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.

Happy Earth Day

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

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

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.