Jesus winks

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

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

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

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

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

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

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!