Delayed light

Solstice has come and gone.  For me, this is the spiritual part of the winter holiday season.

I am Unitarian.  Growing up, we always had secular Christmas, which meant family and food and decorations and pagan symbolism everywhere.  And as I've started older (our family grays early...I state that I am indeed getting older based on the number of grays I have to dye at age 29), Solstice is what rings as my spiritual core.  If I miss celebrating/acknowledging it, I feel empty.  And if I do it justice, I feel good.

This year, my yoga studio had a candle-lit yoga session with live music and chanting.  We did sun salutation modifications aplenty and set intentions for light and hope and growth.  And, it may sound silly, but in that practice I met two of my yoga goals of 2012: to hold crow pose for a substantial amount of time and to be flexible enough to do my downward dog with flat feet.  Light indeed.

Don't get me wrong, Christmas is not about yoga and candles.  It is about a Christmas Eve walk to look at the lights (except my neighborhood now is way to posh and boring with regards to lights) and Silver Packages readings and stockings for everyone.  I buy bagels and lox, because apparently I believe that is what one should eat on Christmas morning?  My husband has learned that I am happier with a tree, and he has started pressuring me to get one earlier and earlier in the season.  And I top my tree with an owl, because I am a dirty pagan at heart.  He has also learned that I Despise malls during this time and has volunteered to go get what we need there tomorrow (a yankee swap gift).  Yes.  Be jealous.

It has been three years since I've been with my parents and family in Minnesota for Christmas, and I ache for it.  And next year I will be a junior fellow with no clout whatsoever.  So I shall call and skype and make chosen family.  On Christmas Day I will join fellow residents in eating decadent food and lighting candles.

Because candles are light, and light is hope.  And even one candle can keep the darkness from being complete.

Votes for Women!

Today, after a 14 hour shift at the hospital, I drove home (past my house and warm bed with husband in situ)  and stood in line for an hour to vote.  There were many other individuals with me.  Presumably, they were getting frustrated with the delay because they had somewhere to be, not because they got 4 hours of sleep yesterday and were itching to get more.  One gentleman decided to tell the poll workers that they clearly weren't doing their job right.  The woman beside me kept telling the air space surrounding her that she was thinking of cutting the line.

Um...What do you think voting is?  And what do you know of the history of voting?  I know you're annoyed that you had to spend some time in the 34 degree chill in your NorthFace jacket, but this is not really suffering for your rights.  I'm sorry this voting establishment in the yuppie intelligentsia side of town isn't big enough or climate controlled or churning out lattes while you wait.

But I had my knitting.  And as I stood in line I focused on the construction of fabric instead of the irritated young woman beside me.  Although, I was tempted to fire back when she said (after 25 minutes), "Oh my god...we're still waiting.  This. Is. The. Worst."  I wanted to say, No.  No, it is not.  Last night I delivered a 25 week baby (breech en-caul) through a uterine incision that will make it very dangerous for her to labor again.  And gave blood to a woman whose body is simply unable to keep up with her needs to make the cells and factors that make blood clot and not simply pour out of you.  It is that last woman I'm trying to push from my mind so I can sleep.  I fight the urge to keep checking her progress and her labs and her CT read today.

That is the worst.  Waiting in line to vote?  That is a privilege, a right, and a personal responsibility.

Minnesota voters: it is you I look to today.  Please validate the same sex couples of your and other states and Vote No.  You are better than that, and I expect the best of you.  Make me proud.

Paradise it has a name

I am going to Utah.

In 7 months, I will drive the 38 hours almost across the country and start measuring addresses by their distance from the Temple.  Yes.  That Temple.

And I will know not a soul for miles and miles.

My husband will be in Philadelphia (probably with our cats, because we all know that if I take the cats he'll just get...more cats) and I will be in Salt Lake City.  And with our frequent flier miles we will go to Fiji at the end of this endeavor.

We are both happy with our fellowships.  Maternal Fetal Medicine at Utah is a dream fellowship, arguably the best in the country, depending on whom you ask.  I wanted it, badly, and I got it because I'm good and I know the right people, and one of the guys there is from Minnesota and went to St. Olaf and has a combination of Buddhist and German Philosophie quotes in his office.  And when I was there I went to the Red Butte Gardens and had a blissful nap on a bench (like drifter) and went to Red Iguana for one of the best Mexican meals I've had in a long time.  And the airport has free wireless and good restaurants.  And the lack of humidity means my hair was so smooth and easy to blow dry.

Brandon gets to do the prestigious health policy research fellowship he's always wanted.  And that is right for him.

I know I will be happy, in part because I am the sort of person who is happy, but I am scared too.  Scared because I will know no one.  Scared because I will be hours from my husband.  And scared because I matched to (arguably) the best program in the country and now I need to prove to them that they didn't make a mistake.

The have a yarn store and a Unitarian church.  If I can find somewhere with good Zumba and good yoga, I can make do with anything.  Wish me luck.

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.

2009

As is the way of things, time for a summary statement:

2009 was apparently a big year of change, if the internets tell the truth. It certainly was for me. It was the year I became a wife, a doctor, and a (cough) New Englander, in chronological order. In 2 months we had the most amazing wedding with so much love from friends and family, quickly drove back to Cleveland for graduation, flew to Milan, honeymooned in Tuscany where we practically drank the olive oil straight (and maybe some wine too), flew back to a Cleveland now empty of our med school compatriots, finished packing, and drove the Penske truck to Rhode Island with the help of my father-in-law. 2 weeks later, I was introducing myself as Dr. G, checking cervixes, cutting into abdomens, and trying to project confidence.

While here in Providence, I have changed. I'm learning to act fast and trust that I actually do know how to manage sick people. I've learned what it's like to bond with oncology patients over time, only to hear that she died over the weekend or two days after you discharged her to home hospice or on Christmas morning. I'm learning about marriage. About relying on your partner enough but not too much. About trying to feel like a human partner after working and worrying about your patients all day. And I've developed my relationship with my sister. We're both on the east coast now, within a short driving distance. More things are possible. Work has provided new friends, including Cat, my "Work Wife," my partner in foodie crime. We go to Boston for Ethiopian food, New Haven for restaurant week, and La Laiterie all too often for cheese. We discuss the changes that our jobs demand of us.

Transition: it's the part of labor where things truly get going, where the pain becomes truly intense. It looks awful, overwhelming, impossible. But it is necessary for birth.

Love my job

Monday, as I performed my first perineoplasty, I had this conversation with my attending:

Attending (A): I would go here...then here...Make it work!

Me (K): Um...The Tim Gunn method of surgery?

A: Hahaha! Yes! It's Project Runway: Vulva Edition! Less is more!

We both were quite amused with ourselves. (Also, I made it work and improved this patient's quality of life, which is the important - but less amusing - part.)

We're currently in the process of interviewing next year's group of interns. This is amazing. It is amazing because it means that I will not be an intern forever! Yay! Also, it is amazing because I get to talk about this program to people who really, really want to hear about it (or at least have to pretend as much). In the process of talking, I realize over and over again how great this place really is. Obviously, it's a great hospital with Ivy League affiliations and wonderful volume, but it's really so much more than that. It's a chosen community of people dedicated to providing top notch, comprehensive health care for women. It's people who are self-driven to great heights and who will support everyone else in reaching their own goals, in good times and bad.

At every applicant lunch we play a slideshow of us working and playing together. I get a little teary every time.

Today

I scraped real vanilla bean into warm cream and grated fresh nutmeg into pumpkin. In a few minutes I will have pumpkin creme brulee. I think this is a pretty good summary of how I feel about the holiday season.

Mu receptors

This weekend, both B and I have BOTH days off. As my mother said, it is time to remember who we are married to.

Tonight involved orecchiette with butternut squash and zucchini, roasted brussel sprouts, and prosecco. And thank you notes. It is embarrassing how delinquent we are on these.

Also, Stanford beat USC. Our household rejoices (I don't really care)!

B said, "If religion is the opiate of the masses, yarn is the opiate of the Karen...says Stalin and I." He's not wrong. Me and my ArtYarns Silk Rhapsody Glitter are getting along just fine.

1 more day

I am home. Home from the 27 hr call shift that ended a string of 13 days straight in the hospital. In that call, I learned:

That if you thought yesterday was bad, today will amaze you with just how much worse it can get.

That if you succumb to your onc intern breakdown (it's a rite of passage; I almost got through the rotation without it) and bawl like a hiccuping baby in the PACU office, the nurses will hug you and send you chocolate later.

That OB/GYN residents can actually run and facilitate a code...and get the patient back.

And now it is time for bed.

Tonight: pumpkin carving with my co-interns.

Tomorrow: mini-med school reunion in Boston.

It's all about looking forward..

Curse my pale allergic self

At the hospital, we deal with smells. In OB/GYN, we deal with smells. It may reassure you to learn that most OB/GYNs truly do not mind most OB/GYN smells: amniotic fluid, placenta, an open abdomen, various vaginal misfortunes, bodily fluids of many identities, it's all good (although we do enjoy teaching hapless med students about the "whiff test"). In fact, when it comes to medical specialties, we OB/GYNs are pretty resistant to smells that other people gag at.

However, every once in a while, we can't handle it either. I won't go into the details, but there is one smell in particular (or rather a combination of smells) that is very present in one room on our service. In the hospital, when smells are bad, there is this peppermint air freshener that gets used to try to cover them up. It doesn't really work. It just adds peppermint to the combination of smells.

My chapstick is peppermint. I realized this a few days ago when I put it on and had a strongly visceral response to the smell. It was time to get new chapstick.

My new chapstick is cherry. I wore it yesterday. It's tinted, and it made my lips a lovely shade of ping, and it did not make me want to vomit. Win! Today I put it on, and after an hour my lips started to tingle. Then they started to itch. Yup. Looks like I'm allergic to cherry chapstick. But I'm sure not going back to peppermint.

Two more days

One of the best things about this program is that you can take vacation on one of your intern oncology blocks (we do two blocks). Intern onc is one of the least forgiving blocks. The hours are not actually as bad as on a couple of other rotations (OB days come to mind), but the work is painful. It's floor work: coming in an hour before the rest of the team to write the day's labs next to the patients' names on The List, writing for daily labs, repleting electrolytes, answering pages on all of the patients on the service, writing the daily progress notes even though someone else got to do the surgery, and being the brunt of everyone else's frustration whenever something is not perfect.

Luckily, the first time we do onc, we get a co-intern as a partner. The second time we're alone, but the first time we are not. My co-oncie is Cat, my Women and Infants BFF. It makes the day better. Less lonely. We can complain to each other when we feel put upon. We help each other out with the work load. And we talk about the patients.

The patients are the worst part. This is not post-partum floor work, where everyone is healthy and relatively young and really quite annoying at times because you get pages about the mundane ("I feel a little sore, you know, down there." Um, yes, you just pushed 8lbs of human out of you. What did you expect to feel?). On onc, the complaints are tragic, heartbreaking. On onc, half of your patients will be dead before you finish residency. This is where we learn about managing pain in the terminally ill, as the tumor presses on their spine or erodes the bone in their hip or compresses their bowel.

One of my patients is one of these patients. She has cancer, doesn't matter what kind, and she is not doing well. She knows it. Her husband knows it, and he is lost. And yet, she always wants to know how I'm doing, if I'm eating enough, if I'm sleeping. She offers me food from her tray. I refuse. I tell her I had pancakes for breakfast. She looks dubious. I ask her about her pain. She tries not to complain, but I end up increasing her dose every day. I don't know if we'll ever catch up to what she needs.

On Saturday, I go on vacation. Every day, driving home, some song on the radio makes me burst into tears. I live 1.8 miles from work. There aren't that many songs. On Saturday, I go on vacation.

I should be cleaning

Achey, tired, sore throat, and full of soup. Smack dab in the middle of two weeks of no days off. I should be cleaning in anticipation of Monday guests (Hi!), but instead I'm doing oh-so productive things like installing Google Chrome, trying to get my computer to access the hospitals records from home, and watching Project Runway. I took care of sick cancer patients today and also did dishes. That should totally be enough.

Also, Ben & Jerry's Oatmeal Cookie Chunk is truly amazing. I highly recommend it. B told me he was going to hide it from me when he bought it. Yeah, he's not a very good hider. To be fair, there are only so many places you can keep ice cream in the house...