Sick Day

Earlier this week, Colin had his very first sick day. On Sunday, we noticed that he was coughing and didn’t have much appetite (which is horribly unusual for him) but we took him to daycare on Monday with high hopes. Then I disappeared from cell phone reception until noon.

When I emerged, I had missed several calls from Cheap and Close as well as Patrick, and had a text message reading, “Colin is sick. Want to flip a coin?”

No need. Thanks again, anesthesia!

When I arrived at Cheap and Close, I found Colin in a playpen pushed against the wall of the living room with the babysitter sitting on the far end of the room. She had quarantined the other kids in the back of the house and was herself sitting on the couch wringing her hands until I arrived. I swooped down upon my little boy, who smiled and said, “HI!” as usual upon seeing me, and held him close to my face. He leaned in for kisses, which I readily gave.

Cheap and Close, an admitted germophone, was horrified.

“Oh, dear. I hope you’ve had your flu shot, because kissing all over him will make you get it for SURE.”

This reminded me of the recommendations for parents of kids with the H1N1 flu that I heard on the radio: Wear a mask. Stay 6 feet away. Keep the ill child away from other people.

Seriously? A MASK? That won’t scare the poor, sick little kid at all. And I guess it’s lucky that Colin, at 13 months, can already prepare his own meals, change his diaper, and administer medication; otherwise I might have to come close to him to care for him.

6 feet and a mask? Please.

So Colin and I trucked on home. It was obvious that he was fine but didn’t feel great, so we flipped on some cartoons and snuggled all afternoon on the couch. Just me, him, Blanket, and a giant stuffed bear, all piled on top of each other, keeping ourselves warm, resting, loving, healing. It was good for us all.

(Except Blanket. Poor thing got vomited on and is coming unraveled. I don’t think snuggling is the answer for it.)

We stayed home the next day too, and my mother came to stay with Colin for a few hours while I ran downtown and took a little tiny 90%-of-my-grade exam. While I was gone she sent me this photo, with the caption, “Your Sick Kid”:



Poor guy looks miserable, doesn't he?

It is my opinion that he faked being sick so that he could stay home and snuggle with me, Blanket, and the bear. He’s pretty advanced, you know, so I don’t think it’s much of a stretch to think that he just knew what he wanted and came up with a plan to get it. Like Stewie, only bursting with love instead of plans to take over the world.

I started General Surgery today, miss my little bug already, and am so grateful for the “sick day”.

All Hallow's Eve

Friday began a ten day break for me from the grueling hours of surgery, taking the form of anesthesia rotation. It is blissful, so wonderful in its 7am – 1pm hours, so encouraging in its “Let the student try first” attitude. I worked for a morning and did more than in a month on surgery. It’s great.

And, since I’m home in time for lunch every day, I have every intention of being productive. Haircut Monday, cat to the vet Tuesday, doctor appointment Wednesday, meeting with important mentor-type person Thursday. At some point I will study for the exam, but not yet. For now, I’m rediscovering my maternal, homemaker side.

For example, on Saturday, I made a pie. No, really, I did! Like, in the oven!



I rolled out the dough and spent approximately six hours (unfortunately, that it not really an exaggeration) trying to get it in the dish. I very well might never make a pie crust again. Horrible, evil things, pie crusts.

Also, since it was Halloween, after all, I carved a pumpkin and dressed up my little one in ridiculous garb. Oh, how I loved it, but the poor child was miserable.



That is the best photo I got, and trust me, there were a lot of choices. He was okay with his costume as long as the hood part wasn’t up. But the second his head was covered he writhed and screamed. So it didn’t last too long. Instead we switched to a pumpkin sweatshirt, courtesy of The Best Nephew Ever.



Shortly thereafter, Patrick ate the first piece of Halloween candy of the year. He bought he candy weeks ago and we were so, so proud of ourselves that we didn’t get into it early. Then Patrick had to go and break our record by eating this candy at 5:30. I think he looks rather like Jaws from James Bond. Am I wrong?



Next year, we’ll walk around on a hunt for candy, but this year we stayed home, Colin greeted kids at the door with his favorite words: "HI!" and "YEAH!" His enthusiasm never dies and I think we distracted some of the kids from our candy with his raw pleasure at having someone to say "HI!" and "YEAH!" to. That is, until he had an epic meltdown at 6:30 and went promptly to bed, which left Patrick and I to growl at kids for trick-or-treating without costumes. Each time the doorbell rang the dogs barked and the baby woke up, and it was usually some teenager dressed as a "skater" or a "rapper". So we turned our light out early, hid in the back room, and ate candy, telling stories of past Halloweens and planning Colin’s costume for next year, when he’ll have enough teeth to be eligible for candy consumption.



Growing up is so much fun.

Surgery, Part One

Firstly, let me thank you all for your very kind and very helpful responses to my last post. I will let you in on a little secret, one which you may have guessed: I like to exaggerate in order to make a point. Upon rereading that last entry, I see that I… made my point quite well. It does speak to my level of exhaustion and exasperation, and our house is a real disaster, it’s true, but you don’t have to worry for our actual safety or health.

(Unless you count this morning at 4:45 when I was leaving for work and ran into a bucket of laundry that Patrick had left in the hall. I know I should be glad that he actually does the laundry, but the giant bruise on my shin is not feeling grateful.)

In medicine, we like “clinical vignettes”, where a case is presented with typical findings of a disease or problem and you theoretically remember the learning points better because it was in the context of a pseudo-real case. I will employ this technique now to attempt to demonstrate the two sides of surgery that I experienced over the last month.

1

It was my first actual surgery. Of all things, it was a liver transplant, a huge, long, dramatic case. It was my first time to scrub in and be expected to learn something since starting the rotation two days before and I was more than a little nervous. Though they were telling me why one technique of hepatectomy (liver removal) was superior to another, I was actually trying to figure out what was sterile and where to put my hands, why the nurse kept squirting the surgeon’s hands with water, and why in the world they spent so much time moving stuff around and just looking into this cavernous hole they’d made in this poor person.

Without any doubt, the best part of a liver transplant is the moment that everything is hooked back up and the floodgates are opened. The surgeons have sewn together all the vessels from the person to the new liver and the unclamp them to let blood flow through the new liver for the first time. What makes this moment so great is not just the “sink or swim” excitement, it is the fact that, as the blood makes its way through the new organ, the liver turns from the pale gray color it got being on ice while being transported to a dark reddish purple. The color advances over the curve of the liver as a wave. It is stunningly beautiful.

On this particular night, things were going well, people were generally happy, and I watched this rebirth with my mouth hanging open. I thought that I’d never seen anything so incredible and it occurred to me that it was like watching a sunrise, the blood pulsing through this life-saving organ and giving this lucky patient another day to live. I was thoroughly moved and exhilarated.

The lead surgeon picked that moment, the same moment that I was taking deep breaths and blinking back tears at the majesty of it all, to throw a complete fit. “How am I supposed to throw a stitch there, with my eyes closed, you jerk? Get your hands out of the way!” I tried to focus. Was he talking to me? No, I wasn’t touching anything. Instead he was talking to his colleague, another surgeon on staff. “Move! What are you doing? Can you not see that you are in my way?” He threw his instruments down and stepped back from the table. “I can’t work like this.”

He actually said that, really. He said, “I can’t work like this” and folded his arms over his chest, glaring at the other surgeon who never even looked up. The lead surgeon pouted in the corner like a little girl in a sandbox who has had her shovel annexed by the other kid. I have nothing against little girls, love them, used to be one. But little girls in sandboxes do not belong in the operating room.

Eventually, he came back to the table and finished the case. As he left, he clapped the other surgeon on the back, saying, “Nice job today, thanks for your help,” and walked out, whistling as he went.

It’s just another example of the well known sentiment: Surgery would be great if it wasn’t for the surgeons.

2

I had the unbelievable luck to be invited to go on a liver procurement. I joined the team at a local private airport where we boarded a chartered plane and flew about an hour to an outside hospital. As they say, organs had “become available” and we went to get them.

It was fascinating to visit another hospital and see how things are done elsewhere. For example, they keep their gloves out of the room, which is much smaller than the rooms I have become accustomed to. The place had been recently remodeled and the dressing rooms had squishy chairs to sink into after a case. Also nice was the fact that the people at this hospital didn’t know I was the lowly medical student tag along, lower than anyone else, and so I was treated just the same as the others. I was not made to wait until the staff and fellows had been gowned and gloved until I was, nor was I told to stand in the corner and not touch anything. Instead, I walked right up to the table and was treated like I owned the place. It was a nice change.

The procurement went well. The patient had been in good health, but only the liver had been offered, so we were the only team there and could take our time. The attending was incredible. He took the time to identify all of the anatomy for me and quiz me on several different important vessels in the abdomen. I was doing pretty well, and I was so pleased to be doing pretty well, but we inevitably came to the end of what I remembered from my classes.

“What two vessels make up the portal vein, and what vessels make up those?”

Nothing came to me. I searched my brain, pulled up pictures in front of my eyes from books, but those spots were mysteriously blank. I started to sweat.

“Er… I used to know this, like seconds ago I knew this… Umm…”

The lights were so hot. The patient’s entire body was splayed in front of me and I was overwhelmed. Nothing looked even vaguely familiar, no landmark whispered hints to me, it was as if it were my first time thinking about anatomy. I could feel the surgeons and the nurses listening for my response and I thought I might stop breathing.

The attending chuckled softly. I thought he was laughing at me and I felt my stomach knot. But then he looked up at me, directly into my eyes, and his eyes were smiling.

“Don’t worry, there’s no pressure. You’re among friends.”

And suddenly I felt fine. I took a deep breath and let go of all the ridiculous tension I had just built up in my body. I could see again and feel my legs again. I was among friends.

I still didn’t remember the answer, but it didn’t matter. They told me and showed me and I saw and understood. (In case you’re ever asked: the portal vein is made up of the superior mesenteric and the splenic veins. The colic veins make up the SMA and the inferior mesenteric joins the splenic.) After the procurement of the liver and knowing of my interest in OB, he proceeded to talk me through a hysterectomy and point out the major places where complications might occur. “Don’t let them make you afraid of the OR. You can do amazing things in the OR, save people’s lives or make them worth living again. Practice, study, and have confidence in yourself.”

And, once again, I found it rather difficult to breathe.

To be taught in that manner, in that patient and accepting way, made all the difference to me and helped to make the evening one of the most enjoyable, educational, and memorable ones in my medical career. (Also, the plane ride was fun.) This particular surgeon enjoys the surgeon stereotype, crass and hardened and perpetually exhausted, which makes his generosity all the more impressive and appreciated.

I have been told that, upon deciding that one does not want to be a surgeon, the surgery rotation is about learning how to communicate with surgeons. I think it is good that I’m only halfway finished with my rotation; after dealing with these two extremes, I don’t think I’ve learned that lesson just yet but I think resilience and confidence are a good place to start.

Insight

Things have been rough around here lately. The sheets haven’t been changed in weeks. There is a solid inch of dog hair in the carpet. Colin is growing something of a mullet, which is a little bit endearing, I’ll just tell you, simply because we can’t seem to find time to get him to a haircut. As for myself, well, I’ve given up trying to run a comb through my hair, yesterday’s makeup seems to work just fine (or was it the day before’s?) and showering once a week seems luxurious. What I’m saying, in clearer and less “TMI” terms, is that we’re incredibly busy and I feel like our lives are falling apart.

We keep losing bills and are confused by the reminder letters. Sometimes Colin sleeps in his clothes. Once, I went to bed in the scrubs I’d worn to work that day, and then wore them to work the next day too simply so I could sleep an extra three minutes in the morning. This is the kind of busy that we are currently experiencing. The level of exhaustion is beyond explanation. It is physically painful to see sunlight, as it has been so long that I’ve lost my tolerance for it. I constantly have the restless, ramped up feeling of too little sleep combined with too much coffee. I recently started taking vitamins again because I eat such crap at the hospital cafeteria (not used to vegetarians, eh?) that my body has started screaming at me to supplement.

How do people do this? Keep up with their lives, make sure the house doesn’t fall down, bond with their children, succeed in their fields, without totally losing themselves in the passage of time? When is there time to write about your son or read a book your sister gave you for your birthday or walk with your devoted-to-the-end dogs? How do you maintain a marriage, or a credit record?

Because of all of these questions, as well as the ones I didn’t list, Patrick and I have, over the past few weeks, strongly considered hiring a nanny for Colin. An incredibly opportunity presented itself and, combined with our current life chaos as well as our crumbling relationship with Cheap and Close, it seemed ideal. IDEAL. I mean it, that word, I mean that the situation seemed like the best thing we could think of. And we were prepared to pay anything to have it.

Except that it is not quite ideal, though it is still close. It is very expensive, as nannies tend to be. Also, the nanny is not very flexible on the hours, which is a main concern of ours. I cannot blame someone for not wanting to work more than 45 hours a week, instead of the 60 or more a week that we do, but that doesn’t leave us with an easy choice. Do we fork over the money, money we don’t have, money that will only cost us more later, for better quality care, more attention, better food and eating habits, and more fun, but still have to find even more care to make up the hours difference? Or do we find some replacement, some alternative that is not ideal, not even close, but that we can pay for and still sleep at night?

So many questions, so few answers, so little sleep.

Help me, internet. Do you have experience in this matter? Were you raised by a nanny or a slumlord and how did it shape you as a person? You could change the arc of Colin’s future by your response – hopefully he will thank you.

Brief

I have not forgotten you, but I do seem to have lost my marbles.

Here is the news:

Surgery is long. Being in the OR is among the best things ever, but it is constantly ruined by the Jerk Face surgeons who are also in the OR. This has happened several times now and I have a whole post working about it wherein I discuss eloquently how grown men act like little girls in a sandbox.

Colin is still cute and still perfect. No change there.

I think I have gained five pounds already on surgery because I live on the graham crackers and soda in the patient nutrition room and I find this horribly embarrassing.

Today I lost my temper with one of the attendings. I told him that he was an insensitive, arrogant, abrasive old dinosaur and that I didn't appreciate his offensive way of communicating. I may never have been so angry in my whole life and it is a gift from God that I didn't cry into the opened belly of this poor patient over whose body this altercation occurred. Afterward, he told me that he liked me because I "didn't take any shit from anybody" and, while it did not change my opinion of him, it did change my opinion of myself. More on this later also.

We are considering getting a NANNY and I am terrified to become one of THOSE PEOPLE.

I get to work at 5:00am. That is seven hours from now. I am really, really tired.

12 Months

I’m not sure why this update is harder to write than the previous eleven, but it is, somehow. This month was not just Colin’s first time to swim or his first birthday party; all those things I could write about without getting this squeezing feeling in my chest. But it is more difficult to write about how, over the last month, my baby turned into a toddler. Don’t get me wrong, I’m excited that Colin is growing up. I want to celebrate each milestone, not mourn the passing of his infancy. But looking back over the last year, be it in pictures or stories or website entries, it is impossible not to feel nostalgic and even sad that the tiny Turnip that I made with my own body is now walking around my house and talking back to me.



He has favorites, preferences, which is incredible to me. When did he learn to do that? He chooses bananas over peaches and blueberries over everything. He very strongly prefers the blue blanket that my mother knit for him above all other things in life. He prefers using his left hand, though the right will work in a pinch. He likes the dogs to the cats, the living room to the den, and me to the babysitter. His favorite book is The Hungry Caterpillar. He sticks his chubby fingers in the little holes that the caterpillar ate and turns the pages that way. He squints his eyes and giggles when his finger inevitably gets caught and needs to be rescued.



One aspect of Colin’s life that has evolved this month is his relationship with Patrick. Obviously, the two of them always had a fondness for each other and enjoyed the other’s company. But something happened this month between the two of them and they are now Buddies with a capital B. I will not pretend to know what goes on in the mind of any man, whether he is 1 or 31, but I can say that these two boys bonded this month. I had no idea how much Patrick and Colin’s deepening relationship would intensify my relationship with Patrick. This is not something I expected, since all you hear about is how your life becomes your kids and you lose touch with your spouse. On the contrary, the closer Patrick and Colin get to each other, the closer I feel to each of them. Our time together has become so much fun this month, like we are all realizing that we three belong with each other, that, together, we make a family.



As I mentioned, Colin went swimming for the first time and it might have been the happiest I have ever seen him. He laughed and splashed and fearlessly threw his head back and forward to get the full swimming experience. It was one of the happiest and most fun experiences of my life too. That is, it was until Patrick took Colin on his shoulders, went into the deep end and lost his footing. Oh, the screaming. Not by Colin, mind you, he was fine, thought it was hilarious, just had a little choking but he recovered nicely. No, the screaming was by me. At Patrick. What was I just saying about us all getting along so well?



And then, of course, his birthday. The morning before Colin’s birthday, it occurred to me that, one year prior to that moment, I had been in labor. It was about 8:30am and I realized that, last year, I had been in labor for six and a half hours already and had twenty-six hours to go. My God. Did I really do that?



Sometimes I think about the person I was before Colin was born, even when I was pregnant with him, and I am humbled. I am not always clear where my religious beliefs lie, but I believe in a bigger picture, a larger purpose, a greater plan and I have never felt so sure of that as I have since Colin was born. Colin came to us at a time when things were turbulent in life, our careers, and our marriage and his presence was transformative. In being required to care for someone else before myself, I learned what it means to help others and how to put them first. In using my body to nourish and sustain a child, I also learned how critical it is to take care of myself so that I may care for others. And in striving to provide a safe and happy environment for Colin, I learned the importance of caring for my relationships, especially with Patrick. I am better because of Colin. A better wife, a better (student) doctor, a better person. All because of a Turnip who grew into a Colin who made me a mother.

Surgery So Far

After two and a half days of relatively painful orientation (at least we got to wear scrubs) I finally started my surgery sub-specialty rotation yesterday late morning. The intern came to fetch me and brought me into rounds, where the attending, who talks just like Taub from House with the notable addition of “eh?” and “aboot”, said, “Did someone just come into the room?” without looking up from his computer. The intern stumbled over his response, eventually communicating that a new person had indeed entered and it was Katie, the new medical student.

“Hello, student. Now back to rounds…”

I got to work this morning at 5:30am, which actually wasn’t as bad as I’d feared but now I am falling asleep. (It’s 7:30pm.) My team has yet to visit the OR since my addition to the team, which I think is why I am bored already on this rotation. Today I rounded three times on the same people, devised a more efficient way to put together “the list”, and went home. I don’t get to follow any of my own patients, nor do I get to present anyone in rounds, talk to any patients, or touch anyone for any reason. (Swine flu!) (Although I did get to remove someone’s staples yesterday. That was fun in the absence of anything else to do.)

Unlike Family Med, I expected to be really busy and stressed and have a ton to learn for Surgery. So far, no one has even talked to me, much less allowed me any actual responsibility. The surgeons are all restless and grumpy and picking on everyone because their hands are feeling twitchy after being out of the OR for so long. It’s a weird feeling to hope that someone gets sick and needs to be taken to the OR, but I, well… you understand, right? I don’t actually want someone to get sick, of course. It’s just OH MY GOD someone get sick so we can wash our hands really well and them stick them in the patient’s belly.

Sorry, was that too much?