January 31, 2012

the nurse and the locksmith

I've been out in the country for my outpatient rotation, which involved seeing patients whose families had been in the area for hundreds of years, lots of procedures, views of the innerworkings of a small hospital, some dangerous drives in the snow on unplowed, unsalted roads, and staying with an older couple who opened their house to me.

The best part was that I got to remember why medicine is like story telling because the easier pace of the outpatient setting and the incredible stories people would share with me.  In fact, my last week one of my attendings handed me a copy of the Boston Globe, an article called Charting the Human Condition, which says that the taking and recording of a patient's history (what we do all day) is "a way for doctors to internalize the patient's experience, to fully understand it, to feel it".  Interestingly, I listened to a radiolab podcast the other day that talked all about how when you are truly empathizing with another person, your brain actually starts to sync with theirs, so that if you are put in a PET scan, you can see the same parts of your brain light up.  Crazy, right? Anyways, in this post, I want to tell the story of the couple with whom I stayed, who were not my patients at all, but whose experience I wanted to fully understand:

They met when they were in their twenties on a blind date.  
He was back from a tour in Vietnam and she was about to start nursing school in the big city.  
He fell for her immediately.  
She was interested but knew he was going back to Vietnam.  
So without deciding to actually date, they decided to write letters.  
Every day.  For three years.  
By the end of that time they were dating and he was hoping to marry her when he got back stateside.  But she would not hear of it until she finished nursing school.  
(She says now this is because she knew that they would need the flexibility in their lives provided by two incomes at least some of the time, and nurses can work anywhere!)  
So he started working with  her father at a nearby elite boarding school, doing all sorts of maintenance and construction work.  
Then her parents decided to move up to the country. 
He went along to keep working with her father.  
She finally finished her nursing program, had her nursing degree.  
They were married in her parents house the next day with 5 witnesses.  
They could not have been happier.  They moved up to the country with her parents and opened a general store.  He built them a huge beautiful house.  When I asked about their big beautiful bay window, he said: "she wanted a bay window, so I built her THE bay window".  
She became pregnant with a baby girl, and it seemed like their life was finally settling into what they had both envisioned.  Then seven months later (8 weeks early) they had their first baby and found out that she had an incompetent cervix all at once.  
Their daughter survived thanks to the NICU, but she would not be able to have any more children.  Since she was clearly programmed to be an incredible mother, when a friend asked if she would consider foster care.  
She talked it over with him.  They decided to go for it.  
And 200 foster children and 5 adopted children later, it is clear to me 
they are also programmed to be grandparents.  

I got to talk with their biological daughter about her experience as the only biologic child of parents who had raised, in part at least, over 200 foster children.  She said that her parents did a great thing from the very beginning: they would only take foster children who were younger than she was.  That way she always stayed the oldest child.  But all in all, she loved it and saw it as completely natural for her parents to be foster parents.  She had five children of her own and when I watched her interacting with them, it was clear that she had inherited and learned the skills of being an incredible parent.

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Ah, I'd love to wear a rainbow every day/and tell the world that everything's ok/but i'll try to carry off a little/darkness on my back/til things are brighter/I'm the man in black
-Johnny Cash

January 23, 2012

Markings of Birth


I'm in rural Vermont without internet for a few weeks, but I dipped back into town long enough for a little skiing, a little time with friends, and to post this video, courtesy of my friend Arielle about the beautiful changes of a woman's body** that happen after pregnancy.  And how even though abdomen's may not be flat anymore (though they can be), they have scars that tell such a story.  
(**don't worry, it's only photos of abdomens - no other body parts!!)
If you're interested in reading about it, check out the website here!



January 9, 2012

It's Complicated

After having a few too many not-so-enthusiastic responses to my starting to tell people that I'm going to be an ob/gyn (YES it's true!  And that's short for obstetrician gynecologist for anyone who is thinking how in the world do I pronounce that) I decided that I needed to write a letter to myself about why I want to do it.  Not because I'm not sure, but so I can reflect back on it whenever I want a reminder in clear, honest words instead of a jumbled, messy "well I don't want to do what you do either!" knee jerk response which is not necessarily the greatest.

As I was groping for the right words I read this awesome post by an ob/gyn from her fabulous blog that I just stumbled upon and thought: SO RIGHT.  I like it because it's complicated.  Because women are complicated.  Because women talk through everything they are thinking and feeling about their health.  Because for women, health isn't just about them but about the people in their lives, the people they love.  Because women's bodies are changing and morphing throughout life in ways that are fascinating to me and aren't just getting older or getting diseases that can benefit from explanations of the inner-workings of medicine.  Because I want to be on the same page as my patients (and while I wish I felt that way with male patients, I just don't).  Because I want to be able to take my patients into their C-sections if that's what's necessary, into their hysterectomies, to catch breast cancer early and explain what happens next, to talk about safe and empowering sex, to deliver a baby and then deliver her baby many years later, to talk about how hormonal changes can affect even the most powerful woman - but how they don't have to be debilitating, to help women make their lives healthy with exercise and good nutrition and screening tests and asking questions.  Because I want to be an advocate for women's health and while I could do that from other fields, it would be only so that I could say I didn't JUST go into women's medicine - when in fact all I want is to go into women's medicine.

phew.  this might need some editing later, but for now I just want it out there in the world.

Pinned Image


December 23, 2011

we can burn brighter

happiness is like a train on a track/coming towards us/stuck still/no turning back
-Florence and the Machine

On a long run with a friend the other day, I was going through all the next big decisions I have to make, all the things I feel I need to figure out about my next steps and how many things I just don't know yet that I feel I should know or need to know soon -

and she just said, Erica.  Listen to yourself.  If this time last year someone had said to you, in one year you will have passed the boards, done well in third year clerkships, be very invested and so satisfied in your relationship with your partner, and be doing yoga and running more consistently than you have for a long time, 
you would say, WOW. I can't wait until December 2011!  
So what is this stress about?

I think sometimes I forget how to just sit with happiness.   I've become so used to having to think three steps ahead that it actually makes me nervous to think that I might just... be happy?
So I think of things that are still not going as well as I think they could, or things that I still don't know, or the next big obstacle or test I'll have to confront.
When really I should be just grateful.

So this holiday season and as I ring in the new year, instead of resolutions, I'm going to focus on being happy and grateful for everything I have experienced this year instead of worrying about the challenges that next year will bring.

To get you in the celebrating mood, check out my new favorite artist Janelle Monae in this video, for more of her check out TIGHTROPE for some MJ caliber dancing.  YESSSSSS.




December 13, 2011

what makes the biggest difference in your health?

After many months of treating really sick people and watching them take drugs with life altering side effects, undergo procedures with lost of risks, be connected to tubes and pumps and monitors to stay alive, and  return to the hospital still not feeling very good, I truly believe we have to focus more on preventing people from getting to the point where it's clear they forget what "healthy" feels like.  

We learn about all the amazing ways we can fix arteries that are clogged, lungs that aren't opening, knees that aren't able to hold body weight, hearts that are too big to pump well, livers that are too clogged with fat to detoxify our blood, blood pressure that is so high it is shearing off the insides of blood vessels, and kidneys that are too full of sugar to filter well,  and I think: 
and people wonder why our health are costs are skyrocketing?  Why you see a gazillion doctors when you're in the hospital?  Why our health system is going broke?
It's because we aren't protecting health enough.  Maybe it's because the consequences sometimes take years to show up, or maybe it's that our society doesn't promote healthy behavior nearly enough by what's cheap, what's available, how much time we have, but those all pale in comparison to what you do now determines whether or not you are ALIVE in twenty, thirty years, much less whether you are connected to a tube or can keep your leg, or need a kidney transplant.

Especially because so much could be prevented with just creating a slightly more health lifestyle!  
here are my 5 easy health rules 
(medical school really has just filled in the details)

1. don't smoke...anything...ever.
2. eat mostly greens and fiberous grains, avoid too much meat and processed food
3. walk (or just move!) as much as possible but at least 30 minutes every day
4. stay connected to a community - any community in any way.
5. get enough sleep (whatever amount like enough to you and is marginally feasible)


check out this awesome video a friend shared with me about the one thing that makes the biggest difference in your health:




in summary, the positive effects of this wonder medicine:

  • Knee Arthritis: reduces rates of pain and disability by 47%
  • Dementia and Alzheimers: reduces progression by 50%
  • Diabetes: reduces progression by 58%
  • Hip Fractures: reduces risk of fracture by 41% in postmenopausal women
  • Anxiety: reduces by 48%
  • Depression: 30% relieved with low dose, even up to 47% with higher dose
inspiration enough to get off your computer and go for a run, or even just go pace around the house as you talk on the phone to your sister for half an hour?  yeah, me too.


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"walking is man's best medicine"
-hippocrates


December 7, 2011

Easy as 123

By the Kaiser Family Foundation, finally an easier explanation of health care reform.  Except it still seems confusing.  Sigh - at least it's a start.  Though I don't know what this is about stopping the huge increase in medicaid/medicare funding to hospitals and doctors - maybe the total amount paid to doctors and hospitals from these programs has increased, but the reimbursement rate has significantly DECREASED per person, and every year congress stalls when trying to decide if they're even going to continue reimbursement.  What a crazy system I've gotten myself into.

http://healthreform.kff.org/the-animation.aspx
Health care reform explained in "Health Reform Hits Main Street."
Confused about how the new health care reform law really works? This short, animated movie -- featuring the "YouToons" -- explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Written and produced by the Kaiser Family Foundation. Narrated by Cokie Roberts, a news commentator for ABC News and NPR and a member of Kaiser's Board of Trustees. Creative production and animation by Free Range Studios