soaking up summer

This past weekend (pre-hurricane) a group of us decided to capitalize on summer and go on a 30 mile bike ride out to waterfalls with the added bonus that these waterfalls happen to be right next to the best brewery around.

game face ON, check. (~9am)

and we're off! check out that beautiful scenery in the background

we stopped at a farmer's market about 25 miles in and got some fresh tomatoes!

and then we got to the beautiful falls and iced our tired legs in the cold water!

and jumped off cliffs!

and got a little bit zen...

or not (she scraped her legs swimming under the waterfall)

and made new friends (we're collecting rocks)

check out that beautiful waterfall - oooh summer.

and then finally we got to go here for delicious local food and the best beer in the area.

my favorite was the pepper, chocolate stout

(of course about two sips in, I was ready for a nap - oohhh medical school)

the end.

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"Summer is the time when one sheds one's tensions with one's clothes,

and the right kind of day is jeweled balm for the battered spirit.

A few of those days and you can become drunk with the belief

that all is right with the world.

-Ada Louise Huxtable

controlling birth

we just had two of the most excellent lectures in medical school so far on Friday - one, on birth control and one on abortion - strikingly and unfortunately related as access to one decreases the amount we have to see the other. it made me realize that while I've touched on lots of women's health issues, I haven't talked about either one on this blog.

BIRTH CONTROL first (because I have to be a little less careful about how I explain everything):

From the beginning - birth control is anything that is designed to prevent a pregnancy. Some also prevent STIs (sexually transmitted infections), some do not. To see a full list of birth control options available in the US and some of the pros/cons, check out the CDC website. If you are considering a particular type of birth control, I'd definitely talk to your doctor about the pros/cons of each type and how that fits with your life.

Some factors to consider when choosing a form of birth control:

1. how much do you not want to be pregnant? as in, how good does your birth control method need to be? For example, if you are not willing to make some decisions about an actual pregnancy, the withdrawal method (where the penis is removed before ejaculation) is not a good method for you, because it's not very effective. On the other hand, IUDs are more effective than tubal ligation.

2. would you rather use something only at the time of sexual intercourse? OR

3. how good are you at remembering something consistently? If taken correctly, birth control pills are 98% effective, if taken incorrectly (like missing them, taking them at different times, taking other medications that interfere with them), they are only about 80% effective, meaning 1 in 5 women who takes them incorrectly gets pregnant.

4. how much money are you willing to spend on birth control? Many people like the hormonal ring because it can be put in for the whole month but is otherwise much like the birth control pill, but it's pretty expensive. On the other hand, condom charges can add up pretty fast. An IUD is expensive up front, but then you don't have to pay anything for the next 5-10 years.

5. is there any reason why you shouldn't use a particular type of birth control? do you have a clotting disorder in your family or a family history of breast cancer? then maybe birth control involving estrogen is not the best for you. If you have a male partner who refuses to wear condoms, well - THAT's not going to work (also, probably worth a conversation about why)

6. Is there an added benefit to using any type of birth control? for example, estrogen-containing pills often also help clear up skin, the progesterone-secreting IUD can make your periods lighter.

7. Do you need to get period every month? Or do you NOT want to get a period every month? depending on your own neuroses, it might be important that you see "proof" that you're not pregnant every month. On the other hand, menstruation might really interfere with your day to day life. Hormonal methods like the pill, the patch, and the ring allow for you to choose if you want to have a withdrawal (of progesterone) bleed, whereas with the progesterone IUD (the Mirena), 1/5 of women stop bleeding altogether.

8. What kind of access do you have? If your job takes you traveling all over the world, you might not be able to get your pills refilled every month. Depending on where you are, it's easier or harder to undergo any procedural birth control like tubal ligation (tubes tied), vasectomy (where the male vas deferens or the tube the sperm swim from the testes to the penis in, gets cut), or even IUD placement (though this is much more widely available).

9. What do you like? If you really don't like the feeling of anything in your vagina, the ring might not be the best option for you. If you're not into condoms, chances are, you won't use them or they'll make sex less enjoyable. If you hate trying to remember your pills, they aren't the best option for you.

10. What does your partner like (or rather, not mind)? male condoms definitely require some male partner consent, especially if he's going to be buying them. There are also those wonderful male partners that help pay for birth control pills or IUDs because he knows he's benefiting too. But there are also male partners who can feel the IUD strings so are less wild about those. Definitely a factor to consider, but I put it last for a reason. YOU are the person who should feel comfortable with your birth control because you are the one who will be pregnant if it doesn't work out.

My one plug is that recently a lot of my classmates have gotten IUDs because with night call and 24 hour shifts and generally unpredictable schedules, not to mention moving around, it became harder to remember any type of birth control (pills, patches, rings). Generally, people are very satisfied - less bleeding, no estrogen meaning no water weight but also no acne control, and best of all: no having to think about it.

The most important thing about a birth control option is that it works for your lifestyle because none are good if not actually used.

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"Birth control is a woman's right to decide when she is ready to be a mother"

-Julie Hebert

"I got a pocket full of rubbers and my homeboys do too"

-Snoop Dogg, in his song Gin and Juice

promoting the use of safe birth control methods

burger party

If you've been reading any of this blog lately,

you may be wondering if I ever leave the hospital, if I ever see anyone who is not wearing the pseudo-smurf outfit that is surgical gear, if I talk about anything besides vital signs and not getting enough sleep, if I ever play outside or have any fun at all.

I find myself sometimes wondering the same thing

which is why I'm glad for nights that remind me how fun it is to be silly

(see below for details)

last Thursday night, I left the hospital around 6,

immediately went on a long hard run

which ended around dusk at the local baseball stadium

where I met a bunch of friends to chill outside, drink some cheap beer (and gatorade),

and play the 5th inning burger game!

TEAM one: PATTY CAKE

TEAM 2: MORE COWBELL

the bottom buns line up at the starting line

and they're OFF!

(in front of several thousand people)

throwing on the toppings (do I see bacon?)

a slider finish (oh-hoh): PATTY CAKE WINS!

a post-race burger bump!

with our favorite SP who also happens to be the guy who runs all the games at the stadium, not to mention about eighteen million other things around town.

and then I got sandwiched, I mean burgered...

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and for an unrelated fun favorite:

Calvin: (peering under his bed) "Any monsters under my bed tonight"

Voice from under the bed: "Nope, No. Nooo monsters here."

Calvin: There better not be, I'd hate to have to torch one with my flamethrower!"

Hobbes: You have a flamethrower?

Calvin: (whispers) "They lie. I lie"

connection to the wild

"The way to maintain one's connection to the wild is to ask yourself

what is it that you want. This is the sorting of the seed from the dirt.

One of the most important discriminations we can make in this matter is the difference between things that beckon to us and things that call from our souls."

-Clarissa Pinkola Estes,

author of Women Who Run with the Wolves

Where are all the grown-ups?

Today I had two surgeries (by "I had" I mean I generally watched and held things): one was a dramatic robotic surgery that was more difficult than they thought it would be so they converted to an open surgery. The second surgery was a suction evacuation of a woman who had had a failed termination of a 9 week pregnancy 3 weeks before and subsequently developed an infection along with not actually terminating the pregnancy. It was one of the most interesting cases I've had yet, not because of the procedure but because of all the ethics and emotion tied up in the case. For starters, it was hard to find staff for the case. It ended up being one attending who did not want it known that she performed terminations and two residents (A first year and a second year) along with a first year anesthesia attending and a circulating nurse who was about my age.

I definitely had a thought before we started like, "but where are all the grown-ups that are usually in the OR with us?" but everything went really well and obviously the OB attending was there, mostly teaching me and confirming what the residents were doing/finding.

After the procedure, we have to confirm that the "products of conception" have been removed from the uterus. This involves piecing through the specimen to find evidence of a gestational sac and organs/structures. It felt very strange but oddly similar to my undergraduate research lab to be searching through bloody mush to find specific parts.

I ended up sitting with the patient a long time afterward because she was so emotional and so scared. It was the one moment this rotation that I've been glad to be a medical student - because I didn't have to run off anywhere to do all sorts of other things and could just answer all her questions whenever she had them. (because otherwise, it's been infuriating to be a medical student and mostly observing...)

Ob-gyn is still going well - I'm done with q2 (every other day) 24 hour shifts on OB and have moved on to the "gyn" section which is a lot of surgery and outpatient clinics, but still requires me to be at the hospital before 5am. A few days ago I had a complete scraping-the-bottom-of-my-barrel-of-energy day where everything felt overwhelming and I felt incompetent. Then I remembered that the last time I got more than 5 hours of sleep at one time was about 3 weeks ago and that I still don't know what meal my body feels like it should be eating. After a run, a good dinner, a glass of wine, and an early bed time (6hours last night, hooray!)

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"self preservation is a full time occupation"

-ani defranco

first test of motherhood

around 4am last night, on the 26th hour of my 28 hour call day, I was standing at the side of the bed of a 29 year old woman who was trying to push out her first baby and screaming "help me, help me, help me. I can't do it. I can't do it" and I was thinking (amidst telling her she was safe, her baby was safe, that she was doing a great job, to KEEP. FREAKING. PUSHING.) that birth is really the first test of a mother. I have yet to see one first vaginal birth where the mother didn't actually tear through her vaginal opening. Not like, it happened to tear. Like, she pushed so hard to get that baby out that she is actually TEARING HER OWN SKIN. It seems like a pretty good test of what's to come: are you willing to tear yourself from the inside out in order to give life, air, comfort to this brand new baby that you aren't even sure what it will be like, but you already know you love it enough to rip yourself open.

The best part is that after the big, (often) tearing push, the baby goes on the mom's chest, the partner leans over and pushes her sweaty hair back from her face, they gaze at their new, crying baby who is covered in white vernix together and glow. They all glow.

Terrifying and amazing.

oh, yeah. so I started my ob-gyn rotation and freaking love it.

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"a healthy woman is much like a wolf: robust, chock full, strong life force, life-giving, territorially aware, inventive, loyal, roving".

-Clarissa Pinkola Estes, author of Women Who Run with the Wolves

10 Things I Learned in Pediatrics

1. it matters what medication tastes like. kids will stop taking medication altogether if you give them something icky. the peds floor might be the only floor in the hospital where patients actually prefer to take medication per rectum...

2. talk to the whole family. in peds especially, but in all medicine, it matters what - and who - makes up the environment that someone heals in

3. kids shouldn't like being in the hospital. and really, neither should adults. so don't blame anyone too much for being grumpy.

4. at the same time, the hospital is not a hotel. we have to wake people up to take their vital signs (blood pressure, heart rate, temperature, etc) to make sure they are okay, to figure out if the treatment is working - so as important as a goods night sleep is to healing, they're in the hospital so we can check on them.

5. if you take a phone call from a panicked patient (or mother, father, grandmother, babysitter, etc) get their name, phone number, and figure out how far they are from the hospital and what sort of transportation they have available - BEFORE YOU DO ANYTHING ELSE. otherwise, how can you get to them if the line goes dead?

6. children are not little adults. this is said all the time in peds, but it's so important to remember. there are things that kids recover from faster and better than adults (hello, cancer!) but there are things that kids can't handle that larger adults would have no problem fighting (heyyy pneumonia)

7. treating people who are sick does not mean you can't add a little fun into your day. we had a bbq chicken party with one patient who had been in the hospital for almost 4 months, one of our patients with ewing's sarcoma started a friendship bracelet "shop" in her room (and swindled us all out of many dollars), and we regularly completed "medical rebuses" by drawing funny pictures on the whiteboard to create medical terminology.

8. when you think about kids, you always think about growth and development - almost any kind of illness or injury is okay if it doesn't affect growth and development so those crazy charts are critical and can tell you so much about how a kid is doing.

9. so much goes on at a hospital at night. and people's interactions get more intimate at night - I guess partly because we're the only people up.

10. if someone comes into the ER with decreased consciousness, here is a list of the "5 things you can do while someone tries to start an IV" that take less than a 3rd year medical student knowledge to know how to do : 1) get a history, especially allergies medications and chronic medical issues, 2) do a physical, especially vitals 3) give oxygen, 4) get a glucose, 5) put an AED on their chest (just in case)