Crazy talk

Baby recap

2012-02-09T17:21:00.000-05:00

I had forgotten how life with a newborn goes...I get 15-20 minutes at a time to do things, but I only get occasional blocks of time to accomplish something substantial. Hence, the delay in the recap.

My disclaimer on this is that the baby recap is as much for me as it is for you--so, there may be a lot more detail in here than you care to read about :) Hopefully it'll be enough detail for me to someday make a baby book (since I have such a stellar track record to this point: 0/2).

As I alluded to in the last post, the story actually starts on Monday, 1/23. I was in for my scheduled non-stress test, which just involved me sitting on the fetal monitors for about an hour. The nurse showed the strip to the doctor in clinic, and he was concerned at the number of fetal decelerations I was having. Basically, the heart rate would go from a baseline of about 150 bpm to 165, but then it would drop into the 110s/120s for a few seconds after each acceleration. Sometimes the drops were associated with contractions, sometimes not. The thought was they were probably variable decelerations, but since I was 37 weeks and technically high risk, the doctor wanted to be safe, and he sent me for a biophysical profile.

I went to wait for the ultrasound, but I was continuing to have contractions every 5 minutes that were a little uncomfortable. The doctor had made it sound like delivery was potentially imminent, depending on the BPP, so I gave Tim and my mom a heads up while I waited. The techs that did the ultrasound commented on how big the baby was (estimated at 7 lbs 14 oz at 37 weeks--a biggie) and how low his head was. In fact, they had to mash on my pelvic bones to try and get a head measurement--and of course, they were pressing right over where I had injured myself falling several weeks earlier. The pain was pretty rough, but I understood that they needed the measurements to get a good reading.

The doctor came into look at the BPP info, and everything (amniotic fluid levels, fetal movements, breathing, tone, and heart rate) looked fine. Ironically, the doctor reading this ultrasound was the same that read my final ultrasound when I was pregnant with Josh--and in both cases, his suggestion was just to deliver. For Josh, it was at around 38 weeks, and the suggestion was because he was measuring so large. This time, his first question was, "What is your cervix doing?" His thought was that if I was making progress at all, I should just be delivered.

I told the doc that as of the previous Friday (3 days earlier), I had no cervical change. He told me that he'd discuss with the clinic doctor that was in, and they'd get back to me. So, I hung out for about another hour. The clinic doctor (who I had never met) had me come back. He was very pleasant, and he suggested that we check to see if I was making progress. When he checked me, he said I was 4 cm dilated. He asked about contractions, and I said I was still having them every 5 minutes or so. He told me that he'd send me home for now, but he wouldn't be surprised if I went into labor that day. He thought just the cervical check might be enough to start real labor. I asked when I should come back in (since I was already having the 5 minute contractions). He said if things got uncomfortable, give a call and come back--he also said I shouldn't wait until the contractions got closer than 5 minutes, since third babies can come fairly rapidly.

So, I went home...and started having fairly painful contractions. They lasted over an hour, and I decided to start making phone calls. It was late afternoon by this point. I told my mom and Tim not to rush. We'd get the kids, get them settled, and then head back up to the hospital, just to get checked out. I wasn't getting contractions closer together, so I figured we had time.

Of course, after making this plan, the contractions very gradually started becoming less painful. They were still 5 minutes apart, but they were more manageable. I debated scrapping heading back up to the hospital. Instead, I called the office and spoke to the doc on call, explaining the situation. She suggested coming back in, just to be safe. So, about 7 PM, Tim and I headed back up to the hospital.

We got checked in and put on monitors. The contractions were still coming regularly, but the discomfort was nearly gone. The resident checked me, and she called me 3 cm, 50% effaced, and -3 station--also known as not really in labor. They kept me on the monitors for a while, and then we decided that I'd walk for about an hour, and she'd check me again. If there was change, she'd admit me. If not, home I go.

So, I walked around the hospital in my very fashionable gown for about an hour. I ran into one of my MSTP classmates who is now a surgical intern, but otherwise it was pretty much empty around the hospital loop. After the walk, it was back to the room to wait for the resident. The verdict: no change. So, about 11 PM, we headed home to wait for real labor.

I give you this false alarm to preface why I was thinking the way I was the following Monday. In the interim, I had another NST, my OB appointment, and some serious contractions on Wednesday. I had several more instance of uncomfortable contractions throughout the week, but the pattern seemed to be the same: contractions that started in my low back and wrapped around the front, coming every 4-6 minutes, and uncomfortable enough that it made me change position and do some deep breathing. Inevitably, they'd last about an hour, and then they'd go away.

I actually had almost no contractions on Sunday--which was a good thing, because late Sunday afternoon, my GI system went nuts. I didn't have a fever, and it was lower GI, but I lived in the bathroom Sunday evening into the night. I stayed downstairs Sunday night because I was still very uncomfortable from the pelvic pain (worsened by Monday's ultrasound), couldn't get in and out of bed easily, and I needed to make frequent trips to the bathroom. I could tell I was getting dehydrated, but everything I ate or drank exited quickly. I figured I'd do the best I could and just take it easy.

So Monday, 1/30, I left home about 9 AM for my 10 AM NST. Tim had offered to go with me, but because I hadn't had any real contractions in over 24 hours, I told him just to go to work. I started having some contractions just before I left. They were a little different than the prior week's contractions--less low back, mostly low abdomen/pelvis, with about the same amount of pelvic pressure. I figured they were due to the GI distress/dehydration, so I left for my appointment. As I was driving, I started timing the contractions. They were 4-6 minutes, and they were definitely uncomfortable. I was able to park and walk to my doctor's office, but I had to stop periodically and let the contraction pass. I got into the office and went on the monitors. Baby looked good, and the contractions were staying steady. The nurse had seen me with contractions like this before, and they weren't getting closer, so once the doctor cleared my NST, I left.

I debated asking someone to check me, but I was still thinking about the false labor from the week before, so I just headed back to my car. I called Tim just before I got to the parking garage, and he could hear me breathing through the contractions. I felt they were getting a bit closer--maybe 3-4 minutes--and I had to stop about every 30 feet to breathe. I wouldn't call them painful though; I thought that labor would be painful, and these were just uncomfortable. He recommended that I go back to the office. I told him I could always come back later.

I took the elevator to my car, and I could barely walk the short distance to where I parked. I had the keys in the ignition and was about to drive out, and something made me call the office again. At 10:50 AM, I spoke to the secretary (who recognized me, since I basically lived in the office), and the nurse she handed me to told me to come back, and she'd have the midwife check me, just to be safe. So I waddled back to the office, deep breathing the whole way.

I got in a few minutes later, and the secretary wished me well, hoping this was it. I still had doubts. It took just about two minutes for the midwife to check me. I think she had doubts too--until she checked and said I was 6 cm. She looked at me incredulously when I told her I was going to go home. She said, "You're having a baby," and made the call upstairs to labor and delivery. So, at about 11:15, I called Tim and my mom to tell them we were having a baby!

The same resident from triage a week earlier came by to check me. At about 11:30, she called me 7 cm, 100% effaced, and 0 station. I was breathing through uncomfortable contractions, but while they weren't fun, I still wouldn't have used the word pain. She said she'd wait to break my water until the attending was out of the OR, but she expected things to go pretty quickly after that. I told her I was waiting for my husband anyway, and she asked if I wanted an epidural. I said yes please! I was hoping that would slow things down enough to give Tim a chance to get to the hospital.

The anesthesiologist got in shortly thereafter, and so did Tim. I had my epidural in by 12:30, but my blood pressures dropped fairly dramatically afterward, and it took about an hour (and several rounds of pressor infusions) to get my BP up over 100/60. Nothing scary, but it dropped enough where I got pale, dizzy, and nauseated just lying in the bed, and the docs wanted to make sure it was up high enough to keep getting good blood flow to the baby. By a little after 1, the epidural had take the edge off of the contractions--I could feel pressure, but the discomfort was basically gone. Life was much happier!

My mom and Jen came up soon after, and Joe was up not too long after that. Another resident had come by after the epidural was in, and she called me 9.5 cm with a reducible anterior lip--basically complete. I had done the 7-10 cm transition before the epidural kicked in; that meant I survived the worst part of labor without pain medication. I knew that the delivery was typically the most painful part for me--and the part that the epidural was least likely to help with, judging by past experience--but I was kind of impressed with my pain tolerance. I had gotten epidurals much earlier with the other two kids. I never even got to 7 cm before epidurals with them. The frightening thing was that the labor pains were never as excruciating as I expected, and I think I could've very easily had this baby at home (or in the car) if I had waited for the type of labor pains I was expecting.

At 3 pm, the midwife came by to check me again. My water hadn't broken yet on its own, but I was otherwise ready to go, so she broke my water. She suggested a trial push, which moved the baby down some, but she suggested waiting to push any more until after we gave labor a chance to push the baby down. Since my blood pressure had stabilized, the nurse sat me up, and we let gravity and labor work.

My OB popped by about this time--she has clinic off the hospital campus on Monday, but she heard I was in labor and wanted to stop by and say hi. Her partner had come by just before to introduce herself, and I thought she seemed like a wonderful doctor, so I told my OB that I was happy to let the on call doc deliver me.

I started having more pressure with each contraction, and I could tell that we weren't far from delivery. I never had a clear urge to push with Sophie--maybe because I pushed for 3.5 hours with her--but I did have that feeling with Josh. I was still unfortunately having some pressure due to my lingering GI issues as well, so it was hard for me to determine exactly where the pressure was coming from. I told the nurse a little after 4 that I thought we were close.

The attending doc came back shortly thereafter, and she checked me. The good news was that the baby had descended a bit, though he was still a little higher than she likes to start pushing. The bad news was that I was bleeding--a lot--and she was worried that I might have abrupted. The fetal monitors were still ok, but as the baby descended, it was harder and harder to follow the tracing. She said that she'd usually give me more time to stretch and let the baby do the work, but because of the bleeding, it was go time.

This is the part where things get blurry for me. Tim tells me that all of a sudden, there went from two people in the room (the attending and the nurse) to about 12. They had planned to call pediatrics for the delivery, just because of the diabetes, but apparently the bleeding caused a bunch of extra people to be on hand for me and the baby.

I think I only pushed about 10 minutes, but they were an excruciating 10 minutes. The pain was so bad that I couldn't even open my eyes. I was actually worried I might pass out at one point because I was so lightheaded. Tim and the doc did a great job of talking me through. The doctor told me afterward that the pain was likely so bad because of a few things: no time to stretch things out, the placental abruption itself is painful, and the little man came out sunny side up (occiput posterior). This is a painful position, and it effectively makes a tight space tighter during delivery. It makes sense, given my presentation: back labor, persistent anterior cervical lip, prolonged labor compared to presentation, and increased stress on the tissues at delivery. Looking back on how things were happening, I'm thrilled that the doc was able to deliver me so quickly. With the big head, OP position, and abruption, there's a decent chance I might've needed an emergency c-section. Instead, we had less than 8 hours of labor total, no need for pitocin this time, and a quick (though painful) delivery.

I got to hold Noah for a little while while they fixed me up. The doctor did confirm the abruption after the placenta was delivered. She told me that while it didn't mean I couldn't have more kids, it was something I should tell any future OB if I got pregnant again. I reassured her that another pregnancy wasn't in the cards, but I appreciated the information. Noah was doing well initially after delivery--his Apgars were 8 and 8, with some residual blueness just beyond the hands and feet. He measured 8 lbs 8 oz, 19.5 inches, with a head circumference of 36 cm. The pediatrician had checked him at delivery and thought he was doing ok. Not too long afterward (maybe 1/2 hour or so), he started grunting while breathing. He was still having normal oxygen saturation, but the OB wanted the pediatrician to come back and take another look. They came back shortly after, and they called the NICU fellow to come and look. The nurse had put Noah back in the warmer, with some blow-by oxygen, and his cyanosis had decreased centrally, with just a little remaining at the extremities. The NICU fellow discussed with the pediatrician for a little bit, and they decided that Noah should go to the NICU for respiratory distress, just to be safe.

I had a hard time with this. All of the ultrasounds had looked great, and I never had any problems with the other kids. I hadn't even thought about the possibility that they might have to take Noah to the NICU. I was beyond 38 weeks--full term--and I had a big baby. He should be great. But I knew it was better to be safe than sorry.

They took Noah away before my family could come back up and see him. Tim and I got to hold him briefly, and they they took him out about 5:30. I was pretty upset, and the OB was very sweet and tried to comfort me. What we had been told at that time was that they would watch Noah in the NICU, probably overnight, and then he might be able to come back to the regular nursery the next day.

Jen had gone home to get the kids and get them dinner, and my mom and Joe came back up to the delivery room after Noah left. Jay and Kim came up with the girls too. It was nice to see everyone, but it felt empty to be in a delivery room with no baby. The NICU had said to give them an hour or so to get things situated, and then Tim could come over to check on things. He headed over there, and family got to go over a few people at a time to see Noah. Jen brought the kids up with my dad after dinner. It was nice to see them, though I could tell Sophie and Josh were a little confused about what was going on. The NICU did not allow kids under 12, so there was no way they could see Noah. I kept trying to explain that to Sophie, but all she had been told over and over again was that she'd get to see her baby brother at the hospital. It was too late to try and explain to her now why that couldn't happen.

We were waiting to be transferred up to a recovery floor, and as it got past 8 o'clock, I could tell Sophie and Josh needed to head home to bed. Tim was going to stay with me, and my mom was going to stay with the kids. People started heading out soon thereafter, and at about 9:30, we got moved to our room.

The women's hospital has two recovery floors, which were recently redone and are very spacious single rooms. The renovations had just started when we had Josh, but even then, the rooms were more than big enough. I was looking forward to finally getting to enjoy the new rooms. Imagine my surprise when they told me I wasn't going to floor 3 or 5 for recovery--I was going to 6. I had been on 6 for a cardiology consult in August. It was the gyn surgery/preterm labor floor. It was old, dark, and had little rooms. Instead of the nice, bright, large single rooms, I was going to a small room that barely fit a bed and had a shared bathroom with another patient in the neighboring room.

When we got up to the floor, the nurse had some trouble locating postpartum supplies. He was very nice, be he said he'd have to go look for some items like large pads, a sitz bath, ice packs, dermoplast, and witch hazel pads. These are things that were usually pre-stocked in the recovery rooms--I had never had to ask for any supplies while I was there with Sophie and Josh. Once I got checked into floor 6, Tim wheeled me down to the 4th floor, towards the NICU. I hadn't seen my son in over 4 hours, and I was anxious to get there.

I was overwhelmed by the NICU. It had recently undergone a huge renovation. Each baby had their own room, with plenty of space, a rocking chair, a large couch, personal lockers, and a mini fridge. There were also multiple family lounges and bathrooms with showers on the floor. Between the main NICU and the stepdown unit, there were 82 private beds. It was unreal--like a hospital unto itself, but one that wasn't sterile and cold. There were lots of bright colors, and the NICU was subdivided into four "pods" that felt less overwhelming.

I was glad that Noah had such a beautiful place to stay, but it was still overwhelming to see him in his little warmer, with an IV in his left hand and a bunch of leads attached to his chest. He didn't require oxygen, which was a good sign, and he was sleeping peacefully when we got there.

I don't know how first time parents feel in the NICU, but even being a "veteran" parent, I found myself unsure of how to pick him up, feed him, change him, etc with all of his wires. The nurse was very nice and helpful--as were all of the nurses we saw in the NICU--and she helped us get settled in. We spent a few hours there Monday night, and the plan was for me to pump overnight and bring it down. He didn't eat after delivery, and he wasn't very interested Monday night, so I said it was fine if he needed a little formula in addition to what I could pump. I am sure that might make me unpopular with some people, but I thought his comfort and nutrition was most important--I knew we'd have lots of time for nursing later.

Tuesday morning, I waited for my doctors while Tim headed over to the NICU. Overnight, I had pumped twice and was anxious to feed Noah, but I had to wait for the on service doctor to see me. Unfortunately, it was the one doctor in the practice I don't particularly care for (and the one that helped deliver Josh), so I was underwhelmed when she finally came by. She obviously didn't know much about me--she thought I was a c-section, and she hadn't realized Noah was in the NICU. After she left, I walked over to the NICU and just caught the end of the team rounding on Noah. It turned out that he was signed up for a 48 hours stay, since he was now a "rule out sepsis" baby. He had already been given ampicillin and gentimycin, and until the 48 cultures came back, he couldn't go to the nursery. This also meant he couldn't come to my room, and I wouldn't be leaving the 6th floor. I was really disappointed by this--I was unimpressed with my floor (those postpartum supplies never did show up), and I knew this meant that Sophie and Josh couldn't come to see Noah while he was in the hospital. It also meant that I might be discharged before Noah. His cultures were due back at 7 PM on Wednesday--and I would be discharged Wednesday morning. I figured this meant he wouldn't be discharged until Thursday morning, after the NICU team rounded on him.

Tim had to leave to go to work Tuesday afternoon. He had a big meeting Wednesday afternoon that he needed to attend, and there was still some work to do for it. He left after lunch Tuesday, and I basically had Noah to myself in the afternoon. I avoided going back to my room--partially because I wanted to be with my son, and partially because my room creeped me out. I had a woman on one side who screamed all day long about her pain (thin walls--she was a 25 week pregnant woman who had come in with contractions, but once the contractions stopped and she was going to be discharged, she screamed about her pain constantly. Was she trying to delay discharge? Who knows...). I shared a bathroom with a woman on the other side--I could occasionally hear her on fetal monitors, but all I knew what that the bathroom was occupied either by her or her male companion for most of the day. I went back to my room for my meals, my motrin every 6 hours, and my vitals check once a shift...and that was about it. I was walking back and forth from my room to the NICU less than 24 hours after delivery. It wasn't because I wasn't in pain, but I didn't have a way for someone to wheel me down there, so I did what I needed to do.

By the end of the day Tuesday, Noah was eating a lot better, and I had caught up to him with my pumping. I got to visit with a mom/former MSTP friend of mine, which made the day less lonely. Tim went home after work to be with the kids, and my mom and dad came up to the NICU. People had gotten to see Noah in the NICU on Monday, but no one had gotten to hold him. I had a nice visit with my parents, they got to hold Noah, and then it was back to my room for the night (pumping every few hours).

Wednesday, Tim took the kids into daycare in the morning, and then he came up to the NICU. I waited for my doctor to discharge me, and then I would head over to the NICU. My regular OB came by just to make a social visit, which was nice, but the service attending still hadn't shown up by the time the NICU team rounded. I felt like a prisoner in my room. I had pumped enough to feed Noah, but I wanted to be over there. Tim relayed good news from the team--his 24 hour cultures had been negative, and the suspicion for sepsis was low, so the NICU team was willing to discharge Noah around dinner time (with an informal call to the lab to make sure the cultures were still negative). That just made me more antsy to be discharged so I could go to the NICU. I was showered, packed, and ready to go since 9 AM. I had signed all the paperwork with the nurses. I was just waiting for the OB to lay eyes on me so I could go.

Noah was scheduled to be circumcised at 2 PM, and I wanted to at least see him before he went, so I told my nurse that I'd be over at the NICU at 1:45--and that the docs could call over if they came by. She was sympathetic to my situation, and she said she had paged them multiple times to see if they were going to see me or just sign off on the paperwork. I went over (finally!) at 2 to see Noah--Tim and Jen were both with him, but they had to leave by 2 for work/school, so no one would be there after 2. I stopped by, held him for a bit, and then headed back to my room. The nurse told me that the doc was just going to sign off on my discharge without seeing me (which sounded unreal to me, but whatever--I was tired of waiting). I grabbed my bags and some veggie sticks from the patient fridge (I hadn't ordered lunch, figuring I'd be gone before then), and I trekked over to the NICU.

Noah's circ was delayed until 3, so I got to see him for a bit longer (though not feed him yet, due to the circ). My former lab PI and my postdoc friend came over to visit about 2:30. They got to see Noah briefly before he was taken back, and then we chatted for a while. When Noah got back, he was ravenous, and things got a little hectic, so the visitors took off, and Noah and I hung out again. The nurse said that we might be able to go as soon as 5 PM, but Tim's meeting ran long, and there were a few paperwork issues, so we didn't actually get to leave until almost 7 PM. It was weird to finally get to hold Noah without all of the wires attached. I packed everything up, and when Tim arrived, we were ready to go. It was a much different experience than when we left with the two other kids. The recovery floors have a system--discharges start about 11 AM (we were usually out around noon), mom gets wheeled out carrying the baby, the baby has to be checked out at the desk with the electronic tracking bands deactivated, and the nurse wheels you all the way to the valet station and the car. Here, Tim brought the car seat in, we put Noah in it, and we just...walked out. Obviously, there was security that we had to be buzzed through, but between me being discharged and walking myself over to the NICU, and now Tim and I walking out carrying Noah, things just seemed much less official.

We headed home, where my parents were watching the kids. We hadn't told the kids for sure that we would be home Wednesday, figuring it would be tough to explain another setback to Sophie. Instead, my parents had them ready, and we now have video of us surprising Sophie and Josh. It was adorable. I hadn't seen them since Monday night, and they hadn't seen Noah at all, so it was so nice to be a family again.

Things have been both easier and harder than I expected. Despite the first day setbacks, Noah eats like a champ--with none of the latching trouble the other two had. Sophie and Josh have both been great with Noah, but there has been some acting out for attention--Sophie much more than Josh. We are working hard to make sure they both get one on one attention, but there have been more than a few frustrating moments.

Noah is sleeping about as expected--not a ton at night, but that won't last forever.

I am recovering faster physically than I did with the other two, mostly out of necessity. The expected areas are still sore, especially when I overdo it. Happily, being sick for most of the pregnancy had some rewards. One, even recovering from delivery, I feel way better than I did pregnant. Two, I gained just under 20 lbs during the pregnancy, and I was at my pre-pregnancy weight 6 days postpartum and am now under it. This means I can wear real jeans again! Things are not back to pre-pregnancy shape, and I still have a bunch of weight to lose before I am back in a healthy range, but it's better than having 5-10 pregnancy pounds that hang around like they did with the other two kids.

Overall, we are all doing well. It's still nuts to me to think we have three kids. We are working on how two adults manage three munchkins, but we will just learn on the job!

He's here!

2012-02-02T11:49:00.004-05:00

It's been a busy few days. The whole story will come later, but Noah Zachary was born on Monday, January 30, at 4:26 PM. He spent some time in the NICU, but they discharged him last night, and we both got to come home! The labor story actually starts about a week earlier, but let's just say I wasn't figuring we'd actually deliver without an induction! Everyone is doing well now, and I'll fill in all the details soon!

Progress, and lack thereof...

2012-01-18T22:52:00.000-05:00

Two quick updates, with hopefully a longer one coming tomorrow or Friday...

First, had my 36 week visit and non-stress test today. Having regular contractions (and decently strong ones) every 5 minutes. Baby is very reactive and is not a big fan of being on the monitors (he tries to kick them off pretty much the entire time). However, all of those weeks of contractions haven't made any progress towards getting me to my Bishop score (and induction at 39 weeks). Might be TMI, but no real cervical change to speak of. This is a bummer, because I had already made good progress with both Sophie and Josh by this point. I still have a few weeks, so here's hoping. My fear is that after delivering two giant children (9 lbs 1 oz and 8 lbs 13 oz) the hard way, this one might be a c-section. Still thinking positive...we'll check again next week!

Second, I had an email when I got home that my USMLE step 2 CK board results were in. I took them on 12/21, and I figured it would be about 6 weeks before they would be back. I was nervous to open the file...I knew odds were in my favor that I passed, but until the scores actually come, you don't know that. Once the pdf opened, I could see the words "PASS" on the score report. I scrolled down to morbidly check the score, and it was a tiny bit better than I expected--a similar percentile to what I scored on Step 1, though a slightly higher numerical score. I wasn't near the astronomical scores many of my classmates got, but 1) I'm going into medicine, so not a big deal, and 2) scoring just slightly above the mean is completely fine by me, especially for the (lack of) studying and taking the 9 hour test during my third trimester. I always wonder if I could've done better, but at this point, I'm glad it is over!

Passing both Step 2 CS (the standardized patient exam I took in September) and Step 2 CK (this computer based test) means I can officially graduate from medical school in May and enter a residency program! It also means I don't have to re-shell out the several thousand dollars those tests cost me. Glad to have that major hurdle out of the way!

Now, I only have to pass Step 3 in residency, then the internal medicine boards, then specialty boards...

I refuse to think about the lifetime of tests I have before me. It's nice to have progress on my medical career, no matter how incremental.

Here's hoping that progress rubs off on other parts of my life soon :) Come on baby, let's make some progress towards that Bishop score!

Hello 35 weeks

2012-01-08T11:54:00.000-05:00

Really, I've been meaning to be better about updates, but life has a way of keeping me busy! I've got much more time now (for the next few weeks, anyway), so I'll try to update in bits and pieces. Today, it'll be the pregnancy update, with the med school/residency search following soon (I hope).

I'm 35 weeks today, which seems a little nuts. I haven't detailed this pregnancy nearly as much as the other two, thus fulfilling all of those third children assumptions that people have, but really, after doing this twice already, I kind of know what to expect. Interesting differences this time:

-I've gotten sicker for longer with each pregnancy. With this one, I was still nauseous and sick until almost the end of the second trimester. I actually lost about 10 pounds early on, and I started gaining about 22 weeks. Considering my starting weight, this is completely fine and no problem at all--I have plenty of reserves :) I'm 35 weeks and up about 10 pounds from my pre-pregnancy weight. Considering the baby is estimated to be around 6 pounds right now, plus all that extra blood volume/uterus/placenta/etc, I'm hoping I'm mostly baby. I also tend to accumulate tons of water weight in the third trimester, which is true this pregnancy as well. Even my loose socks leave 1/2 inch dents in my legs by the end of the day. I have been around 1+ pitting edema by my morning OB appointments, and it's worse by the end of the day. My blood pressure has been fine, so there isn't really any worry about pre-eclampsia (none of the other criteria for that have been issues either).

-The gestational diabetes has been a challenge. It's been tough in different ways: early on, it was tough checking sugars 4 times a day (especially during rounds) and trying to eat on a schedule. That got to be easier (though not fun) as time went on. My sugars had been very well controlled until about 6 weeks ago; my AM fastings were in the 80s, and my 2 hour after meals were usually in the 90s. I was on 4 units of NPH insulin at night, with nothing at meals, until recently too. Despite the lack of weight gain and the good sugars, my 20 week ultrasound suggested we were going to have another big baby; the abdominal circumference was good (a concern for diabetics), but the arm length was >95th percentile, and he had a big head.

-That's right: another boy! We are glad that he looks completely healthy, and we would've been happy with either gender, but at the time of the ultrasound, I have to be honest and say I was a little disappointed we weren't having a girl. I thought it would be a boy, just by the way the pregnancy was going, but I was hoping I'd have another opportunity to use some of the adorable girl stuff we had stowed away. Honestly, Josh was going through a tough developmental period at that time too--his lack of interest in snuggling and his desire to harm himself in any way he could made the prospects of doing boy rearing part two rather daunting.

-Since then, I've come to think having another boy will be good. We had both boy and girl stuff ready to go, so that was no big deal. This way, the boys will be close in age and get to play. Josh has since become a ton of fun; he's becoming much more verbal, which decreases the tantrums. He's also very affectionate, usually happy and playful, and he and Sophie are absolutely adorable together. I think having another little boy will mean the two of them will tire each other out. And Sophie loves being the little mom, so she'll enjoy having two brothers to boss around :)

-Basically, this pregnancy (other than being wicked sick forever) was going along similarly to the other two in terms of OB visits and such. I did have two high risk OB visits with maternal-fetal medicine, in addition to a meeting with a nutritionist, in the first trimester. Since everything was going well, I was on the normal schedule for ultrasounds and follow up. That changed at my 32 week visit.

-I had been having absolutely no fluctuations in my blood sugars until the beginning of December. Even when we were in Florida for 9 days over Thanksgiving, my sugars were fine. I ended up with a head cold when we got back, and my sugars went up a little bit. My OB said that was to be expected. Problem was, they never really went back down, even after I felt better. I was about 30-31 weeks when the creep in sugars started. This isn't unexpected; the insulin resistance in pregnancy worsens as time goes on, which is why women aren't screened until 28 weeks usually. We had discussed in the first trimester that my insulin requirements would go up as time went on.

-Despite knowing all of this, I was pretty emotionally down on myself at my 32 week visit. At that point, I was only up a few pounds (measured at my previous 28 week visit). Despite the fact that my home scale hadn't shown much of a change, my weight showed a 3 pound gain at the office between 28-32 weeks (note: 3 pounds in 4 weeks is usually no problem, but we were really trying to limit the rate of gain to less than 1/2 pound per week so as to prevent a giant baby). Add together the weight gain, the increase in sugars, and the fact that I had 90 minutes in the waiting room to percolate, and I actually had a few tears in the exam room in front of my OB. I told her, "Sorry, I'm not usually a crier," to which she responded, "I know!" Even though I was her last appointment of the morning, and she was 90 minutes behind, we spent a few minutes going over my expectations and how we could keep things in perspective. She told me that even though my fasting sugars had crept into the high 90s-low 100s, this was still better than most gestational diabetics had in the 3rd trimester, especially on a low dose of insulin. So even though I felt like a failure in my management, it was part of the disease--not something personal.

-It also didn't help that I had fallen the day before my appointment and couldn't really do much activity, which could help keep my sugars under control. I had been carrying Josh into daycare, and it was a bit icy. I slipped and fell forward, landing with one knee on the pavement and one in the mud. It was a slow motion fall--I was able to protect Josh and my belly so that I didn't land on them--and under regular circumstances, I would've walked away with just a skinned knee. Unfortunately, since I landed on two different surfaces, I tweaked something right in the front of my pelvis. It was likely a muscle, though we couldn't exclude a small pelvic separation (it's likely I had a minor separation after Sophie was born, and this gets reaggravated from time to time). I knew I had an OB visit the next day, and I had the luxury of being home to study for boards, so I made sure the baby was moving, and then I slept for the rest of the day. My OB wasn't worried when I told her about it, but I could barely walk (and couldn't do any stairs), so she just told me to rest it. It's better now, almost 4 weeks later, except that I still have a hard time finding a sleeping position that doesn't cause tons of sharp, burning pain.

-After that 32 week OB visit, we re-consulted maternal-fetal medicine to see how we should tweak my insulin. I really like the doc I see--he's very chill and realistic--and he almost laughed at me when I told him how concerned I was about my sugars. He said most of his patients were on 40-80 units of insulin at night and reminded me that pregnancy dosing was much different that adult diabetic dosing--so I shouldn't mentally be comparing myself to the patients I treated in the hospital or as outpatients. He recommended gradually increasing the dose to 16 units (from 4) at bedtime over the next week, and then I should come back to discuss. No need for mealtime insulin either, which was good news.

-I also had my first non-stress test (NST) at that visit. That's basically just sitting on the fetal heart rate and contraction monitors for a while. At that appointment, the baby was so active he kept kicking off the monitors. We called that test reactive :)

-I followed up a week later with MFM--at the shortest visit ever. Even though my fasting sugars weren't down to what they had been before, the doc was happy with them. In two minutes, he said we were good, and I didn't need to come to the high risk clinic again unless something changed.

-This was good news, since I was basically living at the hospital. Most of the gestational diabetics have weekly visits with the high risk clinic, plus the regular schedule of OB visits. I was thrilled to have one fewer appointment every week. Already, I had 34, 36, 37, and 38 week appointments with my OB, a 34 and 38 week ultrasound for growth, weekly NSTs until 36 weeks, and then biweekly NSTs from 36 weeks out. Thank goodness I was only facilitating small groups at the med school in the morning! I have no idea how people with a full time job manage to take enough time off for all these visits--and imagine adding in weekly high risk appointments...

-My 34 week ultrasound was good. The baby was estimated to be about 53rd percentile for weight, but his head circumference was >99th percentile. Both the tech and the doc must've measured 10 times. They couldn't find any abnormalities in the brain, and when they looked back and saw Sophie and Josh's measurements, they were less concerned. They did temper the weight measurement by saying that the femur length measured at a smaller percentile than it had previously, and the view wasn't great this time, so he might actually be a bit bigger than 53rd percentile. We'll take a second shot at the 38 week scan...

-The MFM doc did look at the ultrasound, the fact that it is my third, and that it is a boy--and said he will probably be my biggest yet. Hooray...

-My OB considers me to be average risk, despite the diabetes diagnosis, since my sugars have been so well controlled. Because of that, the plan is to let me go to term. She did say she would consider induction at 39 weeks based on my cervix, not the size of the baby. I completely respect her position: she follows the American College of Obstetrics and Gynecology recommendations. No woman wants to be pregnant any longer than necessary, but there are tons of studies that have shown late preterm babies (34-37 weeks) do have higher risks. From uptodate.com:

-Compared with term, late preterm infants had longer hospital stays (5 days vs 2.4 days) and higher rates of neonatal intensive care unit (NICU) admissions (56% vs 4%), feeding problems (36% vs 5%), hyperbilirubinemia (25% vs 3%), and respiratory complications (20% vs 5%).

-In a study of singleton infants born in Florida in 1996 to 1997 with a gestational age between 34 and 41 weeks, children who were born late preterm compared to those born at term had an increased risk for developmental delay or disability when evaluated in early childhood (4.2 versus 3 percent), prekindergarten at three years of age (4.5 versus 3.9 percent), and prekindergarten at four years of age (7.4 versus 6.6 percent)

-Brain immaturity may play a role in the observed long-term neurodevelopmental disabilities in some individuals who were born late preterm. Although data are limited upon the brain maturation of late-preterm infants, autopsy and magnetic resonance imaging demonstrate that at 35 weeks gestation, the brain weighs 65 percent of a full term infant's brain

So even though the absolute risks are still low, I'd rather bake this baby until his brain is fully developed. Although at >99th percentile, his head seems to be well on the way to being big enough!!

-I was induced at 39 weeks with Josh, even without gestational diabetes, both because he was measuring big and I met the Bishop criteria. And he was 8 lbs 13 oz. I'm hoping things will work out as well this time.

-I have been having contractions for weeks now. The last few weeks have gotten more painful and frequent. The discomfort of the Braxton-Hicks contractions has worsened with each pregnancy--I barely noticed them with Sophie, they were noticeable but just irritating with Josh, and they are uncomfortable with this pregnancy. When I was on the monitors for my most recent NST last week, I had about 8 contractions in an hour. They are definitely noticeable, but they are irregular and last only a minute or two. There was one instance of a late deceleration after a contraction, but the heart rate didn't drop to a scary level, the NST was otherwise reactive, and late decels are less ominous when you aren't actually in labor. Again, since I contracted regularly with the other two (they were actually 4 minutes apart and regular when I had the external cephalic version at 36 weeks with Sophie), we weren't worried. I'm just hoping all these contractions show some productivity and help me get to a good Bishop score when she checks me...I'm pro-induction at 39 weeks!

-So, today I am 35 weeks. I'm having wicked heartburn, though somewhat better than I had been about 6 weeks ago. I don't really have any cravings, and I am tired to death of eating the same high protein/low carb stuff all the time (seriously, eggs and cheese may have to come off the menu for a while). I'm tired, I have insomnia, and when I can fall asleep, I only sleep an hour or two at a time due to pelvic pain. I have to drink a ton of water to keep the contractions under control, but all that water makes me swell. Despite sounding like a miserable time, it's actually been fine. I was home most of December "studying" for my boards, and now I've got facilitating/precepting for between 7-20 hours per week (except for the next two weeks, when I am cramming in as much as I can before the delivery). I spend many hours a week at the doctor's office, which means I am still basically driving to the hospital/med school every day. But overall, I think things are going well.

-We haven't prepped anything for the baby yet. We did paint Josh's room (thus continuing my streak of painting rooms when I am >30 weeks pregnant). Theoretically, he can move out of the crib and into his toddler bed any time. Since he is still active, and the baby usually stays in the bassinet until about 3 months old, we do have time in the crib remaining. Beyond that, I need to wash up the bouncer/car seat/bassinets and bring up the baby clothes. That's about it. Oh, and pick a middle name--we have a first name, but the middle name is still elusive. Eh, we've got at least 4 weeks...amazing how much more relaxed we get with each baby.

-And despite the fact that I previously mentioned wanting a girl, this is it for us. The high risk OB said the fourth pregnancy is usually easier, but I don't want to have to go through anything rougher (or higher risk) than this pregnancy. And with starting residency in July, I don't know how I could possibly squeeze in the number of visits I've had this time into a resident's schedule. Plus, we're good with three: they can each have their own bedroom, they'll be close in age, and we'll be done with all of the sleepless nights sooner rather than later. We will have to upgrade my 10 year old Civic into a minivan in the coming months/years, but other than that, we're set for three. I think we're content with three. Never say never, but I'd say the odds of a fourth are slim to none. Especially with the possibility of twins that exists in both of our families...

-I do usually take a 36 week picture, so we'll see if that is up for posting or not. This pregnancy, I wore regular clothes until about 20 weeks or so, and no one commented (they would occasionally throw a glance that said, "Is she getting fatter, or is she pregnant?"). Once I transitioned to maternity wear and the built-in bump enhancement, it was instantly, "Are you having twins?" or "How sure are they about your due date?" I've had many strangers comment on how big they think the baby is. I am carrying far out in front, like I did for Josh, but still--trust me on this, no pregnant women wants to hear about how large you think she is. Friends/family I don't mind too much, but cashiers, secretaries, and total strangers passed in store aisles? Please keep the gigantic comments to yourself. Thanks.

-In summary: rough pregnancy, tired of diabetes, having a giant-headed boy in 4-5 weeks. Otherwise, things are good. Now, I'm off to chug some water to try and stop these contractions, check my sugar, and take some Tums for the heartburn. I'm looking forward to having a baby, but I can't say I'll miss pregnancy! Ok, maybe I'll miss the elastic pants...

Coming soon

2011-11-28T13:03:00.000-05:00

We're actually on our last full day of vacation at the moment (first vacation ever with kids--it's been an experience), and then it's back home tomorrow. I have to study for my boards, but otherwise I am done with clinical training at this point. What this means is that I hope to bring you up to speed on what's been going on the last few months. I've done my medicine acting internship, a psychiatry acting internship, a month of ER/urgent care, and had my first residency interview (with two more in the next 10 days). And I've been teaching on the weekend. And I'm about 10 weeks away from delivering baby #3. So yeah, I've been keeping busy :)

Future updates again soon, I promise.

Catch-up, part one

2011-08-24T09:40:00.000-04:00

So...hey, how's it going?

It's been a while. Funny thing about blogging--for me, the longer it's been since the last blog, the harder it is for me to get back into it. I feel like I need a good reason to come back. I've started and stopped a bunch of posts over the last year or so, but many of them never make it up. Sometimes it's because I just needed to vent (though many of those posts do end up on the blog). Sometimes it's because I'm not sure what I want to say. And sometimes it's because I never finish.

I have a google reader feed full of people who blog daily or near-daily. I don't think I could ever be one of those people. Truth is, my life is not that interesting on a daily basis. I used to have outside interests, but in all honesty, kids and work take up all of my time. The kids are cute, but even I don't want a record of how many times they pooped every day or who ate what for dinner. I do wish I memorialized some of their milestones better, but I try to at least take pictures on a regular basis. That doesn't mean it I get them off the camera more than every few months, but it's a start.

Really, my life doesn't change much. There are interesting medical and personal moments almost daily, but I'm not sure I have the time to really sit down and reflect each day. Once the basics of my day are done, and the kids are taken care of, there's housework, then work-work, then bed. That's about all I can handle right now.

So if I said that it usually takes a reason for me to start back posting again, perhaps you are wondering what the reasons could be?

There are several, which I will not try to conquer all in one post. But I figured I'd better start with the most obvious first: we are expecting a third baby this February.

Yep, I'm almost 16 weeks. The three F's (family, friends, Facebook) have known for a while, so it's not a secret. I just haven't had much energy to talk about it.

We were trying to squeeze in the famous "fourth year baby." For those not in the medical field, the fourth year of medical school is much more flexible than the third year, and it's really the last break before residency/fellowship/a real job take over your life. So, at least in my program, many women try to have a baby during the winter of their fourth year of medical school so that they get time home with the baby before residency starts. Ideally, a six month old should be sleeping better than a newborn (or so I am told), so not having to wake up every two hours is a perk.

The fourth year baby isn't the last option for everyone, but I honestly felt it was for me. My pregnancies have not been fun (and boy, is this one living up to that--more later), and I knew there was no way I could be pregnant and a functional resident. And to wait until a break in fellowship meant that there might be as much as 7-8 years between Josh and a new baby (and I would be 38). That wasn't realistic either. So, we decided that if we wanted a third, this was the time.

Things definitely didn't happen right away. Without too many gory details, I actually had symptoms that made me think I was pregnant the month before. When the test was negative, I started to worry. Based on our timeline, we had two more months to get pregnant before we had agreed that the time would be too tight for maternity leave before residency. The next month, I was sure I wasn't pregnant, and I was panicked that maybe a third baby wasn't in the plans.

Then the test was positive. No symptoms, nothing. I went from shocked to excited to...oh crap, what did we just sign up for?

Don't get me wrong--we were hoping for this baby. But we had started to self-talk that maybe two wouldn't be so bad, it's a even number, we've got a 1:1 parent:child ratio, we wouldn't have to buy a bigger car, we'd have more money every month, etc. We were looking for a reason to not be disappointed if we couldn't get pregnant.

When the test was positive, all that self-talk reversed: we'll be outnumbered, we can't fit three car seats in the car, etc. We had discussed those issues before, of course, but now that it was real, we had some panic setting in.

The other thing setting in: pregnancy misery. I am not a glowing, vibrant pregnant woman. More power to those people. I am miserable for all but a few months in the middle. The result is worth it, but I dread pregnancy. This one has exceeded all my expectations, and each pregnancy has gotten considerably less fun. One of my OBs commented that it is "the curse of the third pregnancy." He did try to reassure me that the fourth is usually better. I said hell no.

The first trimester, I had horrible nausea, upper and lower GI issues, a constant awful taste in my mouth, and food aversions to everything that wasn't ginger ale or saltine crackers. I also was nearly incapacitated with fatigue. I described it to Tim like this: imagine that you just worked an overnight shift that involved extremely difficult manual labor. Then someone forced you to take a handful of sleeping pills. Imaging feeling woozy, dizzy, extremely exhausted. Imagine that it feels like someone is pulling on you, making it tough to even lift your arms. Now, you have to fight off all of those sensations throughout the entire day in order to get your work done. That's what I felt like for several months.

There's the other typical pregnancy symptoms too (no need to elaborate--google it if you want, but it ain't pretty). Those are just nuisances compared to the GI/fatigue issues.

I saw my OB early on, and I expressed to her my concern that I might become gestationally diabetic this time. I was barely OK with Sophie and borderline with Josh. I haven't gotten my weight where I want it to be, and I have a family history of type II diabetes. I knew I was at risk. She did the 1 hr screen, which I failed (as always), but this time my 3 hr GTT was positive for gestational diabetes (not by much, but it still counts).

And so began testing sugars four times a day, meeting with dietitians and high risk OBs, and cutting carbs (which were the only things I could stomach). Perhaps the most difficult thing was adjusting mentally. I told my OB at my next visit that I was really struggling emotionally with this--I know my chances of developing diabetes after my pregnancy (1/3 to 1/2 will within 10 years). I know that because this was diagnosed early in my pregnancy, my risks are probably higher. I know that while my family history is unchangeable, my weight is. And I feel like I've put all of my kids at higher risk because of this. My OB was very kind--she said that this is like receiving a serious medial diagnosis and can be emotionally draining in that way. She knows my personality, and she told be that we'll take care of the baby now, and I can take care of the weight after the baby.

I've been pretty OCD with my sugars (shocker, I know). My OB actually commented that she should write a book on how educated mothers are much more thorough with their risk management, and she'd use my spreadsheets as an example. What can I say, I love excel...

I've seen two high risk OBs too. I brought in my chart to the first one. My AM fasting sugars averaged in the low-90s, and my 2 hr postprandials average in the 80s for breakfast and lunch and 90s for dinner. The ADA goals are under 95 fasting and under 120 at 2 hrs postprandial. However, this OB said he likes to be aggressive, so he put me on 4 units of NPH insulin at bedtime, which brought my AM fasting sugars into the 80s. Recently, I've been getting a lot of readings (especially after meals) in the low 70s--I was told that in pregnancy, you can go into the 50s and be ok, but I feel pretty crappy in the 70s. But, I do what I am told.

The aggressive high risk OB had said to come back in a week, and he thought that perhaps I'd have to come back weekly during the pregnancy. This was a major bummer--it's hard enough to take time out for monthly appointments, and weekly would be near impossible. The next week, I saw one of his partners, who said I was doing great, he probably wouldn't have started the insulin but would continue it now that it had been started (drat), and there was no need to come back unless my regular OB wanted me to. That made me feel better.

Now, the sticking four times a day for blood sugars isn't fun, and it sure isn't convenient (nothing like walking away from rounds to check a blood sugar). But the insulin shots suck. Really, they hurt. I've tried a few sites (and given myself some nice bruises), and I can cope, but it sucks. The thought of potentially having to do it more than once a day is frightening.

Of course, since carbs were all I could eat, and now I can't eat many of them, I've lost five pounds so far. I am eating a lot of protein--and calorie-wise, I am on target--but I am so sick of eating the same few things that don't make me want to vomit. This should get better in the next few weeks, but I seriously can't look at an egg or cottage cheese for a little while.

My OB is happy with things (though she did tell me not to lose any more weight--first time I've ever heard that), and the ultrasounds have been good. My first check came back looking good, so that's one worry down. We'll have our anatomy ultrasound in a few weeks and see how things look then. I can't say that I'm ok emotionally with things--I'm sure you've realized I have deep-seated guilt issues, and this plays right into that. But I am working on it.

Now that we are a few months in, the panic has worn off. I think we realize it won't be easy with three young kids and me in residency. Tim knows he'll have his hands full. But, he already does the vast majority of dropoff/pickup, and if I am home late, he manages just fine. Having family in town is awesome too--which is why we'll stay in town (at least for residency). For instance, Josh had a nasty bug for a few days, and between the two grandmas, we were able to make it work. That is definitely invaluable.

We will need a car at some point, but we are going to try and stretch my 150k+ mileage Civic until the start of residency, and then we'll probably upgrade to a minivan. I swore I'd never drive a minivan, but you can't beat the convenience...

I'll try to update on med school and the rest of life soon. But now at least you know why I haven't had much energy for blogging recently.

How time flies

2011-05-28T13:19:00.000-04:00

I keep meaning to blog, or at least finish up some of the ones I've started over the last few months, but there just aren't enough hours in the day. While medicine is much improved hours-wise than surgery, my ability to get things done outside the house has not improved. The only reason I am even blogging now is because I am on call this weekend and I haven't gotten an admission yet. If I was home, my to-do list is long enough that I would be busy for weeks!

It's tough to do a general catch-up note on what's been going on, so I'll just give you a brief overview and then fill you in on what's up right now. First, surgery is done, praise the lord. I honestly didn't mind the procedures, but the constant pimping, the scut work, the terrible hierarchy, and the lack of focus on the patient's care really turned me off. Maybe it was the thrill of doing something other than surgery, but within a week of starting medicine, I thought this was what I wanted to do.

I like that the patients are complicated. I like that the focus is on patient care. I like that (generally) you are out when you should be--there are some late non-call days, but if you've got your work done and everything is stable, you sign out at 5. The long calls (till 11 PM) can be stressful, and since med students don't stay overnight, we don't get to be post-call like the interns and residents. So that means I'm in 7A-5P every day, with 7A-11P schedules every four days. For example, this is my "black" weekend. It means I am on call today from 7A-11P, then I come in tomorrow from 6:30A-till everything is done (around 1 P), then I am back on Monday (since Memorial Day is not a holiday in the hospital). So the weekend is "black" because I don't get a day off.

I did have my "golden weekend" (off both Saturday and Sunday) two weeks ago, which worked out perfectly. That Saturday was a family party for my brother's graduation, my graduation, my West Coast sister being home, and Josh's first birthday. Then on Sunday, I walked in my PhD commencement ceremony. That was actually more emotional than I expected. I had originally not planned to walk, both because I thought it was weird to walk 6 months after I defended and because I didn't want to shell out the $900 for regalia. However, between my family and my lab mentor, I was convinced to do. I am actually glad I did. In my institution, they let the family walk across the stage with the graduate, so Tim, Sophie, and Josh walked with me. Then I got to be hooded by my lab mentor. It was a very surreal experience to be called "doctor" for the first time--my family has teasingly called me doctor for years, but when the announcer did it, it was for real.

That golden weekend was a nice break. Although the weekend was crazy busy, it was at least nice not to be spending all my time in the hospital. My schedule since the beginning of March has been almost unbearable--and to think that it is only a taste of what residency will be like! If it wasn't for my mom cooking every few weeks, we'd probably starve. She's put meals in our freezer that have gotten us through many nights of being too tired to cook. We almost never order out, but we do eat more quick fix meals than I'd like.

I just really have no time or mental capacity to do anything outside the hospital. Tim does 99% of the daycare dropoffs/pickups (unless I am magically out early one day). The nights I am on call, he has the kids by himself, unless we've gotten lucky and have family up that night. The laundry manages to get done on the weekends, mostly by Tim (but sometimes I help, really!). Everything else though--cleaning, organizing, cooking--generally doesn't happen.

I sometimes get a few hours here or there and try to catch up. Unfortunately, usually it is just enough time for me to get started but not enough for me to finish. For example, Josh is now in 18 mos clothes. I still have 6-9 month clothing to sort and put away. He has clothes all over the spare bed in his room sorted into piles, but I haven't been able to just commit a few hours and clean it up. It's a similar story for the downstairs, where the wet spring has turned our tile floors into muddy messes and the dining room table is covered in stacks of Sunday newspapers that I haven't had time to read.

And forget about doing the drugstore deals, clipping coupons, and hitting the sales at the grocery store. I am actually out of shampoo and will need to (gasp!) pay for it because I am not up to date on store deals/coupons and don't know where it is free at the moment. We've been buying as few groceries as we can to get us through, and obviously we buy what's on sale vs. what's not, but I don't have time to stockpile good sales. I call it "guerrilla shopping." We buy milk, bread, eggs, etc when we have to, buying the cheapest brand, but we don't buy anything we don't need right then. It's not my preferred tactic, and it means we are always scrambling to make dinner with what we have, but I don't have the time to plan things out like I used to.

I have a week off at the end of June, once medicine is done. Initially we were talking about going to my in-laws' condo in Florida; then we decided we couldn't afford airfare and didn't want to drive for two days each way. Then we talked about maybe visiting friends in Pittsburgh for a few days, but we weren't sure we could make our schedules work. Then I was just going to keep the kids home and spend time with them. Now the plan is to keep the kids in day care for a day or two just so I can clean the house, and then I'll keep them out so we can have some time together. I love the kids dearly, but there is no way I can deep clean the house the way it needs to be with both of them running around. Seriously, it's disgusting. I feel like one of those reality TV cleaning people should come over and talk about the filth. I mentally will feel better knowing that at least the house is livable and not harboring disease.

Sad, right? This is only the second week off I've had since I had Josh a year ago. I got along without vacations before, but I used to have two day weekends every weekend. Even if I was in lab on the weekends, I somehow still had enough time to keep up with my life. Now, I'm in the hospital at least one day every weekend for long hours, and I feel like the one day a week I do get off should be devoted to my family. That leaves little time for anything else. Honestly, if my bills weren't auto-paid online, I'm sure I'd be behind on my bills--and if you know me, you know that is the absolute last thing I would ever allow.

I just feel so disoriented--I am sure I could not pass a mini-mental exam. When I ask patients what the date is, I usually have to double check and make sure they are right. The time has gone so fast overall, and yet there are so many days (especially on surgery) where it feels like time is frozen.

How is my son already 13 months old? And my daughter is closer to 4 than 3? Tim & I will be married for 9 years this fall. Unreal.

I know that med school (and soon, residency) is really just a means to an end, but the hours are rough. My lab hours were often tough too, but they were flexibly tough. If I had a doctor's appointment, I could set up my experiments so that they wouldn't interfere. Now, I can't take time if my kids or sick, or I am sick. There's no time to schedule things. And I've missed invites to baseball games and other activities because of my call schedule. Luckily, other than my graduation, there hasn't been anything mandatory yet that I've needed to beg to have my schedule adjusted. But what if I had a wedding to go to, or something similar? And forget just taking a long weekend to get away. Tim's parents sold their camp last year, but even if they still had it, there is no way I could get time off to go.

I've been told that fourth year is much more flexible, with electives making life seem worlds different than third yet. I do have acting internships (one in September, one still unscheduled) to do, which will be tough. Otherwise I am looking forward to taking a breather.

And even though I like medicine, it's still caused me to stop and think about what I really want to do. I had my first patient pass away earlier this week, and I have another patient who was just switched to palliative care and will likely pass away before the weekend is out. That isn't an easy thing to deal with.

I also have the worst luck ever and will be on a difficulty team starting on Monday. My last two teams have been ok--the first was intense but educational, and my current team is not interested in teaching and just wants to be done (it is composed of two prelims, a chief resident serving as attending, and a third year resident--all of whom are moving/transitioning to fellowship in July). Starting Monday, I am going to be on service with my former PI, Dr. B, who made my life miserable for 3.5 years. I was initially worried about being on service with him before I even started my rotation. I debated talking to the clerkship director ahead of time but decided that would seem unprofessional. I worked out the chances of being on service with him at about 4% (using number of attendings, # weeks service/year, and # medicine services in the hospital). I thought a 4% chance should keep me in the clear. Unfortunately, that is just my life.

I did try to contact my clerkship director once I found out that Dr. B would be my attending. Unfortunately, I didn't find out until after rounds yesterday, and when I tried to get in touch with the director, he wasn't around.

I think I am just going to deal with it. It will be extremely uncomfortable, and I am sure he won't give me a very good evaluation--which sucks, because I am working really hard so that I can hopefully get honors in medicine. However, it is two weeks, and I dealt with him for years--at least this point has an end in sight. One of the residents also told me that he comes in for rounds, wants to be super quick, and then you don't see him again. So maybe I won't actually have to spend much time with him. I just think it epitomizes my luck that I had a 96% chance of not working with the one person in the entire system I was trying to avoid, and I ended up working with him. Such is my life.

In general though, I am feeling more and more comfortable with medicine as my choice. I was worried, since I had done everything else and was having a hard time sorting through the choices. I like that medicine is complex (even though I constantly feel stupid). I like that it involves relationships with patients. I like that it allows me many opportunities for different types of practice, depending on what specialty I decide to pursue. I like that (unlike surgery) sometimes people do have lives outside the hospital (and I am hoping I will learn how to do that too).

There are other fields that have pros and cons, but I think medicine is a good match for my personality. I will still specialize in something, though I am unsure what exactly that might be. The other nice perk of medicine is that my home program has a good reputation for it and places people into great fellowships--which means I at least have the option to stay here for medicine if I want to. I will probably apply other places, and if there is a program that jumps out at me, I'd be willing to move. But at least we have the option to stay for residency and then move for fellowship.

Anyway, sorry for the random train of thought. I can't promise I'll be better about updating for the next month, but once medicine is over (and I have my house clean!) I'll try to be a little less sporadic.

Of course, I'll be here late tonight, since it is past 1 PM and I don't have an admission yet. By the time I see the patient, write the note, look up meds/diseases to tweak my assessment/plan, and then staff the patient, it usually takes >6 hours. My team's a bit chaotic, so I am sure that is not the norm, but that's actually a bit optimistic if past patients are any indication. Oh well, such is life. I guess I have all weekend in the hospital to study--that's being optimistic, right?

Another toddler

2011-04-07T20:13:00.000-04:00

Josh officially started walking today--he's been taking 2 steps at a time for a few weeks, but then he would either lunge or sit down. Today, he took multiple steps multiple times, so we're calling it--he's officially walking!

Sophie had an adorable (though preciously out-of-tune) recital tonight for day care, and it really jumped out at me how much the two of them have grown these last few months. I feel bad that I've been missing it with 14 hour days, overnight call, and working one weekend day each week. I keep telling myself it isn't forever--I'll never have a "normal" schedule, but after residency, I'm hoping it will at least be more manageable.

It was another pimptastic day in surgery today--I got singled out by the ICU attending, who pimped me on hyperkalemia for about half an hour. I didn't get all the answers right, but I think I held my own. I can't say the same for the other three hours of pimping I got today, but oh well. Seven more days.

Also, we have a patient on the floor with CRKP. Scary stuff, really, but I am not surprised. These patients get put on vancomycin/linezolid/zosyn/imipenem/etc like it is candy. Antibiotic resistant bugs are a huge problem. Hence, why I was my hands a million times a day (and bugs like C. diff don't come off with the antibiotic foam--you need to actually wash your hands). Between the superbugs, HIV, Hep C, and TB, I'm sort of amazed our patients have any healing ability left in their bodies.

8 days

2011-04-06T20:47:00.000-04:00

8 days of surgery left, but who is counting?

I have two weeks of anesthesia beyond that, but I am not counting that in the surgery total. I will have many stories to share once I have the time to blog about them!

On a continuing note re: grades from my last post, I got my summative feedback from OB/gyn. I had only gotten a few evaluations back, and they were generally benign to slightly positive, except for one. I got a not terrible, but not great eval from the preceptor that used to question me for hours, one-on-one, and his comments were generally "little rusty on knowledge due to time away during PhD, but reasoned answers out well." I'll dig up the exact comments one of these days. Anyway, I figured faint praise is damning, so I wasn't expecting much from my rotation evals. Apparently, more people turned in evals than I saw, because the summative is pretty glowing--the one attending I worked with even suggested I do an OB/gyn AI and consider it as a career choice.

Really? Because I disliked OB/Gyn. I'd say I hated it, but after doing surgery, I'm reserving the term "hate" for neurology and surgery :)

I still didn't do well on my shelf exams, secondary to the zoster, so I'm not expecting honors. Still, I was told I did well on pediatrics, but no one turned in evaluations, so I have mediocre reviews. I feel I did a pretty mediocre job on OB/Gyn, but I have positive reviews (except for that one). Really, who knows how they decide this stuff? Absolute craziness.

Off to read more about things relevant to my patients, but nothing that will help me by giving me info the attendings want to know. For instance, did you know that there is a specific piece of fat near the appendix named for Sir Frederick Treves, who saved Prince Edward from a ruptured appendix days before his coronation? No? Neither did I, but apparently that is what I should be studying, because that is what I was pimped on. Definitely high yield material, don't you think?

Oh surgery, I can't wait to be done with you...

Bummer of a day

2011-03-25T16:53:00.000-04:00

It's been a down day--I know, I know, I'm on surgery and it's been a down few weeks. Today has really capped off this last month, though.

I'll start backwards first. We have this online system for evaluation of our clinical rotations. Basically, you log a patient, send it to your preceptor for evaluation, and whatever the sum of your evaluations says, that counts for 75% of your grade. The other 25% is your shelf exam.

I got the results of my shelf exams earlier this week. They aren't as good as I had hoped (I can always blame the raging shingles outbreak, I guess), but they aren't so bad that I'll be able to retake them and improve my score. It's basically at or just above the national mean for the disciplines--I'm assuming that is a passing grade for my medical school, but who knows. I had been in contact with my dean, and the understanding was that if I bombed the shelf exams, maybe we'd work out a plan B. Instead, I probably did enough to pass them, but the grades will prevent me from getting honors. I won't know for sure for a few weeks yet.

The other frustrating thing is that the evaluations/grades don't seem to mirror how hard I worked. I got really positive feedback from my family medicine people, and if my shelf exam had been better, I am pretty sure I would've gotten honors. On the other hand, less than half of my pediatric preceptors filled out evaluations. The ones that did maybe put in one or two general comments--nothing bad, but nothing that stands out. I got my rotation assessment, and it really seems bland to me. I got better feedback from neurology! So, despite the fact that all of my pediatric preceptors told me I did a great job, I was comfortable with kids, I should think about pediatrics, etc, it doesn't count for anything if they never responded to the evaluation form.

I still don't have my OB/gyn comments back, but the response rate on those was about 10%. So, 75% of my grade will be based on 10% of my performance. Not fair, but that is how the system works.

I am really frustrated by this. I worked especially hard in pediatrics and family medicine. Now it seems as though all of that work is for nothing. I could've worked much less hard for the same grade. The whole system seems arbitrary, and it is extremely frustrating.

Today has also been a frustrating day on my current rotation. The other med student on my team is a rock star (S, if you read this, you are totally a rock star!). She's great, and I'm glad she's on my team. It's tough for me to be the less preferred member, though. It didn't help today that the resident and I got our signals crossed. I had asked him three times about what he wanted taken care of--when I did it as we had discussed, it was obvious that I hadn't done it the way he wanted. There was no patient harm or anything--I'd never do anything if I was worried it wasn't in the patient's best interest--but it was frustrating. At least the other med student had heard the same thing I did, so I wasn't totally out of my mind. I could tell that the resident was annoyed with me, so I went and finished my to-do list out of his way for a little while.

I was definitely feeling like I could do no right, no matter how hard I tried. I was helping him change a patient's dressing a little later, and the patient looked at me and said, "You're pretty." I nearly cried. I was tired, my hair was back in a messy ponytail, I had no makeup on, and I was feeling down. (And let's not even touch the body image issues I've been battling lately). I looked at him and said, "Thank you. That's the nicest thing anyone has said to me today." Granted, he was on pain meds and probably said that to every person he saw that day, but it made me smile.

I'm just down because today I felt worse than invisible. Despite my best efforts, I feel like all my team sees are my shortcomings. I try hard to write thorough patient histories--I might've caught a colon cancer in a patient and prevented him from bleeding out during surgery--but that gets no notice. I do blood draws, I run scutwork, I do whatever needs to be done and am always willing to take on more. Instead, my low moments end up being the highlights. Today, for instance, even though the resident was busy and I had confirmed the plan multiple times, I should've asked him to show me what he wanted done. I know that doesn't save him any time, but then it would have been absolutely certain that we were on the same wavelength. I thought I was saving him trouble. I didn't want to seem like a pest. Next time, I'll be a pest.

I am glad my three weeks of vascular surgery are over. I really feel like I didn't learn much more than what I could've learned reading a textbook. The service is so busy that there really isn't time for teaching. My overnight call this week consisted of three (very stressful) emergency surgeries with an attending I had never met before. Thank goodness the helpful resident was also on call, as was another med student from the general surgery team. We had an abscess debridement (where the patient lost all of the skin from his anus to his scrotum), an emergency procedure where the patient was bleeding out into his abdomen (and lost most of his blood volume), and another exploratory procedure because the patient was though to have strangulated bowel. There was also a respiratory code on one of our patients on the floor. Thankfully, everything turned out ok, but we were so busy with emergencies (and then the usual night shift work) that there was no time for teaching.

I got to watch surgeries these last three weeks, but I didn't get to do much beyond retract and cut sutures. I did a few blood gas draws and one intubation with the anesthesiologist, but otherwise everything else I learned was from reading. I've been told there is more OR time on general surgery (I'm not sure that is good or bad). I'm not looking to become a surgeon, but I'd like to learn about how surgeons decide what is an appropriate clinical indication, when surgery is worth the risk in some of these high risk cases, how you manage patients post-operatively, etc. I feel like the clinical rotation is supposed to be seeing how the service works. I really feel like I was more of a minion than a member of the team--and questions about why we were doing something were absolutely not encouraged. I understand not answering a general question that can be researched. However, I sometimes had specific questions about why we were doing X in a patient instead of Y. Sometimes the chief resident would give me a one sentence answer, but generally everyone was so busy and overworked that they didn't have time for more than a few words.

Anyway, it was just a rough day. I felt like a piece of crap, and seeing how much the resident preferred my co-medical student was the nail in the coffin. It is absolutely not the other med student's fault--I am thrilled she is on my team--but favoritism hurts. I guess all I can do is try my best. All the hard work I do may never get noticed, but at least I know I am doing it. It's not like my online evaluations will get filled out anyway. Part of me feels like that if there is no chance to get an honors grade on this rotation, why try so hard? My sanity and sleep would probably benefit from me back things down a bit. Still, I feel like I need to do the best I can so that I know my non-honors grade wasn't from a lack of effort on my part.

Here's hoping medicine is a better fit for me...

Full circle

2011-03-19T17:40:00.000-04:00

It's been a crazy few months. I feel completely behind in my life (as well as constantly exhausted), which many people would say is to be expected from long hours/overnight call/weekends during my surgery rotation. However, back in October or so, I was on neurology (which also had long hours), writing my thesis in the evenings, and teaching a chemistry class every other weekend (and grading whenever I had time). And Josh was only 6 mos old then--while he is still not a champion sleeper, he is doing much better now than he was then.

So why do I feel so overwhelmed right now?

I think a lot of it has to do with decisions. Starting in July, I will be a fourth year medical student. Which means I will start applying for a residency position. Which means I better decide what the heck I want to do so I know where I will apply. Which means I need to schedule rotations that will help me figure out what the heck I want to do.

I have friends who are sure they know what they want. Some have known since they entered medical school, some found a field that goes well with their PhD research, and others found a clinical area during their clerkships that they love but had never considered before.

I envy them.

For them, they know what they are doing, so they know how to structure their time in order to get the best letters, when to schedule their Step 2 licensing exam, and when they will have time for electives. There isn't a time crunch. That is not the case for me. Since my clerkships run until the end of June, I essentially have July and August to figure out what I want to do. Applications begin on Sept. 1.

I had hoped to do an internal medicine AI in July or August, but they were booked, so I ended up with September. The pediatrics AIs are booked until November I think. I have the option to do electives in July or August, but I am not sure what I want to see. I initially figured that I'd end up in adult cardiology, since that is the closest match to my research interests. I'll probably try to get a cardiology elective in July/August if I can. As for what else might be a good choice--I'm stumped. I have to do a month of emergency medicine and a month of geriatrics per our med school requirements, but I might push those until after interview season. I also have to do another AI, and I might try to do a psych one later (more for fun than anything else).

For licensing purposes, after third year requirements are done, I need 7.5 months of clinical time. Two months are my AIs, two months are ER/geriatrics, and I have one month of credit from my clinical tutorial during my PhD. That leaves me a minimum of 2.5 months of electives. I want to do a cardiology elective, and I think a radiology elective might be helpful for me in general. So, I have to find another 2 weeks of clinical work at a minimum. I'm not too worried about that (and if people have suggestions on helpful rotations, I am game).

The last several months have been extra stressful because all of these decisions about the future have been on my mind. I assumed coming into third year I'd do internal medicine. Unfortunately, medicine is my last rotation of third year. What happens if I don't like it? I'm back to square one. There are a few areas that are definitely out--neurology and OB/gyn for sure. Pediatrics has potential in terms of a specialty, but I couldn't do general peds every day, and I have no exposure to specialty pediatrics, so how would I know if that is a good fit? Psychiatry was very interesting, and I am drawn to "thinking" specialties more than "doing" specialties thus far. However, I have no exposure to outpatient psych, there is a lot of overlap with neuro, and I don't want to solely be doing 15 minute med checks--but a lifetime of inpatient psych seems overwhelming as well.

So far, I have been drawn to areas in which I've received good mentoring. That's why I thought internal medicine was originally a sure thing--I had a wonderful clinical preceptor for three years, and I looked forward to my one afternoon a week in his clinic. I had a great psych attending for a month. I really enjoyed working with all of the pediatric attendings. I felt like all of these people were human--they cared for their patients, they loved their jobs, but they also had families and a life. They treated me like a human and not like a burden. My question is this: did I like these rotations because I like the material, or did I like them because I felt that my personality seemed to mesh well with the attendings with whom I was working?

Surgery exemplifies that dichotomy for me. Really, the act of surgery doesn't bother me--I don't wake up every morning excited to cut someone open (as some of my residents do), but I also don't dread it. Vascular surgery is pretty boring, but I don't hate it. I drew a blood gas and intubated a patient within the first few days of the rotation, so I'm not put off by procedures. The actual practice of surgery is ok--I could do it, but I don't dream about it.

The culture, however, makes it seem completely out of the question. It is completely hierarchical, misogynistic, and impersonal. People are rude and angry. No one seems to like their job. No one teaches. I would like to say that is unique to my service, but the other two surgery services at the VA seem worse, if that is possible. I haven't heard good things about any of the other hospital services either. These people are great surgeons, but they are miserable human beings. They have no lives outside the hospital, and if they are married/have kids, they rarely get to spend time with their family.

That is not how I want to live my life.

Who knows, maybe if I had been with a crappy attending in psychiatry, I'd never even think twice about it. Maybe if I had worked with an outstanding OB/gyn I'd be more interested in the field. I'm not even going to pretend neurology was an option--let's be realistic :) But really, I'm looking back at my experiences and trying to understand how much of my interest is related to the practice of that field and how much is related to how well I fit into the culture of each rotation.

That has been my stress--what if I choose a field based on a month of experiences in one specific hospital? What if that was an anomaly? How do I separate liking the practice of a certain type of medicine and liking the culture?

If you haven't seen it already, you need to check out this cartoon from the underwear drawer. I try to be open minded about life experiences--that whole "not judging a book by its cover" thing--but as Tim likes to say, sometimes stereotypes are a great timesaver. Also, if you are in the medical field and haven't seen ortho vs. anesthesia on xtranormal, you need to go here. I laughed so hard I almost fell off my chair. Granted, it was during an overnight call and I was slaphappy, but still...

Anyway, I've found many of the stereotypes about the type of person attracted to each field to be generally true. There are exceptions, as there are to anything, but it definitely seems like each field seems to attract its own kind. I'm not sure where I fit. I am enough of a people person to not want something like radiology or pathology that has little to no contact. However, I don't know that I could do something like family medicine that involves one billion outpatient clinic appointments every week. I'd like to do something that mixes longitudinal care outpatient, maybe some inpatient, and maybe some semi-urgent consulting (not like ER, more like a doc saw a patient and is worried about XYZ and called me...)

That takes me back full circle, something like a medical specialty...like cardiology.

I actually was fairly encouraged on Friday afternoon. I was post-call but didn't get to sleep after call Friday because we had mandatory lectures at the medical school. Instead, I left the hospital after rounds, got home about 8:30 AM, drank half a pot of very strong coffee, got some work done at home, and went back to the med school about 11:30. We had a small group session with one of the cardiologists I had never met before. And I LOVED it. Most of the students were zoning out or not interested. You'd think I'd be so exhausted I'd be falling over. Instead, I drank it up. I learned about new criteria for categorizing patient's cardiac risk and how to best interpret test results in ways clinicians don't normally do. I was so interested that I spoke to the doctor afterward about what it would take to work in his clinic (which unfortunately only runs one day a week). It tied together clinical cardiology, bench research, biochemistry/pharmacology, and translational research.

Granted, it is still not a clinical experience with patients, but it was so nice to remember how it felt to be excited about a field of medicine. There is still the chance that I will loathe medicine or cardiology once I am on the wards, but there's a glimmer of hope that maybe my best specialty match is still out there.

I haven't completely ruled out pediatrics or psych, but I feel much better about medicine.

I've rationalized it in several other ways too. First, if I do medicine in residency, I still have tons of specialty options. I could do something with more procedures, like GI, or I could do something more hands-off like infectious disease. I could do academic medicine, private practice, government healthcare, research, or even industry like working for a pharmaceutical company. There are way more jobs for adult specialists than pediatric specialists, so I have more choices in terms of practice environments and geography. Most of all, I can find a specialty with a good fit in terms of the forms of patient care (inpatient, outpatient, etc) that I like.

It feels a bit like a cop-out to say it, but it buys me some time to figure out exactly what subspecialty I want to do. Maybe I'll love medicine during my clerkship and have no doubts that is what I want to do. Maybe I'll hate it, in which case it is time for plan B. Maybe I'll like it equally with psych and pediatrics, and then I'll need to weigh pros/cons. I can't predict how I'll feel after spending clinical time in medicine. I do feel a lot better after yesterday's lecture in terms of the subject material, though. What can I say--I'm a nerd, and I love evidence-based medicine.

So, over the course of the last year, I've come full circle back to cardiology as a potential specialty. I'm hoping that the stereotype of cardiologists (which puts them in a category similar to surgeons) is not true. If it is, I need to decide if I can get through training dealing with that attitude until I can get into a job post-training that is a better fit for what I want. That is still TBD.

I wouldn't call this an official decision of what I want to do, it's a start.

And we still haven't made any of the other important life decisions yet. Still no idea on if/when we want more kids, where we want to live/work, etc. One thing at a time, I guess.

MIA

2011-03-15T20:23:00.000-04:00

Sorry to be MIA all of February, and March/April isn't looking much better. I have about 6 half-finished posts saved up, so I'll try to get to them as I can. Here's the brief update:

I finished outpatient pediatrics/obgyn/family medicine about two weeks ago.

I also developed shingles about 2.5 weeks ago, right on my left temple (V1 distribution for you medical peeps). It was painful, and it swelled to cover part of my eye--while I was taking shelf exams. I am sure my scores will be awesome. I talked to my dean about it, so we'll see what happens. It's mostly resolved now, though I do have some residual pain. Here's hoping for no post-herpetic neuralgia!

I started surgery last Monday. I HATE IT. I don't mind the procedures or the patients, but the culture is awful. I had the resident tell me yesterday to stop being nice to patients (I took 10 seconds to put the patient's socks back on after we checked pulses). It's a miserable schedule, a miserable rotation, and it will get worse before it gets better. I'm on vascular surgery now, which at least has limited anatomy to be pimped on. I do general surgery in another 1.5 weeks, and that will be awful.

So, I am up at 4, home at 7 (if I am lucky), on call overnight one night/week, and on one weekend day each week. That schedule has absolutely no time to study, since when we are not in surgery we help run the floor. No time to study or read on patients at the hospital means I have to do it at home. I have about an hour with the kids, then I try to accomplish what I can from 8-10, then bed between 10-11 to get up at 4 again. I was on right after daylight savings on Sunday, so it was like 3:15 AM. And did I mention we don't get to be post-call? Because of our lecture schedule, we can take a nap for a few hours, but we aren't allowed to miss any scheduled AM or PM lectures (or AM rounds). That is awesome too.

I absolutely hate surgery, but I only have to last a total of 8 weeks. However, until the end of April, things will probably be sparse. I'll try to update the half-posts I already have, but I can't promise much more than that.

Ugh. Cross your fingers for me!

Long time no blog

2011-01-30T12:19:00.000-05:00

It's not for lack of having things to talk about...I've had several drafts of blogs that I've saved but have been unable to hit "publish." It's been a very introspective few months, and most of what has been consuming my thoughts isn't stuff I'm quite ready to talk about.

In general, life is good, and I should be skipping around happily every day with a giant smile on my face. Everyone is healthy (minus the usual winter crud), my PhD stuff is totally turned in and done until I walk across the stage in May, our budget hasn't been busted by anything unexpected (knock on wood), and most of the drama in life has settled down. I should be thrilled.

Sure, 3rd year med school is stressful. OB/Gyn was just painful. I'm on a mix of outpatient family medicine/pediatrics/OB-gyn now. It's not fun, and it's made for a few late nights when all heck breaks loose in the clinic, but there is no call. I start surgery in March and medicine in May, which will be a much different story, but I still have a few weeks before then. The weather has been gray (I think we had three days of sun so far in January), and although we've gotten a few big snowstorms, it hasn't kept us from getting to work.

And we've had two weekends in a row where we've either gotten to go out and be social (the winter lab party last weekend) or have people over and be social (my high school friend last night).

So what could possibly be bringing me down?

That's where the personal stuff comes in. Some of it is my own feeling of inferiority based on standards and expectations I put on myself. Sorry for being vague, but that is tied into the personal stuff I am not quite ready to talk about. A lot of it is worry about Tim--he's been working crazy hours (going back into work most evenings after I get home, and going into work every weekend). Add that to the fact that he does most of the daycare drop-off/pick-up, and he's really burnt out. I don't see work letting up any time in the near future, and it's not like my schedule will get easier any time soon. I keep trying to encourage him to get out, find a hobby, do something fun, but it hasn't worked. I can tell he's exhausted, but nothing I've tried has helped.

That actually ties into the biggest thing that has been on my mind--and it's something that is completely hypothetical at this point. I've debated talking about this too, but honestly, it's been so stressful that I'd rather just have it out there. I think most of my family knows anyway.

Tim and I have been debating what we call "the hypothetical third." Yes, third baby, not third cat or some other possibility--we're trying to decide if we want another one, and if we do, when we should have it. I'm going to be 31 this year, and my family history says that I don't have all of my life to wait. If we want to do this, it needs to be in the next few years.

The two available chunks of time would be 4th year med school or during residency. As I think I've mentioned before, the thought of having a baby during residency is absolutely my last choice--while I didn't need bedrest or have other complications, I am not one of those people who feels good through their pregnancy. I have a few months in the middle that are ok, but the first and third trimester are not fun times. The thought of trying to do that while being a resident sounds like torture. I am unwilling to be pregnant during my intern year, so if we got pregnant my second year of residency and delivered early in my third year, I'd be 34 or 35. That's the absolute latest we could push things. It also means there would be 4.5 to 5 years between Josh and another baby. Honestly, I think that if I had a 7 and 4 year old (or 8 and 5 year old), going back to a newborn would be pretty difficult.

So, that leaves us with 4th year. There are parts of this that would be great: after I finish my clinical time, I've got months of elective time free. Many of these electives can be done at home, or can be vacation time. At the earliest, I could be done in January 2012--although February/March would be more likely. Still, if residency doesn't start until July 2012, I'd have several months free any way my schedule would work out. That would be the longest maternity leave yet--I had 6 weeks with Sophie, and I was back in the lab on the weekends 3 weeks after I had Josh. The thought of having several months at home sounds great.

And my salary goes up in residency, so the bump would cover the jump in daycare costs. We'd need a bigger vehicle than my Civic, but considering I bought that in 2002, and it has about 150k miles on it, it's due to be replaced around that time anyway. We've got an extra bedroom, we have everything we need for a boy or a girl, and the kids would be 4 and almost 2 when the third was born.

Sounds obvious, right?

It's not. As much as I would like a third, and Tim is on board (on his good days), I think it would be too much for him. He's told me as much. Both Sophie and Josh are in tough stages right now developmentally. Josh started walking right after New Year's, and he's standing and getting ready to walk. All of the changes mean he is sleeping like crap, which means we are sleeping like crap. This is much tougher on Tim than it is on me--I'm getting ~5 hours of sleep per night, which is like vacation compared to how it was a few months ago. For Tim, that is misery. And Sophie has been regressing in her potty training the last week for some unknown reason, which also drives us nuts. I can suppress my frustration, but the accidents just drive Tim up a wall.

He's a very good dad, and the kids just love him to pieces--I don't want to paint him in a negative light at all. He handles almost all of the daily kid duties. That on top of his crazy work schedule is exhausting. And when I am in residency, he'll take on even more of the day to day jobs. As much as I really want another child at some point, if he says he doesn't think he can handle three, I have to respect that. I don't have to like it. And I'd be lying if I said I was at peace with the idea of being done having children. I don't want a herd--three is my max--but I always thought it would be nice for at least one of the kids to have a same sex sibling.

If it stayed just the four of us, I'm sure we'd be happy. I just feel like I am grieving a little for the third baby I always thought we'd have. The last thing I want to do is have a third kid without Tim on board--I don't want him to resent me or the baby if that isn't what he wanted. But he's really the one doing most of the daily child care, and I can't just have a baby and dump it on him. Already, if the kids get sick, he has to leave to get them. If they have an appointment, he has to take time off. I try to have something for dinner for them when they get home, even if it is leftovers, but he has to feed them and take care of them until I get home. And then he goes back to work for a few hours. It's a tough job, and I'm thankful I have someone willing to break out of traditional gender roles and do many of the things that are usually assumed to be the mom's job. He is the one who keeps things running in the house.

If we could afford a nanny, then maybe this would be doable. However, 1) we can't; 2) I think it's important for kids to be socialized, especially after they are 12-18 months old and are starting to understand that other people exist in the world; and 3) it would be silly to have a nanny for one kid and still send the other two to day care. And it's not like I want to have kids and never see them. That's probably the biggest thing that has been miserable in third year--I hate not seeing my family. I miss them like crazy, and I make sure that the weekends are about them. I hate that my training will keep me from them many nights in the future, but I have promised myself that I will make the most of the time I have with them. And ultimately, I'll have a job that provides us with the ability to go on fun vacations and hopefully lets me be a part of the activities that are important to them. While my medical specialty choice won't solely be based on lifestyle, it'll be a big factor.

Anyway, I'm torn. I can already feel that Tim is stressed and exhausted, and I don't want to add to that. But if we don't have a baby in fourth year, chances are we won't have another one at all. And, umm, gestation takes 9 mos+, so this is a decision we'll have to make in the next six months.

I'd be lying if I said I wasn't terrified of making the wrong choice. I don't know what the right answer is. What is best for the potential third baby? What is best for Sophie and Josh? And Tim? And me? We know that we could provide for another baby--the food/clothing/shelter bit is covered, and daycare would be covered too. It's a personal decision, something I think about every day, and something I am praying about. I'm a rational person who makes decisions by weighing pros and cons. Trouble is, I don't know how to weigh personal feelings and choices.

If having the hypothetical third would only make MY life more difficult, but it wouldn't increase the burden on anyone else, I would do it. I would do anything for my kids, which is why not sleeping/constantly cleaning dirty underwear/reading the same book 37 times doesn't bother me. It's for my kids--so that makes it ok. I have so much fun with them. Watching them grow up has been completely amazing. I feel guilty every day that I don't have more time to spend with them, but they are well taken care of at "school" (what we call daycare) by people trained to take care of kids. And they come home and know we are their family. We try to get them to see extended family as much as we can. Most of all, I think they know they are loved.

My favorite times are when we are all snuggled together, or when Sophie is making Josh laugh hysterically, or when they discover a new skill that they couldn't do before. We have such fun together--there are stressful times too, but I think I do a pretty good job of letting the stressful times pass. Tim holds onto those stresses more than I do, which is why I think life takes more of a toll on him. I'm already worried about how he is coping with the current stresses--I don't think there is any way I could add to that. We've always been a team, and every big decision we've made, we've made together. There's no way I'm going to go solo on a decision as big as having another baby (and, umm, that's not really a solo decision anyway....). We'll keep talking about it. Maybe a way will open. Life has a way of working out. Until then, this will continue to be on my mind.

I always thought that getting through med school would be the most stressful thing I've ever done. In reality, it's not too bad. Yes, the hours can be crappy. But many of my lab years were worse. Yes, it's tough dealing with grouchy attendings. But you are only with them for a set number of weeks. Yes, there is a lot to learn. But it's something that has already been studied and described by someone else--you just have to read and learn it. Yes, I feel stupid on a daily basis. But it's only my ego--better to confirm/ask an attending than put the patient at risk. I'm only a medical student. If I knew everything already, I wouldn't need to be trained.

Maybe that is something positive to come out of my PhD. I take med school so much less personally that I took my PhD. That was MY project, and I felt like it depended solely on me. It didn't, of course, and it should've been my former PI's and committee members' jobs to help me. Hindsight is 20/20 on that one. In med school, it's my job to do the best I can, but the patient is also seen by an attending, and ultimately it is their responsibility to make sure that we haven't missed anything. It won't be this way forever, of course, but it's a comforting safety net at the moment. I haven't missed anything major yet, but I am sure that day will come.

On the other hand, I am responsible for my family--there is no safety net there. I have to do what is best for them. Every day, there are decisions that need to be made, and I try to make the right ones. I'm lucky that Tim and I think alike. We've been together for 15 years this month, and we know each other pretty well. I read other blogs where the wife comes off as subservient and the inferior partner in the marriage. That is so not us. We work because we keep the other person's needs in mind, and we want to make them happy, but we know that we are equals. It's give and take, based on what is best for the family at the time. We've done a pretty good job of making it work so far. There are decisions we'd like to take back, of course, but nothing really major. Maybe that's why I am feeling so much personal pressure about the "hypothetical third." We're such a good little family now--I'd love to add another little person to the mix, but I'd hate to mess up what we have.

Enough rambling for today. If you've wanted to know what's been on my mind, here's one piece. Like I said, there are also personal issues I'm struggling with (many of which have been a struggle for a long time), but it's not something I want to get into yet. Besides, I think this is plenty personal for one day.

I don't know what will happen yet. We've still got some time to think. But I feel like this is probably one of the biggest decisions we will ever make, and I want to make sure we've thought about everything before we decide. At some point we will have to commit. I'm nervous and terrified that will will choose wrong. But, no matter what happens, we'll make the best of it. And if that means we stay a foursome, I can't say that I won't be sad in my heart, but I will be thankful for what we already have.

Peds recap

2010-12-23T10:54:00.000-05:00

Late, as usual, but here is a quick recap of my one month pediatric rotation (done in November). I'm a little behind partly because I have been crazy busy, but I've also been trying to think about what to say that might be helpful when 4th year "me" is debating about residency applications.

Peds (pronounced PEEDS in the biz) started out not so great, as I noted in an earlier post. It did get better, though as I will mention in a minute, many of the undertones of concern from that first week lingered throughout the rotation. Overall, it was pretty benign--any of the really sick kids get sent from the hospital I was at to main campus. Basically, my team's job was to recognize when kids were really sick and needed to be sent out ASAP (there were a few of these), when we could treat them in-house, and when they could go home. Part of the issue was that outside pediatricians could admit their own patients, but as the house team, we did their admission history and physical (H&P). There were many times where we checked the patient out and really didn't think they needed to be admitted, but the outside pediatrician was in charge of their care, so we went along with it.

Most of the kids fell into: bili babies (high bilirubin in newborn babies--they just spent some time under phototherapy lights), gastroenteritis, RSV/bronchiolitis, asthma, or MRSA cellulitis. There were a few other kids that didn't fit into this category, but I'd say 90% of the kids were one of the above. There was one case that was pretty tough emotionally (in addition to the one I talked about before): we had a 5 week old boy come in for failure to thrive, and he ended up having pyloric stenosis. He got his pyloromyotomy, stayed in the hospital a few days, gained some weight, and went home. There were concerns in the hospital about the mom--she wasn't all there, and she visited for about 15 minutes a day while the baby was in the hospital. There were no outward signs of abuse, and social work checked her out, so the baby went home on a Sunday.

On Tuesday, the baby was back in--he had lost significant weight even in the two days since he went home. When he was admitted, mom was told she needed to stay with him 24/7 and do all of his feedings so that she could be observed. She had been given a rigid, every 2 hour feeding schedule, and it came out the first night he was in that she hadn't been waking him at night (or if he was sleeping during the day) to feed him. There was a lot of drama with her, and the baby was still vomiting most feeds/not gaining weight, so it was a tense few days. Two or three days into the baby's admission, the mom admitted that the baby was too much for her (she had a 4 year old at home too), and she was willing to give the baby up for adoption. It came out that she didn't even know she was pregnant until her third trimester, the baby's father was a short term relationship, she hadn't told him about the baby, and he had cerebral palsy and would be unable to care for the baby even if he had known.

It was an obvious relief to her when she heard that she could give the baby to a family who could love and care for him. It turned out that an extended family member (along the lines of a second cousin) wanted the baby, and adoption proceedings started the next day. As soon as the mom said the word "adoption," she left the hospital shortly thereafter (visibly relieved), and the baby was put into temporary care with the future adoptive family (the mom gave them temporary guardianship) while social work figured out the details.

It had to be tough, but at the end, it really worked out for the best for the mom and baby. I wish them both the best.

So, there's a mostly happy ending. Overall, most parents came in, obviously concerned about their kids, and they were cooperative and pleasant to work with. I loved working with the kids--they were sick enough to be in the hospital, but they weren't chronically sick, so they felt better pretty quickly and were social/playful while on the ward. I am sure it is much different with chronically sick kids.

The likes:

-The attendings. Personality-wise, I am probably a perfect fit for peds. All of the attendings were awesome--great teachers, interested in the kids, social and helpful with the team/each other, and they all had lives outside of the hospital. I had a lot in common with them, so there was always a lot to talk about on call/during downtime. I missed them as soon as I started OB!

-The kids. I just like kids. This was a good group of patients, because we helped them from being really sick to being nearly 100% recovered within a short hospital stay. Again, this is totally different from chronically ill kids.

-The lifestyle. This group is a hospitalist group, so they rotate weeks on service and overnight call. Many of them are hospitalists at several local hospitals. Your service week is 8-5, and call is 5PM-8AM (with 24 hr weekend call). It works out to a week of service every 5-6 weeks and call a few times a month when you are not on service. It's great.

-I'm not going to put salary as a plus or minus. It's not as much as adult, but once again, anything is a step up from where I am now.

The potential dislikes:

-The parents. This is a potential dislike, because there were only two cases in the month I was there that parents were a big issue. Most were compliant and pleasant. However, I can see how, long-term, parents could be a stress. If they aren't interested in helping their kid get better, that would infuriate me. I'm an overprotective person, and it wouldn't be very professional to go all mama-bear on them.

-The routine. The way I see it,there are a couple of types of pediatrician lifestyles. There is outpatient, which really doesn't interest me (though I have yet to do this part of my rotation). That is full of well-child checks, colds/flus/strep/ear infections, and other non-intellectually-stimulating activities. There is always the chance you will see a really sick kid who needs to be admitted ASAP, and a pediatrician needs to remain vigilant for that reason. The other end of the spectrum is something like peds heme/onc, where you deal with chronically sick kids (cancer patients, in this case). From what I've been told by attendings, kids that have to stay inpatient for their cancer usually die, and I think working with dying kids would be exceedingly tough. My attendings said that most kids can get their treatment on an outpatient basis (after an initial inpatient admission), and those are the kids that can do ok. My one attending said that every kid she followed during her inpatient heme/onc time died within six months of her seeing them. I don't think I could handle that. The general inpatient I was on this month would be ok, but even I had the protocol for the usual diseases memorized in a month. I don't know if I could do that long term--I might be bored to tears.

The happy medium is probably a pediatric specialty. We had a few cases at the very end that involved a pediatric cardiologist, and that could be a good overlap between my cardiac research and peds. I'd need to do an elective to see what it is really like, but it's a possibility.

-The unknown. I really like kids, but I don't know how it would be to have my own kids and see other people's sick kids all day. Would it make me a hypochondriac about my kids? Would it burn me out? I don't know.

So, the overall is: maybe. I'm curious to see how I like medicine. I think peds stays on the list, unless I find out that I absolutely love something else. If it does stay on the list, I need some more exposure, both more serious illness (like a peds ICU, which someone suggested) and some specialty exposure. I am just worried that I may not have enough time in 4th year to sort all of this out.

I have one more week of OB/Gyn after the holidays, and then I can give that recap. Overall, I have to say that I am very unimpressed so far (to put it mildly).

Nearing a break

2010-12-16T21:53:00.001-05:00

I am so over OB/Gyn--I have one more week of it left after the holidays, but starting tomorrow afternoon, I get two weeks off for Christmas! This time will be filled by a huge catch-up list, which includes some blog time. I need to catch up on sleep first--I averaged 4-5 hours a night before going back to third year, 1-2 hours/night while I was writing my thesis/doing 3rd year (and several sleepless stretches of 2-3 days at a time), and I'm up to 3-4 hours per night right now. I'm functional, but I'm not fun. There is some serious sleep debt to fill (I know you can't actually make up a sleep debt/bank sleep, but it isn't going to keep me from trying!)

I just have to get through tomorrow, and then I only have my giant to-do list left!

Neuro rundown

2010-11-28T23:25:00.000-05:00

It's been over a month, and I am still not sure enough time has passed for me to give an objective overview of my time in neurology. Therefore, this will be a shortened recap, because there is no chance I will do neurology as a career.

The neuro rotation is one month long, and I did mine at the VA hospital (though a different VA than the one at which I did psych). The attendings switch every two weeks. My first two weeks, my attending was pleasant but demanding. I mercifully did not have to localize any lesions for him (though the other med student did, poor thing), but his MO was to pimp you until you couldn't answer any more questions. There were two junior residents and a senior on the team, in addition to the two med students. The juniors saw the admissions, and the senior saw the consults, but when there were med students, we saw the consults. Most were old strokes, Parkinson's, rule out NPH (a constant and perennial favorite), etc. There was also an MS clinic Tuesday mornings and a general neurology clinic Monday afternoons. Those first two weeks, we had around 4-8 admissions and another 5-10 consults we were following, with a few new ones every day (and about an equal number signed off/discharged every day). It was busy, but the attending was very efficient. We started about 8 (and we pre-rounded before that), and we were done by 5-6 PM most nights.

There was some teaching built in--we had a teaching session with Dr. Daroff every Wednesday morning. I don't usually mention doctor's names, but Dr. Daroff (I have been told) is probably the leading living general neurologist. He's my kind of guy--he's been around for decades and loves telling stories. We learned about the different types of reflex hammers (he knew Babinski well!), locked-in syndrome via his own experience with perhaps the most famous locked-in patient, etc. I can listen to people like that talk for hours. He was a great diagnostician too, and we had him look at some of the trickier patients on the floor.

We also had grand rounds every Friday AM, followed by case studies the rest of the morning and regular small groups back at the med school every afternoon. It was different than psych, which had didactics spaced throughout the week instead of all crammed into Friday, but it worked. Because so much of psych occurred in AM rounds, losing Friday morning would've been much more detrimental than it was on neuro, where we were busy all day. And I was thrilled to have one whole day away from the neuro team.

So, the first two weeks were very busy but manageable. I saw some interesting cases, like progressive supranuclear palsy, ALS, fluent aphasia secondary to glioblastoma multiforme resection, and others. I also saw a lot of bread and butter neuro too: Parkinson's, old stroke, dementia, multiple sclerosis, coma, seizure, and syncope. I did not see a single new onset stroke--the other med student saw one, but most of those patients went to a different hospital system (which has a specific stroke service).

Overall, I was struck by how little we could really do for these patients. Even if the second half of my neurology rotation (which I will get to) never happened, I don't think there is any way I'd want to do neuro in the future. There is some treatment for Parkinson's, seizure, and MS, with varying degrees of success, but most of the patients I saw had no available treatment options or had exhausted all available therapy. And, I hated neuro in second year med school, and my feelings on the nervous system in general haven't changed. No offense to budding neurologists, but neural tracts and localization are the stuff of my nightmares.

As I mentioned, the neuro attendings change every two weeks. My first attending was demanding but fine. The second one was hell on earth.

He had a weird affect and poor social skills--I wondered if he was Asperger's or some other autism spectrum--and his mood varied from generally annoyed to hating life. He was super anal retentive; we timed vibrations at multiple joints with specific frequency tuning forks, he made his own reflex hammer because every available hammer was sub-par, and we measured muscle bulk on patients with a tape measure to compare symmetry. And, even if the patient was a consult, you were expected to have looked through every note in the chart (some of these patients have almost one thousand notes). It took hours to do a history and physical, and several more hours to look over the chart.

Thank goodness the service slowed down--we had 0-2 admitted patients and 2-4 consults at a time. Even then, we stayed till 8 PM or later (sometimes 10 PM to midnight) just to see a low volume of patients. These were non-call nights; medical students were supposed to take home call once a week until 9 PM. Obviously, when you are staying in the hospital as late as we were, every day is basically a call night.

The resident team also switched, and while the juniors were fine, the senior was much less efficient and involved. He hated working with the attending, and rather than helping everyone else get done, he just left people alone and let the attending get into it with them.

There are tons of examples about how tough it was to work with the attending--he was a grouchy man usually, and he loved to pimp (and was happy to call people stupid on a regular basis--he was equal opportunity with that). He was rude to everyone--he actually got into a screaming match with another attending during clinic, right in front of a patient's room. He was unprofessional and nasty. And then, he'd suddenly change and try to be social. He'd talk about his kids, movies, music, etc.

I've got to share this one story--we were in the work room, and somehow the topic of kids came up. I was the only one with them, and he asked me how many I had and how old they were. When I told him, he asked me if I had ever seen the movie "Idiocracy." I said I hadn't. He said that I had to have at least one more kid, because right now I was only replacing Tim and I in the tax base--I wasn't adding to it. He said that people who did not contribute to the tax base (but drained it instead) were having many more children than were taxpayers, and it was my job to produce offspring that could continue to support generational welfare. Otherwise, the political system would collapse, and there would no longer be a tax base to support the government. Basically, the idiots would take over.

Umm, ok...

Even after brief moments of what appeared to be interest in people's personal lives, he could then switch gears entirely. The day that broke me was Sophie's birthday. It was a Monday, and I had told him on Sunday (you had to round at least one day on the weekend) that my daughter's birthday was Monday. I reminded him again on Monday morning. The service was slow--we had one admission and a few consults that we had been following at a distance for a while. Of course, rounds still took forever. By the end, we had two new consults, one in the ER and one admitted to another service. I took the admitted patient and a resident took the ER patient. Neither was life threatening--mine was a rule out NPH (turned out to be a 93 year old with moderate dementia), and the other was a Parkinson's patient who was out of medication. We each had our H&P's done by 2 PM, but the attending couldn't come back to round right away. He didn't say when he'd be back--he just told the team to wait until he got there.

We waited for four hours--he finally showed up at 6 PM. I was already upset that I was late for Sophie's birthday. The senior tried to tell the attending that my patient could wait until the next day's rounds, but he wasn't having it. He wanted to see the ER patient first, and he was shocked when we got to the ER and the patient was gone. The ER doc said the patient got tired of waiting and went home. Instead of letting that go, we had to go through all the records, talk to every nurse/doc in the ER to see what they knew, try to contact the patient at home to have him come back in, etc. At this point, it is after 8. The senior again says that my patient is admitted on another service and can wait until the morning.

Instead, the attending sends everyone else home except for me and the on-call resident. He sent the senior (who saw the patient with me after I did the H&P), the other junior resident, and the other med student home. Worse, he singled me out, saying that I hadn't been on call that week (it was Monday) and I was supposed to be on call every week (it was actually supposed to be every other week). I can't express to you the nasty tone he took with me. He was one of those people that you couldn't reason with. The senior again said that this patient could wait, that the senior had already signed my note, and that it was my daughter's birthday. The attending said he didn't care. So, he and I went to see this very basic patient, spent forever doing another H&P, ended up just signing the note I had already written, and then said to me, "You make me tired. I need to go home." It was after 10 PM.

The on-call resident had to go to her car to get something, and she and I walked out together. I didn't even get to the parking garage before I burst into tears. I composed myself pretty quickly, but she again said that everyone knows this attending is terrible, people dread working with him, he's nasty to everyone, and I shouldn't take it personally. I heard this from so many people--including the clerkship director, who apologized profusely for making me work with him. It didn't stop me from crying the entire drive home that night. Sophie was in bed when I got home, and she had been asleep when I left in the morning. I didn't see her awake at all on her birthday. We did celebrate it as a family the night before, so I didn't miss the party, but I didn't get to spend time with her as a family at all that night.

That was a Monday. I had to go back Tuesday, but then we had didactic sessions all day Wednesday (which unfortunately, this attending had a one hour block of teaching scheduled), the psych shelf exam Thursday, and the neuro shelf exam Friday. I steeled myself and spent Tuesday doing what needed to be done, but had I needed to spend one more day with that man, I don't think I could've taken it.

There are so many other things that made me hate my neurology rotation, but dealing with that skunk of a man for two weeks sealed it for me. I know not everyone is like that, there are bad attendings in the world, etc, but the fact that his behavior was well-known and yet still tolerated by the neurology department confirmed that this was not a group of people with which I wanted to work any further.

Anyway, it's done, I survived, and I don't have to do any more neurology until maybe residency. And now, I will probably try to erase it from my mind. Interestingly, I got my written evaluation for my neuro rotation, and it is actually positive and complementary. I don't know my final grade yet, but I was shocked by the clinical eval--I was sure this guy would just rip me a new one. Maybe he was having a good day...

A pediatric rotation recap to follow soon--at least that was much more pleasant. I start OB/gyn tomorrow, so wish me luck!

Done!

2010-11-09T15:22:00.002-05:00

I defended my PhD today, and I passed. So, I guess that makes me a doctor! Well, kind of :) Half of the MD/PhD down, half to go! Now off to celebrate :)

Peds, week one

2010-11-04T22:32:00.000-04:00

Neuro redux coming soon...lots to say on that one, but let's just say it is off the list of possible career choices!

I started pediatrics on Monday...really Tuesday, since Monday was just orientation. My medical school class gets divided into three health systems for each clerkship, and then each of the health systems subdivides into main campus, community hospitals, etc. I am the only student in my health system that is at a community hospital--it is a new program, and there is only room for one student at a time. It's been a much different experience from what I have heard about people doing pediatrics at one of the main hospitals.

First, it is a hospitalist service. There is a practice of pediatric hospitalists who only see inpatient kids. They also cover newborn babies. Basically, community pediatricians have the option of managing their patients when they get admitted (or are born), or they can choose to have the hospitalist service manage their patients. That means that, currently, there are three patients being covered by my service on the peds floor, and there are 15-20 babies/day that need to be seen either for admission (after birth) or before discharge.

The pediatricians can also be called to deliveries if the OB has a concern that there might be trouble with the baby. I got to see my first delivery today (that wasn't for my own child)--the concern was for an IUGR baby, but she turned out just fine. I did get teary watching the baby being born--it's such an unreal event! I still have no interest in OB/Gyn though :) That's next month...stay tuned...

On this service, we get signout from the overnight physician on call from 8-8:30. The resident and I then head to the peds floor and see whoever is on our service. The attending is usually in the nursery seeing the newborns at that time. Then the attending comes to the peds floor, we go over the patients, and we are usually done around noon. Then it's lunch, and so far this week, then it is dead time (though this would be the time for admissions if they come in). It's good in some ways: after crazy neuro, it rocks being able to eat and pee during the day, it gives me time to look up med information, and we've also gotten to do some teaching/learning about important peds topics (jaundice and asthma so far). The down side is that it is SLOW, and I am worried I may not get to see everything I need to see.

For instance, we had the ER call the other day with a kid who was vomiting. However, the kid was a newly diagnosed diabetic. This peds unit doesn't take diabetic kids (unless the community physician is willing to come in and manage them, which they generally are not) because they can be so sick so quickly. So this kid got sent to main campus. We had another call yesterday for a dental abscess, but there is no dental/oral surgery here, so he got sent to another hospital. Basically, we get jaundice, asthma, acute infection (pneumonia, GI, etc), MRSA abscesses, etc. That's not quite what I was hoping to see. It does make it feel manageable--anything touchy never really gets to us--but it's not what my peers are seeing in some of the tertiary care units in the big-name hospitals.

I did see one case yesterday that I wish I hadn't. Again, no details due to HIPAA, but we had a child come in that had evidence of (and self reported) child abuse. This child had "only" belt welt marks on the leg, but there was a history of abuse by the older sibling that required stitches and a general history of hitting/verbal/emotional abuse by both parents. The child was very pleasant and social--a bit energetic, but nothing off the charts for the age. Talking to this patient was tough--the patient talked about how the parents didn't want them anymore, that the parents gave them medication (focalin and risperidone) "because I am crazy," how the older sibling threatened to kill them at night, etc. The parents were arrested and put in jail briefly after bringing the patient to the ER (initially for "behavior problems"), and reading the note was so sad. Apparently, no one was willing to take the patient--the grandparents agreed to take the older sibling, but no one wanted the patient.

We of course got social work and the county involved, but the county wouldn't take the patient. So, despite a restraining order, the parents got to choose who took the patient. There was much drama last night while I was on call about who was actually coming to pick the patient up (and whether one of the people was actually the mother posing as someone else). We did all we could to try and get county/temporary foster care to take the patient, but they wouldn't. When the person picking up the patient arrived (with security, of course), it was obvious that this person was annoyed and wanted nothing to do with the patient. We all stood helplessly at the nurse's station as the patient left, knowing that more than likely, the mom/dad was waiting in a parking lot nearby, and the person who picked up the patient was going to ignore the restraining order and give the patient to the parents.

We all had fears that this patient would get beaten, and the parents wouldn't come back to the ER, since they got arrested last time. This patient was returning to a terrible home life. We protested, we called social work/the county continuously all day long, and there was nothing we could do to keep the patient from it. I'm praying that I don't recognize any news stories in the next few days. The attendings were frustrated too, and they had other stories about abuse kids--how long it took to finally get kids removed from homes, how sometimes what you fear ends up happening, and just generally about how some parents can do such terrible things to their kids. The attendings tried to reassure me that cases of abuse like this are rare, but it didn't make me feel better about this patient.

I am a fixer, and if I could have, I would've personally taken this patient away from the family. I wanted to protect them from what they were facing. It was so sad--the patient said that they feared the mom, dad, and sibling, yet they wanted to go home. While the patient was here, all they wanted was approval. They tried to please the nurses and doctors. The patient was happy and social here--I know no one can live at the hospital, but the fact that life in a little room was better than what waited at home was so sad. The entire time the patient was in, no one called about them, no one came to visit, and no one wanted to take them out of the hospital. It was absolutely heartbreaking.

It also exemplified the biggest concern I have about peds. Let's start with what I like first: the people are great, I enjoy working with kids, and so far, the hours are fantastic. The downside: depersonalization (or lack thereof). I am so protective of these kids. The first day, there was a patient the exact age of my son. The patient's parents were teenagers, and they really wanted nothing to do with the kid. The child couldn't roll over, couldn't sit up, and actually had a flat head because of always being laid down. The parents were never holding the baby when we came in--they were sleeping at all hours of the day, and the patient was in the crib, alone, all day. The patient was so excited to see other people come in! I wanted to smack the parents around. If you don't want the kid, give them to someone who does!

Other patients have been fine--there are plenty of parents who are very worried about their kids and want them to get better. But I think I would have a hard time in peds dealing with parents who obviously could care less about the kids--or worse, parents who are negligent/abusive. I am way too involved with that emotionally. I don't expect parents to be perfect--I am FAR from perfect, and I think a good chunk of parenting involves making mistakes. However, if you learn from the mistakes, and you try to be a better parent, that's the right thing to do. I just don't know if I can see parents that are uninterested or mean to their kids.

The attendings have said that you get desensitized to the parents, but I am not sure if that is good or bad. I think children need advocates. I'm naive in the sense that I think I can make a difference. I don't think I can fix every bad parent out there, but I want to help the kids that I do come into contact with. I just don't know if I can do peds.

And, if I did peds, I couldn't do general pediatrics. I know nothing as a med student, and already some of general peds is mind-numbing. It's the same issue I have with adult medicine--my personality is such that I like knowing a lot about one small specialty, and I like when things are challenging. It's a balance though--I don't want every case I see to be life or death, but I want to have to think about diagnosis/treatment challenges regularly. I like being a detective. Specialty pediatrics could be a lot like specialty adult medicine, which could be fun. But I'd still have to deal with the parents. At least adults are responsible for their own bad decisions. Kids don't have responsibility for what their parents do.

I'm curious to see how I feel at the end of this month. Maybe I will learn to depersonalize and find a way to channel my need to smack parents upside the head. I really enjoy the medical people so far, and they seem very understanding of work/life balance. Those are definite advantages. However, I don't want to come home and feel demoralized and dejected because I couldn't help kids the way they needed to be helped because their parents got in the way.

I may have to do a rotation in one of the busier tertiary care pediatrics wards to see what that is like. Other med students have said that their pediatric rotations were intense and very busy. While I am thrilled that this is low key (I need a little of that in my life right now), it may also not be representative of real life.

Plus, there's always the issue of what to do with my PhD if I do peds. I'm still not convinced that I want to do bench research again, but I also don't want that six years of my life to be a total waste, career-wise.

I guess this pediatrics thing is still TBD. I like the medical people, I like the lifestyle, and I like kids. We'll see if that is enough to put pediatrics on the list!

Psych redux

2010-10-01T14:54:00.001-04:00

Today was my last day of psych, and I was sorry to see it go. I'm going to try and figure out why (mini-psychoanalysis, I guess) so that, in a year from now, I can remember the pros and cons about each of my rotations.

I think part of me liked it because it wasn't the lab. That makes any rotation look good! There were a few low points (one in a minute), but overall, I looked forward to going into work every day. I learned a lot, I thought my team was great, and I feel like I came out of the rotation one baby step closer to being a doctor. Of course, I also liked being an armchair analyst; I listened to lectures and thought, "Oh, family member X must be borderline! Friend Y is totally bipolar!" (relationships changed to protect the innocent!). I didn't mean this in a judgmental way--it was more in line with, "wow, if they were actually treated for this, I wonder how much better their life would be!"

Here's the story on the worst day I had. On Tuesday, I really thought I was going to end up sitting in my car, crying, by the end of the day. The psych ward was extremely busy. I had a new patient whose note needed to be in the computer by 2:45. Rounds went till 12:30, then the ROS/mini mental/physical exam went till 1. We had case conference that was scheduled from 1-2, but it actually went till 2:30. I appreciate that the psychiatrist was letting a manic patient be tangential, but all I could do was sit there and fixate on how in the world I was going to write a huge admission note by 2:45. It was 2:40 by the time I got back to my desk, and when I called my attending to tell her the note wouldn't be done on time, she wasn't there. I checked my email to see if she had tried to catch me that way; she hadn't, but I had a bunch of emails from my lab PI about thesis stuff, and I had emails from Tim that day care had called about Josh.

I just felt very overwhelmed. I called Tim quickly, and apparently day care noticed a rash on Josh and wanted him to go home. He didn't have a fever, he was eating, he was sleeping, and he was otherwise acting normal. It sounded like the rash was just where his sleeper had been touching his skin. Tim, Sophie, and I all have sensitive skin; I told Tim to tell them to put him in another outfit and call if things got worse. I felt terrible, like I was abandoning my baby. Tim had meetings all afternoon, and I was crazy busy. So, we agreed that as long as Josh seemed ok, we'd let it go.

I couldn't even respond to the lab emails. My blood pressure goes up every time I get something from my old PI. It's not personal--it's just that everything is made to sound like a total emergency. I keep telling myself that I don't have to have my thesis to the committee until the end of October. That doesn't give me a pass on finishing it, but it doesn't have to happen this instant. I can't seem to impress that upon my boss, so I have stopped trying.

It did take me a long time to write the admission note. I was so anxious about it being late that I gave myself a headache. Of course, it could have also been that I had not eaten or peed all day (which is normal--I didn't get a chance to eat lunch on the vast majority of the days I was there). When I finally heard back from my attending, she said it wasn't a big deal that the note wasn't in. The goal is to have the psych note in within 24 hrs of admission onto the ward. Since we only see patients on morning rounds, that meant that if someone gets admitted after about 11 AM, we don't see them till the next day. The nurses see them, obviously, but the official note doesn't go in. But, my attending wasn't worried about it, so I calmed myself down about it. By the time that note, all my other notes and orders, and patient family calls were done, I had just enough time to review them with my attending before she left. I got in my car, took a deep breath, and prayed that I wouldn't have another day like that for a while.

That was really my personal low on this rotation, but looking back, most of the anxiety was self-produced or outside the rotation. I didn't want to let my team and the patient down by not having my note done on time. That led to me staring at the clock (and unable to focus) during case conference. That should have been my only stress of the day. Once I was sure Josh was fine (and Tim agreed to be backup in case he did have to be rescued), I should've let that go. And the lab stuff--good God, the lab stuff. The emails on Wednesday were even worse than Tuesday--we got the galley proofs back, and although there were only two sentences they wanted clarification on, it somehow turned into this giant email back-and-forth with a ton of people. I was stressed about it, and then yesterday, I just let it go. My boss can sort everything out with the other author (who suddenly had a bunch of changes that he hadn't mentioned before). I just let it go.

Today, after letting go of the lab stuff, having no kid health concerns, and knowing I wasn't going to have an admission on team today, I was able to relax and enjoy my last day on the wards. I spoke to the team psychologist, social worker, resident, nurse specialist, and nurse practitioner, and they all encouraged me to think about psychiatry. I know this is fairly common, but they all talked to me individually and said they thought I was a great fit for it. The nurse practitioner said to consider the VA as an employer too--she was a single mom of two kids, and she said the VA is great about flexibility. She also said the health care and retirement packages more than made up for the lower pay versus private practice. She thought VA psych would be a great fit for me, if I wanted to consider it.

I met with my attending later, and she said many of the same things. She thought that since I was a bit older, and a mom, I had more insight into personal dynamics. She thought I had a knack for dealing with the psych patients. She didn't push me to commit to anything--she just suggested that, in general, I do some introspective searching and figure out what makes me happy. We talked for quite a bit of time. I agreed with her on a lot of points--like the fact that the goal isn't to make the most money or get into the most prestigious residency/fellowship, just to prove that you can. The goal is to find a job that you enjoy going to every day. If that's psych, great. If not, find something I like. We talked about knowing yourself and what is a good fit.

So that's what I am thinking about now. Honestly, I had not considered psych as an option before this rotation. I enjoyed the committee (they called it the "mind" committee) in medical school. I enjoyed the general psychology class I took in college. But I was not thrilled about the inpatient psych ward. I've experienced being a visitor on these wards, and I was always intimidated. I'm not going to say that I think living in a psych ward would be fun--please! let's be realistic. It sucks to be a patient on a psych ward (although most of these residents have asked at one point if they could live here--beats the streets). But, most of these patients make progress while they are here. Many, if not most, of them will come back. But you help them, you see them improve, and when they are ready, you send them out. If they come back, it's because of their disease. People with chronic medical diseases can have multiple hospitalizations. Psych patients shouldn't be stigmatized because their diseases bring them back to the hospital. Many patients go years between hospitalizations. There are a few who boomerang, but not all. These people get better slowly--but most of them can manage their disease on an outpatient basis.

Things that I liked:

the patient contact. I really enjoyed the time we are given to talk to patients. I'd like to spend some time in the afternoons with new patients, to maybe get a developmental history instead of just a general past psych history. But this part is fun.
the team concept. Not every psych ward works like this, but I loved that there are so many people with different backgrounds working collaboratively to help the patient.
the underlying psychology. I love thinking about the mind. We had a great lecture on psychodynamics of depressions (id/ego/superego stuff). I don't necessarily agree with all of it, but I do think the mind has its own ways of processing information that differs from person to person.
the nature vs. nurture debate. This is one of the few areas of medicine in which we still know precious little about the actual biology of the diseases. For instance, it is known that there is a genetic component to psychiatric diseases, but why do some people develop the disease and others don't? I think there is such potential for research and understanding--which would also increase treatment options (and maybe even prevention.)
the ability to watch a patient improve. So many of these people--especially the schizophrenics--can improve when they are on the right medications. Most of the admissions were about a week long, and in that time, some of the patients were drastically better.
the lifestyle. Let's be clear: I worked ~8 to ~5 every day. Some days were longer, not many were shorter. But for third year medical school, this is AWESOME. This will be the easiest rotation, schedule-wise, that I will probably have. As I said, you are very busy during that period. But being able to be home by dinner? That's awesome
it's fun. It's like playing detective. What's their diagnosis? What is the best plan for treatment? If X didn't work, what should we try next?
training is 4 years after graduation, versus 6 (3 medicine + 3 fellowship) for most specialties.

Neutral

Pay. Again, anything is more than what I make as a student. And the fact is, psychiatrists make less than internists and about what pediatricians make. The amount varied, but the info I found was that the average is about $175,000. That's less than a cardiologist makes (which averages about $300,000, but can go higher). But come one now. That's almost ten times what I am making now, and it is freaking six figures. Basically, anything that is above the student stipend I am making now is a CRAPLOAD of money. Really can't complain.

Negative

This is a negative for most of medicine as a whole, but there is very little "curing" of people. Many of these patients have their lives improved dramatically. And I've been told that on the outpatient side, many people return to normal lives with medication + therapy. But for this inpatient crowd, most of these people will be back in the hospital, mostly due to...
noncompliance. This is noncompliance in general--mostly with medications, but also with substance abuse. Some of the patients don't understand the disease and therefore don't understand the medication. Some are paranoid. Some don't like the side effects. Some can't afford the meds. And for substance abuse, most can't keep with it (alcohol dependence has an 80% failure rate for treatment). This is sad, but a big part of treatment is getting people to own their role in the treatment of their disease.
There is no diagnostic test, procedure, or lab for most of these diseases. When you diagnose something, it's all you. You can ask a colleague for another opinion. But basically, you have what the patient is telling you, what you can gather from other people's collateral histories of the patient, and that's it. You have to be confident enough in your estimation to discharge someone who threatened suicide--are you sure they are better? Is this person really just looking for attention, or are they dangerous? Those are big responsibilities.

For me, I think psych stays on the list. I enjoyed my time in outpatient medicine when I was still in the lab, so medicine (and a specialty) may still be the frontrunners. But to my surprise, I think psych is running a strong #2 at this point. We'll have to see how I feel in the future.

Neurology is my next rotation, and I think I can safely say that it is not on the short list in terms of a career. I hated neuro in med school. This is one month that I am just going to try and get through...

On another note, I came across this post when I was googling psych stuff the other day. Very interesting:

The ten biggest mistakes psychiatrists make

As posted on Facebook

2010-09-18T22:55:00.001-04:00

It's 11 PM on a beautiful Saturday night. The kids are both asleep. What are we doing? I'm working at home, writing my thesis, and Tim went back to the office to do work. We'll both be up way past our bedtimes, and not even for very fun reasons. When did we get so old?

Sweet dreams?

2010-09-16T23:47:00.000-04:00

My late night reading has consisted of schizophrenia diagnosis, subtypes, and treatment, substance abuse and mood disorders, and a bit on delusions and hallucinations. I'm sure that will make for some sweet dreams, if and when I ever get to bed.

These two weeks on the inpatient psych ward have been good and bad, for many reasons. First off, it means I am progressing in training, which is a huge relief. Second, it's gotten me back in touch with the patient experience, which I enjoy. Unfortunately, it's much more time consuming than I thought it would be. And I'm trying to finish a thesis and teach a class on top of doing my rotation. Today though, what's affecting me most is this: it makes me sad.

My biggest fear starting this rotation is that there would be a situation between me and a patient that would be uncomfortable or dangerous. This is taken care of in the unit I am on: the psych teams (usually consisting of some combination of an attending psychiatrist, nurse specialist, social worker, psychologist, pharmacy resident, medical student, and nurse) meet together in the conference rooms to see patients as a group. The patients are brought to the conference room--there isn't a one on one exam in their individual rooms. I really appreciate this, not just for the safety perspective, but because it is more efficient to have everyone hearing the same thing and divvying up the to-do list together.

So, my preparedness for threatening situations is not needed. While I overestimated on that account, I underestimated how much my personal feelings would really affect me. I'll give you two specific examples, though there are many more.

The first was a patient admitted last week. Due to HIPAA, I'm not going to give out specific information. I'll try to give you what we are given in case studies, to keep things legal. So, this patient was admitted for a suicide attempt. He has a long, tumultuous history with his wife, and he attempted suicide, which he later claimed he didn't take seriously but was doing just for attention. The underlying issue was that he was an alcoholic, in complete denial about how serious of an issue his drinking was, and he had no interest to work on his issues. He had been out of work for some time, he had anger issues (and a domestic violence charge in the past), and he fully believed that the anger/violence was due to his wife's provocation and not the alcohol that he drank every night. It was textbook alcoholic dysfunctional family--everything was swept under the rug, things were fine, it was a one time issue, and no, the preteen son had no idea what was going on.

My attending's response: yeah right. Of course the kid knows what is going on. Of course nothing is going to change. Even the way that the husband emotionally controlled the wife was apparent when she came in for a visit. The patient was pretty angry when the team said that his chance of being successful in therapy was slim to none unless he quit drinking. My attending was very up front about the fact that antidepressants don't work for alcoholics, and neither do sleeping pills. The alcohol has to clear the system, the brain has to reset, and that takes time. She (my attending) refuses to baby people through the process. She'll get them the recovery help they need, either inpatient or out, but she tells the patient it's their choice and their responsibility to take charge of the illness.

This alcoholic patient was assigned to another member of the team (though I saw the patient every day on rounds). I was relieved by that. I saw such a reflection of what my mom has gone through in the past--from the hospital ER he was seen in to the intensive outpatient program that he was looking into attending after discharge. It was almost an out of body experience to see that entire dynamic play out with people I had never met before. There have been other alcoholics staying on the ward, and the dynamic is so similar in each case. I really appreciate the opportunity to hear my attending's take on things--I really respect her. She's got a no-nonsense attitude, but she is also very empathic with her patients. It's a good life lesson. But it's still sad to see all of these patients and families battling the same demons--especially when it is a demon I know well.

The second example happened today. We have case conferences every week with a long-time, well-respected staff psychiatrist. Today, we went to see one of the other student's patients. He's diagnosed as a schizophrenic, but he has had an atypical progression. What drew us to the case was the extent of his bizarre delusions. I don't want to tell you all about them here, but even the psychiatrists with decades of experience have said that this man has some of the most bizarre and persistent delusions they have ever seen.

While it was a great learning tool to hear how this man described his illness (which he completely denies having), what came over me was this immense feeling of sadness. Here was this man, beyond middle age, describing a lonely life in which he had never had friends, never had a romantic relationship, and had lived as a loner his entire life. I just found myself feeling so bad for him. The medication isn't helping his delusions, and even when he's been "healthy" in the past, his OCD rituals for keeping his life feeling less chaotic completely consume him. He mentioned several times how his "brain was lonely." It just broke my heart. This man will probably never get better, never have those close personal relationships he longs for, and even if he could find someone willing to take on his illness, his delusions would likely prevent him from engaging in any sort of personal relationship. There's nothing we can do to cure him, and even managing him hasn't given him a "normal" life.

That is the toughest part of medicine for me. There are lots of specialties where we can't "fix" the patient. I accept that, and I understand that a lot of medicine is chronic disease. I also understand that we are all terminal--at some point, people die. I know I am going to need to toughen up and depersonalize better in order to make it through medicine. But psychiatry seems tougher for me than the limited experience I've had in medicine. For the most part, medical patients can understand their diagnosis and what it takes to manage it. Not everyone chooses to be compliant, but at least they have the choice. Inpatient psychiatry is full of people with limited to no capacity to understand what their disease is, and noncompliance is rampant because the patient's can't understand what the medication is from. PS, having a stranger in a white coat feeding you pills and giving you shots is great fodder for paranoid delusions and hallucinations--not helpful!

It was also pointed out on the first day that this service really carries the psychiatric patients with the worst prognosis. It's a process: the veterans on the ward are here because they have no private insurance, usually because they couldn't work after being discharged, usually because they had a severe psychiatric problem that prevented them from working. Many are homeless, most have a concurrent drug abuse problem, and they have nowhere else to go. I've seen ex-convicts, homeless, an elderly man who lived in his son's crack house for years, suicidal patients, homicidal patients, and patients with severe delusions and hallucinations. And I'm only in week two.

There's a part of me that sees such potential for helping people in a field like this. But there's a bigger part of me that knows I would break down. So many of these people boomerang after being discharged. Meds are only good if you take them, and they aren't always that good even if you are compliant. Most of the people that come on the ward have been here before, and they will be back. The one patient I am seeing right now is on his/her fifth admission this year. That's a story for another day.

I feel very stupid on a daily basis, but I also feel like I'm learning a lot about how to be a doctor. Psychiatric issues are a huge comorbidity in the population. It's going to have to be something with which I am familiar. On a personal level, I have a big family history of psychiatric disease, and so does Tim, so it's also in my best interest to know what to watch for and how to deal with it (not prescribing meds to family members, don't worry!).

I'm just worried about how well I am going to deal with my clerkships. I started with psych because it is supposed to have the best schedule and be one of the "easier" rotations. I'm working like crazy. If this is what psych is like, God help me for surgery or OB/gyn....

The psych ward waits for no woman, so off to bed, with all of my reading material percolating in my subconscious. This should be an interesting night--assuming all of the kids/pets let me sleep long enough to actually hit a dream cycle.

New Beginnings

2010-09-06T23:03:00.000-04:00

I'm sitting here, feeling nervous for my first day of school. And this is the second time I've felt this way in just over a week--I had similar jitters before I taught my first weekend college class of the semester. Those jitters went away as soon as I started teaching. I'm doubting my current jitters will evaporate when I slip on my white coat. If anything, I expect them to get worse.

I'm excited, nervous, anxious, worried, and feeling inferior. I had grand ambitions of reviewing all of my psych notes from med school (from back in 2003) before heading to the clinics tomorrow. Unfortunately, life didn't feel like cooperating today. Therefore, none of the things on my to-do list for the day (thesis, thank you notes, notes/assignments/lecture for Saturday's class, and reviewing for med school) got done today. I am hoping tomorrow will be mostly paperwork, and I'll have one more night to prepare.

In the course of getting things ready for tomorrow, I came across my clinical tutorial evaluation from my preceptor. He filled it out on 3-31-10; I just found it in my clinic bag. I gave him an envelope to seal it up. He told me that he wanted me to read it before I turned it in. I hadn't read it yet--I'm not sure why. I don't know what I was afraid of, but I read it tonight. It was extremely kind and thoughtful, and while I am not sure that I believe all of the praise that is in it, it has helped me remember that just being a good person and a hard worker are big parts of having a successful clinical experience. I will need to remember/learn the material at some point. But I'm telling myself it's ok to go back--it's been more than six years since I finished the second year of medical school and took my boards. And it's been five months since I last saw a patient. It's natural that I have some rust--I just have to shake it off and do my best. I hope that'll be enough to get me started.

It's been crazy that my first class was last Saturday, Josh started daycare last Monday, I'm starting clinics tomorrow, and Sophie is also starting Montessori tomorrow. That last one was a bit of a shock. Tim and I carpooled on Friday (my car was in the shop again--that's another story). We both dropped the kids off in the morning, and Sophie's AM teacher asked if the PM teacher had asked us about moving her up to the next classroom. We said no, and the teacher said that since the fall "classes" had just started in Montessori, Sophie would be better off starting ASAP. We were both a little surprised at this. We knew it would be coming--her infant room is for kids 18 mos-3 years, and she'll be three in October. But they transitioned her over a period of weeks when she moved from infants to toddlers. We were expecting the same with the move to Montessori.

When we picked Sophie up Friday evening, her PM teacher reaffirmed that starting Montessori could happen ASAP. Sophie's teacher said that it might help the behavior issues she's been having--her teacher seemed to think Sophie was bored, and that's why she misbehaved (and spent so much time in time-out). I was concerned that she might not be ready--as far as potty training goes, she's nowhere close--but Ms. Sue thought she'd be fine. We asked Sophie if she was ready for Montessori, and she said yes.

A few points of clarification. First, Sophie has spent a little time in Montessori--if Tim drops her off, she spends some time with the older kids for 15-20 minutes max until they can open up the toddler room for breakfast. She's liked the time she gets to color or play. Second, I didn't even know what Montessori was when we first started her in day care. It was the only opening of the many places I called, and I figured we'd have time to decide if we liked the Montessori classroom. The infant/toddler rooms were pretty standard.

Guess what? Time's up. And while I've read about Montessori online (basically, mixed age groups and self-directed learning), I'm still not totally positive why it is better/worse than other things. And honestly, as long as it isn't totally traumatic, it'll be fine. Sophie is comfortable with the routine, comfortable with the teachers, and Josh is going there now. I think we've missed the window to move her. And barring disaster, she'll stay there until it's time to start school.

I just can't believe how many "firsts" we've had in the last week or so. It's been a crazy time. It will continue to be crazy for a long time, I am sure, but I am hoping we'll get some time to enjoy life soon. I really haven't had a weekend to just chill with my little family, and there are a lot of people that I've been meaning to catch up with and haven't had the opportunity yet. Maybe this fall, I can start to feel organized again! I'll try not to feel like a total failure on that front if it takes a bit longer than I'd like :)

Off to find the white coat and the other goodies I'll need. I'm not sure what I need to pack for tomorrow, but I guess I'll figure it out--just like how I am still figuring out the rest of my life on a daily basis.

Transitions

2010-09-03T09:48:00.000-04:00

Today is my last day in the lab. Honestly, with everything I have been through, I really wasn't sure this day would ever come. I also didn't expect to feel sad.

Every job has their issues and quirks. My current lab is no different. But, compared to the hellhole I was in for three years in Dr. B's lab, this has been heaven. The recent scientific meeting I went to was a great note on which to end. I've always enjoyed meetings, because it reignites my scientific passion. I love hearing about what other people are doing, what new questions are being answered, and how people have decided to approach their questions. The time I've spent in M's lab has helped lessen the disdain I had for bench work and reminded me that science isn't what I loathe--it's the bureaucracy and politics involved in academic science. And PIs from hell--I loathe that too :) If only he wasn't still on my committee, life would be perfect!

I'm still not willing to say that I'd jump back to bench research as a career. That's a bit TBD, and I have a lot of clinical training ahead of me before I make any sort of career decision. But, if my time in Dr. B's lab had never happened, I definitely think I'd be considering bench research. I still don't love how much of the day to day work of a PI involved stupid politics, but maybe if I was in a different environment, that would be better.

I do love teaching--I had my first weekend college class for this semester, and I think it is going to be a good class. I'd love to find something that was a mix of clinical work and teaching, so I'll have to see what is around when I am finally done.

It's been a busy summer. I've fallen way behind on lots of things--and sorry, but blogging gets cut when time gets short--but it's been a good summer overall. The marathon last week was being at the meeting in Canada, getting home really late Thursday night, prepping like a madman Friday to clean the house/get ready for the party, teaching Saturday morning, having family dinner Saturday night, and then having Josh's baptism on Sunday. We had fewer people than we expected Sunday (only about 50 came), which caused a little bit of hard feelings (the no-shows were mostly on Tim's side, and he had seen them the day before at another cousin's party, but then they didn't come to ours...drama). But, we're over it, and everything went fine.

This week has been Josh's first week in daycare, which seems to be going well. It's at least been making him tired--he slept through the night for the first time last night! The monthly check is now more than the mortgage on our house (even with the buy-one-get-one-half-off deal they are giving us), but we've been preparing for it since we found out we were pregnant, so we are making it work. If my car would stop breaking down, things would be fine :) I just have to limp the car until I start residency in 2012--then we'll have enough extra to afford another car payment. Come on, car!

Really, we're planners, and we've been saving for emergencies for all 8 years of our marriage. A car repair is an emergency, as was the tree down/broken fence episode from the summer. I'd rather be putting into the emergency accounts instead of taking out, but I keep telling myself that's why we saved for the five years before we had kids. That planning is definitely paying off. We don't have anything extra at the end of the month, but we've budgeted, and we live within our means. My own personal mini-challenge for September is to see how little we can spend on groceries. With the stockpile of dry goods in the pantry, and the meat in the deep freezer, I am going to try to buy only the perishables (milk, eggs, produce, etc) we need to make meals. Tim's already spent a little on pop, which I guess can be his necessity for the month, but I'm going to try my best to not get tempted by the sale papers and only buy what I need. This will take more planning than I've been investing recently, but it'll be a good habit to start with me returning to med school.

I really haven't invested much mental energy into returning to med school. I have always thought that it was so far off. It's the practical things--things like the fact that Sophie ruined my last pair of dress pants, so unless I go shopping, I will have no pants for the first day in the clinics. I think I am going to go thrift shopping this weekend and see what I can find--I like to spend about $5 per pair of pants, so we'll see what I can do. I rocked Target clearance the last time I needed dress clothes, so I may try that too. So, there's the practical (clothes) that I have to plan for, and I should also revisit some of my med school notes to remember how to think. I'm starting with psychiatry, so I'm trying to ease into my rotations.

I still have to give my dissertation, which won't happen for a little while, but otherwise, I won't be in the lab again until probably fellowship. It's a really strange feeling. We'll see how much I miss it when I am gone!

Oh crap

2010-08-20T11:40:00.000-04:00

Things to do in the next 48 hours:
-finish revisions to the paper
-work on my thesis
-prep for the start of my fall course, including a full semester syllabus and four hours of lecture for the first class
-pack/prep for a week-long international business trip next week
-go shopping for food for the baptism party
-clean the house
-prep meals for Tim next week...

Doesn't help that I spent two hours on the phone with United, Continental, and CATSA (Canadian TSA) trying to figure out how to get the pumped breastmilk home. I was even looking into shipping it home. After all that, it turns out I can pack an empty cooler and freezer packs on the way out, and then I can put the milk in the cooler with the freezer packs and put it inside my checked bag for the way home, and we are good to go. Seriously, that's all it takes? I could've carried it on if I was only traveling in the US, but not so much in Canada.

And, Josh is refusing to nap, and Tim has plans tonight. So, hard to do anything today, and once Sophie gets home, I'm on my own with the two kids.

Basically, that means that I'll have late nights once the kids go to bed the next two nights, and I'll have to get most of the classwork/thesis stuff done on the plane rides.

Tim will be getting help next week from his mom (for two days) and my mom (for two days), and he's going to be home with the munchkins the rest of the time. I've got next Friday to clean/cook, then I teach Saturday AM, Tim's going to a party with Sophie Saturday PM while Josh and I host the fam for dinner (Amy's back!) Saturday night (and I am roping the fam into helping with baptism setup after dinner), and then the baptism/Amy's final going-away party is on Sunday.

I am looking forward to this conference next week, but talk about worst possible timing! I've only got one full week when I get back to finish my thesis, and then I start back to med school the day after labor day.

I've always said that I work best under pressure. I guess this counts!

If the posts are sporadic the next few weeks, you'll know why!

As posted on Facebook:

2010-08-18T11:15:00.000-04:00

PAPER IS IN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
It needs minor revisions, but they (hopefully) won't be a problem.
I get to go back to med school!!!
HOLY CRAP, I'M FINALLY GOING TO FINISH MY PHD!!!!!!!!!!!!!!!!!!!

Making money

2010-08-14T14:47:00.001-04:00

Still nothing about the paper--it's been 5 weeks, and we were told we would hear yesterday, and we haven't. So, I am thinking this is not good news. Instead of stewing about it, I've decided to avoid talking about the general anxiety it is causing me.

In the spirit of changing things up, I have talked to multiple people in the last week or so about earning money through the interwebs. While I would consider the money I earn through the drug store savings to be somewhat internet-related (since I find a lot of deals/coupons there), I'm going to focus on things that don't involve you leaving your house at all. Although, I really only do Rite Aid deals at the moment, and I've made a few hundred dollars (plus getting all the free personal products I need) by combining sales with coupons. If you want more info on that, I can fill you in.

So, in order of how good of a deal it is, here's my list:

1) Communispace from Anthem: this was invite only, but I make $10/mo in Amazon.com gift cards for doing about 5 minutes worth of work every week, and there are lots of bonus activities that can bring in $10-$20 Amazon.com money at a time. I've made close to $200 I think (maybe more) doing this since joining less than a year ago. If you get an invite, do it!!

2). Valued Opinions: a general survey site. This site is pretty good at quickly screening you out of surveys you don't qualify for (a big pet peeve of mine), and when you do qualify, the rewards are good. I just finished a panel that made me $25 for minimal work. And, sometimes you'll qualify to try out full sized products in exchange for giving your opinion about them later. In a year, I've made about $160, which I've redeemed in Amazon.com money, but there are a few other redemption offers as well. And, if you join InboxDollars first, you can get another $2 for joining Valued Opinions through your Inbox Dollars account (more on that later).

3). Mypoints: I've been doing this program for many years, maybe going on 10. It's very simple: you get a few points (around 5) for reading emails, 10 points if you don't qualify for a survey/~50 if you do, and then some points for offers, shopping through the site, etc. I don't do much of my shopping through here (I earn more through ebates or fatwallet usually), but just clicking emails/doing surveys earns me between $50/$100 a year. If you want to be kind and link up through me, I'll earn a small percentage back from your referral. Not necessary, but if you feel like sharing the love, send me an email with your email address and I'll send you a personalized link :)

4). Zoompanel: This is a middle of the road survey place for me. On one hand, the surveys are (usually) pretty straightforward, and you get 5 points if you don't qualify. On the other, you only redeem for merchandise, and I've had trouble in the past getting credited the points that I've earned (though after I've contacted customer service, I usually get credit). It seemed like one style of survey never wanted to credit for me, but I've started saving the emails with survey links in a "completed surveys" folder in my email, and then I can double check to make sure I get the points. In about a year's time, I got enough to redeem for a 10-cup food processor, which runs about $60. There are other rewards that are cheaper on the site. I prefer cash/gift cards, but this isn't bad. I've also gotten full size trial items to try through this site, which is fun.

5). Inbox Dollars: This one took me a while to get enough money to cash out, but after that, it's going a little faster. Basically, you get 2 cents for every email you read. You can get money by doing free offers (like the Valued Opinions signup I mentioned before), or more money for trial offers (which I don't do, because I forget to cancel). After you get $30, you can cash out. They'll tell you that it "costs" $3 to cash out, or if you agree to wait a while and earn more money, they'll cash you out for "free". Whatever--I cashed out, and I instantly got a $3 "cash-out survey" that made up for the "fee" they charged. It's slow earnings, but money is money, right?

6) Surveyhead: I've earned decent money on this, but it's more of a time-waster. I do NOT end up qualifying for the vast majority of the surveys they send, and you get nothing if you don't qualify. So, it takes about 2-5 minutes to find out I don't qualify (or that it is full), which drives me crazy. And, it takes 6-8 weeks to get your reward once you cash out (even though the reward is online usually). But, you can get your money transferred to PayPal, which you can then put into your bank account, so it is the closest thing to cash that I've found. I usually only choose to do the surveys that seem like a good fit from the title/description and try to save time that way. I've earned about $80 in 1.5 years, so at least it's decent money. And you may be able to sign up through another program (like Inbox Dollars or Mypoints), so that would earn you more money too.

7) Swagbucks: I just joined this on Thursday, and I've already got 342 swagbucks (a $5 gift card to Amazon.com is 450). There is a swagcode out now that gives you a total of 70 swagbucks at signup (I can direct you to the code, but it expires tomorrow, 8-15-10, at midnight). You usually get either 30 or 40 for a regular signup. They had a code hunt on Thursday that gave me a bunch of codes, and then I won some big codes from searching the internet yesterday. I'm still figuring this out, but basically, you do your regular internet searches through their site (or toolbar, which I installed and find much easier to use), and periodically you "win" swagbucks that you can then redeem for prizes or gift codes. We'll see how well this earns me money over the next few months, but after I figured out the learning curve, it seems pretty intuitive. One note: if you find swagcodes, you can't just post them online. You can give clues to people to help find them, but if the site finds out you just posted the codes, they'll deactivate your account. Just an FYI--my impression from reading other sites is that they take this pretty seriously.

8) Other sites: I just signed up for Global Test Market (through Inbox Dollars) and Opinion Outpost (through Inbox Dollars) less than a month ago, so I can't vouch for those yet. They don't seem as fruitful as some of the other survey sites, so once I reach a cash-out level, I may bail on them.

9) Bzzagent: I've been doing Bzzagent for several years. You get invited to campaigns, they usually send a full size free item plus some coupons/trial size items, you tell people about them and write reviews, and then you get rewarded in Mypoints. The freebies vary from awesome (Starbucks, scrubbing bubbles, and covergirl) to kind of lame (Michelin--just a tire gauge, no easy way to Bzz). I've gotten over 20 campaigns in the last 2.5 years, and it's pretty low key and easy to do. Sometimes I'll be in 4-5 campaigns at a time, sometimes none, so it just varies. And until you earn "honeycombs" to increase your status, the campaigns are usually a little slim. But it's a great way to get new products to try before they are on the market, and spreading your real opinion about them can be fun.

10) ExpoTV: I just joined this recently, but it's basically a video review site. They post items for which they want reviews, you upload a short (~2 minute) video giving your honest opinion, and they reward you with points. They also have a tryology section where they send you a product to review, and you upload a video--you don't get points, but you get to keep the product. I've gotten about 5000 points from this in a few months, and a $50 Amazon.com gift card is 6000 points. Plus, I've gotten 3 tryology campaigns, 2 of which had great goodies. I don't love seeing myself on the computer screen (a personal hangup) but the points reward to time ratio is good.

11) Earning money through online shopping: both mypoints and inboxdollars will reward you for shopping through their links, but I usually find a better deal through ebates or fatwallet. Plus, those usually have a $5 bonus for signing up (or more if you take it in a gift card). The trick is you have to start on their site, you cannot already have anything in your shopping cart at the site you are purchasing, and you can't use a coupon code that is not listed on the ebates/fatwallet page. I usually find what I want at the shopping site, write down the catalog number, then go to ebates/fatwallet to link to the site, then search for the item and add it to my cart. I check both sites to see what the discount is at my desired shopping site (either ebates/fatwallet is better for each particular site), and I also search retailmenot.com to see if a discount code will save me more than the percentage I might earn from ebates/fatwallet. It sounds like a hassle, but it doesn't usually take me more than a minute or two to figure out the best deal. I don't earn a ton from this (most of my online shopping is at amazon.com to spend the gift certificates that I've earned, and there is no shopping reward there), but a few dollars here or there isn't bad.

One note: if you are unsure about a site, google it first. I signed up for a panel last week, and then I thought to research it, and an almost instantaneous google search showed it was a scam. I also recommend using an email account that you check regularly, but isn't your primary personal email. I don't use my school email for anything other than personal/work email, and I have a yahoo account that I use for personal/legit sites (those listed here), and then I have a yahoo account that I use for questionable sites and freebies that I only check maybe once a week. That way, if I get spam, it's not clogging up my regular email.

Overall, I earn a few hundred dollars a year through about an hour or two's worth of work every week. It funds most of our "fun" purchases, like CDs and video games, and we also redeem for gift cards that we can give as gifts or spend (it is financing a good part of our deck). It's a bit of a learning curve at first to figure out what is the best use of your time, but once you figure it out, enjoy!

Quick break

2010-08-04T09:59:00.000-04:00

Sorry for the gap--I've been waiting to hear back on my paper, and I still haven't heard, so I'm being a bit superstitious and not talking about it much--but I found this article today and thought it was very interesting. Hopefully more of an update soon :)

Economic odds stacked against mothers

Omen?

2010-06-29T11:37:00.001-04:00

Yesterday was my first day back at work. I had planned to spend Sunday night getting organized. Unfortunately, we had a strong thunderstorm come through about 5 o'clock. It only lasted a few minutes, but when it was done, our yard looked like this:

Yep, that is our fence under that tree. And it also took down the power lines behind our house. Our power doesn't run off of those lines (the people behind us likely won't have power for days--there were at least 5 different trees down over the stretch of power line behind our neighborhood). But, we had to be careful--with wet ground and a wet tree touching both a power line and the fence, it's possible that the fence was electrocuted. So we didn't get too close.

Our power went off at about 5:30. We had another storm roll through about 9 PM, and although there was a lot of lightning and rain, the wind wasn't too bad. It was enough to knock another big branch down, but that likely would've fallen anyway.

The power stayed off until the next morning. It had been 91 degrees on Sunday--that, plus rain, equaled hot and sticky. I wasn't too worried about comfort--I was worried about the 150+ ounces of frozen breast milk that might thaw. Had the power not come back on, I was going to take the milk to work with me and freeze it there.

Ahh, work. I was trying not to take the crazy storm and falling trees as an omen. I got up Monday morning and actually had Josh fed and Sophie ready to go ahead of schedule. We got to day care--and found out day care had no power and likely wouldn't for 3-4 days. So, it was back home with Sophie, and my sister had a two-for-one baby day on her first full day of watching Josh. Luckily, she was an ace and wasn't in her car driving back to California by the time I got home.

It was a crazy day, and today is another one. Our power went out again, I had to take Tim to work since we dropped my car off at the dealership last night, daycare was still out so Sophie was home again, Josh had his 2 month visit and vaccinations, Tim's dad came over with the earthwork contractor to plan the deck, and then I had to go to work--all by about 9:30.

And I won't go into my feelings at work. The sense of abandonment is less now than with Sophie--probably because I've been through this once before, and also because I've been into the lab quite a bit during my "leave". I am very frustrated that the first time I got revisions back from my boss was 4:56 PM on Thursday--as in, one business day before I was supposed to come back into lab anyway. But, I am trying not to focus on that. I just want this stupid thing out already.

I'm just glad I'm not superstitious, because falling trees and power outages might otherwise be enough to convince me I shouldn't go back into work just yet.

Family history

2010-06-23T09:00:00.001-04:00

It's funny--there are so many things in life that I take for granted or ignore completely. For instance, take my family medical history. I took histories on every patient I ever saw at my VA clinic, and yet I know only bare bones basics about my own.

My GI system has a long standing history of not cooperating. Things have been acting up again recently, and it wasn't until I was talking to my mom that I realized how much of a history I have. I don't want to put all the gory details out on the internet, but one of my immediate family members had their first precancerous lesion found by colonoscopy at age 35. By the CDC/American Cancer Society guidelines, I should have been screened ten years before the age at which the first precancerous polyp was found, or age 25. I'm now 30.

It was suggested that I get a colonoscopy in 2002 after I spent three days in the hospital with GI issues. However, with the insurance we had at the time, it would have been extremely expensive. So I didn't get one.

The GI issues I have seem to come and go, and I know the scary symptoms (melena, hematochezia, etc), but I also know things can happen quietly. I do not think the current issues I have are at all related to cancer (and I've had the same issues for decades), but maybe it's time to get checked.

I don't know why I am so hesitant to see the doctor, and when I do go, why I'm not more proactive. I ask when I have questions, but I am not a fan of medication or procedures on myself if I can help it.

I guess part of me is happier not thinking about my own chance for disease. I know there are some things I need to watch for. Breast cancer is one: my great grandmother died of it, and my grandmother had it as well. Thyroid disease is another: it is very prevalent on my mom's side of the family. And I know things like heart disease, high blood pressure, high cholesterol, diabetes, and obesity are also fairly common on both sides of my family.

Knowing all this, why am I not more concerned with preventable factors like losing weight and getting more active? I guess the answer is that I am concerned, but I am also overwhelmed. I have so much mental and emotional baggage tied up with my weight and body image that it isn't as easy as just going on a diet and starting a serious exercise program. I start making steps in the right direction, but in a very short period of time, I start sabotaging myself without even realizing it.

I need to make progress in that area. I need to make it more about my health than a number on the scale. And I think I need to find out if I'd be covered by insurance for a colonoscopy. It's probably something I need to do sooner rather than later.

First, I need to sit down with both of my parents and do an extensive family history. It's time to find out what other surprises are out there. And I'm the oldest--if I do this now, when the time comes for my sibs to start getting screened, they'll have all the information they need to be informed.

Change of pace

2010-06-22T10:06:00.000-04:00

I decided it was time to spruce things up a bit. More posts to come soon, but let me know if you have strong feelings on the design one way or the other (easier to read? harder to read?). I can change things accordingly. I read my blogs through Google reader, and I don't think this changeup affects that at all, but I want to make the actual page as easy to read as possible. Plus, it's a little more upbeat :)

Worth the read

2010-06-21T16:08:00.000-04:00

I like to pass around articles of use every now and again, and this one really struck me. I think the title says it all:

Why American Workers Need to Toughen Up

Really, I don't think my generation (or the ones on either side of it) have had a lot of adversity. The feeling of entitlement is one of the main things I want to avoid passing on to my kids. Even in my own personal experience, people who were given things don't appreciate them as much as people who have to earn them. This was extremely obvious in college (I worked seven jobs and paid every cent of my college education, and the few subsidized loans I took out are in my name). I knew that my scholarships depended on my GPA, and I worked my butt off. There were plenty of people who had college paid for them by their parents, and in most (but of course, not all) cases, they were much more likely to worry more about the social experience of college than the academic one.

This is also true in my graduate education. There are some people who have been handed their PhDs, either by virtue of a lax set of requirements in their chosen departments, or by joining labs where the projects have already been worked out and they are nothing but a glorified technician. They get their degree (much faster than I have gotten mine), but I have seen first hand how they then flounder in either a postdoc or a position.

I have been blessed with much in my life, but I try never to feel like I am entitled to anything. Even with this stupid PhD, I remind myself that I'm not entitled to it just because I've been around so long or suffered so much. As much as I wish some days (ok, most days) that they would waive the requirements and just let me graduate already, I understand that I have to pass the standards like everyone else.

I want to provide for Sophie and Josh, but I don't want them to feel entitled. I read an article here about how to raise them without entitlement, and we'll see if I can do it. I don't want to manufacture false adversity for them. But I also don't think it's too much to ask them to work for some of the things they want. I'm talking more about things like a car when they turn 16--we had to have a job and have six months of car insurance saved up before we could take our driver's test. But I think even school age kids can pitch in.

I hope that I figure out a way to accomplish this before Josh and Sophie are too old to learn the lesson. Some days it is so tempting to just give in to get some peace and quiet, but I know that boundaries will help them in the long run. Josh is too small for boundaries now, of course, but Sophie isn't. We're trying, but we are definitely not successful every time. I guess we are learning how to be parents--no amount of studying can prepare us for every test.

Routine

2010-06-15T22:21:00.000-04:00

I could talk about the ongoing lab drama (nothing new), or how behind I am in general life stuff (very), but instead, I want to talk about something a little lighter. And probably genetic. That is routine.

Josh apparently has started a routine. Last Monday, here was his routine. He got a bath, and then he was chill and happy:

Then he ate, took a nap in the swing, and had a poop. And I mean, a poop:

That is an out-both-sides, up-the-back, leaking-on-the-changing-pad poop. So, it was into a new outfit for him.

This Monday, he got up, I gave him a bath, and then he was chill and happy. (No pics this time, but you get the idea). He ate, took a nap in the swing, and then:

Yep, another blowout. And he hadn't had one since the previous Monday.

So, my child is also a routine-loving person, like myself. However, this is one routine that I think needs changing.

He did change it up today by peeing all over me, the changing pad, himself, etc. I hadn't had one of those since just after he was born.

Seriously though (or maybe not so), this lab stuff is a huge stressor and consumes a lot of my daily energy, but life is good otherwise. Josh is colicky, and he is still crying several hours a day, but it is getting better. And, he slept for five hours last night, which was just awesome.

And, my cousin had her very adorable baby boy on Monday, so he and Josh will be exactly seven weeks apart. My cousin and I were three months apart, and it was always nice having someone close in age to play with at family gatherings.

And my sister came home from California today--hooray! She has graciously agreed to live with us and the colicky baby for the summer. We'll see if the toddler or baby makes her change her mind, but for now, it'll be nice to have someone else (besides Josh) to hang around with during the day. I really liked the days my other sister and/or my mom came up to hang with me, so having my west coast sis around is sure to be fun.

The whole fam, minus my youngest brother (who is filling the role of California sibling at the moment), got together for dinner, bubbles, and sidewalk chalk tonight, and it was a good time.

(my pic of my brother and sister-in-law was blurry, but they were there too!)

It's the good times like this that I plan to remember, and not the terrible, stressful times that the past six years in my PhD have brought me. I can't say I'd redo the last six years, because then we wouldn't have Sophie and Josh, but there are definitely choices that I want back (say, deciding to stay in my PhD after Frank, my first boss, left in 2005). Oh well, I can't have them back, and I can only take things from today.

I don't like being negative, and I don't want to keep putting negativity out into the universe. I need to get through the paper and my thesis, and then I can get back to my life. Finishing med school won't be easy, but at least it is a defined period of time. After all, I do love my routine.

Once again

2010-06-09T19:49:00.000-04:00

I'm back in lab tonight, and I will be back Friday and Saturday as well. After getting home late last night, I decided that I was more mad about this lab situation than anything. I will have come into work five days this week, in addition to all of the work I've been doing at home. And this is while I am supposed to be on maternity leave. I am supposed to be off for another two weeks. And yet, I think why I am really mad is because, although my boss is putting a lot of pressure on me, I have yet to receive any feedback whatsoever on what I've already sent her.

If I felt like my time was making progress towards me graduating, I think I'd be less bitter about it. Instead, I've been working on my paper during my entire maternity leave. And it sucks, because most of the time I am in work is time I could be spending with Sophie. She came home today, and the first thing she said was, "Mommy, you leaving for work?"

Already I feel like she needs extra attention, since we just had a baby, and instead I'm spending less time with her. It's like I have two full time jobs: I am home all day taking care of Josh, and then I work the minute I can.

And I don't mind the infant caretaking. It's a lot of work, but I'm much more comfortable with it this time. I just wish I wasn't splitting my time.

And since Sophie is third fiddle behind Josh and work, that puts Tim fourth, and me fifth. Not a good thing. Tim and I are coping ok (besides the occasional argument over whose turn it is to wash the dishes), but I've had three hours of free time (one to buy plants, one to plant them, and one to go out looking for planters with my sister). Ok, if you count a visit to the dentist (which I don't), I've had four hours. That's fine for now--I'd much rather have more time to spend with my family.

Sophie was home all last week, and other than a 2.5 hour trip to the zoo, we didn't do anything special with her. I feel bad about that. We were supposed to have family time, and instead my time was consumed with work.

I want to graduate--I am soooooo ready for this phase of my life to be over. But if my time over the last few weeks isn't actually progressing my paper, then why I am here? If this paper doesn't go out until I am back in the lab (which at this point, seems like a safe bet), I could've done this all when I got back.

Oh PhD, how I loathe you...

Not where I want to be

2010-06-08T19:20:00.000-04:00

So, I'm in lab. At 7 PM on a Tuesday night. And I will be here until at least 10, probably later. Why? Because every time I think I am done with experiments, I am not. Let me rewind.

I've been working on lab stuff since mere days after I delivered. I came into lab to run experiments about three weeks after I delivered. And on Saturday night, I was up all night long re-doing figures so that I could meet with my boss at 9 AM on a Sunday. I worked for eleven hours straight, no sleep, during a tornado watch/warning (the same one that killed 5 people in northwest Ohio). And this was a night that Josh was cooperative and actually slept well (Sophie did not--I think she was up 8 times that night). I pulled an all nighter, got into work before 9 AM Sunday morning, and didn't get home until close to 3 PM. And really, it was nothing we couldn't have done over email.

Part of the Sunday pow-wow led to this week's experiments. I have to re-run gels in a different layout so that we can get a pretty picture for the paper. The data collection is done--this is just for an image. So, running today, blotting/stripping/reprobing tomorrow, blotting/stripping/reprobing again (probably Friday), then blotting on Saturday.

Where is this so-called "leave" that I am supposed to be on? This is really getting out of hand. Ok, it's been out of hand. I want to graduate, but I'm burning myself out. Taking care of a newborn is hard enough. Last week, we had Sophie at home for "vacation." Luckily either my mom or Tim was home to help with both of them. But really, the entire point of maternity leave is to heal, rest up, and take care of a newborn. Josh turned six weeks old on Monday, and I have yet to take one nap while he was sleeping.

I am supposed to get eight weeks of leave. I was thinking this would be better than the six I got with Sophie. Not so much!! I have absolutely no energy whatsoever. I'm still flabbergasted that my boss thinks I should have all this time to be working. She has two kids--granted, she had them before she started her PhD (she didn't get her PhD until she was in her 40s). But still--it's a lot of work. I knew I'd have to be splitting time when I went back to work. I really think it is unfair that I'm splitting so much of my time now.

Unfortunately, there is no on to complain to that has any power to change things. The requirements for graduation are clear, and unless I get this paper out soon, there's no way I'll be on the schedule I set for myself. So, that's why I am here.

This sucks. I think my final verdict is in: the PhD was so not worth the time, energy, or emotional angst I put into it. I wish I had a do-over. But I'm too stubborn, and I've put too much time into it, to quit at this point. So, it's back to experiments and the paper for the rest of the evening.

Good intentions

2010-05-26T01:56:00.000-04:00

It's 2 AM, and I am up working on my paper. Josh cried all day today, barely sleeping at all. And then we had dinner at my parent's house (which was very nice) since my brother is leaving for California for the summer tomorrow night.

So here I sit, sleep deprived, battling a nasty cold/sore throat, and waiting for Josh's next outburst so I can feed him again. I really don't know at this point how rational my writing is, so I'm curious to read what I've written tonight. But, my boss wants it out, and I'm starting to have a bit of a panic attack every time I think about my time deadlines, so the late night sessions may have to increase.

I wish I could say that I'll make up for it by napping during the day. Unfortunately, that's a lie. I haven't gotten a single nap since Josh has been born. So much for sleeping when the baby sleeps. Actually, I try to follow his schedule, but he's so feisty during the day that he doesn't sleep for long (unless I am holding him, and then I can't sleep anyway).

I'm a little worried he has colic, but I'm crossing my fingers he's just had a bad few days. Sunday night was really bad--after my cousin and her husband left, he cried for hours. Terrible piercing, angry wails. We couldn't get him to calm down for anything. Tim finally had to drive him around the neighborhood until he fell asleep. Josh is just a vocal guy, I guess. Sophie was such an easy baby compared to him! Had we started with this, we may not have had another baby.

Back to the paper, for now. Maybe I'll get to sleep yet...

Better

2010-05-22T14:26:00.000-04:00

Yes, I am currently at work. Yes, I have been here since 7:30 AM (and awake since 5). Yes, I will be here for a bit more, and I will be back again tomorrow. And yes, my boss did come in today to discuss the paper while I was running experiments.

Despite that, I am doing better. I hate to seem so bipolar in my posts, but I guess blogging serves many purposes. First, when I am having a terrible day (really, one of the worst I've had), it lets me chronicle that. And two, it lets me vent. After the terrible Tuesday night post, I really was stressed beyond belief. But blogging about it forced me to talk about what was really bothering me. I labeled it, and then I thought about ways to fix it.

Wednesday, I gave myself permission to do only one thing: take care of Josh. I told myself that there would be no work on the paper and no thinking/stressing about anything that didn't have to do with what Josh needed at that exact moment. And it made Wednesday a very good day. I think it was Josh's first real smile too, which made things better. I didn't check email, I didn't do any work, and the most non-baby work I did was to tidy up the house a bit and cook tacos. Not complicated.

Thursday my mom and sister came up around lunchtime. It gave me the opportunity to go grocery shopping and buy a few plants. After Tim mowed the lawn, and Sophie went down for bed, I got to spend an hour planting my garden. Granted, it was from 9-10 PM, so I had to do it by floodlight, but it counts. Amazing what about $9 in plants and an hour in the dirt can do.

I also called my boss Thursday afternoon. We talked for about an hour, and actually, I think it lowered my stress level instead of raising it. I think she realized I am really worried about my timeline, so she let me be the one to freak out a bit and she was the reassuring one. I did commit to coming in this weekend, and in a way, that relieved some stress too. By saying I would be in, I knew I couldn't back out just because I was tired or didn't want to go.

And since I committed to work this weekend, I gave myself Friday night "off." I had planned to come in to prep experiments Friday night (to save myself a few hours Saturday), but I decided I wanted that time at home. Tim's parents came up, Tim and his dad talked deck plans, and his mom and I had kid duty. It was nice.

I did take some time last night and this morning to get work stuff organized, but I told myself that by giving a day and a half to work, home time would be my time. I don't know what we are doing when I get home tonight, other than Tim desperately wanting to get a haircut, but that will be family time and not stress time.

I'm still worried, but I've admitted that I will do what I can do, and that's it. I can't magically make things work or make the paper write itself. I need to find more time to spend with it. But, when that time is up, I need to be able to walk away.

I'm still not perfect at this no stress stuff. But if I want to keep my sanity, I've got to find a way.

Back to experiments I go...

Honesty

2010-05-18T23:27:00.002-04:00

I have a confession to make: I am not handling maternity leave as well as I had hoped. It's not postpartum depression--I've been on the lookout for that, and I've been very honest with myself that if I start to notice symptoms, I would call my doctor. No, the big factors can be summed up in two words: anxiety and guilt. And they go hand in hand.

Guilt #1: Sophie. We have been very cognizant of the fact that Sophie would have an adjustment when Josh was born. We worked hard to prepare her while I was pregnant, we made sure that she had plenty of time with me after Josh was born, and we've even made sure that every time we've opened a present for Josh, she's had a present too (really, our family/friends have been great about this, so we haven't really even dipped into the emergency gifts we bought her, just in case).

The pediatrician told us at her two year checkup that she would act out, and it would be at the worst possible times. The first week, we didn't really notice anything. Other than the first day Josh was born, she's gone to daycare every day to keep her routine. We debated keeping her home, but every person we talked to said keeping her routine would be best.

The second week after Josh was born, we started noticing the acting out more. She was defiant, she'd have crying fits/tantrums for no reason, and we started hearing reports from school that she was having trouble listening without getting defiant or physical. It peaked this past Saturday. We talked to several people at daycare and said that time outs didn't seem to be fixing the problem. They suggested we take things away (TV, book before bed, etc) if she didn't listen. We started that this past weekend, and by Sunday night, it seemed to work.

Now, generally, we haven't had too much of a problem getting Sophie to school. She doesn't like to be woken up, but once she's up, she's fairly agreeable. We felt like yesterday was an improvement: getting to school was fine, and she was only in time out one brief time for not listening (way better than her average from the week before), and when she was home, she was fine. No major meltdowns.

Thinking maybe we had made a breakthrough, we were happy that we had stuck with her routine. And then I picked her up today. Tim was working late (more on that later), so I left Josh with my sister, who had kindly come up to help me. I walked in, Sophie came right over to me in an apparent good mood, and then went to get her coat. While she was doing that, her main teacher pulled me aside and told me things weren't going well. Sophie had apparently cried for hours in the morning that she wanted mom/dad/to go home. She said the teachers had called an informal meeting about it amongst themselves, and they all thought it would be good if I could find a way to keep her home while someone else watched the baby so we could have some bonding time. At this point, other parents were coming in, and another issue called the teacher aside. I left with Sophie, holding back tears.

I've tried very hard to spend one on one time with Sophie. We've made it a special point. And here were her teachers, telling me I wasn't doing enough. I know they meant well, but it just cut me. And Sophie was an angel all night--she didn't act out once.

And to top it off, here I was, debating going into work Friday night/all day Saturday/Sunday morning. Those are three of the best times I have with Sophie, and I was going to give them up. Why? Because of guilt #2.

Guilt #2: Work. This has, by far, been my biggest mental stressor (until today, anyway, when I felt like I was emotionally neglecting my daughter). Long story short, I had hoped to have all experiments done before I went on leave, and I wanted to have my paper written and submitted. None of that happened. A good part of that is because so much gets in the way during the week. I'm not trying to make excuses, but there are enough departmental/lab things that are either scheduled or pop up that getting solid time to do experiments takes an act of God. I did get almost everything done, but I didn't totally finish. And delivering a week before my due date cut into some of that time. From the pregnancy standpoint, induction was a good thing. For lab, not so much.

So I have experiments and the paper hanging over my head. That's why I was in lab for the entire day on Sunday the 25th, the day before I delivered. I wanted to get done. Unfortunately, those experiments haven't been entirely cooperative, so I have to run more.

And the paper. Oh, the paper. To give you an idea, I sent out an email birth announcement a week after Josh was born. My boss responded immediately and asked that I call her as soon as I could so we could talk about the paper. I begged off, asking for more time. And I felt guilty for it. I had just had a baby less than a week earlier, and I felt guilty that I hadn't gotten any more work done on the paper.

My sister graciously agreed to come up today so I would have a few hours to work on the paper. She watched Josh, made dinner, and cleaned it up. And I tried to write. I did. But it took me hours just to get organized. I haven't looked at this in weeks--I've got to do a lot of re-reading before I can even start the writing again.

So now my guilt has turned into anxiety. And I'm paying for it. My GI system is a mess, I have horrible headaches that won't go away with medicine, and when I have the opportunity to sleep, I can't. When I'm not working on the paper, I'm thinking about it and stressing. And when I'm trying to work on it, I'm stressing even more that it isn't moving as quickly as I want it to.

And then tonight, my boss emailed me and said she wants me to call her tomorrow so we can talk about the paper. She suggested me calling during a nap.

Part of me wanted to email back and say: do you understand I had a baby three weeks ago? Can I tell you that unless I hold him, he only sleeps for ten minute increments during the day? Did I mention he's a crier? Oh, he'll cry bloody murder for an hour if he wants to. And how about the fact that he's eating every 2-3 hours, and those feedings can take almost an hour? So my day consists of feeding, burping, changing, crying, brief periods of sleep, and then having the cycle start all over? During which of those points would you like me to call?

But that's not what I said. I haven't responded yet. And I feel guilty about that.

Tim asks what he can do to help, and I tell him I need 4-6 hour blocks of uninterrupted time to write. He tells me I should write at night, after Sophie goes to bed. First, on nights when he works late (like tonight), Sophie might be in bed, but I still have Josh. Second, Josh needs to eat regularly. Third, by the time I actually have my hands free (like now), it's after 11. I've been up all day, I get little to no sleep at night, and I barely know my name. Trying to focus and write a paper is impossible. Look at me, I can't write a cohesive blog post. Imagine if I was trying to read and synthesize scientific papers.

I feel for Tim, I do. I know work is busy. But when he works till 9 (like tonight) and then has to go in early (like tomorrow), that means that I have to find a way to pick up/drop off Sophie at daycare (usually with Josh in tow, like tomorrow), and that I have two kids to my one set of hands. Thank God Jen was here today. Joe was around for a bit too. At least I could leave Josh with them and go get Sophie on my own. Last time I dropped off Sophie when I had Josh, one of the infants had hand, foot, and mouth disease, so I had to leave Josh in one of the front rooms (with someone, of course) while I took Sophie back. That's awesome.

So, I have guilt about emotionally damaging my daughter, guilt about not working during my maternity leave, and then lots of little guilts: guilt about some of the resentments I am feeling at the moment, guilt that I can't even keep up with the house/cooking while I am home, guilt that I am spending more than usual for groceries because I haven't had time to clip or match up coupons, and guilt that the one thing I want most in the world right now is a few hours to play in my garden. But then I'd just feel guilty that I am using that time for something that isn't higher on the guilt priority list.

I am worn out. My body is telling me I am worn out. Josh is much more work than Sophie was as a baby, but I'm trying to accomplish more. With Sophie, there are days that we wouldn't leave my bedroom. I'd hold her, feed her, and we'd watch movies together, all day. With Josh, I was up and moving the day after we were home from the hospital. It's a necessity. I don't have the luxury this time of staying in bed for the day.

So, that's part of the reason for the sparse posts. I hate being negative. I wouldn't trade Josh for anything in the world. But I wish I could clone myself to do all of the things that need done.

Before I went on leave, I had high aspirations. Now, I just feel like I am crappy at everything. I don't feel like I am doing one thing well at the moment.

And Tim keeps saying to let the work stuff go (meanwhile, he's spending more time there). If I want to go back to med school on time, I can't let it go. My paper has to be accepted three weeks before I defend my thesis. I need to defend before I go back to med school. Best case scenario, it only takes one try, and a few months, to get accepted. That means it needs to be in by June 1. It's May 18, and it isn't even completely written yet.

I am so screwed.

And every day that I don't get something done on this paper is one more day that is pushing me away from starting medical school in the fall. That's the ultimate goal.

I wish I had time to do one thing really well. Instead, I'm messing them all up. Hopefully I'll get my act together in the near future. I don't really have the option not to. No one is going to do this for me.

(PS: I know anxiety and guilt can be part of postpartum depression, but it is baseless anxiety and guilt. I think I've got solid reasons I am feeling those emotions. And I have no ill feelings towards Josh, and I don't spend my days crying. Really, from the outside, it looks like I am holding things together pretty well.)

Forgetfulness

2010-05-13T13:14:00.000-04:00

No, I haven't forgotten about posting--I've forgotten what life is like with a newborn. I will update as soon as I can, I promise. In the meantime, here's an article that I loved finding today. I'm a planner (aka a spreadsheet loving nerd), so this spoke to me:

Fast track to financial success

Something more substantial soon, I promise. But I just heard Josh poop from across the room (something else I chose to forget about newborns), so poopy diapers beckon.

Finally, a picture

2010-05-03T10:45:00.000-04:00

A week late is better than never, right?

Joshua Timothy Christopher arrived at 2:55 PM Monday, April 26, weighing 8 lbs 13 oz and 20 inches long. We are all doing well, and Sophia is loving her job as a big sister. Tim and I agree that the 2.5 year old has been more work in the last week than the newborn, but I am sure that will change!

And yes, that means the ultrasound was pretty much smack on. They said 8 lbs 10 oz five days before delivery, and he came out 8 lbs 13 oz. His newborn exam also estimated his gestational age at 41 weeks even though he was 39 weeks, so he was definitely ready.

More details to come later today. It's my first day home by myself with Josh, and he's been exceedingly cooperative so far, so hopefully later today I'll give you the scoop.

Quickie

2010-04-30T10:08:00.000-04:00

Josh arrived on schedule on Monday, and we are all home now. I'll give you the details later, as well as some pictures. I had thought I'd be a little more together by now, but I forgot what life was like with a newborn :) Thanks to all who have sent well wishes. I'll give you the full briefing as soon as I can!

So excited

2010-04-26T04:55:00.000-04:00

I finally tried going to sleep last night after 11:30. We had a wonderful day yesterday (after I got home from work): my mom made a tasty dinner, Sophie got to play until she exhausted herself, and Tim and I got in the last grocery run for a while. It's been a total blessing having family nearby. My parents stayed the night here with Sophie, and they'll watch her until we deliver.

I'm jazzed and ready to go! Part of me is sad that this is the last time it'll just be Sophie, Tim, and I--I don't want to lose that special connection. And I know I won't love her less. It's just been the three of us for 2.5 years. But I know she'll be an awesome big sister. And I can't wait to meet Josh!

Not sure when I'll post pictures, but I'll do my best. Wish us luck!

The end is in sight

2010-04-25T11:22:00.000-04:00

Yes, it is Sunday morning, and I am in the lab (and will be most of the day). But this will (probably) be my last day in for a while. I had my doctor's visit on Friday, and she agreed to induce me tomorrow morning. Hooray! So, maternity leave starts tomorrow. I will probably be in on the weekend as soon as I can physically stand it (my guess is 2 weeks) to finish some experiments. This is not ideal, but it is necessary to finish my paper, and I want that out ASAP.

So, Friday I went in for my appointment. I was really bummed Thursday night, and I coped by making a list of things I wanted to talk to my doctor about. I also printed off an article from Uptodate about how induction didn't increase rates of c-section after a woman has had one child. Armed and ready, I nervously waited to see what my doctor would say.

As soon as she came in the room, she told me, "Let me do your exam first, because that is going to affect how I approach things." I was good with this. She was very pleased with how I've progressed (like I can take credit for it...). I was a "good" 3 cm dilated, 70-80% effaced, head down still. I told her about some of my other signs and symptoms, and she seemed to think things were moving right along. She swept my membranes in the hopes of starting some labor, and then we talked.

She began by saying that large babies aren't themselves a reason for induction. She also said that ultrasound measurements are notoriously inaccurate. At this point, I had a bad feeling that her answer about induction hadn't changed.

But then she said that for women with favorable cervices and history of prior delivery, induction didn't result in more c-sections. She again asked if I thought he was bigger than Sophie, and I said I thought he was. She thought he was pretty big too by her estimate. So, me plus her plus ultrasound all agreed.

I told her that my concern was that he was already too big, and more time would make it worse. I mentioned that his 42 week head scared me more than his weight. She didn't seem to think his head was too big yet.

I also said that I felt like my labors weren't destined to progress on their own. My mom has a history of induction, and with Sophie, my contractions never organized. Even after my water broke on its own, my contractions never did anything. I had to max out on Pitocin to get things happening with her. It hasn't been a problem of dilating/effacing--it's actual contractions. So I feel like if I had to wait for labor to start, my water would either have to break on its own again (which isn't that common--the statistics I've seen are 10-20% of labors start that way), or I'd have to go way overdue and be induced anyway.

She listened to my comments, and she agreed that all things pointed to me being a good candidate for induction. It's still termed an elective induction, which I am fine with, since large for gestational age isn't a medical indication.

She checked her schedule, and she would be around Monday afternoon, so we planned for me to arrive at the hospital at 6 AM and start the pitocin at 7 AM. I went to meet the nurse to schedule the details.

The nurse, whom I have talked to several times now, laughed when she saw me. She had just gotten off the phone with the ultrasound doctor who saw me, because he wanted to follow up and make sure they had seen his recommendation.

We went over the process, which is very similar to what I did with Sophie, I signed the papers, and I was off.

I called Tim, and I was absolutely elated that we were being induced. I was cramping pretty tightly from having my membranes swept, but that never went anywhere with Sophie, so the plan to induce made me feel like I had a chance to not be waiting eternally to give birth. I know pregnancy doesn't last forever, but it sure feels like it. I passed the word along to my family, and then I had to go tell my boss.

I know my boss wanted me to have this upcoming week in the lab to finish experiments, but such is life. The postdoc graciously agreed to finish off the blots I am running today, and then I'll come in over a weekend and run another set. Tim thinks I am crazy for being up here on a Sunday, the day before I deliver, but I had to do it. And of course, everything that can go wrong has gone wrong this morning, so it's taking me an hour or two longer than I initially planned. Still, I'll have a set of experiments done today, and then I just have to get some writing done at home.

Exciting stuff! I'm not sure how long I'll be in labor once they start the induction--all the nurses I've talked to since Friday say that I should plan for it to be fast, but they said that about Sophie too. Hopefully, by evening Monday, they'll be a baby!

I'll probably have pictures sometime on Tuesday, if I can get a wireless signal with my laptop. If not Tuesday, I'll have them up as soon as I can. Wish us luck!

Totally bummed

2010-04-22T10:27:00.000-04:00

Well, the nurse just called me. Apparently my doctor is standing by the position that inducing doesn't decrease the chance of complications from big babies, so induction is a no-go. The nurse said that, even if she would consider it, she won't do it before 39 weeks, so tomorrow would definitely not happen.

I am completely bummed by this, almost to the point of tears today. I am so uncomfortable--I popped a ligament in my pelvis last night, and even sitting hurts, let alone standing and walking. I'm not sleeping, I feel like crap, and I have a huge baby.

Like I said a few days ago, judging by Sophie's labor and how I have felt so far, I know I won't go into labor early, if I go into it on my own at all. I've been having painful contractions for a while, but they don't organize and progress.

I talked to the day care teachers this morning when I dropped Sophie off, and they were talking about how they were all induced with at least one of their kids just because their doctor thought they were ready. And they had 7 pounders. If this kid is already 8 lb 10 oz, and gaining, with a huge head, why make me wait?

I have to say, if I end up needing a c-section because this kid is too big by the time I do go into labor, I am not going to be very happy with my doctor. I have really liked her a lot, but I've read the literature too, and I really feel like I'm going to be too big if we wait much longer. Now that I've had another doctor tell me he would induce me, I wish I had a doc that felt the same.

I guess I'll plan to keep doing experiments then. Not what I want to be doing right now.

I am completely bummed right now. That little sliver of hope I had yesterday that we would be done--gone. I don't know how I am physically going to make it another week (or two, or three...).

Quick article link

2010-04-21T13:19:00.000-04:00

I got this in my email today too. Interesting stuff:

Stop paying the mom penalty

I am extremely lucky that Tim does more than his fair share of child/household help. He does most of the laundry and dishes, and he's very flexible about adjusting the daycare routine if I need him to. We are both flexible about schedules, as much as we can be, and I think it works out well. We are still both very busy and stretched time-wise, but I can't imagine what it would be like to be working and not have someone so supportive at home. Especially with the imminent arrival of baby #2.

Cross your fingers

2010-04-21T13:06:00.000-04:00

Well, after working ten hours in lab (plus several at home) on Monday, and eleven plus hours in lab yesterday, I've gotten a half day today by virtue of having an ultrasound in the morning. And I'm hoping the ultrasound changes the plan.

Yesterday, I met with my boss, and I (think) convinced her that the best plan of attack was to back off on the writing/figures of the paper for a bit and let me finish the experiments that actually require me to be in the lab. Best case scenario with those was that I could finish them by working up till Monday of next week (including both weekend days coming up). I didn't like it, but I really need to get these done. She saw my to-do list and agreed that would be the plan.

Well, I am hoping that plan may not work out. And not just because I don't want to come in this weekend.

Tim and I went for my ultrasound this morning. As of right now, Josh is estimated at 90th percentile, and 8 lbs 10 oz. And he could potentially gain 1/2 a pound (or more) a week from here on out. Plus, his head circumference is the size of a 42 week baby (instead of one at 38 weeks 3 days). He's actually increased in percentile since our last ultrasound, which suggests that indeed the weight estimate is likely pretty close (or even a little under).

The technician was joking with us, and as she left, she said, "Good luck!", referring to his size/big head. The doctor came in, and he actually was very nice but very upfront about the fact that he thought we should be induced ASAP. He said that the ACOG recommendations didn't include induction for large babies, but his exact words were that "they are a bunch of morons." He said that risk for shoulder dystocia was very real with large babies, and the best predictor of baby size was size of previous baby. Since Sophie was over 9 lbs, he thought odds were good Josh would be very big (and potentially too big).

He said that absolutely I shouldn't go overdue, and he was going to call my doctor today and recommend induction. He knows her very well, and he called her "rational," so we'll see. He seemed to think she was on call this Friday and might want to do it then. I know she has clinics this morning, so I don't expect to hear anything until late this afternoon. It is probably still a bit on the wishful thinking side of things, but I would love to be done on Friday. I know he's big--and I can tell he is getting bigger. If the biggest contraindication for induction is c-section, I think in my case the risk is equal to needing a c-section if we wait because he's so big.

And actually, I spent some time on PubMed and UptoDate last night when I got home, and apparently the risk for c-section after induction is high in first time moms, but in women with previous deliveries, there was no increase in c-sections with induction. And I've already got a favorable cervix (seriously, favorable cervixes and proven pelvises? Crazy). So I am hoping my doctor will be open to talking about it.

Worst case scenario is that I go in for my regular appointment on Friday, and I don't get to be induced this week. My due date is the 2nd, so something has to happen in the next week and a half.

So, if I get induced Friday, I won't be in this weekend. That screws things up for me experimentally, but I'll figure it out. I'm going to wait to talk to my boss until I have some more information--I don't want to freak her out unnecessarily. But here's hoping.

On the plus side, if Josh is almost 9 pounds, and the estimates for what maternal fluids/tissues weigh at the end of pregnancy are correct, I do feel better that I am mostly baby. My abdomen is gigantic, and my feet/legs/hands are swollen, but I've tried to be good about not putting on too many pounds of junk food. Not that I got a smaller baby by watching my diet...guess genetics sometimes can't be persuaded.

I'm crossing my fingers we'll have some news soon. I may call if I don't hear anything by the end of the day. I'm pretty antsy. Understandable.

3-0

2010-04-19T22:33:00.000-04:00

I can only hope today is not a snapshot into what my 30s will be like...

Today:
-got up early (although "waking up" implies a person was actually asleep)

-left for work before Sophie was up

-harvested tissue (nice way of saying killed rats)

-had multiple things come up in lab that derailed the plan for my day

-worked a ten hour day (not too bad for me, but it was my birthday)

-came home, spent some time with Sophie and Tim until Sophie went to bed

-started working at home

-and I plan to lather/rinse/repeat for tomorrow, especially since my boss wants to meet in the AM to go over my paper, and I have experiments that HAVE to get started before more people come into work and derail my day.

And did I mention that since Josh dropped yesterday, I've been having very painful, crampy contractions constantly (that are unfortunately neither rhythmic nor progressive), a bad head cold, and rat allergies flaring up all day?

Happy birthday to me, indeed.

Honestly though, today's been a real bummer. I have no work-life balance right now--work is all consuming. This weekend was a rare exception--I put my foot down and decided that I needed to step back for a bit. We saw Tim's family on Saturday, after a very productive day of errands. And my parents came up yesterday afternoon to help me prepare--basically my mom cooked a bunch of food that we put in the freezer for after Josh comes. That was awesome. Then I got to see or talk to all of my siblings around dinner time. It was really nice, and I needed some family time.

I unfortunately spent most of last night feeling guilty that I didn't work all weekend, but I tried to remind myself that I also need to be prioritizing the impending arrival of a newborn, so work can't happen non-stop.

I will be so happy when this paper is out. Really, I'm birthing a lab baby at the same time I'm preparing to birth a real baby. I'm not sure which one is more painful at this point.

A belated update from Friday too. I saw the midwife, who said I was a "good" two cm dilated, "at least" 50% effaced, and -2 station. She said Josh was head down, and I said that he was too big to move at this point. She chuckled and asked how big my first had been, and I said over 9 lbs. She thought Josh would meet or exceed that, but she said I had a "proven pelvis," so I should do ok.

A proven pelvis? Should I put that on my CV? Unfortunately, from the sounds of things, that may come back to bite me. I have an ultrasound on Wednesday, and I see my regular doctor on Friday, but it sounds like maybe my proven pelvis will have me waiting to deliver until I go into labor on my own.

I've accepted the fact that my doc won't induce me early, but I want reaffirmation that I'm not going to have to go overdue again. Honestly, judging by these last few weeks (and especially the last few days) of contractions, I don't know that my labor will ever start on its own. Either my water will have to break, starting the clock, or I'll need to be induced. I just think that's the way it is. My labor barely wanted to move forward with high doses of pitocin with Sophie. I just don't know that these contractions will ever organize themselves into actual labor without some outside convincing.

I really thought today that the contractions were progressing. I almost called my doctor at one point to ask if I should walk next door to the hospital to get checked out. I got busy with lab stuff, and the moment passed, but I think that's the best it's going to get.

So much for tradition. I went into labor with Sophie on my mom's birthday and had her the day after. No such occurrence on my birthday.

For now, I'm actually more comfortable dealing with the physical pain of indefinite, un-ending pre-labor. I feel prepared for Josh's arrival. This lab project/paper is much more anxiety provoking for me. I tried to calm my boss (and myself) down in lab meeting today saying that, even if this paper isn't out by the time I deliver, I can be reached at home. I'm not going back to med school till September--while the window for publishing this paper isn't infinite, there is a rather large buffer zone built in. I don't think my pep talk worked.

I'm not trying to put off working on the paper. It's just that, physically, I can only do so much. I get exhausted--I can't do the 12 hour days anymore. I need at least one weekend day to catch up. I hate not living up to other people's expectations (whether they are realistic or not), but I can't keep this pace up. I'm half hoping it puts me into labor, but I think it's just going to make me tired.

I'm trying to hang onto the positive, like this weekend, and let the negative roll off my back. For instance, even though I have several more hours worth of work that I could do tonight, I'm going to go to bed at 11. And maybe I'll even sleep. Wouldn't that be wonderful!

To everyone who wished me a happy birthday recently by phone/text/mail/email/facebook (facebook was a very touching thing today--who knew!), I want to say thanks. I keep hoping that I'll get better at keeping in touch once I have the baby/send out the paper/graduate/etc, but I know life will always keep me busy. Personal relationships are something I need to work harder at, and once I figure out how, I'm hoping to improve. Till then, thanks for your patience :)

The waiting game

2010-04-15T22:07:00.000-04:00

Deja vu...

I remember with Sophie, I had the external cephalic version done around 37 weeks, and all I heard after that was how she was coming any day. At my 38 week visit (basically the same time as the one I am having tomorrow), my doctor thought I might go into labor that day. I was 2 cm dilated and 70% effaced then. We'll see what I am tomorrow.

I've been having painful contractions since about Sunday. On Saturday, we walked the zoo for a few hours, and that might've stressed things for me. On Sunday, my lab had a very nice party (that was initially billed as a lab party and turned into a birthday/baby bash for me--very sweet). Almost everyone brought their kids, so that was some physical activity for me too. I thought Sunday night I might be in labor. Then Tuesday, the contractions were so bad that I was just waiting for them to progress. Yesterday was ok, until last night, when I was so uncomfortable I couldn't sleep. Then again today, between the 80 degree+ heat and standing at a poster for several hours, I thought I might go into labor today.

Long story short, nothing doing. The contractions are painful, and for a brief second I thought my water might've broken tonight (no, I didn't pee myself, but it wasn't my water either). All of the day care ladies keep saying I've dropped, even though I don't think I have. The one woman was even willing to put money on the fact that Josh would be here by Saturday. I said I'd take that bet.

My doctor is out of town till next week, as are most of the doctors in the practice, so holding out for a few more days is ok in that respect. I'm seeing a midwife tomorrow (the only opening they had all week), so we'll see what she thinks. As much as I would love to have this baby soon, I know I probably still have weeks to go.

Part of me would love to go into labor early because it would be less stressful to have a newborn than it has been at work recently. I am sure a lot of the contractions/issues I am having right now are stress related. I've been working on getting this paper out before I go on leave, and every day it seems less and less likely. It doesn't help that when I am not up late because I am working, I'm up late stressing because I am not working.

My boss means well--it's not like Dr. B, who I think knew he was making my life difficult. My boss is really trying to help, in her mind, by constantly asking about the paper and wanting to meet. The trouble is, it takes time. I am working as fast as I can, but there are still a few experiments that need to be run. I'd rather do those and then write the paper from home if I had to. My boss wants the paper now, and we can add experiments later. We'll see if it works out.

Again, she means well. But it definitely has been increasing my stress level. Which makes sleeping harder and contractions stronger. Maybe it'll put me into labor after all--who knows.

I am way past the stage of pregnancy where I enjoy being pregnant. I want this baby out. However, I also know that I'll likely just continue to get more uncomfortable, and Josh will hang out for a few weeks. At least I've been through the anticipation drill before. I'll be pleasantly surprised if he comes early, but I'll plan on making it to my due date.

As I was telling my swollen abdomen last night, "Put up or shut up." I mean that in the nicest way possible, of course :) I just wish all of the pain and contractions was actually progressing things.

Tim says maybe we'll stick with tradition. I went into labor with Sophie on my mom's birthday and had her the day after. My birthday is Monday (yes, it is the 3-0 birthday), so Tim's thinking maybe I'll go into labor then. Hopefully it won't take as long the second time! We'll see--if I had to bet, I'm guessing April 30. Still a ways away.

Baby watch, week (almost) 37

2010-04-09T13:07:00.000-04:00

Appointment stats, for those playing at home:
36 weeks, 5 days today (almost 37)
Head down (yay!)
1.5 cm dilated
50% effaced
Measuring big (duh)
Still high station

So, this means he's moving along, but not too fast. Keep in mind, I was 70% effaced/4 cm dilated for weeks before Sophie showed up. It is common, I guess, to not dilate/efface/drop station as much before labor in pregnancies other than the first, so he could still come at any time. But my doctor had enough confidence that he's going to hang out for a while that she scheduled me for another ultrasound on April 21. And I have two more Friday appointments scheduled (4/16 and 4/23). I'm hoping I won't need one on 4/30, but we'll see.

Josh's room is pretty much done (part of the IOU pictures), the car seat is in, and I will have my bag packed by this weekend. A few more things to get ready, and then we should be good to go.

I wish that the lab paper progress would be as smooth--I'm getting there, but it'll involve a lot of work this weekend.

IOU

2010-04-07T14:54:00.000-04:00

IOU:
-a car summary post
-a general life update
-pictures

I know, I know. I haven't forgotten. I'm crazy busy at work trying to finish up this paper before I go on maternity leave, Tim's been working insane hours (he didn't get home till almost 11 PM Monday night), we're both trying to get things ready for the baby (I do have the car seat in my car, as of last night), and I'm generally exhausted with being 9 months pregnant.

Josh is due in just over three weeks, and that finally hit me yesterday. Somehow, a month was far away. Three weeks seems much closer. And we still have a ton to do. So, blogging has fallen a bit behind. I will try to catch up very soon though. I just wanted to say that I haven't forgotten :)

And no, I'm not nesting. I wish I was--then I'd have the burst of energy that goes along with it! I'm just panicked. If anything, Tim is nesting way more than I am. He was painting shelves for Sophie's room and decorations for Josh's room last night. That's a bit closer to nesting :)

That was fast

2010-03-29T12:18:00.000-04:00

We bought a car yesterday--a 2010 Subaru Forester. Our first choice was actually a Hyundai Tucson, but there were waiting lists to get one, and the Forester wasn't really a step down. I'll post all of the pros/cons, test drive stuff, etc later tonight. That's one thing off the pre-baby to-do list!

Cars

2010-03-26T13:00:00.000-04:00

Also, we are going car shopping tomorrow--woo hoo! Tim's truck has been undriveable for over a week, so his dad lent us his old truck (it's a 1998 that has only a fraction of the miles that Tim's 2001 has...)

We've got our list, I ponied up and bought the Consumer Reports online car subscription thing, and we've lined up the bank (so I guess it will be the bank's car...). Sophie's going to hang with my mom tomorrow, and Tim and I have to test drive a ton of cars in one day. We probably won't buy tomorrow, but we need to narrow down the list.

For all those who offered Facebook recommendations, thanks! We've made a list of those. I'd love any other feedback. We're looking at small SUV's/crossovers with good gas mileage. The frontrunners, in no particular order, are the Forester, Rav4, CRV, Equinox, Escape, Santa Fe, Tuscon, and Terrain. If we find a good one this weekend, I'll let you know! I'm crossing my fingers we'll find a deal.

Nothing like writing a huge check, only smaller than the two house down payments we've had to write...

Patience

2010-03-26T10:36:00.000-04:00

I guess I will need to exercise some patience for the next few weeks. I saw my doctor today, and she said unless my health goes down the tubes (like preeclampsia or diabetes), she won't induce me. She does think Josh is big, but she's not in favor of inducing early. I guess if he gets stuck, we'll section.

I'm pretty bummed by this but not surprised. I read up on fetal macrosomia (big baby) on uptodate.com the other day, and it sounds like inducing early didn't lower the number of fetal injuries (like shoulder dystocia) and did increase the rate of c-section and associated complications. I knew that induction raised c-section rates, but I was hoping a big baby would justify the risk. Unless the mother had uncontrolled diabetes, there hasn't been any proven benefit to inducing early.

I'm a scientist, so I am all in favor of research. I was just hoping it would come out more the way I wanted it to :) Such is life, I deal with unfavorable data all the time! And I would really prefer to avoid a c-section if possible. I know sometimes it is unavoidable, but it is so much better for me and baby to do it the old fashioned way if at all possible. I'd hate to push for an induction before I'm ready. Then again, I did need to max out on pitocin when I was already in labor with Sophie, so I'm sure I'll probably need some sort of help this time too.

My doctor did say that, minus the more rapid weight gain I've had at my last two visits, she's happy with my pace of weight gain. And she said the last two visits (gaining 10 pounds over six weeks) were probably more water than anything, considering how swollen I've been. So that's a positive after my recent weight gain rant.

I guess I'm just going to have to hang in there. I've got another appointment April 9, and then they are every week after that. She said she'll check me at my next visit and see if I'm dilated/effaced. I was with Sophie at 36 weeks, and I'll be almost 37 weeks at my next visit, so here's hoping. Not that dilating/effacing early got me anywhere productive with Sophie!

So, maybe we won't be having an April baby after all. That gives me more lab time, which is good, but I am so ready to have this kid. My abdomen has exploded in the last week--pants and shirts that I could wear comfortably are now tight. The thought that I have about 5 weeks to go is depressing. But I felt this way with Sophie, and I think most people who have gone through it would agree that pregnancy is about a month too long.

And I would've liked to have a scheduled induction so that I could put it on my calendar and plan. Big shock, right? Me, need to plan? But, I'm trying to just let it go. He'll come when he's ready. I'm just hoping he doesn't get too much bigger...

Cracks me up

2010-03-21T21:49:00.000-04:00

Here's an excerpt of what I actually said when we got our ultrasound with Sophie:

"Everything else looked good. We're 36 weeks 2 days, smack on with the original due date (and the one we've been using) of October 16. They checked her heart (heart rate 138, good flow), kidneys, bladder, stomach, brain, etc and it all looked good. They estimated her weight at 6 lbs 7 oz by femur length, which is just under 50th percentile, and her head was just about 50th percentile too. Nice average baby."

That was on 9/20/2007, just over a month before I delivered. And as I mentioned, she was 93rd for both height and weight when she was born. I was 33 weeks 6 days with Josh's ultrasound, and he is about the same size now that Sophie was 2.5 weeks later in the pregnancy. Maybe that means I'll get to go 2.5 weeks early...I'm not counting on it though.

Tim says I should print that out and bring it to my visit on Friday to convince my doctor to let me go early. I'm not sure I'll go that far, but we are definitely talking about a plan this week!

Birthing a linebacker

2010-03-20T16:17:00.000-04:00

Well, we had an ultrasound to guess the weight of the baby. Turns out he's a linebacker. For history's sake, we had one with Sophie around this time to see if she was breech and guess the weight. She was breech, and they were guessing she was about 55th percentile for height and weight (so, not big). At birth, she was 93rd percentile for both height and weight.

With Josh, they measured today and he's high-80s percentile (I forget the exact number) for both height and weight. They estimated him, right now, at 6 pounds 2 ounces. He should be about 5. (I was 6 pounds 14 ounces when I was born!) The technician was moving pretty fast, but most of the gestational age predictions for leg length, BPD, belly size, etc were putting him at 35 week 4 days to 36 weeks and a few days. I'm not 34 weeks till tomorrow. And the doctor, who runs the division, checked me and said ultrasounds will underestimate--they are much less likely to overestimate. So basically, he's big. And he won't be getting smaller--if anything, he would gain about 1/2 a pound a week from here on out (or potentially more).

There was some guessing after my first ultrasound that I may be running a bit ahead on my dates. We didn't change my due date then, but if I was running ahead then, and I was likely to have a big baby anyway, it's not surprising I'm measuring so big.

He was head down though, and there wasn't a lot of room to move, so I'm guessing he'll stay that way. No external cephalic version this time--woo hoo!

I see my doctor this Friday, and I'm hoping we'll talk inducing early. She promised if I was big that I wouldn't go overdue, but I'm hoping (if all looks ok) she'll induce me a week early. Heck, I'd take two weeks early. Either way, considering I was due May 2, I'm pretty sure Josh will be an April baby. Tim wants him on my birthday (April 19) or April 25 (so Josh and Sophie would be exactly 2.5 years apart). I don't know that we'll have that much of a say in it, but I'll take the earliest day possible. I'm sure we'll want to make sure we're past 36 weeks so the lungs are okay, but I'll take the first day they say it is safe.

Good thing we got the nursery painted yesterday. Now there's even more of a push to finish that room up and get everything washed and ready. I'm not nesting yet, but I can fake it! My body is wishing I wouldn't have waited so long to paint--not a fun time--but it would have been worse if we had put it off another week or two.

Of course, my thought was, "Crap, now I'll probably have a week or two less time in the lab to get everything done." Guess that means I'm going to have to find a way to be as uber productive as possible. That may involve finding a place to work where I am not bothered by departmental interruptions. Not sure a place like that exists, but I'll try.

At least it justifies me feeling so pregnant! And it also means I am mostly baby/fluid/placenta/uterus, etc. Hopefully that means the baby weight will come off relatively fast.

I'll keep you posted! I don't know that the doctor will do an internal check this visit (I didn't get one till 36 weeks with Sophie), but if she does check, I hope Josh cooperates with the dilating/effacement plan as well as Sophie did. That will definitely help this to be an induction instead of a c-section.

Wish I had something exciting--sorry!

2010-03-17T11:50:00.000-04:00

Sorry, again. Ask anyone with a blog--the more time goes by between posts, the harder it is to come back. I feel like after a few weeks off I should have some interesting news to share. Nope, not really. It's been the same thing every day, which bores me, so I didn't figure you wanted to hear about it :)

Lab is still moving forward. There are so many loose ends that need to be tied up--I am capable of multitasking, but what I prefer is to complete one task in its entirety so I can cross it off my list. And boy, do I have a list at the moment! Instead, I can only do things here and there, so while things get done, nothing ever leaves the list. But, at least it's progress, even if it isn't the type I prefer.

My committee hasn't changed their minds, so I am working to finish experiments for the paper so I can send it in before I go on maternity leave. A few weeks ago, I thought I'd be done by now. As of right now, I think it'll probably go right up till the end. There are just too many things that come up suddenly, both lab-wise and departmentally, on a regular basis. Those are real time-suckers, and there isn't a lot I can do about them. Mandatory is mandatory.

I am down to my last two patient clinics. I'm finished at the end of March, and it's sad. I've really enjoyed the years I've spent seeing patients one afternoon a week at the VA hospital. I had an excellent mentor, the patients have (mostly) been very understanding and willing to have me learn, and it's such a gratifying experience. Compared to science, where results coming to fruition can take years, seeing a few patients in an afternoon and helping them get their health under better control is definite immediate gratification.

I'm also about six weeks away from my due date. I think Josh turned head down last week, judging by where he is now kicking (and how much more heartburn I have). I'm hoping that means we'll avoid the breech issue this time. I did have a vent session last night with Tim about things though.

Don't get me wrong, despite the third trimester complaints (heartburn, insomnia, hip/back pain, water retention), I feel much better than I did in the first trimester. I'm a lot slower and I can't bend, but at least I can leave the house. Having said that, the end of pregnancy was frustrating for me with Sophie, and it's shaping up to be similar with Josh.

Let me offer a piece of advice if you ever run into a pregnant woman: don't tell her how big she looks, or how she looks like she won't make it to her due date. We feel like whales. We know we're big; we deal with it constantly. You pointing it out doesn't make it better.

I know people are just trying to make conversation. But like I told Tim last night: I don't expect people to tell me I look tiny, but please give me a little credit for not turning into a balloon. I'm almost 34 weeks, and I've gained less than 20 pounds. And a lot of that is water weight: I wake up with 1+ edema, and I'm at 2+ pitting edema by the end of the day. Nothing I can do about the water retention, so that weight I have to deal with. But I'm watching my simple carbs, my blood glucoses have been very good, I'm not eating out much (about once a month), and I'm trying to be healthy. To do all this and then be constantly told how huge I am makes me want to give up and grab a huge shamrock shake from McDonald's.

People mean well, I know they do. But a little recognition of how hard I am trying would be nice. At my last doctor's appointment on Friday, it was a total bummer. I hadn't seen her in 4 weeks, and I had gained 7 pounds by their scale (4 by mine). My blood pressure was good (actually a little low), and my sugar was good. I was really swollen that morning and said so. When my doctor came in, she said that she wanted an ultrasound because I was measuring big for dates and gaining weight rapidly. Her explanation was, "measuring big could just be because I am measuring you plus the baby." She's a nice woman, and I know she didn't mean what I took from that, but I hear, "your fat belly is screwing up the measurements." And she did say that she thought most of the recent weight gain was water, but I've never had a visit where she's commented on the fact that my weight gain has been pretty well controlled. One visit like that would be nice.

I have been petrified of having another big baby. I've done everything I can on my end to try and prevent that, but at this point, I'd almost rather have him big. One, that means I'd get to schedule an induction and not go overdue. Two, it means that the weight I have gained is mostly baby. But I'd also be disappointed, because it means that nothing I have done has worked.

I'm frustrated to the point where I think I should've just eaten whatever I wanted, consequences be damned, and gained 60 pounds. At least then I think the size comments would be justified. I knew I'd never be one of those people who gain seven pounds and look all tiny through the entire pregnancy. But if you're going to paint me as someone who isn't trying hard enough, at least let me enjoy the benefits of not trying!

Anyway, I'm just tired of the comments. Again, I know people don't mean nasty things. But every morning at day care, at least one person comments about how big I am, how I'll never make it to my date, etc. This morning it was, "Wow, you look really tired!" Thanks. Thanks a lot. I am tired, and I needed you to remind me of that.

Tim's been really supportive about this, and he knows how sensitive I am to all the weight comments. That's why I can vent to him. But knowing I have six more weeks, and remembering how I blew up with water retention at the end with Sophie, I am sure things will get worse on that front before they get better. On the other hand, I have yet to take an official pregnancy picture because I've felt so un-picturesque, but that isn't going to improve either. I've been very careful not to talk about any of this in front of Sophie--the last thing I want is for her to learn my body image issues--but it hasn't been easy.

I hate to whine, and I'll try not to bring this stuff up again. It's just that pregnancy is so tough on its own--I don't need other people making me feel like crap on top of it. Yes, I am uncomfortable. Yes, I am tired because I can't sleep. Yes, my ankles are swollen to the point that I can't get my shoes on. Yes, I walk at a glacial pace because my hips and back hurt. You don't need to point it out, thanks.

Anyway, I'm really not oversensitive about it most days. I've done a pretty good job of just smiling and letting whatever comment roll off my back. Yesterday was just one of those days. Both Tim and I are stressed out--he's been working nonstop, including nights and weekends, on this never-ending, undead, frustrating job. He had a rough day yesterday, so I think we both needed a vent session. I'm glad we get along so well, because it's easy to understand what the other person is feeling.

We're both taking Friday off--not as a day of rest, unfortunately, but to try and get stuff done in the house before I am completely immobile. We're finally going to paint the nursery, move furniture, set up the spare bed, and try to get ready for Josh. I did buy size1-2 diapers at Costco last weekend, so if he comes early, we'll have those. I need to sterilize all the bottles and the pump pieces, buy new bottle nipples/pacifiers, and go through all the clothes to pull out the gender neutral things he can wear. Of course, even with those, Sophie was a late fall baby, so we have a lot of heavy sleepers and things he won't need. We do have some white onesies, so if all else fails, that'll be his uniform for a while. My cousin is going to kindly lend us some boy's clothes, and I am hoping Tim's cousin (who has twin boys) will offer us some too. If not, craigslist it is!

Overall though, I have been thankful for how well the pregnancy has gone, and how healthy we all are. We've been surrounded by health issues--Tim's cousin's twins were actually both diagnosed with a very rare genetic disease that may cause them to go blind/lose an eye. They've both already had surgery, and thank god it's not something like retinoblastoma, but that was a wakeup call (they are six weeks younger than Sophie).

And then one of Tim's coworkers had his two year old daughter diagnosed with an aggressive brain tumor. I don't know the type, but she's already had surgery, was in ICU for several weeks, and just this week traveled to Philadelphia for a very uncommon form of radiation treatment. I guess the recurrence rate, best case scenario, is about 50%, and she may have permanent brain damage if she does make it. And she's 5 months younger than Sophie. I was a real mess when I heard about what was going on with them--I can't imagine what they are dealing with. I was distraught when Sophie went back to surgery for 15 minutes to get tubes in her ears. I just can't imagine--it breaks my heart.

Three kids, all around Sophie's age, with very rare diseases. I feel like we are due for something. I'm thankful every day that we have a healthy, strong-willed toddler, even if she is a handful on a regular basis. But I don't know how we are lucky enough to have a healthy child when there are so many other people dealing with life threatening issues. Really, after taking embryology in medical school, it's astounding to me there are so many healthy, "normal" people in existence. So much has to go just right, at the right time, for a person to be born healthy (and stay that way).

And so, in the big scheme of things, I'd rather deal with two healthy kids who gave me issues in pregnancy/delivery. I'll birth another nine pounder if I have to, if that's what it takes for him to be healthy. We've been blessed to be able to have kids relatively easily, which I know many people struggle with, and we're blessed to have lots of people around to help us take care of them. Feeling like a whale for a few months isn't the end of the world. And I know I've done what I can, even if everyone else assumes I've been living it up in the drive-thru lane. That'll have to be enough.

Rest of the recap

2010-02-24T14:46:00.000-05:00

So without going into too much scientific jargon, the recap of the actual meeting is pretty sparse. My committee met without me for a bit, which is the protocol. No idea what they talked about. I started my presentation by overviewing the model and specific aims again, but I didn't do (or need to do) much more background than that.

I went over some of the general measures (animal weights, heart weights, scars, etc) which involved a little discussion. The debate has always been that sometime the high fat diet makes the rats heavier, and some times it doesn't. They never become obese, which would be another confounding issue in the research, but it's something we always have to discuss.

I spent a little time on echocardiography but tried not to focus on it too much since we have much finer measurements that we take at terminal surgery. I did spend some time on those measurements. The biggest comment was from Dr. B, who argued that we don't see the systemic signs of heart failure in these rats that you would see in people. That's a model issue--rodents don't get anasarca, and the failure is more moderate (even with an LV scar that would kill patients). We're consistent with other models, and my boss just put out a paper looking at more of the adrenergic state of our animals, so I tried to defer to that paper a bit.

That line of questioning was my first indication that Dr. B would be the primary cross examiner today, as usual. Sure enough, once I moved into the insulin resistance data, he let loose. He doesn't like how we measure peripheral insulin resistance, even though we: 1) measure it in multiple ways, 2) report the measures most commonly cited/published, and 3) have the director of the mouse metabolic phenotyping core, who oversees these experiments, sitting on my commitee. We debated for a bit about other measures Dr. B wanted to see, but everyone else was happy with the report, so we moved on.

The next section was the PET data, which Dr. B is big into right now. Everyone was happy with the images and the final analysis, especially with how clear cut the results were. Dr. B argued about how this result could be an artifact of our glucose infusion protocol, but I pointed out the controls we did to make sure that wasn't the case. If anything, I was polite but a bit over-defensive. I wasn't about to redo all the (very expensive) experiments to tweak one little thing so he would be happy. It wasn't nasty, but once again, Dr. B was interrogating and I was left to defend myself.

We then went on to the protein signaling work I've been doing. This is what my committee was really on me for last time: show a mechanism. They wanted to see signaling changes. So, I've been working for the last six months to show signaling changes. This has involved a lot of troubleshooting, which I didn't get into at my meeting, but it has been very time consuming.

And of course, this is when Dr. B said none of the signaling mattered. He said that showing intracellular mechanism didn't show us anything additional about the model beyond what we saw from the PET data. I actually had to defend the search for signaling changes even though last time, he was the one that wanted me to do it.

After some protein discussion, we got to the experiment that didn't work in Utah. I think it would really complete the story--it is the final common pathway of the signals we are studying--but it is technically difficult. This is where the rest of my committee showed their first signs of concern. The consensus at the time was that yes, we needed this data to have a complete story. They suggested that I spend a few weeks troubleshooting, but if I couldn't get the method to work on the frozen tissue I had, I'd have to collect new fresh tissue. This would involve at least 32 more animals, which would take minimally a month or two to collect. The committee's suggestion was to tinker for a month and then have another meeting to see how it went.

I also went over my timeline for return to med school. I said that I am slated to start my clerkships the day after Labor Day. My committee asked what my drop dead last date was, and I said November (that still puts me in residency in 2012--anything later pushes me back a year). They were concerned that I might run out of time if these new experiments didn't work.

And then I presented my outline for uniting my two publications into a thesis. This is actually where I anticipated the most debate. I was leaving out all three years of work that I did in Dr. B's lab. One, it was never published. Two, we never got to the heart of the issue. Three, the heart of the issue wasn't that interesting. Four, it has absolutely nothing to do with either of the other two labs I've been in.

I thought Dr. B would raise a stink about that, and I figured G would probably agree with him. As I mentioned in the last post, everyone was on board with my idea--everyone. They liked the overarching theme, and although they agreed it would take a lot of writing to link the two, they thought it was a good plan.

So then I left again, they discussed for a while, and I came back in. According to my boss, when she was with them but I was gone, they were still saying that this difficult assay was really key to getting the paper published. When I came back in and my boss left, they were saying that the experiment was important, but the data I had really could stand alone by itself. They had concern about the particular difficulties associated with the assay, but they were all pleased with my progress.

After the meeting was over, my boss and I chatted about what had been said. We both agreed that maybe instead of prioritizing this tough experiment, we should tie up some loose ends, write the paper, and submit it. We figured it wouldn't get accepted right away, and that would give us time to tinker with the tough experiment while we were waiting for comments.

As I mentioned in the last post, then Dr. B and I chatted, and he said that he and G had discussed the same thing. My boss then had a faculty lunch with two of my other committee members, and they said they were on board.

So the plan went from me trying to get this tough assay to work before sending out the paper, thus putting me in a time crunch, to having me finish up some loose ends, writing, and submitting the paper before I start troubleshooting the hard experiment. Weird how things changed dramatically in an hour.

There wasn't a lot of hostility in the meeting--just the typical interrogation by Dr. B. It's strange though--he used to do the same thing when I was in his lab. We'd go over my talk before my meeting, and he'd be on board. Then he'd rip me apart in the meeting. And then he'd be all positive about it after the meeting. I just don't get it.

I'm still a little stunned at how things went down, but the long and the short of it is that I'm now on the path to graduation. As is typical with scientific time (read: glacially slow), it'll still be a few months. It'll be about a month or so to finish experiments and write the paper. Then we have to submit. Then it'll be maternity leave probably, although I am hoping to at least start the tough experiment before I go. Then it'll be writing the thesis, doing experiments/revisions for the paper, and defending. Still late summer, by the time things are done.

Totally crazy. Maybe this will sink in by tomorrow. I'm actually going to graduate!

Twilight zone

2010-02-24T11:22:00.000-05:00

Ok, I only have a minute to post, so I'll fill in details later. I just had the weirdest experience of my life.

Thesis committee went well. Some typical hijacking, but I think I handled it well. Nothing really nasty or mean--just people questioning things based on their own areas of expertise. The general consensus at the time was that if I could get this one experiment to work, I was golden (the one that didn't work in Utah). If not, then people were concerned.

After the meeting, my boss and I were chatting, and based on the committee feedback, we think we could write up what we have (filling in a few quick blanks), submit the paper, do the tough assay while we were waiting, and then add it when we did revisions.

Dr. B had mentioned in the meeting that he had done a different protocol for this tricky assay in the past. He mentioned a reference. After the meeting, I searched for the reference and sent him an email asking if it was the right on. He emailed me back right away and said to call him. I was nervous, but I called.

He started out by saying that he thought the presentation was very good. He then started on the whole, "you know, you are pregnant, and things happen...." tangent. I braced for the worst--the pregnancy stuff hadn't come up at all in my meeting. I thought, "Great, he has me one on one on the phone, I'm stuck now..."

But then he said, "you are on a limited timeline, and G (my MSTP committee member) and I were thinking that you have a paper now without that assay." Actually, I think he said that I had a paper without all the Western data too, in which case I would have been done in the fall...

He said, "G and I think you should write up what you have, submit it in the next few weeks, and then work on the assay while that is in." I told him that my boss and I had come to the same conclusion after the meeting.

Here's where it gets weird.

He said, "you're a beautiful person, we had a great relationship, and I love you as a person and want to see you succeed. You have a very exciting project, and you deserve to be finished."

WHAT?!?!

Seriously, I thought: a) I'm hallucinating from lack of sleep, b) an alien has taken over Dr. B's body, or c) this is all some kind of sick practical joke.

He said again how happy he was I was almost done, and then we hung up. I called my boss right away to tell her what happened. We both agreed that isn't typically how Dr. B comes off, but we also both agreed that we didn't think he ever meant to be such a terrible boss--he just was.

In the meeting, at the very end, I presented an overview of my thesis. I said that I was planning to tie my work in Frank's lab with my current work. And that's it. It's an overarching theme of cardiac dysfunction in ischemia (with lots of differences). But no mention of the three years of work I did in Dr. B's lab.

This is where I expected the biggest fight. And nothing. Everyone (including G and Dr. B) nodded in agreement and thought it was a good plan.

What just happened here?

I am thrilled that things were so positive. And I was so nervous in the meeting that there were probably a couple of points at which I was overly defensive, since I was anticipating a fight.

But overall, it looks like I'm almost there.

Honestly, I wasn't sure I'd ever be almost there. I was seriously thinking I was going to have to fight to defend my thesis by the fall.

I think it's going to take some time to sink in. But with the tiny amount of sleep I've been getting, I'm still concerned that this might all be a dream or hallucination somehow.

Interesting article

2010-02-18T10:21:00.000-05:00

I try to keep up on articles from Yahoo Finance (with the exception of Robert Kiyosaki, who I think is a quack). I particularly enjoy the "Money and Happiness" column, and today's got me thinking. It's called, "Would you do this to double your pay?" and the "this" they are referring to is work every day of the year.

Apparently 25% of people would work every day to double their pay. Of course, I've been working overtime with no increase in my pay, so this makes me sad. The most interesting point was that people underestimate the value of their leisure time. I am definitely feeling this. I have no time whatsoever to catch my breath, and it's taking a toll. My committee meeting is in a week, but that doesn't mean my schedule will magically slow down. I anticipate some resistance to my timeline, and the way to ameliorate that is to work constantly and show I can get these experiments done.

I think though, for my own sanity, I am going to need to take a day or two off at some point. Tim and I had both discussed taking a weekday off together to paint the last few rooms of the house. That's not exactly relaxing, but at least it isn't the same work we've both been insanely busy with.

Back to work for now, but I'm definitely thinking about a break...

Better

2010-02-12T10:30:00.000-05:00

I had my OB appointment today, and my sugar was fine--100 mg/dl 1-2 hrs after eating breakfast. Normal. I'm still watching what I eat, but the doc is happy, so I'm happy. I wish I was sleeping, and we talked about how working non-stop is not helping my stress level, but for the moment there isn't a lot I can do about it.

I'm trying very hard to keep things in perspective. Lack of sleep plus pregnancy hormones doesn't help with that. I think Tim would testify that I'm pretty even keeled, despite the crazy hormones, but every now and then I just hit a funk. The next few weeks are going to be very busy for both of us, but I'm trying to just breathe and get through it as best I can.

I'm looking forward to an MSTP mommies meet-up at a friend's place this weekend. I'm going to head over there after I'm finished in the lab tomorrow, and Tim has graciously agreed to watch Sophie a little longer than planned so I can be social. I think I just need to get out a little more. It is amazing what an hour or two of socializing can do for me! I feel bad about taking that time away from Sophie and Tim, especially because I've been seeing so little of them recently (getting home at 8 PM will do that), but a few hours once a month is time I need to stay sane.

Tim and I both want to take a day off together during the week after my committee meeting/his project. I don't know what we'll do, but I think we both need it. We were able to go out for dinner last weekend while my parents watched Sophie--it was nice to share a meal and not have to rush so the toddler doesn't have a meltdown. I need some girl time with Sophie too in the near future, and I'm trying to think of something fun (and warm) that we could enjoy together. She loves the zoo, so maybe we'll hit the rainforest exhibit (indoors) one of the weekends after my meeting.

I am trying to keep things in perspective. It's not the easiest thing, but I am working on it.

And I am going to have another baby in less than three months, so I better get this worked out now!

Great

2010-02-10T20:47:00.000-05:00

Just what I need in life: more guilt.

Mom's obesity puts kids at risk for host of ills.

Seriously, not that I could ever become anorexic (I like food waaaay too much for that), but the guilt is probably enough to drive some women to it. As a scientist, I'm all about more data. As an overweight pregnant woman, this is not what I need to be hearing.

Ugh.

Coping

2010-02-09T10:21:00.000-05:00

I'm doing better, and thank for all the kind wishes/comments/emails. My stress level hasn't gone down much. I'm not sleeping better (or at all, if last night is a good example). But I do think I'm coping better. I've just accepted that I will get done what I can get done before my meeting, and then everything else will get done afterward. I'm still working as much as I humanly can, but I'm not beating myself up if I only work a 60 hour week. And with the impending snow storm coming through tonight into tomorrow, if I have to be a few hours late so that they can plow my road, I'll just stay late. I'd rather be safe.

I'm tired, and frustrated, which leaves me with a short fuse. But I'm also appreciative of the help and support I have. For now, I'm just pushing through. I really need a vacation, but that will have to wait. Till then, back to the grind.

Boiling over

2010-02-03T21:45:00.001-05:00

I have generally tried to stick to the mantra, "if you don't have anything nice to say, don't say anything at all" when it comes to big time venting on the blog (recently, anyway). However, the last week has been the pits, and so in an effort to be upfront and honest with myself, I feel like I need to vent a little.

First, my GTT from last week came back borderline. That means that I'm not technically gestationally diabetic. However, because Sophie's test was also borderline, she was 9 lbs (although overdue), and I had a tough delivery, the nurse wants me to follow the diabetic diet as much as I can. I don't need to check sugars, which I guess is a plus.

Problem is, I didn't have a lot of pop/juice/sweets to cut out. I do eat a lot of carbs daily, but I choose whole grain/high fiber options. My English muffins are only 100 calories and have 8-9 grams of dietary fiber. I've been trying very hard to make good choices all the time. I don't eat a ton of meat, so adding protein has actually been difficult for me. And I can only eat so many eggs/grilled chicken breasts. It's only been a week, and I am officially in a rut.

Emotionally, it hasn't been easy for me either. I take the ramifications of high sugars very seriously. There are two clear feelings I've been dealing with: the first is feeling like I've failed my child(ren) before birth, and the second is feeling like all the good choices I've made up to this point were a total waste. The guilt is harder to deal with because it involves others; I hate to think that I've set Sophie and Josh up for a lifetime of increased risk of obesity and diabetes because I had borderline glucose levels while I was pregnant with them. The genetics for those two factors suck on both sides of my family. The only glimmer of hope is that all of the kids born on Tim's side of the family have been very large babies, and they are all very thin in adulthood. I'm praying my kids have Tim's genetics as far as that goes (although I really hope they got my hearing...).

The "woe is me" for myself is easier to get over. I've tried very hard to watch my weight gain this pregnancy. It has been far from easy (more of which I'll get into later). My goal was to gain less weight both for the sake of the baby and for my own good. Granted, I lost all but five pounds within a week of having Sophie (the joy of putting on water weight), but I could've done a better job. And starting out overweight, it's not like I need to add fat reserves. Still, despite my occasional bad day of eating, I am trying hard this time. I still have twelve weeks to go (hopefully less), so if I can keep it to a pound a week from here on out, I'll be under my goal of 25 pounds for the whole pregnancy. I can already tell I'm starting to pick up water weight--that means a pound a week may be unrealistic, but I am going to try. Even though I have days where I want to blow it all for a blizzard (or four), I've managed to keep my cravings on the moderate side. But there are days when junk food calls to me...I'm hoping resisting the call pays off.

So, the glucose issue has been downer number one this week. The second group of frustrations is just day to day stuff. For instance, on Saturday, Tim accidentally locked Sophie and Macgyver in my running car while it was six degrees outside. He felt bad about it, and AAA (and the sheriff's department) were there within ten minutes, but it was probably the most stressful ten minutes of my life. It took everything I had to suppress the urge to break out the window. Sophie was fine--she couldn't figure out why we wouldn't take her out, but she was calm about it. And the heat was running in the car, so they weren't cold. I worked very hard not to scream at Tim about it (it was an accident), and I felt much better once the door was open. I'm making it sound a bit lower key than it was, but you get the idea.

That's been the most extreme case of stress this week, but there have been all sorts of little frustrations. Waiting at the ENT's office over an hour to be seen for three minutes. Unexpected bills and money being paid to me late. The daily morning frustration of trying to get a willful two year old out of the house on time. That one really gets me. I love Sophie dearly, I do, but I am convinced she would have been an only child if we had waited another few months to get pregnant. She can go from being sweet and cuddly to full out tantrum in two seconds. I guess she's that way at school too. I don't want to have "that child" that teachers complain about, and we work hard at home to discipline her when necessary, but I really hope the terrible two's don't last forever (or are at least not an indication of how she will be as a teenager).

The biggest stress recently has been the lab. If you've been around the blog for a while, you know how bad my last lab was. Because of that, I have made a conscious effort to not complain about my current situation. Everyone has bad days now and again, and the worst day in my current lab is still one thousand times better than the best day in my old lab.

Still, the last few months have been very frustrating to me. And it is only intensifying as I approach my next committee meeting on February 24.

I am a thinker. I always have been. And if anything, one of my biggest faults is that I overanalyze and think things to death. I've actually worked very hard since high school to get in touch with my feelings more than my thoughts. In science, thinking is a good thing. Really, it's the only thing. Data are data, but without analysis, you don't know what your experiments are telling you.

I unfortunately haven't ever worked in a lab where time to think is set aside. I know some labs like this do exist--there is time protected for catching up on literature, and sometimes lab meetings are all about discussing ideas. That is probably the environment I needed in order to be content in lab. My current lab, while very busy and constantly producing data, doesn't do things in a linear manner.

I was thinking last night about what I've done in the six months since my last committee meeting. I finished GTT's on my rats, continued and then finished PET scans, spent several weeks troubleshooting homogenization buffers, spent several more weeks getting antibodies to work, went to Utah for a week to learn a new technique, spent about six weeks trying a new detection system that didn't work, went back to the old system, spent a few weeks trying to strip/reprobe blots that wouldn't cooperate, came up with a new way to analyze the data without needing to reprobe, started a new gel system to analyze my Utah data, and am now trying to troubleshoot a new extraction method while using another method to probe for different target proteins.

And in the course of doing this, I've submitted multiple abstracts, presented my data on several occasions (and won an award for it), assisted with day to day activities in the labs like echocardiography and surgery, worked with two different rotation students, and attended an average of 3-6 hours a week of seminars/student meetings. I've been busy--that's what I am trying to say. And I've done this through a terrible first trimester of pregnancy.

So, I know I've done a lot of work. The first issue is that it is never enough for my committee. The second issue is that you don't get credit for troubleshooting--all they care about are the final results. And if you have three million projects in progress, but no results, then those things don't exist. The other issue is that by constantly producing data and never having time to sit and analyze it, I'm not even sure what my entire story is.

I only have three weeks before my meeting. I'm working seven days a week to produce as much data as I can. That is what I am being pushed to do. What I need to do is sit down, analyze my data thus far (including statistics), organize it, and figure out what I want my story to be. There are still key experiments that need to be done, and I know what a few of those are. But what I need to prepare is an outline of other potential experiments my committee may want to see and why they would/would not help my story.

It's frustrating. I wish I could do one group of experiments, analyze them, and then move on to the next. That's the best way to figure out where I need to head. I know my boss is frustrated that the Western blot stuff takes so much troubleshooting, but the postdoc and I both agree that the troubleshooting of Westerns always takes way more time than the data producing. Once you have a protocol that works, it's like a recipe: you can do the same thing over and over and get good, consistent results. Making the recipe is what takes time.

My boss is a very nice person, and I'll be forever grateful for her taking me on. But, she raises my stress level. I KNOW I need to get things working. I am spending every minute I can on it. But doing the same thing over and over won't get me a new result. I need to look up new methods (which involves literature digging). I need to think about which method to try first. And it might take a few tries to find one that works in our system.

I know this, but after being so beaten down by Dr. B, I still have a hard time asserting my own opinions as far as experiments are concerned. So I've been doing everything in the order my boss wants me to, which is the reason I'm trying to finish six things at the same time. And dividing focus almost always leads to mistakes.

What I should have done was stand up and say, "I am doing X now, and when that is done, I will do Y." Utah was a great example of this. The priority was getting one target working, and Utah involved another target we weren't ready to focus on yet. I went to Utah immediately though, did experiments, and got samples, but I wasn't ready to analyze the samples until last week. And that's when we figured out the Utah experiment didn't work. If it had been a linear progression, we could've found that out right away and tried something else. But I caved and diverted attention, and now we are back to square one.

My committee will put the blame for diverting my attention on me, and I don't intend to argue with them. I feel like it's my job to do what my boss wants, and so I have. I used to get berated for doing it any other way in my old lab. Old habits die hard, so I am still in boss-pleasing mode. However, I do think I should've asserted myself sooner, and so for that reason, I'll take my lumps at my meeting.

The meeting will be rough, but the day to day stress has been worse for me. I go home with a headache just about every day because of the constant push to get as much done as I can, immediately if not sooner. I'm tired when I get home, and then I spend several hours trying to make dinner, taking care of a toddler, and generally attempting to not make my house more of a mess than it already is. By the time Sophie goes to bed, I'm wiped. I have zero energy to run errands, and I'm mentally drained. I can get absolutely nothing done after 9 PM, and I try to be in bed by ten.

The issue is that going to bed doesn't mean sleeping. For a few weeks, I was doing really well with sleep, getting 5-6 hours a night. I'm back to one to three hours again. I'm so tense and stressed that all I do is alternate between thinking about all I didn't accomplish today/everything I need to do tomorrow and feeling guilty about how bad of a mother/wife I am. Work is completely overtaking my life, and it will have to until I defend. I only get to see Sophie a few hours a day (and most of those hours aren't spent doing fun/quality time/memory making things). The weekend used to be the time that I could catch up on family time. Working seven days a week makes that impossible.

And the house and budget have suffered as well. I have no time to run errands or do chores. That often means there aren't groceries in the house (we always have the stock of semi-prepared food in the pantry, but that's a last resort). Because I have no groceries, I can't just get home and make dinner. This means we eat a lot more of that crappy semi-prepared food, or we pick something up. We don't do the fried/greasy food, but pizza and prepared grocery store food isn't much of a step up. In January, we spent triple what we typically budget on eating out, and our grocery bill was higher too (because I don't have time to hit all the sales). Our budget is stretched to the max anyway. I don't like the idea that work is now costing my family money.

The work stress impacts all phases of my life. Like I mentioned earlier, I'm having trouble eating healthy. There are two parts to that: I'm having trouble eating healthy food, and I'm having trouble eating in a healthy way. The food I've already mentioned; I used to meal plan based on sales and have fresh veggies/meats/etc ready to make healthy meals. I don't have the time or energy for that anymore. The stress also pushes me back towards my disordered eating habits, and the last thing I need in my life is to re-ignite my eating disorder. I don't need the calories, I don't need the weight gain, and I don't need more guilt in my life. I have already felt myself being pulled towards giving in and having an all-out binge, and thus far I've been able to suppress it. I need to find another way to deal with the stress. Whether it's journaling, meditation, or walking, I've got to find the energy and time to let myself decompress in a healthy way.

I guess life in general just has me frustrated. I think part of it is the delayed gratification. There's this voice inside me that would love to tell my committee exactly what I think. I've been in the PhD for almost six years. I've been in three labs in that time: one abandoned me, one tormented me for three years and did absolutely nothing for the advancement of my degree, and my current lab has only been my home for a little over a year. I have people from other labs ask me for help on their techniques, so I'm not incompetent. Other department students have spent six (sometimes more) years in one lab and have produced less than I have. I have done everything ever asked of me, and more. I can think of several students who have gotten their PhD recently in my department who did all of their experiments without putting much effort into developing the projects--they did what they were told. And yet, I am still here, and they are graduated. Give me my damn PhD and let me go already!

The delayed gratification is the toughest part. I don't mean that the idea of putting off enjoyment is bad--I've functioned my entire life that way. I've always been a saver and a planner. It's pathetic, but I take some pride in not having everything I want when I want it. I feel like self-deprivation makes me a stronger person. No, I haven't had time to work that issue out yet :)

Security has always been one of my main core values. I went through not having security financially during a good chunk of my life, and I really believe that has shaped who I am.

The problem is that delayed gratification in my life no longer equals future security. That dissonance bothers me. I have twelve years of post-high school education. Twelve! And I could make more money (and have much less stress) as a waitress. That would give me equal or better ability to provide for my family--and therefore more security. It would also give me more time with them. It wouldn't be as personally fulfilling, but my own needs have always been secondary to the needs of people I care about.

And even if I wanted to have a personally fulfilling career, I could be part way through fellowship by now if I had just done medical school. I never did the dual degree program just for the monetary benefits--trust me, practicing medicine for six years (instead of doing a PhD for six) would more than pay off med school loans and cover the piddly stipend I get.

I didn't know all of this when I joined the program. I made the best decision I could at the time. But looking back, I wish I would've just done medical school. If I decided that research was something I wanted to do, I could've picked up a project in fellowship. My PhD has been so emotionally, mentally, and financially draining that I would never do it again if I had the choice. I am sure others have had better experiences--I know other people in my program have had great experiences. But if I could've looked in a crystal ball and seen what was ahead, I would've passed.

I'm going to be 30 in a few months. This is the part of my life where I was hoping all of that delayed gratification from 10-15 years ago would start paying off. It's not that I need all of the latest toys. I've never been very attached to things. But if we need to buy a car, I would like to feel like we could get a $150 a month car loan and not kill ourselves trying to pay it. I'd love to have one couch in the house that isn't 15 years (or almost 30 years) old. I wish we could afford a vacation--just enough to drive to a beach and rent a little place for a week. I don't want anything extravagant. I just want a little bit to enjoy now and again. I am glad we have made retirement saving a priority, but I wish we could be doing the same thing for Sophie and Josh's future college expenses.

I try very hard not to look at what others have around me, and I am very thankful for all of the wonderful gifts we have been given. It makes me feel very ungrateful when I wish we had more money--especially since we both have jobs, food, and a roof over our head. I just wish I had made a career choice that would have me actually contributing to the household budget in a meaningful way.

I work seven days a week, come home worn out and exhausted, contribute little to the family's finances, and have very little quality time with my family. That's why I feel like I have no control over any aspect of my life right now. I read these magazines about work-life balance, and I think about how my balance is non-existent. I am doing nothing well right now. Thank God Tim is as good with house stuff as he is. He's really doing much more than his share right now (and he's got an insane time at work right now too). I really don't know what I would do without him.

I guess at the heart of the issue is that I am too stressed to do anything well, I feel guilty about it, that stresses me more, and the frustration just builds. I know this won't last forever. I'm going back to med school in the fall, no matter what my committee might say. I'll be a little flexible on exact timing, but I will go back this year. I've earned my PhD, and even if they don't want to give it to me, my life can't handle any more delayed progress. I need to finish med school, do residency and fellowship, and move on with my life. I've been swimming against the current for six years, and I feel as though I've moved only inches. I need to break free.

The next few weeks before my meeting are going to be crazy, so this blog may be sparse. And really, you don't want to hear me be Polly Pissypants until then anyway. I'll try and post when I can (say, an evening when I haven't passed out). Just keep your fingers crossed for me. I could use all the prayers/luck/wishes that I can get.

Jitters

2010-01-25T09:35:00.004-05:00

I'm sitting in the waiting room of the hospital, not quite halfway through my 3 hour glucose tolerance test. Fun stuff. I ended up here because I failed my 1 hour glucose challenge. The same thing happened when I was pregnant with Sophie. I failed that 1 hour challenge (just barely) and then had to do the 3 hr test (which I passed).

I fasted for the 1 hour challenge with Sophie, but this time I ate breakfast. I don't know what I was thinking. Well, I sort of do: I was thinking that if I had food in my stomach, maybe it would slow the absorption of glucose and make my reading lower. Except that I ate a whole wheat bagel. At about the same time I drank the nasty orange sugar water crap. Right after I did that, I realized I'd be failing the test.

Sure enough, I failed it. I missed it by more than I did with Sophie, but I didn't have double the reading or anything crazy like that. Unfortunately, taking the 3 hour GTT is not a good time. You have to fast overnight (no big deal), and then you have to drink 100 g glucose solution on an empty stomach. THAT is terrible. I get all nauseous and jittery, but if you vomit, you have to come back and do it again. And that is not something I want to do!

You also have to sit still in the waiting room for the entire three hours. I brought my laptop with me this time, despite the spotty wireless, in the hopes that keeping busy would prevent me from realizing how terrible I am feeling. That hasn't worked 100%, but I am willing myself to not get sick.

I'm nervous about the outcome of the test. I'm hoping not to have gestational diabetes--I've been feeling fine, but that doesn't matter--but at the same time, I can't say I'd be shocked. I've been eating ok. I haven't done a lot of junk food/fried food/sweets, but I also haven't been able to cook as much from scratch. The quick fix meals we end up with a few times a week are usually high carb and as low salt/fat as they sell (which still isn't terribly low). I know my diet has been fairly carb heavy. That is something I've been meaning to change, and it will have to change if this test comes back positive.

I have a lot of emotional turmoil about this. I know that having gestational diabetes sets the baby up for future metabolic issues. I also know it means I may have another big baby. Even without the diagnosis last time, Sophie was 9 lbs. She was also overdue, which I am hoping means she would've been a little closer to an average weight had she arrived on time. Both for my sake and the baby's, I don't want to deliver another 9 pounder. I also know that having gestational diabetes means I am at increased risk for developing type II diabetes in the future. I do have some extended family members with the disease--another reason I am praying Sophie and Josh get more of Tim's genetics!

I really want to improve my diet and exercise patterns, both now and after I have the baby. I know life isn't going to get calmer, and I've got to find a way to make it a priority. I already get very little sleep--but finding another hour or so a day may have to come out of that time pool.

We'll see how the test turns out. Even if the test comes back ok, I may ask about seeing a nutritionist. I feel sort of stupid asking, since I am a medical student doing some diet-related research. It's not like I don't know what is good and bad for me. I'm looking more for some real-life suggestions that also fit in a busy schedule.

I should know how things are looking in a few days. Till then, I'll keep focusing on not puking or passing out. I don't think I'll ever be able to drink orange flavored anything ever again...

Pushing through

2010-01-23T11:08:00.002-05:00

Sorry again for the big gaps. I've been pushing through, trying to get as much done in the lab as I can so that I can be done with experiments and have my paper submitted before I go on maternity leave. That means today, and many weekends to come, will be spent in the lab. As much as I miss that time with Sophie and Tim, I can get way more done on the weekends without the constant distractions/interruptions that come with being in the lab during the week.

Last weekend was supposed to be my last weekend of freedom. My family came up to watch Sophie on Saturday night so that Tim and I could get in one date before the weekend working started up full steam. Unfortunately, he had a terrible sore throat, and I had GI issues, so we bagged date night. We did run some errands together (romantic, I know), but that was it. It's been months since the two of us went to dinner alone, and it will likely be several more months before we can do it again. Oh well, such is life. We don't really have the budget to be going out all the time anyway, so it is mandatory frugality.

Actually, date night was going to be sponsored by the medical school. I presented my research on the medical student research day and won a poster prize. The award was $150, which is big money to me! I split it up into three pools: 1/3 for maternity clothes, 1/3 for my steam mop, and 1/3 for a date night.

The maternity clothes came from the clearance section of oldnavy.com. I got six shirts/blouses and a pair of pants for $55. Unfortunately, sizing must have changed since I was pregnant with Sophie. I have one pair of old navy maternity jeans that I wear, and although they are a little loose, they fit ok. I ordered all but one shirt in the same size as the jeans. When the clothes came, they are HUGE!! And that's saying a lot coming from me--I like my clothes big. The pants were big, and I tried to shrink them. I think they'll be ok at the end of pregnancy, but I could fit another baby belly in them right now! The smaller size shirt fits ok, but the blouses (which were billowy to start with) are like muu muus. The issue is that it's $6 to return things, and since they were on clearance (and are no longer there), I can't exchange them for free. Most of the shirts are cotton, so I am going to try and purposely shrink them and see how it turns out. It was less than $6 a shirt, so I guess I can't complain too much. I'll know better if I ever order there again!

The steam mop was a better deal. I've been looking for one for a while, and the Eureka Enviro steamer got the best reviews. It was on sale at amazon.com for $65. I had $20 promo credit from a survey site I use, so I paid $45. And it has a $10 mail in rebate. For $35, it's only a little more than what I would pay for a swiffer wet jet or something similar. It came on Monday, and I've only used it once. Pros: only uses steam, so I don't have to put chemicals on the floor. It does a good job with spots and stickiness. And it supposedly steams to about 215 degrees, so it sterilizes the floor. Cons: the reviews said it blasted tough dirt off of tile. I have some caked on/worn on spots from high traffic (rubber soled shoes, etc), and that didn't really go away. That may involve lots of hands and knees scrubbing (once I can bend again). But, for $35, it's a great every day/weekly steam mop--much better than a wet mop. It doesn't leave a lot of wetness--and no stickiness from chemicals--and it's a quick job. The semi-annual scrubbing may just have to happen the old fashioned way.

And as I said, the last $50 for date night didn't happen. We ordered some Chinese for everyone instead, and it was nice to be social.

Actually, despite all of the recent busyness, I have gotten to be a little social. We've seen a lot of family, which is always nice. And I got to catch up with an MSTP friend who's also a busy mommy. I really appreciate having a wide group of people to talk to. I don't have a lot of people in each group--maybe one or two--and I don't get to catch up with them as much as I'd like. But I've got family who've known me forever, a few pre-college friends, a college friend, some MSTP mommy friends, some MSTP classmates, and some lab friends. Each group really lets me get in touch with a specific part of my life. I wish I would've done a better job of keeping up with people over time, but I think it's natural to move closer towards people you connect with and farther from people with whom you don't share as much in common.

And of course, there's Tim, who really serves as the daily sounding board. We have always gotten along really well and share similar interests. Some things don't even need to be discussed. Needing to be near a tv for football playoffs? Of course. Watching HGTV and discussing future remodeling projects? A favorite pastime for both of us. We really spend too much time together--we can always tell that we need to get out more when we start saying the same things at the same time. That is the downside of being too similar :)

I have been forced to be more efficient at home while I'm being crazy busy at work. We got Sophie's new big girl room finished. My mom put up the border on Monday, and we set up Sophie's bed, dresser, and bookcase. We aren't pushing her to use the room yet, but I think she likes it. The colors cam out very cute (after painting it several months ago, I was worried, but it all worked out). It inspired us to paint the rest of the house. We've got the living room, dining room, nursery, and last upstairs bedroom left. Home Depot had paint on sale last weekend, so we bought a few gallons to round out what we already had at home. I have no idea when we'll actually have time to paint, but when we do, I think it'll look finished (finally). Never though it'd take three years to paint the house!

I've been doing rebates and coupon clipping as much as possible too. I don't have nearly the time I used to, but I try to cherry pick the best deals. With two in daycare by the end of the year, we need to save every penny we can. Coupons/sales are one little way to help. It does add up!

I also got caught up (almost) on pictures. I had a coupon for a free photo book, so that inspired me to load the rest of the pics on the computer. I can't believe how big Sophie has gotten! I don't have the pictures on this computer, but I'll try to do better about getting a few up here and there.

My blot incubation is almost up--back to work! I'll try to be better about posting, at least on the weekends when I am in lab and have a few minutes. The next few months will be brutal, but I'm willing to do whatever it takes to be done!

Oh, and I start the third trimester tomorrow. How crazy is that?

Catch-up

2010-01-07T15:07:00.003-05:00

Sorry for the delay, but after Sophie got sick, things got crazy (not like they aren't usually). Here's the catch-up:

-We pushed back Christmas for Sophie. She was still sick later on the 24th, so we laid low at my parent's house on the 25th, came home after dinner, and pretended that the 25th was Christmas Eve. Tim read her "Twas the night before Christmas," she wore her Xmas PJs, and once she was in bed, we got ready.

-I had gotten a bunch of toys off of Craigslist for free/cheap, but they needed to be cleaned up. It took me till 11 PM to clean everything off with lysol. Tim wrapped gifts, and I started to feel sick. I had more abdominal pain than I had in labor, so I knew it was going to be a rough night.

-Sure enough, 1 AM on the 26th, I was sick. Almost seven years to the hour after I had to be hospitalized for the stomach flu, I had another terrible bout. As I was laying on the cold tile in the bathroom, I willed myself to stay awake. I was dizzy and disoriented, and I was worried that I was dehydrated. Since that caused me to go unconscious seven years ago (resulting in an ambulance ride in a blizzard), I wouldn't let myself go back to sleep until I kept some powerade down.

-I was sick all day. Really sick. Sick to the point that Tim videotaped Sophie opening her gifts because sitting upright made me almost faint. Poor Sophie.

-And I suffered some additional Christmas guilt too. I spent $13 on Sophie for Christmas. That's it. $5 for a little tikes vanity, $7 for a step 2 kitchenette, and $1 for a coloring book. The rest were Craigslist freebies (books, stuffed animals, clothes, a few games, and some learning/alphabet toys) or CVS freebies (a magna doodle and fishing game). I spent more on an exchange gift for my extended family than I did on my daughter! Luckily, she liked everything, and she got spoiled rotten by our families. Money is tight, but it's not that tight. Is there a line when getting good deals becomes being too cheap?

-I was upright on the 27th, and Tim started feeling off. He never had the full flu, but he didn't feel 100% until the 30th/31st. Since Sophie started on the 24th, that was a full week killed by the flu. We washed every piece of bedding in the house multiple times. Fun.

-And that was my week off. I didn't have a car for three days of it (one to get the window fixed, one to get the rest of my maintenance done, and an extra because the mechanic tripped the security system I didn't know I had, couldn't start the car, and had to get the dealer involved). So I was car-less and recovering for my vacation. So much for the long to-do list I had hoped to clean up.

-On New Year's Day, we finally planned to visit the extended family we didn't get to see on Christmas. And on that day, it started to snow. We made it to my mom's side, but by the time my dad's side started, the roads were horrific. We had to bail and head home.

-The next day, we headed down to visit my parents. On the way down, the car in front of me hit a deer. I saw the red spot going up the hill, but the car and the deer were just after the peak of the hill. The car was off on a side road, but the carcass was in the middle of my lane. And there was another car coming up the hill towards me. I couldn't swerve, and all I had time to do was slam on the brakes and hit it head on. It was revolting.

-My car drove ok, but the check engine light came on, and we could see a wire hanging down. I took my car into the shop (again) a few days later to get it fixed, and luckily it was an oxygen sensor, a cracked bumper (which I didn't care about--it's plastic), and a hose-down. Less than $150, no insurance involved.

-And this was the day after Tim and I talked about how my car should be up to speed for the next five years after doing $$$$ worth of maintenance to it in 2009. Figures.

-And since New Year's Day, we've been getting constant snow. On Monday night, in a brief break, we had 15 inches on the ground, with drifts over four feet tall. And it's snowed since then.

-And we're in an Alberta clipper now, which should drop 3-6 inches, with lake effect snow tomorrow potentially dropping another foot.

-Did I mention I have experiments tomorrow? And Saturday?

-And that Cleveland is only supposed to get 60 inches of snow in a winter? We'd be at almost half that in a week!

-This is the time every year when I ask, "why can't I live somewhere warmer?"

Anyway, that's been what is keeping me busy. Despite all of that, I have been really upbeat. I am looking forward to 2010. I'll get my PhD, have a baby, return to med school, and generally progress in my life. Things have felt stuck during my PhD years, especially as I watch everyone around me move on to bigger and better things. But soon, it will be my turn...

I'm hoping there is much less car drama in the near future. I would have never put that much money into my old cavalier (which started clunking at 50k miles and didn't make it to 75k). The difference is that every mechanic has told me that the car *should* run problem free for another 100k miles without more than oil changes. Let's hope so...

Money is tight, especially with daycare costs going up this year, but I am thankful that we have jobs, a house, and our health. None of those should be taken for granted ever, but especially not with what other people are facing right now.

Sure, I wish I would've gotten a vacation. I wish it would stop snowing! But I'm taking things in stride as much as I can. Now, we desperately do need to get to the grocery store soon, but I'm hoping we can make it past the next round of snow. And I have a lot of experiments scheduled. But other than those two things, I think everything else can slide for a little while.

No new year's resolutions this year. I am trying to improve many aspects of my life slowly, and I feel more successful without imposing start/stop times. Life in general is a work in progress.

I'll try to be back sooner rather than later. If I get snowed in, you may hear from me more than you might want :)

Merry Christmas Eve

2009-12-24T09:46:00.003-05:00

It's already been a day (and a week) of ups and downs. Tuesday was a good day at work (minus a few frustrations): drew bloods myself on rats successfully, figured out a problem I've been having with my Western blots, and did a steroid knee injection on a patient (with supervision, of course). Wednesday involved a nice lunch with a friend but not a lot of sleep and a ton of anxiety, due to my sister's surgery.

Jen is doing much better today and should be discharged soon. I'm scheduled to take the evening shift with her, but that may be complicated. This morning, Sophie woke up vomiting. This is the second time since she's been born that she's thrown up--she did it once when she was six months old, and that's it. We've made up for it with respiratory stuff, but the GI's been pretty good (she didn't get that from me).

It hasn't been bile-y vomit--no need to go into a ton of detail, but I think it might be more that the house is dry and she has some drainage that is making her gag. No fever, she's very active and wants to play, and she just seems...fine.

Tim's going to stay with her tonight while I'm with Jen, just to be safe. He's not heartbroken about missing his family's Christmas--for once, the drama has been on his side of the family and not mine. We're really playing all of Christmas by ear. It all depends on how Jen and Sophie are doing.

I think Jen's surgery was even more serious than any of us expected. They actually took her top jaw, moved it forward, rotated it, and pulled it down in the back. They also did some work on her septum and lip, and they actually had to move the facial nerve a bit. She'll permanently have plates and screws, and she can't chew for six weeks, but since they didn't have to do the work on her lower jaw, she doesn't have to be wired shut.

I guess she is night and day compared to yesterday. I didn't get to see her yet, but I can't wait to spend some time with her. I was very relieved to get the update that things are going well. Not that there is anything I could've done, but that didn't stop me from worrying.

So, it may end up being a bit of a chaotic Christmas, but I think in a way it's really working to reinforce what's important: spending time with family. I'm looking forward to mass tomorrow to get back in tune with the reason for the season, but prioritizing around what is best for family makes Christmas seem even more important. As my mom said, this is one year. Next year we can be back to the usual. For now, we'll try and see extended family when we can, but if it can't happen at the big events, we'll make some personal visits over the next week and try to catch up.

It's been a good but exhausting week, and I'm sure that will continue for the next few days. I just want to say Merry Christmas, and I hope that this holiday brings you together with the people that are important in your life.

Pictures, part 2

2009-12-20T20:35:00.003-05:00

So I am even FARTHER behind in the picture department than I originally thought. I went to update the computer, and I haven't taken pictures off since August. Oops.

Lots happened between then and now, so I'll just give you two pics for now. One is from Halloween--I actually didn't have a lot of success with the posed pics this year, but here's the best of those:

And one from yesterday, before we went to dinner at my friend's house:Looking over the pictures, I can't believe how much she's changed over the last few months. I really need to keep up better. And it's not going to get easier with two (and then med school, and residency, and fellowship...)

Pictures, round 1

2009-12-20T19:37:00.004-05:00

Way behind on blogging (as I am with most things in my life right now), but I did finally get scans into the computer. Here are a few of the pics from the recent ultrasound (minus the money shot, but trust me, it's a boy!) Some of them are grainy, thanks to the scanner I am using, but you get the idea.

I would like to introduce you to Joshua Timothy...

2-d ultrasound, profile shot.

Hard to see on this image, but the right and left feet and toes.

These views always look a little creepy, but it's as if he's looking at you (you can see the eye and nose openings).

I didn't realize we'd get a 3-D ultrasound, but once the doc came in, he just started getting pic after pic. Totally amazing. He didn't print them all, but it was so cool to see. This is the left hand (look in the mid-right bottom area).

In this one, you can see both his arms covering his face. You can just see his nose and mouth. He had his arms covering his face for most of the visit.

This is a 3-D profile, looking at the left side of his face. You can see his arm, hand, shoulder, ear, nose, and eye. This was even clearer on the screen when we were there, and the doctor could rotate the picture for us. Totally amazing (a word we used a lot).

The doctor kept trying to get us a clear face forward shot, but the baby kept moving his head. That's why the face looks a little elongated. But you can see part of his face, abdomen, and his leg curling up.

The doctor got some other shots, including this absolutely astounding reconstruction of the spine. He rotated it so you could count every vertebrae and rib. We were pretty cheesed at having to wait two hours to be seen, but the tech and doctor spend an hour and a half with us, so that made up for it. We saw the organs, including multiple amazing shots of the heart beating. I wish they took video here. I could watch it over and over.

There's lots to talk about regarding the baby, including my personal feelings on finding out it was a boy. That may have to wait till later this week when I have some time at home. For now, I'm going to head to the other computer to upload Sophie pictures (I haven't done it since before Halloween...)

Big ultrasound news

2009-12-09T18:28:00.001-05:00

After waiting two hours to be seen, we got to see pictures of the baby. And it was totally worth it. I have a dinner to go to tonight, but I'll scan some pictures later. The big news is...

It's a boy!

No doubt about that one, either :)

Focus

2009-12-07T10:20:00.002-05:00

I am completely distracted today. Sophie is home sick with a fever and nasty cough. However, I am not distracted because I am home with her. I am distracted because I am NOT home with her. My mom was kind enough to come up and watch Sophie so that Tim and I could go to work today. I have complete faith in my mom--she did deal with five different sick kids over the last thirty years. It's that I want to be the one home taking care of Sophie. I'm her mom.

Yesterday actually brought me a lot of comfort--I hope it did for Sophie too. Just being still and doing nothing but being with Sophie helped me get my priorities in line a bit. Sophie, Tim, and I never really made it out of pajamas. Tim and I took turns holding Sophie and taking care of her. That's the entirety of what we accomplished yesterday. For as bad as I feel for Sophie when she is sick, it's so wonderful to be able to take care of her and know that she wants to be snuggled and comforted. All she wanted was to be by Tim and me.

And then to be able to call my mom last night and have her come up today--it reminded me why it's so nice being near family.

I have a ton to do this week at work, as does Tim, which is why we asked my mom to come up in the first place. But being here completely goes against what I remembered is important yesterday--family. I know Sophie is in good hands. I want them to be my hands.

This has been a serendipitous week for me. At the same time that I've been debating what I personally want from my life, I've come across a lot of papers and editorials talking about women physician scientists. The theme is that they are funded much less frequently than men (although when they are funded, they are funded for more money). The fundamental question is: are women funded less often because they are not capable, or is it because they are choosing not to pursue the same path as men physician scientists? Overwhelmingly, the consensus has been that it is choice. The fact that funded women are funded at a higher amount than men would suggest that they are equally competent, if not more so. All of the personal accounts seem to suggest it is a choice made by women to have a career that allows them to also have a personal life.

I see myself moving toward that trend. In college, I had every expectation of completing my MD/PhD program, getting a high powered residency/fellowship, starting a lab, and striving to be successful at a well respected academic institution.

I've seen myself change. My personal lab experiences have led me to move away from wanting to fund and run my own lab. Starting a family has made me re-evaluate the goal of a career. Do I want to be the best, to receive recognition from people in my field? Or do I want to do well but be content with a smaller contribution to my field?

Part of the reason I chose to do an MD/PhD program in the first place was to set myself up for option #1 above. I told myself that, as a clinician, I could help individual patients, but as a researcher, I could change the course of a disease for millions of people. Yes, that is a naive statement, but fundamentally, I think it is true. The issue is that most research isn't geared towards breakthroughs. People pick a problem, or a protein, or some small piece that they want to study and be the expert on. They publish, they get funding, but only rarely is it important to anyone outside of their niche. True valuable translational research is hard to do. It doesn't always work. And you have to be comfortable moving to whatever technique you need to do to answer a question. It's tough. But it's important.

Of the three labs I've been in, my current project has the most translational value. Even then, it is years, maybe decades, away from actually impacting patients. IF I could find a way to do more translational research, I might consider running a lab. But right now, despite my earlier desire to help millions of patients instead of a few thousand, I'm leaning towards clinical practice.

And if clinical is the way I want to go, getting the absolute best residency/fellowship is less of a "have to" and more of a bonus. I don't want to take a step down--I'm currently in a top 25 med school, and I'd like to stay around there ranking-wise for residency. But do I need to do the absolute best? I don't think so. I need to be trained well. But if clinic is my focus, my patients won't pick me based on where I did residency or fellowship (ok, some might, but most won't). I'll attract patients and find jobs based on my skills and my referrals.

It all comes back to my goals. If I wanted to follow my original path and be a well recognized lab, I would go for it. I'm stubborn--I'll try anything if I have my heart set on it. But I know the sacrifice that would take. And I'm not sure that the personal satisfaction of research can equal the satisfaction I get from my family. That's just me.

Having said that, I also couldn't give up a career entirely. That's also me. I've said it before--more power to stay at home moms, but that's not who I am. I want a career, and I love science and medicine. As long as I can have a family life and a career, I want both.

I understand I have a little under a year left of the PhD, two years of med school, three years of residency, and probably three years of fellowship left. A lot can change in that time. But for where I am right now in my life, I feel as though I owe it to Sophie and baby #2 to try and balance family and career as much as I can. If that means staying near family for a while, that's fine. I know people do residencies with kids in cities where they know no one. I give them a lot of credit. But if I have the option to stay in Cleveland for some of my training, I'm not going to turn it down just to tell people that I did things the hard way and succeeded. A lot of people don't have that option. I'm lucky enough to be someone that does.

I still think the best chance for us to move out of town is for fellowship. Depending on what I decide to specialize in, moving may be the only option. That's still at least six years down the road. We'll see where I am in my life then. Having moved a lot as a school age child, I can tell you that wherever we move, I want to get a job there. I don't want to be yanking kids out of school every few years to find another place for training/employment. There's another reason to not have a lab--I'd like some control over my geography.

Anyway, Tim and I had a few conversations this weekend that went along with the idea of focusing on what is best for our family. Maybe I'll get to those sometime this week. It was just a very clarifying weekend for me. I feel like I'm more sure of what is important and what is not.

And one of those important things is home sick. But I'm trying to focus on how appreciative I am that we have family that can take care of her, how important it is that I finish what I need to do in lab so I can move on with my training, and how quickly today will go.

I may not have accomplished much physically this weekend, but mentally, it was good for me. Now, if I could have an equally productive weekend with my to-do list, I might someday be caught up!

On a more upbeat note...

2009-12-01T10:21:00.004-05:00

I can't credit the source of this pic, since I got it through an email forward, but I thought it was funny:

How Pumpkin Pies are Made:

2009-11-30T13:39:00.003-05:00

Oh my god, this cartoon is so my life right now. It's courtesy of my weekly pregnancy emails from babycenter.com. I had an absolute meltdown (ok, it was all mental, but a meltdown none the less). I woke up Thanksgiving morning and couldn't find any clothes that fit. The pants were ok, but all of the shirts hugged all of the wrong places. I must've changed outfits ten times.

I finally settled on something non-maternity, but it still obviously showed off my growing belly. Since I carry most of my weight in the stomach/hips/rear area anyway, I was definitely borderline between the "is she pregnant?"/"did she gain weight?" areas. Seeing as how I have almost ten years of serious body image issues, this is not a good place for me to be.

I got over it and was doing ok until Tim's cousin came after dinner and said, "oh, I totally forgot you were pregnant until I saw you!" She was trying to be nice, but it put me over. I sucked it up and smiled, but that didn't help my mood.

Yes, I am 18 weeks pregnant. Yes, I've gained a few pounds (still less than five, thank goodness). But I'm not ready for my body to be changing. And my wardrobe is definitely not ready. I have some way pregnancy pants that don't stay up yet, and I have two pairs of dress pants that have kindly been handed down, but I am otherwise between clothes. And about 95% of what I bought with Sophie is shorts/t shirts/tank tops. Not good for a winter pregnancy.

I know I will feel better if I invest in some decent maternity clothes. However, it is not in the budget (and definitely not when 50% off is still $20 per piece of clothing!). I am going to start hitting thrift stores soon, but with none nearby (and even less time to go shopping for them), I need to improvise.

I am happy to be having a baby. I am not happy to be pregnant. I've never felt glowing/radiant/full of life like all of those women's ads suggest. I feel frumpy and huge and sick all the time. The end result is totally worth it, but I could fast forward through the pregnancy and be fine. Even 16 hours of labor with three hours of nonstop pushing with a failed epidural is better than pregnancy. At least that is over in less than a day.

I am trying to enjoy it. We will hopefully find out the sex next week, and I should feel the baby at all/more regularly in the coming days (I'm not sure what I've felt so far is baby). Those are all positives. I just needed to vent a little bit about the negatives.

I know I am going to have to accept that I am getting bigger. I went through this when I was pregnant with Sophie. Once I am as big as a house, there is less doubt about what caused it. But for now, it's just a tough transition.

Also, I did not accomplish nearly anything on my to-do list over the break, but I am working on it. More upbeat posts (and hopefully pictures) to come in the near future...

Why do I always do that?

2009-11-25T10:14:00.003-05:00

So, I of course posted last time about how I was feeling more human.

And then I had almost a week of feeling like garbage. Maybe I'll just keep my mouth shut the next time I'm feeling well :)

Thursday it was nausea and dizzyness, Friday was better, and then Saturday it returned and worsened. Saturday night I started getting a headache, and Sunday it turned into a migraine. All I can take is tylenol, which does nothing, so I dealt with it as best I could. I got less than an hour of sleep Sunday night. Of course, that made the migraine worse, and I was forced to stay home and try to take care of it with rest as best I can. At its worst, I was dizzy and nauseous to even sit upright. Good times.

I've still got a bit of the dizzyness and nausea, but the headache is down to more of a tension type headache. I didn't sleep well last night, and the more time goes on, the more I think my lack of sleep is worsening how I feel. That seems obvious, but I've coped on 3-4 hours of sleep a night for about two years and done ok. That just may not be compatible with this pregnancy. I don't know how I am going to sleep better, but I have to find a way.

Today will hopefully be a short day--I'm waiting for some antibodies to arrive, but after that, I'll hopefully be able to leave a little early. Maybe I'll get a nap in--we'll see. I also have a huge to-do list that is calling my name...

Hopefully having Thursday, Friday, Saturday, and Sunday off will give me a chance to do some housecleaning (literally and figuratively). I'll try to catch up on pictures and everything else if I can. Have a happy turkey day!

Umm, surprise?

2009-11-18T10:41:00.003-05:00

I have all of these things going on right now, but I noticed that all of them need one tiny piece of information that I haven't told you about yet.

I'm pregnant. Surprise!

Ok, in no way was this a surprise. First, I'm 16 weeks 3 days today, so I've known for some time. Second, this pregnancy was completely planned. Third, it happened the first month we tried (which I guess was the only semi-surprise of the entire thing).

I had my 16 week visit this morning, and things are good. The results from the first screen a few weeks ago (an ultrasound and a blood test) were that we are in the lowest risk group possible for Down's syndrome and trisomy 13/18. Very good news. The baby was very active on the ultrasound a few weeks ago (yes, much to Tim's chagrin, there is only one baby. I'm thrilled about that). So far, so good with everything they could check.

I have been wicked sick up until last week. That's partly why the posting has been sporadic. I've had constant nausea, and I'm exhausted. And I couldn't tell you why I was sick and exhausted. So I just didn't post much.

The nausea meant that I didn't gain any weight until last week (thanks, a whole week of restaurant food...). And it's only about two pounds at this point. I'm fine with that, my doctor's fine with that, and it's not like I didn't have a whole bunch of energy reserves before I got pregnant.

Just last week I started feeling almost human again. And this week, I am hungry. ALL THE TIME. There are still a lot of foods that don't sound great, and no food cravings yet. But I am always starving. I'm not eating constantly--no need to make up for lost time on the weight gain--but if you put food in front of me, it's gone.

So why the wait to share the news? Well, I told my boss right away, and she suggested we keep it a bit quiet for a while. This was partly because she figured it wasn't anyone's right to know--if it doesn't affect my progress, people shouldn't care. Partly it was because of the issues I had with Dr. B last time (who is still on my committee). And partly it was because things can go wrong early on. Unlike Sophie, we told all the family right away this time. And I was actually ok with the idea of just putting it out there at work as soon as we knew. But, waiting was fine too.

Since there is such an overlap between the blog/facebook/work life/real life, it hasn't been easy keeping it on the DL. I told the entire lab a few weeks ago at lab meeting, and word has slowly been moving around since then.

I'm not ashamed of the pregnancy, and I'm fine with people knowing it was planned. We had a several month window between the end of grad school and the beginning of med school, and that's what we aimed for. We hit the beginning of that window (I'm due May 2nd). It won't impede my grad school progress. And I'll be able to finish maternity leave before I go back to med school. It's all good.

So now I can explain to you why my moods are swinging everywhere, why I'm tired all the time, and why we now have to go car shopping. No, we won't be moving this time (thank God!)

I'll try and catch you up on some of the more topical stuff in the near future. It is nice to know that I can speak freely now without worrying about slipping :) The last ultrasound didn't give us very good pictures, but we have the anatomy ultrasound on December 9, so I should have some pictures then.

Just wanted you to know Bucky's good (Baby Under Construction, same as Sophie was), Sophie's thrilled, and Tim and I couldn't be happier. Sophie's new thing is walking up to me, lifting my shirt, and saying, "baby come out?" She's sung Bucky songs, given kisses and hugs, and now has a thing for baby dolls that she can dress/change/feed/push in a stroller. I think she'll be a great big sister :)

I guess I was due

2009-11-13T10:46:00.002-05:00

I haven't had a real bummer of a day in some time. Tim said he really can't think of any since I left Dr. B's lab over a year ago, so I guess that is a good thing. Yesterday, I guess I was just due for one. I'm feeling a little ill (I think it's more from traveling than an actual illness), I'm tired, I miss my family, and I'm just generally feeling burnt out.

So, I guess that is a predisposing condition for feeling bummed. Then I got an email about a proposal I had written, and it was (not so nicely) rejected. Not the end of the world, but added to how I was already feeling, it just put me over the edge. Tim was working late, so I didn't get the chance to talk to him until late last night.

It just wasn't a good day. Talking to Tim made me feel much better, but there's something about feeling down that just makes the world seem tougher. Anyway, I feel better today. It helps that I am going to be home tomorrow. Salt Lake City is beautiful, but without a car, I'm feeling a bit trapped. There is nothing even close to walking distance by the hotel, so with the exception of Wednesday night (which I will recount to you when I get time), I've been stuck in the hotel alone every night. This is also the longest I've been away from Sophie and Tim since, well, ever.

One more long day in lab, and then it's a long day of flights tomorrow. But at least I'll get to (not) sleep in my own bed! Yeah, apparently insomnia doesn't stay in Ohio for me...

Salt Lake City

2009-11-11T13:03:00.002-05:00

I'm in Salt Lake City this week, and my computer has decided to connect to the internet for the first time this week! Not sure how long I'll have it, but just wanted to say hey while I had the chance. Hopefully I'll have time for a full update in the near future.

Come hear me speak!

2009-11-06T20:31:00.002-05:00

I gave two versions of my talk today to school groups, but if you want to come out, here's the deal. And not that all the below info doesn't have the real contact info on the web, but just not to advertise personal info too much, that junk has been removed.

Speaker Series Schedule 2009-2010

BioMedTech’s Speaker Series features interactive presentations from leading experts in the field of biomedical technology and engineering. Check back for more up-to-date information.

Saturday, November 7, 2009 at 12:00 PM – General Visitors
Topic: Diabetes: Causes and Consequences
Presented by Kate X, Bridgette X, and Chep X, Ph.D. Candidates, (my school).

In recognition of American Diabetes Month, graduate student researchers will engage the public in understanding the causes and consequences of diabetes, specifically diabetic blindness and heart disease. Students will utilize hands-on demonstrations to explore the anatomy of the eye, simulate vision with diabetic retinopathy (blindness), and observe the fat-sugar-protein ratios in common foods.

Presentation is free with paid admission to Great Lakes Science Center. Space is limited. No reservations required.

Hooray for shots!

2009-11-02T09:43:00.002-05:00

I got my seasonal shot on Friday, and I found an H1N1 clinic that is giving the injectable dose tomorrow for Tier 1 groups. Both Sophie and I classify as Tier 1, so we are preregistered and good to go for shots tomorrow. Tim's family has had at least two (maybe more) confirmed cases of swine flu going around. We actually cancelled dinner with his family last night just to be safe--his cousin was home from work for three days with flu, and his aunt wasn't feeling well. Better to be safe than sorry!

And now, I'll have both flu shots before I travel next week. I feel much better about that. Unfortunately, Tim isn't in the high risk group, so he has to wait a bit for the H1N1. His company is doing flu shots next week at work, so at least he'll have that.

I never thought I'd be so happy to get two shots in one week. But I am!

Another note

2009-10-30T10:56:00.001-04:00

On another note, I'll have updates from Sophie's big 2-year-old birthday party last week (I'm trying to figure out how to do short videos from longer videos), and I'll have some Halloween pics soon too. It's been wicked busy at work, and Tim's been working late for a project, so I haven't had a lot of time this week. More complete update coming next week, I promise!

Note of the day

2009-10-30T09:42:00.001-04:00

Just saw this on Yahoo, and thought I'd pass it along--my last comment about flu shots, I promise (and I finally found someone that has them--I'm getting mine today!)

When moms get flu shot, baby benefits too: study

Travel

2009-10-22T12:02:00.004-04:00

I just booked a trip to Salt Lake City for work. There's a collaborator there who is going to teach me a technique that will hopefully help me finish up my project. The city looks like a beautiful place, and the university overlooks a large, undeveloped expanse of wilderness. I won't have time for sight-seeing, since the whole point of the trip is to get as much work done as possible, but I'm excited that I get to venture out to a new city.

It reminded me of another trip that involved lots of travel and not a lot of sight seeing:
It's been over three years since Tim and I drove with my sister to her new job in California. Yes, the white dots were the stops; we foolishly attempted to drive from Cleveland to Amarillo, Texas, in one day. I guess it wasn't an attempt--we did it, but it wasn't fun. And Missouri is still dead to me. The rest of the trip was nice (except for the emergency stop in Gallup). We visited family in Phoenix, and I really loved how beautiful the Southwest was (but man, it was HOT!).

Someday, I'd like to fly out to New Mexico and drive around the west/Southwest. I don't see too much of a need to see the middle of the country--I'm sure it's nice and all, but I do live in Ohio, and it didn't seem that different. Someday, when I make non-student money, Tim and I actually have vacation time, and our current/future children are either old enough to enjoy the trip or are out of the house, we'll take a long vacation. A girl can dream...

And my sister's still out in CA, although she's thinking of going even farther west. What's farther west than California? Japan. Yep, she wants to teach in Japan. No matter what you think, we are genetically related--she's the adventurer, and I'm the homebody. I just live vicariously through her adventures, and she gets to hear about poopy diapers and time outs from me. Maybe that's why she wants to move farther away...

Mis-information

2009-10-15T12:43:00.002-04:00

I am somehow now involved in an online pissing match with someone I don't even know on Facebook. It started off that a mutual acquaintance mentioned he was unsure about the swine flu vaccine. By the time I saw the post, a person had posted that the swine flu is made up and the vaccine is more dangerous than the disease. I tried to nicely state that, scientifically, that isn't the case, and she went nuts. I'm so tempted to ramp things up--there's been so much misinformation about the vaccines that I almost lose it every time I hear people spread lies. But, I've decided to just stop checking Facebook for a while. I'm trying to be the calmer, if not better, person.

Just last week, I was driving home, and this stupid shock jock radio host (who I only listen to in order to get traffic reports on the tens) had on an osteopathic practitioner (disclaimer: I have no inherent problems with osteopaths) who claimed that cancer was a vitamin imbalance, modern medicine does nothing for disease, and the flu and H1N1 vaccines were completely unnecessary and even dangerous because of the link between vaccinations and autism/other diseases (which she didn't elaborate on).

First, that autism link is anecdotal, and clinical trials have not shown a correlation. Second, she used bad statistics to say that more people will be hit by lightning than die from swine flu. While, at the time, about 300 people had been confirmed to be killed by H1N1 in the US (that number has risen), if this becomes an epidemic, that number isn't static. As another caller pointed out, that's like saying that since AIDS deaths in the early 80s only killed a few hundred people, it wasn't a public health concern.

I'm still thinking that this H1N1 won't be a massive killing machine, or at least not much worse than seasonal flu (I believe the statistic is that 36,000 die from seasonal flu every year--I'll try to confirm that), I think it is completely irresponsible to fear monger about the ingredients in the vaccine. Give people the proper information and let them decide for themselves! I'm on the list for both the seasonal and the H1N1 shots here. I can't make anyone do anything, but telling them that they'll suffer harm from the inert ingredients is unconscionable. Misinformation makes me crazy, and yet it is such a huge part of what I see every day. I'm lucky enough to work with well educated, scientific minds (for the most part). People are generally rational. Not the case in most of the rest of my world.

I feel that whole cliche, "with great power comes great responsibility." I'm lucky enough to have received (and I continue to receive) a medical education--I feel as though it's part of my job to stop the flow of bad information. I just can't take it too personally when I'm not successful every time.

2009-10-13T20:24:00.001-04:00

Busy, busy, and an update coming soon, I promise. Till then, I've been pretty skimpy on the pictures. Here's Sophie's school picture, which we just got back today. And they were able to photo shop out her black eye--hooray!

The general ick

2009-09-24T09:06:00.003-04:00

Long time, I know. It's tough to get out of the habit--weeks go by, and I feel like there's nothing so important that I need to blog right now, but I also don't want to just rehash the same old stuff that's been going on every day. Right now, I'm recovering from a disgusting GI thing I've had for the last week. I've been a little off for a few weeks now, but Sunday I was very faint, pale, and dizzy. Then Tuesday night, things erupted (not in a good way), and I had to stay close to a bathroom yesterday. Today I can at least sit upright for more than a few minutes at a time, but I don't feel great. Sophie and Tim had a little touch of it, but as usual, my GI system reacted much worse than theirs.

This whole illness thing has continued to make me realize how nice it is to have family in town. Poor Tim and Sophie have had to fend for themselves food-wise for a few weeks, and although Tim's been doing as much cleaning and maintenance as he can, I had fallen way behind on things like dishes. Sunday night my parents, Jen, and Joe came up. They played with Sophie, they brought steaks to grill and potatoes to mash, Mom washed all my piling-up dishes, and they generally took care of things so I could try to not puke. It was amazing.

Sometimes it's tough to be so close to family. Thank goodness the drama has been pretty calm recently, but that is a very stressful thing when you are a short drive away. At those times, I'm a bit envious of my sister in California, who realistically cannot be expected to fly out every time something goes bad. But really, 99.9% of the time, I love it.

There are the obligations to all the family events (for both Tim and my sides)--which can be very enjoyable, but there are some weekends where all I want to do is relax. That's not a good excuse for missing a graduation party or something similar. Tim and I have instituted a few guidelines--for instance, if we don't get a direct invite via mail/phone/email/etc, then we aren't obligated to go. Posting something on a fridge or sending something to my parents (and expecting it to get to us) aren't enough. We've been married since 2002, and almost everyone is on facebook--there are plenty of easy ways to get a hold of us. There are some exceptions--picnics are almost always word of mouth, and Tim's family is small enough that very rarely are invites sent for anything. We do our best for those. But, if we get an invite, it goes on the calendar, and we do everything to be there.

I do feel like we are busy almost every weekend. We had talked about going into Pittsburgh this weekend to visit a few friends and see the zoo/museums, but between me feeling crappy and the G20 summit, that visit will have to wait. I am going into work on Saturday for a few hours--I took yesterday off to be sick at home (I actually tried to come in but didn't even make it on to the highway), so I'm going to make up some experiment time. Which I don't mind at all--one weekend here or there is nothing like what it used to be!

I do have pictures and things to post at some point. However, I consider the day a success if I shower, go to work, attempt to eat, and get Sophie fed. If I have to crash at 7 PM (which I have), so be it. I can't add anything to my to-do list until I am feeling a bit better. I'll try to blog when I can, but again, no promises. I will hopefully do better than once or twice a month. But we'll see when this bug lets up.

Added: so I reread this and realized I got totally off topic. I'd blame the bug, but I have a habit of that when I am healthy. Anyway, my point was that it's been wonderful to have family around to help, and it's going to be tough to leave for residency. I don't know what the future holds yet, but if there's a way I can have the career I want without having to move, I would definitely consider it. That decision is still years away, but it's going to take some serious convincing to get me to leave willingly. Either that, or I have to pack up my family and move them with us. I'm thinking that's not so likely :)

One of those days

2009-09-02T11:04:00.002-04:00

Lots of fun things to talk about from last week--my sister was in town from CA, and there were lots of family outings together.

But for today, a little venting: why have a schedule if you don't follow it? I am doing PET scans today, and I was supposed to be doing them tomorrow. We've been on the schedule for weeks--it was told to us that we HAD to be on the schedule to reserve scanner time. We obeyed and have been very diligent about updating the schedule as needed.

Yesterday, I met with the PI and the student that are collaborating with us on the PET study. The student has a class in the AM, so we had to work out who would help me in the mornings. We set everything up, and I was done with that meeting by about 10 AM.

At 11:30, I get an email that they want to move experiments to Wednesday (today) instead of Thursday, citing that there is another group who will have animals ready on Thursday. This group has helped me with catheters in my rats, so I felt obligated to move.

Trouble is, there was a dissertation defense from 11-12, and I leave for the VA at 12:15. So in 15 minutes, I had to completely move experiments around. I luckily had someone that could fast my rats for me at the proper time, but I had to get in super early to make solutions and everything this morning. And since things were changed at the last minute, the student who usually helps me had other commitments for most of the day.

This means that the experiments have been totally disorganized. Apparently our transmission scan didn't work, so we'll try that again. Hopefully the emission scans are working or else we have to scrap all of the experiments. It's been nuts trying to get everyone on the same page. And this is only the first rat of the day!

I'm a planner. I like being organized. I set out a schedule for myself for the week and try to follow it as best as I can. Changing things at the absolute last minute (especially when using the schedule has been harped on so frequently) is absolutely aggravating. Still, I am the lowest person on the totem pole, so I suck it up and deal.

Oh well. Hopefully the next animal will go more smoothly. For what we are paying to do these studies (not to mention the time commitment on my part), I'm going to be pretty ticked if these experiments don't work because we got off schedule.

Crazy talk

Baby recap

He's here!

Progress, and lack thereof...

Hello 35 weeks

Coming soon

Catch-up, part one

How time flies

Another toddler

8 days

Bummer of a day

Full circle

MIA

Long time no blog

Peds recap

Nearing a break

Neuro rundown

Done!

Peds, week one

Psych redux

As posted on Facebook

It's 11 PM on a beautiful Saturday night. The kids are both asleep. What are we doing? I'm working at home, writing my thesis, and Tim went back to the office to do work. We'll both be up way past our bedtimes, and not even for very fun reasons. When did we get so old?

Sweet dreams?

New Beginnings

Transitions

Oh crap

As posted on Facebook:

PAPER IS IN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!It needs minor revisions, but they (hopefully) won't be a problem.I get to go back to med school!!!HOLY CRAP, I'M FINALLY GOING TO FINISH MY PHD!!!!!!!!!!!!!!!!!!!

Making money

Quick break

Omen?

Family history

Change of pace

Worth the read

Routine

Once again

Not where I want to be

Good intentions

Better

Honesty

Forgetfulness

Finally, a picture

Quickie

So excited

The end is in sight

Totally bummed

Quick article link

Cross your fingers

3-0

The waiting game

Baby watch, week (almost) 37

IOU

That was fast

Cars

Patience

Cracks me up

Birthing a linebacker

Wish I had something exciting--sorry!

Rest of the recap

Twilight zone

Interesting article

Better

Great

Coping

Boiling over

Jitters

Pushing through

Catch-up

Merry Christmas Eve

Pictures, part 2

Pictures, round 1

Big ultrasound news

Focus

On a more upbeat note...

Why do I always do that?

Umm, surprise?

I guess I was due

Salt Lake City

Come hear me speak!

Hooray for shots!

PAPER IS IN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
It needs minor revisions, but they (hopefully) won't be a problem.
I get to go back to med school!!!
HOLY CRAP, I'M FINALLY GOING TO FINISH MY PHD!!!!!!!!!!!!!!!!!!!