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)

Bill & Melinda Gates Pledge $1.5 Million to Child and Maternal Health

From the NPR Health Blog:

Gates said that in a lot of the communities she's visited, women are very vocal about wanting access to birth control.

She doesn't think there is as much of a cultural obstacle as it might seem to some Americans.

"I actually think the biggest barrier is sometimes the American public," she said. "The way we think about reproductive rights is pretty different than the European women do or the women I meet in Africa and even the governments in Africa."

"We make it a big debate, and it really shouldn't be," she said. (Click here for Gates on birth control in her own words.)

We had a discussion about abortion in our "social medicine" class a few months ago and a few things that came up:
- when you're a doctor will you refuse to perform abortions
- is it okay to make a distinction between what you would do and what you allow of your patients
- does the debate really come down to when you believe life begins, and if it does, where is the space for a good debate?


Check out the whole article (and Melinda Gates on Birth Control) here.

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To make you think:

"No woman wants an abortion as she wants an ice cream cone or a Porsche. She wants an abortion as an animal caught in a trap wants to gnaw off its own leg (to get free)."
-Frederica Mathewes-Green

(who is interestingly, decidedly anti-choice; check out her views on her website)

More Pro-Choice Quotes here

Languages of Love

So my female friends were talking the other day about the many ways people express (and receive) affection - and someone brought up this "theory" from an apparently super famous book about the five languages of love. Then we proceeded to write them on one of the big white boards we normally use for studying drugs and diseases and tried to figure out which were the ways we expressed affection (we're not so big on the whole "love" term at the moment) and which were the ways we enjoyed receiving affection. We decided to each pick 2 for ways we express affection and 2 for ways we like to receive affection. (Can you guess what mine were?)

Here are the 5 languages of love:
1. Words of Affirmation
2. Gifts
3. Acts of Service
4. Physical Touch
5. Quality Time

It was fun to see how different we all were and to think about my friends (and past lovers) and the many ways we figure out (nor not) how to show someone -either romantically or not- how much we care about them, as well as how we learn to read someone's gestures of affection.

My parents have this amazing cartoon on our fridge of a man and a woman talking to each other - but neither of the bubbles are actually filled with text. The woman's is filled with these bubbly curvy lines, while the man's is filled with boxes and straight lines. So much frustration and hurt can be caused by not understanding the way other people show emotion. Not just affection, but fear, shame, anger. One of the doctors I worked with before medical school told me that she felt like she had a sort of 6th sense about people because she picked up on unusual signals indicating their state of being. I can definitely see how being able to read the many ways people can signal states of being would be helpful for a physician (or just in life).


A goal of mine for the week (month? year?) is to be more careful about observing the people I love, work with, or just see a lot, and figure out the ways they communicate their states of being.

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"Lovers speak is so much different
only they can understand
lets all share this coded secret
let us in, let's all join hands"
-Joni Mitchell, Lovers Speak

Whatchu Eating (now that you live in a beautiful house in the country?)

An incredible summer recipe from a friend:

Bean Salad Recipe (makes a lot!)

1 can kidney beans
1 can garbanzo beans
1 can black beans
3 c. blanched green beans (buy fresh), chopped into bite sized pieces
1 c. corn (frozen and thawed or boiled)
2 small carrots, chopped into bite sized pieces
1 medium Vidalia onion, chopped

Rinse beans and corn (if frozen, to thaw) and throw in a big mixing bowl with green beans, carrots and onion.

Dressing:
1 packet of Italian dressing mix (directions on packet, makes about 1 cup)
2 Tbsp. water
¼ c. vinegar (I use 50% rice vinegar and 50% red wine vinegar but any kind will do)
½ c. extra virgin olive oil
2-3 Tbsp. of fresh dill, chopped (optional)

Mix all dressing ingredients except oil. Slowly introduce oil while whisking to fully emulsify.

Dress and toss. Cover and let marinate in fridge over night (flavor gets better the farther in advance you make it!). Toss again and add extra fresh dill (or other fresh herbs) before serving.

Note: this is a very easy, flexible recipe that’s great for hot weather. You can change up the veggies you add and the dressing (a Dijon mustard dressing is also good). I like to keep a big batch in the fridge and add to it to keep the flavors going.

like Kevin Garnett, anything is possible

this weekend was AMAZING for so many reasons -

1. it was three days long
2. the weather was incredible
3. my family came up
4. a whole bunch of my friends/colleagues and I ran the Marathon! (many people for the first time ever)
5. I now live in the most beautiful house with beautiful people and even though we moved the day after running a marathon, friends came and helped for all of it so by the time we were winding down and the fatigue and soreness were setting in - I realized that even with all that, in that moment, it was EXACTLY where I wanted to be .

Whenever I talk to people about running a marathon (and inevitably hear them say that they could never do it and that I'm kinda crazy for doing it) I always say two things:

*unless you have some part of your body that is permanently injured, anyone can do it - you just have to train;
*it changes your idea of impossible - and that carries over into lots of other areas of your life. Once you've over-ridden the impulse to stop, to quit, to give in when you feel your whole body aching, you realize you can do that other times, with other types of pain or frustration or need.

it's pretty incredible.

I also basically did not do any work, so this week will probably not be amazing, as I try to really move into my house and try to catch up on all the work I haven't done yet, but somehow, I feel okay about it right now.


PS: My time was 3:42! but something malfunctioned about my chip...so it's not posted anywhere :( but I have lots of witnesses to my running it!

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here are a few good ones about the impossible:

It always seems impossible until its done.
-Nelson Mandela

It's absolutely impossible, but it has possibilities.
-Samuel Goldwyn

It's kind of fun to do the impossible.
~Walt Disney