Typical....

Some people think routine is boring or that sameness and repetition can lead to a monotonous and mundane life. Well, in many regards, I agree. But with adventures I have encountered in the last few years, and multiple moves and separations and changes, a weekend like this makes me thankful for "typical weekend." Since JT and I have known each other, we have both been HUGE sports fan. Those of you who know us are acutely aware of this. And though JT was a basketball coach and fan as long as I have known him, the fall sports season has always been our favorite. Saturday College Gameday Football on ESPN, NFL Sundays, and baseball playoffs. While I was in Dominica and last year moving around, we had to forfeit this much loved part of our year and our relationship. Well, this weekend is the first one of the year. AND the Cubs are on TV, which is rare in NYC Yankee/ Mets land. Plus we have been following the Dallas Cowboys on HBO's Hard Knocks, so we can watch them tomorrow. As well as watching UK vs. UofL.... I know most of this is not of interest to anyone, except, well me. This goes with out saying that between quarters and innings we, well, I, will have to watch politics.... Such is life, but now, at least, it is starting to feel like real life.

Also, I know I am weird but I love sending cards. I love shopping for, picking out and sending cards. If you are close to me, you know this to be true. Today, I wanted to go to Hallmark to just browse. JT just laughs at me and goes along. The only compromise was that if he let me "card shop" for people I had likely sent a card to last week, I had to let him listen to as much George Jones as he wants....AND let him sing as loudly as he wants. I guess it was worth it. I got to buy some cards, but had to listen to "Who's Gonna Fill Their Shoes" and "He Stopped Loving her Today." But, again, I guess it is worth it.

Well, I am going to go study pediatrics and review old material. I have some week areas that need freshing before starting surgery! Have a great weekend!
~nat

A Set of Lungs...

Today was the last day of my week in the nursery, and I will truly miss it. The nurses are kind and happy and pleasant to be around, unlike most other floors. The doctors, in general, are more optimistic and love to teach. And the patients do not talk back. They are precious, cute and tiny. and man can they cry!!!! They lose their minds over the smallest thing. Their swaddles blanks come unwrapped.....they cry. Someone bumps their cradle....they scream. They pee a little bit.....they lose their minds!!!! It is amazing that fixing the smallest detail can eliminate their problem and stop their crying or do just the opposite and escalate the issue....

Anyways.... it was my last day and I really enjoyed it. The others gave me a hard time because I would hold the babies like a football. I mean it makes sense to me....they are protected just like I protect a football. Oh well!

We do not have much planned for the weekend. I was supposed to run a 10k on Sunday but I have not trained well enough for it. I know.....I am soft. We may go tour West Point tomorrow, but we have not made up our minds.... I hope everyone else has a good weekend.
~nat

Babies...

Like I said before, I am in the nursery this week. In the morning we examine the babies, write progress reports, and everything like that. When there is a new baby, we do the initial newborn examine, complete an admission note, and present to the attending physician. But that is not the fun part. The fun part is playing with the babies....ie rocking them, feeding the ones whose moms are post c-section. It is amazing how swaddling a baby can almost invariably stop their crying, I mean as long as they are cleaned and fed. I am glad I have babysat and done the daycare thing before or changing a diaper would be foreign to me.

However, like the field of medicine in general, there are always problems. For instance, we had a baby yesterday who was diagnosed with congenital hip dislocation. The mother of another baby was diagnosed with ovarian cancer just after she delivered and it ruptured. She was in the ICU until today and the baby had only been held when the dad came down in the evenings... It is just the nature of the field I chose. The happy with sad.

Well, I am going to go. I have a presentation tomorrow and need to some reading before dinner. Have a great day.
~nat

Nursery Time...

Tomorrow, I start my week of the nursery and neonatal intensive care unit (NICU)....but mostly the nursery, since the NICU babies are so fragile. Supposedly, we get to examine the babies, change their diapers, feed them, meet their mothers, and so on. Every now and then, we may get a lecture, write a progress note, or do something medically related, but as a whole, we will be playing with the babies for a week. I will definitely enjoy it, or at least I hope that I do. I think this will be even more telling if a pediatric residency may be something I am interested in. Hopefully I will have some interesting stories from this week.

Well I guess that is about all I have for right now. I am going to finish watching Iron Chef America and head to bed pretty soon. I hope everyone has a great week.

~nat

Pediatric Cold....

Ironically, I have not missed a real day of my core rotations since starting. (Now in medicine I missed a few days but it was a different kind of rotation). My attendance is mostly due to the fact that I have not really been sick this year. Well, that was until I started pediatrics. By Wednesday night, I had a scratchy throat. And yesterday, the headache, running nose and cough came with it...Today, stomach issues. Tonight, thankfully, I feel much better. JT is happy I feel good now so that I will pick up my clothes and books. He hates my disorderly nature, but I am working on it. We all have faults, but some die hard.

I just finished reading a good book my friend Paige loaned me. If anyone is looking for a quick ready, I highly recommend this one. It is called "The Man with the Iron Tattoo." It is written by two neurologists in Pennsylvania and is about their careers and patients. It is a book that made me, as a future doctor think differently about my patient encounters and medicine as a whole. It was moving and educational all at the same time. And even for those who are not in medicine, it is still a great read. Two thumbs up from me!

On Friday, I was able to see a patient with cerebral palsy with the pediatric neurologist. Now he was a third grader, but he was born at 28 weeks, suffered from a lack of oxygen, and underwent an emergency c-section. He can read like a four year old but can't write because he does not have fine motor skills. He was precious. He could not verbalize much. However, when asked about current events, he told us that Barack Obama was running for president against the white haired man. It makes me thankful for my health and prayful for the health of my future children. But it also demonstrated the true capacity of children to smile and to love. He adored his mother and constantly grinned and smiled.

Well I guess I am going to go. It is midnight and need to get some sleep. Supposedly I signed for a 10k next weekend and have not really trained for it. So I am in for crash training this week or I am walking it. We shall see. And there is church tomorrow too. Oh, and I have to put together a power point presentation for Thursday on tracheo-esophageal fistulas and esophageal atresia....yuck!

Have a great Sunday.
~nat

Tied together by stuff too difficult to explain to someone new....

My friend Emily sent me this ecard today. It made very happy to hear from her. I also think it is such a great quote and ridiculously true, especially in some relationships. Regardless of the length of the time of the relationship, some are just involved to let someone else in. I just thought it was something neat to think about.

Today was my third day in the pediatric clinic, and so far I have really enjoyed it. The two female doctors that run the clinic are the kind of doctors I would hope to be. They take the time to teach, are kind to the patients and the patient's parents, and know what they are talking about. I have encountered so many doctors who can not do all three, like those that know everything but can not talk to people. I am sure you have met these doctors. And though these two ladies are not perfect, they do a good job of balancing, from what I have seen.

I am feeling kind of sick, strep throat-like. NO surprise considering I am in a peds clinic. I am going to a "going away party" tonight for my friend Eunice....she is moving back to DC for a research rotation....Should be fun, more fun if my throat was not so scratchy.

Well everyone have a great day.
~nat

Pediatrics....

I am starting six weeks of pediatrics tomorrow morning. Tomorrow is actually another tedious orientation at the hospital...my fourth time repeating the same routine. It is just part of it. This specific hospital makes you repeat the orientation for every rotation regardless of how many rotations you have done previously. Oh well!!! My friend told me that for pediatrics it is broken down into one week increments. Three are done at Wyckoff Hospital in Brooklyn, doing one week in the peds ER, one week in the NICU, and one week on the pediatric floor. While at St. Johns Hospital in Queens (where I did OB), you do 1.5 weeks on the floor and 1.5 weeks in the nursery and in afternoon clinic. So the breakdown should help time go by faster.

It seems so crazy that in only six weeks we will be leaving NYC and heading back home... The picture to the right is taken from Dad's deck at home. I love NYC in so many ways and dislike it in so many others. I am just really happy for the move, even though I will changing lives, yet again.

Well I am going to run a little bit while JT naps.... Talk to you soon!
~nat

OB Ends....

Today was officially the last day of OBGYN. Honestly yesterday was the last day because it was the day of our exam and on the floor. So today we did the "official" sign out and such. It felt great to sign out... Now on to pediatrics. Not much planned for the weekend...Catch up on sleep and pick up somethings at the store. We might go see Dark Knight. I hope everyone else has a good weekend.

~nat

Love...

So I do not have much to say today. Nothing big happened at work while I was covering the floor, just sitting. Right after I left, there were two c-sections and one vaginal delivery. I ate lunch with Paige, my friend from this rotation. One of the residents has taken to calling her Gail and me Nancy. And not jokingly....she really calls us that. How crazy is that. It is ridiculous and has now become a joke. Anyways, that is about it from today.

I found this poem saved onto my hard drive. Appropriate for my anniversary. It was quoted in Patch Adams, the Robin Williams movie. It is quite beautiful.

I do not love you as you were salt-rose or topaz,
or the arrow of carnations the fire shoots off.
I love as certain dark things are to be loved,
in secret, between the shadow and soul.

I love you as the plant that was never blooms,
but carries in itself the light of hidden flowers;
thanks to your love a certain solid fragance,
risen from the earth, lives darkly in my body.

I love you without knowing how, or when, or from where.
I love you straightforwardly, without complexities or pride;
so I love because I know no other way than this.

Where I does not exist, nor you,
so close that your hand on my chest is my hand
so close that your eyes close as I fall asleep

5th Anniversary (and Counting)......
8/9/08

We returned today from our weekend in Vermont. It was so nice to be alone, without using our phones or computers and being alone. We stayed in a great bed a breakfast in Wilmington, VT, a town with no fast foods, strip malls or anything modern. There was one grocery store, a post office, and a bank. There were inns and bed/breakfasts but no hotels. The town featured small cafes and pubs, craft stores and gift places. We drove into the mountains and rode around for a while. We also drove into the town called Marlboro, just for the sake of the name and saying we had been there. Our room was at the b/b was bigger than our NYC apartment. It had a king size bed, with a separate step down living room with a fireplace. There was a walk-in closet and a huge bathroom with a large two person jacuzzi tub. Breakfast was included with both nights and we had Saturday dinner there as well. The owner's wife is the chef. Prior to moving to Vt, she was a pastry chef at two San Francisco restaurants. Needless to say, the food was fabulous. In addition, the town was having a blueberry festival with everything from blueberry muffins to blueberry shortcake to buffalo wings with blueberry glaze. Crazy, huh? We did not have the wings... I enjoyed taking the time to be with my husband, away from the hustle and bustle, and talk to each other and just enjoy being together. I included a picture of the b/b we stayed in. Our camera was not charged and we discovered our charger was broken. Therefore, we had to use a ghetto disposable camera; thus, we do not have the pics back yet. Oh yeah, and, we stopped at the basketball hall of fame in Mass on the way home. Honestly, kind of a waste of time since my husband is a black hole of sports knowledge.... He already knew everything there.

Moving On....
So I do not have pictures back to our wedding and before. We did not have a digital camera back then and they are in old school format but I have pictures from June 2006 until now August 2008, which is a little over two years of our marriage. For those of you that know us, also know the years prior to these are not the most figure flattering years and possibly better that the world not see these pics. Anyhow, I have included pictures with dates over the last few years. It has been so crazy. We started in Gallatin, TN and moved to Athens, GA on our first anniversary for JT to work at UGA. In December 2005, I left for Dominica to live for 20 months without JT. While I was gone, JT had gastric bypass and lost between 150 and 170 pounds and then had to have gall bladder surgery. He also moved back to Louisville and worked at his home high school. We ran our first half marathon in April 07. I moved home in August 07, then we headed to Dallas for a six week test prep and since then have moved to NYC. And in two short months, we will be moving back to KY. What a five years!!!! I can't imagine the next five could have nearly as much change and moving around. Then again, who knows!

June 2006 at Tomato's restaurant in Dominica
August/September break in 2006, Indiana
September 2006; Morton's Steakhouse KY
Christmas 2006; JT's parent's house
March 2007; Portsmouth, Dominica with TruTru, the resident drunk
March 2007; Dominica; 4th Semester Banquet
April 2007; Running our first half marathon in Louisville
May 2007; JT's parents home
July 2007; Blue Bay restaurant in Dominica
August 2007; Bill Clinton's birthplace Hope, Arkansas (This is my least favorite t-shirt of JT's)
August/September 2007; Dallas, Texas USMLE Kaplan course
September 2007; Springfield, IL posing with wax figures of Mary Todd and Abe Lincoln
Sept/Oct 2007; The Cubby Bear in Chicago
Sept/Oct 2007; Outside Wrigley Field; Cubs clinched the NL Central
November 2007; our NYC apartment
December 2007; Rockefeller Center
Christmas Eve 2007; Celebrating our first and only NYC Christmas
June 2008; on Liberty Island looking back at Manhattan
July 2008; Central Park.

8/8/08 (How Cool)
Tired and Thankful....

I am tired because I have been awake for 27 hours, 40 minutes and counting. I also am tired of laziness. And because I am thankful that both of my parents in their own way taught me to do your work the right way the first time. I mean, really, who wants to go back and redo work that should have already been done. Obviously some of my sloth classmates. And, I know, I know, this is life and how people are. But for me, being anal retentive with my paperwork and follow through and basic tasks makes me appreciative of the mundane lessons I learned when small, and not so small. Like mom making us re-dust the house if it was not done correctly the first time.

Sorry for venting but I am completely perturbed....but not enough to keep me from sleeping for a few hours. Oh, and we delivered two babies between one and two am today....and their birthdays? 8-8-08. I think it is a cool birthday to have. And one of the moms was my hero. 4 hours of labor. NO PAIN MEDICINE, and an episiotomy with only a quick local anesthetic. What a lady!

Okay, goodnight at 924am. We are leaving for Vermont this afternoon. I will let everyone know how it goes! I am excited!
~nat

Welcomed Cries....

Her head popped out of the tiny belly of her mom. Her nose and mouth were suctioned with awkward blue bulb I remember in our closet from childhood. Her PINK little body slid into my hands as the doctors, resident and attending, clamped her cord, I held onto her. Then, she fell into my arms, screaming and kicking her little legs, as I passed from her mother's belly to the pediatrician. And she kept crying, and kept crying and kept crying. All I could think of was the silence and beeping machines from 24 hours previously as I looked at the previous baby, dead baby, as this beautiful pink little girl screamed her way into the world at 3:52 pm today. It is the good for the bad, the pain for the joy, the love for the hate. The antithesis of life....

I won't be able to write tomorrow because Kyle and I are on call. I am going to sleep all day Friday, take the train to JT's office, and we are leaving for Vermont. We are going to stay in at a bed and breakfast in Wilmington, Vt as a short vacation for our 5th anniversary, which is this Saturday, August 9th!!!! It has been a short but long, difficult, and wonderful ride. I would not change a moment (well maybe two or three).

I hope everyone has a great weekend if I do not get chance to write for a few days.
~nat

Coming in 3's....

The hands were pale white, gradually getting pinker the further up the arm. As I watched for an hour, the lips, from the outside in, turned from a plump pink and a ghastly gray. I lifted the lifeless curly-haired boy onto the scale. Seven pounds eleven ounces. Five days short of his original birthday. I rolled him to slide the yellow and green Winnie the Pooh snap up shirt onto his ashen body, placed a diaper over his bottom, pulled up the striped pants, and placed the too big hat on his head, I watched the nurse on his other side empty all of tears under her surgical mass. I rolled his feet in ink and stamped them, the usual practice I was told. Tears did not come. It was a moment when all the emotions you have should elicit tears but the ducts are dry. I was there.

She, the mom, said she had not felt the baby move in a few hours. Medical student, nurse, two residents, and one attending later the mother was told her third child, a son, was not "viable". Her baby was dead and was before she came to the hospital. Ten hours later, I was standing in the operating room waiting listening to the silence of beeping machines and laying a lifeless, beautiful boy onto a scale and carefully dressing him. They say it comes in threes. Deaths, births, life events. Well, I pray, sincerely and more than anything else for this week especially, that no other mother, no other father, family, doctor....no one has to hold a baby while staring so hard, begging the chest to rise and fall in a breath, feeling the disappointment when the small breastbone does not move and the pinkness turns blue-gray. So, please, if anything, do not let this come in 3s, at least for mothers.

And the enjoyment of my evening, dinner and watching Hopkins and Wipeout with my new friend, Paige, and JT, is overshadowed by the silent sorrow I witnessed today. How can you move on? I have done CPR on adults and had them die under my palms, but secondary, more times than not due to damage brought on by their own doing. But this perfect baby, this little guy did not have a fighting chance. So despite the fun, I think it is hard to erase what I saw, what I felt. I am sorry that the last two posts have been so sad, but at the same time, isn't this what my blog is supposed to be....my life in medical school, whether good or bad.

Apgar 0/0....

Today was a normal day for me. Woke at 5:35am after tossing and turning till nearly one in the morning, showered, dried my hair, put on my scrubs, walked to car, picked up my friend Kyle and rode to work. Kyle and I got out of the car at 6:38am, as usual, and went into the hospital to begin doing discharge paperwork with our group, or those that show up early with us. One the two people we work with was on call last night. He told us that during the night an emergency C-section was done, and the baby was dead. Fetal Demise. Stillbirth. Apgar 0/0. Agpgar is the numeric measurement of a baby's viability (ie.... Activity, Pulse, Grimace, Appearance, and Respiration) with each area getting between 0-2 points, for a possible 10. This baby, a little girl, was 0/0. The mother, who was under general anesthesia, was unaware for almost seven hours of her daughter's short life, a life that did not even make it beyond the womb. I will go into the medical logistics of what happened. It would be too much medicine and too long and too complicated. And regardless of whose fault, residents, attending doctor, nurses, or no one at all or everyone at once, a baby girl is no long with us and the 24 year old mother is left to wonder. Even more, one of the delivering resident's is 18 weeks pregnant with her own son.

So while this was a normal day for me, while I was tossing and turning at 12:38 am, a girl around my age was losing her first child. It is just one of those things that reminds us to our lives in perspective.

On Being a Nerd...

So I am a nerd, not hard to believe since I am in medical school. But I guess I have recently realized that part of being a nerd is being fond of and finding shear amusement in ridiculous things....ie....the below video. The new Swiffer wet jet commercials have quickly become my favorite commercials, making laugh every time regardless of how many times I have seen them or how silly they are. Likewise, I have found a new love for the summer show Wipeout where people go through crazy obstacle courses to win $50,000. And though it may sound bad, the chubbier and more unathletic the person, the more hilarious the show is. So, I recommend checking it out...Tuesdays at 8:00. Let me know what you think.

Peace.......
This is another scene at dad's houseboat on Lake Cumberland. It had been storming all day on the 4th of July and this makes me think of the calm after the storm. It also makes think about appreciating the small moments we have each day. One of the other medical students I am doing my OBGYN rotation with lost a high school friend this past Thursday. The friend died in a plane crash. While it is sad and I hate seeing her grieve, it reminds me that each day is gift and a blessing. And being so, we should try to be more peaceful. I have been reminded of this and am going to make attempts to realize the small moments of peace in each day.

On a lighter and different note, I finished my fourth week of OBGYN. The past two weeks I was in GYN surgery. Most days, there were not many scheduled surgeries, but on Friday we had eight on the schedule. My surgery was at the end of the day and was called a Bartholin's cyst marsupialization. The bartholin's gland is a small gland that is found on each side of the vaginal opening. In some women, it can become infected. Normally they can be drained in the office and treated with sitz baths. However, they can easily recur. If this happens they can form abscesses and more aggressive treatment is necessary. What we did was take a scalpel and make a small incision in the abscess, drain it (which is DISGUSTING). Then the skin is folded over and sewn open so that another pocket will not form and decrease the likelihood of another abscess. I know that this is way too much medicine. But at the same time, I thought it was a neat procedure and I learned a lot and actually knew more about the treatment and did more reading that one of the residents so that was good.

Well, have a good weekend. Lata Gata!