Part of that world

Yesterday I learned that the labor nurses have a nickname for me.

When I first heard this, I thought, "Yikes. Nothing good comes from this." What was it? I thought I had really good rapport with them, at least with the day team whom I've really enjoyed working with this year. Was it something mean? Patronizing? Something to put me in my place, take the resident down? I had not seen this coming.

Turns out, it was none of the above.

You see, they have started referring to me as "Ariel." A few months ago I died my hair red (the goal was Addison Shepherd red...this also works as Ariel red). And on the labor floor I wear green snakeskin (?fishscale) Dansko clogs. Thus...Ariel. And, to quote Donna, the labor nurse who told me about my new name, "because I'm so sweet." Awwwwww!



I'll definitely take that. And I don't think the seashell bra would really be appropriate on the labor floor.

Gratifying

Can I just say, it's really, really awesome when a patient wants to take a picture of you holding her newborn before she goes home from the hospital? I delivered her baby and tied her tubes, and she couldn't be happier. This is a truly amazing job.

Glycemic control

Sometimes I feel like a small child on call. For example, when I look back on the night and realize my PO intake consisted primarily of:

-apple juice (from the labor floor juice machine "for patients only")
-graham crackers (from the ER cracker box - saltines or graham, take your pick)
-peanut butter M&Ms (from the triage nurse who said I "look like I need some food")

Good thing I'm not diabetic. Oh, yeah, I also had french fries for lunch. Because I got down to the cafeteria after the "real food" was finished, and I had the forethought to realize that a salad just was not going to cut it. One of the silver linings of calls like last night is you feel totally justified in the amount of junk you eat. M&Ms and all, I still didn't get enough calories to make up for a) my basal requirements or b) my running around like a crazy woman. I need to hire someone to spoon feed me mac and cheese while I write notes or I'm going to whither away.

In other career news, I start my first day of my first Maternal-Fetal Medicine rotation tomorrow. I'm so nervous. More nervous than I've been for a long time. It's like a first date with someone I really, really like. Is this going to work? Is this for me? Could we make a go of it for the long haul? What should I wear? (Cough...I may have ordered fancy new scrub caps in hopes of wearing them on this rotation...oh, yeah...) The more I learn about MFM, the more I think it might be what I want to do with my life. It's complex and dramatic and emotional...you can see why I might like it. It's about thinking like a medicine doc and cutting like a trauma surgeon. It's about saving lives - two at a time (sometimes three or four at a time). It's about being the resource for patients whose babies you cannot save. And, unlike what my med school MFM department led me to believe, it is NOT just about diabetes.

Local cuisine

I don't think I've stated it on this blog before, but I have a complicated relationship with food. Namely, I think about where it comes from and how it was grown/raised. I also love it and am a total food snob in a lot of annoying ways. Lots of reading and discussing has led me to a place where my "food rules" are as follows:

-I only eat meat (includes poultry and four legged creatures) if I can confirm it was raised in a humane way, i.e. running around in the grass and killed in a so-called humane slaughterhouse. (I've done a significant amount of time as a vegetarian and 1 year as a vegan, so I've played the spectrum.)
-I eat fish. I don't eat the "bad" fish if I can help it. I consult these people to get an idea of what is okay and what is not. However: if I'm on call and starving for a protein source, I'm flexible.
-I buy free range/no antibiotics eggs, preferably from the farmer's market looking the farmer in the eye. At work, I eat any egg. I believe that this compromise makes me a happier resident (see also: well fed).
-I'm doing my best to decrease high fructose corn syrup. I don't think it's evil, per se, but the more I read, the more I'm convinced that it isn't doing anyone any favors.

Tonight for dinner, I made rice, Rancho Gordo heirloom beans, Ledge Ends CSA swiss chard with tomatoes, topped with farmer's market eggs. I'm pleased. And well fed. And also becoming more and more like my mother everyday (I'm pleased with that too).

Like a Prayer

Me: I have Madonna in my head right now.

B:...Yeah, I tend to assume that's the case. You know...at baseline.


Later, Brandon presents his dinner, complete with cooking show style commentary. Imagine Top Chef/Iron Chef voices. Imagine Brandon performing all of the roles.

B: Tonight we have a trio of frozen veggie burgers, reheated and served with a trio of red sauces. I call this one "American ketchup." This, to add some flare, is sriracha chili sauce. And lastly, Johnny's hot sauce, made popular by the "barbecue chicken wing."
I appreciate the way his sauces bring out the different flavors of the veggie patties. Still, I would have liked to see a different shade of red. These reds are just so....red. And isn't the patty a little overdone? This beef is too...beefy. But it isn't beef!

Yup. It's possible the heat has gone to our heads.

Snapshot

Note: I am not pregnant. Here I sit with my glass of wine - soooo not pregnant. Just thought I'd get that out of the way before sharing the conversation B and I just had.

B: I'm going to get a burrito, and then stop at Juniper on the way home. (Juniper is the name of the frozen yogurt pinkberry style place near us.)

Me: Juniper! That's the baby name I was thinking about today! You know, for a girl. We could call her Juni.

B: ... Yeah. I like it. If we were movie stars.

Me: Hey!

B: Or we could call her Apple.

Me: ...

B: Caperberry?

Scene

Now, real snapshots:

I take pictures of my husband in profile: in Maine and in Chicago.










We see old friends: in New York, Providence, and Chicago.










I pretend to be a New Englander and pose in front of the boats. Also, my intern class - no longer interns.




















But mostly I take pictures of food. And booze.



















*Events celebrated include: trip to NYC, trip to Maine, trip to Chicago, Amy visits Providence, wedding anniversary, residency graduation*

Did you know...?

I am done being an intern. Done, I tells ya. This morning at 6am was my last non-crash primary Cesearan section for a very long time. (Second year residents do repeat sections and crashes; interns do primary sections). As I left the OR, the circulating nurse said, "See ya next time...second year."

Apparently, I am still alive. I made it through. Not sure when I'm going to catch up on my sleep debt (retirement potentially), but I'm breathing.

I've done some really amazing things this year. It's been a privilege. There have been deliveries and urgent cesareans and end-of-life conversations and heroic measures and prevention of unwanted pregnancies and counseling about pregnancies that were desperately wanted but are now over too soon. The learning curve is vertical.

I'm starting to feel a real home in obstetrics, particularly dramatic, high risk obstetrics. Still not sure how that will play out with regards to my career, but it's a thrill to experience.

My marriage is strong. When I woke up at 9pm (got home at 3pm from being awake 23hrs), Brandon was there. "I brought home leftovers from dinner. Salmon and potato latkes. And I bought beer. Oh, and this week's Glee is on the DVR." This is a good man.

I have new friends. It's the whole boot camp mentality: we've been beaten down together, and that makes us inseparable. Who else can truly understand the glory and the shame of being an intern?

And I'm alive. The new interns don't start until 6/24, but for the next 2.5 weeks we're in flux mode: some of us "advance" and some of us stay the same year. Sunday night I go back to work as the second year night float resident.

Trust Women

Yesterday was Blog for Choice day. Thanks to MICU call, I'm a day late. I know that some of the things I'll say will disturb some people who read; some of you are friends and family who I love. If you don't want to know some of my rawer thoughts on the topic, don't read (when has that warning ever stopped anyone?).

This year, the theme is "Trust Women," the George Tiller slogan. Remember when George Tiller was murdered in his church? I sure do. I was a wreck . I was a new doctor, a few weeks away from starting ob/gyn residency, a training program where I planned on performing abortions. This was after doing a Family Planning elective in Pittsburgh with some of the people who get called upon to testify in supreme court cases. Mitch Creinin, Matt Reeves, some of my early mentors in this field.

At Pitt, I saw women come from Baltimore, Philadelphia, Cleveland to get care, and we weren't considered a late term center. We were just a place that the woman with the anencephalic fetus (no brain = 100% mortality) could get a 20 week termination, or the woman with heart failure who was slowly dying from her pregnancy could get a 22 week abortion. We went to the state limit of 23 weeks and 6 days. Was the 23 and 6 week abortion I saw disturbing as hell? Absolutely. But was it necessary? I have to believe so. Because that woman wouldn't have chosen it if it was not necessary. She chose to value her life. I have to trust that. I never actually performed the procedures as I was still a medical student, but I would do the prep on some: speculum, lidocaine injection, dilator placement. I was involved, an active participant in this emotionally and politically wrought procedure.

So when George Tiller was shot, it was personal. I immediately thought of the next George Tiller. The next murder in the name of a false justice. There are the obvious names that were immediately introduced in the media: Carhart and Hern immediately came to mind. But I thought of other people, people I knew: Mitch, Matt, Bea, Lisa. And then, Karen. Because now, as a resident, I too have become an abortion provider. And so I have the fear, the fear of being gunned down or watching my professional colleagues be gunned down for providing reproductive rights.

Recently, a new George Tiller quote was discovered:

"It is not for you, if it is not an inner calling, it just isn't. It doesn't work that way. It's not the technical component, it's not the intellectual stimulation, abortion services are a heart issue. It's a heart issue, and if you have a willing heart to help women in catastrophic situations, you can be an abortion provider. You can qualify and have a satisfactory life. There are probably more physicians who get shot working in an emergency room than are abortion clinics. There are all sorts of dangers - postal workers, firemen, police officers. Everything has a risk to it."

I try to remember that. I try to remember that this is important. I trust my patients, and I trust myself. If I'm going to be brave enough to do this, I have to trust in my passion, my heart, for this field. There are 1787 abortion providers in this country, according to Guttmacher data. If not me, who? Trust women.

Knitterly husband

The following conversation just happened:

Background: a pregnant friend sent me a pattern for a "baby cocoon" that she would like for her fetus, you know, in two months when it is external. It is knit with chunky yarn on size 15 needles, so I was all, yeah, no problem.

Me: Arrrrgh! I can't believe T paid money for this pattern! It's a tube! It's essentially a long hat! If she wanted a tube for her baby, she could have just asked me. I can make up that pattern as I knit! I mean, I guess a totally new knitter might want a pattern, but I don't need one. Grrrr...

B: ....?

Me: See, here's the picture. It doesn't even make room for the head. I'm gonna change it. I'm gonna add short-rows and make head space. It will be better. Everything is better with short-rows. I can't believe how stupid this pattern is.

Note: B gets subjected to these knitting rants a lot. I'm never sure how much attention he's paying. Until now.

B: (as he looks at the pattern notes) Well, it does call for Lion Homespun acrylic, so what do you expect?

Yup. My husband is a yarn snob.

Win.