resident mama

Thanks for Local Farmers, Fathers-n-Law and Sustainable Oyster Beds

2008-11-28T14:44:00.000-08:00

Only a small amount of marital strife as we prepped on Thanksgiving Eve. My spouse is picky about pie. He had a Grandmother who was the best pie-baker this side of the Pacific. I suggested adding a bit of ginger to the squash pie. He protested at first, until I mentioned that ginger was an anti-inflammatory food which may help prevent Alzheimer's. I could literally see the neurons perk up and pay attention. And I was free to add all the ginger I wanted. The next day, Thanksgiving, while preparing all the other pro-inflammatory foods we would feast upon that day, I heard a story on NPR about real traditional Thanksgiving foods and they said that the Pilgrims used spices, including ginger.
We had a few more local food items this year than last. Each year I hope it is more. The squash that went into the squash pie was grown by my father-n-law, aka retired wood cutter, plower of snow, fix-it-guy turned squash farmer. He also grew the monster pumpkins that contributed to Pumpkin Frenzy last month. We had cranberry sauce made with cranberries grown by a local farmer from whom we also often get eggs, and produce in the summer. The turkey was raised by a couple who live about twenty minutes away and do just a little part-time farming. The oysters in the Baked Oysters Parmesan (not pictured) are from an oyster farm in a tidal river just south east of our own river valley. The potatoes, while not exactly local, were likely from our region. Oh ya, and the onion in the stuffing was grown by our friend Charlie.

Llama, llama red pajama, Thanks for voting>>Barak Obama!!!

2008-11-05T12:57:00.000-08:00

Cajun music speaks louder than words

2008-10-22T17:57:00.000-07:00

I can hardly even talk about what is about to happen in a few weeks...(the election that should not be named)...but this song sums it up for me. Thanks mama CM from NO.
Check out the Oct 22nd post.
http://supercenter.blogspot.com

Pumpkin Frenzy

2008-10-19T17:28:00.000-07:00

When Joan was asked how her husband managed to grow such big pumpkins she replied "throw a seed on a manuer pile."
This can only mean one thing....my favorite holiday is approaching...

Palin FYI

2008-10-01T17:11:00.001-07:00

Subject: Dispatch from Wasilla
> >
> >
> > Below is an email letter from a Wasilla resident, Anne Kilkenny, who
> > summarized her thoughts on Barracuda Sarah for her friends. The email letter
> > went viral overnight and onto the web. She was interviewed on NPR's All
> > Things Considered this evening.
> >
> > ABOUT SARAH PALIN
> >
> > I am a resident of Wasilla, Alaska. I have known Sarah since 1992.
> > Everyone here knows Sarah, so it is nothing special to say we are on a
> > first-name basis. Our children have attended the same schools. Her
> > father was my child's favorite substitute teacher. I also am on a
> > first name basis with her parents and mother-in-law. I attended more
> > City Council meetings during her administration than about 99% of the
> > residents of the city.
> >
> > She is enormously popular; in every way she's like the most popular
> > girl in middle school. Even men who think she is a poor choice and
> > won't vote for her can't quit smiling when talking about her because
> > she is a "babe".
> >
> > It is astonishing and almost scary how well she can keep a secret. She
> > kept her most recent pregnancy a secret from her children and parents
> > for seven months.
> >
> > She is "pro-life". She recently gave birth to a Down's syndrome baby.
> > There is no cover-up involved, here; Trig is her baby.
> >
> > She is energetic and hardworking. She regularly worked out at the gym.
> >
> > She is savvy. She doesn't take positions; she just "puts things out
> > there" and if they prove to be popular, then she takes credit.
> >
> > Her husband works a union job on the North Slope for BP and is a
> > champion snowmobile racer. Todd Palin's kind of job is highly
> > sought-after because of the schedule and high pay. He arranges his
> > work schedule so he can fish for salmon in Bristol Bay for a month or
> > so in summer, but by no stretch of the imagination is fishing their
> > major source of income. Nor has her life-style ever been anything
> > like that of native Alaskans.
> >
> > Sarah and her whole family are avid hunters.
> >
> > She's smart.
> >
> > Her experience is as mayor of a city with a population of about 5,000
> > (at the time), and less than 2 years as governor of a state with about
> > 670,000 residents.
> >
> > During her mayoral administration most of the actual work of running
> > this small city was turned over to an administrator. She had been
> > pushed to hire this administrator by party power-brokers after she had
> > gotten herself into some trouble over precipitous firings which had
> > given rise to a recall campaign.
> >
> > Sarah campaigned in Wasilla as a "fiscal conservative". During her 6
> > years as Mayor, she increased general government expenditures by over
> > 33%. During those same 6 years the amount of taxes collected by the
> > City increased by 38%. This was during a period of low inflation
> > (1996-2002). She reduced progressive property taxes and increased a
> > regressive sales tax which taxed even food. The tax cuts that she
> > promoted benefited large corporate property owners way more than they
> > benefited residents.
> >
> > The huge increases in tax revenues during her mayoral administration
> > weren't enough to fund everything on her wish list though, borrowed
> > money was needed, too. She inherited a city with zero debt, but left it
> > with indebtedness of over $22 million. What did Mayor Palin encourage
> > the voters to borrow money for? Was it the infrastructure that she said
> > she supported? The sewage treatment plant that the city lacked? or a
> > new library? No. $1m for a park. $15m-plus for construction of a
> > multi-use sports complex which she rushed through to build on a piece
> > of property that the City didn't even have clear title to, that was
> > still in litigation 7 yrs later--to the delight of the lawyers
> > involved! The sports complex itself is a nice addition to the
> > community but a huge money pit, not the profit-generator she claimed it
> > would be. She also supported bonds for $5.5m for road projects that
> > could have been done in 5-7 yrs without any borrowing.
> >
> > While Mayor, City Hall was extensively remodeled and her office
> > redecorated more than once.
> >
> > These are small numbers, but Wasilla is a very small city.
> >
> > As an oil producer, the high price of oil has created a budget surplus
> > in Alaska. Rather than invest this surplus in technology that will
> > make us energy independent and increase efficiency, as Governor she
> > proposed distribution of this surplus to every individual in the state.
> >
> > In this time of record state revenues and budget surpluses, she
> > recommended that the state borrow/bond for road projects, even while
> > she proposed distribution of surplus state revenues: spend today's
> > surplus, borrow for needs.
> >
> > She's not very tolerant of divergent opinions or open to outside ideas
> > or compromise. As Mayor, she fought ideas that weren't generated by
> > her or her staff. Ideas weren't evaluated on their merits, but on the
> > basis of who proposed them.
> >
> > While Sarah was Mayor of Wasilla she tried to fire our highly respected
> > City Librarian because the Librarian refused to consider removing from
> > the library some books that Sarah wanted removed. City residents
> > rallied to the defense of the City Librarian and against Palin's
> > attempt at out-and-out censorship, so Palin backed down and withdrew
> > her termination letter. People who fought her attempt to oust the
> > Librarian are on her enemies list to this day.
> >
> > Sarah complained about the "old boy's club" when she first ran for
> > Mayor, so what did she bring Wasilla? A new set of "old boys". Palin
> > fired most of the experienced staff she inherited. At the City and as
> > Governor she hired or elevated new, inexperienced, obscure people,
> > creating a staff totally dependent on her for their jobs and eternally
> > grateful and fiercely loyal--loyal to the point of abusing their power
> > to further her personal agenda, as she has acknowledged happened in the
> > case of pressuring the State's top cop (see below).
> >
> > As Mayor, Sarah fired Wasilla's Police Chief because he "intimidated"
> > her, she told the press. As Governor, her recent firing of Alaska's top
> > cop has the ring of familiarity about it. He served at her pleasure
> > and she had every legal right to fire him, but it's pretty clear that
> > an important factor in her decision to fire him was because he wouldn't
> > fire her sister's ex-husband, a State Trooper. Under investigation
> > for abuse of power, she has had to admit that more than 2 dozen
> > contacts were made between her staff and family to the person that she
> > later fired, pressuring him to fire her ex-brother-in-law. She tried to
> > replace the man she fired with a man who she knew had been reprimanded
> > for sexual harassment; when this caused a public furor, she withdrew
> > her support.
> >
> > She has bitten the hand of every person who extended theirs to her in
> > help. The City Council person who personally escorted her around town
> > introducing her to voters when she first ran for Wasilla City Council
> > became one of her first targets when she was later elected Mayor. She
> > abruptly fired her loyal City Administrator; even people who didn't
> > like the guy were stunned by this ruthlessness.
> >
> > Fear of retribution has kept all of these people from saying anything
> > publicly about her.
> >
> > When then-Governor Murkowski was handing out political plums, Sarah got
> > the best, Chair of the Alaska Oil and Gas Conservation Commission: one
> > of the few jobs not in Juneau and one of the best paid. She had no
> > background in oil & gas issues. Within months of scoring this great
> > job which paid $122,400/yr, she was complaining in the press about the
> > high salary. I was told that she hated that job: the commute, the
> > structured hours, the work. Sarah became aware that a member of this
> > Commission (who was also the State Chair of the Republican Party)
> > engaged in unethical behavior on the job. In a gutsy move which some
> > undoubtedly cautioned her could be political suicide, Sarah solved all
> > her problems in one fell swoop: got out of the job she hated and
> > garnered gobs of media attention as the patron saint of ethics and as a
> > gutsy fighter against the "old boys' club" when she dramatically quit,
> > exposing this man's ethics violations (for which he was fined).
> >
> > As Mayor, she had her hand stuck out as far as anyone for pork from
> > Senator Ted Stevens. Lately, she has castigated his pork-barrel
> > politics and publicly humiliated him. She only opposed the "bridge to
> > nowhere" after it became clear that it would be unwise not to.
> >
> > As Governor, she gave the Legislature no direction and budget
> > guidelines, then made a big grandstand display of line-item vetoing
> > projects, calling them pork. Public outcry and further legislative
> > action restored most of these projects--which had been vetoed simply
> > because she was not aware of their importance--but with the unobservant
> > she had gained a reputation as "anti-pork".
> >
> > She is solidly Republican: no political maverick. The State party
> > leaders hate her because she has bit them in the back and humiliated
> > them. Other members of the party object to her self-description as a
> > fiscal conservative.
> >
> > Around Wasilla there are people who went to high school with Sarah.
> > They call her "Sarah Barracuda" because of her unbridled ambition and
> > predatory ruthlessness. Before she became so powerful, very ugly
> > stories circulated around town about shenanigans she pulled to be made
> > point guard on the high school basketball team. When Sarah's
> > mother-in-law, a highly respected member of the community and
> > experienced manager, ran for Mayor, Sarah refused to endorse her.
> >
> > As Governor, she stepped outside of the box and put together of package
> > of legislation known as "AGIA" that forced the oil companies to march
> > to the beat of her drum.
> >
> > Like most Alaskans, she favors drilling in the Arctic National Wildlife
> > Refuge. She has questioned if the loss of sea ice is linked to
> > global warming. She campaigned "as a private citizen" against a state
> > initiaitive that would have either a) protected salmon streams from
> > pollution from mines, or b) tied up in the courts all mining in the
> > state (depending on who you listen to). She has pushed the State's
> > lawsuit against the Dept. of the Interior's decision to list polar
> > bears as threatened species.
> >
> > McCain is the oldest person to ever run for President; Sarah will be a
> > heartbeat away from being President.
> >
> > There has to be literally millions of Americans who are more
> > knowledgeable and experienced than she.
> >
> > However, there's a lot of people who have underestimated her and are
> > regretting it.
> >
> >
> > CLAIM VS FACT
> > *"Hockey mom": true for a few years
> > *"PTA mom": true years ago when her first-born was in elementary
> > school, not since
> > *"NRA supporter": absolutely true
> > *social conservative: mixed. Opposes gay marriage, BUT vetoed a bill
> > that would have denied benefits to employees in same-sex relationships
> > (said she did this because it was unconsitutional).
> > *pro-creationism: mixed. Supports it, BUT did nothing as Governor to
> > promote it.
> > *"Pro-life": mixed. Knowingly gave birth to a Down's syndrome baby
> > BUT declined to call a special legislative session on some pro-life
> > legislation
> > *"Experienced": Some high schools have more students than Wasilla has
> > residents. Many cities have more residents than the state of Alaska.
> > No legislative experience other than City Council. Little hands-on
> > supervisory or managerial experience; needed help of a city
> > administrator to run town of about 5,000.
> > *political maverick: not at all
> > *gutsy: absolutely!
> > *open & transparent: ??? Good at keeping secrets. Not good at
> > explaining actions.
> > *has a developed philosophy of public policy: no
> > *"a Greenie": no. Turned Wasilla into a wasteland of big box stores
> > and disconnected parking lots. Is pro-drilling off-shore and in ANWR.
> > *fiscal conservative: not by my definition!
> > *pro-infrastructure: No. Promoted a sports complex and park in a city
> > without a sewage treatment plant or storm drainage system. Built
> > streets to early 20th century standards.
> > *pro-tax relief: Lowered taxes for businesses, increased tax burden on
> > residents
> > *pro-small government: No. Oversaw greatest expansion of city
> > government in Wasilla's history.
> > *pro-labor/pro-union. No. Just because her husband works union
> > doesn't make her pro-labor. I have seen nothing to support any claim
> > that she is pro-labor/pro-union.
> >
> > WHY AM I WRITING THIS?
> >
> > First, I have long believed in the importance of being an informed
> > voter. I am a voter registrar. For 10 years I put on student voting
> > programs in the schools. If you google my name (Anne Kilkenny +
> > Alaska), you will find references to my participation in local
> > government, education, and PTA/parent organizations.
> >
> > Secondly, I've always operated in the belief that "Bad things happen
> > when good people stay silent". Few people know as much as I do because
> > few have gone to as many City Council meetings.
> >
> > Third, I am just a housewife. I don't have a job she can bump me out
> > of. I don't belong to any organization that she can hurt. But, I am no
> > fool; she is immensely popular here, and it is likely that this will
> > cost me somehow in the future: that's life.
> >
> > Fourth, she has hated me since back in 1996, when I was one of the 100
> > or so people who rallied to support the City Librarian against Sarah's
> > attempt at censorship.
> >
> > Fifth, I looked around and realized that everybody else was afraid to
> > say anything because they were somehow vulnerable.
> >
> > CAVEATS
> > I am not a statistician. I developed the numbers for the increase in
> > spending & taxation 2 years ago (when Palin was running for Governor)
> > from information supplied to me by the Finance Director of the City of
> > Wasilla, and I can't recall exactly what I adjusted for: did I adjust
> > for inflation? for population increases? Right now, it is impossible
> > for a private person to get any info out of City Hall--they are
> > swamped. So I can't verify my numbers.
> >
> > You may have noticed that there are various numbers circulating for the
> > population of Wasilla, ranging from my "about 5,000", up to 9,000. The
> > day Palin's selection was announced a city official told me that the
> > current population is about 7,000. The official 2000 census count was
> > 5,460. I have used about 5,000 because Palin was Mayor from 1996 to
> > 2002, and the city was growing rapidly in the mid-90's.
> >
> > Anne Kilkenny
> >
> >

How to make an apple pie

2008-09-28T17:02:00.000-07:00

The apples still grow even though the press is covered with dust.
Make friends with the frogs along the way.
Pick enough. Just enough.

Kid Music

2008-09-26T06:20:00.000-07:00

I like to dance like a dork to this music with my kid.

Letters

2008-09-16T21:23:00.000-07:00

She does it on her own initiative which I think is simply perfect. I just want her to play and use her imagination and cast broad strokes of gloppy finger paint across the big paper on her easel from Santa, but if she wants to sit down and practice writing letters then I'm all for it. She has a natural interest in the shape of letters. She likes to look at the Waldorphy alphabet books I bought that present letters in works of art: using a painting of a mountain with two peaks to teach the letter M, a river with two forks and a connector stream to teach R, three witches on a broomstick to teach W. For a while she has been writing her name. The S is usually backwards and I used to not say anything about it because she received such joy from the accomplishment I didn't want to ruin the experience with a criticism. But now she has written the whole alphabet, several times, and even a three word sentence once, that I feel like I can be more honest. And so the other day when she told me that they all wrote their names at preschool the other day I asked, "Did you write the S backwards?"
"Yes, I wrote it backwards, wait..no, I wrote it the right way."
I remember writing my name for the first time. I remember sitting at our dining room table with the plastic gold tablecloth in our government house in the valley. I remember the way the letters looked on the sheet of white paper. Same size. Same boxy feel. Four letters. I remember what it felt like to put letters on paper.

Water

2008-09-04T19:53:00.000-07:00

Swimming lessons has been a hit this year. Ms Perpetual Motion has conquered her fear of getting her face wet and plunges into the pool, the lake, the shower and the rain, nose first with glee. She graduated from the Pike class and is now an Eel. She wants to swim all the time, even on windy, sunny..yet chilly, early September days at the lake. Normally I would wimp out, requiring heat, deep heat, to go swimming in my old age, but I actually found the cold immersion convenient for keeping myself awake on post-call day so I could actually hang out with my kid.
I noticed at the beginning of the summer she was more content to hang out in the sand, sifting tiny pebbles, mixing sand-pie batter, creating muffin pan after muffin pan of delectable beachy delights. Catching frogs has also been a favorite pastime this summer. She has become quite adept at sneaking up on the green spotted creatures and deftly flicking her wrist and hence the net squarely down on their amphibian shoulders. But since the water-in-the-face feat has come and gone she has come back to the water as her primary source of play at the lake. She wants to swim with someone, preferably an adult who can also launch her into the air so she flops down in the water. She wants to tool around on the big floaty lounger. She swims underwater for a distance of three, four even five feet. She works her skinny fins hard to keep her button nose just above the surface and makes that gasping sound when she comes up out of the water after being completely under.
She was born in the water, surging out with the force of a mighty wave. Now, four years later she has found her welcoming water home again. She says she doesn't want to be astronaut. But I think this summer she has found an otherworld in the under, in and on water and is exploring it to it's fullest splash extent.

Circus

2008-04-29T17:47:00.000-07:00

We went to the circus the other night. My favorite part was the Rolling Diamonds, roller skaters on a platform several feet up. T enjoyed the pigs of course, evidenced by our freezer full of pork. He also seemed to notice all the groady details of circus performance like when the performing goats humped a little before their number was over and like when the performing dogs enjoyed a little snack of goat droppings before their number was over. It was like I was at the circus with two kids, a little one who kept saying, "How does she do that?" or "How does he do that?" and a big junior high age one. The finale involved a little too much patriotism for my liking and I think we could have done without the National Anthem in the beginning especially since it seemed to put a girl four rows in front of us into a seizure. The clown medics were right on task though and no, their O2 tank did not shoot out confetti, it really had oxygen in it. Did you know that blue cotton candy turns poop green? I guess I am just as juvenile.

This one is for you weasel.

Spring Tonic

2008-04-22T14:06:00.000-07:00

A few weeks ago I had my first dream about residency*. I was in the clinic with three other interns (first year residents) and every other resident in the practice was also in the clinic that day so it was really crowded. The senior residents were sort of enjoying a mild form of hazing by monopolizing the exam rooms with their patients and making it difficult for the interns to get their patients seen. My attending from third year med school rotations was there as well as a few other attendings I'd worked with in the past. They were directing us interns, trying to provide some guidance in the insanely busy clinic. One attending in particular who I have shared my med school mama musings and writings with in the past was even trying to protect us shivering lost little chicks and keep the disorderly senior residents in check. I don't remember details about the patients I saw in my dream but I know I did because the next thing I remember is writing my first prescription. I wrote a script for maple syrup.

*I matched at my first choice family practice residency. I start in June.

Happy Patriots Day

2008-04-21T17:36:00.000-07:00

Well, I was living in the South at the time.

Only Once A Year

2008-03-27T17:50:00.000-07:00

Happy Spring!!!

If you have rabbit ears that work better than ours you may have already seen this.

http://www.nbc.com/Saturday_Night_Live/video/play.shtml?mea=221774

Public Service Announcement to all Parents...don't bring your kid to the Emergency Room

2008-03-16T16:26:00.000-07:00

Unless of course your kid turns blue, does not wake up, gushes blood, needs stitches, ingests poison (call poison control first 1-800-222-1222 or on the way), falls several feet, gets hurt 100 or more miles away from your home or does something else that causes your heart to stop. The ER is not a good place to doctor your kid for colds (viruses), influenza, ear infections or chronic low grade things that you could wait to see your regular doctor for. Because the stuff is there they will use it: x-rays, cat scans, other people who are good with needles to stick your kid and draw blood. Why expose your kid to radiation for a cold or flu? And beacuse ER docs are just trying to do a good job in the world of medicine with no follow-up they will defer to antibiotics more often than a family doc or pedi might because they have better contact with you. So your kid might not really need a bacteriacidal agent and still get one. One day down the road they may get a more serious infection and need an antibiotic and it may be harder to find one that works because so many organisms are developing sneaky, witty, dammblasted resistence that is faster than we are because we have overtreated with the magical cillins, mycins and sporins at our disposal. Really, we don't even have to write the scrips anymore, just push a few buttons. I'll just briefly mention the cost thingy. I see a lot of financial waste with kids being treated for really, really, really non-emergent things in the ER. And this is coming from a member of the Green Party and if there was a Socialist Party in this country I would sign up in a tenth of a heartbeat. Single-payer I believe in thou.
I want to reiterate that I am a student and this post has not been evaluated by the AOA or the AMA and nothing I say should be taken as sound medical advice or doctoring know-how.
But this is my opinion. Next time stop and think, do I really need to take my kid to the ER for this? And if you have the luxury of stopping and thinking about it maybe you could just as well wait for your doc's office to be open.

Drugs...Bad

2008-03-10T15:13:00.000-07:00

The ER is the wildcard of medicine. You never know what the day will bring. Some days are slow and you see a few of the regulars: shortness of breath, fever, cough, low back pain, dental pain. Some days are busy and full of the kinds of ailments that are served much more efficiently and holistically in the primary care provider's office. Some days brings horror.
I recently witnessed my first cocaine overdose. Hyperthermia, hypertension, tachycardia: the sympathomymetic toxidrome, the awful truth of what can happen to what is essentially a kid. It was difficult to watch a person who is in leathers with dilated pupils, appearing scared and basically unresponsive but it is even more difficult to see their parent when they come in the room and know that it was the coke and wonder why it had to happen to their kid.
There was not a whole lot we could do for this person but we did everything we could. People who were on call at home came in to the hospital. Other ER patients had to wait. Medicines, hopeful antidotes, lined the counter and waited for their turn to be injected into the veins of a person who is not really with us anymore, and likely will not return. The overdose was strong, it antagonized many of the interventions. Finally a call was made to move the patient to a bigger institution. Maybe they could help.
As financially inefficient as it is I would rather have a day full of ear infections, colds and low back pain than a coke overdose. That is something the world could do without.

Feverish Snowstorm

2008-03-02T14:41:00.000-08:00

It is possible that the flu made it's way into our home this weekend. Yesterday Ms Perpetual Motion spent pretty much all day on the couch: napping, watching a movie and the most amazing part, just lying still. I am calling the sickness that gave her a fever a flu because I think it must have been to stop my girl in her tracks. The virus that set up shop was so powerful that it kept Ms PM from even wanting to participate in making cookies, with white chocolate chips. That is one superbug.
As the snow blew outside, Iris and I cuddled on the couch wrapped up in our fish print Mexican blanket that we purchased two Christmases ago when I had the flu on the beach in San Carlos, Mexico. A few sips of broth, orange juice and water was about all I could get into her. She didn't even want a whole white chocolate chip cookie that I had to make by myself. Her lungs sounded clear, her heart was beating fast and her little lips were cherry red and dry. She coughed off and on, said her throat hurt when she woke up and had a few sniffles.
I remember her very first fever. It was around Valentine's Day when she was 9 months old and we had just returned from a trip to visit friends (with sick kids) up the coast. Back then I had the medicinal power of breastmilk. I held her all night, alternating between the rocking chair and the couch. I watched her like a hawk because I didn't know what else to do. She slept most of the night, off and on. I slept a little of it off and on. She seems to have inherited her Daddy's knack for going to sleep when sick and waking up better.
This morning brought requests for water and giddy chatter. She hopped right up out of bed and sauntered downstairs ready to dive into the day. By mid-day she was hurling herself into the snow outside and crawling into her snowcave that she dug out of the gargantuan snowbank in our driveway.
The superbug had left, disgusted by a peacefully sleeping child. I just hope he or she or it does not decide to return and re-institute torture of a tired mama who sees "flu" like symptoms in the ER all day.

Rorschach...I see a heart

2008-02-14T14:14:00.000-08:00

Blog for Choice Day 2008

2008-01-29T17:22:00.001-08:00

This is me and Ms PM getting ready to go to a pro-choice rally before "the hardest day," when Bush was re(retch)-elected.

"On the 35th anniversary of Roe v. Wade, we asked pro-choice bloggers to join us for Blog for Choice Day!
Blog for Choice Day provided us with an opportunity to raise the profile of reproductive rights in the blogosphere and the media, while celebrating Roe's 35th anniversary. Plus, it was a great way to let your readers and the mainstream media know that a woman's right to choose is a core progressive value that must be protected.
This year's topic: tell us, and your readers, why it's important to vote pro-choice".

Blog for choice day is past but I'm assured it is acceptable to post this late. This has always been an important topic to me. Being pro-choice is something that has always felt normal and natural to me. I consider myself pro-choice in the whole realm of women's reproductive health. This includes whether or not to continue a pregnancy, how to continue a pregnancy and plan for birth, having a full range of accessible birth control options and support around infertility treatment. I don't have a lot of stories to tell that would convince anyone to vote pro-choice. I just know in my heart that it is the right and moral thing to do.
My experience with access to abortion services has always been positive. I don't have a personal memory that extends far back enough to pre-RvW. Since college I have always lived in towns or regions where abortion services were available, safe and supported. A few years ago I did a half-day preceptorship with an older doctor at Family Planning. He told me about his first years in residency and how he remembered coming in to the hospital on Monday mornings and seeing the ward filled with women who had sought out "back-alley" abortions over the weekend and had come into the hospital with infection or hemorrhaging. This is something we do not want to go back to. Voting pro-choice is crucial because any limitations to access can put women in situations where they may try to seek out dangerous options. Forcing someone to raise an unwanted child can lead to a whole other batch of misery and suffering. And I cannot imagine the unmeasurable pain of being forced to carry an unwanted pregnancy to term and giving the baby up for adoption. Nobody deserves that kind of torture. We should not have to keep fighting so hard for the right to choose. But we will.

Weekend Creations

2008-01-27T07:50:00.001-08:00

Soon to be "Closing Ale."

Can you guess what this is? For details look up the January/February 2008 issue of National Geographic Little Kids. That issue also has some pix of adorable Inuit kids and some great white animals I want to see before I die or they become extinct.

The Astronaut

The Sun Ice Block

I also made a chicken soup but thought I would spare my vegetarian friends.

The Closing

2008-01-26T14:22:00.001-08:00

The house in the picture above no longer belongs to us. Yesterday we closed the sale. When the noon bell rang at the end of being on call I drove down to our state's metropolitan center, met Sugar Daddy, Ms Perpetual Motion and father-n-law and we all met with the title co lawyer, real estate agents and buyers. We signed our name a thousand times, listened to a bunch of mumbo-jumbo mortgage/state law/fed law/realty stuff (remember I was post call and still had EKG criteria for left ventricular hypertrophy, atrial flutter and supraventricular tachycardia pin-balling around the inside of my head; another rotation done) and got our check which we put promptly into father-n-law's hands so he could get to the bank and be able to sleep that night. It is a relief to have the house sold in this depressing housing market, however, I will always miss that house which was built, every stick, by Sugar Daddy. Ms Perpetual Motion was born in that house and to my heart's delight she proudly let everybody know that during the closing yesterday. We only lived there for a few years but those years hold some of the best memories of my life. When my grandmother died she left me the money which we used to buy the lot. My dad and my father-n-law helped Sugar Daddy build the house. Our cousin did the electrical work. Ms PM was born there. We had her first Christmas there with all of my family. Sugar Daddy got two deer the first year we lived there and I completed the first two years of medical school while there. We also made about 20 gallons of maple syrup while living there. I guess carpenters and builders always build houses and live in them for a while and then move out. I've lived in a lot of houses during my life and that one was the most beautiful, the warmest and the sunniest.

Goodbye Star Hill House

Salad

2008-01-23T17:02:00.000-08:00

I know something like salad should not influence my life course but there is just no way I can do residency/three years of my life (at least) in a place where I cannot stand the food. There has to at least be a tolerable salad bar.
Problems with the salad bar where I am currently rotating:
1)Can't stand the salad dressings...especially the one that is supposed to be an italian dressing but is a strange gel-like consistency instead of good old olive oil and vinegar consistency.
2)No reliable daily source of beans. I like to have kidney beans or garbanzo beans in my salad. You know when the salad is the meal it is nice to have some protein. This bar sometimes has a sort of three bean salad and I have nothing against vinegary green beans but I prefer the kidneys or chicks.
3)Lacking sunflower seeds. I see sunflower seeds as a huge asset to a salad and this place never has them. Huge oversight by caf administration.
4)Unrelated directly to salad bar but a factor none-the-less: not enough veggie options overall. I am not a vegetarian but I just cannot bring myself to eat the meat served in the cafeteria. And so I look for seafood (rare) options or veggie and they seem to be difficult to come by. Green bean casserole, stuffing and deep fried varieties of potatoes are regulars but nice steamed broccoli or green beans are only occasional and the dark leafy greens are even less frequent. I thought...oh never mind...I was going to say I thought hospitals were supposed to have something to do with promoting health. Silly me.

Never Think Never

2008-01-20T06:13:00.000-08:00

Something I never thought I would do is purchase a piece of exercise equipment for my personal home use...until this winter. I could have used this machinery last winter but I was way too overwhelmed with third year rotations that I didn't even think about it. I like to think that I would just get outside and go for walks and hikes and x-country ski but the reality is now that I am not an early riser and so it is enough to just get up in time to do what I have to do: get dressed, get coffee, take Ms Perpetual Motion to preschool or at least help get her dressed, brushed and braided. Despite her name, Ms PM is a slow-mover in the mornings, just like her mama. Lately I have not even been able to help with any of that because I have rise at 4:30 and be on the road by 5 to get to the rotation on time. (And when that is the case it is really annoying when people can't get to sign-out on time, morning or PM. Rag for another post.) And since I don't get home till well after dark, an evening walk is out of the question unless it is a nighttime urban sledding night. And that usually just occurs on pristine snowy nights. So when father-n-law called and told me about the elliptical trainer available at reduced cost at local moderate-sized-box-store and said it would be a holiday gift I went forth and acquired. It is nice to have an opportunity to sweat other than when presenting a case to my attending or senior resident. The key to home exercise equipment is a good stash of music. I'd like to put a call out to Country Mouse and Weasel, my most musical friends, for a get-movin mix if you have time or inclination. And I'll treat you to a couple pints at our local establishment where Sugar Daddy wishes he got to spend more time; and a bowl of organic mush of some sort or another for Newtie.

The Better Part of Valor

2008-01-15T11:08:00.000-08:00

I have not been terribly inspired to write much lately. Mighten' be because of the heavy work schedule lately. But I am trying to get back into the groove because writing helps me think and I have a lot of things to think about. I'm in the middle of a super learning rotation now. I'm seeing a heavy volume of really sick people in the hospital. And I am realizing that I am not always very astute at recognizing sickness. I am much better at recognizing health. Fortunately I have been surrounded by many, many healthy people in my life. I've lived in communities where people challenged themselves artistically, musically and academically. I know a lot of people who are very physically active and folks who have traveled to many different countries and enriched their lives with acquaintances from all over the planet. But recently I missed a guy who turned out to be quite sick. I went through the night wondering a little why this guy was admitted only to find out the next morning that he was septic. He just did not look very ill to me. Presentation clinically and his labs could have represented a viral bronchitis. CXR was unremarkable. The guy was joking and smiling. But he was sweating and that should have made more of an impression on me. I've dealt with fever more in kids than with adults and I think fever is often over treated in kids but I'm learning that fever can mean different things in adults. My nature to be non-interventionist probably contributes to my difficulty in recognizing real sickness. Fortunately there were a lot of other people besides me who looked at this guy and their suspicions were higher and riding along the better part of valor.

The Match??

2008-01-09T18:00:00.000-08:00

This is very magical to me, it is not just meaningful, not just medicinal.

The Match?

2008-01-08T17:43:00.000-08:00

New Hampshire is nothing.

Arts and Crafts and Sleep Deprivation

2008-01-06T11:48:00.000-08:00

I don't mind living in a house where there are no carpets. So when water spills from the child's tea set or the geriatric cat pukes or the geriatric dog has an accident in the middle of the night leaving generous sized "hershey's kisses" on the floor for us to find in the morning at 4:30 am when I have to get up to get to the current rotation by 6am, clean-up is easier than it would be with carpet. Everyone is entitled to and proud of their creations.
I don't mind drips of fingerpaint on the floor because I only buy washable, water soluble paint so we have had very few tragedies despite the amount of painting we do around here.
I don't mind little hands covered in Elmer's glue covered in short grain white rice (even though the original idea was that the rice be glued to paper) because ultimately it washes off and probably provides a satisfactory sensory experience.
And then I don't mind that the rice project turns into a "cooking" project and one certain corner of the "kitchen" is scattered with dry rice and little puddles of water.
I actually like the mess. I like that things are being tried and tested. I enjoy a certain amount of chaos and clutter. Milk crates and cardboard boxes have always been a part of our home furnishings. Makeshift pantry shelves in a corner, closet or half-bath fill a purpose. Piles of laundry get a little tiresome but they always seem to shrink eventually like a bug bite.
The rainbow-speckled, multi-colored characters in Ms Perpetual Motion's new coloring book make the mess a perfect gallery in which to display all of our creative endeavours. I just wish I could get a little more sleep so I wasn't so tired during the daily art shows.

Nocturnal Urban Sledding

2007-12-13T18:18:00.000-08:00

My family has engaged in a new winter activity this year: nighttime urban sledding. I was out-of-town the first snowstorm/night the sled came out. I had to fly to Philly to take a very secret test with pretend patients and I can't tell you anything about it because it is considered top secret and very "high stakes" in the world of medical education. What I can tell you is that it was very long and exhausting (the whole process of getting there and taking the test), the food was hideous and the hotel I stayed in did not have hot water for my shower. We had to circle Philly an extra time before landing because of high winds which was a bit nerve racking and I was going to be really pissed if I died because of that stupid test. And to top it off I had to miss the first night of urban sledding.
But I got to go tonight! I don't have any pics because our camera does not have working flash. We found alleys, empty lots and snowbanks to sled down about town. It was really fun to just walk around and look for places to "catch a hill". And when we didn't have a good/safe hill to sled down Ms Perpetual Motion plopped herself in the sled and we parents ran while pulling the sled down the sidewalk. She only flipped out of the sled and did a faceplant once.

Sledding

2007-12-09T06:59:00.000-08:00

Important to make sure you live in a town with adequate sledding hills in the vicinity.

The patient is a whole person who pees out their meds.

2007-11-26T20:30:00.000-08:00

The good stuff always comes towards the end. After the "pertinent" information has been gathered: how long noticed memory problems, episodes of falling, do your own cooking, shopping, manage finances, med list, orthostatic hypotension, focal neuro findings... Then we fill in the gaps and add some color to the snapshot. Sometimes we hear about a traumatic event from earlier in their adulthood, travel between countries and continents, impressive careers, hearts broken, love lost. I like to save my notes from these evaluations because they become experience for me. They have the potential to stick with me for the rest of my life. The header is just an age and a sex. The rest of the page is the beating heart as told by the patient and if we are lucky by the patient's family too.
I think it is the ultimate goal of the family physician to get to a point in the relationship with the patient where you can acknowledge all the aspects of a person's well-being. You will probably not be able to fix everything. But you can always address things. And what we should really be doing with people is having conversations; letting the patient tell their story and interpreting it back to them; commenting on their story; giving our (hopefully) experienced opinion. Unfortunately our primary source of "opinion" has become the faxing of a script for a pill. And people, hold your hats because I am about to write something very disturbing. You know how people go fishing to relax and feel better by being in the outdoors, maybe relieve some depression? Well fish are now showing up with levels of prozac. That is just one example. I like the irony of the whole relaxing fishing vacation/depression med thing. But the thing is is that there are a lot of meds in our water now. And it is not just from flushing unused meds down the toilet but it is also from excreting swallowed meds via the flush. FYI

No Starving Pilgrims Here

2007-11-23T08:32:00.001-08:00

Our locally raised slate turkey.

Locally grown cranberries prepped for cranberry pie. I forgot to add the almond flavor so it was a little more tart than usual. Excellent with vanilla ice cream.

I am thankful for all of the great food available to us either from local farms or generous gentlemen farmer friends.

I am thankful that my 1st choice residency interview is over and went pretty well, if a little unorthodox. I was the only candidate not wearing a black suit. I went to medical school, not business school and so I decided a smart gray skirt and sweater would be fine with my purple danskos and tights. So of course the doctor and geriatrics fellow I have been working with during this rotation tease me first thing in the morning about not wearing black. The interviews were my favorite part of the day. I received a few compliments on my personal statement and I felt I was able to be myself throughout the interviews. Now I will have to just wait for February.

I am thankful for the amazing support provided to me unconditionally by my family.

I am thankful for the invaluable teaching and autonomy offered upon me during my geriatrics rotation.

Ms Perpetual Motion was thankful for maple syrup and cookies.

I am thankful to Cooks Illustrated for enlightening me as to how to make a flaky, prize winning, crust by substituting vodka for water. I won the crust category of the pie contest two weeks ago at work.

Locally grown eggs with non-local milk for custard pie.
Happy Thanksgiving Everybody!!!

Euphrasia officinalis Morning

2007-11-10T07:01:00.000-08:00

Upon awaking to L-sided conjunctivitis.
And trying to take a history from a three-year-old.
Without the parent from the night before around (hunting).

And no milk for pancakes.
Should have known there was no milk because I am mother.
But I was out last night with friends. Ha.
And going out again tonight.
After getting one solitary eyedrop into Ms Perpetual Motion's hurty eye.
She cried herself to sleep agonizing over another potential eyedrop.
Luckily I will have a beer to cry into soon.

Lipizzaners

2007-11-03T09:54:00.000-07:00

After a week of a new, great rotation how better to celebrate than acrobatic, dancing horses? This is how pathetic I am though. During intermission while waiting in line at the snack bar for some juice and water I found myself visually inspecting a large skin lesion on the upper back of the person standing in front of me. Then I found myself looking around for one of the attendings I had seen earlier who was also watching dancing horses with her son because I really wanted a preceptor at that moment.
DDx:
giant seborrheic keratosis
melanoma
giant nevomelanocytic nevus
epidermal nevus
burn
french clay mud (on the upper back)

I was able to accept the fact that I would have to let this one go and return to being an attentive mother.

My favorite holiday-Halloween

2007-10-31T17:27:00.001-07:00

Tigers prowled around our neighborhood stalking little old ladies holding baskets of goodies.
After the kill.

My favorite holiday-Tuesday

2007-10-30T18:55:00.001-07:00

Treat bag. Getting closer. Lucky for us our town is full of nice witches and nice monsters.

My favorite holiday-Monday

2007-10-29T16:58:00.001-07:00

Finished. Just needs a few safety pins here and there and some wooly long johns underneath.

Jack

My favorite holiday-Sunday

2007-10-28T17:51:00.001-07:00

Former massage therapist turned osteopathic medical student and mother uses former massage table turned osteopathic manipulative treatment table as Halloween tiger costume prep table.

I would have finished it tonight if I had not run out of thread. Stay tuned...

Old-Timey Osteopath

2007-10-26T14:12:00.001-07:00

Sphenopalatine Ganglion Treatment:
Yesterday before I left the clinic early because I felt too snotty and coughy and wasted to be hovering over patients I asked one of the providers to treat me with some OMT (osteopathic manipulative treatment). She did some cranial osteopathy including a sphenopalatine ganglion treatment. Stimulation of this parasympathetic nerve ganglion by the pinkie tip of a trained provider can be quite painful in the back corner of your mouth behind your molars and off to the side a little. But a little pain is better than thick, sticky mudslides of mucus down the back of your throat. This treatment helps to thin secretions. This is the kind of OMT I like the best, for complaints other than chronic low back pain that will really only respond long-term to better physical conditioning. Through my career as an osteopath I hope to develop a skill set of OMT that I can use for things like upper respiratory infections, bowel complaints, chronic sinusitis, colic and reflux.

Colored Queen Anne's Lace and other joys in life

2007-10-26T13:55:00.000-07:00

One day this past summer Ms Perpetual Motion and I were walking down the road when she looked over at some QAL and said, "Mama, let's color the flowers."
My Great Aunt Helen used to do this with me.
I thought it was magical.
I do not remember ever discussing this with my wee one. And Nana said she never did either. So with a chill creeping up my spine on a hot August day we collected flowers and took them home to drink the colored potions we lovingly brewed with food coloring and tap water in funky seventies style glasses.

I have Internet again again after six months!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

In three days I will be finished with a challenging rotation and in five days will begin a new one at the place I hope to be a resident next year.

I did something nice for myself today, got a physical. It had been way too long. I got to be the one who got to talk all about themselves and have someone interested and caring listen. I got to stop feeling like quite so much of a family medicine/preventive health care advocate/hypocrite. And those ladies at FamPlan are so nice and considerate.

Transformation

2007-08-12T11:44:00.000-07:00

Moving from third year to fourth year: Regular people might not realize the significance of this but other doctors and residents and nurses know that there is a difference between third year medical students and fourth year medical students worth noting. Third years are new to the whole clinical scene. Third years are not only learning medicine but they are learning where the bathrooms are, how to write notes and orders, how to get a list of really handy phone and beeper numbers, passwords for all kinds of electronic medical records systems, how to present cases. Fourth years are still learning all of this but they have been through one year of it already and that counts for a lot.

I remember sitting in the ER during one of my first admissions in Internal Medicine and painfully, slowly struggling through trying to figure out how to write the orders this guy would need to get admitted for his heart failure or COPD exacerbation or whatever was going on with him (still not 100% sure). And I remember being aware of the resident and attending who were graciously sitting there with me while I painfully, slowly struggled. They had to make themselves sit there and let me get through it. They had to literally sit on their hands and I am eternally grateful for that.

A few days after that I picked Ms Perpetual Motion up from grammy's at the end of another long, tiring day and just wanted to get home where it would be time to feed the dog, make supper, try to herd a wild child inside while I cooked so she would not drown in the lake while unattended and of course Ms Perpetual Motion wanted to buckle her car seat buckles herself. And she could do it, I knew that, but it would take longer and I had to sit on my hands and let her struggle through it so she could learn how to function in this world and my tired ass would just have to wait (supported by my hands of course).

I will be starting my fourth year rotations soon and Ms Perpetual Motion will be going to an organized preschool type deal soon as well. I am just hoping we are both prepared enough.

I Don't Study Everyday

2007-08-08T09:19:00.000-07:00

After a few hours of studying or doing Kaplan Q-bank questions my brain feels like these cups of swirled paint. So this is what I do on some days to reboot.

Wicked good Chocolate with rainbow sprinkles.

Water can be very healing. That was not in the board review book, I learned that on my own.

The Cat Came Back

2007-08-01T08:15:00.000-07:00

I walked all around the house and all through the yard cooing, clucking and calling 'here kitty kitty kitteeeeeeeeeeee.' I called down into the heating vents, into the bushes, into culverts and throughout the musty basement. Nothing. It was time to go get Ms Perpetual Motion but I could not give up. Husband had seen her. She was alive. I would get Ms PM and come back. I left the bag-o-tuna out and drove over the bridge to the calm serenity of Ms PM's baby sitter's house. When we returned I decided to try the trail out behind the house. Maybe, just maybe she was out of earshot. I thought it was a long shot but had to try. I got the stroller that we had left in the garage and put Ms PM in it. It would be easier to search for the cat if Ms PM was somewhat confined. We walked a lot further down the trail than I thought necessary but I just needed to clear my head a little, when who should spring out of the bushes with a chirp but the mangy gray cat that was our pet. "Crescent!!!" squealed Ms PM. My cat is no ordinary cat. She loves us but does not know how to show it. I could tell she desperately wanted to come home but she refused to simply come to us. We had to slowly walk back towards the house, continually calling 'here kitty kitty kitteeeeeeeeeeee.' She slowly walked back through the woods parallel to us but about 15-20 feet away. When she was close enough to smell the tuna she took off like a shot across the yard.
Now how was I going to actually catch the cat and put her in the car while keeping Ms PM at bay?
"Ms PM," I pleaded, "Please wait here while I get Crescent."
"No mama, I wanna help."
It went on like this, me pleading and Ms PM refusing to sit idly by.
Eventually I had the clever idea of opening the front door of the house which Crescent could not refuse. She really wanted inside. And I was able to trap her in the tiny mudroom.
Now Ms PM could be of use. While I tried to keep from getting shredded by the scared, hungry kitty I asked Ms PM to please open the car door. She did, but bonked her head in the process. Now I had a crying child and a scared cat getting more and more agitated by the moment by the cries of my child who I could not help because my arms were full of terrified cat.
"Just get in the car," I cold-heartedly demanded. "Just get in the car so I can put Crescent in too." We all piled into the back seat in a sweaty, pained mess. I slammed the door shut. We had her. The cries faded with the excitement of having a cat in the car. I managed to get back out of the car to shut the front door of the house and back into the car without the cat escaping. As we pulled out of the driveway I spotted the stroller.
"Damn, I left the stroller out."
When we arrived home with the hungry, skinny cat and Ms PM doing just fine I asked husband to swing by the house tomorrow and get the stroller.
"Don't forget," I emphasized, "The blanket and sweater Nana made (by hand woven blanket that probably took about 8000 hours and knitted sweater) for Ms PM are in the pocket of the stroller."
I swear to goddess he said, "ok."...

Lost

2007-06-08T09:52:00.000-07:00

Moving becomes more and more traumatic each time, since having Ms Perpetual Motion in our lives. There is so much more stuff: blocks and books and old ratty cloth diapers and adorable onzies I can't part with even though they have not fit for two years. The poor dog and cat get awfully neglected during these weekends of utter chaos. During the second to the last move, in August of 2006, the dog practically went into respiratory distress between the humid, miserable August heat and the inevitable dust whirling through the air during the packing process. He fared better this last move but the cat suffered instead. We had decided that we would just get her loaded at the very end, after everything else had been dealt with. It was a pretty complicated move because some stuff would go with us for five months or so and some stuff would go to a few different storage facilities. The owners of the house to be moved out of were there fixing, painting, cleaning, mowing and such in preparation for re-entry onto the housing market. I was in the middle of one of my tougher medicine rotations. And in and out and all around amongst all of this was a wild-child zipping here and there, feeding voraciously off of the madness of her sticky, filthy parents. This time it was the cat who got left in the dust. She was not actually abandoned. We looked for her at the end and we suddenly realized she was nowhere to be found. I sent everyone away and tried calling her all through the house and all around the house and yard. This technique had worked in the past. She has a history of only coming to me and only when there is an ire of calm. But I heard nothing. No mews or meows or chirps which she sometimes makes when sprinting across the yard or living room. It seemed as though she had become fed up with us and our hectic life and just took off to live out her days in an undesirable town.

I went back to the house three or four afternoons in a row after work the following week and tried calling her. We had left tuna out. I went down into the basement and tried to listen for any little kitty footsteps in the extensive duct work. Nothing. I worried she had wedged herself into the drier vent, got stuck, suffocated and expired. There were no real signs of this except for my paranoia. (She had done this before when my parents moved out of one of their houses, but that drier vent had a larger diameter and less tortuous course.) Into the second week of the disappearance I had given up hope. She was a fifteen year old cat, seemingly in fair health but maybe she had just gotten tired and decided to take that last venture into the shrubs I thought.

At the beginning of the third week missing I got a call from my husband saying he had gone to the house in the morning (doing a little post-move-out turd-polishing for the owners) and he saw Crescent streak across the yard. He attempted to call for her but knew it was pretty much futile. I managed to release myself from the chains of the hospital world a little early that day and made a stop at the market for some tuna in bag on the way. I had about 30 minutes before it would be time to pick up Ms Perpetual Motion from the baby sitter's. It would be so much harder to catch the cat with her at my side. I knew I had to work efficiently.
To Be Continued...

The Pirates Have Landed

2007-05-19T15:39:00.000-07:00

After moving among boxes and contractor size plastic bags of clothes for a week we have finally settled into our new home for the warmer months. We have not moved far from our previous abode. If I had to deal with moving more than twenty minutes away I think you would find me on that psych ward I rotated on a few months back. The beach needs to be cleaned up a little and it is pretty chilly in the mornings now but it is going to be a very nice place to come home to after staring at sick, leaking, coughing, infected people all day.

Moving

2007-05-13T07:50:00.000-07:00

Moving for roughly the 19th time in my life.
Goodbye to river valley life.
To someday permanently affix a framed picture to the wall is a dream.

Learning How To Take Of

2007-05-05T14:45:00.000-07:00

This Internal Medicine rotation is really great because I feel like I am learning, learning, learning a lot, all the time. I go see patients on my own, write notes, go back and see what the residents and attendings wrote, read about stuff, order something if I think it is necessary (have it cosigned of course), read some more, review the notes and the lab results, attend teaching rounds and conferences. There is a lot of repetition and that is good for me because I feel like it takes me awhile sometimes. I have to feel like I am experiencing something to learn it.
As I was driving home from my weekly 30+ hour "shift" I thought about how sometimes when I am presented with a question I sometimes have the right answer in mind, or a gut feeling about the right answer but I freeze when it come to actually saying the answer out loud. And then I thought about how this rotation feels like being a mom. I see patients in bed, during the day, at night, in the morning when they just wake up or I wake them up. I ask them about how they slept or ate or pooped. I look at their feet and then tuck them in again. Sometimes I check on their or their labs in the middle of the night. I walk down the halls past their rooms while they are sleeping, I peek in their rooms. I have a lot of confidence taking care of my daughter when she is sick and well. I can gage her fever and how she seems and decide if she needs medicine or not. I can assess her nutritional needs and what would be a healthy and good-tasting snack. I can tell if she needs to go to the bathroom or if she is a little constipated or hungry or tired or hurt or if she should drink some water. It took a while to gain that confidence and it is not there 100% of the time. So I realized that I need to just gain the confidence to make decisions about my patients in the hospital because I am taking care of them too, sort of like like a mom. Instead of deciding about a carb snack or a protein snack I am choosing an antibiotic. In addition to learning the medicine this rotation has taught me about my role as a caretaker and decision maker for my patients.
It has seemed scary in the past to let my then one year old go outside without enough clothes on for a clammy, rainy day and splash around in the puddles. And it is really scary to pick out drugs for people to take and invasive tests for people have but that is how they get taken care of in the hospital.

Happy Earth Day

2007-04-24T17:18:00.000-07:00

I celebrated Earth Day and the two day interlude between Family Medicine and Internal Medicine by going to a really beautiful part of the world with Ms Perpetual Motion. It turned out to be the perfect mix of sun, fun activities for kids, and hands-on with sea creatures. We both returned home a little brighter and little sleepy from a whole weekend of walking!!! After arriving we did not drive once until we got in the car to go back home. It was really nice because now I am driving about 40min. each morning to go learn from really, really sick people. Yesterday I felt a little overwhelmed after spending several hours in the afternoon in the ICU struggling to understand the dynamic process of multiple organ failures...cardiac, lung, renal...in the same person. OK, since I was raised a Human Ecologist, I should be able to grasp this concept pretty easily. Everything is interconnected. The heart is like the watershed, the lungs are like the trees and the kidneys are like the wetlands. If you destroy the wetlands, then silt and junk builds up and becomes toxic. When the trees are gone the world becomes hypoxic. And if the watershed is interrupted plants and animals starve or get flooded out.
Today was a little better. I was able to find my way around the hospital a little more. Mother Earth was stable on her ventilator. But one big lightening strike could settle things down to a depth deeper and more still than Death Valley.

Texture

2007-04-11T11:26:00.000-07:00

I love seeing patients out in the community. I don't acknowledge them unless they acknowledge me first and then I just say hi. I don't engage in any conversation about their health. I just like seeing people in little snippets of their lives because it adds texture to the picture I have of them in my mind. Occasionally I see patients at stores around town, walking down the road, at the park or playground, at community events or waiting for a bus. Most of the time I assume that patients don't remember me because they may have just met me once when I was shadowing another doctor. I have not had many patients of my "own" so far so I don't run into those precious gems often. The context in which you see a patient can highlight aspects of their history or medical issues. I like to see a patient, who has been working on things like lifestyle changes or stress reduction, out for a walk. It can be telling to see a patient who claims to be in 10 out of 10 pain with a terrible limp, walking easily up a hill.

Once I saw a patient heading into a pharmacy a few hours after getting a prescription for antibiotics for her child. It was a freezing cold day. A few days later I saw that same patient on the other side of town near a part of town that she probably lived in. I knew she didn't drive and that she had had to walk a few miles, pushing her son in a stroller on a cold, windy day to go get those antibiotics. I think it helps to have as telling a picture of your patients as possible. You can ask all kinds of questions but actually seeing people in moments of their daily lives adds a much more tangible element to the care that they can receive from you. A psychiatrist once told me that you have to care about a patient in order to help them. For me that continuum comes more easily the better I know a patient and the more connected I feel with them.

Once I saw a patient who I felt I had completely blown it with in the office. Her kids were actually the patients and she was a tired mom who had been up all night with a sick child. I just managed to fumble through the visit, probably adding to her already fatigued level of elevated stress. I happened to be with my daughter when I saw her out in the community and found myself wishing that she would see me and remember who I was and see a snippet of my life, as a mother, and maybe see that I could relate to her a little even though I was not the best student doctor that she saw that day with her sick kiddo.

To me this is part of what family practice is all about. I envy the doctors I work with who have been seeing the same patients for ten or twenty years. The doctors know a lot about their patients and the patients know a lot about their doctors. They see each other in and out of the office. Their kids might know each other. They might have the same mechanic or hairdresser, and they might fight for the same issues at town meetings. Or they might have very different opinions about the community they share. When I grow up I hope I live in a community where some of my patients live.

Happy Bunny Time of Year

2007-04-08T16:58:00.000-07:00

The sugaring is drawing to a close but we have lots of colorful eggs, eggs, eggs to make us feel better. And that adorable bunny who manages to make the rounds without a sleigh or the help of dozens of elves or reindeer. Ms Perpetual Motion was thrilled with her basket, it had a farm theme this year, and she didn't even mind the bunny poop. She insisted that it was not bunny poop, but chocolate covered blueberries. I'm still not sure. It looked a lot like bunny poop. We went for a toboggan ride, yes a toboggan ride on Easter, searched for tadpoles and released several million cattail seeds into the blustery April sky.

Vernix Queen

2007-03-29T15:29:00.000-07:00

There is no better high for a medical student than being able to correctly answer a question asked of you by an attending. Today I had the correct reply to "What is that white , cream-cheesy stuff that covers the baby when they come out...?" "Vernix," I replied with confidence and a spring in my step. A small thing, I know. But it does not take much these days. I know some stuff but I am continually disappointed by the periodic realization of how complex patients can be and my baby steps toward being able to handle and just be aware of that. But that is the great thing about family practice. It is not just low back pain or just a tickle in the throat. The back pain and the sore throat come with many strings attached. Some strings are attached to heroin abuse, some attached to an abusive husband. A lot of the time strings are attached to depression and/or anxiety. Chronic medical conditions get attached, like diabetes, hepatitis C or lupus. Some strings attach to a spouse's medical condition, like migraines, or a spouse's substance abuse, like second hand smoke exposure. These strings go in and out in all directions until you are left with a picture of a big sticky spider web sketched out in the chart. It can be overwhelming when I am having a hard time just remembering the names of a few medications. It is fascinating to watch seasoned doctors weave their way through these webs. And then being able to dictate that all from memory is another feat.

Mental Health

2007-03-25T08:02:00.000-07:00

The sweet steam of spring has begun to waft through the air and temp taste buds toward fresh green shoots and warmer weather. Soon summer will be here. Between quarts of maple syrup lining my pantry shelves, being fabulously entertained and rightly challenged by my family practice rotation and watching four kids under the age of six churn through a bubble bath like a pod of wriggling tadpoles, I'm enjoying every minute of life these days.

Family Medicine

2007-03-15T16:05:00.000-07:00

Knee deep in family practice right now. I was a little worried before the rotation started that maybe I would not like it and then what would I do because I've always thought that family practice is what I want to do. No worries so far, I am loving it. I'm even having fun with the overweight men with diabetes, high blood pressure and high cholesterol. I think family practice has the perfect blend of talking with patients, examining patients and doing small procedures. The brain and hands both get a workout. In one week I have had a plethora of interesting patient encounters: Intractable crying, except when lying down, Kids with hurty ears, Buddhist with schizophrenia, Lots of high blood pressure, Lots of depression, I got to do a pap!, Knee injuries, Vague chronic pain, you name it and it will probably walk through your door eventually. If the psych ward is like a pirate ship (not my analogy but I like it) then the family practice clinic is like a circus.
Everyday I laugh, want to cry, am challenged, feel incredibly naive. I don't think my naivety is a completely bad thing even though it feels like a hindrance sometimes. I think it can be valuable to come at medicine or patients with a lets call it fresh perspective. Here is an example of where I am naive, I mean fresh. People can get really sick. I am totally new to the idea that someone can have so much edema/swelling that it can seep out through their skin. I don't think I really knew this a month ago. And I have been interested in health care for about 17 years, I've been thinking about medical school for about 10 years, I've made an actual commitment to becoming a doctor for 7 years now and I didn't fully realize that you could soak your pants and shoes with fluid seeping out your skin. I feel silly and thankful that I've had such a healthy family. In other words, this never happened to any of my grandparents. I also feel really naive about medications. They have never really been a part of my life and I have a hard time relating to them. I also have a really hard time imagining myself actually prescribing them without freaking out about it. I am a not pill person myself. I don't even like to take ibuprofen or tums. I do sometimes, but very rarely. It just doesn't occur to me to take things, except a multivitamin and a fish oil capsule. Does that sound weird? It feels weird in the world of medicine. So these are a few things I have thought about this week.

A Crafty Blogger I Will Never Be

2007-03-10T15:10:00.000-08:00

As much as I would like, a crafty blogger I will never be. I love to escape into the beautiful, artful, original, creative, crafty blogs that sparkle and dazzle and make me feel like a complete loser. The crafty toys my daughter has were purchased, the homemade skirt I own has little threads coming out the bottom because I am too lazy to do a proper hem, I can't find the time or energy to seek out thrift store and yard sale gems. But I still love to wander slowly through those blogs of amazing ingenuity and adorably cute creations and just be taken away by it.
I can write though, a little. At least my sixth grade teacher said I was good at it. And I always feel better after writing a little about my day so I sweatingly decided to start a blog. Shhh, don't tell anyone.
On reason why I will never be a crafty blogger is because my time is spent trying to make myself go insane by being in medical school, not giving my daughter up to an orphanage or running wild on the streets and trying to slap together some semblance of a homelife with my husband. Here are some more reasons why I will never be a crafty blogger:

It seems like crafty bloggers, in addition to creating their crafts, always have really clean homes, even when they have two or three kids running around. Here is a typical mess in my house after daughter squirt has used my neatly stacked pile of books like a treadmill.

This is our craft area, a mess.

This is the most crafty thing I have created in the last several months, a bunch of paper hearts glued to a thread and hung up for Valentines Day.

Another reason why my home will always be messy...and full of wet kisses.