Thursday, October 25, 2012

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!

Sunday, October 21, 2012

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.

Thursday, October 18, 2012

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...

Tuesday, October 9, 2012

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!

Saturday, October 6, 2012

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!!!

Thursday, October 4, 2012

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.]

Wednesday, October 3, 2012

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.