Vacation Garbage

I've got a confession to make, and I'm pretty ashamed to do it. Actually, a few confessions. Not to be complaining about time off (time off is always great) but it's seriously reduced the substance of my life to, well, pretty much garbage.

I would say that it started on the 2.5 week epic journey. I read the first Twilight book just to keep me busy. But, like a fast-growing cancer, I couldn't get the next one in my hands and read fast enough. So, I blew through all of them as quickly as possible. I'm trying to keep some of my dignity by NOT going and seeing the movie--I'll keep you posted.

During the week days, I've slept and sat at home. Daytime TV leaves much to be desired, especially the 2:00-3:00 time slot, oh, and the 10:00 time slot as well. I've resorted to Judge Mathis and The People's Court, as well as Matlock in the a.m. I've even caught myself contemplating watching all of the paternity tests on Maury, but am so disgusted by the people who take procreation so lightly that I have to turn it.

Tonight, I'm sitting here watching Momma's Boys...completely horrible. Do you see the slippery slope? I still have a month of vacation left, oh lord, by the end, I might end up as a guest on the Jerry Springer Show if I don't watch out!

Christmas Card Guilt

Well, I'm so so so happy to be home after my huge interviewing trip. But, there was a pile of guilt waiting for me when I got home. More specifically, Christmas cards.

Everybody ranging from the insurance agent, to residency programs, to very good friends from church have sent us cards--there are 12 of them, and I'm sure more will come.

In years past, I have sent cards out...but I didn't this year or last year due to medical school interference.

I'd really like to return the favor to people, and show that I appreciate that they took time to send me a holiday greeting, but I just don't have the energy to do it, so I feel guilty.

Does anybody else out there feel guilty due to unrequited Christmas card greetings?

Completely Random

So, I've been so absent lately because I'm on my epic 2.5 week interviewing journey. It's been crazy. One thing I have learned though is how to be a Hampton Inn connoisseur. As such, I must say I'm a bit confused by the various Hampton Inns' randomness evidenced in their elevators.

In each of the elevators, there is a different graphic with a "cute"? saying...and I'm not sure what the sayings are supposed to impart as far as deeper meaning. (If there is anyone out there who knows the key to all of this randomness, please drop me a line.) Here are the examples:

• "If the shoe fits..." --- with a woman's feet pictured in high heels which are clearly too big
• "With a 'baa baa' here...." --- with just a sheep standing around
• "petal pusher" ---with a kid in one of those like, Tyco plastic buggy/car things
• "Singing in the rain" ---with a little boy in a rain jacket, but no rain
• "Walking the dog" ---with a little girl holding a yo-yo, walking the dog
• "Can you hear me now?" ---with a little girl holding a tin-can telephone

I really am tempted to ask a person at the front desk about all of this, even at the risk of them looking at me as if I'm insane. Who knows, maybe they have a special prize awaiting anybody who has the intellectual curiosity to ask....

Oh the Humanity!

I just found out today, after having a weird craving for these oh-so-greasy and oh-so-sinfully-full-of-calorie-treats...that Planters has stopped making them. They may have stopped making them as long as 2 years ago (you can tell how long it's been since I had them). Now there's a small, empty hole left on my tongue---full of tastebuds which were specially attuned to the savory flavor of these crunchy delights. There are few things in the world with as much cheesey (spelling?) goodness as found in these. What are they going to do next? Stop making pasteurized cheese in a can? I can't bear the thought!

Ugh...

How does one not become jaded and discouraged before even beginning practicing? This article has me posing this question. All the time you hear the bleakness of the medical picture, how primary care is undervalued and not compensated, and how things may get worse or won't get fixed.

Legislating the Doctor-Patient Relationship

I read an article recently in the AMA News about some new legislation in California. Read here:
http://www.ama-assn.org/amednews/2008/11/10/prsc1110.htm

They have made it a law (the Terminal Patients' Right to Know End-of-Life Options Act) that doctors are required to talk to patients "at the patient's request" about end-of-life care, specifically hospice, but they do not have to talk about those "grey areas" (ie, withholding nutrition and water, palliative sedation) that may hasten death.

Now, anybody who knows me might think that I'd be excited about this legislation, given that I have an interest in Advance Directives and informing patients about options near the end of life, the limitations and uncertainties of the medical system, as well as just opening up communication lines regarding death and dying.

My first response though was to scoff at the idea. I realize that this is all in patients' interests--to be informed and to have understanding, and I don't want anything to get in the way of that. BUT SERIOUSLY? Making it a law? These discussions should be happening anyhow--they're part of a responsible doctor's job to make sure that patients are as well-prepared as possible for what may lie ahead.

What good does it do to say that doctors are required to provide this information "at the patient's request"? This is still putting the responsibility upon the patient.

Legal Rep: "Doctor, why didn't you talk to this patient about dying?"

Doctor: "Well, he didn't know he was dying, and didn't ask me about dying, so I didn't need to bring it up."

Legal Rep: "Oh, ok, then, well, as long as they didn't ask about it...I guess we don't have a beef."

And honestly, those doctors who aren't talking to their patients with a terminal condition about end-of-life care.... does anybody think that having it written down as a law somewhere will make them any more apt to talk about it with their patients? This isn't a conversation that you have because you're "required" to do it--it's a conversation you have because it's a privilege and it's what's right to do for your patients.

Another thing.... nothing in the article mentions what the "penalty" under law is--so it would seem just another worthless piece of paper that tax dollars were spent buying....a distraction to the lawmakers so that they might be able to say that they are "contributing to the health care system" all the while the other problems are sitting around, stewing, because, well, who knows.... "Pay no attention to that man behind the curtain."

Lesson Learned: You can't legislate the doctor-patient relationship.... it would seem legislators are a bit clueless in this realm.

What it's Worth: It's worth being able to keep a true sense of what the doctor-patient relationship is built upon.

Yo, Adrian!

AMC is creating the bane of my existence currently. They've decided to run the "Rocky" series of movies on multiple nights this week. Although I don't particularly have one TV show I must watch, Rocky, Rocky II, Rocky III, and Rocky IV have been on the TV..........ugh........ I really don't know what else to say. I thought about putting up a picture of Stallone just as a graphic for this post, but I'm too disgusted to see his human growth hormone-loving face one more time, or to have it on my blog.

On Another Planet

I started my outpatient Dermatology rotation today. The details of the "other planet" are dizzying. I'm not talking about me being clueless regarding dermatologic disease, I'm talking about the way that a Derm office runs. I must say, it's pretty obscene.

Firstly, the doctor has appointments scheduled every 10 minutes, some (probably 1/4) are double-booked. AND THEY NEVER RUN BEHIND!!!

The nurse to doctor ratio is 3:1....let me repeat, the doctor has 3 nurses to herself, probably leading to why the first point above exists. Each nurse comes into the room with the doctor and performs the following duties:

• Getting all of the Chief Complaint, History of Present Illness, and Past Medical History from the patient without the doctor repeating the questions
• Writing prescriptions and if a patient needs refills, the nurse goes ahead and writes it
• Ripping the carbon copy off of the prescription (as in, today, the nurse handed a prescription to the doctor with its carbon copy on the back and the doctor handed it back to the nurse--I think, for the only purpose of the nurse ripping them apart and handing it back to the doctor)
• Numbing areas to biopsy
• Being at the beck and call of the doctor to run and get samples, etc.
• Doing all the teaching regarding wounds and dressing

My mind was boggled at what the doctor DIDN'T have to do...and how she billed for the visits.

One visit she called a "Level 4" (which, for those non-medical out there... pretty complicated but not the highest, Level 5) --the patient was on Accutane, she looked over his dry skin, suggested heavy mosturizer, asked him a few questions about mood, and looked at his lab work...that was it! Geeze, I'm sure in Family Medicine nobody would get away with calling at a Level 4.

And one last thing...all of the patients came in with an understanding that only their skin would be taken care of, that's it. It was so strange to not have them bringing up multiple, unrelated complaints...and very boring.

Lesson Learned: I'd be bored to tears and unable to sleep in peace at night if I did "medicine" this way.

What it's Worth: Seeing how "the other half" lives.

Words!

I've decided I love words. Last night as I was trying to go to sleep, I was thinking about how remarkable they are. A series of letters, put together to convey greater meaning, to share thoughts, and to connect the human experience. I was thinking of some of my favorite words--some are my favorites just because of the sounds they make coming off of the tongue, and some are my favorites because they are just perfect for what sentiment, what action, what thought is needed for any situation. So, here they are...in no particular order:

1. Raucous--"disagreeably harsh or strident OR boisterously disorderly"

2. Serreptitious--"done, made, or acquired by stealth OR acting or doing something clandestinely"

3. Recalcitrant-- "obstinately defiant of authority or restraint OR difficult to manage or operate OR not responsive to treatment "

4. Glower--"to look or stare with sullen annoyance or anger"

5. Querulous--"habitually complaining, fretful, or whining"

6. Candid--"free from bias, prejudice, or malice OR marked by honest sincere expression"

Lesson Learned--none really from the statements above, but I will leave it with the following caution from the Bible:

"When words are many, sin is not absent, but he who holds his tongue is wise." Proverbs 10: 19

I'm still working on that one.

(also, many thanks to merriamwebster.com for their formal definitions.)

Personal Responsibility Anyone?

I think I may write a more coherent and collected blog about this later (maybe). I don't know if I'd be able to accomplish this without being, well, legalistic, unforgiving, judgemental, condemning... yadda yadda. If you've not seen the following articles online lately, I suggest you read below.

http://www.foxnews.com/story/0,2933,409262,00.html

and

http://www.cnn.com/2008/US/10/08/nebraska.safe.haven/index.html

and

http://www.foxnews.com/story/0,2933,429106,00.html

Basically, the genius lawmakers in Nebraska have made a law letting people "abandon/drop off/give a safe haven" to "children." They left it open to interpretation (seemingly intentionally) as to children up to 18 can be given over as wards of the state. I think that one of the fatal flaws in their thinking is that those people who actually TAKE THE INITIATIVE to drop off their children probably wouldn't have been horrible parents in the first place, because they care about how their children might turn out. Those who actually are playing an active role in abusing and neglecting their children--I wonder how many of them would use this law?

Now, I'm not implying that any child should be deprived of a safe, nurturing, supportive home. Where is the personal responsibility in all of this? As Americans, we've become devoid of any consequences, ready to have somebody bail us out, give us a quick fix, and take away any little thing that may cause stress. Promises seemingly mean nothing, nobody stops to think ahead.

Out of all the actions we can perform on this Earth... shouldn't the decision to have children be one that gives us the most pause?

Horsebite!

I had a great weekend .... except.... well, see below:











That would be a horse bite...and no, I really didn't do anything to the horse to make it bite me. And yes, it did hurt as badly as it might seem from the picture. The "eyes" of the bruise (the two lighter areas) were where her teeth actually made contact.

We ended up riding after that, but I wasn't on her. :)

We went camping on Friday, horseback riding Saturday. Lovely weather, lovely time. I love KY in the fall.


Lesson Learned: Never trust a horse, even if you've known it since it was a little one.


What It's Worth: Not having to explain that your husband doesn't, in fact, inflict bruises upon you, haha.

Ah, Yoga

While on this away rotation, I've not done much to enjoy myself or the town I'm in, but I'm so forutnate to have gotten to stay with a lady who teaches a yoga class. It had been forever since my last session, but oh goodness...how quickly I realized I must get back into it for my sanity!

I never would have thought that I'd be a yogi. It seemed too, well, new-age granola and also intimidating. When I first started at my YMCA, I didn't figure that I'd last. I quickly discovered how great it was.

It doesn't matter what is going on in your head prior to the session-- a bad experience at work, school, horrible fight with somebody--whatever. I promise, if the class is of decent quality, by the end, you will have cleared your mind. The breathing. The stretching. The gentle pushing, pulling, and sometimes contorting. I'm not one to say that I'm in touch with my body, but in yoga, you can become one with your body and mind...I know... it sounds like some bad info-mercial, but it really made me think more about mind-body-(spirit) medicine and complementary and alternative treatments as well. Mostly about my own sanity though. I needed it during second year of med school...and I think I need it now! If you've not done it--try it--- I don't think that you'll regret it!

A Bit Lighter?

Well, I was looking at my recent blogs, and one might think that things have been pretty dark lately. They haven't been too bad, really. Tonight I was going to air some more of my frustrations, but I've decided instead to post a link to a video on YouTube which, although it makes me cry, it puts things into perspective. I hope you enjoy it as much as I do. It has already put me in a better mood this evening.


http://www.youtube.com/watch?v=zCdZwitrNoY


Lesson Learned: Watch the video, you'll see.

What it's Worth: It's worth what nothing else is worth--and it's worth what matters.

Frustrated!

I've just come to understand something about myself. I guess I knew it before, but this evening, I just figured out how to put it into words.

One of the best ways to frustrate and disappoint me is to refuse to address an issue that I expect some discourse on.

I might say something, bring up a topic, or put it in an email, and if said listener or reader doesn't respond appropriately (or, with something that I deem appropriate) I quickly become frustrated, angry, disappointed, and possibly even paranoid.

So then, I sit and seethe, and play out the possibilities as to why said person may not have responded to me. All the while, they sit there probably pleasantly ignorant as to my internal turmoil that bubbles into a bad mood.

What can I even do about it though? It's not like I can FORCE somebody to share their thoughts (or non-thoughts) with me about whatever it is I'm wanting to discuss. Sometimes I'm sure it would be best for me just not to say anything at all. If there's no discussion, then there are no expectations of what the discussion will be or what goals it will achieve. Usually though, one would expect that when Person A says something like "I wonder about this" or "I thought ______ about that" or "I'm (sad, angry, frustrated, happy, disappointed, joyous, excited) about __________" That the natural human response would be to address the thought or the emotion.

Lesson Learned: Stop having expectations about how people might behave.

What It's Worth: Not being frustrated by unmet expectations.

God Second-Thinks?

So, I've been reading 1Samuel some. It's about how David got put into the position of "being a man after God's own heart." Good story. I've not finished it yet, but still, I know it's a good story. But the other night, I was reading and I was surprised by something I read.

Now, this doesn't happen much-- not surprise/shock. The most probable and correct assumption would be that I don't read the Bible enough then. But ususally, I do have something that speaks to me or is unexplicably wise, but usually not surprised. Here it is---

1Samuel 15:35: "And the Lord was grieved that he had made Saul king over Israel."

My first response was "Wow, really? The Creator of the Universe was sad that he did something?" I mean, he's omnipotent, omniscient, omnipresent... He knew what the outcome would be before the world was even made, yet even then, He was sorry that He did it. He doesn't answer to anybody, has no obligations to fulfill, and can do whatever He pleases.

The Israelites had asked that God give them a king. He tried to indicate that even though they thought they did, they didn't want to be like all the other kingdoms, but they insisted--and got Saul, who was awful. All this time, God was planning on putting David in after Saul. So, if Saul was the means to the end to get David in, then why would He be sorry?

This is one of the times where I wish I knew Hebrew. I'd like to understand the nuance of grieved. Was God grieved because of all the trouble His choice was causing Him? (like, needing to do more work to fix it?) Was God grieved that He was seeing His children make a bad choice, which He granted? Was He just grieved that He'd made a bad decision? But how could it be a bad decision/mistake if He knew the outcome and could have prevented it in the first place?

Ok, my head is spinning now, but you get the point.

If God was grieved over a decision He made, I wonder what other times that He grieved/grieves in the same way? I'm sure there was grieving over Jesus' death on the cross, but at the same time joy.

Lessoned Learned: Maybe sometimes God isn't so happy with all of the things He decides to do.

What it's Worth: It's worth knowing that I have a God who understands what grieving over a decision is like, and He's here to comfort me through it, and He's got a plan further down the line that's better.

Blow Up

Today, I went over the edge. Blew my top, had the straw break my back, flipped out, flew off the handle--all of that. We're talking about yelling, face turning unnatural colors, sweating, and a few small choice words, then more yelling. It may be that I've been stressed lately (probably that's umm 99% of it) but it was also the FACT THAT NOBODY EVER SEEMS TO KNOW WHAT'S GOING ON WITH AHEC ROTATIONS!!!! For those of you who don't know, those are rural rotations out in other parts of the state--Area Health Education Centers(?)

I've been signed up to do a Rural AI with our Dept. of Family and Community Medicine SINCE MARCH...and the rotation is supposed to start Sept. 1..... today, after speaking with multiple people multiple times (oh...about a total of 8 emails/face to face convos/etc.) I FINALLY get the name of just one person down there, so I wouldn't just show up and have nowhere to go.

The thing is, the AHEC coordinator had never heard of this so called "Rural AI" --didn't even know what an "AI" is...here's the thing: IT'S A COURSE IN OUR CATALOG!!! IT'S BEEN A COURSE IN OUR CATALOG!!! Somewhere, obviously, somebody isn't so organized or good at sharing information. I don't blame the AHEC person, either.

Lesson Learned: Just because something is listed as available, it doesn't mean that it will go off without a hitch, even though any NORMAL person would expect that.

OH-- update--this just in, I will NOT in fact be living in what is quoted as "Housing is in an efficiency basement apartment with its own entrance. The apartment consists of living room, bedroom, bathroom, dining area, and a small kitchenette in the utility room. There is a microwave oven and refrigerator. You will be sharing the washer and dryer with the family on weekends. The apartment is completely furnished (please bring bath towels, wash cloths). " I just spoke to the lady who has said area and she says "Oh, did Kathy not tell you? There's already a student living there, she couldn't find anywhere else for you to live, so you'll be living upstairs in a room in my house, you'll have a private bath, but you'll have to share the kitchen with me.

Now, I'm very fortunate to have a place to live, I'm happy about that. BUT IT WOULD HAVE BEEN NICE TO HAVE FOUND THIS NEW INFO OUT A LITTLE SOONER, dontcha think?

Dream Deferred

I'd never really understood Langston Hughe's poem "Harlem" or "A Dream Deferred." Then, I heard it read by Morgan Freeman for one of the Olympics commercials...and it made sense. Call me a literary idiot, but I just didn't GET IT until then- I think I thought that he was talking about a dream that you have while asleep.


What happens to a dream deferred?
Does it dry up
like a raisin in the sun?
Or fester like a sore--
And then run?
Does it stink like rotten meat?
Or crust and sugar over--
like a syrupy sweet?

Maybe it just sags
like a heavy load.

Or does it explode?


We read it in high school, and I would challenge that high schoolers really have no business reading it, or at least reading it for being understood. Read it for historical perspective, possibly. But, I think it takes an adult to understand "dream deferred." I think you have to have had a "dream deferred" to understand it.

I also looked up the Merriam-Webster definition of "deferred"-- "to put off, delay OR withheld for or until a stated time."

That's the power of this poem, and of dreams--Langston Hughes didn't say a dream demolished, or dead....it's been deferred (but still has the possibility of exploding).

I think mine right now is somewhere between festering like a sore or rotting like meat... or sagging like a heavy load-- it basically depends on the hour of the day and who I see in passing or who I'm with.

A Thread That Joins Us

Today, I cried at school. It's happened before, and I'm sure it will happen again. But this wasn't related to my grades, my classmates, a patient, or even a human. I read this story about a gorilla whose 3 month old baby died. She's been carrying him around with him ever since. I hate to
include such a gruesome picture from the story, but I'm going to.

Her baby is on her back (where it seems she often carries him) and another gorilla's baby is in her hands.

I'm almost at a loss of words describe how much this affected me, and how deeply it resonated. I know some would say that animals don't have feelings, or a soul, or the capabilities of emotion that would come near what we have as humans, but I think that the power of motherhood and the sense of loss here clearly challenges those boundaries.

I feel as though she is looking at the camera, saying "Here is what I had, here is what I lost...and here is what I wish I still could still have."

I don't know about the long-term memory of gorillas, but I'm sure that she'll continue to carry that baby on her back long after his little body has been removed.

Square Pegs in Round Holes

I promised to do a blog on a summary of third year... now it's fourth year and I've not gotten to it, and this blog isn't the review of third year either, sorry.

Right now I'm doing research, which I started during our (3 week) summer break. It involves surveying patients, assessing their health literacy, asking them some true/false questions and then randomizing them to a verbal or video & verbal module designed to teach them about severe dementia and the end-of-life choices somebody could make before coming to that state of being. The choices are Life Prolonging Care, Basic Medical Care, and Comfort Care. The website for the video can be viewed here: http://gallery.mac.com/avolandes#100033

During this research, I've often been frustrated at patients not answering my questions to fit in my neat check-boxes. I've often screamed inside, "IT'S TRUE OR FALSE, STOP HEDGING/QUABBLING OVER ONE WORD!" But then I have to remind myself, they want to do well, and have varying experiences with dementia and end-of-life decision making. Still, fitting square pegs into round holes has been hard.

I've also been confronted with my too-much type A syndrome. There are times that patients tell me things and I'm just wanting to focus on the matter at hand--doing the survey, watching the video, getting through the protocol. I feel like time is being wasted by small talk, or interjections of "one time so and so down the road had this happen..."

But, they keep my type A in check because there are times when I've been blown away by some of the stories that complete strangers have told me. One doctor from olden days disclosed some of his former ethical battles involving too few iron lungs and too many critical polio patients (I would love to go into more detail, but think it's best that I not do that in this forum). Another lady related how she was responsible for one of the first Alzheimer's nursing units in the state. Another talked about her nursing career working with mentally handicapped children.

A man told me how much pain he was in after the loss of his wife only a few weeks earlier. He said, "and I'm about to explode right now" regarding thinking about the loss of his companion after 60 years, and how, although he knew it was coming, he didn't expect it when it did occur and how much her absence had overtaken his life.

Another man, who was still relatively young (and appeared younger than stated age), told me that he had metastatic cancer, but felt fine, and so didn't know how to answer the question "In general you would say your health is ... " They always tell us that the definition of health isn't just "being free of disease" but I didn't believe them until then.

A woman related some of her distrust in the medical field due to her mother (who was DNR) being brought to the hospital after a carotid blow-out. She felt that the surgeons tried to save her just to get practice in doing the procedure, and when she relayed her frustration to the doctor, he said "Well, why come to the hospital then? You only come here if you want saved."

One lady told me that she'd never told anyone this certain fact--that she had doubts about her one of her family member's choice of a husband.

I'm almost in disbelief of how much information people are willing to share with somebody who is in the medical field, or who the person sees as fulfilling a "doctor" role. I'm just a medical student doing research--I have nothing to do with their medical care or visit during that hour, but many want to share with me. I find it hard to imagine how much I'll learn while being a "real doctor." I hope my "type A" doesn't taint my encounters and that my patients see in me a willingness to listen and hear, and thus want to share those things on their minds that day. I'm sure my healing will be much more potent and successful if I can do that.

Lesson Learned--The power given to us as doctors is immense, and part of the power lies in being a ear for our patients to be heard.

What it's Worth--It's worth being satisfied with my job, loving my patients, and having my patients be satisfied with me.

Politically Correct ... Genital Warts?

Ok, a medical rant!!! I'm tired of the Gardasil (copyrighted) commercials which continue to shroud the prevalence and problems associated with all things sexual.


STOP SAYING "AND OTHER HPV DISEASES" and be out with it-- GENITAL WARTS, GENITAL WARTS, GENITAL WARTS!!!!!


Here's the website in case you're wondering: http://www.gardasil.com/


I guess the new euphemism for "genital warts" is "other HPV diseases." As if saying "genital warts" causes them to come into existence. Do people ACTUALLY think that the average patient, let alone the AVERAGE girl/young woman between the ages of 9-26 knows what they mean by "other HPV diseases"?


Honestly, I've seen genital warts. They're not pretty. At all...not to mention uncomfortable. (No, I don't know this because of my own personal experience.) You have to freeze them off, or burn them off with a laser, or use cream...and even then, they can come back.


It all comes back to the worry that vaccinating girls against this highly prevalent virus (between 1/2 to 3/4 of people have it) will remove all of the consequences from having sex ...either at a young age, unprotected, unmarried, with multiple partners (take your pick) and will all of a sudden cause them all to run out and have sex, since they no longer have to worry about *gasp* other HPV diseases. Come on. Honestly, I'm sure that it's the rare girl who said "No" to sex only because she was afraid of getting cervical cancer or genital warts.


That said, I'm completely for the vaccine, don't get me wrong. And I'm also all for waiting until you are in a stable, committed, adult (preferably married) relationship before having sex. But all of the rhetoric surrounding it, as stated above, is just silly. Young people need to know all of the consequences and responsibilities of sex--physical, emotional, social, financial. In the US, 1/2 of all pregnancies are unintended. Obviously, hiding behind euphemisms and sweeping things under the rug isn't quite cutting it.


Lesson Learned: Euphemisms, especially medical ones probably don't help anyone. Be clear and honest, especially about some of the most intimate things humans deal with.

What it's worth: It's worth saving some confusion and lots of uncomfortable explanation later.

Oh, and I apologize for not giving you references for the above stats...but I'm being lazy this evening, and they're true, I promise.

A Picture

Here's a picture I meant to post with the Red River Gorge post from last week. I've got more blogs to write, but I keep wasting time in the evenings on Facebook and oh, just wasting time in general.

Red River Gorge(ous) and a Wonderful Weekend

I have so many blogs in my head to post, I figured that I shouldn't let this one go too far past this weekend.





Friday, my husband and I left town to visit one of the best natural beauties in Kentucky--Red River Gorge/Natural Bridge. My best friend and her husband got a cabin for the weekend, and invited us along. The drive there was beautiful, and when we got there, the cabin was quaint, cute, and without air conditioning (not so pleasant, but bearable).





We had a dinner of steak and baked potatoes with salad and then dessert by the fire. MMMMM 'smores. I'd been craving those for quite some time. I can't remember the last time I sat by a fire, not worrying about the next test, the next day, the next hoop to jump through. Other than mosquitoes feasting on me, I can't complain at all.





The next morning, we had yummy bacon, biscuits, apples, and eggs. We went hiking for around 3 hours. I love hiking, and it had been forever. I like getting to find tiny things along the trail, like a snail with it's "antennae" outstretched, gliding along a leaf; a vibrantly colored piece of fungus growing on a log; an oddly shaped tree mimicking a pregnant belly, or making a perfect seat out of its branches. I love to see the motion of tiny things alive, juxtaposed against an overall silence and stillness.





We got tired and hungry after our hike, came back to the cabin and were quickly rained in by a down-pour. We took full advantage, and had a refreshing nap. Afterwards, we canoed a few miles UPSTREAM, and I jumped off of this rock:

Seriously, it's a LOT taller than it appears, especially from the top.

We canoed back to the cabin, had dinner of chicken and veggie kabobs, and sat by the fire again, roasting marshmallows.

Sunday, we came back to town for church, and had a wonderful service about the qualities of a Good Shepherd. I'm so happy to know that I have a savior who I can trust, follow, and lean on. Sunday night was VBS. Seeing the kids participate and learn is great, and I had fun along the way too.

Heaven on a Table and a Burrito?

Ahhhhhh. Freedom. TODAY WAS THE LAST DAY OF THIRD YEAR! WHORAY! I'm going to blog a reflection on third year soon, but I had to say what I did to celebrate first.


Last fall, my wonderful husband got me a gift certificate to use at a local salon and spa. So, today, I got my first ever massage and herbal body wrap, as well as my second ever facial. Heavenly.


I'm not sure which part I liked best. The facial was delectible. The herbal wrap, a little weird, but, I got to take a nap during it. The massage needed to last longer....ahhhh.


So, the burrito part. For the herbal wrap, they took these sheets which were steeped in some tea-looking liquid and put one under me, one over me, and then proceeded to wrap me up in this garb, which, seriously, had to have made me look like a burrito (aluminum foil included). There was a layer of plastic, then multiple layers of those hypothermia/fire protective tent thing type material, then more plastic, then blankets, and then more blankets. It would have been great to have gotten a picture of me in there!


This might have to do instead:

http://newmedia.funnyjunk.com/pictures/kitten-burrito-in-a-spinach-tortilla.jpg

After that was the massage, mostly of my upper back, shoulders, and arms, with a bit of neck thrown in.

Nice, very nice. I recommend it to everyone, especially after finishing third year.

July 1 = The Medical New Year

This year, I was actually on the wards when the infamous "JULY 1" occurred. It was interesting, and a bit terrifying.

One of our new interns was from my medical school, the other, from a state in the North East... a foreign man in a very foreign country. He had the unfortunate "luck" of getting one of our most complicated patients for his first day EVER as a REAL DOCTOR.

Poor thing, to say he was a bit discombobulated is putting it lightly. His first presentation was probably the quality of a third year medical student in their first few months of school. Granted, as I said, this patient was VERY complicated, but he was not able to calm himself enough before hand and get collected over the whole thing. His order was wrong, he left things out, included things he shouldn't have, and said the name of each electrolyte before each of their values in the BMP. Needless to say, by the end of his presentation, there were beads of sweat on his brow. By the end of rounds, he was kneeling down, muttering unintelligible phrases and what I think were a few curse words as well.

In the next few days, he seemed to rebound, but his rebound came in the form of assertiveness about things sort of ancillary to the beef of the presentation. I'm sure he'll be fine, but to see his thrashing, treading, and near-drowning the first day was a learning point.

Lesson Learned--
1. July 1 stinks
2. Remember to breathe July 1, 2009---this could very well be me (and will probably be me in 2009)
3. Consider staying the night of June 30, 2009 in the hospital, just to get ready
4. Do whatever it takes to prepare for the morning of July 1, 2009
5. Remember to breathe July 1, 2009

What It's Worth--
It will probably be worth not feeling as if my entire previous 4 years of medical education weren't wasted, and also be worth some self-esteem that first gut and mind wrenching day.

Like a Knot on a Log

I used the wrong criteria with which to choose a husband. Instead of choosing a loving, caring, handsome, smart, faithful man, I should have chosen based on one thing.... Is he a lighter sleeper than me? His alarm is forever going off in the morning, NEVER bothering him, and keeping me up with the constant snoozing and snoozing and more snoozing.

This morning was the worst--his alarm went of 1/2 hour before mine, and continued to buzz for the next 30 minutes, every 5 minutes. Needless to say, I was less than happy with him. So, I thought I'd exact a little revenge--after getting out of the shower, I flipped the overhead light on, hoping he'd wake up.

NADA--not so much as a squint.

So then, I decided to stomp through the house.....not a FLINCH! Then, I decided to pull the covers from his body............THE BOY DIDN'T MOVE! By this time I was incredulous at how much of a heavy sleeper he is, and truly wanting to strangle him in his sleep for it. I decided to dry my hair and leave the bathroom door open.....shortly thereafter, he rolled over and opened his eyes, but I'm pretty sure it was just a coincidence, not me being successful at waking his butt up. From now on, I've decided I'm just going to roll him from the bed in the mornings, and let the floor wake him, he he he.

Lesson Learned: Pick a husband based on who is the lighter sleeper (j/k)

What it's Worth: An extra 30 min, 45 min, whatever of sleep each night.

God Sent a Rainbow

In the span of two days, I've seen a real rainbow, seen a picture of a double rainbow (on the screen at church), and heard somebody as I was walking by mention the word rainbow.

I think it's a sign.

When I saw the rainbow, I did think it was a message and a promise from God. It sent calming, peaceful feelings, and I had a sense of "Don't worry, this won't happen again." I hope I'm reading the signs correctly.

Today in church, they had a rainbow up on the projector just because. So I decided to look up the part of the Bible where God explains His meaning behind the rainbow.

Genesis 9:7-17

"...As for you, be fruitful and increase in number; multiply on the earth and increase upon it." Then God said to Noah and to his sons with him: "I now establish my covenant with you and with your descendants after you and with every living creature that was with you--the birds, the livestock and all the wild animals, all those that came out of the ark with you--every living creature on earth. I estabilsh my covenant with you: Never again will all life be cut off by the waters of a flood; never again will there be a flood to destroy the earth."

And God said, "This is the sign of the covenant I am making between me and you and every living creature with you, a covenant for all generations to come:

I have set my R A I N B O W in the clouds, and it will be the sign of the covenant between me and the earth. Whenever I bring clouds over the earth and the rainbow appears in the clouds, I will remember my covenant between me and you and all living creatures of every kind. Never agian will the waters become a flood to destroy all life. Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth."

So God said to Noah, "This is the sign of the covenant I have established between me and all life on the earth."

I've had a flood recently, and been found wanting of a rainbow. I finally got it this weekend, literally.

Lesson Learned--God does send us messages to say "I'm here, I love you, I'm watching, and here's my promise."

What it's Worth--Security

Addendum

For those wondering if I'm dying of cancer or something, be relieved, I am not. This something I speak of which is going on is not something that would threaten life or limb, just a something that was acutely painful and will be remembered the rest of my life as such. I'm doing ok, I'll be ok. Just taking some time.

Definition

Well, I've been dealing with something that I really don't want to describe in detail online, but let's just say that it's been emotionally and physically difficult. Some people know about it, others have absolutely no clue, and for those who don't know about it, I'll probably keep it that way as I don't necessarily want to divulge the info in anything that might be construed as an attempt at pity or sympathy. At this point, I feel if I were to tell somebody about it, then it would feel to me as if that would be the purpose of telling somebody--just to have them feel sorry for me.

This time has been spent trying to take care of myself and still deal with school, and I feel that I'm stretched and challenged by walking the fine line of paying too much service to either one. I know that people might find it ridiculous that I feel guilty for paying too much attention to myself, but it's an ugly truth as to what school has done to me. Feeling this way has somewhat opened my eyes as to how much pathology is involved in school... I've been consumed with it all my life, and I often am enveloped in the idea that focusing everything on school is in effect focusing on myself, but really, this is an illusion. I've felt that school has left me a flat, one-dimensional person who is only capable of having life defined by school.

Perhaps I'm being too hard on myself-- after all, I have a husband, an active role in my church, two dogs, I play soccer and softball, and I occasionally get to do one of my favorite activities--riding horses. But I do feel that I often have a hard time defining myself outside of school, a hard time in finding meaning in my life outside of this educational process which will turn into a career which will define me as well.

If I had any readers (haha) I'd pose this question-- how do you find balance? On Oprah's re-run today she was talking to Justin Timberlake (one of my FAVES!) about celebrities having a hard time not letting "What you do" define "Who you are" I don't think that it's just celebrities that have a hard time with that---I think everybody does...how does one find definition outside of "what you do" to help answer the "who you are"?

This post is getting really long. Perhaps I'll return sometime soon, I'm still pondering.

Learning Point--sometimes life comes in and awakens us to what's going on, instead of us just floating along the merry way

What it's Worth--I'm sure the worth lies in not having to wake up one day at 50 years old and realize that you've wasted your youth and vibrancy without knowing who you are and what you're truly doing.

The Meat Truck Men

I was just awoken from a nap by one of those Meat Truck Men...the ones who have a cooler in the back of the truck and then drive around the neighborhood acting as if they "Only have a few steaks left that I really need to get rid of-- I'll give them to you for a really good price. I'm practically giving these away to unload the truck."

Who ever thought this was a good idea? Who actually is willing to trust some random truck driving around to sell something better than Quality F meat? And you know, the men on these trucks are always well-put together, clean shaven, and wearing clean, crisp uniforms with a trustworthy appearance and a great sales-pitch....cough *sarcasm*

These aren't the Swanson men--and even then, I mean really, do we not live in a country where there's a SuperWalmart within 30 miles of EVERYWHERE? It's called a GROCERY STORE people!

Ok, I'm starting to sound a little worked up. Maybe this concept of driving around is just a leftover from a simpler time, where the iceman delivered the ice, the milkman delivered the milk, and the meat man delivers the meat (ha ha). I think I'd personally rather have a toilet paper and milk man coming by my house--- I'd probably be buying every time!

Motion Proves Life

So it's been a while. Now I'm procrastinating doing some more reading this morning--what better way than to blog!

I've got to write about this patient that I had at the VA though--and how church the next Sunday made me think about him again.

So, there's this guy who came in for something totally unrelated, but when we were going through his medical history, part of which includes history of transfusions, his wife goes, "Oh yeah, I'm sure you had some transfusions in Germany, right?" And then she proceeds to say that....

He was in a car wreck and "The coroner found a pulse."

I immediately respond with, "The coroner? Was he in the morgue?!"

They respond, "Yes, he was pronounced DEAD at the scene, was taken to the MORGUE, and then the coroner found a pulse on him--then he went to the hospital."

The patient: "Yeah, I didn't know who I was for about 11 days."

Just like that, matter of fact, they didn't seem too impressed by the whole thing, but geeze, how many people can say that they've met somebody who took a trip to the morgue in a body bag and then survived to tell the tale? CRAZY!

So then, in church, our minister is talking about a passage out of James-- 2:14-26, and about how "Motion Proves Life"--that we have to have both our faith (the part without much motion) and works (the motion part of our Christian life) to prove that we are alive in our faith, alive in the promises that God has given us. Proof of life is the guarantee that death has not occurred, and motion is usually the proof of life needed.

My patient was motionless (almost) and then his heart was able to say, "Wait, I'm still moving! I'm still alive!"

I've felt alot of times that I'm like that patient as far as my faith and works go. I feel like there's barely anything there, and I'm in the morgue, but then somebody may come around and at least check for a pulse--and feel a faint one. I'm glad there's a faint one there, but I know that a faint pulse doesn't usually last too long on its own. I want to show that I'm alive, and I hope that I do. I spend alot of time on the morgue slab of school though.

Lesson Learned--Check for a pulse (maybe multiple times). Patients have weird stories to tell us, usually stories completely unrelated to what they're being treated for currently. Look for opportunities for those stories to connect to some real-life things

What it's worth--It's worth is in being reminded that I shouldn't just merely let a faint pulse just get me by.

In another's control

Today's Continuity Clinic had a theme, sort of. We had two patients (both very nice) who talked at some length about the stresses placed in their lives by other people. Their reactions to their situations, however, were much different I think.

The first--she was at the visit for something unrelated, but started talking about her mother. She actually started to say "I wouldn't have normally brought this up" (getting ready to tell me the reasoning why she did bring it up--but she was interrupted and never finished the thought--to my disappointment). She talked about how her mother intrudes on every aspect of her life, from how she shops, who she has over in her home, and how she pays her utility bills. She is a 44 yo AAF with one child who is getting ready to graduate high school. She felt overwhelmed by her mother's insistence to be so involved that she actually had seen a counselor before about it, but never went back because the counselor was a white male, and she felt that he wasn't empathetic and couldn't connect to her as an African American and as a female. She went on to say that she was having to hide things around her home, such as liquor and martini glasses to keep her mother from commenting. She was worried that her mother was pumping her 17 year old daughter for information about the goings on in her home. She felt guilty that she was kinda expecting her daughter to lie to her mother about things. She described multiple instances where her mother had called to say "I just went ahead and paid your water/electric/gas whatever bill for you" or said, "I was shopping today and got you this" but would expect her (the patient) to pay her back for the things she didn't necessarily want, need, or like. Our patient told us that this stressed her out so much, because she wanted to tell her mother to back off, but wasn't sure that it would be effective. She talked about the strain it was causing on her relationship with her two sisters, how she couldn't tell them anything for worrying that they would tell her mother. This lady seemed to feel extremely guilty about how all of these familial relationships were arranged, and I honestly feel that her self esteem suffered for it.

Our next patient--when I walked in the room, I was struck by her extreme appearance. Not extreme as in piercings everywhere with tattoos and goth, but extreme in that it was clear that she was a runner and wanted everyone to know. In her early 50s, with salt and pepper hair, I think I could have almost identified every muscle in her upper extremities and torso, along with their attachments. She wasn't anorexic thin, but definitely someone who seemed very focused and set on maintaining herself to look a certain way. She was wearing pants with leg warmers on her calves...on a day that was pretty warm anyhow. She and the doctor had a bit of a disagreement on the plan how to manage some possible tendon strain she was experiencing. The doctor required her to be seen by sports medicine before PT to get cleared for treatment, however, she insisted that she thought she could just go straight to PT without the Sports Med visit. The discussion and discourse went on for about 10 min of the visits. Interspersed throughout this was that she was having tons of trouble with her contacts, wasn't able to drive really, and one more appointment would not be good. But then finally, she said, "Well, you see, I've never been the one controlling the household finances." From there, she talked about how for 26 years, she had to wait to finish the education she so desperately wanted, raised 5 children only allowed to use 25 hours per week of childcare, and tried to take multiple courses throughout that time. Her husband also eventually prevented her from taking her dream job at Cornell. She said her children were great kids, and that's what had kept her in the marriage. What was notable during the interaction with her though was her need to exert herself as a person to us. She talked about her running and being thin, and after we left the room for a short time and came back, she had pulled out this Alumni Feature magazine from her Alma Mater school which featured her.... in the Fall of 2004. I read the article and in it, it mentioned how for 25 years she had to wait to finish to fulfill herself. I was just in awe how this woman, through being repressed by wife and motherhood had to use any way possible to validate herself within the world. She wasn't dislikable, but I pitied/had sympathy for her.

Lesson Learned--My attending said that the above interaction "wasn't that great of a medical learning case, and you'll get plenty of that (psychosocial) in residency"--I tend to disagree--We never know who's controlling the lives of those around us and how it colors their interactions with the environment.

What it's Worth--The worth of the context of the patient and how they deal with problems/people, whether externalizing or internalizing their problems is probably invaluable, and something I won't forget.

a career?

well, if i had any readers out there, and they acutally knew me, they'd know that i've been see-sawing back and forth over med-peds and family medicine. but this week, i've just been thinking about babies...and how i don't want to give up the possibility of delivering them for the rest of my life. and how i like knowing lots of stuff (which, med/peds people do too) and how i mostly hate the adult inpatient wards...and how much i like thinking about prevention, and how really, family medicine is more "family friendly" than med/peds programs. i really would like to have kiddos before i get to thirty or so, meaning that i'd have to start pretty soon anyhow to get two in during the next 5 years. i just hope that this feeling lasts.......................

A start.

Well, I've toyed with the idea of blogging...and I guess I'll give it a go. I've never been very good at doing anything on a schedule very well.... other than studying maybe. There are things that I want to talk about, and maybe even have people hear/think about/ponder/argue with... whatever. So. Here goes my first blog. Right now I think I'm mostly just procrastinating having to type up a patient's H&P. I'm a little frustrated at myself (and one of my classmates) over it. I had it about 3/4 of the way done, left my computer without saving (dumb me) and then when I came back, my classmate had turned the computer off because he couldn't log into it, and had to turn it off in order to do so. SO, apparently, Word 2003's document recovery feature doesn't work too well if the computer just abruptly gets turned off? I don't know, it just disappeared. So, I just really really really don't want to have to start typing the stinking H&P again cause it takes forever! Boo!

Learning Point of the day--when the tiny voice in your ear says "you better save now" you might want to listen

What's it Worth?--Obviously, it's worth not having to try to recreate whatever it was from memory, but also, who knows, you could use the time you saved by not doing it a second time for something fun, or a nap.