forme fruste: 30 days to WILDLY successful

Lawyer: Even for a surgeon, wouldn’t you call that kind of schedule grueling?
Miranda: YOU could say that. I wouldn’t. I would say it’s wildly successful. But then, I would never put a woman’s success in the “con” column.
~Grey’s Anatomy

The first thirty days. sisyphus-happyThe learning curve is as sharp as Sisyphus’s mountain. The holes in my training and short attending tenure are evident. The new experiences bound off my shoulders as I push the boulder with each new patient encounter. I have arrived. I am not hiding behind the outpatient clinic sign. No longer sending patients that are too sick to the ER to be managed by another physician. No longer delegating the responsibilities of hospital management. No longer desperate for obstetric patients, as there is clearly ‘something in the water’.

The first thirty days. Emergency management of STEMIs, septic patients, fractures. More OPERATIVE deliveries than ALL of my deliveries for the last year! Twins. Twice. VBACs. Breech deliveries. Inpatient management. An outpatient clinic that has been as busy in my first month as in the last months of my previous practices.

The first thirty days. Living in a community of glass houses has also been quite the intimidating summit. As the latest local novelties, our every detail is in the paper and on the Internet. Strangers know details of our family, previously restricted to our circle of friends. Details of our family have been creatively changed resulting in giggles among those that know the truth.quote

The first thirty days. Infinite sunrises. Sunny afternoons. Sipping wine. Reconnecting. Girls on bikes and scooters. A dog beneath the oaks. New friends. Smores. Fire pits. Deliveries of corn, beans, brownies, cookies, cakes, and plants.

The first thirty days. It has been grueling. More importantly, it’s wildly successful.

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Bubbles and princesses.

Art with KateThe fields lay in the distance full of ripe soy beans and corn. Nearly ready for harvest. The sun rests just beyond in a burning orange as it begins to slip past the horizon. The children’s shrieks of laughter come from behind as they run through our front yard and the yards of our neighbors. Even the fur-child has found a friend and rolls beneath the large oaks in the lush bright green grass.

Our new home. There is magic here. I hope to scoop some of the fairy dust that had been sprinkled on us in the community with gifts of corn, green beans, and tomatoes and place it in my pocket for a rainy day.

The laughter stops briefly, as a princess in heels and jewelry scootering down the street has fought the dragon and lost. She refuses to extend her arm. I know what it is, and how to fix it. Something so satisfying in reducing a nursemaid’s elbow. The faint click as bones go back to their intended spaces. The joy of the bubble returns.


Puzzling it over…

Puzzle-Piece_SuccessI spent many summers around a card table with my Gran putting together puzzles. She started at the edges. Instructing me that if you lay a good foundation with the border, all the other pieces are easier to place. I preferred, and still do, the haphazard method.  I find a piece and try to find other pieces that fit. It definitely takes longer my way. I find that as I’m teaching my girls how to complete a puzzle, I encourage them to start at the edges and work from there. However, I still can’t help the urge to pick up any piece and find out where it goes. It is so satisfying to get a run of random pieces together and place that group as one piece in the bigger picture. Puzzle1

Medicine is like that.  You can work from the edges.  We have innumerable panaceas.  There are guidelines and gold standards of care to direct the care. Start from any corner of the world, on any patient, and eventually as you put all the pieces into place, you’ll see the health of the patient bloom. It’s beautiful. Yet, you can also start anywhere. I love that. I love the magic that I feel as I uncover the pieces that were previously scattered now snapped into place. Perfection. Still longer my way.

Life is also like that. Hungrily, I have grasped at the pieces that seemed to fit together. I have pressed and at times tried to force the pieces that didn’t quite fit. Like square pegs into round holes. But it didn’t work. Now, as I find that pieces that glide into place, it seems as if I have been guided into that rhythm that allows first one piece then another, then another, then another…you get the idea. I have now gotten to take that large section and place it into the border that has defined the edges of my life. The structure. My family. My friends. I cannot quite make out the final image yet, but that’s okay. It’s cheating if you look at the front of the box anyhow. And it’s more fun to watch it develop as every piece falls perfectly in place.


A very merry unbirthday to you!

Alice fell down the rabbit hole chasing the white rabbit. Many allusions have been made to falling down before finding success. We all have a rabbit we are chasing. And time is always running out. Medicine is no different.

alice-in-wonderland-06Medical students find their passion. They chase that passion through fields of angry flowers. In a world of peonies and roses, I’m a wildflower. Headstrong and driven, I’ve always known where I was going, just not sure how to get there. I’ve grown and flourished in good times and bad. Residency is no tea party, but the first years as an attending is like playing croquet with the queen of hearts. At any moment, you could lose your head!!

The transition to attending from resident is one that some do with grace. Others, myself included, land a giant belly flop and wake up the next day with a bruised ego and a hesitancy to reenter the water. But, “we are all mad here”. So, we suit up and try again. The next attempt may hurt. Or it may be, just maybe, that we finally worked out the kinks and land that perfect 10 dive.alice2

Residency prepared me for many things. It did not reveal, however, what truly awaited on the other side of my final June 30. No. THAT is left for life (and death) to teach you. As a new physician, I have struggled with what I desire and what I have before me.alice

Like Alice, I was too quick to take a bite of the cookie and found myself unable to attain what I wanted. Then, too quick to take a drink, again found myself unable to chase MY rabbit. However, persistence has led me to finally have the magic ratio.

Here we go, into Wonderland. Full of magic, fear, and ferociousness.  A new adventure waits.

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“Decide. Is this the life you want to live? Is this the person you want to love? Is this the best you can be? Can you be stronger? Kinder? More compassionate? Decide.”

~Grey’s Anatomy


Sparing consciousness, but not the heart.

Dementia is a terrible disease. Defined as senility, it covers a ‘broad category of brain diseases that cause a long term and often gradual decrease in the ability to think’. It robs you, like a thief in the night of the person that you once knew. Dementia robs the patient of their independence, personality, skills, memories, and ‘selfness’.  It spares the consciousness.

This is what haunts me the most. 

Globally, dementia affects 36 million people.I have seen so many patients over the years with the disease feeling a deep connection to them, their struggles, and the struggles of their loved ones. Because of one patient. The one that belongs to me. The one that I would’ve given anything to develop a cure to save. Except. There is no cure for dementia.1

This is the woman that could not swim and was deathly afraid of the water, but kept me from drowning as a child when I was too tired to bathe before bed. That ensured I survived after throwing rocks at Pop’s camper. One. Too. Many. Times. She was a saint that mailed me cookies, cakes, brownies, muffins an innumerable number of times in college. Feeding my dorm, my sorority and me by sheer volume. Her baked goods reaching far and wide not just across the US, but across the Atlantic, comforting and feeding the Spaniards as well!

Mrs Fields, Betty Crocker, and Paula Deen have nothing on this woman.

She served as my guide on how to cook, providing recipes, secret tips – you must bang it on the counter to get the air out – no, seriously, bang it! She served as my role model for what a wife should be: a partner, made from his rib, to stand by his side. She served as a map when I had lost my way and my faith.  She served so many roles; the void will never be filled.

But that’s how doctors are made. Like clay in potter’s hands, every patient, every loved one, every experience in life molds a doctor. There are cracks here and there. Sometimes the vase folds and returns to the lump of clay from which it started. Sometimes, once we have been made, we are broken, and we are forced to reexamine what made us, ‘us’ to begin with.  I am so thankful she cared for me so tenderly and helped me become who I am today.  I will continue to see her in every sweet-no-holds-barred firecracker that comes to my office refusing to slow down. I will continue to fight the thief that robs my patients of their memories and selves.  Hoping, against hope, for a cure.

IMG_4445My favorite memories, in no particular order:

1) lying on the sofa with my head in her lap

2) word searches

3) love/hate relationships with Matlock and Jessica Fletcher

4) on pledging my sorority, learning she too pledged: ‘eata byta pi’

5) always kiss him goodnight; it’s not worth yelling

6) if you spray bees with water over your head, you will get wet

7) don’t pray for patience and strength; God will answer your prayers

8) dancing is a lot of work and takes practice

9) buy the green properties in monopoly

10) i love you a bushel, a peck, and a hug around the neck

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1http://www.who.int/mediacentre/factsheets/fs362/en/

 


Do you know why the caged bird sings?

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We’re PRISONERS. Handcuffed. Placed in a 6 x 8 cell. Told what to do and when by wardens who have no idea how to handle a ward. When you are fighting the uphill both ways, barefoot in the snow battle to become a physician no one mentions THAT in the brochures for medical school. But then, perhaps there would be an excess of baristas and an even greater shortage of physicians.

Then, when you’ve actually made it – when the battle is over and you stand triumphant over the enemy that were drugs you were unable to pronounce, diseases you knew you and half of your closest acquaintances had acquired, origins and insertions of muscles you previously did not know existed, and every crease and crevice of every bone in the body. You are victorious. You will go out. You will use those drugs to treat those diseases and heal the muscles and bones of the bodies of people who place trust in you and your education. Except it’s not like that at all. Because you are prisoner 8675309. Yeah. They’ve got your number. THEY. Who is the infamous they? Who is holding bright, motivated new doctors hostage? The insurance companies. The patients. Their parents or their children. Google doctors.

TRAPPED!! New physicians rush into the fray of practice believing their desire to cure disease, heal the masses, change the world will be enough to overcome the red tape. New physicians arecharliebrown_2764183k armed with the drug of choice, the gold standard test, and algorithms designed to identify, evaluate, and treat disease. But then again, “anyone can find disease, to find health, should be the object of the physician”.1 So the physician seeks out health and prevention of disease, and is met with a grown man with his fingers in his ears saying “nah-nah-nah, I can’t hear you”….seriously.   The insurance company denies the drug of choice because it’s not the preferred drug on the plan. The gold standard test has to be pre-authorized – by someone who graduated from high school. The parent denies the vaccinations that have eradicated disease because Google said Andrew Wakefield said mercury in vaccines causes autism.

FREE public service announcement: Vaccines do not cause autism. Vaccines prevent disease.

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However, like most new providers despite the challenges, “I find I’m so excited, I can barely sit still or hold a thought in my head. I think it’s the excitement only a free man can feel, a free man at the start of a long journey whose conclusion is uncertain.”2 At the end of the day, a patient realizing out loud YOU are their doctor, THE person they can confide in, the person that will treat the disease, cut the red tape, and jump through the flaming hoop, if necessary. Because, YOU ARE A DOCTOR. “Some birds aren’t meant to be caged. Their feathers are just too bright.”2

1 AT Still

2 Red, The Shawshank Redemption


See you later alligator!

“I love crocodiles. They’re like little tiny babies,” number three reports from her seat in the back. The next question: “Mom, do you love little tiny babies”, hits me from left field, but I swing with an, “Absolutely. I love you, baby. Yes ma’am.” However, lately, I’ve been up to my armpits in alligators. HardshipAnd, I am not loving that. Nope. No way. No how. This is not the adventure I wanted to take. Never-the-less, here I am.

Premedicine students see the beauty of medicine for all of the things it can be. The chance to develop a cure. The opportunity to offer a cure developed. Patients graciously accepting a developed cure and well, being cured. Or perhaps they see the chance to intervene in a patient’s life prior to the development of disease. Offering preventative medicine to interrupt the disease process prior to its onset. Maybe educating parents on the developmental milestones for their little tiny babies. Even still, the premedicine student may see the possibility of offering comfort to patients when there is no cure. Premedicine students see medicine in its purest form. The reason we all set off on the adventure.

As medical students, the medicine becomes the adventure. Learning the science of medicine itself is the challenge. Miles of books to be read, seas of drugs to be learned, mountains of tests to be taken. Once the finish line of med'$600 may be a lot for a pair of boots, but this was the best purchase of my life.'ical school is passed, the adventure continues through residency. Residency is where you BEGIN the adventure that is learning the ART of medicine. A friend once told me you can train anyone the science, but it takes a person with the inner gift to master the art of medicine. Our gifts are revealed in times of turmoil and distress. I remember something about coal and diamonds…but I digress. Frederick Douglas said, “Without struggle, there can be no progress.” The last year fighting alligators in the swamp has helped me to progress – as a mother, as a physician, as a friend, and as a wife.  Take no prisoners, leave no witnesses.  I have learned a very powerful lesson. “Don’t taunt the alligator, until you’ve crossed the creek.”

alligatorsHowever, there may be a diamond in this rough yet. I start on a new adventure tomorrow. I am excited. I am hopeful. I am certain I will be reminded of the initial beauty of medicine. What I am not – is looking back.


Care from cradle to grave…or the other way around.

baby_feetI love my job. The reason I know I love it, is because I come into your room in the dark of the night to take care of you. I take care of you and yours when my own need taken care. I set aside the recitals, the school programs, and the PTA events to be with strangers at their time of need. I stand beside the gurney in the ER and discuss the risks and benefits of continuing your care. I discuss how aggressive you want me to be in your hour of need. Then, I follow you to the floor. I check in on your nurse to make sure that I’ve not forgotten the small details of care – like whether or not you have a diet ordered so you can have breakfast in a few hours. You may be feeling better or you may be worsening. I evaluate my treatment plan and worry and pine over you. Your job is to get well. My job is to worry. I do my job very well. The nurse pages me and your condition has deteriorated further. I stand with you as your soul leaves your body. I comfort your family after you have gone. We tell each other that you are in a better place. And my pager erupts. Someone else needs me. I think, as I take the stairwell, running over your last few hours. Is there a sign I missed? Did I do everything I could have or should have done? The next page is a new life entering the world.


I’m not the doctor. I’m the mom.

IMG_0603She grasps her chest dramatically and falls to the floor. Her eyes flutter as she tries to hold them closed. Her one arm across her chest the other flailed in theatrical fashion to her side. She’s dead. Her heart is broken. The other jumps from the bed, and after landing, reports her leg is broken. She hops about the room, unable to use the leg and there are no crutches or small wheel chair for her to use.

“Sweetie, are you okay?” “Mom, mom! Mom!!” “I’m not dead. I’m okay.” This last sentence in addition to the frantic “moms” break the trance that the chart-grind has induced. “What?!” I start. “I’m not talking to you. I’m talking to her.” She replies. This is number three discussing number two.   I realize the pretend play now. The doctor kit is scattered over the floor. Stethoscopes are draped from both necks. The pager hangs from one pajama dress. They rotate quickly back and forth who is the doctor who is the patient. So I join in, to number three, “are you taking care of her?” “Yes.” I smile, brushing the curls from her sweet forehead, “You’re such a great doctor.” “I’m not the doctor. I’m the mom.”

I watch in amazement as the two littles easily rotate roles. Why is this a difficult task for me? As I near the end of the second month of my practice, I realize over the last month, I have plunged beneath the seas of work and have not surfaced for life. The balance is off. I have the sensation immediately of being hit by another wave before I have gotten my breath. I can’t help but be distracted by the freedom with which they “practice” their craft. Magic Band-Aids are applied over broken hearts. The otoscope is used to evaluate the broken bone. The blood pressure cuff is applied to the ankle as a cast of sorts once the diagnosis has been confirmed. IMG_0641

Turning back to the computer, I stare at the work-list with charts, results, documents, and tasks taunting me. “You cannot complete me.” It’s like building a sandcastle at the edge of the sea. You may get the first towers built. You may insulate the castle with a moat. However, the tide is coming. And the work you complete will shortly be washed away. This is one of the most difficult lessons to learn as a new doctor. However, I am bound and determined to build. I will build a practice, but I will also build a life. It will be another long night. There are only a few times that there is this type of carefree play. The charts will wait. The broken hearts and legs I have seen through the day can have their notes finished after bedtime. Right now, I have two little girls that need a story and a cuddle, and I need a lesson in multitasking.


Burger (or Attending) Expectations

Let’s talk about expectations. And I’m talking the Dickens’ kind. When you watch television, the food flaunts itself before you. Tempting you with golden buns and perfectly placed pickles. The models eating those perfectly styled burgers are the same – airbrushed to perfection. Most often, limbs are stretched to unrealistic proportions and curves are molded and erased to fit someone’s view of beauty.

When someone first takes the baby steps to venture into medicine, they expect to find the cure for cancer. They expect to heal the sick and raise the dead. However, all is not as it seems.

The hamburger, and I’m not just attacking hamburgers – but that’s what’s on the menu tonight, is perfectly stacked and delicious appearing. However, when photographed from the back reveals the T-pins, sponges, and wax to make it so. So much more is revealed when the actual food itself is discovered to not be food at all but some substance that takes a better photo. Those ads sell because they appeal to the your (and my) mind’s eye.

pinkMedicine, when photographed from the back-if you could do that, reveals the red tape of unrealistic processes and procedures, coding complications, and the reality of the EMR. The delusional that enter medicine only see the styled front. We see patients. We see disease processes that can be treated. We see magic.

Who among us has not given “the talk” – I’m sorry your loved one is dying – only to see them make a full recovery. Later, they return so you can bang your head against another wall convincing them controlling their diabetes and hypertension could help ward off another heart attack. Who has not seen a patient survive a fatal congenital anomaly to later tempt fate with smoking, drug use, or some other equally destructive behavior?

But the dang ads are so tempting…everyone looks so happy. Not in the cigarette or drug commercials (I already told you those were fake…pay attention) – but the ads that are our experience. Ads that convince us this path is ours. Physicians, innocently, but deceptively coax students into deciding their specialty is the right one. Often, one preceptor can change the entire direction of a student. Recruit them to the dark side – because we have cookies or ice cream – or give them such a strong aversion to the field they determine then and there they will never practice in that specialty.

It is so difficult to then leave that daydream with perfectly proportioned everything and enter reality. Although they have seen some tarnishing of some their ideals, most residents graduate with a fire to still heal the sick and raise the dead. In the first years (let’s be honest weeks) of practice, it’s hard to see the magic. It’s hard to remember that even though the burger is not as pretty as the ad, it is still pretty damn tasty.