thankful

this christmas season, i was surprised to find myself in one of my favorite places: the company of old friends. we had a dinner party of 10 at our place, and it was perfect.



i was also lucky enough to spend time with my little sister. can't ever seem to spend enough time with her.


there were presents at my parents' place. oh, there were presents.


the best present award probably goes to cat tank given to us by my sister beth and brother-in-law drew for our cats. that's right, a cat tank.


all-in-all, it's been a lovely break -- first one henry and i have spent at home in two years! (taiwan two years ago, philadelphia last year) even so, i'm looking forward to hitting the interview trail again in a few days for my fun-filled month of seeing the entire northeast. :)

genetics

a light-hearted post since my past 2 weeks in MICU have been anything but...



from xkcd.com

if you don't already check out this website... you should probably check out this website. it's geektastic. :)

my favorite season

"Delicious autumn! My very soul is wedded to it, and if I were a bird I would fly about the earth seeking the successive autumns." -George Eliot

picture window

a few months ago, i nearly had a stroke when i found out about a project between two of my favorites: author nick hornby and singer/songwriter ben folds: lonely avenue. the lyrics are written entirely by nick hornby and the music/performance is done entirely by ben folds. it's an interesting concept - and brilliantly carried out. i highly recommend it, regardless of your familiarity with either hornby or folds.

the first time i listened to the second track on the album - "picture window" - i bawled. if you've followed my blog the past few months, you might remember a particularly depressing entry this past summer when i discussed a patient who died while i was rotating on the gynecology-oncology service during my OB/GYN rotation. it was a very difficult experience because there was so little we could do for my patient and many others with end stage disease. as trite as it might sound, this song somehow embodies my experience and allows me to have catharsis for this rotation. i've included the lyrics below.

they checked into the hospital new year's eve
nothing to be done about that
rainbows, daffodils, she's not naive
symbolism's all crap

there's a big picture window in their room on the ward
with a view over parliament hill
but the view offers more joy than they can afford
when there's this much pain to kill

(chorus)
you know what hope is? hope is a bastard
hope is a liar, a cheat and a tease
hope comes near you, kick its backside
got no place in days like these

at dusk the darkness surrenders to colour
as the fireworks streak the sky
and their window gives them the prettiest picture
the useless luck makes her want to cry

(chorus)

then it turns to midnight, the shitty old year's spent
another mum gives her some sparkling wine
she nearly gives in to the moment
but she'll be sick in 2009

(chorus)

and just as she's thinking of pulling the blind
a huge rocket bursts, right in front of her eyes
the city lit up, London's given a bright crown
as she tires, and fails, to stop spirits rise

(chorus)

-----------------------

interestingly enough - consistent with the song - the rooms on the gyn-oncology floor all have gigantic picture windows. here's a view out a patient's window i snapped with my camera phone one day. thanks, nick and ben. you guys help keep a poor medical student sane.

lemon and saffi

posting twice in one night?! it's true. but this one's all about the pictures. we visited my sister and bro-in-law last weekend, spending lots of quality time being licked by their 6-month old golden retriever puppy and getting reacquainted with their 4-year old yorkshire terrier. here are a few shots we snuck during calm moments.

snickerdoodles

for as far back as i can remember growing up, we made snickerdoodles. i'm not sure exactly where the recipe came from, but when i got married, my mom made me a little cookbook and included the recipe.

today is my mother-in-law's birthday, and instead of going with a cake (they're so fattening, you know? wink, wink), why not cookies? time-honored, mouth-approved, pierce family tradition. plus i got to use the kitchen-aid mixer and take our new canon powershot SX120 IS for a drive. i only wish i could share the smells with you all.

(henry and i may have eaten a few of the "broken" ones)



all the ingredients: ready for action


eggs and butter: irresistible already


the dough formed into perfect little balls


one of the tricks to the taste: rolling in cinnamon sugar


another trick: the fork smush


the goods (and oh, it's good): the perfect snickerdoodle

best and worst

it had been my intention to blog much more often during my weeks in clinic. my patients were great – they taught me so much. i learned better ways to ask questions, tricks for less awkward physical examination, and even once had a 10-minute conversation about Alabama football (shout out to my husband for his help on this one). i got to know people the way you cannot in a hospital setting. i got to see repeat patients. i loved recognizing patients, meeting their family members, finding out how treatments had or had not worked. here are a few highlights i meant to tell as stories:

-removed half of a q-tip from a lady’s ear (that she waited a week to come to the doctor for)

-smoking cessation counseling: “so, ms. so-and-so, when do you plan on quitting smoking?” (without missing a beat) “when i get old, develop alzheimer’s, and forget that i do.”

-middle-aged lady, on getting her throat swabbed for strep: “i’d rather get something shoved up my vagina than down my throat if you know what i mean!” (we can only assume she was referring to a preference for a pap smear over a throat swab.)

-middle-aged gentleman, flies a lot for his job: “you know what they say about birmingham: when you die, whether you go to heaven or hell, you have to go through atlanta.”

-older lady getting her blood pressure taken, as the cuff tightened: “god bless america!!!”

-85yr old lady (with poison oak on her ankles for the 3^rd time acquired from her cat who goes outside, plays in poison oak, then flops himself all over her slippers) offering me life advice (i got a lot of life advice): “let me give you advice. don’t try to own the road. i got in a wreck last year because i’m too aggressive. stupid @#$%# GMC. my kia was totaled.”

i had an excellent teacher for most of my time at the clinic. i worked primarily with dr. l. when i signed up for the course, i had asked specifically to work with her – and i got to – but she works only tues, wed and thurs (and spends the rest of her week at home working her butt off with three young kids; her husband’s an MD, too). dr. l is great at instructing and giving feedback, but she also has a humble attitude, something incredibly hard to find in medicine. she advocated for me doing any and all procedures patients needed. i froze warts off feet, elbows, and fingers. i sent patients for x rays, urine studies, and to the lab. i did more pelvic exams/pap smears with dr. l than i did on my entire ob/gyn rotation.

on mondays and fridays when dr. l wasn’t in, i worked with some of the other doctors at the practice. most of them were great. one of them was not. dr. b was not a surgeon with a “god-complex,” nor was he a “know-it-all” resident. even so, each time i worked with him i gained a clearer picture of the type of doctor i never want to become. dr. b is an older man. he had a practice at another hospital in town that went bankrupt a few years ago, thus finding himself without a practice. instead of retiring, he took a job with this practice at UAB. it’s obvious dr. b is miserable, and that he has completely checked out. exhibit a: one morning working with him, i saw his first three patients while he meticulously placed stickers on one of those mail-in sweepstakes return envelopes to the national rifle association, complaining to his nurse that he never wins anything and makes no money compared to his colleagues in surgery and other fields.

one of the most frustrating things about dr. b is that he gives out narcotic pain medications (among other controlled substances) liberally. many of his patient encounters started something like this: “so what brought you in today?” “well, my friend/neighbor/boyfriend told me that you’re a really good doctor for controlling pain. i don’t like what my arthritis doctor put me on, and i want some lortab.” and he would give it to them. even ask the dose. and whatever other controlled substance they asked for. so much so, that the clinic created a policy that requires patients on pain meds to get them from a pain management clinic. what does dr. b do? gives the patient the note with the clinic’s policy with one hand, and the prescription for lortab with the other hand.

seeing a patient before dr. b, i talked to her about the harms of narcotic pain meds. she told me she needed them. we talked about how she could try to use less, how she could try other things long term, etc. i didn’t really think i got through to her, but maybe one day she’ll think back to the conversation we had. i was feeling ball-sy and mentioned to dr. b i had talked to her. “what difference does it make?” he laughed in my face. “that’s how people are.”

----

so if ever someone says to you
"life isn't fair, get used to it"
then you should say:
"well it might be
if folks like you would let it be"

-the avett brothers, the lowering

----

clinic

something unique about me among many of my colleagues: i love clinic. and this is great because i started my outpatient acting internship in family medicine this week.

and it's awesome. i knew it would be. here's why:
1. laid-back doctors who let me do a lot ("did you write the prescription? order the labs? can you just run my clinic?")
2. steady flow of adult patients (no babies! or kids!)
3. 8a-5p, baby
4. and - dum, dum, dum - i did my family medicine clerkship here! so i have intimate knowledge of the whereabouts of important things like the bathrooms, vending machines, staff microwave, younameit

in medical school where you sometimes switch to a different ward/service/specialty as often as every week, it was such a delight to be starting something where it didn't feel like my first day was my first day.

and my cheap jab above about not seeing kids in the clinic? nah, don't sweat it. they say kids say the darnedest things, but i'd be willing to fight 'em for it. here's an example from today from a delightful little woman in her late 60s. my patients say plenty to keep me rolling all day long.

"hi, ms. so-and-so, what brings you in today?"
"this awful cough" ::coughs:: "i've had it for a month. last time i had a cough like this it turned into pneumonia. i hadn't planned to go to the doctor that time, but my husband told me he wouldn't have SEX with me anymore if i didn't get myself fixed up, so i guess i just HAD to!"
"i see. well we wouldn't want that to happen. tell me more about your cough..."

age

when i was 16, i went to the beach with a friend and her family. one night we decided to hit up a little amusement park, and my friend and i rode pretty much every ride that didn't make me barf. most of the park workers were local teenagers, and as teenage boys are wont to do, they flirted with us. except - they flirted with my friend, telling us they thought she was 17-18 and i was her 13yr old kid sister.

when i was 21, i was in my senior year of college. i went to a local restaurant in the city with some friends for a champagne brunch. we were carded, of course. but when the waiter looked at my license and looked at me, he frowned and said he needed to take my card to his manager. mind you, my friends had out-of-state licenses, in-state licenses, you-name-it. here i was with my in-state as-legitimate-as-you-get-license, getting the twice-over from some waiter likely because of my age.

i could go on and on. apparently i look younger than i am.

but - over the past year, something changed. around january, i stopped getting carded at restaurants. it was mysterious really. i would order my drink, look down to my purse to fumble for my license, and the waitress would have already disappeared. i have been chalking it up to the chronic state of sleep deprivation and stress of third year, especially since just prior to january i had my surgery rotation.

and then it happened. we got our pictures taken for our residency application, and i picked them up yesterday. i looked nice, i thought, and then, out of nowhere: "hey, who is that grown-up?!" apparently somewhere along the way it is the goal of medical school to attempt to make you look like you are old enough to take care of so-and-so's dying mom. hey medical school? goal accomplished. ...or maybe medical school has just flown by so fast the last time i looked in the mirror was my early twenties? in any case, here's the evidence.

yours truly, all grown-up:

coping

how is the language we're speaking the same?
shape shifter have you discovered a change?

why does the soul hallucinate?
i've got control, i shift my shape

your eyes, they swell like a riot, deranged
tomorrow you're laughing like a child again

why does the soul hallucinate?
i've got control, i shift my shape
if flesh and bone do not contain
the mirrors don't reflect my face

psycho, you killer, you cancer, my friend
why don't you give me an answer for when
when you'll let it go
when you'll let it go
when you'll let it go

shape shifter, local natives

bye bye, babies!

so i survived OB/GYN. !!! this is big, people. all-in-all i was pleased with my performance, although henry will tell you i whined my way through the entire 8-week rotation.

i actually ended up enjoying OB more than i thought. it's definitely one of those specialties (like trauma surgery) where you acquire awesome stories to tell at dinner parties (y'know, one day when you have time to go to dinner parties and friends who throw them). in retrospect, i am actually thankful for my newfound ability to wield a speculum, acquire and interpret a wet prep of vaginal discharge, and manage every aspect of a pregnancy. and i will say that when i got to deliver my first baby, it was - without a doubt - one of the most rewarding and beautiful things i have done in my short medical career.

and now i am one week into my four-week block of studying for 2nd round of boards and preparing my residency application. that's right, my RESIDENCY APPLICATION. after a lot of strife this past week, my application is mostly complete and ready to be sent to 20 (yes, twenty) residency programs on sept 1 when they start accepting them. it is completely befuddling to me that in less than 8 months, i will actually be an MD. simultaneously exciting and terrifying. sort of like a roller coaster, although maybe that's a bad analogy considering that i vomit every time i get on one.

after i take the USMLE step 2 CK exam on september 17, i fully plan to venture back into the world of pleasure reading. i have a stack of books i've been acquiring over the past few years in medical school (which in their own right have been acquiring about a 1/4" of dust). a few among them: inside the outbreaks, by mark pendergrast - a historical/ investigative report about the epidemology intelligence service at the CDC, aka my dream job; every patient tells a story, by lisa sanders - the writer who helped inspire the series House, MD; a few titles by my favorite author ian mcewan, saturday (from my dear from amanda) and the innocent; and my stroke of insight, by jill bolte taylor - a neuroscientist who had a stroke and wrote her story.

ahhhhh, 4th year. hurry up and be awesome! for now, though, i'm happy to bask in the glory of OB/GYN being over -- and the fact that i won't have to look at another vagina for a very long time.

when i go down

in case this is my first blog post you've ever read, newsflash: i've been sort of a downer lately. life's been getting me down. one of the things that has added insult to injury was henry and i didn't get to properly celebrate our wedding anniversary earlier in july due to my all-consuming schedule.

and then - as if a direct gift from heaven (and i truly believe it was) - came my OB clinic week. i was scheduled for a few afternoon clinics, with friday and the weekend off. holy cow! thank you, jesus! so henry whisked me off to panama city beach, fl for a weekend getaway. it'll be 3 weeks of delivering babies starting tomorrow, but i feel refreshed and ready to go. bring on the baby-mamas!

here are a few pictures:

when i go down

i lift my eyes to you
i won't look very far
cause you'll be there
with open arms
to lift me up again

.relient k.

futility

although i attempted to be optimistic on gyn-onc, it eventually got the best of me: between the hours, the scutwork, and the overwhelming sadness. during the two weeks i was on, three of our patients died (including one i took care of every day). additionally, i helped operate on a number of women with late stage ovarian cancer who had prognoses of maybe 6 months. i laughed with them. i cried with them. ultimately, there was nothing i (or any of us) could do for them medically.

i will never forget the morning ms. p died. it was like any other day, but it was somehow so different. i went in to round on her at about 4:30am (as i normally did), and she was lying on her side, awake.

"how did you sleep?" i asked her, apologizing as i always did for the early hour.

"not well." she looked different. she was breathing fast. "help me sit up a little, will ya?" she reached for my arm. i helped her sit up in bed as i counted her respiratory rate. it was too fast. we both half-glanced at the infomercial blaring on the tv. it seemed so irrelevant and intrusive.

"any pain?" i placed my stethoscope on her chest.

"nah, sweetie. just trouble breathin'." she was sitting up in bed now, but every muscle in her body looked uncomfortably drawn.

"try to rest, ms. p. i'll be back with one of your doctors."

my resident went to see her. she was a 50yr old lady with known metastatic cancer; our plan was to continue to follow her symptoms and offer any comfort care we could.

around 7am, i went to the operating room to help with a case. we'd been operating for about an hour when we received a call to the OR - ms. p had died. just like that. gone. i was scrubbed in to the operation and my entire job as a medical student consisted of cutting suture and retracting... i was so distracted for the next 10min i had to be reminded to cut.

sigh. her time was coming sooner or later... it was just hard for me in my small understanding of mortality to experience sooner. but here i am. and there she is -- in a better place.

attempt at optimism

i'm currently on my OB/GYN clerkship, 3 weeks in. my first two weeks were pretty cush -- i was on REI (reproductive endocrinology and infertility). as my resident simply put: it was our task to knock people up. the hours were awesome.

starting week 3, i am now on Gyn-Onc surgery (gynecological cancer). we operate on & treat vaginal/cervical/uterine/ovarian cancer. the hours suck. get there at 4am - usually leave around 5:30pm. this rotation is something of a UAB med school rite of passage. we stay incredibly busy all day long, have very sick patients (1 died today), and work with intimidating attendings.

3 days down, 11 to go. in an attempt to keep my morale up, i am dedicating the rest of this post to all the positives i can come up with about Gyn-Onc:

1. no AM traffic & ideal parking spot: getting there before 4am everyday means i have literally no competition for commute or parking.

2. crazy awesome surgery: yesterday i helped take a tumor out of a lady's belly that was the same shape as a football but about 1.5x its size. holy cow. my attending was on a high; it was insane. today i got to watch an operation with "the robot" - the da vinci robot surgery. it's wicked.

3. potential weight loss: it's hard to eat breakfast at 3am when i wake up, and often there is not time throughout the day for a proper lunch. we are on our feet a lot. burned calories > consumed calories? time will tell.

4. fellow students: i'm working with 3 brand new MS3s. they're awesome. i am trying to get them oriented to wards. it is delightfully refreshing how not-jaded they are (and kind of scary how far i've come in that department).

5. perspective & conditioning: nursing shift changes twice while i am on duty and hearing all three sets of nurses complain about their tiredness/workload/etc has rendered me much less likely to complain. lame of them. win for me.

6. it's only 2 weeks. i can do anything for 2 weeks, right?

and because i can't stop singing it (to myself, my residents aren't amused) every time i think about the da vinci robot surgery:

domo arigato, mr. roboto, domo arigato mr. roboto ::incredibly convincing robot dance::

altered mental status

although i owe the interwebz a decent post about my glorious month on the famed (and often infamous) tinsley harrison internal medicine service, today i will whet your appetite with an anecdote.

every patient who comes in to the hospital has recorded a "chief complaint" which is the reason for coming in his or her own words ("chest hurts" or "short of breath" etc). the best chief complaint from my personal annals: "this bitch just slapped me" (true story! courtesy of a psych patient). however, if the patient is unconscious or otherwise unable to give a CC, "altered mental status" is written.

enter: tonight's anecdote's patient. altered mental status, but doing much better. as we were rounding this past weekend, post call (read: having been awake for 30hrs straight) our attending entered the room and began questioning the patient with some typical orienting questions "what day is it? what's your name?" etc. the patient feigned sleep, rolled around in bed, then her eyes popped open.

"where are you?" my attending prodded.

"yoooou tuuuube." the patient drawled.

i smirked; bit my tongue hard. my attending unfazed.

"and what's your name?" she continued.

"charlotte," the patient started, seeming to collect herself. we all looked at our rounds papers to see if she had gotten the answer right.

"charlotte's web." the patient finished with a grin.

"oh, ok. get some rest." we quietly exited the room with our lips pressed together. the door shut behind us, and i lost it, totally rolling in hilarity. everyone was smiling.

she'll get better... but until then, her child-like confidence in her imaginary location and identity will help us get through the day. and on tinsley - that's all we can ask for.

The Bird

i will update soon about this month on Tinsley for my acting internship! it's going great. but first, i have to talk about... The Bird.

as far as i'm involved, this all started a few weeks ago, although i've heard that The Bird has been around since last year in other locations.

so here's the set-up: everyday i park in my parking lot near children's hospital and walk the few blocks to university hospital (west pavilion). i created a schematic for reference (this is hardcore, people). the red arrows depict my walking route.

so one morning a few weeks ago, i was walking on the right side of the street and passed the first "X" on the map. i saw The Bird perched on one of the parking meters up ahead but didn't think much of it... until it started flying at me like a torpedo. WTF? i reacted reflexively and jumped to the side, only to feel something thump me on the head a few moments later. i walked a little quicker, and then i heard its awful call and saw it. it was chasing me! i squealed and started running. it flew into me about 2 more times before i lost it.

at this point, i was completely confused. i ducked into the psychiatry hospital (near the second "X" on the map). my conclusion: The Bird had a nest, and i must have gotten too close to it. the behavior still seemed incredibly violent, but animals can be pretty protective and territorial. plan: walk on opposite side of street.

after a few days of walking on the left side of the road, we met again at the second "X". same circumstances: i saw The Bird from a few yards off on a parking meter. although i suspected it would attack again, i stupidly continued on my way. the carnage? 3 times to my head. i tried to whack it with my bag, but it was not deterred.

it was about this time facebook statuses and twitter updates started rolling in: my classmates were also being attacked. what could be done? i started walking inside - there's an enclosed walkway through children's hospital to university. amazing how such a small, deranged creature can change our daily patterns.

so on one particular morning last week, about a week or so after i resolved to walk inside, i was coming in pretty early for call (around 6am). i decided to press my luck with walking outside, especially since The Bird had moved further down on my walk - i figured i could always duck into the psych hospital (how fitting) if i needed to. the chorus of early morning birdsong made me nervous, and i was watching the sky suspiciously, fully expecting every bird to swoop down and peck my eyes out. i probably looked like a lunatic. you bet i accounted for every parking meter. there were two people walking about 20-30yds in front of me, and i watched as they entered and exited the "danger zone" unscathed... and BOOM. back of the head. then, BOOM, BOOM. back of the head, arm. i started running, at this point too far past the psych hospital to duck in. (third "X")

needless to say, i have been walking inside the past week. i have been trying to explain to henry why bringing my tennis racquet with me would be a good tactic, but he keeps saying bird guts on the racquet would be suboptimal. i don't care, though. i think it's about time for bloodshed. i'm not usually a violent person, but this bird has waged three unprovoked battles against me and countless more against unsuspecting passers-by. i can watch the sidewalk from the indoor walkway, and yesterday i watched a guy hold a book over his head as a shield as he passed through. two of my fellow acting interns were both attacked walking in yesterday morning and today.

all of this to say...

if you are driving on 7th ave at UAB in the next few days, and you happen see someone in a white coat, stethoscope around the neck, hair flying everywhere as she uses a tennis racquet/umbrella/bag/book to impale with intent to kill a deranged mockingbird, please smile and continue on your way knowing that social justice is being done.

cheers!

rosemary & research

here's a great, short article i caught on new york times' science section today:

the claim: rosemary helps reduce toxins in grilled meat

it's widely known/studied that grilling meat can create certain chemicals that have been shown to be carcinogens - a term that means they are compounds that can potentially cause some types of cancer. this article presents some evidence that treating meat with rosemary (and to a lesser extent with onion, garlic, and lemon juice) can help prevent some of those compounds from being formed. awesome! especially if you like these tasty herbs anyways.

but - i have to say as a total geek and firm believer in scientific research - one of the best things about this article is the hyperlink in it to a REAL RESEARCH ARTICLE. (the abstract on the pubmed search engine, in fact.) holy cow. i breathed deeply, sighed, and teared up a little bit on that one. bravo, new york times. eternal kudos for you tonight. ::electronic hug!!::

buddies

henry took this picture of our two cats lounging all over me a few weeks ago.

i love our cats. regardless of their sometimes silly (and at times annoying) antics, they defy the stereotypes of their species and make us melt.

millie (striped) plays fetch like a dog. throw the right toy, and she'll bring it back to you every time. she's fastidious and proper. you'll always find her curled up in a sunny spot or cleaning herself. she's the first to greet me when i get home (and also the first to ask for food at any meal time, although she's the skinnier of the two only eating a small portion).

fuzz (black & white) is the lazy, laid back, goofy one. she follows henry around the house like his shadow. in the mornings he has to throw a toy to keep her from following him right out the door to work. she grazes at the food bowl, slow and steady, and has surpassed millie in weight because of it. she's slower moving, but tender and affectionate.

both are surprisingly social for cats, which keeps things fun around our place. it's hard to believe millie turned 2 this month and fuzz turns 2 this fall. i don't think either of us had any idea what kind of buddies our kitties would be when we picked them up from the humane society, but we're grateful daily that we did.

feeling

so there's this relient k song - "this week the trend" - that i think probably sums up the way we all feel a lot of the time. here's a taste:

and this week the trend
was to not wake up till 3pm
i picked the few conscious hours that i chose to spend
and slept away the rest of them

and this week the trend
was to crash and burn and then return again
to practice the life that i pretend
provides enough to get me through the weekend

so i say get me a solution
and watch me run with it
and then you gave me a solution
what have i done with it?
cause i was absolutely sure i had it all figured out way back then
and now it's this minute, this hour, this day

and i just want to get mugged at knifepoint
to get cut enough to wake me up
cause i know that i don't want to die
sitting around watching my life go by
and what we take from this is what we'll get

and we haven't quite figured it out just yet
because all of us are all too stuck
strapped to a chair watching our lives blow up
stuck watching our lives blow up

...wow. it's true, though. what is this thing we call life when we are sitting in a chair, watching and waiting? misery. the singer is begging for something horrible to happen to him, so he can FEEL. so he can live.

i sometimes hear people say things like "life is hard." i often wonder what they mean. getting mugged at knifepoint, at first glance, seems like it would qualify as something that would "make life hard". on the other hand, the passive, numb way of living i've described would also make life hard. if given the choice, knowing life has to be hard, i think many of us prefer the latter because it is safe. we may be numb, but we're not bleeding. in so doing, we miss out extravagantly on the range of emotions we've been created to experience. we miss out on giving and receiving grace. we miss out on mourning and having our joy restored. we miss out on life.

although i didn't specifically ask or sing for it, i was recently "mugged at knifepoint" so to speak. my heart has recently been opened to a range of emotions... and i've let them pour forth. what a painfully human journey it has been and will be. how thankful i am for this opportunity to open my eyes and my heart and get up from my chair.

dear brothers and sister, when troubles come your way, consider it an opportunity for great joy. for you know that when your faith is tested, your endurance has a chance to grow. so let it grow, for when your endurance is fully developed, you will be perfect and complete, needing nothing.

[james 1:2-4 nlt]

sigh.

and the hardest part
was letting go, not taking part
was the hardest part

and i tried to sing
but i couldn’t think of anything
and that was the hardest part

oh and i
i wonder what it’s all about

everything i know is wrong
everything i do, it's just comes undone
and everything is torn apart

oh and it’s the hardest part
that’s the hardest part
yeah that’s the hardest part

the hardest part, coldplay

(no subject)

i got this feeling that they're gonna break down the door
i got this feeling they they're gonna come back for more
see i was thinking that i lost my mind
but it's been getting to me all this time
and it don't stop dragging me down

silently reflection turns my world to stone
patiently correction leaves us all alone
and sometimes i'm travelling
but tonight this engine's failing

i still hear the children playing
dead beat dancers come to us and stay

cause i don't care where you've been
and i don't care what you've seen
we're the ones who still believe
and we're looking for a page
in that lifeless book of hope
where a dream might help you cope
where the bushes and the bombs
are tranquilized

tranquilize, the killers

MS4

and so commences my fourth and final year of medical school! AHH! for those counting, i am now in 20th grade.

i'm currently on my last week and a half of a radiology elective. because of our research block during third year, i have one clerkship to finish during my fourth year this summer. here's the lowdown:

june: internal medicine acting internship

july-august: OB/GYN clerkship

september: anesthesiology elective @ VA, Step2CK

october: family medicine acting internship

november: off for residency interviews

december: medical ICU acting internship, Step2CS

january: off for residency interviews

[jan-april]: clinical skills teaching assistant for 1st years

february: master physical diagnosis

march: ambulatory internal medicine @ VA

april: infectious diseases elective

may 15, 2011 GRADUATION

i'm pretty pumped about all this. now i just need to figure out where i'm going to spend the next 3 years of my life training as an internal medicine resident and get them to pick me. !

death

this morning i met a patient. she's 92. she is blind. she reads rolling stone magazine in braille. she loves hip hop music. she's dying.

her next-door-neighbor is a patient who is 85 and loves country music. he has 50+ tattoos, some of which he has given himself. the nurses report he even has a tattoo on his you-know-what, although he certainly didn't give himself THAT one. he is also dying.

down the hall is a 55 yr old who is the primary caregiver for both of his parents who suffer from Alzheimer's dementia. he is angry at the world. he has six weeks to live.

yesterday, i met an 82 yr old patient whose daughter was by her bedside. she was sleeping, but i admired her freshly manicured nails. her daughter had painted them a deep pink, and completed the look by adding some flower decals. the patient died today.

---

where am i and what am i doing? i'm spending a week on the palliative care units at the VA and university hospitals.

palliative care is the type of care patients can receive when they have a terminal, incurable disease. many of these patients have cancer or other end-stage organ disease, and they attempted curative treatments without cure. many of these patients have multiple disease processes. palliative care focuses on the patient's comfort and symptom relief. dying is a natural process, and the focus is not to prolong it unnecessarily once it is imminent.

it's hard to simplify what i'm doing and seeing, and here's why: death is taboo in American society. we watch "shoot 'em up" movies all the time, but when it comes to someone we know dying, people are incredibly uncomfortable with death.

even in medicine, it is our goal as physicians to "cheat death" or at least prolong its inevitability. we constantly talk of "adding years to our lives" or "preventing mortality." we prescribe treatments to asymptomatic patients to prevent long-term consequences of high blood pressure among other things.

the premise of palliative care, then, where we basically say, "death, you win" has been paradigm-shifting for me. all bets are off. in a patient who has 6 weeks to live, he may eat whatever he chooses. there's happy hour on the palliative care unit. pain medicine is given out liberally. this is not "traditional medicine" as we are taught in medical school, but a hybrid of symptomatology and compassion.

i chose to spend a week on the palliative care unit to see what goes on, but also to sort out my own feelings about death. it's probably natural to be uncomfortable with death, even so, this discomfort undoubtedly stems from the mystery of death. we all fear what we cannot understand. for me, it's been therapeutic to participate in the dying process with these patients. they've taught me much in their few short last days.

in any case, waterproof mascara is recommended. and a box of tissues.

new place, new strategies

although i've not used this blog as a vehicle to update the world on my every move, here's an update: henry and i moved to a new apt 2 weeks ago and we absolutely love it. we're not entirely unpacked yet, but it's a lot newer, cleaner, and well... everything's more level. it's true.

we've done a few new things that we're proud of since we've been here that have enriched our lives and/or saved us money.

1. putting up bird feeders. this is more strictly an "enriching our lives" endeavor (but quite honestly, it's not very costly. only $3.96/each for bird feeders and ~$7 for a 15lb. bag of bird seed at Home Depot). we put the two bird feeders up on friday and within a few hours we had a variety of birds already munching. our cats have been glued to the windows, too.

2. combing the publix ads. henry and i are self-proclaimed couponers, anyways, but before the two weekly shopping trips we've taken since living at the new apartment, we've sat down with the weekly publix ad and circled/made a list of the specific things on sale we would get. we also went through coupons. we usually spend ~$100/week for groceries before coupons. these past two weeks, our bills have come up to ~$60, with a bold "you saved ~$40" declared at the bottom of the receipt. MONEY. literally.

3. living cable-less. when we moved, henry made the bold suggestion that we drop our cable tv. *gasp* as an avid watcher of food network, HGTV, and discovery channel (just to name a few), i was a little resistant at first. i came around, though. the fact is, henry and i don't really watch much tv. neither of us follow any shows regularly. we figured if there are any shows we want to watch, there's always hulu.com. and, on top of that, we bought an HD antenna (~$30 from Walmart) with which we can pick up all of the local networks (CBS, ABC, NBC, etc) through the free digital HD signals over the airwaves. so march madness? yup, we get that for free on CBS. in HD. huzzah. and honestly, i don't really miss cable. in fact, i'm watching "APT Create" right now, APT's version of an HGTV/food network hybrid. it's lower budget, but it's totally up my alley... and guys? it's FREE. (anybody backpacking in europe ever get the rick steves books? right now i'm watching "rick steves europe: venice." it's awesome. it's like an awesomer version of samantha brown's "passport to europe" from the travel channel.)

moving to the new apartment has given henry and i the opportunity to reevaluate the way we do a number of things in our daily lives - it's funny how moving every single thing you own and having to find new places for each of them will do that. the experience of doing something like dropping cable has been a huge encouragement to find other ways to save and re-shuffle our budget. here's hoping we'll continue this 'spring-cleaning' of sorts. cheers!

psychiatry

psychiatry. where to begin? today was the last day of my 4 weeks on this rotation. the schedule is great. the patients are challenging. it's definitely not boring.

psychiatry is one of those fields where you collect an excess of wonderful dinner party stories. i'm serious. i probably collected enough over 4 weeks to last me a lifetime.

why? the presentation of acute mental illness is usually completely socially unacceptable, but somehow humorous at the same time. patients are paranoid, suspicious, bizarre, withdrawn, talk to themselves, injure themselves, pace, stare, younameit. they make other people uncomfortable. as someone in the community, this may be all you would ever see. as someone who treats them in the hospital, these patients open up to us. they tell us their beliefs. many believe others are after them. some believe they have special powers. some see codes. still others have even more bizarre beliefs. some see and hear things we cannot. the list of symptoms goes on.

here's one example of many. while on service, i daily interviewed a patient who was very ill. she was brought in by the police because she was found wandering the streets confused. she smeared her bodily fluids at every opportunity (on anyone, anything). she did not answer questions appropriately or know where she was. every morning the nurses gave report that she was constantly naked. she was sexually inappropriate with other patients. she endorsed hearing voices. she saw bright things on the wall. she told us that she had a gift from god. she could open doors that were locked. she could hurt people if she wanted to. on one particular occasion when i was interviewing her, she was looking out the window at construction workers on a nearby roof. "you see them?" she asked me, staring blankly. "i can make them fall off the roof if i want." over the course of her stay she has gotten better - she really has. but it was both troubling and entertaining to talk with her each day. you never quite knew what to expect.

will i be a psychiatrist? nope. i'm glad for the experience. the stories will stay with me for a lifetime.

hem/onc jesus

so for my last week of pediatrics (last week), i was on inpatient hematology/oncology (for non-medical people, this is the blood diseases/cancer service). it was actually really interesting and fun. our kids were sick, but many were getting better. my attending was fabulous. he was a recent transplant from st. jude in memphis ("the mecca", our fellow liked to call it), and he made a huge production of teaching me every second he had available. he'd pull up powerpoints from "the mecca" and the fellow would roll her eyes (then secretly smile). he'd call to me from across the ward - "are you ready?" - and take me into patient rooms. he would teach these poor sweet overwhelmed families how to calculate absolute neutrophil counts. it might have been a little overboard, but it was awesome. i ate it up.

the hem/onc ward itself was pretty much like any other floor in the hospital. slightly different equipment, etc, but more or less the same. on one particular day, however, i was sitting at the computer in the unit looking at labs and glanced over at my hand holding the mouse to see jesus staring up at me. no, i was no hallucinating. it was jesus.

this is the best approximation of him my google search results could find.

i kept one eye on 4inch plastic jesus while i finished my computer business, then i left the nurse's station. i actually didn't think much about it that day.

the next day i came in, i looked for jesus. in fact, he was lying face down near some phone books. oye! i didn't mess with him, but that seemed sort of weird.

the next day when i came in, jesus was up on the top of the counter of the nurse's station next to a chart, situated in such a way that just his little face was looking out over the patient's chart and his body was obscured.

i found this entire thing very odd. my first thought was: "oh, this is the hem/onc floor -> kids with cancer ->prayers needed -> jesus can watch over them." but then my second thought was: "they sure treat 4in plastic jesus pretty crappy if they're hoping for him to watch over people." and then my third thought was: "this is the only children's hospital in the state, nay, the region and i imagine it's a pretty culturally diverse place, so where's the 4in plastic buddha and muhammad and mother mary, etc." ... and at some point i stopped thinking and just enjoyed the irony of the situation: a 4in plastic jesus was getting tossed around a nursing unit where we miraculously cure children of cancer daily.

it's that time again!

and i don't mean furniture rearrangement... except for i sort of do! it's true. we're moving again.

but don't worry, we didn't get kicked out of our current place. we kicked ourselves out. our lease is coming up in another month and it came time to decide - stay another year or move on?

it was our hope when we moved to this apartment a year ago that we would stay here for two years - until the end of my med school (and probably our move out of birmingham). we made a lot of compromises picking our current place - no dishwasher, tiny bathroom, oldoldold everything, putting our washer/dryer in the dingy basement, shady parking situation (which most of you know resulted in my car being totaled last summer), etc. we thought that the awesome location, the millions of windows, the gas range, and the "charm" would be enough to hold us over. unfortunately, we were wrong.

even so, it wasn't necessarily our intention to look to move. i'm in the middle of my stressful 3rd year (as i'm sure can be deduced from my recent posts) and henry's nearing completion of his master's degree... not exactly the most convenient time to undertake a move. but we have had our eyes open for a few weeks looking at what's available. we'd talked it out and agreed that we would only go through with the huge task if it would solve a few major problems: kitchen, bathroom, laundry, and parking without creating any major new ones: location, overall size, price. we also really wanted to be saving money rather than spending more or even paying the same amount. pretty tall bill, eh?

so our new place, discovered almost by accident, is a 2bed/2ba behind the summit. it will save us $175/month baseline on rent. ! this is 1 more bathroom than we have now. laundry INSIDE the apartment. huge kitchen with dishwasher. walk-in closets. marked parking spaces in a lot. etcetcetc. compromise? probably location. we'll have to factor in the drive to work. all that said, henry and i are ecstatic. there is a unit available exactly when we need to move in, and what's more, henry's employer is "preferred", so the app fee and deposit were cut in half. everything fell into place so smoothly and fit our incredibly tall order - it's easy to be confident this is where we're supposed to be.

so... in 3 weeks... we return to the land of buildings which are 1. up to code, 2. relatively level, and 3. free of lead paint and excessive amounts of mold. can't wait to take a bath in a tub that hasn't been PAINTED. !!!!!!!!! (not kidding there.)

celebrations

happy chinese new year! xin nian kuai le!

it's been a big weekend for events: opening ceremonies of the olympics, chinese new year and valentine's today. other events going on in the city/region: mercedes marathon, mardi gras parades, and a "snow-storm".

ah, the olympics. i've had the opening ceremonies for the olympics on my calendar for a few weeks; i get pretty excited about the olympics. my obsession probably started when i was in the 3rd grade when i was asked to do a project for class. that was the winter olympics of 1994 in lillehammer. shortly after, my family moved to birmingham and the olympics were in atlanta in 1996. i saved clippings from the newspaper and made an olympics "scrapbook". some of the soccer games were actually in birmingham, so it was incredibly close to home. in summer 2004, i pretty much watched every event that was televised, as i was bound to the couch after having sinus surgery. i've never really been a kid with any hopes of competing in the olympics; i'm not an athlete and don't dream of being one. there's just something thrilling about the games, all the nations, the drama of it all that has kept me excited through different ages and stages in life. this weekend i've found myself once again transfixed by the competition. here's to two more weeks of hypnotizing entertainment!

we had a very low-key new year's celebration with henry's parents last night, and his mom brought us sushi today. mmmmmm. always good food.

valentine's day was also a pretty low-key celebration for us. henry got sick at the end of the week with some sort of yucky upper respiratory infection, so he's been taking it easy. we were pretty lazy all day, and it was wonderful. the idea of valentine's day sort of conflicts me; when you have a valentine who treats you special every day it seems silly to ask him to go above and beyond that already high level of awesomeness on some made-up holiday. still, henry surprised me with flowers and a cookie cake. i'm a lucky lady to be married to such a consistently loving, caring partner in life.

---

last weekend, henry and i made the trip up to louisville, ky to visit my sister beth and her husband drew. they recently bought an adorable house with oodles of charm. we spent time with them eating, playing, watching movies, and generally having the time of our lives. on sunday morning, we drove to lexington, ky where my dear friend amanda and her husband ben live. we planned to have lunch with them there. another dear friend and college roommate, laura, came down from cincinnati with her boyfriend to meet us. what a reunion! the whole weekend made me long to live closer to both my sister and my close friends.

---

back to reality. this week i'll be in the well-baby nursery at uab. it's where all the freshly born, healthy babies go when they are not with their moms. it should be a fun week! i mean, there will still be lots of screaming babies, but at least they won't be sick. next week i'll be on inpatient hem-onc... those kids will be sick. i'm interested to see how that will go. then pediatrics will be over. i won't lie - i'm not sad for it to end. glad for the experience, glad it will be over. such is the story of third year.

180.

i just finished my four weeks of inpatient pediatrics. the first few days helped me realize that pediatrics is not my life's path.

somewhere in the middle of the month, one of the other teams' residents mentioned to my resident that she was about to go admit a 'crappy patient.' it didn't register for me until a few minutes later that she used the adjective 'crappy' to describe her newest admit. understandably, crap is not a foreign substance to a children's hospital, so this is not surprising. but in this case, the resident was talking about the patient being crappy - an undesirable patient. the patient had a chromosomal abnormality, present from conception, that caused a constellation of medical problems.

it hit me later that day why pediatrics wasn't appealing to me. on inpatient pediatrics, all of our patients were as the residents' newest admit - complicated and suffering some type of long-term incurable illness - or incredibly uncomplicated. by uncomplicated i mean: has a cold and can't eat, so has to be admitted for IV fluids and will go home the next day. obviously this is a gross generalization, but surprisingly accurate.

there's a list of other things that don't appeal to me about pediatrics: working with 75% female residents, dealing with primarily non-verbal/non-history-giving patients, dealing with parents, being out-of-touch with adult medicine, and calculating medicine/fluid/calories based on weight of individual patients among others. then there's the list of illnesses common in a pediatric population, many of which have some connection to embryology and/or genetics (neither of which hold my interest much).

after all is said and done, i also realized about myself - surprisingly - that i don't like taking care of kids medically. i've always been someone who is passionate about understanding people and helping others understand things. enter - pediatrics. it's impossible to explain to a 5-year-old why it's necessary to place stitches on her lacerated chin. impossible. i tried. don't get me wrong - i don't expect every patient i ever have to understand. it's just going to be a much more plausible task in a 30 yr old vs a 3 yr old.

nonetheless, pediatrics has taught me loads about myself and how i relate to people of different ages. prior to starting pediatrics, i was certain it was my career path. halfway through, i'm certain it's not. disorienting? yes. exciting? double-yes. can't wait to see how much more 3rd year will shape my own self-awareness.