A Good Year

Since I'm eschewing the culture's mandates of partying tonight and sitting at home with a glass of wine and the wombmate, I decided it's the perfect time to revisit my resolution for this year and look ahead to next year.

I'll be honest; I often forgot that this had been my resolution, but it was a good one, and we'll see how I did.

Overall, I know I put this last year in God's hands. I remember feeling somewhat overwhelmed by trying to find a job for after graduation, but not all that worried about it, because I knew it would work out. And it did. And the rest of the big things went similarly. It's more the little things that I have a harder time turning over to God. But if I break it down into the things I know God is asking of me, maybe it will become easier.

Celebrate the little things--I think this one was a success. I had super fun checking things off my '30 Before 30' List--Run a 10K, Take a Class, Irish Car Bomb, Get a Real Job, Pass Boards, Twin Sister IPA, Cherry Cricket, Exotic Foods, Boulevard Tour, Stranahan's Tour/Tasting, and Reading 3 Pulitzer Winners. Each one was a little check in the Win column, a tiny party for having accomplished something and relishing it. And there were plenty more things that weren't on my list. Had my first smoked ham for Easter, threw myself a lot of goodbye get-togethers in KC, enjoyed every single episode of Blue Bloods, lots of happy hours and porch time, won a few awards to finish out residency--I think you get the gist.

Reach out--This one is a little harder to quantify and say for sure that I've completed it. But I know I've tried. There have been many times where it would have been more comfortable (and probably lonelier) to stay in my introverted cocoon. Classic example was as I was getting ready to leave KC, wanting to get everyone together and celebrate in the style of some of my favorite memories (Friendsgiving, Easter, that one day after the NICU, etc). I was stressed about finding a place to host it, knowing that what I really wanted was for Other Laura and Jill to host/plan because they throw a mean party. So after much waffling, I just said, "I would like to volunteer you to plan my going-away party, and Laura and Chris should host." And the rest is history. But there have been lots of moments like that this year, where I have to suck it up and just chance that someone will say "No. You're crazy. Why would we want to hang out with you/help you out/do that?" (which no one has yet by the way). So I successfully got myself two job offers, a medical student to precept, a fun Christmas party, and a whiffle ball season which wasn't a total wash. And lots of other meaningful moments in between.

Show love first--Somewhat related to reaching out, but this taps even more into my insecurities of thinking people would rather just me leave them alone, and so I often wait for a sign that the friendship is worthwhile for them before I show love. I don't know that I was as bold as I could have been, but I definitely tried to initiate more phone calls, more hanging out, and sending more cards for no reason, just because I wanted to. Good to know I still have room to grow.

Be a leader--I know Mom says I'm really good at delegating (because I am!) and I prefer to think of myself as helpful rather than bossy, but I think being a leader is more about actions than direction. I was forced into leadership positions in some of my residency months just by virtue of being the most experienced person on the team. But I also tried to take a lead in helping with recruitment dinners, working on resident wellness, and giving a send-off to the Program Directors. As I mentioned, I took on a medical student to precept, and often look for opportunities to teach the 3rd year medical students as well. I'm going to try to look for more opportunities for this next year, both at work and at home.

Pray--this one always is a challenge, and I haven't yet found a way to truly build a habit of daily prayer that sticks for more than a few weeks. But, lest we chalk this one up as a total failure, I continue to do my Total Consecration, have been able to go to daily Mass more since coming home, and I have re-committed to this particular resolution many times this year without giving up completely. I'm starting off next year with a Spiritual Exercises retreat which I'm super pumped about and hope to use that to jumpstart the new year.

Focus on the Positive--for whatever reason, this seems to come more easily to me now than it has in the past. I'm more aware of my own words and choice of conversation topics, and definitely am more aware of it in others, trying not to get sucked in to the pity parties at work and instead continually reminding myself that I love my job. And I do. I honestly couldn't have planned this for myself; where I'm at, what I'm doing, what I've accomplished. It's wonderful. And it's all God.

Accept where I'm at. That's a pretty big goal, but for now, it seems within reach. At least for right now. I don't ever want to get complacent and forget where I'm supposed to be going, but no matter how much I worry about the path ahead, the truth is that I am where I am right now, and there's no changing that, so I might as well get used to it. A book called "Wherever You Go, There You Are" made it into my hands last year, and I think that has increased my ability to accept things and to challenge myself with these resolutions.

Well, that took it out of me. I'll have to pick another time to choose a resolution for next year. If you've made it this far, thanks for being one of the many blessings in my life and for reading. May God fill you with love and peace in the coming year and always!

The year in books

In January, I started keeping track of each book I read--just the titles--so that when people asked me for recommendations, I would have them handy. And so that I could monitor the types of books I made it through. It has made me a little more selective of what I read (and I was already pretty darn selective), because at least a part of me wanted that list to be somewhat respectable (although James Patterson's 'NYPD Red' did make an appearance; old habits die hard).

As we near the end of the year, my list has hit 30, not bad for someone finishing out her third year of residency, moving back to Denver, and starting a new job. Although it seems the busier I get, the more I need to read for my own sanity. It is an escape, an anchor, and a way to connect.

The list includes a wide range of titles, everything from the critically acclaimed--'Olive Kitteridge', 'Devil in the White City', 'Cutting for Stone'--to compelling non-fiction--'The Emperor of All Maladies', 'Unbroken', 'An American Life'--to old classics (some of them re-reads)--'The Alchemist', 'Little Women', 'Frankenstein'--to pop-culture sensations--yes, I'm two-thirds of the way through the Divergent series, and loving it.

I read more--and more diverse--books this year than I think any year in the past, and I think being conscious of it through keeping a list was a big part of that. I'm excited to continue my pursuit of great stories in the coming year, and am always willing to take (or give) suggestions!

A light shines...

Again.

That's what the headlines said last Saturday. In a way it felt familiar. The thirst for information, for any new details. The striking images of grief. The prayers that unite a community.

But it's different too. To see the fence around the soccer field where I played every day after school corralling students with their hands over their heads. To feel the pride swell, knowing that Warriors really do take care of one another. To hug a friend whose daughter is wrestling with the effects of being inside.

My whole family was together last night at a prayer service at St. Thomas More, amidst good friends and strangers, members of a community that have this awful tragedy in common. Together we joined our intentions to create a chain that is stronger than each individual, a visual reminder of the power of the Communion of Saints and of our need for each other and for God.

For me, the question is not so much how a good God can let evil like this happen. Rather I often wonder why it takes something like this to trigger the show of support and love that is already there. Why we wait for something awful to remind us how important we are for one another and how we cannot do this alone. Why I was so quick to rush to the adoration chapel last Friday when I have so many chances to go there every week and don't. Why it doesn't take any cajoling to get the family to sit together last night, but otherwise trying to arrange a family outing is like herding cats. Hopefully this can be a step towards making God's light evident every day, not just when we are threatened by darkness.

The prayers of our community

Freedom

My mechanic is a doctor. Not in a metaphorical he-heals-my-car kind of way. He's literally an MD. A foreign medical grad and a family practitioner, he tried extremely hard to jump through the hoops of becoming certified in this country and was unable to. "But I'm happy," he says. As a mechanic.

I can't imagine doing all the training and sacrifice of becoming a doctor to give it up for a blue collar job. And yet, this man would rather change oil in America than be a doctor in his home country. For all that's wrong and frustrating with our country-and there's a lot-I'm grateful for the freedoms and opportunities that make it worthwhile for a doctor to change careers just to give his family a better life. And grateful that I'm not faced with the same decision.

Gifts

On Tuesday I went to a presentation called "Gifts Our Patients Give Us." It was a timely reminder of why our jobs aren't just a job and the importance of being grateful for it. Panel members and several in the audience shared things they've learned from their patients. I kept my hand down because I had a hard time keeping a handle on my tears as it was, but I wrote down a few thoughts for later (aka now).

I am grateful for the trust that parents give me, letting me take care of their children in a vulnerable time, and that they open their lives to let me in. I'm grateful for Emma, who taught me that death isn't the worst thing, and that life is worth celebrating. I'm grateful for Taya, whose hugs and smiles always brightened my day. I'm grateful for Aidan, who made all of us laugh at 2 in the morning with his racecar noises. I'm grateful for parents who are physicians and have to learn how to be both. I'm grateful for the dad who was in the middle of a crisis and still took the time to thank me by name. And I'm grateful that I recognize how incredible it is that I get to experience this every day.

Teaching the next generation

I remember feeling a little bit sad when I found out that I wouldn't be working with pediatrics residents at the Network sites. I was looking forward to imparting my incredible amount of knowledge (see: 160-pages-of-content-specs-for-boards) on the world's future pediatricians. Turns out all the peds residents end up in the main ED and as yet there are no urgent care electives. Instead we get medical students. You know, the same med students that were super annoying when I was a resident? They asked inane questions and were worthless and took your computer and your free lunches? And then they expected you to teach them?

Just kidding. (Mostly) I did become invested enough in shepherding the little mongrels that they gave me a teaching award my intern year. Then I graduated to trying to teach my interns something, and they became my little pet projects and punching bags (and the students took a really far away back seat).

Well, fast forward to my big girl job, where it's medical students or nothing. Turns out I like teaching. I know from experience that they will retain about 11.2% of what I tell them, but it's still fun to try. At least most of the time. Hint to any future or current medical students reading this (yeah, right): at least ACT interested. It makes me want to tolerate your presence and maybe even go out of my way to show you things.

Like last night when I was 10 minutes from my shift being over, and I saw a two year old with chief complaint of "arm injury". For all of you who didn't memorize those 160 pages, that means Nursemaid's elbow until proven otherwise. Which just happens to be one of my favorite diagnoses. Easy, dramatic cure which never fails to impress the parents. Since I love Nursemaid's and since my current med student is on the far end of the "interested" spectrum, I grabbed her so she could do the reduction. Her reaction was gratifyingly similar to mine: "That was awesome!"

Did I mention this was after said medical student made a run to Starbucks for chocolate cake pops? I have the best job.

And apparently I'm invested enough in the next generation of doctors that every medical student I've worked with (and three of the residents at the main ED when I was learning the ropes) has asked me to do their evaluation. From experience, that is an honor and leap of faith not bestowed on just any attending, because that stuff goes in the Dean's Letter (aka Your Ticket to Match Day). Not that I care so much about that as I want to be able to give back in the same way my mentors did when they taught me.

Which is why I signed up to be a preceptor to a brand-spanking-new medical student for the next three years. She's so cute--"What are retractions?" I only hope I can do the preceptor experience justice and that by the end she's learned something about taking care of kids. It's a daunting task, but I think I'm up to the challenge.

The White City

I just finished reading "Devil in the White City" and wondering what took me so long. I think Michelle's had it sitting on her bookshelf for about 4 years. I thoroughly enjoyed the history of Chicago in the time of the great World's Fair--the challenges of architecture in the city, the trouble with workers' unions, the origin of the Ferris Wheel and PBR, and the effects this one event had on our country for the following century.

It was also a fascinating look at the success and power of two men who had great ingenuity, determination, and influence, and how differently their lives played out. One man--Daniel Burnham--was the driving force behind the building of the World's Fair, the world's greatest architect of the time, and probably one of the biggest reasons the fair succeeded at all. He orchestrated things that even with today's technology and advancements, would seem incredible. The other man--a physician who went by the pseudonym H. H. Holmes--was a psychopath in the classic form, putting up a very convincing front of charm and innocence while murdering probably dozens of people in nearly broad daylight. Both men put significant effort and planning into their respective dreams, to starkly different effects.

What makes one man's dream of greatness change the world and another man's lead to death? The book gave very little insight into the upbringing and moral formation of these two men, though I suspect that had a good deal to do with it. It highlights the importance of an informed conscience, of the building up of virtue, of the importance of looking outside oneself. For even though Burnham started with the goal of notoriety, in the end he fought for the glory of his city and his people, which Holmes thought only of his perverse pleasure.

I'm sure Larson's next book "In the Garden of Beasts" will make it's way into my hands sooner rather than later.

A Moment of Gratitude

A lot of people take the month of November as an occasion to offer thanks. I'm not so organized as to remember to document daily, but I will jump on the band wagon right now.

Things I'm particularly grateful for:

a job I really enjoy that is challenging, rewarding, and allows me to enjoy my down time
coffee in the morning (and Lucky Charms)
electric blankets
a warm house and a dog that motivates me to get off my butt and take him for a walk
coworkers that are as bad at pool as I am
long lists of books to read
my friends, of all sorts, that truly do give me a sense of communion
being happy

I'm going to try to be more aware of things to be grateful for this month, and always.

"Quiet"

That's the name of the book I'm reading, subtitled "The Power of Introverts in a World That Won't Stop Talking." I've only just started, but it makes me want to stay up later just to read it. It argues the point that our world has gone from a Culture of Character (back when integrity, work ethic, and virtue meant something) to a Culture of Personality (where the most eloquent, glamorous, and youthful win out), and that because of that, introverts have become a sort of "second-class citizen, somewhere between a disappointment and a pathology."

Does that hit home with anyone else? I almost cringe at the amount of time I spent feeling like a disappointment because of my introversion (I answered "yes" to 17 of 20 screening questions to identify introverts). And the rest of the book lays out that we can benefit from the gifts that introverts offer--the ability to listen, work independently, and see things differently.

One of the interesting points in the first part of the book was how Christians can often feel like failures if they are introverts, because evangelization is much more tangible if you are extroverted. I have often felt like God is calling me to be more involved, meet more people, attend more events. But what if He's calling me to be my introverted self? To listen and engage a select few and encourage them? To quietly trust and be the best I can be, even if that's someone who stays home on Friday night?

The more I meet true introverts, the less I feel like an oddity; and the more I understand that certain things about me relate to that specific trait, the more I can accept it. I always felt guilty that I often let my phone ring through to voice mail or that I never wanted to run for student council or that working on group projects is painful. I felt somehow inadequate, but research shows that at least to a certain extent, introversion is genetically hard-wired, and a lot of it depends on our early environment as well. Not that I'm completely pigeon-holed by that one characteristic or that I don't need to challenge myself, but it's freeing to see that I don't have to change who I am. I have gifts to offer just as much as the student body president does.

Knowledge is...something

I should be studying for Boards instead of writing about studying for them. In case you were curious, next week, recent graduates of pediatric residency programs all across the country will sit for an eight-hour test that will determine whether they know enough (or are good enough guessers) to practice pediatric medicine in all its forms.

I mean, I'm glad that there's some sort of benchmark, because, after all, we wouldn't want just anyone taking care of your kids. But it's still daunting to try to know everything that the American Board of Pediatrics thinks I should know. Especially considering that the content specifications for the exam number 160 pages. That's not 160 pages of material. It's 160 pages of what the material covers. In the "tell 'em what you're gonna tell 'em, tell 'em, and then tell 'em what you told 'em," scenario, the 160 pages is just the first part. I have to know the middle part.

Some of them are fairly straight-forward: "Know that a headache can be caused by depression." Check.

Others take a little more know-how, like section XXX:4--Critical Care: Cardiac. Yup, that's the whole content spec in one line. Just all of cardiac critical care. You know, like the topic that requires an entire extra year of fellowship on top of critical care. Just know that. Next!

I've been working my way through the material on those 160 pages for the last 2 years in various forms, and my brain is just about full. I'm so ready to just be done. To be able to read about what I want to or what is interesting or what I see in practice, instead of which metabolic disorder smells like sweaty gym socks (hint: it's isovaleric acidemia).

Prayers for motivation to study these last few days--and for clarity on exam day--would be much appreciated. And then hopefully, according to some random group of doctors and a computer, I will be deemed smart enough to practice for the next 10 years.

And I'll be celebrating in sophisticated fashion--with Harry Potter and chocolate stout!

Me, Myself, and I

It's way too early to be sitting in the Detroit airport, waiting to fly back home. The last week was spent at the 26th Annual Michigan Pediatric Board Review Course, trying to cram everything the ABP thinks I should know into my mostly-already-full brain. It was lovely to see the 19 other Mercy grads that were able to make the trip up; I miss those kids. And yet...

It struck me that although we spent the entire day essentially quiet, face-forward, listening to presentations, the mere fact of being surrounded by so many people exhausted me. You would think by the time they released us, I would be ready to talk, laugh, catch up. But after three days, I was about to explode. All I wanted to do was go to my room, lie on the bed, and just be.

Alone.

I missed my me time. Introvert to the core, I suppose. The more people that are incredulous when I tell them as much, the more I doubt whether I'm truly introverted instead of just shy. But this confirmed it for me. Only an introvert would want to go sit in a hotel room by herself after 10 hours of sitting quietly. And you know what? I'm okay with that. It was reaffirming to recognize what I needed and allow myself to do that without feeling guilty. I was still able to get in plenty of social time without burning myself out.

So now, 53 hours of CME later, I'm ready to get back home, back to my routine, back to sitting and eating breakfast by myself (or with the wombmate, but since we both just read the paper, it doesn't really count). Hooray.

And tomorrow it's back to work

Pretty sure I did nothing today that could be construed in any way as productive. Sleeping in, breakfast and the paper, post-breakfast nap, family time, delicious lunch, celebrating Dad's birthday, and parking on the couch for about four hours watching football. I didn't even shower. (TMI?)

It's hard to do much when I was so tired from all that bike-riding and beer-drinking and spectating yesterday at the Tour de Fat. Coloradans love their outdoors and craft brews and super hero costumes, and of course anything that combines all three. One of Michelle's friends asked "What's the point of all this?" Clearly, not a native.

This is what I've missed the last three years--the elusive weekend. I hope I never lose my appreciation for it.

Psych, MD...not!

So, here's the deal. I went through a LOT of schooling and training to be a doctor. I'm not bragging; I'm stating a fact. I have learned a lot, because, let's face it, there is a lot to learn. And there is plenty more still I haven't learned. One of these things I haven't yet mastered (and I am going out on a limb to say I never will) is how to read minds. I know it may seem like it when I can spot nursemaid's elbow across the room, or guess rashes from the age of the child (a fun game we liked to play in clinic). Some things are just more common than others. But the truth is, if you don't tell me certain things when you bring your kid in to see me, I am not going to be able to provide good care.

The following are true stories (or compilations of multiple similar stories), with very little changed to protect patient privacy.

Me: Any medical problems?
Dad: Nope.
Me: Any medicines she takes on a daily basis?
Dad: Oh, the Synthroid for hypothyroidism.
Me: Any hospitalizations?
Dad: That one time for asthma.

Oh, I guess those don't count.

Me: Does she get headaches?
Mom: No
(An hour and a half later after treating with ibuprofen and fluids)
Mom: What is going on? This is just like what happened before?
Me: Oh, has this happened before?
Mom: Yeah, we went to the doctor. Here's what they said. (Hands me discharge instructions from Neurology Clinic saying the patient has migraines.)
Me: So she has migraines?
Mom: What's that?

Hmmm....

Me: Medical problems that run in the family?
Parent: Nope.
Me: Anybody with asthma?
Parent: Oh yeah, I had that as a kid.
Me: Eczema? Allergies?
Parent: Oh yeah, all the kids have those.
Me: Any of the kids have asthma?
Parent: Her two sisters do.

Maybe I should have just skipped the first question.

Me: Anybody else been sick?
Mom: Nope
(10 minutes later after I finish my exam and diagnose Hand, Foot, and Mouth)
Mom: Oh, about a week ago I had these blisters in my mouth that were awful, and I had these spots on my hands. I thought it was an egg allergy.

I really wish I was making this up.

People get mad when they have to tell the same story over and over again--to the triage nurse, the ED nurse, me, the admitting team, the consultants, etc. But the truth is the story keeps changing. And if someone asks a question in the right way, they get the right answer.

I get it, it's a stressful situation and sometimes people forget. But sometimes people just aren't taking responsibility for their own or their child's health. It's dangerous to assume that we know more than you about you or your child. Knowing the history makes a huge difference and can sometimes be the deciding factor in whether you get an ineffective or even harmful treatment.

So please, know your own medical history, your family's medical history, and especially your children's medical history.

That way I don't have to guess.

Even though I can sometimes be a pretty good guesser.

To read makes our speaking English good

I've been on a roll lately with choosing my books. It's justified my commitment to read more than just dramatic fluff, and increased my desire to have some sort of book club in which to discuss my good finds. Instead, I'll just tell you about them.

Major Pettigrew's Last Stand (not to be confused with Mrs. Pettigrew Lives For a Day)--reminiscent of Jane Austen's commentary on manners, class, and interferring in matters of the heart. A retired British major and widower finds a kindred spirit in the widowed Pakistani shop keeper, and together they work through family drama, racial misunderstandings, and Kipling's poetry. Believable characters I wanted to root for, with human flaws and perseverance.

Divergent--a dystopian drama bordering on fluff, considering that I read it in a single 5-hour sitting, but also an interesting discussion of what society values, the tension between one's tendencies and one's choices, and how loyalties are formed and changed. I found myself unable to keep from turning the pages, but also wanting to slow down and savor the deeper themes. Already reserved the sequel at the library.

Frankenstein--how did I get this far in life without this ever crossing my bookshelf? Nothing like Mel Brooks' interpretation--which nonetheless deserves its place amidst the cultural icons--it is a fantastic true horror story, dreamed up--quite literally--as part of a contest between Mary Shelley, her soon-to-be-husband, and Lord Byron. The original story is far more believable than Hollywood's green monster spin-offs--the frenzied obsession as Dr. Frankenstein pursued the secret of life, the repulsion he felt when he succeeded, and the fear and dread that haunted him the rest of his life, running from his creature's vengeance. Definitely a classic for a reason.

Not sure what's up next--I've got a small stack on my bookshelf--but as always, I'm up for suggestions.

...and follow Me

Yesterday in the Gospel, Jesus encountered the rich young man, who went away sad, unable to detach himself from the things of this world to gain the next. It's easy for me to simply think of material possessions that I could give up, and consider myself good to go. I have all of two purses, still sleep in a twin bed, and Michelle is embarrassed by the paucity of my DVD collection. But to me it's all just stuff.

However, as I reflected, I realized that it's easy for me to be detached from things when I am financially secure. If someone wrecks my car, I have insurance, and the ability to buy a new one. I am not living paycheck to paycheck, and can afford splurges like a trip to Ireland or an extra dinner out. I tithe, yes, but it has never been a matter of deciding whether that money goes in the collection plate or to pay my electrical bill. Would it be as easy for me to be detached if I had no way to replace the things I owned?

Furthermore, what of attachments to things besides possessions. If Jesus asked me to give up my job, would I follow Him? What about my health and ability to be active? My eyesight or one of my limbs? My family? The opportunity to worship freely, or to live in a land of relative peace? My ability to call my free time my own? Would I, too, be walking away sad?

And yet, all of these things are gifts from God, not things I've earned. Why should I not be willing to give them back to be with Him?

Medically clear doesn't mean okay

I mentioned in my last post that one of the jobs of the third (non-emergency-medicine) attending at the main ED is medically clearing the psychiatric patients. Denver is one of the few cities with an inpatient pediatric psych unit (we referred to them from KC) and has a lot of resources and a lot of patients. Many of the families of patients in the Medical Day (psych) program-or who have recently gone home from inpatient-are instructed to bring their kids to the ED if they are having behavior issues. Here there is 24-hour psychiatric coverage and the ability to be monitored or admitted to the psych unit if necessary. These behavior issues can be anything from a patient saying "I want to die" to being handcuffed by the police for violent behavior. And all of them need medical clearance before they can be appropriately placed.

I suppose one could easily walk in and out within a minute and a half, make sure the kid's heart is beating and then order the urine tox screen. But that feels like a dismissal of someone who has spent their whole life being dismissed. And though they put up a tough front-acting like they don't care about the scars on their arms or the fact that they are living in a group home-you can easily hear the cry for help, and I want to show them that I see them as a person and care about them, even in that briefest of encounters. It's one of the hardest parts of my job so far, knowing that I can easily say "medically clear" and walk away, but that they are likely in for a lifetime of conflict, heartache, and ER trips just like this. I wish we did a better job with pediatric mental health from the beginning, teaching parents how to discipline and set boundaries, but also how to show affection and listen. Teaching kids how to express their frustrations in appropriate ways and to treat others with kindness. Screening for family history of mental health or risky social situations so we could watch for it.

Instead we see probably an average of 40-50 kids a week hitting the ER because there aren't a lot of other options. I'm glad we have the safety net, but sad that we need it at all, and doubtful that it's making any lasting changes. I guess I would just encourage all of you who interact with children or teenagers in any way to let them know they are loved and worthwhile every chance you get, and that they don't have to do anything alone.

Working Girl

Well, I'm three shifts in to my big girl job, and I've already had to present a patient at my first Morbidity & Mortality conference (did NOT feel like a stellar start). I wish I'd appreciated the hand-holding more as a resident. Because in real life, there is no candy bowl or Mario Kart tournaments or Chief's office to escape to. There is just do your work.

And I don't mean "just" do your work. Because when it's a brand new computer and hospital system, you have super complicated kids, and you are making the final decisions for the first time, that work can seem pretty daunting. There was a very real moment of panic at the end of my first shift when there were 27 patients in the waiting room, every ED bed was full, and I had finished exactly zero of my notes--what the heck have I gotten myself into?

But Day 2 was better. And so was day three. And everyone has been super nice. And I'm not the only one that feels slightly overwhelmed. One of the other just-graduated-attendings told me today that even though she did her residency here, her first day was still a bit rough. "No one's standing behind me telling me what to do. Are you sure you don't want me to check this patient out just for kicks?"

Small successes--I did my first two sedations today, have learned a few nurses' names, and have gotten quite proficient at medically clearing the psychiatric patients (something I didn't realize was a big part of my job during my main ED shifts).

It's all just growing pains, and thankfully I've got a good support system and excellent training, and soon I will be able to look back on this trial by fire and smile.

Deer in the headlights

Just finished my "shadow shift" in the ED, and have my first real shift on Saturday. Apparently, "shadow" means "see your own patients and carry your own phone" so even though I was nowhere near my usual efficient self as I tried to navigate a new system, I still was the one making the final decisions. It's weird knowing that I'm not going to run the patient by anyone who will hopefully catch anything I missed. That there isn't another, much more experienced set of eyes looking at my patients. I felt sneaky discharging the patients, like someone should still be double-checking me.

The good news is that I like the people I've met so far who are starting with me, even though because we're all new, we won't really be working "together" for a while, I finally got my access all set up, and I don't have to worry about learning a whole new city in addition to a new hospital system.

But still I'm having a lot of trepidation as I get ready to start, knowing that I'm just going to have to truck through the overwhelmingness of it and learn as I go. As one of my new co-workers said yesterday, after doing something different every month in residency, having no idea how things work and who people are should be old-hat. Hooray for us.

Alive

"The glory of God is man fully alive." -St. Irenaeus

This is an oft-quoted statement from one of the early Church fathers, but I wonder how many people have thought about what it fully means. I would think that all of us, whether religious or not, would want to live our lives "fully alive." To be fully alive, I think it naturally follows that we must be fully human, because that is what we are. A tree cannot be fully alive by trying to be a flower, or a mountain, or a butterfly (indulge me in my anthropomorphizing). Man cannot be fully alive unless he is fully man (or woman).

Blessed John Paul the Great, before he was pope, was a great philosopher and spent much time and energy developing an anthropology that drew from ancient Greece to Jesus to modern day. In Gaudium et Spes, which he had a large part in writing, we learn that “Man is the only creature on earth which God willed for
itself, [and he] cannot fully find himself except through a sincere gift of himself.” (GS 24) I don't have the knowledge or ability to defend that statement as it deserves, but I do know that my own experience has shown this to be true. JPII also said that "to be human means to be called to interpersonal communion." If you take it from a religious perspective, it makes sense that, created in the image of the Trinitarian communion, we would only find fulfillment in relationship with others and God. From a biologic, psychologic, philosophical perspective, we are the only beings capable of conscious thought, with a will and an intellect, able to experience love.  Man does not make sense in isolation, only in communion.

So we can see that man, "fully alive", must be in relationship, and that relationship can not be one of selfishness and utilitarianism. Communion can only be achieved through self-gift and a receiving of that gift. So much of today's world facilitates relationships that give me something, that I profit from, and that allow me to rise in the standards of the world--wealth, beauty, power--which, as you'll notice, are not what it means to be "fully alive."

It's counter-intuitive only because there are so few voices for truth, and the voices of the world are so loud. If you stop to really think about it, it's completely intuitive. It's a challenge that I continue to take upon myself to live in a way that will help me become the best version of myself, the most fully-alive version of myself. Which is to say the version that gives of myself, is in communion with others and with the God who created me in His image.

Home Sweet Home

Things I did in my first 24(ish) hours in the state:
-Nap (very important first step)
-Avery Brewing Co's The Reverend Quad (mmm)
-Meet Lucy, the newest family member
-Breakfast with the twin, good coffee, Sunday paper
-Mass at STM
-Open house to see lots of fun people
-Cook Greek food
-Stuff my face with said Greek food, plus Mary's seven layer cake, out on the back deck with the mountains as a backdrop

Success.

Take a good look around...

As I wind down my final hours in the city too big for one state, I'm trying to cram 3 years of memories into something a little more manageable. Besides the obvious residency events and people that I will miss so very dearly (and because it makes me too sad to think about it), I've tried to come up with a highlight reel of sorts for the city itself. And so here is my list...

Things That Weren't Able to Keep Me Away From the Mountains For Very Long (but that I will still miss)

The Z-Man. After trying probably most of the top BBQ joints in the city, I can definitively say that Oklahoma Joe's is my FAVORITE. Like don't leave a single fry crumb or drop of BBQ sauce on the tissue paper favorite. And I will dream about that onion ring perched atop a mountain of brisket and provolone, slathered in half regular/half spicy goodness, the perfectly seasoned fries, and the baked beans that are a meal in themselves. Too bad it probably doesn't ship well.

Fireflies and greenery. I know that in general, humidity is evil, but I will miss the walks in the park after dinner with overbearing foliage and flocks of lightning bugs. Reminds me of Grandma's house.

The Plaza. Let's be honest. All you really had to say was four-story Barnes and Noble and free parking and I would be there. Throw in dozens of shops that I actually don't mind setting foot in, a handful of decent eateries, and the best Christmas lights in the city, and it's even better. Plenty of days off spent window shopping. Or real shopping. And the Art Fair? Yes, please. Give me this over Park Meadows eight days a week.

Getting through the airport in less than 15 minutes. DIA is pretty much everything I loathe about air travel. I'll trade the abundance of post-security food options for the ease of walking right to my gate every time. All this is supposed to be changing, so I may not have anything to miss. Too bad. Throw fairly manageable roads in here as well, both traffic and ease of travel. KC is WAY more navigable than Denver, and I will miss the sense of freedom that comes with that.

Tank 7 on tap. 'Nuff said.

But really, compare that to mountains, blue skies, family, no humidity, mountains, more microbrews than you can count, the Broncos, family, Coors Field, mountains, the new puppy...you get the picture. I'm ready to be home. But I'll be back.

Slainte!

"Celebration is only possible through the deep realization that life and death are never found completely separate. Celebration can really come about only where fear and love, joy and sorrow, tears and smiles can exist together. Celebration is the acceptance of life in a constantly increasing awareness of its preciousness."

Again, Henri Nouwen is spot on. This is exactly what I'm feeling as I finish residency and my time in Kansas City. So it was almost a relief to read these words last night. Because it made it okay that I'm not just feeling giddy with joy and smiles, but also feeling some fear, sorrow, and apprehension about leaving and moving forward. I thought I should be leaping for joy at being done and moving home and starting my job. But it's terrifying and sad too. I'm leaving behind so much, not the least of which is familiarity, and we all know how much I love change. I've been kind of unable to feel the fullness of any one emotion because there's the opposite emotion pulling me in the other direction. But Nouwen's words make total sense and allow me to truly be present in this moment, whatever emotions are there. Because all of it can be wrapped up in this celebration of the preciousness of this part of my life. And I really can celebrate. Cheers!

Residency 3.12: Hem/Onc

I did it! I managed to post after every single month of residency. Also, I finished residency. Not too shabby.

The last month was spent back on the Hem/Onc floor (cancer and blood disorders), with some of the sickest, saddest cases. What a way to end. We had several rocks that we got to know pretty well throughout the month, which is good for continuity but bad for morale. It stinks to see a previously healthy 16 year old wasting away with no hope of going home any time soon, or maybe ever. There were some bright spots, like dancing to "Step In Time" with a 3 year old boy who loved Mary Poppins, having a mom say she's so glad to see me, and high-fiving a nurse for a successful PICU transfer without having to call a code.

But holy cow, am I glad to be out of there. I was almost giddy as the minutes ticked down on my final 28-hour call. It's really surreal to be done, and there's not really any words for the roller coaster of emotions as I finish up this 3 year journey. I have to go back Monday to turn in all my stuff and get my certificate, and I know as I walk out those doors for the last time (at least until I come back to visit), my steps with be somewhat heavy. I'm looking forward to resting and enjoying the next 2 weeks, although I've already started packing and eww.

Ready too, to get home to the fam and the mountains. Thanks for following along on this journey. Feel free to stay aboard for the next leg.

Freedom

This isn't anything new or ground-breaking, but I wanted to organize my thoughts on the topic. I've always been bothered by people who reject religion or the Church because they don't want to be told what to do. Not only does it mean that they have the wrong idea of what the whole purpose of religion is, but they are assuming that they know better than God or anyone else what is best, not only for them, but for others. They are putting themselves above the law (which I recently learned is the root of the word hypocrisy--"above" the "law"). I'm not calling them all hypocrites, but I want to point out what I think is the main flaw in their logic. A logic that has pervaded our Western culture. Namely that the ultimate goal is freedom, and that freedom means license to do whatever one pleases. It's freedom from restrictions. If you subscribe to that, then of course you reject a Magisterium that comes and says you can't do whatever you want.

I would argue two things. Firstly, that freedom is not the goal in and of itself. People who stop at freedom are cheating themselves of a greater good. And secondly, that freedom is not license to be subject to our passions, but rather liberty from those passions to pursue that greater good.

The Christian understanding of freedom, expressed beautifully by Paul, is that we have been set free for a purpose. You have to start with an adequate understanding of the human person, as body and soul, subject to passions and sensations, but also with an intellect and a will to govern those. If I merely follow my passions--by eating whatever I want, ignoring difficult tasks, satisfying sexual urges, acting on anger--I am not free, but rather enslaved by those impulses. If my intellect and my will are able to choose the good, to choose to love, that is when I am truly free.

Christianity helps illuminate what that greater good looks like, gives us tools to tame our passions and to submit our will so that we are free to choose. I'm borrowing this example, but if I am angry at someone, the freedom is not that there is no law prohibiting my killing him, because then I am a slave to my anger. The freedom is when I can change to loving him so that I no longer desire to kill him. The commandment that prohibits killing is not what is preventing my freedom; it's merely a guide to help me until I can discover true freedom.

I hear the train a comin'

You guys, we are getting SO close to the end that it's ridiculous. Tomorrow is Halfway Breakfast of my LAST month of residency. I can count on four fingers the number of calls I have left. I've hit the required number of clinic patients I have to see. Graduation is over and done with. And I have sixty-some dollars to spend in the cafeteria and snack shop before my food card is deactivated.

Bring it on.

Celebration

Seems fitting that my 300th post is marking a milestone as big as residency graduation, not that I planned it that way. Friday night we got to celebrate the culmination of years and years of school and training...my 13 years of basic schooling, 4 years at Creighton, 4 years of medical school, 3 years of residency...basically I've been in learning mode my whole life, working towards this moment when I can call myself a pediatrician. (Minus the fact that I still have three weeks left of work. Whatever.)

 We had a beautiful night and a great event space down in Power and Light. Lots of family members and lots of faculty mentors come to send us off. I was asked/volunteered to give a tribute to our program directors, thanking them for their support over the last three years. It's hard to put into words stuff like that, but I was grateful for the opportunity; we don't say thank you enough.

This was before I started crying

I also had the great surprise of winning The Wasserman Personality Award (aka The Tie Award), given by one of our great retired toxicologists to a graduating male and female based on "no specific criteria, just gut feel." This was Wass' 42nd graduation, although he attended via video because he's in the hospital, and he has been a Children's Mercy institution and a model of excellence in clinical prowess and resident education. I have no idea what prompted him to award me a tie, but I am honored.

"It can be a scarf or a belt"

All in all, it felt like a very fitting tribute to all of our work, sweat, and tears, and I'm proud to claim Children's Mercy and my classmates, and will be sad to leave it all behind. Thanks to the fam for making an event of it and braving I-70 and early mornings.

Residency 3.11: Board Review

Okay, this wasn't a real month per se, but I'll check in and give y'all an update. I actually stuck to my study schedule pretty well, and while the hours spent studying weren't always what I'd planned (or probably needed), I did at least cover all the topics, get through all the MedStudy books, and do like 500 questions. Apparently some of this stuff is actually relevant...one of my night in the ED on a float shift, I saw my first case of popsicle panniculitis (what? I know!) and then 3 days later had the same thing as a board question--true story!

One of the reasons I didn't get more studying done was that I was constantly horizontal...I was EXHAUSTED! I think the combination of coming off PICU, finally being able to relax, and trying to catch up with 3 years of residency sleep debt caught up with me. I was sleeping 10 hours at night and still needing naps during the day. There were times I couldn't drag myself out of the recliner/off the couch. And now that I'm all sort of caught up, I'm right back to Hem/Onc with 28-hour calls and a wonky sleep schedule.

I also didn't get quite as much training in for the Hospital Hill 10K as I had hoped. Nonetheless, I discovered that listening to "Catholic Stuff" podcasts while running is actually more enjoyable than music, and that I can in fact enjoy running. Fun race, great weather, check another thing off the list!

It's also hitting me that we're nearing the end. We had our class retreat, I had my final performance review with my program director, yesterday was the graduation awards ceremony, and we have graduation in 3 days. I'm gonna have to start saying goodbye real soon and it makes me sad. What an incredible three years this has been. More than I ever could have imagined or hoped for. Super excited to have the fam in town to meet everyone and vice versa (cause they've heard a LOT about the Zapapi), and to have an evening for just our class.

A broken world?

The Oklahoma tornado is just the latest in a string of heartbreaking events. From the Aurora shooting to Hurricane Sandy to the Boston Marathon bombings to back alley abortion clinics to this. The worst of human nature and Mother Nature all marching us towards...what? People look around and say "Where is your god?" Even Christians have a hard time reconciling what is going on in the world with what Scripture says and what we know to be true in our hearts. So what are we to think?

(Disclaimer: I'm totally stealing this from the Lanky Guys Pentecost podcast, but since I know that no one will go and listen to the whole podcast if I post the link, I will summarize the opening for you here.)

We do not, in fact, live in a broken world. Well, at least not JUST a broken world. We live in a broken, but redeemed, world. Yes, sin has entered and the natural order is disrupted, but Christ has still won the victory. The lanky guys liken it to World War II. Scott Powell says that we are in the period similar to the one between D-Day and VE Day. Once the Allied forces were closing in and the Nazis knew that they were losing, did they free the concentration camps? No, they "wreaked as much havoc as they could because they knew they had already lost." We are in that limbo period. Christ has won, but we are awaiting the Second Coming, which will essentially be our "liberation" from this "concentration camp" of a broken world. Evil knows it has lost, and Satan is wreaking as much havoc as he can in the meantime. So take heart, because all this tragedy means that Christ has already won.

One last hurrah

After spending the weekend with my class in the Las Vegas of the Midwest (apparently that's what Branson is called; I also heard "Las Vegas for Pastors and Old People"), I feel a little more acutely what I am leaving behind in July. Three years of going through pretty much everything with these wonderful, amazing people. Potlucks and game nights, happy hours, baby showers, weddings, funerals, baseball games, birthday celebrations, horrific call shifts, patients that make you laugh and ones that make you wanna throw things. We've cooked together, changed diapers together, gone to church together, and cried together.

So we had one final hurrah before graduation to enjoy each other's company. We had reservations at Still Waters Resort, a sprawling camp ground right on Table Rock Lake. A nice little treat to have 2 queen beds, a porch, and a kitchenette all to myself. Although my room was closest to the pavilion so I did share my bathroom quite a few times during the barbeque Friday night. It was so good to see everyone and catch up since I spent last month in the PICU and have spent the first half of this month studying at home.

 Saturday brought lounging at the pool, boards games, snacks, playing with the kids, and then some time on the water before we all headed into town for dinner and drinks. So nice to not have anything on the agenda and to have lovely people to share the beautiful day with.

While I'm going to be ready to move on in terms of being done being a resident, I will miss these wonderful friends and their families that have been my support over the last three years. And I'm grateful to have had the retreat weekend together. Looking forward to graduation and a few more happy hours before we're done.

A little bit of awesome for you

Things that made me smile this week:
-making a toddler squeal with delight
-the smell of flowers blooming
-friends who offer me a taste of their husbands' drinks
-birthday surprises (yes, I know my birthday was last month, deal with it)
-other people's birthday surprises
-freshly cut grass
-fancy delicious dinner in a former-speakeasy-now-jazz-club with good friends
-surpassing the 5-mile mark for the first time ever on a run (okay, I mostly was trying to stay upright, not actually smiling, but now I'm smiling)
-when I can actually feel my body relax when my head hits the pillow and I know I don't have to set an alarm
-hugs (hugs are always awesome)

Residency 3.10: PICU

Well, I survived. It's hard to look back on the whole month objectively because I ended on a rather sour note (read: the worst day of the month and in recent memory). But, in trying not to let that color everything, I have to admit that overall it was a positive experience. The attendings and fellows did a lot of teaching, the nurses were awesome, I learned a thing or two, I worked with three awesome residents, and we got to do Musical Rounds (see prior post).

I think the best part of the month was getting to watch kids get better, which doesn't always happen in the PICU. The patient I put a chest tube in, the patient I did chest compressions on, the patient who went on ECMO, the patient who kept bleeding from her lungs...all now either on the floor or back at home. Success. Another highlight of the month was two of the nurses telling me they wished I was staying in the PICU because they trusted me. Makes it a little easier to put that last day behind me.

Now if I could just get my body to catch up on sleep so that I don't have to spend my entire board review month taking 3 hour naps like I did yesterday, that would be great. But if not, hey, I have the ability to take 3 hour naps every day. Yippee!

Last Supper List

On the latest episode of "Castle" he mentions his LSL--Last Supper List. The 12 people with whom you would sup at your last meal. Yup, just said "sup". Castle's includes Lincoln, Einstein, and some billionaire with a great accent. Got me thinking about mine. In reality, for my last meal, I would go Jesus-style and pick my 12 best friends, my Everybody Committee, if you will. But for the sake of the argument, if I were to pick 12 people, past and present, with whom I could share a very unique meal, I would choose:

1. Blessed John Paul the Great.
2. C.S. Lewis
3. James Patterson
4. Blake Shelton
5. Kate, Duchess of Cambridge
6. Grandma
7. Kristine Lilly
8. Peyton Manning
9. The apostle John
10. Immaculee Ilibagiza
11. Leonardo da Vinci
12. St. Teresa of Avila

I also got to thinking about a dream fictional character list. We'll make it a Last Lunch with six.
1. Mr. Bennett
2. Hermione Granger
3.Frank Reagan
4. Anastasia (from the movie; the real Anastasia was probably a diva, and also didn't speak English)
5. Kakuro Ozu
6. Lucy Moderatz

Alright, who's on your list?

Today I saved Musical Rounds

So, it was my fault that Musical Rounds were in jeopardy in the first place. Let me explain. Our attending this week on the CV surgery side is one of my favorite attendings, but also, as one of our nurse practitioners called her "a little high-maintenance." Not in a bad way once you know to watch for it. Just in a way that she likes things very much her way. Like don't replace potassium IV. And never call her with a blood gas. And every post-op patient must have a drawing of their anatomically (for them) correct heart at their bedside.

Well, in the mess of having a large service and three surgeries on Tuesday, I may have run out of time to do the drawings and then completely abandoned my colleagues by rounding on the medicine side yesterday. When I apologized this morning, they said, "Yeah, we heard about it all day." In other words, Big. Trouble.

Additionally, we had been looking forward to Musical Rounds all week, where each patient gets a theme song played on rounds.

Unbeknownst to me, our attending was planning on canning Musical Rounds since we had failed epically at getting the drawings up on Tuesday. But when I was reminded about them this morning, I cranked out 4 surgically-corrected-congenitally-abnormal heart drawings in about 6 minutes (and then had to fix one cause I didn't realize he also had a right-sided arch). We ran off to tape them to the beds right as our attending walked in from a meeting, ready to round.

I announced our triumphant return to grace and was rewarded with "You just saved Musical Rounds." Score!

I wish we had video-taped the craziness that ensued. First patient--7 year old who has become a favorite of all of ours, sitting wide awake on his ventilator playing with shaving cream--getting extubated. His fist pumps earned him "Eye of the Tiger" (cue dancing and more fist pumps and high fives). Best. Extubation. Ever.

Rounds also featured Michael Jackson, the Beatles, and a rousing sing-along of "Leavin' on a Jet Plane" which I think frightened the floor team who had come down to round on transfers. We did have to pause "White and Nerdy" while some potential big-time financial donors who were touring the PICU walked by.

At some point, I think we also treated some kids who were sick.

Normal isn't a bad thing

When you're in the PICU, it's hard to find moments of normalcy. Working 70+ hours a week with a 4:40 am alarm is NOT normal. Putting in 5 chest tubes in 3 days (not me personally; I only did one of them), watching a rhythm strip progress towards asystole in a DNR patient with 25 family members in the room, running to 3 codes in one night, constantly pacing from one end of the 1/8 mile unit to the other...NOT normal.

So, imagine the treat it was to sit out on a back porch post-call, drinking Boulevard, listening to feet-tapping music, eating jalapeno-cream-cheese-and-bacon-stuffed mini peppers and homemade pizza (yeah, my friends know how to cook like whoa), and playing Mexican dominoes. Barefoot and blissfully happy.

If I can have a few of those moments every week, I may make it out of this month between a 3 and a 7.

Residency 3.9: Green Team

"I'm tired. The kind of tired you can't sleep off."

I'm watching 'Blue Bloods'--my new favorite past time--and Frank's talking about retiring. I'm not ready to retire quite yet, but I am tired. This month was long. If you'll remember, Green Team is our senior-only inpatient team. This month, due to some unforeseen scheduling difficulties, our teams were restructured and we ended up with a bigger team and a bigger census. Made for busy days and sometimes painfully long rounds. Even with having my favorite attending on for two weeks of the month, it was draining.

I think one of the things I'll take away from this month is just an appreciation for the breadth of our training. When you're on inpatient, you hear about every interesting kid who comes through the hospital, even if they aren't on your team. Every diagnostic dilemma, PICU transfer, bizarre test result. We see some really weird things; things that you only read about in textbooks, and have access to awesome specialists. Part of the reason it's hard to reflect on these months is that we see SO much that by the end, it's somewhat of a blur. It's hard to retain anything when you never have time to sit down. But I know that some of it must stick.

Yesterday, I took checkout on two different kids who were being transferred to our team. Both were complicated stories in their own right, and as I listened to the check out, I found myself formulating and adapting a differential and a plan on the fly, anticipating what my next five steps were going to be. And I realized that the scope of our experience prepares us really well. When you've seen just about everything that can cause abdominal pain or seizures, it makes it a lot easier to look for the zebras, or to rule them out.

So, I suppose it should be a good tired. Because it means I'm becoming a better doctor. Which won't make it any easier to get up at 4:40 tomorrow morning to head into the PICU. So off to bed I go.

He is not here

Alleluia! This morning my heart is light and my God is risen. Lent this year brought many opportunities for me to face my humanity and brokenness, and also many opportunities to draw near to the foot of the cross and cling to the feet of my Savior. And many glimpses of grace from a God after my heart. The sun breaking through the clouds, the right song at the right moment, a memory of joy surfacing at an unexpected time, a much needed call from a friend, and of course the more substantial things of finding a job, being affirmed by my supervisors, seeing my family. We are not in easy times as Christians, and especially as Catholics. The world hated Him before us, and if we imitate Him like we should, it will hate us too. Yet as much sadness and despair is in me when I look at our broken world, still death has been conquered and hell is overcome. The empty tomb means everything. I am so grateful.

Introducing...

I just accepted a job at the Children's Hospital in Denver, doing urgent and emergency care in the satellite centers. It's scary and exciting at the same time. But since being terrified has never been a reason not to do something, I'm diving in. I've been doing a Novena to St. Joseph in honor of his feast day today (I started a day late, so I'm not quite done yet!), and I've been praying for our new pope and my new job, so today seems like a great day to accept the job (and a great day to install a pope). Thank you to everyone for your (continued) prayers as I plan to embark on this next great adventure.

Things I like

Fun things from the last week--
*Lunch at Maggiano's with the whole fam. Accidentally licked my finger after getting sauce on it and endured an epic glare from Mary. Hilarious.
*Getting done with clinic way early
*The gorgeous day on Friday and getting to sit outside for a bit in the new chapel garden
*Two job offers back in the Centennial State--gonna make a decision this week--stay tuned.
*New pope! And he's awesome!
*The amazing green frosted chocolate chip cookie I just ate 'cause it's Sunday
*Checking Irish Car Bomb off my '30 Before 30' list (also accompanied by maybe the best mac'n'cheese of my LIFE
*Getting to work out 3 whole days this week (assuming I kick it into gear after this)
*Baking lazy Irish beer bread (hopefully this ends up a success and not a flop)
*Mom likes Blue Bloods as much as I do; and the library has the second season on hold for me
*Got a GREAT complement from someone I look up to a lot
*Good book: The Elegance of the Hedgehog
*My favorite attending on service

Residency 3.8: ER

I was looking forward to this month as a chance to cram in as much learning as I could, being that I'm interviewing next week for an urgent care job, and this could be my life for the next few years (and even if/when I end up in private practice, there's lots to be gained from good ER training). While the respiratory season is slowing down, it was still a decently busy month, with plenty of opportunities to practice my diagnostic and technical skills.

Two successful lumbar punctures, a deep leg lac requiring a three-layered closure with vertical mattress stitches (something I haven't seen since medical school), nail trephination (cauterizing through the nail to release blood), trauma, shock, new onset seizures, abscess drainage, ingestions, appendicitis, plenty of fractures, asthma, influenza. All the good stuff.

It makes me smile that I think of all that as the good stuff. I've decided I really enjoy the quick pace, the challenge of having a limited amount of time to see a patient and trying not to be lulled into complacency by so many similar complaints, because you never know which vomiter is going to be the pyloric stenosis and not gastroenteritis. And as I've said before, the doctors that work in the ER are some of the most fun people to be around, because they love their jobs and they have to keep things light because otherwise it gets to you.

Things like seeing a little girl in foster care come in with belt marks across her back. Or a teenager who came in after a suicide attempt and you almost pray that he's not resuscitated, because a brain-dead kid with a pulse is harder on everyone than just pronouncing him. Or the boy who was found in a car abandoned after a police chase, with no name and no family. Those days make this job hard. And for me, I think one of the hardest parts is that it doesn't get to me like it used to. But I know that a big part of that is that I've learned to protect myself from it, so that I can still do my job. It's hard to do chest compressions if you're having to think about the outcomes if you succeed in bringing a kid back. Or if you fail.

To end on a lighter note, I finished out the month by swapping arterial sticks with one of the other residents. We need to prove that we can do them in order to graduate, and neither of us have had a chance to do one on a patient, so we offered each other our wrists and stuck each other. Watching the disbelief on the nurses faces while we did it was by far the best part. Well, that, and the fact that now I can graduate.

Pray for my job interviews next week. Hopefully all this experience isn't going to go to waste.

Cabin fever

Stuck inside. Again. Two record-breaking winter storms in the last week have buried the city under almost 2 feet of snow (minus some much needed melting over the weekend). Even though I have 4WD, no one else seems willing or able to venture out, so my social calendar cleared itself pretty rapidly, leaving me BORED. I shoveled, watched TV, baked bread, vacuumed, wandered the grocery, wrote a letter...still BORED. Almost makes me wish I were at work. ALMOST.

My fellow residents have been rockstars during these storms, showing up with overnight bags, pillows, and smiles in a not-so-smiley situation to make sure that the kids were cared for. The chiefs have gone above and beyond to fill gaps and keep spirits up. One of the attendings went to Costco before the storm got bad to stock us all up on snacks. The docs in the ER last night kicked as many of us out early as they could, making sure we got home safe. It makes me proud to be a part of such a program, not that I need another reason, and just a teensy smidge jealous that I somehow made it out of the last 4 major storms without ever getting put up in a hotel for a slumber party.

The price you pay

I've gotten into watching "Blue Bloods" lately, thanks to Hils. Tom Selleck's commissioner has become one of my favorite TV characters of all time. Recently, in talking to his granddaughter about the strength needed to face the emotionally draining duties of a cop, he hit on something that I think has equal relevance to being a pediatrician. I substituted in some words, but I think you get the idea.

I've cried, but I learned pretty quick that you can't be a [doctor], especially a good [doctor], if you let your emotions take over, so you sit on 'em, push 'em way down. I don't know if that's a good thing, but it's a necessary thing. I had a partner who always said [doctors] can't cry so that their [patients] can. You pay a price? I think so. But it's the price you pay for the privilege.

Just within the last week, I saw a teenager come in nearly dead from septic shock, and watched my attending have the very tough (and necessarily brief) conversation with her father that she may not make it. I had to tell a family that their son had cancer. I called a mom to tell her that her son was not outside playing anymore like she thought, but had just been brought to the ED by ambulance after being knocked out of his shoes and thrown 20 feet by a car. While each of those moments touched me, they were also routine. Pushing fluids, calling consultants, ordering CT scans. Breaking things down into English so the parents could understand them. And then moving on.

I hate having to be stoic in the bearing of bad news, being objective in the middle of a crisis, ignoring the parents while I order epinephrine and chest compressions, having to finish rounds when a patient has just died, and then not being able to process it afterwards. I would rather sit and cry, hold hands, be silent, stay and answer questions, tell them it's all going to be okay. But that's not my job (at least not most of the time).

When I was taking care of my mentor's son in the ICU, for that brief week, I questioned every decision I made, avoided going in the room because it felt like an invasion of privacy, and had to leave the room when things went downhill because it was too hard to see people I knew watch their son dying. In short, I wasn't a good doctor. So instead we sit on it. We don't let emotions take over. It doesn't mean that we don't go home and cry, because I think all of us have. But it probably means that we seem a little distant talking about illness and death. That we're overly focused on the medical details. That we often forget that it's not routine for the families like it is for us. It may not be a good thing, but it's necessary.

Declaratio

Today Pope Benedict XVI announced to his brother cardinals that he would be stepping down at the end of the month. My initial thought was "Why?" I so admired JPII's perseverance to the bitter end, when it was no longer glamorous for him to speak before an audience, when he couldn't be the outdoorsman he once was, when he received the Sacrament of the Anointing of the sick. Why would he step down when there was so much to be gained by staying put. And yet, as I read his statement, it all made perfect sense. He's not JPII. He has different gifts, a different purpose for us. I'm glad he didn't feel the need to follow in his predecessor's footsteps, that he was able to discern for himself God's will in this difficult time. I found a quote that puts it more eloquently and succinctly than I could. "Pope John Paul II remained in office so that he might show us how to suffer and how to die. Pope Benedict XVI is leaving the Papal Office so that he might show us how to live in humble honesty." (-Sr. Mary Theresa)

Because he was elected on my birthday, I'll always feel that BXVI was a special gift. In my mind, when Blessed John Paul II died, no one could fill the void. And yet he did, with a humility and faith that largely flew under the radar, but that was much needed. I am grateful for his leadership and service and sad that I didn't know him and his work better. 

"I don't need to change myself; I like myself"

According to my mom, that's her older brother's take on conformity. Since embellishment runs in the family, who knows exactly what he said, but I like the sentiment. And I like Uncle Dave, so we'll go with it. Before Lent arrives to remind me that I'm nothing more than dust, and before Valentine's Day shows up to tell me I'm incomplete without a man, I figured I'd lay it out there that I'm me and that's good enough.

Here's the thing...

I like to read, like a lot, and if the last seven things you read were all off the rack in the checkout aisle, then it's hard for me to take anything you say seriously. Likewise if anything on your bookshelf starts with "50 Shades of..." There's something to "poison in, poison out" and I don't want to spend my time pretending that romance novels (or worse) or tabloid covers are reality. And I feel the same way about movies. I never want to see "The Hangover" or any of its sequels. Or anything that relies solely on crotch humor, or on degrading the sacrament of marriage, the Church, respect for women, honesty, or good judgement. My time is too valuable for that. I pretty strictly screen movies that I'm going to watch. And I think I'm going to stop apologizing for that.

I don't like to wear makeup. I did finally decide to bring my makeup into the 21st century, but I'm pretty content not to cake something on my face that I'll just have to wash off everyday. Sorry if you don't like the way I look without it. Same goes for not highlighting my hair or spending insane amounts on haircuts. My mom cut my hair all the way up through medical school, and I turned out just fine (though still single, yes, I know). I don't want to own hundred dollar purses and clothes that I'm afraid to get baby drool on. I hate shopping (unless it's at REI or Barnes and Noble) and I'd rather go barefoot than wear heels. I hate spending money on stuff, because it's all just stuff. I don't need a hand mixer or a printer or a full-size bed or cable TV. I'm doing fine without all those things (although yes, now I own a hand-mixer, even if it currently lives in Denver).

I like sports. And talking about them. And watching them. And playing them. And I may have become very intense one or two (or a hundred and thirty seven) times while doing all of the above. Oh, well. Again, I think I'm going to stop apologizing for that. No, it's not very ladylike, but who cares?

I hate talking on the phone. I don't know any of the top songs on the radio. I'm not a good skier, and that doesn't make me a bad Coloradan. I still like Lucky Charms. And Return to Me. And Hanson.

So there.

Now, on to preparing for Lent...

ADDENDUM: Make no mistake, the above is just a rant. The truth is that I do need to constantly be evaluating myself to see whether I'm in line with God's plan for me, and that I should like myself because God likes me. Loves me, created me, holds me in the palm of His hand. But still, I'm not getting cable.

Residency 3.7: Gold Team

Gold Team (GI and Endocrine) is notorious in our program. Having kids with abdominal pain just brings out the crazy in parents. Like moms who prefer that their child get a G-tube and receive formula feeds when they're doing perfectly fine eating a regular diet. Or moms who spend 9 months seeing every specialist except GI, even though every other doctor says, "I think you need to see your GI doc" and saves samples of her child's spit which she wants tested for parasites. While we know that sometimes you just gotta play the game to please people, things often get a little heated. We had to call security twice this month ("They're gonna haul me off to jail for what I'm about to do!" -typical Gold Team mom) and stories about our patients made the rounds through Housestaff pretty quickly.

There was the kid who ate couches and had to have a huge ball of whatever couches are made of surgically removed from his stomach. The girl who ended up with part of a charm bracelet stuck in her appendix. Kids who ingested toilet paper, dryer bars, and household cleaning spray. I'm no longer surprised by what kids will put in their mouths.

And actually, we had a pretty decent month in terms of real pathology (as opposed to just the crazies). Bad ulcerative colitis, achalasia, hepatitis A, biliary atresia, pancreatitis, new diagnosis of Crohn's, etc. We also had a girl with a very severe bleeding ulcer who required 7 blood transfusions and emergency surgery which probably saved her life. The sad part about it was that we're pretty sure the situation was worsened, if not directly caused, by mismanagement at an outside hospital that does not deal with kids all that well. It makes it a little daunting to be five months from going out on my own, because none of us want to be that person that gets talked about the day--"They did WHAT???"

The Endocrine part of the rotation was good as well. Lots of new diabetics, but also some other interesting pathophysiology as well. As well as time for plenty of teaching. Yours truly won the steroidogenesis olympics for memorizing this and got a box of Christopher Elbow chocolates to show for it. We also got the opportunity to wear continuous glucometers which measure our blood sugar every 5 minutes and record it on a computer chip, which is later downloaded and synchronized with our record of manual blood sugar checks and charted. There's a site with two sensors that's injected and then taped to your body, like so. And then for three days we recorded what we ate (the massive amounts of brownies and donut holes we had to celebrate the end of the month wreaked havoc on my pancreas I'm sure) and when we exercised, etc. We'll see what it shows.

Still having no luck finding a job, since no one in Denver seems to even be hiring, which makes it hard to get interviews. Going to spend the weekend exploring new options and bugging people again. Back to the ER this next month, which should be fun. Until then!

Run down

Got a lot on my mind tonight, feeling like I need to vent. Probably just need to pray, which is next on my list.

Still having trouble hearing back anything about jobs. Trying not to let "trusting in God" mean that I don't exhaust all of my options. But really I just don't want to think about it.

Totally over being on inpatient right now. Frustrated with the fact that my decision often doesn't count for much, that I have no control over when patients are admitted and when they go home, and that I'm at the hospital 13 hours a day. Yesterday my body mutinied and slept through my alarm, leaving my team senior-less for an hour and a half. Good thing my interns are so good I'm practically worthless anyways.

Have had four codes while team leader this month that have left me feeling rather inadequate. I've had a lot of moments where I've been reaffirmed, but they don't stick out as much in my hypercritical mind.

A friend of mine was way too close to a tragic murder in Philly this week that left me feeling physically sick and I'm sure has devastated an entire community. Praying for her and not really knowing how to help. Hating that there's that kind of senseless suffering in our world.

Reading a really decent book right now--The Rook. It's like X-Men meets The Bourne Identity, and it's a perfect escape. I'd rather do that than study or work out or look for jobs or clean my bathroom or cook real food (I ran my dishwasher a week ago and still haven't emptied it because I haven't eaten real food in my apartment since).

Like I said, what I really need to do is just go sit with God and let Him reassure me, because I'm not my lack of job or my burnout at work or my imperfections or my inability to comfort a friend or my poor motivation. I am a daughter, servant, and beloved of the Father. If only I could convince myself of that.

Under the banner

In the Spiritual Exercises, St. Ignatius calls his readers to imagine themselves in a battle, with two armies. One under the standard (or banner) of God, and one under the standard of Satan. We must choose which standard we will follow. St. Maximilian Kolbe imagined himself a warrior against Satan and wanted to create an army for the Immaculata to win the world for her Son. Make no mistake, that battle is still raging, perhaps more so now than ever before. The last several months of news has caused me to give up a little, between the healthcare mandate, mass shootings, the stress of work, and the suffering of those around me. It's easy to spout words of trust and then retreat into my own corner. But God has given me just a bit of a competitive streak, despite my protests. And so, the other part of my new year's resolution is to tap in again, suit up and run full on into the battle, whatever that ends up looking like. Again, still working out the details... 

Resolution

It feels like everyone's life is moving on without me. Marriage, pregnancy, houses, new jobs. And I'm happy for them, each and every one. It's exciting to be a part of their journeys. It just feels a little lonely to not only have none of those things, but to feel like I don't have anyone to share my own journey with. And yet, I know cognitively (though my heart is a little slow on the uptake) that God has amazing plans for me. Plans for my happiness. Plans for my fulfillment. Maybe my resolution this year will be to believe in His plan. I know that's quite vague. I'm still working on the details. I want to celebrate the little things, not be afraid to reach out, show love first, be a leader, pray, focus on the positive, and accept where I'm at. Because the truth is that this is where God has led me, and that means it's where I'm supposed to be. And who I'm supposed to be. So I guess I should be okay with me.