the thrill of hope

the thrill of hope, the weary world rejoices

for yonder breaks a new and glorious morn

this christmas, I feel like I have grasped a new meaning of christmas -

hope in a time of the greatest darkness.

hope for the weary.

as one who has truly joined the ranks of the weary this year, I am feeling more and more touched by the spirit and wonder of christmas.  chris and I are back from hawaii with his family and up in the northeast with my family to celebrate and rejoice for the next week. just this morning, my dad and I picked up antepaste for the coming feasts and the line at our favorite italian market in town was literally out the door.  no worries though, as the ten guys and ladies behind the counter were pros, the guy took my order (of about 10 different things) and got it all just right. ofcourse, while we were waiting, I also got to hear about what was in the stuffed peppers and sample christmas cookies and sopressa that the woman next to me offered straight out of her basket, saying I just must try them.  I love the holidays.  family, joy, hope.  so much hope.

speaking of which, enjoy this beautiful flash mob by berklee students at the MFA in boston:

On Holiday

I made it! I am halfway through intern year as an ob-gyn and I finally have my first vacation!  

My plan was to try to take two weeks in a row over the holidays because this way we could spend time with Chris' family and my family- but it meant a lot of waiting for all my days off at once.  Now that I'm here - in Hawaii (!!) and on vacation with no near end in sight, I'm so glad we did it this way.

This is my early morning view from the hotel balcony.  Pretty sweet, huh?  I've been getting up earlier than everyone by several hours because not only am (was) I on east coast time, I was on residency east coast time, meaning up at 4:45, asleep by 10:30.  It has actually been great though, as it has given me a few hours to myself before the rest of the day starts to reflect and get a bit of studying in.  

But the days have been just perfect for vacation for me.  Wake up with hours to reflect or work our by myself. Breakfast and then heading out - to a beach, for a hike, something active! Then by he time the rest of the world is up and crowding us, we are ready to head back for lunch and calmer afternoon activities like swimming in the pool, playing board games, and reading on our own.  It's a bonus that my niece (5 yo) and nephew (2yo) are here, as they provide oodles of entertainment!  We have definitely had all sorts of vacations in the past but right now this balance of play and rest, balance of together and solo really works.

How is your ideal vacation time spent?

Since not only us but also my future brother and sister and law are planning a wedding, we have been talking a lot about how to organize future family vacations.  My other brother and sister and law (the ones with the kids) said they have just decided to alternate thanksgiving and Christms between their two families each year, and now have coordinated with his whole family so they all do the same thing.  We decided we should just all coordinate with them.  That way, we can all plan with our other families well in advance.

How do you organize the holidays with your families?  

As mine gets bigger and more wonderful. We are still finding new ways to navigate it so that we get to revel in everyone's company.

That's all for now, got to get back to he vacationing! 

Happy and Merry holidays!

e

how a baby is born

if you're reading this, you probably have noticed that I have not written a blog post in over a month and a half. if you know me, you know that that means I probably have a whooole lot to write about. where to begin?

Well, to start, I just completed my month as the intern running the labor and delivery floor. I use "running" loosely, as I'm definitely and positively the intern. I also use "labor and delivery floor" as often it felt more like a cardiac floor or an Emergency Room or a psychiatric ward or a nephrology consulting office.

Oh yes, there were also beautiful normal vaginal deliveries.

One woman had been working for approximately 9 months on her "delivery playlist" which was just amazing - so much Alicia Keys.

One new dad kept saying to me "Can you believe it? Can you really believe it? We are parents!" about a million times with this huge grin on his face like he had just won the world's biggest prize without very much work at all (which, in some ways, is exactly what happened, right?).

One woman delivered her baby and then literally moments later was up walking in the hall with her three year old, saying hello to all the nurses.

One woman delivered beautifully in a squatting position and told me that she thought her delivery was smooth because she had been swimming throughout her pregnancy; in fact, she had been swimming comfortably only hours before her contractions started.

But there were a lot of stat cesarean sections, a lot of baby's born early and requiring more support from the pediatricians than anyone wants their baby to need. There were a lot of sky-high blood pressures that scared us about seizures. There were placentas that broke off the wall of the uterus and threatened to deprive the baby of oxygen and have the mother bleed to death. There were babies that were so big that even making a large incision, delivering them took a lot of strength and pressure.

But birth is amazing.

And the things that we can do - that I can do - to help make it safer and better, are amazing.

Despite having been on for about 6 weeks straight (yes, weekends and all),
there's nothing like looking into the eyes of the world's newest human being and getting to be the first one to say,

"hey baby, welcome to the world; we are so happy to have you here"


more soon.

Poetry Tuesday: Persimmons

For this poetry tuesday, a poem I just re-discovered that is a favorite of an old friend:

Crush
by Ada Limon

Maybe my limbs are made
mostly for decoration
like the way I feel about
persimmons. You can't
really eat them. Or you
wouldn't want to. If you grab
the soft side with your fist
it somehow feels funny,
like you've been here
before and uncomfortable,
too, like you'd rather
squish it between your teeth
impatiently, before spitting
the soft parts back up
to linger on the tongue like
burnt sugar or guilt.
For starts, it was all
an accident, you cut
the right branch 
and a sort of light
woke up underneath,
and the indelible fruit
grew dark and needy.
Think crucial hanging.
Think crayon orange.
There is one low, leaning
heart-shaped globe left
and dearest, can you
tell, I am trying
to love you less.

welcome, october

how lucky am i that my first day off in over two weeks is the first day of the best month of the whole year?  well, and coincidentally, the day the rest of DC is also off (thank you Mr Speaker).  my plans for a whole day to myself in the city I'm making my life is to read in bed all morning, slowly sipping coffee and using the other parts of my brain (check!), meet a friend for brunch to hear about the wonderful world of politics, head to a vinyasa yoga class to get all stretched out, and then to the Hirshorn Museum of sculpture and art, back home to do a bit of educational reading, make dinner for my husband-of-the-future and myself, and curl into bed with one of my new books.  what could be better?

~~~~~~~~~~~~~

"I am so glad I live in a world where there are Octobers" 

-Anne of Green Gables

Thoughts for a crazy weekend on call

“You're a poem?' I repeated.

She chewed her lower lip. 'If you want. I am a poem, or I am a pattern, or a race of people whose whose world was swallowed by the sea.'

'Isn't it hard to be three things at the same time?'

'What's your name?'

'Enn.'

'So you are Enn,' she said. 'And you are a male. And you are a biped. Is it hard to be three things at the same time?”

From ― Neil Gaiman, Fragile Things: short fictions and wonders

To Eat & To Watch: 30 and chick peas

In my new (old) obsession with TedTalks while cooking, I serve you Psychologist Meg Jay talking about some lessons for your 20s and a recipe for a dutch baby pancake.

TO WATCH: Meg Jay

   "the only things required  to do something meaningful

 are a good idea and not quite enough time" 

(or something close to that)

A Summary of her Advice to 20-somethings:
(1) - forget about having an identity crisis and get some identity capitol
(2) -work your friends-of-friends-of-friends connections, they might lead you to your next love, job, house, true friend/family
(3) -choose your family of friends intentionally

TO EAT:
Chickpea Salad
(adapted from Martha Stewart's Meatless Mondays)


I'm actually obsessed with chick peas and for some reason, when you bake them they take on this most unexpected, kind of salty, very spicy, super fun flavor.

ingredients:
chickpeas, paprika, garam masala, olive oil, salad greens, tahini, cucumbers

1. heat oven to 350 degrees F
2. drain chickpeas and rinse with cold water, dry a little bit with a towel or paper towels
3. spread the chickpeas on a baking sheet
4. sprinkle olive oil (just a little bit) on top and roll the chick peas in it so they're coated
5. add your paprika, salt, pepper, garam masala and roll the chickpeas again so they're covered
6. bake in oven for 30-40min
7. while they're baking, chop cucumber and prepare salad greens
8. take chick peas out of oven and pour onto salad greens and add chopped cucumber
9. drizzle with tahini and ta-da!  chickpea salad for you!

Autumn Reading List

one of my dreams since moving to DC has been to join a book club.  it seems like everyone is in them here.  I want to be one of the people who meets up with brilliant, clever, funny people to discuss how a book made them think, feel, wonder differently about the world.  I'm in the process of scouting a few book club options, but in the meantime, here's my personal fall reading list:

1. When Everything Changed by Gail Collins
a nonfiction account about the truth, myths and mystery in the US women's revolution

2. The Fault in Our Stars by John Green
nonfiction account of a 16yo with terminal cancer who is just. so. freaking. hilarious and profound

3. A Suitable Boy by Vikram Seth
a full immersion story about relationships and life in India

4. Expecting Better by Emily Oster
a chicago economist takes on the data about pregnancy recommendations

5. Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande (a  re-read)
a book about how medicine is human

6. The Collected Work of Nikki Giovanni by Nikki Giovanni
a book of poetry by one of the most wonderful modern poets

7. A Spiritual Guide to Midwifery by Ida May Glass
a nonfiction account of Ida May's midwifery practice from beginning to present day

8. A Practical Wedding by Meg Keene
because, you know, I'm planning a wedding but don't want to be a crazy, silly bride

9. Let's Explore Diabetes with Owls by David Sedaris
my official book club book and one of the FUNNIEST authors ever. I'm so excited

10. The Guernesy Literary and Potato Peel Pie Society by Mary Ann Shaffer
recommended by several friends, entirely of letters during WW2

what's on your reading list?  what should I add to mine?
Also, I love the paintings of people's bookshelves in Jane Mount's book - I keep thinking about what would be on my idea bookshelf.  Maybe at some point I'll have to actually design one and draw it out.


photo credit: idealbookshelf by Jane Mount

two stories: 9/2013

story 1*

After a month in the ICU, I worry I've become cynical.  Not because I don't believe in the power and might of modern medicine but because I worry that we use it too much instead of trying to help people cope with questions of happiness and mortality, quality and quantity of life.  Since my month has started, several patients have died in the ICU, all of them incredibly sick and all of the stories incredibly sad.  It's often a burden to carry the knowledge I've worked so hard to obtain about human physiology and pathology of different disease processes because it's often so much more obvious to me (and to the rest of the medical team) than to the patient's family that the patient - their husband, daughter, wife, brother - is not going to get better.

But this week I'm more optimistic.  I've been talking a lot with the partner of one of my patients, let's call the patient Tom and the partner Pat.  A few days ago (when I'm writing this, not when I'm actually publishing it) Pat was incredibly overwhelmed with grief.  Tom had been intubated for over a week and didn't appear to be getting any better.  Pat was plagued by the big questions that arise whenever a loved one is incapacitated and decisions have to be made by loved ones, including "is this what he would have wanted?"  Tom had come in directly from an ambulance after a motorcycle accident, had fractured his pelvis, arms, and legs, and had suffered multiple abdominal injuries requiring the placement of a feeding tube to give his intestines some time to heal.  He had also been intubated with an endotracheal tube and put on a breathing machine.  Tom had been through multiple surgeries at this point, had been given so much fluid to try to keep his blood pressure high enough to perfuse his brain and other organs that his skin was stretched and puffy.  His bruises that formed after the accident were turning every shade from blue to yellow and gave his skin a patchy appearance.  I talked to Pat most days and updated him about how we were caring for Tom and answered his questions about next steps.  But yesterday, Pat took me aside and just said to me, look.  I just want to know if you think he's going to get better, because I have to tell you, I'm getting discouraged.  Every day it looks like he is in more  pain, is more bloated, and getting worse.  And I totally got it.  Tom DID look horrible in lots of ways - the tubes, the lines, the sedation, the bloating, I tried to make myself see the picture that Pat was seeing so that I could fully understand.  But strangely, after four years of medical school and three months of intern year, everything I know now makes me look at Tom with great optimism; he's the kind of person who truly gets better in an ICU.  He had his reconstructive orthopedic (bone) surgery and it went really well.  The drains in his abdomen were taking care of a lot of the fluid.  His kidney tests looked great.   All of the cultures we had taken showed that he didn't have any infections.  Yes, he was sedated and using the tube to breath, but that wasn't because he necessarily couldn't breathe without it, it's that we we still determining if it could be removed, and were therefore sedating him so that he wasn't (appropriately) agitated by having a tube down his throat.  So I went through all of that - or most of it - with Pat and said, I know it doesn't look like it to you, but Tom really is getting better.  And Pat believed me, and it gave him hope.  I left for home that day thinking that it's these moments when I feel the most privileged, helpful, and just so proud of how hard I have worked to gain this knowledge and the skills to be able to explain them to help people cope.


story 2.

A few weekends ago, on a unique day off together, my husband-of-the-future and I biked to a farmers market in town.  We bought tomatoes, cheese, garlic, and iced coffee, wandered around a bit more checking out all the stalls, and then decided to bike home.  Our bike home took us on a bike path along a busy city street.  We were talking about what we were going to make for dinner when all of a sudden a motorcycle swerved into the intersection just as a taxi cap decided it would try to make the last second of a yellow light and the two collided in a loud crash.  Without pausing for one moment, both Chris and I biked right up to the accident, threw our bikes on the ground and went to the side of the motorcycle rider to assess him.  I'm sure if we had been a movie, the screen would have zoomed in on our minds scanning the scene for dangers, looking at the man to see if he was moving, breathing and if there was blood.  You would have seen us click through the steps of out-of-hospital resuscitation including CPR and rescue breathing.

And there may have been a flashback to another bike ride, in another time, when I didn't know what to do, didn't know how to be responsible for someone being injured, and instead of jumping into action, I froze.

The man turned out to be just fine.  He probably broke his ankle, but was otherwise completely injury free, just angry with the taxi driver.  During our assessment, other people had called 911, so by the time we were helping him move to the side of the curb, a fire truck was already arriving on the scene.   All in all, we didn't do much, but the fact that neither of us paused to think we didn't have the knowledge or the skills, but knew confidently that we did, was an amazing feeling in which to revel afterward.

*like all my stories about patients and my work, many details have been changed to protect the patient's and hospital's confidentiality, but the meaning is all true.  

To Eat & To Watch: manipulating the data

I've started a tradition (or habit?) where I watch Ted Talks while I cook, so perhaps this is a new tradition of a post that combines a must-watch TedTalk video and a must-eat recipe.  If you've never heard of TedTalks, I highly suggest you check them out.  It's a database of hundreds (thousands? hundreds of thousands?) of people talking about the most fascinating topics, and the best part is, every one has to be less than 20 minutes, so they are concise and profound without ever getting boring.  Here's one of my new favorites by Hans Rosling explaining (visually and like a sports caster) how our world dynamics are changing.  I may be a little biased because he starts out by talking about how we all assume that The Western World = long lives and small families and The Third World = short lives and big families, and then goes on to debunk it all.  Enjoy!

For more fun visualization of populations, check out this Racial Dot Map, from the Welden Cooper Center for Public Service.


Recipe: Shrimp Avocado Salsa
(adapted from Smitten Kitchen's Mama Canales-Garcia's Shrimp Avocado Salsa)


(photo credit: smitten kitchen blog)

ingredients&instructions:

-1 lb shrimp - de-vein the shrimp and take the shell taken off.  boil a pot of water, then turn off, throw shrimp in and cover for 5-7 minutes.  ta-da! cooked shrimp!  now chop into small pieces.

-2 avocados - chop into small pieces and put into a large bowl

-1 jalapeno (or less or more depending on your spicy preferences) - chop into small pieces

-3 tomatoes or a whole bunch of little grape/cherry tomatoes - chop into small pieces (you see where I'm going with this, right?)

-2 limes - squeeze all the juice in!  you really can't have too much

-splash of olive oil, a dash of salt, a shake of pepper

combine altogether, serve with cilantro, tortillas and/or good bread.  we ate ours with a decided-ly not mexican bagette and it was delicious.

august 2013

I know I've taken a late summer break from blogging about life/work as an ob-gyn intern, but I have lots of good reasons:

a hike in great falls

a wedding in calfornia (on a boat!  with all my future inlaws!)

bike ride dates with my ladies in the city

another wedding in california!

okay, this one's from the beginning of the summer, but sums up how I feel about summer in a nutshell:

(stay tuned for more serious thoughts on being an intern, 

I'm finishing up an ICU rotation -

and have had lots to think about):

Poetry Tuesday: A Time to Laugh

Today's poetry comes from my research to find readings for our wedding (I have some time, I know, but I just love thinking about the ceremony) but I think is very appropriate to my life right now, when I'm trying to not take anything personally and laugh at all my mistakes.  I think the last one is my favorite though - laughing when plans get changed because now I get to be spontaneous - to "take a piece of life and treat it with reckless abandon"!  Enjoy!

e

A Time to Laugh, By Sister Joan Chittister

1. Laugh when people tell a joke. Otherwise you might make them feel bad.

2. Laugh when you look into a mirror. Otherwise you might feel bad.

3. Laugh when you make a mistake. If you don't, you're liable to forget how ultimately unimportant the whole thing really is, whatever it is.

4. Laugh with small children. They laugh at mashed bananas on their faces, mud in their hair, a dog nuzzling their ears, the sight of their bottoms as bare as silk. It renews your perspective. Clearly nothing is as bad as it could be.

5. Laugh at situations that are out of your control. When the best man comes to the altar without the wedding ring, laugh. When the dog jumps through the window screen at the dinner guests on your doorstep, sit down and laugh a while.

6. When you find yourself in public in mismatched shoes, laugh as loudly as you can. Why collapse in mortal agony? There's nothing you can do to change things right now. Besides, it is funny. Ask me; I've done it.

7. Laugh at anything pompous. At anything that needs to puff its way through life in robes and titles. Will Rogers laughed at all the public institutions of life. For instance, "You can't say civilization isn't advancing," he wrote. "In every war they kill you in a new way."

8. Finally, laugh when all your carefully laid plans get changed; when the plane is late and the restaurant is closed and the last day's screening of the movie of the year was yesterday. You're free now to do something else, to be spontaneous ... to take a piece of life and treat it with outrageous abandon.

- Sister Joan Chittister, originally published in her book, There is a Season

(and recopied from the knot readings post)

everything that goes wrong

As an intern, any time there's a debate about whether something actually IS wrong vs. you DID something wrong, you always think it's the latter (at least I do).  The dressing is soaked? maybe I didn't close the wound or dress the wound correctly.  Her pap smear came back abnormal? Maybe I didn't do it correctly. The medication isn't working? Maybe I prescribed it incorrectly.  She's bleeding? Maybe I forgot to give her medications/ didn't do something completely.  This constant underlying mindset of "everything that goes wrong is my fault" is important in understanding this story.

It is one such struggle to find the right plane that this story takes place - I was running around in clinic, per usual, and my senior resident calls me into his patient's room to do an ultrasound so he can evaluate and teach me. Every new obstetrics patient needs an ultrasound to date the pregnancy.  One cool thing (well, obviously I think it's cool) about the developing fetus is that in the first, and really even in the second trimester, most fetuses are about the same size, giving us the ability to measure different body parts (head, abdomen, thigh bone) and accurately determine how long the woman has been pregnant.

For this patient, I introduce myself to the patient, explain what I'm going to do, she gives me an excited nod like "yes! show me my baby!" (women love their first ultrasound and I don't blame them) and I place the ultrasound on her belly.  By her last menstrual period, she should be about 20 weeks pregnant, which means the fetus should be pretty easy to see and measure.  I'm trying to scan quickly because I've already done 10 ultrasounds today and I have three patients waiting in rooms for me to get back to them, but also accurately so I can show my senior resident that I am capable of independence, so when it's difficult to find the right level of the head to measure the BPD, I get a bit impatient with myself for being so incompetent and slow.   Then I decide to try to measure the femur instead, because it's actually the more accurate measurement anyways, and can get a pretty good view of the femur, but it's measuring small - about 14 weeks.  I think to myself, "man, I'm such an idiot that I can't even measure a femur correctly" but decide after trying for a few minutes to move onto the abdominal circumference - but I just cannot get a clear picture of the fetal abdomen - everything seems a bit...squished.  At this point, my senior resident has been trying to correct my verbally for about five minutes (try moving your hand to the left, don't push as hard, make sure your angle is correct, no that's not quite it) and finally gets frustrated enough to just take the ultrasound probe from me and try himself.  I step away from the machine feeling like a complete and utter failure, not only because I somehow couldn't measure any part of the fetus correctly, but because I still have 3 patients who I'm keeping waiting in other rooms.  I mentally beat myself up for a moment and then a thought occurs to me:  "Elias!" I say calmly, "Can you check for FHM?"  this is code for fetal hearth movement, a tell-tale sign that a baby is alive and well.  I say this in code because I just realized I didn't do that at the start of the scan and reflecting on what I did see, there wasn't much movement at all.  Then, as Elias scans through the patient's uterus,  he and I both realize at the same time that this fetus is not alive, has not been alive for probably over a month.  The patient,still craning her neck to better see the ultrasound, asks us if we can tell if it's a boy or a girl.  Elias and I look at each other, and then, as the senior resident and the person ostensibly in charge, he says, "we are having a hard time seeing the baby's heart beat.  we need to check with a better machine."

He and I both know that no machine is going to show us a beating heart in this fetus, but as the doctors in training, we have a responsibility to the patient and to our attending physician, to make absolutely sure that we have not gotten something wrong.

As I stood explaining the next steps to the patient, I wished two things: first, that I did make an error and therefore there was some other explanation other than her baby had died, but second, angry at myself for being so self-doubting, so certain that all inaccuracies were from my lack of skill or knowledge that I didn't even stop to think: what if I am scanning this correctly and this baby is 6 weeks behind its dating with anatomy that doesn't look quite right.

It is an important lesson of intern year that I keep learning over and over again - yet can't seem to get quite right: trust in the knowledge that I do have and at least consider the possibilities if I assume that I do know what I'm doing some of the time.

*an instagram original of me staring into my coffee cup at 5am 

wondering what this day has in store for me*

~~

 "Gilean threw his head back and laughed 'a mistake? one mistake? you should be so lucky.  you'll make dozens!  I made four or five on my first day alone! Of course you'll make mistakes.  Just don't make any of them twice.If you do mess things up, don't try to hide it. Don't try to rationalize it. Recognize it and admit it and learn from it. We never stop learning, none of us."

-John Flanagan, Erak's Ransom

Wednesday 3 things:

1. courage

well, there aren't really 2 more things to follow that!
have a good week!

not to seek

I have been trying to restart my yoga practice and think I've finally found a studio that gives me the spiritual and physical work-out I need, with more emphasis on the former than I realized I needed.  I talk often with friends and family about the search for a spiritual community in our highly-educated, agnostic and scientific lives.  Especially as I get closer to establishing my own new family and going through the rites of marriage (most of which we are adapting and blending from all the spiritual and community traditions we like), I find myself thinking more about how to cultivate this part of my life - both within myself and as a more public acknowledgement of spirituality as an important part of my life.  

so for you, a public acknowlegement of this with a quote from Rumi and my favorite chant we have done in yoga class lately, the Gayatri Mantra.

"your task is not to seek for love, 

but merely to seek and find all the barriers within yourself 

that you have built against it"

-Rumi

the literal translation of this repetitive chant is:

"May we attain that excellent glory of Savitar the god:

so that he may stimulate our prayers"

Flashback Thursday: Augusts of years past

Flashback to Augusts past...

from my 100-mile relay

August 2011: the first test of motherhood
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.

August 2010: Rilke inspiration: live your way to the answer
I would like to beg you dear Sir, as well as I can, to have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language.

August 2009:  Atul Gawande's 5 rules of medicine

1) ask an unscripted question
2) don't whine
3) count something
4) write something
5) change.

magical moments

While biking home from clinic a few days ago (yes, the bike commute is the best!) I was thinking about how I wanted to go into this field because I like being able to offer support, guidance, and skills at women's most vulnerable moments - but that these moments don't always take the form of delivering a beautiful baby or removing a breast mass or uterus and curing someone's cancer, they are not always helping someone get pregnant after years of trying.  Often they are much less magical and women feel much more ambivalent about how helpful I'm being, and more frustrated or scared about their situations -

they're a woman who comes in from clinic after being told she has an intrauterine fetal demise (IUFD) for induction, a woman who thought she was coming in for a regular prenatal visit who is told she is in preterm labor and going to deliver her baby months sooner than she had planned, a woman in her 40s with symptomatic fibroids (pain, bleeding) who has never had sex, but doesn't want to have a hysterectomy because she doesn't want to give up on the idea that someday she could be pregnant, another woman in her 50s with vaginal bleeding for years who has never had a pelvic exam or a pap smear who you have to counsel about her high risk of cancer, a woman who fled her abusive family to come to a new country only to live with abusive "friends" here with few other options because she is still undocumented, another woman trying to figure out what she is going to do with her young child in labor because she has no one to watch him, or the woman with a urinary infection during pregnancy who refuses to leave the hospital, even after her antibiotics, because she is so afraid of the pain she isn't sure she can go through with labor, a woman spending her pregnancy in prison who hasn't slept for days because she cannot figure out a comfortable position for her growing abdomen on her one allowed mattress and built-in pillow.

** 

but I guess those ARE the moments why I went into this field: to explain what's happening with her body, to explain that it's not her fault, to explain what we are going to do to try to make it better or easier, to write prescriptions for extra mattresses, to talk to the other people in their lives with the authority of someone with knowledge and skills, to counsel about her options, to hold her hand and tell her that 

I'm just so sorry this is happening to her.

~~~~

"the wound is the place where the light enters you"

-Rumi

soy una doctora

me llamo Erica, soy una doctora aqui

apparently now I speak spanish. or at least am really, really trying to speak spanish.
this month, I'm assigned to our resident clinic, which serves a large spanish-speaking population.  One thing I love about living here is that I feel like I travel to different countries throughout the day.  During my morning commute, I feel like I'm in India - where people can disregard lanes and honk just to say hello (as well as to communicate several other, less kind, things), when I enter the hospital parking lot, I feel like I'm in Ethiopia, since all the men who work in the parking garage are Ethiopian with huge white smiles and absolutely no patience for my inability to fit into the parking spots they have chosen for me.  Later, in clinic, I travel between rooms and it feels like I go from El Salvador to Guatemala to Somalia to Cote D'Ivoire.  After clinic, travelling to happy hour, it's as if I drove down to Mexico, because our waiter tells us (in spanish) that these are the best nachos in town because the chef is truly from Mexico.  I don't know what's better - that nacho chefs exist or that I got to eat the illustrious final product.  When I coast back home on my bike, it's a bit like being in Amsterdam with all the bikes lined up one after the other along the river bike path.  Finally, while falling asleep, I hear Billy Holiday playing loud on our neighbors stereo and realize it doesn't matter where it is, I'm home.

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wednesday giggles

and because I'm still in a CS Lewis mood..

"hardships often prepare ordinary people for an extraordinary destiny"
-c.s. lewis

Poetry Tuesday: CS Lewis

Sonnet by C.S. Lewis

The stars come out; the fragrant shadows fall

About a dreaming garden still and sweet,

I hear the unseen bats above me bleat

Among the ghostly moths their hunting call,

And twinkling glow-worms all about me crawl.

Now for a chamber dim, a pillow meet.

For slumbers deep as death, a faultless sheet,

Cool, white, and smooth. So may I read the hall

With poppies strewn where sleep that is so dear

With magic sponge can wipe away an hour

Or twelve and make them naught.  Why not a year,

Why could a man not loiter in that bower

Until a thousand painless cycles wore,

And then - what if it held him evermore?

after a full two days off

nestling into our life here is starting to feel pretty good. I almost don't feel like I'll wake up to find my bike stolen. I almost don't feel like somehow my alarm won't go off and make me late for work. I almost don't feel overwhelmed by the idea of submerging back into the time warp centripetal forcefield that is intern year at the hospital. I almost feel well rested enough to almost not be worried that I did something today that hurt someone or prevented someone from getting better. I almost don't feel panicked that I signed up for four years of feeling way over my head with people's lives in my hands. almost.

and for laughs (??) a photo of a sign posted by the computers where we do the most charting....

Poetry Tuesday: Opposition

Opposing Forces
by Eamon Grennan

Even in this sharp weather there are lovers everywhere
holding onto each other, hands in one another's pockets
for warmth, for the sense of I'm yours, the tender claim
it keeps making—one couple stopping in the chill
to stand there, faces pressed together, arms around
jacketed shoulders so I can see bare hands grapple
with padding, see the rosy redness of cold fingers
as they shift a little, trying to register through fold
after fold, This is my flesh feeling you you're feeling.

It must be some contrary instinct in the blood
that sets itself against the weather like this, brings
lovers out like early buds, like the silver-grey catkins
I saw this morning polished to brightness
by ice overnight. Geese, too: more and more couples
voyaging north, great high-spirited congregations
taking the freezing air in and letting it out
as song, as if this frigid enterprise were all joy,
nothing to be afraid of.

someday

...and now I am solidly in my intern year! yup, that's right - the beginning of July is one of the scariest times to be in a hospital because everyone is brand new at their role - well not everyone, but it's the medical world's version of the start of the school year.

somehow in this week, I've taken care of women who are miscarrying, performed c-sections 9not by myself), managed several laboring patients - not to mention their partners, learned how to take care of common post-partum problems, helped separate several women from their uteri, helped a mom breast feed her baby in the ICU, circumcised a bunch of new baby boys, and learned a ton. Its hard to believe that I've had just one day off since we started (one day in three weeks!), with most of my days starting with me waking up at 4:30 and not leaving work until after 8. I still am running around like a chicken with my head cut off. I am only just figuring out what goes where, all the shortcuts around the hospital, where to get snacks in the middle of the day - you know, all the important stuff, but it is so awesome, that even though I wake up in the middle of the night thinking about a patient and wondering if I should have said/done/thought something differently, I really really love it.

so, my stories:

story 1:
I was in my first c-section a few days ago and I got to do my "half" of the procedure in a woman who had an emergency c-section before her due date, a rather scary version of a pretty basic and common procedure. Typically c-sections are performed by two surgeons and they mirror each other with steps, each working on the side with which they have the best angle. The c-section can basically be divided into three parts: (1) the exposure of the uterus, (2) delivering the baby, (3) repairing all the abdominal layers and controlling bleeding. You would think the first part would be the scariest, because the baby is still yet to be born and sometimes you want to get the baby out pretty fast, but actually, parts 2+3 are much scarier. Delivering a baby out of a hole that is not designed to deliver a baby is incredibly difficult and involves a huge amount of pressure on the top of the uterus (or bottom, depending on your perspective). So in this c-section, my attending delivers the baby and I am pushing on the uterus. Then the baby is out, the cord is clamped, and I realize the baby is looking a little blue and not really breathing well, just as my attending yells - take it to Peds (pediatrics). I felt like the world just paused as I looked around the room, through my mask, at everyone else's masked faces with their eyes staring wide, expectantly, at me.

That's when I realized that they meant ME. me? ME! ME to pick up this kinda blue, kinda not breathing, very slimy baby and carry it across the operating room to the pediatrics team. So I grabbed the baby's feet in the hold that they teach us, put one hand under his head, supporting his entire little slimy body with my arm and carry him over to the pediatrics team - where he started breathing and regaining color immediately. No one else even noticed how long those two seconds were for me, but I definitely was full-body blushing under my layers of sterile gown as we started to close the abdomen.

story 2:
I admitted a young woman in her early 30s for induction for low amniotic fluid and was with her all day as she slowly moved into labor. She had been trying to drink tons of water all day, because she thought that might increase her amniotic fluid (possible, unlikely). I explained to her that we give women fluids when they are in labor earlier than we want them to be (preterm labor) so there is one school of thought that thinks that women trying to get into labor should have less fluids (or at least not over-hydrate) because it concentrates the amount of oxytocin (the hormone that stimulates contractions) and explained to her what the monitors were saying. I think she liked that I included her in how we were interpreting the tests. But after a full day of laboring patients, it was time for me to go home just as she was reaching the active phase of labor. she thanked me, gave me a huge hug and said, so sincerely, so gratefully, "Erica - you are going to be such a great doctor someday. I will definitely be a patient in your practice!"

I was obviously very flattered, but then I thought - wait a second, I AM A DOCTOR! but I know what she meant - without supervision, making all my own decisions without having to get some (or maybe all at this point) approved by someone else.

that's all - to yoga and to bed to wake up and do it all over again.
I feel so grateful and honored to be able to do this for women.

The World is not Conclusion

This World is not Conclusion by Emily Dickinson

This world is not Conclusion.

A Species stands beyond - 

Invisible, as Music - 

But positive, as Sound - 

It beckons, and it baffles - 

Philosophy - don't know - 

And through a Riddle, at the last -

Sagacity, must go - 

to guess it, puzzles scholars -

To gain it, Men have borne

contempt of generations

And Crucifixion, shown -

faith slips - and laughs, and rallies - 

blushes, if any see-

plucks at a twig of evidence -

And asks a Vane, the way -

Much gesture, from the Pulpit -

strong Hallelujahs roll-

Narcotics cannot still the Tooth

That nibbles at the soul.

Flashback Thursday: June 2009-2012

For this flashback Thursday, I give you the wonderful month of June:
(click on the titles to check out the whole article)

June 2008: In Praise of the Man Who Asks Questions
In Boston, figuring out the dating scene.  While I'm not as concerned about this myself, I still find myself talking about this so much with my ladies:
If I were to give one general seduction tip (and this has been confirmed by many) it would be this: ask lots of questions... and then actually pay attention to the answers.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Love is the irresistible desire to be irresistibly desired"
-Robert Frost

June 2009: The Metrosexual Package

The summer before medical school - still in Boston.

Total Randomness but reminding me of a few people who have danced into my life lately: 

"...that quintessential California type, the overgrown and hyperactive child. Immensely gifted but flawed, he is a jumble of self-regard, self-confidence and self-immolation — potential greatness and a potential train wreck in the same metrosexual package."

June 2010: On Transitions

my first summer after medical school, leaving my new friends (and new lover, now FIANCE), but how perfectly fitting for right now:

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.

June 2011: What Love Means to Kids

I just love this post, and possibly see a wedding reading in the making...

“When someone loves you, the way they say your name is different. You just know that your name is safe in their mouth.” Billy – age 4

June 2012: Backyard Brewhouse

I really loved this night - Chris and I decided because we were only in town for a few days to head out to our favorite beer garden and just tell everyone to show up to see us.  It totally worked!

 

Only a Door (Poetry Tuesday a day late)

This felt like the most perfectly fitting poem for the start of residency:

Prospective Immigrants Please Note
by Adrienne Rich

Either you will
go through this door
or you will not go through

If you go through
there is always the risk
of remembering your name

Things look at you doubly
and you must look back
and let them happen.

If you do not go through
it is possible
to live worthily

to maintain your attitudes
to hold your position
to die bravely

but much will blind you
much will evade you,
at what cost who knows?

the door itself 
makes no promises
it is only a door.

I wonder if I changed in the night

“I wonder if I've been changed in the night. Let me think. 

Was I the same when I got up this morning? 

I almost think I can remember feeling a little different. 

But if I'm not the same, the next question is 'Who in the world am I?' Ah, that's the great puzzle!” 

- Lewis Carroll in Alice in Wonderland

and so it's begun...

this past Saturday began my first week of orientation as an intern in Obstetrics and Gynecology - and I don't know if I've ever been so excited and so nervous. We started with a two day course in Advanced Cardiac Life Support (ACLS) which is learning the skills and protocols that skilled health care providers (read: not the medical students we just were) use to save someone's life after s/he has suffered a cardiac arrest.  As part of this, we had to run a mock MEGACODE, which meant that we were given a scenario of a patient suffering a cardiac arrest and had to be in charge of making all the decisions, assigning tasks to the rest of the team, and adjust as things changed.  Even though it was just a (very sophisticated) mannequin, it felt more real than (almost) anything I've done in medical school.

after that, we started a long (and not always exciting) orientation to all the things that we should know or start to think about as interns.  Some of these are covered in any new employee orientation, regardless of your field, including how to get paid, how to sign-up for parking, etc.  But others are decidedly unique to medicine, such as Emergency Disaster Preparedness, Burnout and its Consequences for You and Your Patients, and Risk Management.  As part of the last part - which is normally a pretty dry lecture about how to minimize risks by maximizing systems, our CMO showed us the following video of a mother talking about the medical mistakes that led to the death of her young daughter at one of the best hospitals in the country:

Later, we had a panel discussion with the program directors of a bunch of different fields and they showered us with words of wisdom.  I'm going to write them down here in hopes that I can come back to this when I'm in the thick of residency:

(1) Don't take it personally.  

No patient is having their favorite day if they're coming into the hospital.

(2) Greet people warmly everywhere you go in the hospital.

(3) Remember to keep reading.  

If you skimp on reading because it doesn't feel like you have time, soon you feel like you don't know enough and that knowing enough is out of your control.  This program director suggested reading 7-10 hours each week (!!)

(4) Know when to ask for help

(this one seems critical, but also very, very tricky)

(5)  Don't be so self-important.  

Remember that even though your life will be super hard, it doesn't drop you off the hook for taking care of the people you love or the rest of your life stuff.

(6) Sit down.

not only because they'll be plenty of time to stand, but also because it reminds you (and your patient) that in that moment, s/he is the most important thing - not whatever you have to do next.

We ended today with a scavenger hunt around DC in the rain - taking photos at some of the most famous places in the world, and hanging in monuments dedicated to amazing people (Einstein, FDR, MLK jr, to name a few), giving me some perspective on contributing to society.

  

I ended the day with a very happy happy hour with all my co-interns - so wild to think that I'll be sharing insane, crazy, exciting, terrifying, sad, and exhilarating moments with these ladies for the next four years:

we've done it! (now we can start)

the past few weeks, it has felt like the manfriend (manfiance now!) and I have a "to-do list" 8,000 items long, and each time we knock one off, we barely have time to pat ourselves on the back before we realize that there are five other things we didn't even realize we had to do.

but I guess that's just how it goes when you graduate from medical school, move to a new city, set up a "real" house with your partner, start a new residency program, get a new car, and get engaged to your best friend, right?

every day we climb into bed completely exhausted, and I haven't even started residency yet! chris has just started orientation but we definitely both have the pre-starting/just starting jitters. it is somewhat familiar, actually, in a start of college sort of way (do I have the right shoes? oh no, what if I didn't have time to get all the books yet? do I know how to get to class? etc) all the stuff you realize that you JUST. FIGURE. OUT.

finally, finally, finally, I feel like our home is pretty set up. it's not all the way there yet (we still have folding chairs - nice folding chairs, but still - as our dining room chairs) but thanks to a trip back to my parents house to rifle through their basement, a couple leaving the city for dubai who sold us their furniture for super cheap, and our amazing but slightly crazy landlord who replaced our broken down fridge (but not freezer?) by carrying the old one out and new one in himself - it's starting to feel like we live here. check out the photos of the new place below.

chris and I are definitely starting to feel settled in. today I found another adorable neighborhood coffee shop, studied in my living room, and went on my first solo run in the city; it was just lovely. I start tomorrow (with an acute cardiac life support class!) and I'm just so excited!!

----------------

"what is not done today will not be done tomorrow"
- faust, translated from german by our landlord

Poetry Tuesday: Habitation

Because I'm thinking a lot about both marriage and living in a new house, a poem to restart Poetry Tuesdays by Margaret Atwood, called Habitation.


Habitation

Marriage is not
a house or even a tent

it is before that, and colder

the edge of the forest, the edge
of the desert
the unpainted stairs
at the back where we squat
outside, eating popcorn

where painfully and with wonder
at having survived even
this far

we are learning to make fire.

Life Moves Pretty Fast...

It's been a while since I've blogged but since then:

I spent some time with wonderful friends and family...

...hiked the Presidential Traverse in New Hampshire (a dramatic 23+ miles in one day)

....packed up our whole house to move to Washington, D.C.

(believe me, you do not want to see photos of this)

...graduated from medical school - now Dr. Erica! (and Dr. Chris)

...and I got engaged to my long-time love, Chris!!!!!!!!!!!