick up there next time. Til then, thanks for reading! Brandi

***Now it's 5:50 in the morning. The papers and the mold persist, and my kids are still abed. But I want to tell you what has happened and how I tolerate things I never used to tolerate. I have to say here: the mold and the papers are an emblem. In fact, I am not simply a former neat-freak. I am a former control freak. The mess stands for a lot of other hidden factors that are harder to explain. But we'll call it mold for now. ***What happened was the inevitable march of time and data adding up to one shocking conclusion: my kids are thriving and my husband is a good person to care for them. I know, it's stunning, right? When I felt a strong disparity between the real and the ideal of daily life, I started going through the mental exercise of asking myself: Will this hurt anybody? If the answer was no, I forced myself to put it aside. This tactic works fairly well with non-domestic aspects of child-rearing also, by the way. ***While it may seem that my domestic standards have been thoroughly dismantled, with only "Remaining Alive and Free of Injury" remaining, the shift has allowed me to see the entire world and my role in it much more pragmatically. I still strive to do excellent work, but I really try to let go of everything that doesn't really matter. I will still drop everything to help mediate an argument between my kids...or help with an art project...or answer one of those really interesting questions I can't believe they asked. I haven't thrown out the baby with the bathwater. But I think I have jettisoned a lot of unnecessary baggage. I don't worry about how they look. I encourage their own sense of style. Lots of times they put together really interesting outfits that I never would have thought of. ***I certainly don't worry about how a thing gets done. I don't exert my control over the orderliness of the shelves. The laundry festers awhile before it gets folded and I don't iron it either. The thing we insist on is having a clean sink before bedtime, and usually Richie does that while I cram a few more school-related things into the end of the day. I don't worry about the way I look very much, and I certainly don't worry about the way my house looks. I still love the feel of clean floor under my feet. Richie cleans up in the ways he thinks are important, and his ways are important. They are different from my ways. But he does it and I don't get to tell him how to do it. ***I am also more relaxed with my kids, much less likely to micromanage, and much more likely to say Yes. I love to say yes. If I say no, I usually ask them to think about the logistics of their request and try to get them to see it my way before I say no. ***So, what felt horrible at the time has actually been a powerful and necessary transition - a transition that has forced me to let go of some things only I cared about and to do a lot of things that a lot of people care about. Now I am about to march forth with research, writing, and learning how to care for patients. These activities are extremely important to me. If I don't do well at these, someone will get hurt - or at least helped less effectively. Meanwhile, my kids are thriving. I find creative ways to have fun with them, and I savor time with them as I never did before. My husband is an amazing domestic god. I help out, but I have to ask where the scotch tape is. ***There are some to whom the above struggle would not make sense at all. It looks from the outside like a no-brainer: you have the opportunity to go to med school; who cares about the running of the household? But if you are a stay-at-home mom, I'm sure you get it about the ownership and sense of pride you begin to take in the running of your household. It's relatively thankless work, denigrated since the late sixties. But it can be beautiful, pleasing work as well. I just had to switch to a job with an 80-hour work week, and since I was so invested in domestic work and it was part of my identity, it felt really bad to let it go. ***I'd love to hear feedback on what I've written. I've left a lot unsaid, and maybe some of that was crucial. In the meanwhile, feel free to respond!

Everything has changed again!

Hello! It's been a long time since I've posted because I've been doing a ton of other stuff. This summer has been wonderful so far, with the ability to make my own schedule as long as I work a lot :). Seriously, I get to spend several hours in the late morning with the girls each day, and that has been wonderful. Now, for instance, we are all eating our yogurt/flax seed/fruit parfaits while sunlight streams through their hair and they tell me about their plans.

I heard Mazie come down the stairs this morning and go directly into the kitchen. Vivian and I were playing in the living room at the time. I got up and followed Mazie to the kitchen to say good morning. She had already gotten out the bread and tin foil to follow through with her plan to befriend a crow.

Vivian has already made jewelry for Flowers, her toy piglet.

*Abandoned post and then came back* Whew! Today I: emailed about a zillion people to work on gaining access for my surveys, got a dress altered, bought more blue paper (with girlies - they got erasers), washed two loads of laundry (including my lab coat which was looking dingier than need be), showered, rode bus to Emory, collected surveys mostly in surgery waiting area and radiology, created more surveys (thereby disturbing a considerable number of people in the med library), rode bus home, organized surveys...and now we're about to leave. Good day!

Lovely May

Mazie's art got to be in an installation at the High Museum of Art downtown. Mazie's is the fish in the jar (top).

This is what it looks like at our house right after bathtime.

The girls together outside the High Museum. Mazie is feeling conspicuous. Can you tell by her face?

Mazie "Boots" Gunn, doing a project that involved a length of board:

Vivian playing the stick game:

Spring has flown by. Tonight a storm rolled past, but did not storm on us. It mainly just tinted the sky a funny color and caused all the leaves on the trees to turn over. What a lovely evening to eat ice cream on the stoop! The girls have one more week of school. I cannot believe that third / first grade is already finished! The girls have both had wonderful years this year. We had three little girls on our block who were just their ages. Then, a few weeks ago, they all moved away at the same time. Our girls will have to get new neighborhood friends because their buddies' absence definitely puts a kink in their summertime gang plans. Warm weather is here, and for the Gunn family that means open windows and salads. Ahhhh....

Spring update

Not flattering, but real: Me post-all-nighter with Richie at the playground with the girls (not shown :)
We went rollerblading...
And got caught in a rainstorm! Boy, was it fun!
Art Installation: Dinosaur Wedding by Vivian Gunn.

It's been a super long time since I've posted anything, even photos. I have been in work mode to the point where I sort of cut off all distractors. The reason I'm posting today is that I feel pretty cut-off from a lot of people and things I love. Certainly, I don't begrudge the intense learning year that's just passed, but I hope that relationships and outside interests will perk up again when I feed and water them.
What's going on right now is the conclusion of 1st and 3rd grades, lots of meticulous detail work at Bankhead Mfg., and Step II studying.

Vivian and Mazie have worked hard and done well this year. Vivian is a fearless writer. She will crank out a multi-page story without taking a break. Those are always fun to read - I'll try to post one. Vivian got a really cute discipline reminder that Richie and I had a difficult time taking seriously - "Whistling in hall." Yep. She's a whistler. We told her we loved to hear her happy sounds, but to please remember that the hall is a quiet zone. Mazie has had project after project after project this year. It's actually a running joke among third grade parents. She's built a shadow box of York (of the Lewis and Clark Expedition), she's illustrated a poster for Frightful's Mountain, she's made a diorama of the Washington, D.C. Mall. Her most recent project was "Become an expert;" she chose to make a poster about cartooning. I'll definitely post that one. Mazie and Vivian's birthday parties had to be postponed because Vivian got Strep throat the night before. I'll post photos after we have it, though!

Richie has just finished up a project with work that is a plate steel sign that commemorates one of the older retiring heads of the company. It's funny - the sign looks great judging by the photos I've seen, but the devil is always in the details. With the sign, the details apparently have nothing to do with the design of the sign - "that's easy" as Richie says. For this project, they decided that if they constructed the sign the way things are ordinarily constructed, it would end up looking like it was crying once oxidation set in and the rust ran down. So they modified the construction of it such that there's a complicated drill-hole pattern in the back that has to match perfectly between elements. It all came out great and the sign will never cry, but Richie was fretting over the drill hole pattern for a bit. That's just an example of the problems he solves at work.

We get a month to study for Step II, and I am trying to use it to its fullest. Step I studying whips us into shape for being able to put our heads down and chug through practice tests. It's actually pretty fun to synthesize disciplines and put it all together. I am feeling the weight of my education. I am not the quickest study in my class by far, but I have learned an incredible amount. The coolest thing studying for Step II versus for Step I, which was taken before Core Rotation year, is that I've actually seen most clinical scenarios that come up in practice questions. I'm thinking back to the patients with a gastric ulcers, the patients with diabetic ketoacidosis, the ones who suffered side-effects of medications. Learning really is different in context.

Thanks for reading and happy springtime!

Look carefully! This is the Aviary at Emory University Hospital Midtown (Crawford Long). It's all fixed up for Christmas. The birds looked sort of freaked out about the nutcrackers who were appearing to be moving in on their food.

This is the skyline from EUHM. Pretty nice.

This is a gathering at the Moriches' for a belated Thanksgiving celebration. Totally awesome!

Mazie and I were twinsies. Vivian joined in.

And last, but not least...egregious blonde depiction of Jesus from a children's Bible at Richie's folks' house. What?! How did someone get away with this?

Happy Holidays!
PS we have a tree but it is without lights or ornaments at present. I have spent most of this weekend doing a literature search for research project!

Happy Crafting

- Mazie's Georgia Animal report picture: Bobcat.
- Mazie and Vivian making clay animals.
- Mazie and Miss Laura Jane at a piano lesson.
- Smiley Mazie





*This is accidentally a sort of Mazie-centric post.

Wow - I can't believe it's already the sixth of December.

The month between Thanksgiving is crazy for everyone, I'm sure. I can't even put my sweatshirt on frontwards, for crying out loud.

Earlier today there was a flurry of e-mails regarding snowflake costumes and then one about green pants for a tree costume (mazie's grasshopper costume had green pants so we were able to help). We are trying to let everyone know that as far as the Decatur Gunns are concerned, Christmas is for children. I just picked up two very bright crocheted afghans at Last Chance Thrift Store half off Monday on my way home from clinic yesterday - one for each girlie, post-laundering, of course. And it is time for me to submit my research proposal. Thursday is an advisor meeting and Friday is a dean's meeting. Tomorrow my uWise tests are due for OB/GYN. Tonight was small group. Richie is at the church right now (since 7 when I got home from small group), helping to renovate. He was there last night from 5-10.

And there's OB/GYN...so interesting. Today I got to be in the operating suite and in the clinic at Midtown. It's so interesting, and so much fun! Can't wait for L and D.

Now some pictures. They'll appear at the top.

Wow - I can

Happy Thanksgiving Treeeeeees!

Favorite Holiday

I think Thanksgiving is becoming my favorite holiday. I just wrote a ton of thank-you notes, hoping for amnesty on the timing. I am done with Ambulatory Care (which I loved) and am on to OB/GYN next. I can't wait to catch babies!!!

Vivian had her Zoo Atlanta field trip yesterday. Her favorite animal was a bird whose name she can't remember that had a special behavior. The tour guide would stand next to the glass and open her mouth and the bird would try to feed her through the glass. That was what Vivian said, anyway.

Mazie is doing a project of her choosing in school. She is researching sound effects and Foley artists. We are pretty sure it's just to increase her repertoire of mouth sounds (which are - no kidding - turning into bona fide tics), but she's really interested in it. I'll try to remember to post what she comes up with.

Here are some pictures of The Gunns' attempt at cheerleading stunts. I can't remember when during public school I learned to do this, or who my cheering stunt partner was, but this little move has served me well for something like 20 years.

Some pictures

Dr. Rogerses

The Dr. Rogerses of Halloween 2011.