Transformation

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

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

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

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

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

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

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.