spotted

Jesus winks

2011-10-18T06:26:00.000-07:00

There's an icon that sits on my bedside table, a red line drawing of Jesus, winking. My priest gave me this image during my pregnancy with Sam. The suggestion that what was happening to me, to us, might be a big fat joke was oddly comforting. We'd laugh about it all -- the bleak season of infertility, IVF, horrifying bleeding, relentless pre-term labor -- someday! But someday is now, and I'm not laughing.

I'm pregnant again, this time with what Brian calls our "free baby". The pregnancy has been entirely uncomplicated. So normal as to be almost cliche. In February, I felt nauseated on call, and took the contraband pregnancy test my intern swiped from the store room in our hospital emergency department: positive. Since then, I've tripped happily through my rotations, my expanding girth a conversational touchstone for my patients and my colleagues. Nothing to report outside a little extra swelling, a trifle more fatigue. I don't have so much as a stretch mark to show for my adventures.

Now I'm winding up and slowing down. My rotation these past two weeks has been "women's health", an ABIM requirement for medicine residents, especially those of us who spend a disproportionate share of our training in VA hospitals, caring primarily for aging (male) warriors. These two weeks are hardly sufficient time to balance the years I've spent prescribing phosphodiesterase-5 inhibitors and counseling veterans about prostate cancer screening, but here I am. Here we are.

Friday, I spent the afternoon at Stanford's reproductive endocrinology clinic. I gently suggested to my attending that perhaps the IVF clinic wasn't the best place for me, in my condition. Her response -- "Don't worry about it; if the patients have a problem, it's their issue" -- was entirely my point. (And made me think, well, look who got pregnant on her first try. That must have been so very nice for you.) But it wasn't only their issue: the flash of pain on the patients' faces when they met me was painful to me as well.

Then yesterday: Planned Parenthood. And you know, there was the same flash of pain on those faces when I waddled into the exam room in introduce myself. A flinch followed by a firm mustering up. Wielding the wand of the transvaginal ultrasound I measured centimeters on a grainy screen: gestational sac, fetal pole. Eligibility for the "pill" vs the "procedure".

And now I think I see that the wink wasn't merry. This is not an inside joke, but a serious business. Even though I've come through a short season of infertility with my happy ending intact, with Sam on my lap and a bonus baby on his way, I still remember exactly how it feels to be on the other side.

Ordinary time

2011-09-28T13:08:00.000-07:00

Today is pure heaven.

This -- my last month before maternity leave -- is my "ambulatory" rotation. Mostly, it's like being a medical student. Medicine residents rotate through various non-medicine specialty clinics: this week, I've spent time with orthopedic surgeons, dermatologists, podiatrists, physical therapists, neurologists. Later this week, I'll wander through obesity clinic and pain clinic. I know next to nothing about most of those specialties and since no one expects me to know much, my job appears to be trivial: I shadow, I learn, I see what's interesting and ignore the rest. I come late and leave early.

But today -- after a grueling morning shirking work and squinting at warts in dermatology clinic -- I have a precious "reading" afternoon. And it's raining. So I'm sitting under a canopy at an open air cafe, eating a salami sandwich and drinking a latte and feeling entirely, completely, blissfully happy. In a few hours, I'll pick Sam up from school and maybe we'll go to the library or the craft store. But for now, I'm updating my blog with pure fluff, then reviewing a little clinical hepatology in preparation for my upcoming in service exam this weekend. Or maybe just reading the novel I have stashed in the bottom of my purse.

There are big changes coming for our family. A new baby. The end of residency and the beginning of a demanding fellowship. But today is easy, and I'm soaking it up.

The mother of all updates

2011-05-01T07:25:00.000-07:00

It's May!

This past month, I've been on the pulmonary consult service, a welcome respite from back-to-back critical care, then wards ... then wards again, starting next week. Life on the pulmonary consult service is relaxed, for the simple reason that the commonest breathing problems in the hospital are readily handled by generalists (pneumonia, asthma exacerbation, COPD exacerbation) or are so severe that they require mechanical ventilation in the ICU, in which case, the attending physician is generally a pulmonologist anyway. So we don't see too many consults on the intpatient pulmonary consult service, and the cases we do see have been fascinating esoterica. Lung inflammation caused by chemotherapy, or rheumatioid arthritis, or amiodarone. New lung nodules in a immunosuppressed woman already on serious anti-fungal therapy. Shortness of breath in a pregnant woman with a rare clotting disorder. Massive and disseminated tuberculosis infection that initially presented with an esophageal ulcer. In other words, fun!

Which leads me to: I have a humbling confession. After years of generally cursing myself for choosing to go to medical school, ranting to basically anyone who would listen about the mess that is contemporary American health care, griping about my hours and my patients and my paycheck ... I actually like my job. And not for any reason that I clung to as a pre-medical student; not for any reason that featured prominently in my various personal statements over the years. Helping people? Ha. Science? Whatever. Fair compensation for the my time and efforts? Hilarious. No, what I like -- what I am coming to treasure -- about my job is something much more pedestrian. As a physician, I have a truly unusual opportunity every single day to be kind to someone who needs kindness. I don't have to seek them out; they come to me. It's an honor, this job, and a blessing to recognize it, however belatedly.

In other news, we've had a number of occasions and celebrations since I last posted. Sam's third birthday was back in March.

And because I can't stop myself, a few more:

In other-other news, I am pregnant, due in late October. I feel well and the baby appears to be healthy and growing. Brian and I are elated and Sam is absorbing the news in his own way. Which is to say, intuitively and incompletely and sweetly.

Easter pictures soon!

Happy

2011-01-24T14:56:00.001-08:00

This winter is a blur of critical care, first my ICU rotation and now I'm in the CCU. Critical care leaves very little time for blogging, but today I was printing some pictures of Sam for him to take to school -- apparently it's his turn for the "All About Me" board -- and I found this in Brian's photo folder:

That about sums it up for me right now. I'm happy. Sure, I'm tired. Yes, it'd be nice to have a weekend off now and then. But I've passed the half-way point of my residency and every day I see myself growing into the physician I want to be. Brian is still in quiet awe of our new backyard; he can't stop talking about where the blueberries will go, and what kind of currants we should get. (Grapes! Peaches!) And, of course, I'm still mother to the world's most irresistable kid. Happy happy happy!

2 Advent

2010-12-05T14:23:00.000-08:00

My favorite thing about finishing a wards month is being back at church. Today, the second Sunday in Advent, I served as subdeacon. After the service, we gathered to celebrate the recent ordination of a member of our parish, and to decorate gingerbread houses. Sam took to the task with enthusiasm and his house is now proudly displayed on our dining room table.

In unrelated house news, our house buying situation remains maddenly up-in-the-air. It appears we'll close a day or two after my three weeks of vacation end, just days into my ICU rotation. Ugh. But at least some needed repairs are moving forward relatively swiftly; the house is tented for termites as I type; tomorrow the roofers arrive, weather and G-d willing.

The upside of the delayed closing, of course, is that I'll get a real vacation this month. Sam and I plan to spend a few days in Seattle watching on with excitement as my sister chooses the dress she'll be married in come June. Otherwise, we'll be at home. We'll nap/park/library when it suits us, maybe do some holiday baking should the mood strike ... and that's about all I have "planned".

Heaven.

The break also affords me the chance to reflect on my first month as wards resident. The job entails running a general medicine wards team, responsible for supervision and teaching for two interns and two medical students. I, in turn, was supervised by an attending physician, but that person was only in the hospital intermittently, and generally left diagnostic and treatment decisions to me. It marked a big change from internship for me, and I'll freely admit that I was nervous about the new responsibility. But the month went well: we took good care of our patients, my team and I. We learned from them and from each other. We even had some fun.

One call, the night float intern poked her head into our team room. She had an EKG in her hand and a worried look on her face. "I need a little help," she said and handed me the EKG: wide complex tachycardia. I was out of my chair before she could describe the patient. Together, we pushed adenosine, called a code, prepared for cardioversion, and sent the patient, a cachectic woman with lung cancer, to the ICU. A few hours later, I found a little note taped to my keyboard: Thanks for the back-up.

Ahhh. This job is starting to get good.

New house

2010-11-19T19:33:00.000-08:00

Today was my day off from the wards and Brian and I took the chance to meet with our realtor and sign our names about one billion times each. We're in contract to buy a house in Sunnyvale and so far it seems that everything is on track for an early December closing. Pinch me! The virtual tour is still available online here. The house itself is quite modest but the yard, neighborhood and excellent public schools are a dream.

Picture drop

2010-11-15T20:48:00.000-08:00

Brian's taken some really lovely pictures of Sam lately.

I was on call for Halloween (again!), but Sammy dressed as a firefighter:

The following weekend, I missed a train ride:

And some bed-jumping:

Five more days on the wards!

Adventures in potty training

2010-10-19T21:46:00.000-07:00

Daycare has its perks, I admit. One great thing: they (help to) potty train your kid. Downside is, you have minimal say on the timing, at least at our daycare center. Sam's on the potty training fast track these days and it's not because he's a bladder control prodigy. Nope, it's because, you know, there are tiny infants in our neighborhood whose moms and dads need to go back to work in January. So if Sam doesn't get his literal you-know-what together, there won't be space in the two-year-old room (sunshines!) for all those one-year-olds (moonbeams!) who are getting displaced to make room for ... the infants. It's somewhat surreal to me that my son has to give up his diapers because a stranger just had a baby, but there you go.

On the upside, he's looking forward to being a !starlight. (I know, I know. Ridiculous.)

Having said all that ... the potty training ... it's not going so well. The other day I sailed out of clinic early to pick him up for some much-anticipated library time. I found him sitting on the potty, singing a little song. After 20 solid minutes of, ahem, no productivity save that song, we left for the library. Once there, I plopped him back on the (cute, toddler-sized) toilet for another 15 minutes of nada. But five minutes -- FIVE minutes, people -- in the picture book room and he managed to pee on the floor and poo in his superhero underpants.

Whoever those new parents are, enjoying their babymoon, putting all thought of January and the end of parental leave out of their minds ... I kind of hated them in that moment.

Inservice

2010-10-02T21:07:00.000-07:00

Yesterday was my inservice exam, an annual test required of internal medicine residents. I'm a fast reader and was completely clueless about far more questions than is strictly optimal (second line therapy for psoriatic arthritis, anyone?) which meant I finished the morning session with more than an hour to spare. To kill time, I wandered over to Nordstrom in search of new shoes, something I very much need. But I'm pathetically out of practice when it comes to shopping. I wander aimlessly, I can't settle on any particular object, I get overwhelmed before I try anything on. So after a quick look through shoes and around sweaters, I spent the hour eating nicoise salad at the Nordstom cafe, bent over the new Jonathan Franzen novel. I'll curse myself Monday morning when I still have no suitable shoes to wear to work.

Work this month is the "same day" clinic at the veteran's hospital. It's like urgent care and so far, I like working there, for the simple reason that I never get in before 8 AM and I never leave after 4 PM. (If I had known, eight years ago, that my criteria for professional satisfaction were so simple, I could have saved myself a lot of trouble.) But I do find myself amazed on a near daily basis by the complaints that bring patients to the doctor. Two days of mild cough. Intermittant toe pain (that's not even happening right now). One guy came in Friday because he'd changed his mind about that prostate biopsy the urologist offered him nine months ago. I met a woman last week who was having a mild sore throat and "when I stand up, I get nauseated". I'll admit I have limited tolerance for this sort of thing. Brian likes to joke that my favorite clinic patient is actually dead, holding a slip of paper with the diagnosis. What a trouper!, he says, mimicking me. I don't think that's entirely fair, but I do get annoyed with complaints that any reasonable person would treat with common sense and patience. Sometimes, I want to tell my patients, people cough and then a few days later they stop. Once in awhile, we all get a headache. And I bet if I got a new fitness machine, my knee might hurt a little the next day too.

On the other hand, some patients are too stoic or too scared for their own good. Last week I saw an elderly man with shingles in his eye; he'd waited six or seven days before coming in. I suppose he was thinking, whatever it is, maybe it'll go away. And it probably will, but it may take the eye with it. Or the 85 year old woman, coughing for the past three months and losing weight despite forcing herself to eat, who just casually mentioned that her mother died of tuberculosis. Or the obese smoker with a family history of early heart disease whose worried wife hauled his butt in after three days of left-sided chest pain that started when he was cleaning a pool. Our exchange was mind-boggling. "I don't understand why this is happening to me," he kept saying.

"Well," I said, "for one, you're fat. For two, you smoke. Your mother had her first heart attack in her 40s. Your blood pressure is 175/95 and God only knows about your cholesterol."

"OK," he said, "but why is this happening to me?"

We went around like that for several minutes, until finally, I said, "I don't know why this is happening to you. Sometimes people get chest pain. And sometimes it's nothing, but sometimes it's a heart attack. Please let me take care of you."

And you know, it's taken a long time to get to say that. Four years of undergraduate education, five years of medical school, a grueling internship. But finally now, ten years in, I can look my sick patient right in the eye, and offer to take care of him, and actually mean it. And that exchange -- of help offered and help accepted -- is exactly as satisfying as I thought it would be. So maybe same day clinic isn't so bad.

Unrelated: we went fake-real camping two weekends ago (where you sleep in a tent 10 feet from the car and eat steak and drink beer and drive into town in the morning for a decent cup of coffee, not to be confused with fake-fake camping, where you stay in a hotel and tell Sam, "We're camping!"). Brian is begging me not to share these pictures with you until he has a chance to process them, but too bad for him.

Endocarditis

2010-09-15T22:02:00.000-07:00

Another perk to my temporary life as a cardiologist is that I don't need to arrive at the hospital before 9 or 9:30, so I've traded gigs with Brian and have been dropping Sam off at daycare in the mornings. We've already developed a weekday routine that involves a morning coffee (for me) and a morning scone (for him). Yesterday as we were walking toward the coffee shop, we passed one of the baristas, empyting the garbage. "Stay in school, kid," he said to Sam. "You don't want to spend your life empyting other people's trash."

Yeeeeeeeeeeesh.

Speaking of gratitude, here's a story for you. One aspect of modern medical care that I suspect many non-doctors don't fully appreciate: the log-jam. I recently helped to care for a patient at our veterans' hospital with so many medical problems, it is almost impossible to treat him. Poorly controlled diabetes earlier in his life resulted in kidney failure; a decade ago he underwent kidney and pancreas transplantation. Unforunately, his shiny new kidney was infected with a virus and was subsequently removed and he is now a dialysis patient with permanent vascular access. But his borrowed pancreas still functions, and he remains on immunosuppressive medications. (Note that permanent vascular access + immunosuppressive medications is a bad, bad combination.) He rolled in to our VA emergency department four or five days ago with a high fever and severe back pain. An MRI showed a large abcess in his lower back, tracking along his spine. The next day, his blood cultures grew Enterococcus and an ultrasound of his heart revealed a infectious goober flopping along on his aortic valve. The valve itself is no longer functioning adequately; he is increasingly short of breath and hypoxic as a result. Treatment for an epidural abscess? Surgery to drain the abscess. Treatment for bacterial endocarditis causing heart failure? Surgery to replace the valve. But the heart can't be fixed before the back; can't put hardware in a patient with an active septic focus. And the neurosurgeons are -- how to say this? -- declining the opportunity to operate on this man's back due to his kidney disease and overall clinical instability. "Poor surgical candidate," they called him. ("Poor non-surgical candidate," the medical team noted.) In the meantime, his fevers and rigors continue despite horse doses of antibiotics and all the while he remains paradoxically on medications to suppress his immune system. The whole situation is a complete snarl and the patient is desperately, desperately sick. I'm not sure what will happen for him or to him.

Cardiologist for a day (month)

2010-09-02T22:05:00.000-07:00

This month, I'm on the cardiology service at our veterans' hospital. Among other things, the new rotation means WEEKENDS OFF. My first so-called "golden weekend" (known to non-residents by the common moniker, "weekend") was last week. Brian, Sam and I celebrated by spending the weekend at Lassen National Park. Despite a Bay Area heat wave earlier in the week, it actually snowed in Lassen over the weekend. Snow! In August! Even with the incement weather, we had a wonderful time. On Sunday we hiked to the top of the Lassen cinder cone for a view of the painted dunes and lava beds. It's quite a steep climb and poor Brian carried Sam on his shoulders the entire way. When we got to the top, Sammy announced, "I HIKED!" Um, sure, kid.

I'll post pictures of Sam "hiking" and "camping" (technically, a hotel, but what does he know?) when I can.

August update

2010-08-14T14:41:00.001-07:00

Still here, still alive.

This weekend, Brian and Sam are in Oregon, throwing rocks into the Rogue River and catching up with old friends. I'm in the middle of a run of night shifts in the emergency department at our university hospital, so I got left behind. What this means is that, for the first time in over a year, I have an entire day to myself.

Sleep until I wake up, check. Coffee and the NYT, check. Pedicure, check. Eating ice cream in bed while I update my blog, checkity check.

Emergency medicine has been an interesting experience so far. As a medical student, I felt reasonably certain that the specialty wasn't for me, so I didn't bother to do an emergency rotation; this month is my first exposure. While my time so far has confirmed that emergency medicine isn't a fit for me (noisy, chaotic, waaaaay too much psych and OB), I'm enjoying myself. Nice people, interesting cases, shift work.

Last night I met a 59 year old woman who was billed as "headache, vomiting" and triaged to the less-acute area of our department. I strolled in, expecting a migraine or maybe meningitis. But from the doorway, it was obvious that my patient was much sicker than advertised. She was slumped to her side, shuddering and moaning. Three hours earlier, her son explained, she had argued with a neighbor, then been struck suddenly with an overwhelming headache. She fell to the floor, unable to stand or walk, and proceeded to vomit again and again. When I met her, she no longer recognized her son and she couldn't look at me, answer any of my questions, or participate in my cursory neurological exam. After surveying the scene for about a minute, I had heard all I needed to hear; I called a stroke code and 10 minutes later, I was standing in the control room for a CT scanner across the hall with the on-call neurologist, looking in horror at images of a brain filled with blood. We wheeled our patient back to the emergency department, pushed mannitol and 23% saline to prevent her brain from swelling, then waited for the on-call neurosurgeon to make his necessary arrangements. I suppose it's a sign that I don't belong in the emergency department that when my patient left for the operating room -- no longer my patient -- I wanted to go with her. To be sure, I am not the doctor she needed that night, but it doesn't sit well with me to triage and stabilize, then hand off care for my patients to other physicians. I'm glad I'm not an emergency medicine resident.

On a happier note, here are some pictures of Sam at the science museum in San Francisco.

Photography

2010-05-26T13:00:00.000-07:00

Brian's been making noises lately about "needing" a new camera. (Note to self, this must be where Sam learned to use the word "need".) I am having trouble being supportive of this need. His collection of camera equipement is already a) extensive and b) expensive. Does he really need another DSLR? Wouldn't life go on, just as it has, without the capacity to shoot HD video? The camera he has his eye on isn't available yet, so I have a temporary reprieve, but even so, I admit to a bad attitude about spending $2K for the latest version of what we already have.

Having said that, Brian was processing some pictures last night and had this to show me:

This shot completely captures my memory of our trip. I suspect I'll look at this picture again and again over the decades of my life and be transported back to a moment so flawlessly happy, it's almost a miracle.

Which makes me think I shouldn't interfere with Brian's pursuit of his photography hobby.

PS. In case it's not obvious, that blur in Sam's hands is a little wooden sword.

Limping

2010-05-16T15:36:00.000-07:00

It's been an eventful week. For starters, on Tuesday, Sam developed an atraumatic limp. By Thursday, the limp was worse and both my brain and stomach were churning (!sarcoma! !leukemia! !septic joint!) so we piled into urgent care where Sam limped obligingly up and down the clinic halls, giggling. The ped, thoughtful and thorough, sent us home with reassurance. But the next day his limp was worse yet, so back to urgent care we went. This time: plain films of the hips, knees, ankles and some basic blood work. All blessedly normal, and today the limp has more or less disappeared. I am relieved, but still a little rattled.

It's always interesting to me to be a patient -- or worse, a patient's mother. There's this out-of-body thing that happens: helpless, I watch myself morph into the kind of patient who drives me bonkers. I'm irrational, I cling to my own explanations, I demand needless intervention.

All very humbling.

Work has been less humbling. It's near the end of intern year, and I can feel myself starting to get cocky. After ten months as an intern, I can write an H&P in 20 minutes, I know where the radiologists hide in the middle of the night and I actually remember which carbapenam doesn't cover pseudomonas. I know how to distinguish between right and left atrial enlargement on an EKG, how to triage respiratory distress, how to perform a thoracentesis. I have the pager number for the on-call ICU fellow memorized. I even know where the obstetricians stash their free hot chocolate. I've got this down.

Anyway, I'm working this month on the private hospitalist service. The schedule is more or less the same as for the university wards -- Q4 overnight, roughly 80 hours/week -- but interns work directly with attendings. Some of the attendings are micro-managers and others don't seem to care at all what I do for our mutual patients so long as everyone's alive in the morning. Needless to say, the second type is my strong preference.

I was on call last night with an especially hands-off attending. We admitted a 56 year old woman who for the past four years has been inexplicably unable to walk. Apparently, four years ago, her legs developed intractable spasms and over time, she walked less and less until she became essentially immobile. Yesterday, her husband had finally had enough. He picked her up, carried her to the car and drove her to urgent care. From urgent care, they dispatched her immediately to the hospital for additional imaging of her brain and spinal cord. In fact, when I left this morning, she was in the MRI scanner. I'm not sure what's wrong with her, although the posibilities are numerous and interesting (multiple sclerosis, a severe B12 deficiency, syphillis, diseases that form benign CNS tumors like neurofibromatosis or tuberous sclerosis, probably several other things I haven't thought of), but what's really fascinating to me about this woman is her indifference to the problem. Apparently, years ago, she was a ballerina. But for the past four years, her legs just ... didn't work. And she did absoutely nothing about it. What does that mean?

I dare you

2010-04-21T10:56:00.000-07:00

... to keep from smiling while looking at this picture. Can't be done!

Home!

2010-04-09T18:25:00.001-07:00

More Tuscany

2010-04-07T13:05:00.000-07:00

The last pictures from Italy! We fly to London tomorrow.

This is my favorite shot of Sam, just outside the restored cloister where we're staying:

We spent an afternoon in San Gimignano, amazingly overrun with tourists even in April.

On the way to Volterra, we stopped at a farmhouse for some agriturismo: delicious food and a place for Sam to run.

We were tempted to stay (forever) at the farm, but eventually made it to Volterra.

Today we went to Montalcino, for some famous wine.

Siena

2010-04-03T13:15:00.000-07:00

On one of our last nights in Florence, we three got caught in a thunderstorm on the Ponte Vecchio. Dreamy beyond dreamy and Brian shot the perfect picture:

Now we're off to the hill towns. En route to Siena, we stopped in Monteriggioni.

Amazingly enough, Tuscany actually does look like this, from pretty much all angles:

We LOVE Siena. You can keep Florence; I want Siena.

Pearls before swine, redux

2010-04-03T12:59:00.000-07:00

Sam at the Uffizi: "I don't want more art. I want more CHOCOLATE." (Yes, that's chocolate around his mouth. Yes, I brought bribe-chocolate into the Uffizi. If you can think of a better way to get a two-year-old to spend an afternoon looking at Giotto, I'm all ears!)

What else am I gonna do while the kid naps?

2010-03-29T08:47:00.001-07:00

In the picture below, Sam and I are checking out the scuptures that adorn the Piazza della Signoria, which include the famous Rape of the Sabine. Just around the corner, there's some construction going on at the Galleria degli Uffizi. As we're perusing, he says, "See it, Mama? Looking?" "We are looking," I told him. "No, Mama. FORKLIFT."

Pearls before swine, I tell ya.

Ciao, bella!

2010-03-28T06:57:00.000-07:00

We made it! Three flights and three utterly exhausted toddlers later, we're here. And turns out, it's *wonderful* here.

New brother

2010-03-06T14:32:00.001-08:00

Last weekend, my sister and her boyfriend became engaged. Nick blessed our whole family by inviting us to witness and participate in their engagement. We gathered at a vineyard in Napa, watched him kneel on one knee, and then celebrated all together over a gorgeous meal with an even more gorgeous wine pairing.

As it happens, I was the one who introduced Alison and Nick. It seems like forever ago -- six years! -- that I sent Alison an email telling her about a single classmate of mine. At the time, I didn't expect them to be a match, which just goes to show what I know. After watching them grow together these past six years, I couldn't be happier for them, or for the rest of us. I feel so blessed to be gaining such a wonderful new brother. Congratulations, you two. I love you both so much!

PS. Brian took some really lovely pictures of the occasion. My favorite few are below; many more are here.

Puddles

2010-02-06T21:51:00.001-08:00

It's taken a little longer than I expected, but Sam finally *gets* boots.

Tahoe

2010-01-28T21:38:00.000-08:00

Last weekend, we went to Tahoe for some snow, Sam's first. He was unimpressed, to say the least. After just a few minutes in the snow, he said, "ALL DONE!"

Haircut!

2010-01-03T22:28:00.000-08:00

Because I can't stop myself

2010-01-02T23:39:00.001-08:00

I can't say for certain, but this may be my favorite picture of Sam, ever.

Christmas bubbles

2010-01-02T23:26:00.001-08:00

We had a wonderful Christmas! Family on both sides came to join us, and we feasted and laughed more in a few days than is strictly possible.

I don't have time for a proper Christmas picture post, but these shots are too sweet to keep to myself. For Christmas, Brian bought Sam an automatic bubble machine. Needless to say, it was a hit.

Family wedding

2009-12-19T14:14:00.000-08:00

Last weekend my brother Andrew got married. The wedding was really gorgeous and I'm so thrilled to have a new sister. In other news, it was Sam's second wedding, but his first as a dancer and he wowed us all with his moves.

Part-time residency

2009-12-07T15:53:00.001-08:00

Now that I'm out of the Q5 frying pan and into the Q4 fire, it seems like the right time to write about part-time residency.

One or two years ago, part-time residency wasn't even a glimmer in my imagination. Never occurred to me that it might be possible. Then I received my UCSF residency interview invitation and discovered !they offer part-time residency! I interviewed there -- and was so impressed with the program -- but ultimately decided that adding an hour long commute to my life was the opposite of family-friendly. But the seed was planted and I matched at Stanford with the expectation, misguided maybe, that part-time residency was going to work for me. Hey, if they can do it at UCSF, why not at Stanford?

As it turns out, they *can* do it at Stanford. At least, I can. After some careful negotiating, I am the proud owner of a shiny new part-time residency, starting next year. I'll spread my remaining two years over three years total, doing two months on, followed by one month off for 36 months. Even better, the call schedule quiets down considerably starting next year. As an R2, I anticipate five or six call months; I'll have four or five call months as an R3. In other words, stanting in July, my life will go like this: call month, followed by elective month, followed by month off. Rinse, repeat.

To say that I am overjoyed about this development is a severe understatement.

There are some downsides here. For one, I won't be paid during my months off and neither will I be eligible for benefits. Happily, Brian earns a salary and receives benefits, so this isn't a crisis. Also, I'll have to keep up my continuity clinic during the off months, at least for the first 24 months. On the one hand, drag. On the other, it's probably for the best that I'll keep the clinical side of my brain engaged during those months off.

While the major motivation here is simple -- more time to mother my small son -- I do anticipate doing some research during my off months and I've begun to talk with my research advisor about possible projects. Even so, he's encouraged me to enjoy these months off for what they are: pulses of diastole amid the systole of residency.

Oh, I am happy about this.

Postcard from internship

2009-11-24T10:04:00.000-08:00

So the other night, I'm interviewing this vet with no legs. At some point, it seemed reasonable to ask about it.

Me: Sir, I notice that both your legs have been amputated above the knees. What happened to your legs?

Him: <flinging the sheet aside, inspecting his well-healed stumps with some surprise> I don't know, Doc. Couldn't really tell you. I don't remember.

You can't make this stuff up.

Excuses

2009-11-17T14:39:00.000-08:00

Last month, one of my ICU patients called the police from his hospital bed and told them I was trying to kill him. The police showed up at 2 AM -- I suppose they have to -- to take the patient's story and to question me. As it happened, that night was one of the busiest nights in the ICU that entire month; we admitted four or five patients over the course of as many hours, several of them desperately sick. I stopped briefly to talk with the officers as I moved from disaster to catastrophe. Of course I'm not trying to kill my patient, I told the cops. Although now that you mention it, the idea does have merit. I'm not sure what's happened since then with the investigation; I certainly haven't heard anything more from the police. And the incident did yield a dash of surreal humor to what would have otherwise been an entirely humorless night.

As luck would have it, I readmitted this delightful patient to the hospital on Sunday night.

Un-freaking-believable.

So far, he hasn't called the police again to report me (so far as I know), but every encounter with him is intensely unpleasant. This man may be the most miserable human being I have ever met. He is nasty and hostile. He is racist and sexist. I can't so much as greet him without being subject to a stream of profanity and disdain, sarcasm, rage, hate. Because he's been sick more or less continuously since July, he has been cared for, at one time or another, by many of my resident colleagues. So far as I can tell, he is universally despised. Post-call yesterday, I was briefing the dayfloat resident (DFR) who covered for me in the afternoon. As it turned out, DFR also had cared for my patient, a couple of months before, and he knew more about this man's history. Apparently, a few years ago, my patient's college-aged daughter was raped and murdered. And that's why he's so miserable and mean, DFR said.

Wait a minute, there. I certainly don't diminish the tragedy my patient has experienced. But does a tragedy -- even a horrific one -- entitle him to be hateful to strangers? Maybe I'm heartless, but I don't think it does.

California Academy of Sciences

2009-11-09T21:47:00.000-08:00

Yesterday we took Sam to the California Academy of Sciences. He pretty much made this face all afternoon:

Great Pumpkin 2

2009-11-03T21:32:00.001-08:00

Great Pumpkin

2009-10-27T21:19:00.000-07:00

Last weekend, we took Sam to a local pumpkin patch.

There was a little petting zoo at the patch:

We had a wonderful time!

The more things change

2009-10-17T14:08:00.000-07:00

I have a day off from the ICU today and I’m sitting in Starbucks, putting together a poster for the annual ASN meeting next week in San Diego. I finagled another day off for the conference and will fly to San Diego and back all in one day to present my poster and hopefully meet some of my future colleagues in academic nephrology. Catching a 6 AM flight only to fly home 15 hours later doesn’t sound like much of a day off, but that’s probably just the crazy-tired talking.

The crazy-tired does a lot of talking these days. Truthfully, the ICU has been harder than I expected. Part of the problem comes from that fact that our VA ICU is an MS-ICU, which means that both medical and surgical patients are cared for by the same ICU team. In some ways, this is a good thing. For one, my residents this month come from general surgery and anesthesia, as well as medicine, and I’ve enjoyed meeting and learning from this diverse group. For another, managing a post-CABG patient, the bread and butter at our VA, is good learning for medicine interns. Where else do you consistently encounter concomitant distributive and cardiogenic shock? On the other hand, some of the differences in approach between the two services (medicine and surgery) are -- how to put this delicately? -- frustrating.

Right now in our ICU there is a patient with severe congestive heart failure, in cardiogenic shock. Essentially, the pump function of his heart is failing and he is unable to pump sufficient blood forward to supply oxygen to his organs and tissues. One consequence of this problem is that the patient’s lungs slowly fill with fluid as it backs up behind the failing pump. The medical approach to such a patient is to temporarily give medicine to augment the strength of each heart contraction (inotropy), as well as medicines to reduce the extra fluid in the lungs (diuresis) and to lower the pressure against which the weak heart is pumping (afterload reduction). The surgical approach, apparently, is to insert a chest tube to drain the fluid around the lungs. The surgeons are also refusing to allow the ICU team to provide afterload reduction. Meanwhile, the patient is requiring ever-increasing doses of inotropic support, in the form of intravenous dobutamine, which increases his risk of a dangerous arrhythmia. Our various consulting teams are wondering, first politely, and now with escalating boldness, why -- why, exactly? -- the ICU team is mismanaging this patient so spectacularly. It’s an irritating situation and brings to mind that old joke about the various specialties: Internists know everything and do nothing. Surgeons know nothing and do everything. Psychiatrists know nothing and do nothing.

But despite the irritation and the crazy-tired, I’m doing OK. Brian is home from Japan, finally and blessedly. And Sam is Sam. And that right there is enough for today.

Puzzles and tricks

2009-09-19T14:00:00.000-07:00

Last week Alex promised Allie more Sam videos, so here ya go! Replete with our standard gold-plated production values, to say nothing of the editing botch job. Eh. Good thing the kid's pretty cute.

Blogging fail

2009-09-07T11:34:00.000-07:00

I can’t help thinking that when I read back over these posts next year, it will seem like my intern year was composed entirely of days off spent at the spa. I’m off today, sitting with my post-pedicure toes under a dryer, wondering how many minutes are required before I can safely slip my sandals back on.

It’s early in the afternoon, but already, it’s been a productive day. Since Sam went to bed last night, I’ve performed the final post-mortem on our Thursday night dinner party (read: two hours of scrubbing dishes, the stove, the kitchen floor), done three loads of laundry, finished up a few nagging research details and sent them to my advisor, planned our family menu for the upcoming week, gone to three grocery stores and dropped off a donation at Goodwill. Now Sam is napping, and I’m blogging. I’m hoping my toes dry in time for me to get in a short nap myself before he wakes up.

I love not being at the hospital. Oh, how I love it.

But that’s not what I wanted this blog to be about. I wanted this blog to be about my life at the hospital and about my patients. It’s not that there’s a scarcity of stories to tell. Just in the last couple of weeks I’ve dealt with addiction and psychosis, sepsis, flash pulmonary edema. I’ve called strangers in the middle of the night to tell them a loved one is unexpectedly dying. Alcohol withdrawal. Heart attacks. But I’m finding it very hard to find the space and the energy to tell those stories.

On a lighter note, Sam loves to watch Brian in the kitchen lately, which Brian facilitates by letting Sam stand on a dining room chair so he can see up on the counter. Downside here, obviously, is that Sam tends to fall off the chair. I've been thinking about buying this:

... but the $200 pricetag has dissuaded me. So tonight while I was napping on the couch, Brian fashioned a solution out of a dining room chair, an old bike tube, two C clamps and some zip ties:

Aaaaaand now I'm thinking $200 sounds like kind of a bargain, now that you mention it.

In order of awesomeness

2009-08-30T21:04:00.001-07:00

Things that are awesome:

1. Chicken schwarma for dinner
2. Pictures of Sam on the Golden Gate Bridge
3. Three tickets to Tuscany for my vacation in April
4. A day off from night float

In no particular order

2009-08-29T23:54:00.001-07:00

Things that suck:

1. Night float
2. Night float
3. Night float

Night float

2009-08-27T02:15:00.000-07:00

It's almost 2 AM and I'm camped out in what passes for a "hotel room" in our hospital. It looks more like a drab dorm room: narrow twin bed, non-functional lamp, cramped desk. Even the alarm clock is broken. Tonight's my second of fourteen nights on night float and my pager has been relatively quiet but I can't sleep because a) ever the pessimist, I drank an enormous quantity of coffee four hours ago and b) I'm waiting for a repeat hematocrit on a bleeding patient, anxiously refreshing and refreshing my computer screen.

Night float is a necessary evil in medical training. In years past, before new limits on duty hours for residents were adopted, the on-call resident handled cross-cover and admissions, but this genius system resulted in marathon shifts lasting far longer than the supposedly enlighted 30 hour maximum that's the current standard. So now we have night float and for the next two weeks, I'm it. My shift starts around 8 PM and lasts until the primary interns and residents return to the hospital in the morning to resume care of their patients. I cover patients for 12 doctors overnight -- typically about 80 -- but I'm not responsible for admitting new patients. All night long, I answer pages about Ambien and hypotension, I follow-up on recommendations made by subspecialty consultants, and I see and evaluate patients for whatever comes up overnight: pain, agitation, abnormal vital signs.

Night float is generally considered to be a pretty miserable time, and so far, I'd say that's right. It's lonely, it's boring, it's annoying, it's frightening. The good stuff about residency -- the honor of a patient's trust, the commaradie among residents, the satisfaction in mastering a new skill -- is essentially absent. What's left is the chaff of residency: paperwork, a never-ending succession of pages, uncertainty and inadequacy. For instance, I just took a break from writing this post to see a patient downstairs who's nauseated and vomiting. I have no idea why he's vomiting. A quick review of his chart reveals that the vomiting is a new problem for him, so the doctors who know him well haven't left me any clues. He could have an infection, or the vomiting could be the result of his kidney disease, or maybe it's from the medicines we're giving him. I suppose he could have an entirely new problem: heart attacks and pancreatitis can cause vomiting. So can a million other conditions, like migraine headaches, toxic exposures, small bowel obstructions. But my patient doesn't have a fever or an elevated white blood count. He's getting regular dialysis that appears to be adequate. He has no additional symptoms like chest pain, abdominal pain, headache. So here I am. Other than medication to treat his nausea and a couple of simple blood tests that I don't expect to be spectacularly revealing, I'm not sure what to do. It's now 3 AM and frankly 7 can't come soon enough.

Day off

2009-08-03T12:09:00.000-07:00

Yesterday morning, post-call and semi-delirious, I was rushing around the hospital to examine each of my patients before our early rounds in the CCU. One of my patients this week is a lovely woman in her mid-50s with radiation-induced pulmonary fibrosis and severe damage to her heart from chemotherapy many years ago. The radiation and chemotherapy cured her cancer, but that's small comfort now that her heart and lungs are failing. She's been virtually confined to bed for years, but lately she's taken a turn for the worse. Her left lung is full of fluid and she can't so much as roll over in bed without becoming severely short of breath. Making matters worse, several times each day, her heart goes in and out of a very fast rhythm that exceeds the upper limit of her pacemaker. After listening to her breathing (crackly in some regions and eerily silent in others) and her heart (fast with a loud whoosing murmur), I started to leave her room, already ruminating on my next task. Once I was halfway to the door, I thought to turn around to ask my patient if there was anything I could do for her before the day got underway. "Just enjoy your life," she said sadly.

Whew.

So today, my first day off in ten days, I am determined to do just that. I started the day with an early morning hot tub soak and massage, then biked home to play with Sam and feed him lunch. This afternoon, my sister and I will pick our youngest brother up at the airport and I'm hopeful that we'll have time to take Sam to the park before the gang of us go out for dinner. Maybe after Sam's in bed, we five can sit in the backyard and share a bottle of wine. There's laundry to do and dirty dishes in the sink, but they can wait. Today I'm enjoying my life.

Insomnia

2009-07-22T02:58:00.000-07:00

It's 3 AM and I can't sleep. This almost never happens. There was one night in college when I rolled around in bed for most of the night and for years afterward, I refered to the experience as "that time I had insomnia". Generally, I fall asleep as my head is hitting the pillow, if not before. Tonight, though, I woke up a couple of hours ago to the sound of Sam having a nightmare, and although he fell asleep again almost immediately, I haven't been so fortunate.

Here's what's bothering me: what if I'm making a terrible mistake?

I start Saturday in the CCU, which means for all intents and purposes, I start internship on Saturday. And suddenly, I feel sick to my stomach. I am reasonably sure -- as sure as you can be, I suppose -- that Sam will make it through the year unscathed. But will I? Earlier today, Brian and I talked (calmly, rationally) about how he and Sam will likely go to Oregon for Thanksgiving and Christmas, leaving me here in California alone. (Thanksgiving = VA wards; Christmas = University hospital wards.) So I will miss my baby's second Thanksgiving and his second Christmas.

Oh, nuts. Now I'm crying.

More than the holidays, though, I'm going to miss a thousand ephemeral moments with my tiny son over the next year: swinging at the park, snuggling on the couch with a library book, hanging out laundry in the backyard. And I just wish there was some way to know for sure that it will be worth it. I wish there was some way to look forward to the future, to the time when I envision meaningful work matched with ample time to mother and ask my future-self: was it worth it?

I've thought this issue through from every side, talked about it with friends and family until there's nothing left unsaid. I'm desperate to make the choice that will most bless my son, my husband and myself, over the long term. Caitlin Flanagan famously wrote that "when a mother works, something is lost." What she failed to mention is that something is lost either way. If I don't complete an internship, I'll leave behind a career I've worked years to build. Doctoring offers me the opportunity to set an example for my impressionable son, flourish in the public sphere, nurture my peer marriage, maintain my economic independence. A second income will give my family security in uncertain times. More important, I'm good at it. More important still, it needs doing. But at what cost?

Beach baby

2009-07-17T14:31:00.000-07:00

Last weekend, while Brian lived it up in Gold Beach, some friends rescued me and Sam, and spirited us off to Pescadero for an afternoon at the beach. We had a wonderful time and I took this little movie of Sam digging in the sand.

Warning: this movie contains no content. It's just Sam, digging. If you aren't crazy about this kid, the movie may actually bore you to death.

By request

2009-07-11T20:41:00.000-07:00

My mother asked for a new video of Sam. He isn't exactly John Barrymore, is all I have to say.

Chest pain

2009-07-04T12:06:00.000-07:00

Being on call for our university-affiliated nursing home this week has been an interesting introduction to doctoring. On Thursday morning, I was paged for the following question:

"Mr. W. is having some new left-sided chest pain. He thinks he's having a heart attack and he'd like to take an aspirin. Can we give him aspirin?" There's a pause while I reflect momentarily on the insane conversation I'm having.

"Okay," I say to the nurse on the phone. "Aspirin is fine." And I'm thinking, she can't be serious.

"Well, what dose of aspirin would you like us to give him?"

WAIT, she IS serious.

"Do YOU think Mr. W. is having a heart attack?" I ask her.

"I don't know," she says, sounding disinterested. And I'm thinking, aren't you CURIOUS? I sure as hell am.

"Let's get an EKG," I suggest.

"I don't know," she says, dubious. "We'd have to send him to [our university hospital] for that."

WHAAA?

Off to a slow start

2009-06-27T12:32:00.000-07:00

Well, I've been a resident for four days now, and so far, it's been a breeze. I started on geriatrics, which is a soft landing to say the least. All outpatient, no real call, Fridays and weekends off. On my very first day as a doctor, I saw a total of two patients, both in erectile dysfunction clinic. (Oh, the jokes. So many jokes.) In an odd example of life imitating my nightmares, both patients asked me how long I've been a doctor. I figured, they had already opened up to me about much more intimate matters. Plus, they weren't wearing pants. So, I came clean: "Today's my first day!" Juuuuust what they wanted to hear.

On the upside, I never have to say that again.

I was also "on call" over the weekend for the skilled nursing facility associated with our university hospital. I got called exactly once, for a very trivial matter which I knew how to resolve. Weirdness. And the nurse on the phone kept calling me doctor. More weirdness.

To round out this useless post, here's a video of Sam eating a popsicle. I love summer.

Apologies to Mae West

2009-06-23T17:23:00.000-07:00

Too much of a good thing is wonderful!

Twins

2009-06-18T22:12:00.000-07:00

Wherever we go, people tell me my son looks exactly like my husband. Frankly, I just don't see it. When I look at Sam, I see Sam. But we were looking through some old family pictures recently and even I have to admit that baby Brian looks an awful lot like baby Sam.

Scheduling

2009-06-17T21:47:00.000-07:00

So I have a tentative schedule for next year. There's clearly something wrong with my schedule because it includes five -- count them, people, FIVE -- weeks of vacation. That won't last. My other beef with the schedule as it stands is that my first rotation is geriatrics, which is BY FAR the cushest intern month at Stanford. And I have it first! DRAG. It would be lovely beyond words to have a geri-vacation sometime in the middle of the winter when it's really needed. Instead, I get it in July. I'm already all rested up! And it's too early in the year to use the geri month as Step 3 study time. Other lowlights of the schedule: Thanksgiving and Christmas on call. And I get to finish off the year with back-to-back wards months. Honestly, it's hard to find much to like about this schedule. Other than the five weeks of vacation. Which, like I said, won't last. In any event, here's the run-down:

1. Geriatrics: 1 week

2. Vacation: 2 weeks

3. Coronary care unit: 4 weeks

4. Rheumatology: 2 weeks

5. Endocrinology: 2 weeks

6. VA ICU: 4 weeks

7. VA wards: 4 weeks

8. University wards: 4 weeks

9: Nephrology: 3 weeks

10: Vacation: 1 week

11. Oncology: 4 weeks

12: University wards: 4 weeks

13. Vacation: 2 weeks

14. Infectious disease: 2 weeks

15: County hospital wards: 4 weeks

16. VA wards: 4 weeks

On the upside, there's no neurology. And no night float. And no emergency medicine. And as it stands, I never have more than three call months in a row. So I suppose it could be worse. But really not that much worse.

This residency thing is seeming less and less like a good idea.

In other news, our program director -- widely regarded as a Force for Good in the universe -- is resigning come September.

Pffffft.

Graduation

2009-06-14T18:49:00.000-07:00

We did it!

Lady of leisure

2009-06-11T13:55:00.000-07:00

So lately I've been thinking about leisure. Mostly, my thinking goes like this: Mmmm, this couch is so absurdly comfortable. I freaking LOVE sitting on the couch. Next year -- and by "next year" I mean two weeks from now -- I won't be able to sit on the couch like I do now. Which is a serious drag, because this past year, I have turned couch-sitting into high art. I've had more leisure time this year than any other year in recent memory. It has been absolutely luscious. I have luxuriated in my endless afternoons. I have reveled in my free evenings. Golden weekends, every weekend.

I've always thought I prefer to be busy. Productive! But this year I've been more or less a part-time researcher because I wanted to seize the opportunity to spend significant time with my son before residency. I expected to love the time with Sam: taking walks around our neighborhood, playing at the park, lingering at the library. But what I didn't expect, exactly, was how exqusitely I love doing ... not much at all. Turns out free time is habit-forming and I'm hooked. Today, for instance, I woke up with Sam, around 7 AM. We took our sweet time getting dressed and eating our oatmeal. We listened to the news on the radio and made the beds together. During the late morning, we ran a few errands. At Target, we browsed the aisles, just waiting for something to catch our fancy. I bought a new dress, jeweled sandals. An orange rash guard for Sam. We dallied at the grocery store, then back home for lunch. I intended to work on my abstract submission for ASN during Sam's midday nap, but instead, I curled up on the couch and read a novel. In the afternoon, Sam and I walked to midtown for a few more groceries and an iced coffee. After dinner, Brian and I ate ice cream and watched Benjamin Button. It was a perfectly delicious day.

Recently I asked some friends, both academics, what's the optimal number of leisure hours per week? One of them counted the bulk of his working day as leisure, because he loves his job so much. Lucky him! I like my work well enough, but I definitely don't consider running around the hospital "leisure"! The other friend came up with a number: 30. That sounds reasonable to me.

Maybe a better way to pose the question is this: how many hours each week do I want to work? Based on how happy I've been this year, how balanced I've felt, I'd say the ideal number for me is somewhere between 30 and 40. I'd love to work 30 hours a week forever, but I'd be willing to work more like 40-50 under the following conditions: 1. One full weekday per week free, 2. Home for dinner most nights, 3. Off most weekends. I think a schedule that adhered to those requirements would result in an adequate amount of couch-sitting.

This kind of analysis is relevant for me because in the near future I need to begin to make professional choices that will result in more or less leisure, and I want to think the decision through carefully. So I'm interested to know how other people think about this question: what's your dream schedule? How much couch time do you need? How much do you want?

Hoosiers

2009-06-01T21:50:00.000-07:00

We’re back from Indiana, exhausted and just brimming with happiness and gratitude. My beloved friends Teena and Matt were married on Saturday, and it was quite the family affair: Brian took the pictures, Sam was the flower boy/ring bearer/mascot and I officiated. It was such an honor to participate so intimately in their wedding day, such a privilege to observe their grace-filled relationship and such a joy to celebrate with them and their guests. Not to mention, delicious. We are overwhelmed with blessing.

Ahhh.

Brian took such lovely pictures; I can’t keep myself from sharing a few.

Here's a shot from the rehearsal dinner; Rachel and I took the opportunity to embarrass Teena and Matt a bit with a silly game.

Sam munched on a lemon.

In her continuing bid to be the Most Awesome Woman Ever, Teena made her own wedding cake. A small entourage accompanied her as she carried the cake to the reception site, but no one had the cajones to actually help carry it. Too much pressure!

Here's Sam before the wedding started.

We pinned the rings to his back so he wouldn't swallow them accidentally on purpose.

A shot from the ceremony.

The happy couple!

We went hiking the day after the wedding. Turns out Indiana is beautiful -- who knew?

Happy campers

2009-05-24T20:10:00.000-07:00

Brian and Sam are home safe from camping. They had a wonderful time -- and brought home some great pictures.

And just like that

2009-05-23T13:14:00.001-07:00

Medical school is over.

Yesterday was my last day. As last days go, it was lovely. Conference was canceled, so my residents and I lingered over lunch at an outdoor campus café. Feeling expansive, they sent me home early. I walked out of the hospital and back into the sun, and I thought about how the next time I walk through those double doors, I’ll be a doctor.

Today, I feel strangely weightless. My guys are gone for the holiday weekend, camping at Little Basin with some friends. I took the opportunity to sleep in ... then I got a facial at La Belle ... I'm sitting at a coffee shop, wondering what I'm supposed to do with myself now. I mean, seriously, now what? It's disorienting: at age 29, after 22 years of school, I'm no longer a student.

Of course, in the most practical sense, now what? is a simple question. This weekend, I'll rest some and undertake a few preparations for our trip to Indiana next week. This month, I'll play with my son, spoil my husband, and try like heck to get organized for my internship. And next month, of course, I'll walk back through those hospital doors. But today, I think the thing to do is just to sit still and try to absorb the in-between-ness I'm feeling right now.

In that spirit, here are some pictures Brian took of me and Sam at the park last week:

The unit

2009-05-15T16:16:00.000-07:00

I’m now three quarters of the way through my ICU rotation. As I expected, I’ve liked this month quite a lot – interesting pathology, great colleagues, free lunch. Also – unexpectedly – decent hours. My strong preference is to work early-to-early: I like to arrive at work early and leave early enough to spend meaningful time with my kid and husband in the afternoon and evening. These days I tend to get in around 6:30 and I’m usually out the door by 4. Miraculously, medical students in the ICU have weekends off. So, I’m happy: between the ICU and mothering Sam, life is good.

But here’s an ICU tidbit for you: at Stanford – to be fair: Stanford is not known for Wal-Mart prices – ICU beds cost in the range of $30,000 a day. And that’s just the bed! $30K a day before the patient gets a single CT scan, dialysis treatment, liver transplant, subspeciality consult or – as a patient of mine received yesterday – 150 grams of donor derived albumin. ICU stays easily and frequently run to the seven figures and as much as no one wants to think about it, let alone talk about it, the cost of intensive care is a real problem.

There’s a patient on our team, insured by the state’s Medi-Cal program, who has been in our medical ICU for weeks. When she was admitted, the cause of her severe and refractory respiratory distress was somewhat mysterious. In her late 50s, she’s a cancer survivor who received radiation treatment to her chest earlier this year. (Radiation pneumonitis?) Then, midway through her ICU stay, she was found to have a significant burden of blood clots in her lungs. (Pulmonary emboli.) Now, she has a ventilator acquired pneumonia. So she’s been treated for this range of maladies (steroids! Anti-coagulation! Antibiotics!) over the course of the past three weeks and the effect has been … nil. She’s still desperately dependent on the mechanical ventilator to breathe. Worse, her pain and agitation have been exceedingly difficult to control; she vacillates between significant sedation and sedation “holidays” that aren’t fun for anyone, especially the patient and her (equally agitated) nurses. My attending has expressed near certainty that she will never again breathe on her own. Her lungs are too stiff and too scarred. Despite our range of treatments, her morning chest radiograph looks just as bad now as it did when she was admitted. (To wit: it’s hard to see her lungs at all. “White out”, the radiologist calls it.) In fact, there is unanimous consensus among our ICU team that the time has come to withdraw ICU support and to help this patient die comfortably and with dignity. And yet – understandably, I acknowledge – her family continues to drag their feet in a frustrating cycle of missed family meetings and refusal among her adult children to make a decision regarding their mother’s care unless the entire family quorum is present. So we continue to prolong the slow and tortured death of this woman who alternates between sedation and frantic agitation, breathing at a rate that’s more than twice normal. And we continue to spend money at an equally alarming pace: $30,000 or more a day from the California state coffers at a time when our fair state is running a $40 billion deficit.

It’s frustrating to say the least. No one seems to know what to do.

Happy Mother's Day!

2009-05-10T12:56:00.000-07:00

I'm enjoying the heck out of my second Mother's Day. Breakfast in bed, a luxurious morning (coffee shop! park! library!) with my husband and son ... and now, time to blog in my bathrobe.

Ahhhh.

My Mother's Day gift to the mothers reading this post is this video. It's long, but worth it. I tried to reserve the related book at our local public library, but discovered that there are ten people in line for the book before me. So I think we'll take a Mother's Day trip to the bookstore and pick it up today.

Movie round-up

2009-04-18T16:45:00.000-07:00

Movies galore from our Easter weekend! Below are some highlights.

Sam with his birthday hat:

Sam and Brian, doing their (silly) thing:

We still can't convince Sam to do much walking on his own, but he loves to walk -- and run! -- with just a little help:

OK, so this last one is is simultaneously gross and hilarious. We have these little plastic ping pong balls that Brian discovered -- heaven knows how -- make Sam laugh hysterically when they're bounced against the living room window. Especially if you shoot the ping pong ball out of your mouth. What ensues makes me fear for my future, it really does.

Holy Week

2009-04-06T15:12:00.001-07:00

My favorite week of the year is here and as usual, it couldn't come soon enough.

Two years ago, I cried in the pew through the Good Friday meditation at our parish, overwhelmed with the hurt and shame and anxiety of my infertility. Last year, I was 39 weeks pregnant on Easter Sunday. And this year, we're planning to baptize Sam at the Easter Vigil. I've been waiting impatiently these past 18 months -- ever since we saw Sam dancing on the ultrasound screen -- for the moment when Brian and I will offer Sam back to God, our hearts unimaginably stuffed with joy and gratitude and happiness. Just thinking about it, I'm crying.

We've had other opportunities to baptize Sam, of course. There was Pentacost, when Brian was baptized seven years ago. There was All Saints'. And the Baptism of the Lord in January. But we've waited all year for the Easter Vigil, because, well, it's the best. What could possibly be better than a squirmy naked baby, full immersion in the horse feed tub in Jarrow Garden, Easter alleluias and Easter promises and Easter miracles, surrounded and uplifted and joined by our parish, our family, our friends? Really, what could be better than this?

It's fitting, I guess, that this is the year I'll finally make it to every Holy Week service our parish has to offer. I've always attended church on Easter Sunday and I've been adding one additional service, more or less, for the past several years. It always happens the same way. Someone in the parish will say to me: "You don't come to the Maundy Thursday/Good Friday/Easter Vigil service?" [incredulous] "But that's the best service of the YEAR!" And, so, the following year, I go. And it is, indeed, the best service of the year. This year, though, I'm not limiting myself to just one best service of the year. There's more than enough best to go around.

Birthday boy!

2009-04-01T20:52:00.000-07:00

Sam turned one last night. Here are some pictures from his little party!

I made cupcakes, but mostly, they were confusing.

He got some wonderful presents ... wrapping paper, equally confusing.

I love this picture of Sam and Ardan, lit by the weird glow of his new, um, drum:

My little guy ... TODDLER!

SAMZILLA!

2009-03-27T16:24:00.000-07:00

Video is self-explanatory.

PS. Sam walks!

Matched

2009-03-22T21:37:00.001-07:00

I matched at Stanford! I'm pleased and grateful to know where I'll be next year. Yay!

In the picture below, Sam is holding my all-knowing envelope just before the Big Moment.

Oh heck!

2009-03-20T22:57:00.000-07:00

Sam has learned to say no. We're in trouble!

The sound of one hand

2009-03-17T21:31:00.000-07:00

So Sam's new trick is clapping and -- I know I'm his mother, and that makes my judgement suspect at best, but trust me here -- it's ridiculously cute. Off camera, he claps for anyone and anything, acheivements large and small. He's all about equal opportunity affirmation and he happily claps for me, Brian and himself. He claps on cue and he claps spontaneously. It's beyond delightful and we are lapping it up. Tonight we tried to catch the clapping on camera but he was having none of it. Still, the ensuing video was pretty adorable, so here it is.

(The usual caveat applies.)

Trial and error

2009-03-13T23:02:00.001-07:00

It's been a crazy week on the general neurology service. During my mid-rotation feedback session with my attending yesterday (*mwah mwaaaah mwaah*), I cast about briefly for something -- anything -- positive to say about my experience so far. "We've seen a wide variety of patients since I came on service," is what I came up with.

"Well," he said, "it's not usually like this."

Have I mentioned that I just love in-patient neurology?

In any event, I really have seen a wide variety of patients since I came on service. There have been some good bread-and-butter cases: strokes and multiple sclerosis flares, a couple of people with seizure disorders, a case of neurocysticercosis. Two days ago, I admitted a man with glioblastoma multiforme, a devastating form of brain cancer. But there have also been some mysteries and even a few zebras: slurred speech caused by the same auto-antibodies that cause type 1 diabetes, progressive multifocal leukoencephalopahy in a patient with leukemia, weirdly chronic meningoencephalitis that didn't seem to be caused by an infection.

The upshot of all this variety has been surprisingly unvaried: brain MRIs and lumbar punctures for everybody; steroids for almost everybody. There were a couple days earlier this week when my team was a virtual lumbar puncture machine. There were so many LPs to go around that the residents let us medical students try our hands with the needle, which was simultaneously an opportunity (for me) and a torment (for both me and my patients -- and probably my resident too). I didn't succeed in finding the dural space a single time and at least once thrust my needle into a patient's spinal nerve root, sending a zing of electric pain down his leg. There's nothing quite like pulling a four inch needle out of someone's back, slightly adjusting the needle's angle and then shoving it back in. And then doing it again.

Good times, I tell ya.

Like every single medical student in the history of ever, I'm deeply ambivalent about practicing painful, invasive procdures on real live people. But I also understand that there's simply no way to learn medicine without practicing on patients. Other people have written more eloquently than I can hope to on this subject. For now, suffice it to say that I'm very grateful to my patients for trusting their medical student with something so precious.

Moviestar

2009-03-11T21:09:00.000-07:00

I'm finally posting video! My dad has been asking for video of Sam crawling, so here it is. He's been working very hard on standing up lately, so I think the crawling is just about over. I'm in pre-mourning, I admit. The crawling has been so darn cute.

Warning: this video is only appropriate for serious sam-o-philes. It's pretty boring otherwise.

Zoology

2009-03-07T09:15:00.000-08:00

Last weekend, Brian's parents came to visit us to celebrate my mother in law's birthday. We took Sam to the zoo for the first time. I expected him to relish the experience, but instead, he seemed almost disinterested. We could hardly get him to engage with the animals in the petting zoo at all.

The tigers were in a particularly fiesty mood; I've never seen tigers wrestle, race and pounce like they did last weekend. But Sam was much more interested in the large bolts that keep the tigers in their cage.

By the end of the day, Sam had found his groove: he loved the pigeons and squirrels best. I think we'll stick with the park for a few more months. The zoo can wait until he's a bit older.

Peace, love and neurology

2009-03-06T21:55:00.000-08:00

So I'm one week into my neurology rotation and I have to say, I hate it exactly as much as I expected to. Neuroanatomy was by far my weakest subject during the preclinical years of medical school and even now, I get a little jumpy when I hear words like thalamus and medial lemniscus. Scanning through a brain -- or worse -- spine MRI is enough to make me feel queasy and I panic slightly when the conversation turns to cranial nerves. The upside I suppose is that this reaction confirms my decision to go into (internal) medicine. One of my patients, admitted following a small stroke, had the decency to muster up a little chest pain overnight and as a result I spent a few happy hours reading EKGs and checking troponins. Fotunately for her and unfortunately for me, her angina resolved after a single dose of sublingual nitroglycerin and hasn't been heard from since, so now I'm back to counting down the days until neurology is over.

One of the aspects of neurology that's particularly difficult is that it's damn depressing. One patient recently discharged from our service is a young woman with a history of leukemia for which she received chemotherapy injected directly into her spinal canal. The chemotherapy cured her cancer, but also caused a rare and catastrophic neurological toxicity. Apparently when she was admitted to the neurology service a few days before I began my rotation, she had completely ceased to speak or move. After a week or so of our able care (!), she was talking in one and two word sentences, following simple commands very slowly and copying her own name with a pencil. The left side of her body remains profoundly weak. Her husband has kept a vigil at her bedside, feeding her and encouraging her, taking her for slow walks around the hospital. She is expected to recover some additional function, but will almost certainly never regain her full self. I'm not even sure what to say about this couple. When I think about them, loneliness and disappointment wash over me. This can't be the way they expected life to go.

I've been thinking about disappointment in general lately, in part because I submitted my rank order list for the match a couple of weeks ago. In the end, I ranked Stanford first; staying here in Palo Alto is what's best for my little family and I'm deeply grateful to be in a position where I have the luxury to simply choose what's best for my husband and son. Plenty of medical students every year feel lucky to match anywhere, let alone to a program as excellent as Stanford's. But I'm also disappointed, maybe more than I'm willing to admit, that I'm giving up BWH. The truth is, that's where I want to be next year and I suppose I'll always wonder how my career might have been different had I trained there. Of course, this is a very small disappointment, and already I feel more wistful than resentful. But I've vicariously encounted a few other disappointments lately, much larger than the little scratch I'm currently nursing. So I'm thinking about disappointment.

And, of course, we're in Lent, the season of loneliness and disappointment. Last week, my priest caught up to me at coffee hour and handed me a printed packet of poetry, left over from a Lenten concert. The poems, she said, were for the part of me that's "neither a doctor nor a mother."

"That part is very small," I told her.

"Of course it is," she said. "But don't worry. It's there, just waiting for when you're 60."

Inside the packet were poems by Shakespeare, Auden and two poems by Wendell Berry, new to me. Here are a few lines from 'A Timbered Choir':

The clearning rests in song and shade.
It is a creature made
By old light held in soil and leaf,
By human joy and grief,
By human work,
Fidelity of sight and stroke,
By rain, by water on
The parent stone.

We join our work to Heaven's gift,
Our hope to what is left,
That field and woods at last agree
In an economy
Of widest worth.
High Heaven's Kingdom come on earth.
Imagine Paradise.
O dust, arise!

And suddenly, I think I can see that the cure for disappointment is anticipation. So as my Lenten observance this year, I'm looking forward. Looking forward to Easter, to being an intern at Stanford, to being 60.

Economizing

2009-02-16T21:33:00.000-08:00

Today I was sidelined at home because our daycare center closed for Presidents' Day. It rained most of the day, so Sam and I camped out in the living room, building block towers and listening to NPR. As I always do when I listen to the radio all day long, I learned a few things. For one, it turns out the unemployment rate in California is almost 10%. I knew it was bad out there ... but geez. Unemployment in my fair state has nearly doubled in the last year. If our legislators can't arrive at a budget compromise -- now eight or nine months late -- our governor is threatening to lay off another 20,000 people. But our state's economic crisis feels surreal to me because I have been virtually unaffected. I'm already unemployed, and my job for next year is secure. So far as we can tell, Brian's job is secure too. If anything, we stand to benefit from the mess: real estate is on clearance and gas is oddly cheap. I feel a touch of survivor's guilt.

In other news, last night Brian and I went to a Punch Brothers concert and earlier in the week, we attended an evening event at church. We left Sam with a sitter both nights: his first experience with being put to bed by a non-parent. Apparently, he rose to the occassion reasonably well, so I'm optimistic that it will be possible for me and Brian to go on somewhat earlier dates from here on out. I'm continually surprised that this parenting gig appears to be getting easier and easier. Now that my kid sleeps 11 hours straight at night, gobbles down table food and puts himself to bed when he's with a babysitter ... being a mother is a snap! Bring on the octuplets!

25 things

2009-02-04T07:59:00.000-08:00

I recently stumbled across a list, published in the October 2008 issue of Popular Mechanics, of 25 skills a man should know. It's a pretty sexist list, I suppose, and lots of items on the list are things both men and women had better know how to do, like perform CPR and maneuver a car out of a skid. On the other hand, there are plenty of things on the list that a) I have no intention of ever doing because b) my husband can do them, and do them well. Like fillet a fish. And back up a trailer. And build a campfire. And navigate with a map and compass. Actually, he can do everything on that list, with the possible exception of framing a wall. But I bet if we ever needed a wall framed, he'd be up to the task. His general guy-competency isn't a surprise to me, of course. I like to joke that experimental physicists are the handiest kind of white-collar husband, but my guy is particularly handy, even among his experimental physicist peers. It's something I really appreciate about him.

But this list has got me thinking over the past several days. What are the essentials skills that women should have? I've come up with a preliminary list of 25 and I admit that my list suffers from the same sexism that the Popular Mechanics list exhibits.

1. Make a pie
2. Negotiate a raise
3. Be a gracious hostess
4. Walk in stiletto heels
5. Allocate the investments in her 401(k) with confidence
6. Cook Thanksgiving dinner
7. Flirt
8. Do her taxes
9. Rebuff an unwanted advance graciously but firmly
10. Care for a sick person
11. Comfort a grieving person
12. Entertain a child
13. Travel alone
14. Speak before a group
15. Organize a child’s birthday party, a charitable fundraiser and a funeral
16. Bring order and beauty to a home
17. Run a meeting
18. Speak her mind without apology
19. Chose clothing and makeup that suit her
20. Make her guy feel like a hero
21. Write a thank you note
22. Make small talk that’s interesting and effortless
23. Be the boss without being a bitch
24. Purchase a thoughtful gift and wrap it beautifully
25. Make other people feel at ease at socially awkward moments

I'm very interested to know how other women think about this question. What do the women you admire know how to do? What do you wish you could do?

Dispatch from the frontlines

2009-01-27T08:32:00.000-08:00

Yesterday, I picked Sam up from daycare and his wonderful caregiver handed me his diaper bag as we zoomed out the door, off to a meeting for which I was already late. Later, when I checked in the bag to clean it out and reload it, I found ... my own underwear. My skimpiest, sexiest pair. How those made it into the diaper bag, I'll never know.

That sums up my life these days. Deep and enduring disorganization and incompetance with a splash of mild embarrassment -- yet the whole mess is somehow funny.

Back in the saddle

2009-01-23T15:41:00.001-08:00

I'm finished with my interviews and back at home -- what a relief! Our trip to Boston didn't pan out quite as expected. For starters, it was horribly cold while we were there, which meant that Brian and Sam spent the greater part of each day trapped in our hotel room. When we did venture out, we bundled Sam in layers and a fuzzy snowsuit, but we couldn't find a way to keep the chilly wind off his little face and his cheeks and nose turned bright red within minutes! (If you live in a cold climate, surely you don't keept your baby inside all winter! What do people do?) So that was a drag.

The other surprise of our trip was that I loved Brigham and Women's Hospital. Loved it. Loved it loved it loved it. So now we have a dilemma. On the one hand, residency is just about the worst time to move my little family thousands of miles from home to sub-freezing temperatures, leaving behind our hard-won support network, not to mention a fabulous job for Brian and a fantastic daycare for Sam. Leaving behind our parish. Our friends. (Our housekeeper!) On the other hand ... loved it loved it loved it. So I'm stuck. I have until the end of February to make my match list. In the meantime, Brian is scouting out Boston jobs and I'm scouring craigslist, trying to picture us living in the apartments for which pictures are posted. That could be Sam's bedroom, I think. Or, hmmm, does this kitchen have enough counter space for Brian?

What's been interesting to me about this to-move-or-not debate is how guilty I feel about the whole thing. If the situation were reversed, if Brian was the one contemplating a temporary cross-country move to take advantage of an amazing professional opportunity, I (like to) think I'd tell him go for it! Let's go! And he is certainly saying that to me. But I'm having a very hard time imagining myself letting him make that sacrifice for me. Almost as if I've internalized the notion -- much as I despise it -- that Brian's career is the "real" one and I'm just fooling around. I'm not sure what to make of this.

Christmas pictures

2009-01-13T23:43:00.000-08:00

We spent Sam's first Christmas in Corvallis with his grandparents. We had a wonderful time! It was such a joy to watch his bond with his grandmothers and grandfathers deepen. And of course, it was so much stinkin' fun to watch him ogle the Christmas trees, fiddle with the wrapping paper on his gifts, and munch on the packaging from his new toys! Below are some shots from Christmas morning.

Resolved

2009-01-13T17:27:00.000-08:00

Even though we're well into the new year, I'm still formulating my resolutions. In the past, my strategy has been to undertake very small resolutions: one year, I resolved to stop losing my keys (success!) and another year, I resolved to start drinking V8 (failure). This year, I'm inclined to take the same approach and a number of potential resolutions present themselves. I could resolve to improve my skin care routine (eye cream! facials!), for example. Or organize my spices, once and for all (IKEA!). On the other hand, this year is ripe for a grandiose resolution. I'm flabbier and more deconditioned than ever before in my adult life. A modicum of financial self-control over the next year will help us pay off my medical school debt and save a down payment for a house. As I get busier, efficiency and organization in pretty much any aspect of my life will be a real help. And I'm very worried that I won't adequately nurture my husband and son, not to mention friends and family, as internship revs up.

I think I'm going with the facials.

PS. Tomorrow we three fly to Boston. Apparently, the high on Thursday is supposed to be 12 degrees. I'm fairly certain that's colder than I've ever experienced.

Lakewood

2009-01-07T20:04:00.000-08:00

The biblical deluge continues here in Washington. Amid rumors that the I-5 would close tomorrow, we left town today after my interview only to spent two hours going 40 miles in a blinding downpour. The rain is so severe that the 5 closed tonight, so we're holed up in a drab motel off the interstate. How I wish we had stayed in Seattle where we had a posh hotel and plans to see an old friend for dinner! Double blech.

On the upside, I enjoyed my interview day very much. The UW program is truly excellent and there were numerous advantages, mostly in terms of research opportunities, that I hadn't previously considered. It would be an honor to train here.

Seattle

2009-01-06T21:19:00.000-08:00

I'm here in Seattle with my mother and my son and the night is looking up. We're tucked into bed, all three of us, post-room service. I'm nursing my glass of wine and plugged into the free Seattle wifi. The drive up from Corvallis is a dwindling memory, but it was pretty awful: torrential sheets of rain and appalling traffic. While stopped in a spontaneous parking lot overlooking the Space Needle, we listened as a radio announcer very helpfully alerted us to a flood warning "over the next seven minutes". Needless to say, we took all appropriate precautions for at least eight minutes. All told, it took six and half hours to make a trip that Google maps promised me could be dispatched in less than four and a half. So far, Seattle is not making a good impression. Despite this, I'm optimistic about tomorrow. I've got a hotel shuttle to the UW Medical Center lined up, and I've already scouted my morning cup of coffee. It's my first interview at a top program that isn't my home program, so I'm very curious to see how it all pans out. For now, though, time to sleep.

Christmas baking

2008-12-19T09:02:00.000-08:00

I can't quite figure out why there are no cookies in my house. I've done more than my usual holiday baking over the past couple of weeks, and there isn't so much as a crumb to be found.

I'm on a ginger kick these days and my baking reflects that. So far this season, I've made white chocolate gingerbread blondies and chocolate chunk sour cherry cookies. (Long gone!) Alison and I did our traditional baking for care packages: sugar cookies, chocolate ginger cookies and cranberry shortbread. The cookies that remained after I mailed our packages were gone in a day or two and we've been left with a serious Christmas cookie shortage for the past week. To compensate, I made chocolate dipped gingerbread men (are you getting the pattern here?) for a parish meeting earlier this week ... but those were gone by Day Two as well. Now I'm contemplating some more baking this afternoon ... I have another ball of gingerbread dough in my fridge, but at the same time, I'm wondering what untried ginger recipes could possibly be left in my cookie cookbook.

I need some inspiration. What kinds of cookies are you enjoying right now? And no pine nuts, please. :)

Delish

2008-12-18T21:18:00.000-08:00

For Sam's sake, I'm hoping he cuts a couple of teeth sooner rather than later. I can't wait to introduce him to foods other than rice cereal and pureed prunes. The kid's going to go nuts.

All for you, Matt!

2008-12-17T19:33:00.000-08:00

Sam recently got a new bathtub. He loves it!

Needless to say, there will be bath toys for Christmas. Oh, will there ever.

The thrill of victory

2008-12-16T21:46:00.000-08:00

Lately, I've had a few triumphs, large and small:

1. Today I got my eyebrows waxed while sitting up, with my kid still strapped into his Ergo carrier. Begone, frumpy mom-ness!
2. Last week, I interviewed at Stanford for a spot in their internal medicine residency program, and it went very well. In terms of its philosophy, the program is a perfect match for me and my interview day deepened my already deep sense that Stanford is my intellectual home. I've been here so long, I almost feel as though the institution has remade me in its image. I fit here, and it's a lovely, comfortable feeling.
3. I mailed my last Christmas card yesterday.

I'll leave you to discern which triumphs are the large ones.

Girly man

2008-12-07T19:44:00.000-08:00

Why does everyone think my baby son is a girl?

Today, Sam and I went to Target and as we were leaving the store, we stopped to talk with the Salvation Army volunteer collecting Christmas donations. She referred to Sam again and again using female pronouns and I didn't bother to correct her. For what it's worth, he was wearing denim overalls, a shirt covered in little cartoon bugs and a navy blue hoodie. Gender-neutral, maybe ... but hardly girly. Then, as we walked to our car, a woman walking the opposite direction caught his eye and said, "Que linda!"

Sigh.

This happens all too often and I think it's strange. My feeling is, sure, it's hard to tell if a baby is a boy or a girl. If the clothes don't offer sufficient clue, ask. But geez, when my kid is dressed in head to toe blue, don't say she-she-she! My favorite of these conversations happened at a Starbucks in Oregon. I had Sam perched in his Baby Bjorn and I was chatting up a stranger as we waited for our drinks. It went like this:

Her: *she-she-she*
Me: *he-he-he*

... repeat and repeat ...

Her: Wait ... is your baby a boy? Are you sure?

For anyone else wondering: yep. I'm sure. Short of karyotyping my kid, I'm sure.

Here are a couple of recent pictures. Does he look like a girl?

Update

2008-12-04T22:03:00.000-08:00

I ordered Christmas cards.

Express mail

2008-12-03T07:41:00.000-08:00

Yesterday, I received a shock. I got a Christmas card.

On December 2.

Seriously?

The card was from a dear high school friend and displayed a lovely picture of her family. Coordinated outfits. Everyone smiling, all at once. In a word: impressive. Also: unsettling. I am just never going to be that woman who sends Christmas cards in November. Never ever EVER.

Am I OK with that? I'm not sure.

The funny part about all of this is that yesterday was also the day I decided not to send Christmas cards at all this year. I figure, it would cost somewhere around $100 (50 cards and stamps) and take a couple of (pleasant, latte-fueled) evenings to write personal notes in each card and address them. In years past, I've used Christmas cards as a way to stay somewhat familiar with out of town family and friends, old bosses and coworkers. I was hashing and rehashing all of this with my husband last night. His take: Does my old boss reeeaaaally care if he gets our Christmas card? (Probably, no.) And wouldn't I rather spend that cash on something else -- like a massage? (Definitely, yes.)

OK, so he didn't actually suggest I blow our Christmas card budget at my fave day spa. But still, the guy has a point. The truth is, the people with whom I most want to stay connected ... I already do. And the folks I only think of at Christmas? Maybe it's time to let them go.

Which brings us to the present. I'm having a full-blown personal crisis over the Christmas card issue. Not because I'm mourning the loss of a beloved holiday tradition and not because I think my old boss will be hurt (or even -- who are we kidding? -- notice) when he doesn't get my Christmas well-wishes. But because I've bought into the idea that homemaking is a competitive sport, and I fall further and further behind every day. Holiday preparations are a race and a contest and my friend -- who I am certain intended only to spread holiday cheer and not to make me doubt my very womanhood -- has qualified for the Boston Marathon of Christmas.

Which, I admit, is small-minded and counter-productive. Not to mention, crazy.

Part of me is ready to chuck the Christmas cards into the same heap where I already offloaded homemade baby food and cleaning my own bathroom. This year, I'd like to focus my Christmas energy on what matters most to me: co-chairing the Adopt a Family drive at my parish, sending holiday goodies to the trio of lonely, elderly ladies in my life, helping the Sunday School kids get ready for their pageant. I'd like to go to more concerts and more church services. And I maybe I should get that Christmas massage.

But part of me is simultaneously thinking ... I could order the cards tonight ... they'd be here next week ... two day turn around, three max ...

Surprise, surprise

2008-11-24T15:06:00.000-08:00

Despite the fact that its advent couldn't have been less of a surprise -- that's what happens, I suppose, when you're infertile and conceive only on monster doses of recombinant gonadotropins followed by in vitro fertilization, then go on to have what I can only describe as an intensely monitored pregnancy -- motherhood itself has consisted of one revelation after another for me. Ever since Sam was born, I feel continually surprised. Something new and unexpected, just about every day. Almost all of the surprises are wonderful. I never would have guessed how fun it is to take a baby for a walk or to the park. I didn't expect my infant son to be such terrific company. I didn't know how immediately and thoroughly my friends and parish family would embrace my baby, how sincerely they would delight in him. And my husband has bowled me over with his skill, patience, instinct and love -- he is an even more wonderful father than I dreamed he would be.

But the biggest surprise for me has been my own response to motherhood. Specifically, I expected to be torn apart by guilt when I returned to work. I expected to agonize. I anticipated crying jags, threats to quit, despair.

Didn't happen. At all.

Instead -- shockingly -- I don't have any guilt about working whatsoever. It's so clear to me: my working is what's best for my family. And -- more shocking -- my passion for the practice of medicine and my pride and optimism about becoming a doctor has only expanded and deepened. Not a small part of me is actually looking forward to residency. I can't wait to introduce myself to my future patients as a physician rather than as a medical student.

However.

Another thing I didn't fully anticipate: being a working mother ain't easy.

Sam is sick today; I think he probably has an ear infection given his spiking fevers in the absence of an obvious source, although since I cheaped out a couple of years ago and declined to purchase the otoscope my medical school recommended, I can't actually confirm this diagnosis. Both Brian and I had important and full days planned for today, so a sick kid presented a real challenge. There was very, very little sleep in our house last night and today was a logistical maze that resulted in me sprinting through the halls of our university hospital twice, once with a sick baby strapped to my person. I'm sure I looked like a lunatic, shuffling frantically along, carrying two large bags (diapers, a half curdled bottle of breastmilk, the results of my logistic regression all stirred together) and singing to my son to keep him (and me) from crying. No doubt: working motherhood at its worst.

On the other hand, somewhere between the two sprints, I sat between two senior and accomplised researchers, calmly and competently leading them through my recent analyses. Quiet murmurs of agreement, surprise, interest. Smart questions. Plenty to think about as I begin to draft our manuscript this week. More important, these men support me as a colleague. We plan to undertake a small interventional study on the basis of my new results, the kind of study that might provide pilot data for a larger grant. Needless to say, I am ridiculously excited about this possibility. Walking out of our meeting, my boss grinned at me. "You won!" he said. "Now go home and take care of that sick baby."

Working motherhood at its best.

Catch up

2008-11-17T12:51:00.000-08:00

Sam and I are home from our whirlwind trip to Boston. We had a wonderful time! We stayed with my college roommate, Rachel, and her husband, Eric. We were joined by my other college roommate, Teena, and her finance, Matt. In the space of two days, we celebrated Rachel's pregnancy and Teena and Matt's engagement. We shopped, cooked, took walks, hosted parties, and caught up on the happenings, big and small, in each other's lives. Weddings and babies are blessings under just about any circumstances, but this wedding and this baby could not be happening to lovlier people. I'm so happy for them!

In other news, yesterday was my first residency interview. I interviewed for a categorical spot in the internal medicine program at our county hospital. Definitely my lowest pressure interview ... the only non-academic program I have on my list. Despite that, the program impressed me. The people are smart and kind, the call schedule is sane and -- I hadn't considered this until yesterday -- the patient population is almost ideal for residency training. At a tertiary referral center like Stanford, most patients arrive at the hospital with a diagnosis. There's plenty of learning in caring for these patients, to be sure, but there often isn't much diagnostic mystery. At the county hospital, on the other hand, patients mostly come from vulnerable, underserved groups: immigrants, refugees, homeless, the poor. These folks have limited interaction with the health care system before getting sick and as a resident, I'd be the one puzzling out the diagnosis. And, on a personal level, I think I'd really enjoy caring for them. I wasn't strongly considering this program before yesterday, but my interview may have changed my mind. I could remain involved in the research I'm currently doing while receiving excellent clinical training AND sleep in my own bed seven out of eight nights during internship. Not bad at all.

I'll post pictures from my trip to Boston when I have a chance.

PS. Just for my own accountability: mama-mojo makeover is in progress and going very well:

1. ~~Haircut~~
2. ~~Brow wax~~ and pedicure
3. ~~Better skin care~~
4. ~~New glasses~~
5. New make-up
6. ~~A pretty new dress~~

In which my life is awesome

2008-11-05T11:28:00.000-08:00

I learned yesterday that UCSF offers part-time residencies for parents. I am so excited about this, I feel a little giddy.

Defining success as a mother

2008-11-04T08:00:00.000-08:00

Lately I've been thinking about how I'll know, someday when my son is grown and gone, if I was a good mother to him.

I spend my mornings these days doing epidemiological research in geriatric nephrology, which is a fancy way to say that I mess around with huge data sets, trying to coax out new stories about the way kidney disease plays out in the lives of elder Americans. So I do medical research, basically. One of the first things you learn as a medical researcher is that you must be very explicit about outcomes and endpoints. You must be clear, from the begining, about how you're going to measure whatever it is you're going to measure.

So I'm trying, as a thought experiment, to apply the same concept to my mothering.

As a matter of belief -- because I don't have any proof; the idea is controversial on both sides -- I happen to think that parenting has a negligible effect on intellectual development. I don't think there's much parents can do to make kids smarter. I think, chances are, my kid is probably pretty smart. Chances are, he's about as smart as Brian and I are: smart enough to have plenty of choices and opportunities in this life, but likely not a rare genius. And short of locking Sam in a closet for the next 18 years, he's going to be about the same smart. No amount of Baby Einstein, Kumon, oboe practice, flashcards, or whatever other enrichment nonsense is going to transform him into a genius. (I do think parenting affects fund of knowledge, of course. My choices will help my kid learn more stuff. So we're planning to send him to private school and we'll probably do some part-time homeschooling. Because, hey, knowing more stuff is useful. But knowing stuff and being smart aren't the same thing at all.)

But I do think that parenting can affect character development. So that's where I'm going to focus my attention as a mother, on forming my kid's character. I'm making a list of the ways I hope to shape his character. It's a work in progress.

1. Kind. I can't stand mean. If Sam isn't kind, I failed. It's that simple.
2. Disciplined. It's critical that my kid can do stuff he hates, delay gratification, work hard, save money, etc.
3. Humble.
4. Generous. My husband has a tendency to be stingy and I don't like it.
5. Manly. This one is tricky for me, because as a woman, I have only an indirect appreciation of manly virtue. But I know it when I see it, and when I see it, I like it. The heart of masculine virtue, in my opinion, is strength and courage coupled with a sense of duty to protect the weak. There is also an "uncomplainingness" about men that I so admire, a willingness to do the hard job and take the hit and get up tomorrow and do the whole thing over again in service of those they l0ve.

So that's my list. Harvard, Schmarvard. If adult-Sam is kind, disciplined, humble, generous and manly, I've succeeded. I'd love to hear how other mothers are thinking about this issue. What do you hope to teach your kids? How will you know that you've been a good mother?

First Halloween

2008-11-01T19:02:00.000-07:00

Earlier this week, Sam helped Brian carve our pumpkins.

Despite this seeming endorsement of all things Halloween, he was decidedly unenthusiastic when we put his costume on last night.

Eventually, he perked up.

We spent Halloween with some friends after all. (I really hope they don't catch Sam's cold.) They made the most amazing lamb for dinner. Definitely going to add this to my recipe box.

Least worst

2008-10-31T12:47:00.000-07:00

I'm crabby today. My kid is mildly sick -- just a runny nose, just sick enough to keep him home from day care, keep me home from work and keep us both completely crabby. And we canceled our Halloween plans in order to prevent spreading the baby germs to our friends' toddler son. And it's raining. And Brian took our shared car to his consulting gig.

Blech.

In order to cheer myself up, here's a list of 10 things I don't completely hate:

1. My new trench coat. Whereas I usually look like a rumpled and disheveled mother when Sam and I take our morning walk to Starbucks, today I looked like a rumpled and disheveled mother with a snazzy trench coat on. Vast improvement.
2. My housekeeper. She came yesterday, so today I may be trapped inside, but at least it's clean in here.
3. Baby saline nose drops. Utterly ineffectual, but they give me the illusion of doing something to help my son's stuffy nose.
4. My ridiculously flexible work schedule and absurdly supportive boss. Enough said.
5. The Grocery List Generator from Mozilla. Just discovered it this morning. Neat-o.
6. tinyprints.com. I'm having fun playing around with different photo Christmas cards. (Aside: what is it about becoming a parent that makes you suddenly want to send photo Christms cards?)
7. Martha Stewart's cookie cookbook. I think I'll make some of those chocolate chunk gingerbread cookies this afternoon. Cheeriness increasing all around.
8. Daydreaming about how wonderful it's going to be to have my parents, my in-laws, my sister, my brothers and my brother's girlfriend gathered in my home for Thanksgiving. Magic.
9. Lentil soup and crusty bread for dinner. (Maybe a rainy fall day is good for something after all.)
10. Ombligo. Probably the only face that can reliably make Sam smile, even when he's sick. God save us if anything were to happen to him.

Feeling better already. :)

Mama mojo

2008-10-23T10:13:00.001-07:00

As much as I am loving being Sam's mother, there are certain aspects to my new life that leave a little to be desired. The one that's bugging me most right at this moment is the very limited time I have (make? take?) to maintain my appearance. I haven't had a haircut in six months. I haven't waxed my eyebrows in nearly that long. No pedicure since the beginning of the summer. And my chronic lack of sleep is really messing with my skin. Not to mention: I have been to the gym exactly twice since Sam was born and I still have seven or eight pounds to lose.

Not a pretty picture.

To be fair, this slow slide into frumpery started long before Sam was born. During my third year of medical school, the busiest year, I neglected my workouts and my eyebrows. And my wardrobe has been in an ever-increasing state of paucity and disrepair for years. So really, Sam's arrival has only exacerbated an already disturbing trend.

Well, I've had enough. I can't diet right now because I'm breastfeeding. But the other stuff can and will be addressed. Here are my beauty resolutions:

1. Haircut. Not a trim. A cut with real style. Something that requires blowdrying.
2. Brow wax and pedicure. Bring Sam along if I have to.
3. Change up my skin care routine. It's time to starting using a richer eye cream and a better daily moisurizer. I'm not 18 anymore.
4. New hip-er glasses. Actually hip would probably give me whiplash, but I can go for hip-er.
5. Department store "make-over" and splurge on at least one new make-up item.
6. A pretty new dress ... not for special occassions. Something I can actually wear.

I'll report back on my progress.

Park on Park

2008-10-22T09:20:00.000-07:00

Last night we took Sam to one of the several parks within walking distance of our apartment. This park is down the street from the house where I lived during the summer after my junior year of college. I have such fond memories of the place. And the park itself was just recently "remodeled" ... so the play equipment is all new and there are always plenty of other children and parents buzzing around. I think we'll spend a good amount of time there in the coming months.

Best of all, the light was just gorgeous last night, so Brian was able to get some really lovely pictures.

Flu shot

2008-10-21T16:37:00.001-07:00

Every few months for the past several years, I catch the real estate bug the same way people catch the flu. For a few days, I'm under the weather: endlessly checking movoto.com and redfin.com ... plugging numbers into online mortgage calculators ... updating and revising my various spreadsheets, all of which -- inevitably and definitively -- tell me the same thing: we can't afford to buy a house.

I caught my most recent bug when I saw a headline in the San Jose Mercury News: prices in some Bay Area towns and neighborhoods are down 20-30%. For the first time, it appears we may actually be able to afford a place of our own. Of course, we'll need to wait until after the Match and after Brian graduates and is gainfully employed. Even then, it may be difficult to quality for a mortgage, given the current credit crisis. And who knows if the dip in local prices will last into the spring. It's anyone's guess.

But ... maybe ... maybe we could buy something. And that's enough to keep me logged in to movoto and spinning my spreadsheets. We would almost certainly have to buy a fixer-upper, in a neighborhood that oculd only be described (generously) as up-and-coming.

For example, check out these pictures of places in our price range:

Who takes pictures like this when listing their home for sale? Seriously? You couldn't move the tub of clothes off the bed?

This last one is the best. Just looking at it makes me laugh.

What you can't see from these delightful picitures is that the house is in a terrible school district. But at least the Mexican food is great. And I'm wondering if maybe that isn't enough. A place of our own, and great Mexican food. Sounds pretty good to me.

My family

2008-10-21T10:33:00.000-07:00

Because my blog is looking a little sparse and lonely, here's a picture of what I love most in this world: my husband and baby son.

Anyone out there?

2008-10-21T09:38:00.000-07:00

I'm going to give this blogging thing a try.

By way of introduction, I'm a 29 year old wife and the mother of one wee boy. I'm also a medical student in my last year, applying to residency programs in internal medicine this fall. I'm hopeful that blogging will be a way for me to record my progress through the residency application process and will help me make the most thoughtful decisions possible when I create my rank list. I also want to provide encouragement and commeriseration for other medical mamas out there. And I never shy away from yet another venue to post pictures of my adorable son.

So, here we go!