3...2...1...Happy

At the end of last year, I lamented the fact that I didn't have much to look back on. I resolved to do more this year. I think I succeeded. I look back on a very full year, and I feel like I was really living.

I'm a little too tired and brain dead to think of a creative way to summarize the whole year. So, in absolutely NO particular order or format, here's what was superlative about 2012...

Kilimanjaro--Obvi. Glamping at 19,000 feet is pretty memorable. I even enjoyed training for it. It was a physical, mental, spiritual challenge, awesome time with the fam, totally outside my comfort zone, totally brag-able (that's a word now), and lots of other wonderful things.

Lots of good food, new beers, new restaurants, happy hours. French toast in Portland, Tank 7 on tap, homemade mini apple pies, wine and cheese, KC BBQ, diabetes cake.

Building and deepening friendships, having people on speed dial, seven second hugs, coffee dates, funny cards, dinner parties, being in the right place and the right time, making myself at home, YouTube videos, nights sitting on the balcony, pick-me-up texts, having visitors.

Finding my groove as a resident, knocking out the PICU, 2 Professor Rounds, committee work, and learning to run a tight ship (or at least a ship that can stay afloat) as a senior.

Having the best job in the world, even if it does wear me down. Getting to take care of some truly amazing kids that I will remember forever, and their midnight birthday celebrations, colorful beads, tearful faces, painted toes, and sticky hugs.

Checking half the things off of my 30 before 30 list, and loving it. Except "Tinkers." I didn't love that book. In fact, I didn't finish it, so I'll have to find other Pulitzers to count. But the rest of it has been great.

My crazy family. Zapapas should be an adjective, and it can mean a lot of things, but it's all us.

Laughing out loud at movies, crying at a good book, live theater, Castle, Rizzoli and Isles, belting a song out over and over and over.

Sitting and praying in the quiet, wrestling with God, feeling overwhelmed with blessings, and overwhelmed with grief, finding the perfect verse, or the perfect prayer, seeing God work miracles.

Here's to lucky 2013!

Residency 3.6: PCC

Doesn't feel like I've even worked enough hours in the PCC to be writing a blog about this month. Although our clinic schedules were often full, the show rate was pathetic by any standards, and we more often than not sat around wondering what to do with ourselves. I know I shouldn't complain, but I was hoping to get a little more experience on my last clinic month before graduation. Obviously I have 6 months left of my weekly continuity clinic, but I still feel woefully unprepared to handle ADHD, learning disabilities, most rashes, lactose intolerance, and many other normal pediatric things. I guess that's why we train to be life-long learners.

Nonetheless, there's plenty of things I feel comfortable managing on my own, and I was able to teach our interns and medical students a thing or two. Plus, I got in a few good weeks of boards studying, which is always beneficial.

Other notables this month: Christmas party full of Disney sing-alongs and good food, the fruition of a project I've been working on for a few months, seeing Les Mis live, and me getting a decently bad case of bronchitis which mostly (but not completely) dampened the previous events. Come on, immune system, any time now would be fine. Oh well, at least I'm glad to have friends in high places to call me in some good drugs.

And now I'm in for 12 days of friends and family, no sick kids, and lots of Colorado!!!

Grateful for the ride

It's always hard when a child dies. But even more so when it's sudden, when we know and admire his family, when so many of us have taken care of him, when we've watched him overcome obstacle after obstacle and get SO close to going home. And it still doesn't make sense. But I am grateful that I had a chance to know him and care for him, even for a short period of time. That I got to stand by his bed and whisper prayers when things weren't going so hot. I'm grateful for the amazing witness that his parents were to the sanctity of life and the power of hope, and that I was able to share in some of their journey. I'm grateful I work in a program where it's okay to cry and hug and take care of each other. I'm grateful for a God Who has His hand in all of this. I'm grateful for the reminder of how important our work is, and how every child we take care of is someone's son and brother and little warrior.

This has been posted on the family's blog for the last 9 months, as we all were along for the ride. Now their little warrior's heart is whole again.

It's a beautiful day up in heaven. Jesus is rounding up his tiniest angels, to go live on earth, and be born. One of the sweetest angels says to Jesus "I don't want to leave, I like it here, and I will miss you". He reassures the scared little angel that everything will be okay, and that he is just going for a visit. He is still not swayed on this idea. So Jesus kneels down, and says, "How about if you leave half of your heart here with me and take the other half with you, will that be okay?" The angel smiles and says, "I guess that will work." But the little angel is still a little scared. He asks, "Will I be okay with only half of my heart?" Jesus replies, "Of course you will, I have other angels there that will help out, and you will be fine."

Then Jesus gives the angel more details about his plan. He says "When you are born, your mommy will be scared, so you have to be strong, and when you feel weak just remember that I have the other half of your heart". "Enjoy your time with your family, play and laugh every day. When its time to come back to heaven, I will make your heart whole again. Always remember that you are not broken, just torn between two loves."

Little Angel (borrowed from the family's blog with thanks)

Residency 3.5: Purple Team

Oh man, I've been so caught up in having a normal life that I forgot to post about my month on Purple Team. Maybe I've also blocked pieces of it out of my head. If I ever needed convincing to not do inpatient medicine full-time, this was it. My stress level is on high when I am in charge of four interns, five medical students, 18 patients, and have to run a code to boot. Frequent baked goods made things a little bit easier, but still.

Most of the crazy stories that I would love to tell you about this month would probably violate HIPAA in some form, but suffice it to say if I had one more rapid response called for a pseudoseizure while I was team leader, I might have exploded.

Nevertheless, even in the most hectic of rotations, when I never get a chance to sit down, or when I'm ready to throw the pager out the window or refuse to go see one more patient, there are still moments that remind me why I have the best job in the world.

We had a toddler with a dog bite below her eye that had to be admitted when it got infected. She was scared at first, but warmed up nicely when she saw my light-up frog. We were able to get her appropriate treatment and in 2 days, she was a brand new kid. Her parents were super sweet and understanding and sent me a thank you email after they had been discharged that made me forget about all the negative stuff that week.

We had a tiny baby who wasn't growing so she was admitted by her pediatrician. Typically failure to thrive babies are boring. We feed them, they eat, they grow, they go home. This one was different. She ended up with a fairly uncommon endocrine condition and after we changed her formula and started some medications, she, too, was able to grow just fine and go home. But it's that one in a hundred that keeps things interesting.

And now, I'm back to a clinic month and loving life, except for that stress of trying to find a job. Keep me in your prayers. And happy almost Advent!

The best laid plans

I had my whole day planned out. A perfect day off, really, Black Friday. Sleep in, do some shopping for Christmas gifts, set up the tree and Nativity set while blaring "Tennessee Christmas." Unfortunately, my body didn't cooperate. I thought my stomach ache last night was from Thanksgiving indulgence, but when I couldn't fall asleep and ended up running to the bathroom at midnight, hugging a trashcan, I realized that my day off wasn't going to be so perfect. I was just talking with Michelle the other day how we need to learn to be more docile. It's hard to admit, but I don't always have to be right. Whether it's letting my interns do something differently than I would, not getting somewhere on time, letting someone else pick the menu for a dinner party, getting stuck with an extra call shift, or whatever. Sometimes it's good for me not to get my way. It reminds me that Someone else is in charge, and I need to swallow my pride and try things His way. I guess I'll use today as practice, while I lay on the couch and stare at where my Christmas tree should be.

The pagers...

I'm counting this as a small success. Or maybe a not-so-small success. On Tuesday, I had the dubious honor of wearing the Team Leader pagers, which means all day long, I just pray not to hear the "whoop whoop" go off overhead. Cause that means someone either fainted while getting their blood drawn, or is dying. Or something in between. But I'm supposed to run to the rescue and then run the show. Like someone who could handle a really sick kid. Like someone who knows what they're doing. Like someone who doesn't throw hand off the pagers to the night team at 6:01 like they're infected with the plague. Anyways, back to the story. So we're all sitting around in the workroom in the afternoon, trying to keep our mess of a team from imploding, and I hear "Rapid Response..." announced overhead. So I run up to the room and--you guys, this was a big deal--I was calm. For the first time in the last two and a half years of being on the Code Team, my legs and voice weren't shaking when I arrived. I'm not kidding. I still have nearly a full blown panic attack any time I run to a code or have to transfer a kid to the PICU. But yesterday I felt like I at least had some handle on what was going on, and successfully ran the rapid response and dismissed everyone when it was over. Of course, this is probably due to the fact that this was the fourth pseudoseizure event this month, along with two actual status epilepticus patients, so I've probably just become decent at watching kids shake. But this also came on the heels of getting one of sick kids down to the PICU last Friday without calling a code, which, trust me, is an equally impressive feat. Don't get me wrong, I will still be super glad when I hand over those pagers for the last time, but I had to brag a little bit that at least I've gotten to the point where I don't have to give myself the Ativan.

City of God

Today we celebrate the many holy men and women who have gone before us. A rich soldier who gave it all away to become a beggar. A pediatrician who valued life above all things. A fisherman who stuck his foot in his mouth as often as he said something right. A priest who died in a prison camp. And so many others that go unnamed. I'm grateful to have them as examples, but also to think of what waits for us--the heavenly Jerusalem. Because this is not our home, and so often I feel like I don't belong. But I'll keep going, hoping that in some small way, I'm bringing Jesus to the world.

Residency 3.4: Dermatology

This month I felt a little naked as a pediatrician. I'm so used to having a stethoscope around my neck that even at the end of my dermatology rotation, I felt like I was forgetting something when I went into a room or off to see a consult. Turns out skin doctors don't care what the heart sounds like. However, they have lots of their own toys, like dermatoscopes, microscopes, rulers, and Woods lamps.

As a general pediatrician, I will see a LOT of skin complaints. Rashes, moles, acne, eczema, birthmarks--you name it. So this was a great month for me to learn a lot about stuff I tend not to see (or worry about) when we're seeing kids in the hospital.

While I still don't feel like I can look at any rash and know exactly what it is, I did see a lot of cool things that I will probably come across in my career. And now I don't have to give a blank stare when the parents ask me what it is. Plus I've got my eczema management down pat, and have a foundation for acne as well.

While I'm sort of looking forward to getting back to treating the whole person, I very much enjoyed my month and got a lot out of it. I only hope I can retain some of it until boards and beyond. And I definitely won't miss looking at scabies mites under the microscope. Gross!

My new Everybody Committee

A friend and I were reading through a magazine yesterday and came across an article that stimulated a lot of good conversation. I do not claim the ideas as my own, only wanted to share them.

The writer asserts that much of our negative self-view is built up from holding onto the opinions of a few judgmental people around us and extrapolating that into the view of "everybody." That one girl that told me I was the worst player on the soccer team when we were seven shattered my confidence playing the game for years, because I was convinced that "everybody" felt the same way. The girl in middle school who implied (and not very subtly) that I was ugly has been sticking in the back of my mind since, saying "everybody" thinks the girl next to me is prettier. Of course we all know that we shouldn't listen to these voices, but even loved ones can unwittingly damage our self-esteem. I share a dream of mine and someone tells me that it's unrealistic, or I admit to a fear and get told that I just need to get over it. What I hear is that "everybody" thinks my feelings aren't important. We appoint these people, perhaps unknowingly, as our "everybody committee" who sit before us and judge our actions. In reality, of course, they are not sitting around critiquing us (more likely, they're thinking that we're critiquing them), but we tell ourselves they are. The key, the author of this article says, is to remake your "everybody committee" with people who love you unconditionally. Use their opinions of you (or imaginary opinions, since remember, they're not really sitting around judging) to build up your confidence.

Here's the steps if you're curious. For me to stay grounded, I know that Jesus needs to be a part of my committee, but I was able to come up with 3 other people right away who also get seats. At first I felt guilty for leaving some people off. It doesn't mean they don't love me or that I don't love them or value their opinions, just that their voices don't get to validate my decisions or worth.

In the end, I think that a good amount of time in prayer focused on our worth as children of God might have the same end effect, but this was an interesting activity for a Saturday afternoon. And if you disagree, I guess I don't have to care.

Is there a doctor here?

Got a bunch of questions right at our radiology lecture today, had three of my patients' families in clinic yesterday tell me they thought I did a really good job, and the attendings have agreed with my assessments on both my consults this week. Feels like I'm starting to get this doctor thing down. Of course I'm sure next week I'll be baffled by something really stupid or stick my foot in my mouth, but until then...

Day 6 and 7--The Roof of Africa (and back down)

9/30--0800. I'm exhausted. Sorry that that's the first thought but it's true. [Now that I'm back and have slept and can breathe again, I will add in a bit more commentary to the summit experience.] We had good weather in terms of clear skies and little wind [Remember, we started at midnight, so it was dark even with the full moon. The stars and a full moon are beautiful at 19,000 feet. I had to take quick glances or I would trip on a rock, but seriously, gorgeous], but it was cold enough that the CamelBak bladders and our Nalgenes started to freeze [using an insulator and blowing the water back into the bladder only worked for a few hours, then everything iced over anyways. We didn't want to take any breaks because as soon as you stopped moving, everything got a lot colder. So even though we were all pretty nauseated and uncomfortable, we kept moving]. We took it pole pole. In the dark, all you could do was follow the person in front of you, step by step, try not to trip, and ignore the discomfort. [As I was walking and praying, meditating on the walk to Calvary made me smile in solidarity with Christ. It wasn't that I received some amazing strength or that I didn't feel sick. Instead I cherished the weakness and the nausea and the chills because they brought me closer to His suffering. Thank you for everyone who allowed me to pray for them. I know that God knows the fruits of those prayers, even if I never will.]

At the top of Uhuru Peak, the highest point in Africa

We summited at 0540--right at 5 1/2 hours, which I understand is good time. I had my iPod going, and as we got to the top, "All Glory to God" was playing, which felt so appropriate. I just felt relief at the summit. Just take pictures and get down. It was so cold. [I know, I'm pretty articulate when deprived of sleep and oxygen.] The sun started to rise as we were descending and it was gorgeous! The glacier and Mawenzi Peak were stunning. Right as we left the summit we saw our Utah friends (they made awesome time!) and I think when she saw us, (their) Mary almost cried. It's been a long week!

2000--Final dinner at Mweka Camp. Huzzah for more meat! [The last day and a half at altitude, we had run out of meat, as it wasn't safe to have stored it for that long, but they had people truck supplies up from the bottom to the last camp.] Our appetites are back. We got to try the "stiff porridge" that the porters eat every day--looks like thick mashed potatoes and tastes a little like hominy. I'm glad that's not what we were eating, but also glad we got to try it. Now even though I slept for 3 hours when we got to camp, I'm ready for bed.

Sprite never tasted so good

10/1--1030. Back down at the gate. Every step hurt. But at the bottom we had chairs and cold soft drinks waiting for us. [We got our certificates and a few more pictures and then were trucked off to a hotel for showers before the LONG trip home, which wasn't all that exciting.]

Zapapi and the Kiliwarriors

Thanks for reading along! Poa sana sana!

Day 5--The final push

9/29--Better spirits this morning. The sun is up and the view is breathtaking. Summit behind us and a huge valley below, and the ever-present blanket of clouds. Altitude may be affecting our clarity of thought. Michelle tried to put her second gaiter on top of the first one. "Well, that's not effective!" I called Dad's hat a shirt. We're all excited that we only have to wake up once more in the cold--tonight for the summit. It's our least favorite part. I think after this, I'll be a warm weather camper only. And I may splurge on my heating bill this winter. [Just switched on my heat last night. What happened to fall???] All I can think about is being warm. [Part of this is because at altitude, my brain had a lot of trouble multi-tasking, so I could only think about one thing at a time anyway.]

1245--We've set up our final ascent camp--800 feet above Barafu Camp. This evening should be interesting. Lunch at 1300, then nap, dinner at 1700, a quick briefing, then another nap, then up around 10 or 11 and off at midnight. We're still force-feeding Mary and Michelle.

1930--Pulse ox 85%, resting HR 100s. [My handwriting at this point is nearly illegible, either from fatigue, altitude, trying to write while inside my sleeping bag, or all of the above.] Trying to take a second nap but I slept like a rock for 4 hours this afternoon so I'm not all that tired. Appetites were good at dinner--caramel cupcakes for dessert! I can't believe we're really doing this. God willing, we'll be back here to camp for a nap after having summitted in 12 hours or so. The full moon over Mawenzi Peak [The second highest of the three peaks on Kili] is gorgeous tonight. The summit will be beautiful.

Moon over Mawenzi

 2300--Slept a bit. Clear skies. Let's do this thing. Blessed Pier Giorgio Frassati, pray for us.

All dressed up with somewhere to go

Stay tuned for the summit!!!

Day 3 and 4--Becoming quite the adventure

9/27, 0745, Shira Camp. Slept better last night. It was below freezing--the water bowls for washing were ice this morning.

1700--Good day of hiking today to Barranco Camp. Except for that hour before lunch where the Diamox and 2 cups of coffee kicked in and "pole, pole" was not getting us to the toilet tent soon enough. We got to climb Lava Tower--250 feet of hiking over rocks and bouldering--fantastic fun. Shanta and Hosea have taught us a lot of plants--paper flower, Scottish thistle flower, wild carrot, and a cool plant--giant senecio--that takes 15 years to grow a new branch, so you can tell its age roughly by the number of branches. We saw a huge one with 12 branches--180 years! [Was unable to verify this tidbit, but it makes for a good story. Wikipedia says they branch two at a time, so maybe not true.] Mary bit it today crossing the stream, and while she was mostly pissed at getting dirty, she did slice open her thumb enough for us to break out the first aid kit and feel all doctorly and thankfully not enough to use the sewing kit that I brought along just in case. Got to wash my hair with the waterless shampoo when we got to camp. The actual process was freezing because the shampoo lathered and I had taken off most of my layers to not get soap on them, but afterwards felt glorious.

Lava Tower

2100--Our Utah friends--Mary, Steve, Peter, and Michelle--came to visit us tonight. We chatted for a while about pharmacy questions (they love having Michelle at their disposal), being cake eaters (they tease us for some of our extra perks), and how much we're gonna freeze on summit day. And then they taught us the card game Golf and we played a few hands, laughing and teasing each other like we've known each other for longer than 5 days. They also reminded us of the hot-water-bottle-between-the-legs-at-night trick. And. It. Is. Heavenly. The sky is super clear and the snow-painted summit is looking mighty cold beneath the stars and soon-to-be-full moon. Trying to think positive.

New friends!

9/28, lunch time. Karanga Camp. "Karanga" means peanut. This morning Michelle and Mary weren't feeling so hot, so it was a difficult hike. Even I didn't realize how physically and mentally exhausted I was until I sat down at camp. We didn't even hike 4 hours. We started with the Barranco wall--several hundred feet of steep climbing, stepping up rocks, and using hand holds. There were several traffic jams as hundreds of people had to squeeze through tight climbing spots one at a time. We have the afternoon to rest which is a Godsend since right now we're tired, bordering on cranky.

If you look closely, you can see the single file line of hikers up the Barranco wall

1700--Well, after an afternoon of rest, several trips to the bathroom tent, enough Advil to kill a kidney, and us force-feeding Mary anything that wouldn't make her vomit, we're feeling a little better. [Remember that "better" is quite a relative term and I'm sure that when I say "we", I'm probably not speaking for them] Although Michelle just groaned and said, "I don't feel very good." [See?] So much for positive thinking. Our afternoon ritual is to sit in the mess tent, eat popcorn and drink tea, maybe play a hand of Euchre, and pile all of our newly-filled water bottles on the table to steripen them. Hosea said our camp uses about 200 liters of water a day, cooking, cleaning, and drinking, and all of it is carried by the porters from the closest stream fed from the glaciers. They balance the full 5-gallon buckets on their heads as they trek back to camp. It's so impressive. I was encouraged that I was warm enough to sleep well last night, until Hosea said, "Oh yeah, very warm last night, I sleep just in my underwear." I guess "warm" is relative. [Notice how many things are relative. This truly was a trip outside our comfort zone, but for them, it's just normal life. We should not have anything to complain about.]

Afternoon popcorn and Euchre

2000--bedtime. Spirits were down at dinner. Mary and Michelle still aren't feeling well, and I know Shanta and Hosea mean well when they say you have to force food at altitude but I know that internally, Michelle and Mary are cussing them out, because they know they have to eat, but even talking about food makes them want to vomit. And it's cold, even just at 13,200', and we have a long way to go. Michelle and I especially hate being cold, so it's discouraging to think about the fact that we're sitting in the mess tent 6,000 feet below the summit with nearly every layer we have, drinking hot tea and still shivering.

Shanta gave us a wonderful reminder tonight when he saw how down everyone was. "Excuse me. You believe in Jesus, right? I tell you, for me, when I first start on this mountain, it was very hard, and I say, 'Jesus, You be strong for me.' And He was. And when I am sick, I say, 'Jesus, You are the best doctor. Give me your medicine.' And I am better. So when you feel that way, you don't think about it, you just say, 'Jesus.'" [I knew for me going in that this trip would be offered up as one big prayer, but it was so refreshing and encouraging to hear Shanta talk about it this way as well, even though he's climbed the mountain a hundred times.]

Machame Route Day 1 and 2: A rough start and a piece of home

Here's the start of the trek, in all of it's unedited glory...

8/25, morning, Machame gate. Dozens of tourists, hundreds of porters, piles of duffels.We found our friends from the airport, all of us dressed to the mountaineering nines and ready to go. I inaugurated our trip by falling out of bed this morning--woke up as my neck hit the chair. Not quite sure what my body was thinking, except that I think the wake up call triggered a reflex to jump out of bed and run to a code, but the rest of me didn't get the memo. I'm hoping a sore neck is all I'm taking away from it.

Machame Gate--the start of an incredible trek

Noon. Still waiting to start. Our guide has had some trouble with all the permits and fees and we're sitting around, hearing yet another "you have to wait a few more minutes." I've run through 2 of Mother Teresa's power novenas and hoping that this isn't an indication of the general organization of the trip. It's frustrating having no control, but I'm just trying to offer it up as part of the pilgrimage.

Tea and popcorn for snack

1845. Sitting in the mess tent by candlelight. We've had tea and popcorn and figured out the toilet tent and unpacked a bit. Today's hike was 5 miles and we did it in about 4 hours. The jungle was striking, as was our first view of the peak. We learned a few Swahili words (dada, baba, nzuri sana). There are 26 guides and porters for the 4 of us, carrying all of our tents, food, water gear. [sounds TOTALLY excessive, I know. But apparently that's about par. If you think about all the food, tents, dishes, propane gas, water buckets/filter, etc., it makes sense. And we were grateful for every single one. I'm convinced we had one of the best crews on the mountain.] O2 sats 98%, heart rate 78. [twice a day we took vitals to monitor our adjustment to the altitude. Unsurprisingly, like everything in our family, it became a competition for highest sats--the 98% on this day won for the trip--and lowest HR--Mary hit 50 on one day.]

Our awesome group of porters, cooks, and guides

Tutaonana kesho.

9/26, 0900. Day 2. Slept about par for camping. In other words, pretty crappy. But having the toilet tent makes is so much easier to go in the middle of the night. Stupid Diamox. I went 8 times in 24 hours.

Lunch. A few hours of steep hiking this morning. More gorgeous weather. The path was dusty, single or double file in most spots, allowing for the porters to pass us. They are quite a sight. Their own backpacks on, and huge bags, tents, foods, buckets, etc. resting atop their heads or behind their necks. They have an array of varied hand-me-downs for clothes and gear--everything from REI packs and Asolo boots to American t-shirts (Purdue!) and Vans. [weirdest clothes I saw on the porters: hot pink spandex pants, loafers, girl's high school volleyball t-shirt, and cut-off denim shorts] And they carry their double load right past us to set up for lunch.

1800. Tonight we ate with Efata ("Shanta"), our assistant guide. We found out this is his first trip as guide. We talked about movies and motorcycles and music. "Do you know 'Jolene'?" Oh man, do we ever! [This was the start of several days of all of us breaking out singing the Dolly Parton hit, including both of our guides and even a guide from another group; apparently "Jolene" is very popular in Tanzania. What are the odds of finding someone who even knows this song, much less all the words?!] I love learning about the guides and their lives. Shanta gets to see his family for 2 days and then goes back on the mountain. But, as he says, "What can I do?"

Shanta, our assistant guide. Roll Tide!

Jambo Tanzania

So, I'm back. It is A-mazing what sleeping in your own bed and getting to choose your breakfast and drink real freshly-ground coffee will do for morale after 28 hours of travel and sheer exhaustion. It's impossible for me to put into words the last 10 days, and while my journaling was not the most eloquent or thorough while I was over there, I figure it gives the most accurate running log of the trip (plus the over-150 photos that I have to sort through). So, for the next few posts, I will be offering excerpts from my journal from the trip [with post-trip commentary]. And thank you, thank you, thank you for all your prayers for the trip. I am above all grateful that we are all home safely. And now, without further ado...

Sept 22, 0820. At the gate. Super excited to meet up with the fam in Detroit. Forgot to take the pedometer off at security = pat down [And definitely not the only pat down of the trip. Um, always remember to take metal necklaces off when going through that funny spinning x-ray. Otherwise your whole chest lights up and the ensuing minutes are quite uncomfortable]. Whoops. Have only thought of 2 non-essentials that I forgot.

Evening over the Atlantic. The reunion in Detroit was dampened by the fact that I puked and nearly passed out as I landed. Stupid vagal response. Hopefully that's the last of it. Left my watch at home. Between that and my cellphone being off, I feel totally disconnected and at the same time more able to live in this moment right now. ["This moment" was not all that exciting to live. 9 hour flights are kind of painful no matter how you slice it.]

Me and Mary from Detroit to Amsterdam

Sept 23, Amsterdam. "The number one airport in the world." It. Is. Huge. And there are all sorts of people/languages/style here. I feel a mixture of relief and embarrassment that everything is in English. I'm tired but not sleepy enough (or comfortable enough in these airport chairs) to take a nap. The flight from Detroit really wasn't bad at all, thanks to half a dozen beverage cart runs, 2 meals, 2 movies, and an aisle seat.

Trying to catch some sleep between flights in Amsterdam

Afternoon, over Egypt. As we waited at the gate, more and more travelers wearing backpacks and hiking boots made their way down. We met Mary, Steve, Michelle, and Peter, all climbing the Machame route with us [hereafter, we just referred to them as "Utah" and they referred to us as "Denver". Funny that we had 2 Mary's and 2 Michelle's. Also incredible was the fact that Peter had been calling Michelle "Mitchell" since they started dating years ago. What are the odds?] Just knowing that we may see familiar faces at camp Tuesday night is comforting.

Sept 24, Midmorning, poolside. Life is grand. After 28 hours of travel we crashed at Mount Meru Hotel [in Arusha]--truly an oasis in the middle of the third world. Across the street from our gated, manicured grounds are hundreds of people in colorful dress, dragging carts, leading donkeys, selling fruit. But here, by the glass-top pool, all you hear is the waterfall and the birds (and occasionally a truck out on the highway). The weather is gorgeous, though we're all in longsleeves in case of mosquitos.
     The breakfast spread was unlike anything I've seen. Fresh fruit, crepes and jam, roasted vegetables, bacon, sweet potatoes, thinly sliced cured meats, omelets, coffee and tea, cereal. Truly a feast. And after 11 hours of catch up sleep, it was pure bliss. We can see Mt. Meru from the hotel. 15,000 feet and beautiful.

Breakfast in Arusha

Mount Meru

Poolside with mosquito protection

Okay kids, that was just getting there. More to come soon about the first days of our hike.

Here we go

Excited. Nervous. A little bit still in disbelief that we're doing this. Hoping I didn't forget anything.

This is going to be an amazing trip, and I'm extremely grateful for the opportunity. Not just to have all the cards fall in the right place to allow four of us with varying schedules to all be able to make the same trip, but also to be physically and financially able to do it, to do it with my family, to be united in prayer with so many others, to challenge myself in such an extreme way.

Pier Giorgio Frassati was an Italian mountain climber and activist who loved the Lord. On the back of a photo of himself, on what would end up being his last climb, he wrote "Verso l'alto"--towards the top. This was how he lived his life, in climbing and in faith, striving for greatness in everything he did. I pray for the grace to do the same.

SAD

Paraphrased from an old dooce post. I wanted to share in case anyone needed to read it. This is pretty spot on. I'm grateful to be in a good place right now, but if you know someone out there (or even a little closer to home) that finds September (or any season) hard, take heart. It won't last forever.

Five years ago Jon and I took a mid-week afternoon drive through the Alpine Loop to take photographs of burnt red trees and the sharp shadows of aspens standing in formation, ready to march, waiting for a signal. We stopped for lunch at Sundance, several memory cards full of images telling the story of the mountain's transformation.

Jon looked at me over my iced tea and asked me what was wrong. I didn't know what to say to him because, while I knew there was something wrong, I didn't know what it was.
What is worse? Being sad because something tragic has happened, or being sad because that is all your brain knows how to do?

My psychiatrist recently told me that more people commit suicide in March and September than during any other time of year. The rapid change in light, he says, roughs up those of us who have those frayed circuits in our brains, even if we're medicated.

Now we know, and I thought that the knowing would make it easier. And it has in that September will turn into October and October will merge with November, and I won't be sitting at my desk feeling sad for no reason. But it's knowing that there is no reason that makes it even more unbearable. Because as much as a person with depression is sad, we are the same measure of angry that we can't just stop feeling this way.

Now that we know, I finally have an excuse to look forward to winter.

What do margaritas, Twitter, Blake Shelton, and my dad have in common?

Lots to be thankful for in the last week.

September 4—Today I slacked off a bit and was down in Housestaff “studying” since there wasn’t much going on in the Kidney Center. Ran into one of the graduated residents and a good friend, who I hadn’t seen in a while, and who also happens to give A-mazing hugs. Hugs that last longer than the seven seconds it supposedly takes to release endorphins, that leave no room to breathe between you. I am grateful for those kind of hugs.

September 5—I got to chat a bit with Catalina today, which normally is quite a rarity, but more common lately as she’s had a few “doctor” questions to ask me. Not that I’m masquerading as an internist by any means (and I may have phoned a friend, who phoned her husband-adult-ER-doc), but I’m grateful for any chance to talk to Cata and feel involved in her life, since I did such a crappy job of being supportive growing up. I’m grateful that she makes me laugh, that she’s not afraid to say, “I love you,” and that all the workup is normal so far.

September 6—Tonight I went to an art exhibit with Rashy. In addition to feeling artsy, free margaritas, and Chipotle snacks and coupons, we had lovely conversation, ranging from reflective to challenging to slighty goofy (that was a STRONG margarita). I'm grateful for friends that let me be myself and share my faith and that I feel comfortable saying just about anything to.

September 7—Our advocacy lecture today was by an awesome community pediatrician about using social media to educate ourselves and our patients. She finally motivated me to get on Twitter, so that I can follow the leading voices in peds healthcare across the country. This way, they can do all the work for me of filtering through secular media and pop culture as it relates to medicine, and I can read the highlights. I’m grateful for something simple I can get excited about that may help the way I change kids’ lives.

September 8—Today I checked 3 more things off of my Kili packing list. There’s almost nothing left to get! And I had time to go for an 8 mile hike/walk in the park in nearly perfect hiking weather (sunny, light breeze, 70s). I’m super grateful that I get this amazing opportunity with my family to take this trip of a lifetime, no matter the outcome. But as dad said, it would be fine with us if we summited.

September 9—Today is Padre’s birthday. So, so, so grateful for him in my life and all the things I’ve learned from him and the great example he is to me. I could rant and rant, but we’ll just leave it at the fact that I have a pretty sweet dad. And no, I didn’t just put that because I know he’s always the first one to read my posts. Also, today, I’m super grateful for an awesome fall day with fun photos, mimosas, football, friends, and key lime ice cream. And since I know he’s reading...I said doody!

September 10—I know this sounds kind of stupid, but season 3 of The Voice started tonight and I LOVE it. Yes, I love hearing people with amazing voices. But mostly, I love watching Blake and Adam yell at each other and Blake do his little finger motion. I haven’t laughed that much watching TV since probably the first time I saw Wipe Out. I’m grateful for a schedule this month that lets me just hang out in the evenings, and for laughter. And for Blake Shelton. :)

Verso l'alto

We're getting down to the wire with the Kilimanjaro training. Just packed up all my stuff to make sure I was under the weight limit, and I'm about to head out on a hike. I still can't believe we're doing this. Remember how only crazy people climb mountains? Nineteen-thousand-foot mountains?

At this point I'm down to a few last minute purchases (snacks, lithium batteries, cheap paperback for the airports) and tasks (put the mail on hold, remember to start my malaria pills), and trying to keep up on the workouts without getting totally burned out.

As I collected prayer requests to take with me to the top of the mountain and back, I was struck primarily by two things. First, I have incredible, holy friends. People willing to pray for us, and asking me to pray for their vocations, growth in holiness, dear friends for whom they are storming heaven, etc. I am super blessed to be surrounded by awesome examples of Christ's love and sacrifice. Secondly, there is a lot of suffering in this world. As the intentions came in, my heart broke as my loved ones shared with me their fears and pain. It's not insurmountable, as we have a God that is bigger than all of it, but it drove home the fact that this life just doesn't make sense unless through the eyes of faith. We were made for more, and the road is not easy, but worth it. I can't imagine trying to make it alone.

Please keep praying for us as we get closer to launch. And please, if you have other prayer requests, shoot them my way. I'll offer up the sleeplessness, fatigue, knee pain, and discomfort for grace for you.

Belay on

Rashy took me rock climbing last night. My lats still haven't recovered. This is not your Family-Fun-Center-scramble-to-the-top-any-way-you-can rock climbing. This is people-bring-their-own-shoes-and-don't-even-think-of-using-a-hold-that-isn't-on-the-route rock climbing. And. It. Was. Awesome. Mentally and physically challenging, great community, lots of room to grow. I'm hoping to go back soon. For now, enjoy this shot of my butt.

Residency 3.2: NICU, Part the third

Just finished my third and final month of NICU, and let me tell you, there was no love lost as I waltzed out of there at 4 pm. As you may have surmised from my prior NICU/Truman posts, this is not my most favorite place in the whole wide world. In fact, I think it may come in as like my 145th favorite place in the world, behind Target, but ahead of airports. In reality, we didn't have that bad of a month. My calls were fairly mild, our interns were strong, and though the census was high, the babies weren't all that sick. Still, I get cranky way more often over here than on other rotations, it seems. And, this time around, it was coupled with just a touch (read: whole-whopping-lot) of senioritis. Is August too early for that? Too early for tuning out during rounds, taking 30 minute breakfast breaks, and stretching meetings an extra hour just to not go back to the NICU? Brace yourself, cranky-pants, we got another 10 months to go.

I remember back to my first time in the NICU and those terrifying calls where I had to look up what to say in response to, "He hasn't peed in 23 hours, what do you want to do?" The answer--always--is wait longer. See? Now you can skip straight to second year. However, besides getting more delivery experience (which was essentially the goal), and teaching my squirrely interns the ropes (who am I kidding? They basically teach themselves), I don't feel like I learned a whole bunch, and I'm hoping that doesn't set a precedent for third year. I don't wanna be so checked out that I'm not taking advantage of these last few months where I have a safety net and plenty of resources at my fingertips. Right now, all motivation has to go towards finishing my Professor Rounds presentation and prepping for Kili, followed shortly by job hunting (yikes!), but maybe if I wish hard enough, I'll become a human sponge and just start absorbing things around me. Only useful things, though. I don't really care about the Chiefs' front line or how much 'Magic Mike' took in at the box office.

See? I can't even focus long enough to write a proper blog post. I better quit now.

The Burning House

Foster Huntington, in May of 2011, asked himself what he would take with him if his house were on fire. The answer led to an intriguing project that demonstrates how uniquely each of us attaches to material things. It got me thinking about what I would take with me. I was surprised by how many of the things I've accumulated over the years that I was ready to leave behind. It's all just stuff. Stuff that I like, and that would take me a long time to replace, but just stuff.

In reality, the items I chose were so scattered throughout my apartment, and I had to think through each one of my storage spots, that there is no way I would actually be able to gather this exact collection to save. If I had that much time, I'd just put out the fire. No, in real life, I'd look around, grab an armful of the most expensive things, plus the cash and savings bonds in my dresser (don't come rob me), and get the heck out of Dodge, praying that I'd estimated high on the renter's insurance. But if we suspend reality for a moment, to let me reflect on irreplaceable things, here's what I would grab (let's pretend I could carry it all in one trip).

Twenty-eight years' worth of stuff

1) My laptop. Too much stuff on here, and no backup drive (I know, Dad, I should back everything up)
2) My phone. Cause, otherwise, how would I call the fire department? Also, let's be honest, I'm now lost without my phone.
3) My TEC Bible...I've already got all the important stuff underlined. Don't want to waste all that work.
4) I've got a drawer full of all sorts of things I want to keep. We call it a "Forever Box", cause that's the stuff you want to have, you know...
5) Couple of pictures that are professionals, so I don't have the negatives...Michelle hooding me, Mimi and Grandad, and the Zapapi.
6) Also, a photo strip from Milwaukee with The House, after Brady's wedding--first photo booth experience, and it was everything I wanted it to be.
7) Various artifacts from my globetrotting sisters...Moroccan jewelry box from Michelle, Jamaican drum from Kelly, German beer boot from Mary.
8) The pearls from Mimi and Grandad for my 16th birthday
9) Pearl necklace from John
10) Grandma's diamond cross necklace
11) My keychain collection--I'm proud of it, and it would take WAY too long to replace.
12) My billfold--you know, driver's license, credit card, Starbucks' card, library card, PALS card--all the good cards.
13) My passport (complete with Tanzanian Visa)...no way I'm jeopardizing my Kili trip this close to launch time.

The End.

Residency 3.1: Urgent Care

Whoa--we've hit version 3.0, kids. This is the big time. No turning back now! Who am I kidding? There was no turning back once that first med school tuition check was written--not wasting that kind of money.

But really, it does kind of feel awesome to be the top dog. So I started out my third year by getting the heck out of the hospital. Seriously. Cause hospitals are scary places to be in July.

I did an elective at our Northland Urgent Care this month, seeing everything from fractures and split chins to bug bites and sore throats. Also got to see chicken pox, pertussis, a Morgan lens (look it up, it's like a Chinese torture device), viral meningitis, tons of hand, foot, and mouth disease, and lots of super cute kids. Also, still lots of convincing parents that viruses get better on their own and antibiotics won't help.

I wanted to try out the urgent care setting to see if it is something that I could see myself doing at least for the next few years. It's pretty tempting. Shorter shifts, low-key atmosphere, minor procedures for quick fixes (stitching, nursemaid's elbow), sort of sick kids (but not too sick), elements of primary care that I like without some of the stuff I don't like. I still have to decide if it's worth giving up the continuity and getting to know the families in order to have less call and more flexibility.

The schedule lent itself very well to getting my Kilimanjaro training seriously underway. There will be more on that to come, I'm sure. Right now, I'm just trying to build up my quads and my stamina, doing a fair amount of running, swimming, lunges, and hikes with my pack on. With all of that, I've increased my fluid and calorie intake by about 30-40% it feels like, just to keep from losing weight. Makes me wonder if I can keep up on the mountain, since I've heard that altitude makes your appetite fade. Gear shopping is almost done too; picked up some more key items a few weeks ago--headlamp, gloves, CamelBak insulator, etc. We're getting close!

Until next time...go Team USA!

7/20

The events of yesterday have thrown me into unrest. I expected the shock and horror and sadness. These things always make us stop and think. How life is short. How much we have to be grateful for. How we shouldn't wait to do the important things. How important it is to reach out to those who are hurting. But then everyone moves on. I think that's what make me crazy. Thirteen years ago, when the rest of the world had moved on, I would sit in my biology classroom and wonder where I would hide if someone came in shooting. When my college roommate watched "Elephant" and said it was so artistic, I wanted to curl up in a ball or vomit, because it was all too familiar. Whether it's right or not, it hits a lot closer to home when the headlines say Colorado. When I drove past that movie theater every day on the way to school. When I have to wake up to an email from my dad saying everyone is okay. And I know that for those much more intimately involved, it will never go away. And when the rest of the world moves on, or uses this to fight political battles about gun control, or when the next shooting comes, they will still be in pieces. And it breaks my heart, but I don't know what to do besides pray.

Father, send Your angels down to wrap Your children in Your love and protection. Soothe their grieving hearts and lift their eyes to see Your light. Draw us back to You and give us the strength to reject the evil one and his lies. Give us Your peace. Amen.

The tough questions

I finished a fluff book from Michelle's bookcase the other day (really, are there any other types of books on that bookcase? just kidding, there's also "Orthodoxy," a book that was recommended to me by my own genome and I had to put down out of boredom. Point: nurture). And in the book, the main characters answer three questions...

1) What do you want to be doing when you die?
2) What would you regret not doing if you died right now?
3) What do you want on your tombstone?

Those questions sounded entirely too morbid for a blog post. At least for a beautiful summer afternoon. And since I make a lot of decisions by ruling things out (see: career choice, hair style, things I can cook), I figured I could at least decide the following...

1) What do I not want to be doing when I die?
      -burning alive
      -swimming/sinking/bathing/choking/holding my breath in any way
      -shopping
2) What would I not regret doing if I died right now?
      -becoming a doctor
      -seeing the Pope
      -eating a Twinkie in one bite
3) What do I not want on my tombstone?
      -She forgot to pull the ripcord
      -The evil twin
      -1984-2012

See kids, we're making progress. I've already ruled out a lot of things. That's pretty close to deciding, right?

Here's to uplifting books!

Residency 2.12: Blue Team

Well, I made it through another year. Go me. My final month of 2nd year was spent with the same kids I first took care of as an intern on inpatient--heart kids and cystic fibrosis. It's amazing how much I've learned in between. I remember my very first overnight call on Blue Team, not letting my senior out of my sight, asking whether it was okay to redose lasix if a kid puked. Last night, on my last overnight call of Blue Team, I basically just laid down and let my fabulous intern handle everything. Maybe all I've learned is how to delegate. Just kidding, I've been doing that for years, right, Mom? Okay, but seriously, it was somewhere in between pushing adenosine on rounds before sending the kid to the PICU and getting every question right on Cardiology Jeopardy that I was able to sit back and go, huh, turns out I know something after all.

Specialty services are funny, because the inner general pediatrician in all of us gets to shine a little bit. When one of our heart babies spiked a fever, the recommendation of the attending cardiologist was to "consider evaluation for otitis media." Resident to the rescue! We didn't even have to call ENT. Another one of the cardiologists admitted to having palpitations when we asked him to come look at a rash. Once again, we saved the day (diagnosis: miliaria crystallina).

Of course, these kids have much bigger problems than ear infections and heat rashes. And even though you know the outlook for heart disease is bad, it doesn't make it any easier to come in one morning and find a kid that you talked to yesterday is brain dead. And it's rather depressing watching teenagers with cystic fibrosis sit around waiting for a lung transplant because they have lost most of their ability to breathe. Thankfully, there were some silver linings. One beautiful boy with Down Syndrome suffered several strokes after his heart surgery, and when he came out of the PICU we weren't sure he would recover any function. He would lay in bed and stare at you, occasionally moving his right hand. But after several days of set-backs, lots of therapy, and optimizing his heart and lung function, we came in on the morning of discharge to see a new boy. He was sitting up in bed, circling his finger near his ear, the universal sign for "You're crazy" with a huge grin on his face. When we came in with the whole team wearing party hats to celebrate him going home, we got an enthusiastic double thumbs up.

This month I had an exceptionally amazing team that worked together like a well-oiled machine, if well-oiled machines could laugh until they cried. Still, I wasn't sad at all to pass off the baton this morning to three brand-spanking-new interns with wide-eyes and shaking hands. I ended check-out with a horror story of a single-ventricle patient who came in overnight with cardiac tamponade, SVT, and laryngomalacia who needed pericardiocentesis, adenosine, and chest compressions, all on the floor since the PICU was full. "And you better run up and check on him right away to make sure the fluid hasn't reaccumulated." The look of relief on their faces when I told them I made the whole thing up was priceless.

Tomorrow I start my Urgent Care elective. Hopefully a nice break away from the hospital that will perhaps help narrow down career choices. But mostly I'm excited to only be working 16 days this month. Hasta!

My heart song

It was sophomore year, the first game of the season. We sat in a dark classroom, our giant ABK bags spilling out from underneath our desks, heads down, as the music started. "We call them cool, those hearts that have no scars to show..." As the song played, I could feel the energy building throughout the room, 17 girls ready to leave it all on the field, "yearning to get out of control."

That was the first time I heard it, and every time I hear it again, that memory comes back. The motivation to go outside myself, to risk something for a purpose, to lay everything on the line. It's something that I've faced over and over. That first time, it was just a soccer game, but in the 13 years since, it's been many things. Serving on team for TEC, applying to medical school, climbing 14ers, moving to Kansas City, being vulnerable in friendships, standing up for what I believe in, caring about something so much it hurts. They were times that I could feel the fear inside me rising up, threatening to take over, making me want to go back to someplace safe. It's so easy to stand on the edge and sigh with relief that I don't have to feel...heartache, disappoint, regret, shame. But it's never enough. It's never enough until I push myself into the flames. Yes it burns, but it's a purifying fire that gives life, not death. It's there that I feel alive.

We call them cool
Those hearts that have no scars to show
The ones that never do let go
And risk the tables being turned

We call them fools
Who have to dance within the flame
Who chance the sorrow and the shame
That always comes with getting burned

But you've got to be tough when consumed by desire
'Cause it's not enough just to stand outside the fire

We call them strong
Those who can face this world alone
Who seem to get by on their own
Those who will never take the fall

We call them weak
Who are unable to resist
The slightest chance love might exist
And for that forsake it all

They're so hell-bent on giving, walking a wire
Convinced it's not living if you stand outside the fire

Standing outside the fire
Standing outside the fire
Life is not tried, it is merely survived
If you're standing outside the fire

There's this love that is burning
Deep in my soul
Constantly yearning to get out of control
Wanting to fly higher and higher
I can't abide
Standing outside the fire

Standing outside the fire
Standing outside the fire
Life is not tried, it is merely survived
If you're standing outside the fire

Moving on...

I've been so busy at work lately that the end of this year has crept up on me. All of a sudden, we have new chief residents, the senior roast, graduation, people packing up their stuff, signing contracts...and new intern orientation starting tomorrow. TOMORROW! I'm not quite ready for this year to be done. Not ready to say goodbye to people who have been by my side for the last two years (although thankfully several of them are going to be hanging around in various capacities; I might die if they were all leaving), not ready to break in a whole new class of baby doctors, not ready to be the third years--the ones everyone else looks to when things go wrong, the ones who should be level-headed and know what to do next, the ones who have to start looking for jobs (eek).  Up until this point, my whole life has been neatly mapped out for me--college, medical school, residency--I didn't have to have a 5-year plan, because I was on an 11-year plan. Well, I've got one year left until I have to be a grown up...better make the most of it!

Residency 2.11: Well Baby

Wow, as I typed that title, I'm realizing that we are very close to Residency version 3.0...does that scare anyone else? Where have the last 2 years gone?

I spent the last month over at Truman in the Well Baby Nursery. We mostly just got to look at cute babies all day, plus go to deliveries and cover the NICU when we were on call (which felt like ALL the time). There were a few long calls, and a few sick babies, but overall it wasn't bad. Had a few cool moments that reinforce this crazy career choice, like last night when I got to reassure a tearful mom that her baby was going to be just fine, or getting to intubate a lifeless baby in the delivery room and then see the baby do great. We also did something like a thousand circumcisions. I always did a little dance inside when the baby was a girl.

And I will say there are few things more therapeutic than rocking a cute baby to sleep in your arms. But the best part by far was the great group of people that were over there this month--attendings, seniors, and interns. Truman can feel very isolated and lonely, but we made the best of it, and I dare say, occasionally even had fun (awesome halfway breakfast, guys!). Makes all the difference in the world.

And now I have to go read about my new team that I take over tomorrow. And maybe eat a cookie.

Blessed and Broken

A great truth from Henri Nouwen's amazing Life of the Beloved:

Our brokenness reveals something about who we are. Our sufferings and pains are not simply bothersome interruptions of our lives; rather, they touch us in our uniqueness and our most intimate individuality. The way I am broken tells you something unique about me. The way you are broken tells me something unique about you. That is the reason for my feeling very privileged when you freely share some of your deep pain with me, and that is why it is an expression of my trust in you when I disclose to you something of my vulnerable side...Facing [anguish] and living it through is the way to healing. But I cannot do that on my own. I need someone to keep me standing in it, to assure me that there is peace beyond the anguish, life beyond death, and love beyond fear...And so the great task becomes that of allowing the blessing to touch us in our brokenness. Then our brokenness will gradually come to be seen as an opening toward the full acceptance of ourselves as the Beloved.

Al dente

Yesterday I was feeling stressed. Rushed and a little overwhelmed and just down. And it was a gift when I ran into Brandi in the Chiefs' office and she asked how I was. You know how you can tell when people ask and actually want to know? So I said okay, knowing she would know exactly what I meant. She did. And invited me out for what I think was a pre-planned birthday celebration dinner, but she let me crash it anyways. It was exactly what I needed. Garlic cheese bread and Apples to Apples and laughing until tears were streaming down my face. And Jess may have snorted. Three times. I don't think any work people even know about this blog (oh, except the FDMDP--shout out!), so gushing their praises here may fall on deaf ears, but it's safe to say I'm super grateful that my coworkers are one of my biggest supports (when I allow them to be) and sources of joy. Also, that garlic cheese bread, I'm telling you, it's magic.

Residency 2.10: ER

Last night's shift felt like it was never going to end. I think one of the things that the control freak in me hates the most about the ER is the unpredictability. One night we completely cleared the board and I sat around for an hour and a half catching up on work and doing nothing, and two nights later we're literally sending out-of-town referrals to hotels because we can't let them wait around until the specialty clinics open. I'm more of a steady, work at my own pace kind of person. If anyone figures out what career that points me towards, let me know.

I don't have much to add that was all that different from previous ER months, except that I think each month I get a little more jaded about what people use the emergency room for. I could tell you some stories. Except then I start to get bitter. On the plus side, I'm getting more comfortable doing procedures and making decisions on my own, which is always my goal in the ER. It's one of the places where we get the most autonomy, and I push myself to take advantage of it.

Until next time...

An awesome ending

I had read last week that 1000 Awesome Things was ending, that after chronicling one thousand things that make your day more, well, awesome, Neil Pasricha was retiring his keyboard. So, last night, I went to the blog to see. A pleasant surprise...the final awesome thing was posted on my birthday, and it was whatever I wanted it to be. That's right, out of all the awesome things on that site over 4 years (you really should check it out...there is definitely something awesome about sneaking cheaper candy into the movie theater, hitting a bunch of green lights in a row, the moon, and that moment right before you fall asleep when you know you're about to fall asleep), the most awesome one is mine. And so, in honor of a great idea, and my birthday, here are a few recent awesome things:

-free Starbucks
-checking things off the bucket list
-2 dollar bills
-laying down in bed at the end of an exhausting day (this one is actually on the blog, but I SO agree)
-the first sip of a really good beer
-flip flop weather
-samples at the farmer's market
-phone calls from friends you haven't heard from in a while
-when the sun comes out after days of rain
-when you happen to pick the perfect, best thing off of the menu and it's exactly what you wanted
-family members that will call and check on you twice a day when you're not feeling well
-wandering into little bookstores and just browsing
-praying night prayer together
-when God works miracles (haha, Mom, that one is for you!)

I don't know that any of those are the #1 MOST awesome thing. Instead, I really think it's that moment when we are able to recognize the awesome in our lives and be grateful for it. To just stop and say, yeah...AWESOME!

Take me out to the ballgame

While I generally would not recommend double-calf-tattoo-security-guard-bud-light-drinking-season-ticket-holder as a best friend or cat sitter, he makes an EXCELLENT source of entertainment if you sit behind him at the Royals game. Other things that make for a lovely game:

-blue and white margaritas in signature glasses
-funnel cake
-calling the double steal before it happens
-skinny jeans joke that never dies
-good company
-"Moooooooooose!"
-Boulevard wheat dispensed from a Ghostbusters backpack
-very nearly come-from-behind win (oh well, next time)

(ignore the mostly photoshopped watermark from the fan photos website)

Amazing grace

Easter is always a time that reminds me of God's faithfulness. Through everything. No matter what. Every time I try to comprehend the love that it would take to send your only Son to suffer and die for someone who you knew would fail time and again to return that love, someone who would be selfish and stubborn, who would turn their back at the slightest struggle, who would doubt at the first sign of something not going according to my plan, and yet He loves me anyway...it just blows me away, and I'm left humbled with gratitude.

On today, Divine Mercy Sunday, it's a perfect time to renew my faith and say, no matter what this world throws at me, Jesus, I trust in You.

Residency 2.9: PICU

It's hard for me for to sit down and write a blog post about my month in the Pediatric Intensive Care Unit for a couple of reasons. I'm so delirious with relief from being done, and with the gorgeous day outside and the nagging of all the things that didn't get done last month, it's hard for me to sit still at all. It's also hard to sum up so many experiences into one blog post. And for now, I almost want to just say, "it's over" and leave it all behind. But that wouldn't be fair to my two readers, so, for you, I will sum up the last month.

For those of you who aren't in health care, I don't know if there are ways to describe what a 26-bed ICU is like. Besides the NICU, which for some reason is very different, my only real experience with an ICU was in medical school at the VA--a 10-bed unit that often wasn't even full, and that was managed by the general teams instead of intensivists (so that tells you how "intensive" it really was). So to be frank, a busy day in our PICU was a rude awakening. I would LOVE for someone to just follow us around for a day and see the craziness. Where nobody bats an eye when rounds are interrupted by having to do chest compressions on a kid whose trach fell out. Or to walk in in the morning and see one of the rooms converted into an OR so that the surgeons can "explore the chest" of one of the post-op heart kids who's having too much bleeding. Yeah, that's totally normal. I could go on and on. Oh the stories!

Somehow in the midst of this environment, I did manage to learn a lot, to grow more confident in my decision-making, and to become (very slightly) more comfortable with really sick kids. I also had the opportunity to be a part of some very difficult end-of-life situations, which, while I wouldn't seek them out and I don't always enjoy, reveal God's hand in so many ways. There are some things that just won't ever make sense unless through the eyes of faith. It was really a good place for me to be during Lent--over-worked, under-rested, totally stressed out, but at the end of the day, my suffering didn't compare to the parent watching their child slip away.

So yeah, it was an intense, intense month. And I'm super glad to be done. And to have a life again, especially with spring being here (Hazzah!). Looking forward to Easter and sunshine and sleeping in and PORTLAND!

Hasta for now!

Down time

I’m on my second overnight shift in the PICU. The fact that I’m having time to blog is encouraging, although I fear that it will come back to haunt me in the next few days. I don’t have a whole lot to share, but posting is one of the only ways I can stay in touch with the outside world, since all my time is spent at work or sleeping (see post from 3/5). The PICU in general is steadily busy, but there is a huge spectrum ranging from blog posting to stay awake to never sitting down and having 34 verbal orders to sign at the end of a shift (which thankfully, I haven’t experienced yet, but like I said, I’m expecting payback for this night).

One thing that is striking about the unit is how differently each of the attendings does things. There are a dozen different ways of solving the same problem, from different meds to different fluid choices to how quickly you make changes. It makes keeping up a little difficult, but it also makes for learning a lot of different options in a short period of time. As long as I can swallow my pride about looking stupid when one attending does things totally different than the last one (and usually they switch just as I’ve gotten used to one way of doing things), then I think I will be fine.

I’m almost halfway there.

What a difference a day makes

So that last post...disregard please. That is NOT indicative of the reality of the PICU. Remember that whole "we don't have any beds" thing? Apparently that is not a deterent. I'm pretty sure Tuesday was more typical of a day in the life. Rounding by myself on the whole surgery service, two post-op admits, including one who wound up on ECMO...Good thing they changed the duty hour rules so that that 10 hours between shifts is more of a strong suggestion.

But...BUT!

I had the day off today. Finally. And I slept in, and I made a delicious breakfast with delicious coffee and went to Mass and worked out and sat in my recliner and read a totally non-intellectually-enriching fluff book with a bowl of popcorn. And some chocolate-covered pretzels. And it was glorious. And I'm (almost) ready to go back tomorrow to do it all again.

Between a 3 and a 7

I'm 4 days into the PICU...Dad says I have to update this so he knows I'm alive. I'm pretty sure if a certain someone wouldn't teach a class on the rare occasion that I have time to call him, he would know for himself.

Surviving so far...I'm on the cardiac surgery service and they keep having to cancel surgeries because we have no beds (thanks to the overflowing medicine service...influenza and RSV are nasty, but I'm grateful that it keeps our service smaller). Learning a bit about efficiency, physiology, interpreting data, good communication, and how to sneak snacks when no one is looking. I'm not going to say anything about the kids mostly behaving at the risk of jinxing something. Two more surgeries tomorrow (and not simple ones) and my co-worker has the day off, so I will be seeing all the kids myself (if there are no more updates, you know it broke me).

So far, we've had visitors every day bearing gifts of Chipotle, chocolate, hugs, and binder clips (for the charts that keep getting thicker). And I haven't cried...yet.

I told Dad that my priorities are as follows:
1) Don't kill any kids
2) Sleep as much as possible
3) Everything else

I guess this falls under everything else, so I must be doing something right on those first two. Off to bed!!!

Residency 2.8: Green Team

Tonight I'm headed out to our celebratory end-of-Green-Team dinner. We're a few days early, and it might not be so much of a celebration as a decompression, but I'm definitely looking forward to it. Green Team is one of our general pediatrics inpatient teams, but it's senior-only, which means just me and another senior and the attending. No interns, no medical students, no pre-rounding. Just seeing patients and making the plans. It's a LOT of work, especially since there were just 2 of us.

It was a real challenge to be the person in charge and making the plan for the day, deciding when someone is ready to go home, or whether another test should be run, and then being the one to explain it all to the patients and parents. For example, how do you decide how much work up to do on a 16 year old that you're pretty sure is new-onset schizophrenia, but you can't rule out a rare autoimmune disease, especially when he won't wake up from his catatonic state enough to answer any questions and has to spend 24/7 in restraints? And how do you explain things to a grandma who believes he has a demon inside him? Yeah, that one was interesting.

I was super grateful that I had an amazing co-senior on with me. We got along famously, worked hard and well together, and had a lot of laughs. Even though I'm ending the month a little burned out, I can't imagine how much worse it could have been.

I go next month to the PICU, which I'm scared for but I know I'll learn a lot. Please pray for me. Also, feel free to send me care packages, love notes, pep talk voice mails, etc. I'll see you on the other side.

Almost a lifesaver

In my first year of medical school, they had this big tent out on the quad where you could swab your cheek and sign up to be part of the National Marrow Donor Program. Being all young and idealistic about my new chosen path of saving lives, I naturally swabbed away. And kind of haven't thought about it since. Today I got an email saying I could be a match. I almost had a heart attack.

So many questions--would I get chosen and get to save a life? When would this happen? Would I be able to get off work? If I was chosen, would I have to do a bone marrow aspirate? (Cause I've seen them done...they do NOT look fun! At least not from the patient's standpoint. From our standpoint, it was pretty cool...until Becca sprayed blood everywhere...long story)

Turns out I was WAY ahead of myself and when I called the registry, I found out I was disqualified for now on a bit of a technicality. And I'm not sure if I feel more disappointment or relief. Probably both. I have the utmost respect for those who choose to be donors, especially for complete strangers. I suppose that when I signed up, I really did hope that I could save a life some day. And if for that, if I have to suffer through someone jabbing a HUGE needle in my hip, then I guess I'll do it...some day.

For now, I'll have to save lives the old fashioned way.