a flying leap

I forgot how nice it is to be able to really appreciate the day stretched ahead of me - as time I have to use however I choose. This past weekend has been full of insightful conversation, getting all sweaty, ice cream, and lots and lots of playing.

simply heavenly.

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"long live the flying leap!"
-anna quindlen

Women with Moustaches

"a woman with a mustache is always happy"
-italian proverb
(referring to the fact that increased androgens = increased libido...and extra hair)



At work this week we've talked with a lot of women about libido. It's fascinating the things women feel able to talk about pre-pelvic exam vs. post-pelvic exam. In the pre-exam discussion, I have noticed that women sit up very straight and even though they answer all questions - and sometimes ask their own - there's a propriety that sort of divides the patient and the doctor. But there's something that changes - I won't say relaxes because that's definitely not the right word - but maybe shifts? - while a woman sits with her legs spread wide and lets you look at her most intimate parts - most of which she has not seen herself.

For example, the cervix looks like a soft, silky pillow with a small hole in the center about the size of the tip of a chopstick. That's where a baby's head is when they say "it's CROWNING". Yes. Out of the hole the size of a chopstick in the center of the soft, silky, pillow-like part. This thought occurs to me every time I see a cervix and I stare in wonder and awe. As I see more and more cervices, it also consistently occurs to me that I have not seen my own cervix. Someday I'm going to have to figure that one out.

The doctor I'm working with makes terrible jokes throughout the entire exam. Not terrible in an inappropriate way, just not entirely funny. We talked about this and she said that gynecologists and urologists have to make jokes because they have to keep people both distracted and comfortable while talking with them and touching their most sensitive parts.

Which I think is a valid point.

After the pelvic exam, we leave the room so the woman can re-robe, and then re-enter to review the results of the exam with the patient and answer any questions. For some reason it is at this point when all the good questions come out. Everything from, "sooooo...my boyfriend doesn't really ejaculate. ever. is that normal?" to "what's trichimonas?" to "have you ever met a woman whose gone this long without having sex? I mean, I'm honestly asking you, have you?" and "how common are hemorrhoids anyways?"

It's pretty hard to talk about the female reproductive system without talking about sex. And it's pretty hard to talk about sex without talking about relationships. So this is my favorite part of working with a gynecologist - I really feel that I'm hearing (and sorting through) women's most intimate fears and concerns.

Even though it's my favorite part, it always leaves my mind reeling from the day, so I'm grateful to have the hour bike ride home along the river to take everything I've seen and heard during the day and just let it roll around itself in my head.

On Transitions

Before I left my country home, I was sitting on our brand new (ish) back porch with one of my room mates talking about leaving. She reminded me that humans adapt so much more easily than we anticipate we will. Transitions are hard for everyone - humans fear change more than anything - except boredom, maybe. And I think that's what saves us.

Tonight, on another porch, with old friends from my life in this city, talking about soccer games, relationships, and memories, it feels like maybe those two porches aren't really the worlds away they seem sometimes.

as I get older, the more I realize that goodbyes are really see you laters and try to embrace the transitions as the present. As I biked back from the clinic today, I was thinking of things that I have learned help smooth transitions for me, maybe by bringing me to the present:

-being outside
-talking with people I love
-finding something inspiring
-wandering around, getting lost, getting un-lost
-dancing

and one thing that I am not doing well right now, but find that I need more of in transitions is time by myself - to not think about anything in particular, but just let my thoughts wander. like biking in the rain back after a day of talking about sexual practices, STDs, and learning how to give a pelvic exam.

yup, lots to think about.

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“Sometimes when I'm talking, my words can't keep up with my thoughts. I wonder why we think faster than we speak. Probably so we can think twice.”
-Bill Waterson
(author of Calvin & Hobbes)

The (first) Day of Many Vaginas

I started my preceptorship in Gynecology today. It began with my attempting to put my bike on the front of the bus, involved seeing many things for the first time (trichomoniasis vaginalis, genital warts, cervical dysplasia, post-baby uterus, and a greater variation of breasts and vaginas than I could have - or maybe just would have - ever imagined.

the female body is incredible in all it can encompass and all it can do. The idea of a baby fitting inside any of the approximately two inch cervices of the young women we saw today is completely unbelievable.

Maybe the more interesting things I have seen - or rather heard - have been the stories. From my preceptor, who repeats over and over that birth control is God's gift to women, to a 38 year old woman who did not want to have children at all, to an 18 year old who we talked to about the possibility of her being pregnant and what she would do, to a 53 year old woman who just separated from her mildly abusive middle eastern husband, to another woman whose son and husband were just diagnosed with Asperger's Syndrome, simultaneously. One thing that fascinates me is that it is difficult to make a woman tell her own story, even when you ask "so how are YOU doing, Ms. ???", somehow her husband, her partner, her children, even her coworkers, become her story and she forgets her own. I think each woman has a variety of strings that tie her to other people and on which she feels different pulls at different times; I sometimes wonder if men have this, or if sometimes they can just detach all the strings for a while, so it doesn't matter how hard you pull.

It's odd but when a woman's feet are in the fuzzy slippers covering the stirrups and we are giving her a pelvic exam, moving her own hand to her abdomen so that she can feel her ovaries (and so that she will relax her abdomen so that we can feel her ovaries) seems like one of the few times women feel totally present with their own bodies.

pretty magical, this doctor thing.


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From The Vagina Monologues, a play written by Eve Ensler:

The first question I asked women was: if your vagina got dressed, what would it wear?

A ralph lauren skirt
or a calvin klein dress or something like that
i would probably put a hat on it
lots of glitter.
red silk.
jeans.
probably a red boa.
hiking boots and lots of sun block
something from the 40s
i like leather, its sexy
it would be bald
and it'd have an earring
actually my vagina's a nudist
doesn't wear anything anymore
some "tims"
some baggy jeans
probably a hoodie
like a little old fashioned dress?

Lemonade and Soccer Games: First Year Comes to A Close

It's been a wild few weeks as my first year of medical school has wrapped up. A friend and I were talking the few days before our final exam about how we were slightly worried that it would be anti-climactic. It most certainly was not - last Friday felt like a crazy, wonderful blur (certainly not still less than a week ago). The US-Slovenia game was on during our exam, so any time anyone had a break between parts of the exam (we take a practical, where we identify structures in the lab, and also a regular multiple choice exam, where we are on computers) they would be in a room cheering and getting rowdy.

I practically leapt into the arms of one of our professors when I handed in my final exam for the practical. I was in the final group to finish the written exam, so when I got out I was bombarded with people who had already been done (and mayyybe had had a few drinks) for the whole second half of the US-Slovenia game. After jumping around, berating the refs (check out the story and watch the replay here), and saying "hey second year" to each other as many times as possible, we all headed to a watermelon/lemonade social and then to the BEACH!

It was pretty crazy to start the goodbyes, to think about not seeing these people who I see literally all day every day for two months. But then I remembered that I see them all day every day and that two months started to feel pretty short. I was describing it to a non-medical school friend as the feeling I got when I left studying abroad (except that this was a really really really mentally challenging study abroad) - where I thought: "man, I'm going to have to explain this to everyone, how am I ever going to do that?" but was pretty excited to take a break from having to be so "on" all the time.

My sister, her boyfriend, and my dad came up for the weekend so I have had so little time to actually start to ponder all the thoughts and emotions that this year has stirred. I'm hoping that I'll get to do a good bit of that this summer.

For me, summer starts with a preceptorship in Gynecology in a city I love, followed by a roadtrip all over the United States to places I have never seen, before heading to my parents for a few days then back to school!

My (only) to do list for the summer:

- talk to my mother a whole lot
- catch up with friends about things other than medical school
- master the art of driving a standard car
- read a lot of books that are not related to medicine
- play ultimate frisbee, city style
- maybe work on memorizing some drugs & bugs
- wear my cowboy hat in texas
- climb at least 4 mountains in 4 different states
- howl at the moon
- line dance
- dabble in learning how to play a few beatles songs on the guitar

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because I'm still a hopeful romantic and my sister and I just watched Julie&Julia:

"you are the butter to my bread and the breath to my life"

-Paul Child (Julia's husband)

PS: that's us watching the opening game of the world cup at 10 am, at a german bar, skipping neuropharmacology. we were maybe a little too excited both for soccer and for a chance to shake up our routines.

A Return to Empathy

We worked with standardized patients yesterday on psychiatric illnesses - we were assigned one partner in our class and had to enter three rooms of patients with different "diagnoses". Here's how it works: we get our schedule of rooms (ours was, room 2, then room 3, then room 1), go up to the door of the first room, read the "chart" posted on the door, which has vital signs and a brief explanation of who the person is and why they've come in - similar to what you see in real doctors offices.

Our three cases were:
(1) a patient suffering from a depressive episode of bipolar disorder
(2) a patients suffering from mania that precipitated from treatment with an antidepressant for his long-standing depression
(3) a patient suffering from pain who was also addicted to her pain medication, who showed up randomly and demanded more medication.

Our third case was the toughest - the patient with substance abuse who the instant we walked into the room said "you're not my doctor. does that mean I can't get my pills?" we started a little bit shaky and it just spiraled downhill, with her getting defensive about everything we said, with us continuing to say "okay, we're trying to help, we just need to get through these questions..."

Finally we took a "time-out" - which we're allowed to take in select exercises, and talked with the psychiatrist attending. His advice was for us to
Regroup to a Place of Empathy

by saying something like:

We are so sorry to hear that you're in pain, it sounds pretty terrible. You've been on these medications for a while; we don't see any reason why you would not be able to get refills on them today. How does your pain interfere with your life? Maybe we can figure out some other ways to help with your pain..."

It was incredible the difference when we tried that - it felt like we were on the same team with her instead of mid-battle. I just liked that phrase a lot -

regroup to a place of empathy...

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“If you just learn a single trick, Scout, you'll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view...until you climb inside of his skin and walk around in it.”

-Atticus Finch (from to Kill a Mockingbird)