Children Keep Dancing…

There are a million things to say about Kenya which I can’t even begin to process

Today I started my peds ortho away with my childhood doctor. For starters there are ghosts, memories, hopes, dreams, sleepless nights, screaming, pain, sweat, blood and tears behind every corner even with the remodel of the hospital the worst and yes even some of the best of my childhood is contained within these walls. I tred carefully for as has been the theme of the last week I stand on sacred ground.

As I child I feared/loved my doctor and he haunted my steps at times, made me think before I lept. Now he is my attending. A strange change of power….its odd for him too. About half the time he introduces me as his former patient, the other half as a random med student.  He teaches me quite passionately and patiently. he is far more patient with me sitting in the OR or struggling with my sewing than any surgery attending I have ever had. Of course he is. But I am wary with him,  its awkward a lot but it works best when he is teaching me as my attending and not trying to process the oddness of me at 25 grown up, on my own and not his patient.

There are strange moments though where its very hard for me to sit back and play med student.  I scrubbed in on a Cervical fusion today (ha!). The induction took a looooooooooong time. It was a skeletal dysplasia kid, one of my kin.  The neurosurgeon made several jabs about how my doctor’s “population” always took this long.  I bristled, my face was hot. hey buddy, those are my people.  I remember once there was a ENT who made several really unnecessary comments about Chinese  students with a Chinese student sitting right there.   I remember thinking what an idiot for not even noticing the med student was Chinese for crying out loud. But here I was pierre robin in all siting there staring at this highly educated doctor and I realized that he had no clue.

In a way it made me happy. Sometimes I forget that I can do this. Blend in if I am sitting. Later in the case he starts to inquire what a good Southern girl n from such a good school was doing in Delaware.  I told him I was referred here as a child, he looks at me and still doesn’t see it. Finally my doctor rescues him, she has Kniest…she is just tall.

Good for her, neurosurgeon says

Not good for her orthopod says

Honestly its all I have known I am neutral on it at the worst, I say really not wanting to debate my perspective on losing/winning the genetic lottery for the whole OR.

then they go talking about how people with conditions go into what they know.

I was glad more than anything that the secret was out I felt so much more at home among my people than I did in the blue scrubs.

African Arrival

Jan 6 will remain as one of the craziest most out control days of my life. I awoke at 6AM in Balitmore, at noon I was interviewing at Johns Hopkins and by midnight I was crossing the Irish Sea by air.  I wouldn’t recommend it honestly. By the time I got to London, I was totally fried. It has snowed there the day before and everything was terribly backed up in DC becuase all London flights had been canceled. I nearly missed my flight because I couldnt’ get through the lines. I got the 3rd degree in security between the new shiny hip and  many strange tools one carries in a carry-on to go be a doctor in Africa.  I did though have the amazing blessing of being ugraded to business class. And while that was pretty spectaclar I felt like an idiot because I couldn’t figure out to make the bed thing work or the TV or really anything. But I can say I have now flown first class on an overseas flight. The rumors are true, there is real silverware, free wine and flat beds.

London was beautiful from the air, the english countryside was bathed in white.  My connection went flawlessly and although my flight got delayed a bit on the ground it was a great flight. One I will never forget. I watched the map program every couple of minutes once we hit the Med. Sea wanting to see the coast of Africa as we crossed it. It was beautiful and shockingly different than the coast we left behind in Italy.  I watched the sunset of Sudan and by the time we entered Kenya, I couldn’t sit still with excitement. The last time I did this whole go to a new country/new continent thing on my own I was 19 on my way to Romania. I was considerably less freaked this time around. I got my visa without problem despite the fact I accidentally left my original copy of my yellow fever vaccination in America on my scanner. All of my luggage made it and I was picked up by a kind man named George who took me to the Mayfield guesthouse. The guesthouse is lovely, full of  African art, mosquito nets and people from all over Africa who are passing through. I shared a room with a lovely girl from Ireland who is going to teach in a primary school in the North of Kenya.

I didn’t sleep much but I enjoyed what little I did get. I woke up early since my roommate was on her way north.  Took a shower, felt human and then explored the guest house. We eat meals family style here. The rest of the medical team that was supposed to meet me in London finally made it. Two of them will come to Kijabe with me. While they slept I went to orientation at the AIM office. I also saw Nairobi by day.  The smell is a cross between the humid, thick magic of a Carolina magic and the strange pugant tang that I associte with Bucharest. I am not sure if its a city smell or a developing world smell but it smells like home. Kenya has had two years of drought but its been raining and everything is green and there are many flowers.

Orientation was oddly interesting we talked a lot about the history of Kenya and plans for medical missions here in Kenya. I will write more tomorrow once I reach Kijabe. For now I am exhausted…

Snowed IN Rank list

I have been blog slacking…mostly because I have been living in my car for the last 3 weeks interviewing all over for my peds residency. Its been quite the ride. I loved some programs, hated some programs, had a fender bender, driven over 2500+ miles on my car and been in 10 states.I listened to 2/3rds of my Lord of the Rings on Audiobook unabridged that should indicate how much of my life has been in the car.  sigh. On top of that craziness in the middle I got a call from a top program that I had not heard from saying there was a computer glitch….I canceled an interview to fit them in.  I also bought a plane ticket so I could go from Texas to NC to VA to Ohio in less than 36 hours.

Now I am on Day 3 of being snowed in under two feet of snow at my Parents’ house in the Blue Ridge Mts. The valley roads are ok but for some gosh awful reason no snow plow has come up the mountain.  I missed Hopkins because of the snow.

I can honestly say I am ready to leave Wake Forest after interviewing all over. Its been a great, great home for college and medical school but I am ready for a change. And their peds program is just not global health minded.  Thats the main conclusion I have at this point. I have some favorite programs but not for the same reasons and its hard to shake out a rank list.  But here is my opinions….if you are curious….

I interviewed at the following: Wake, Emory, UVA, Duke, Vanderbilt in TN, Cincinnati Children’s (the late addition), Baylor in TX, Pittsburgh.And yes there are now to be LORD OF THE RINGS analogies mostly because I feel odd publishing my rank list on the internet…but if you try you can figure it out.

The Shire-beautiful facilities, familiar, nice people who mostly want to live in the shire forever.  q 4 call for 5 months. Good electronic medical records (EMR).  home  for me yet not home forever.

Helm’s Deep-Rural, mountains,  horses, close to parents, surprisingly nice global health program, not nice facilities, q4 call for 6 months. Close to wheelchair skiing. Would actually have to eat my ACC liver and be hated by my family to go (just kidding!).  crappy EMR (no notes). nice people.

Isengard-has hospital symbol that looks like Isengard. would seriously have to wear my black/gold tie-dye shirt every day of basketball season to not feel like a traitor and will be hated by all my friends from college (Not actually kidding)..  nice people, close to Rohan (parents’ home), close to the Shire. q3-4,no golden weekends (UGH!!). not nice facilities, hard to navigate on pony (or wheelchair).  Very controlled and structured global health program.  Did I mention I would have to sell my soul?

Minas Morgul: Cold, dark. Not terribly far from Rohan (6hrs) but have to go through the Morgul Vale roads (state just West of Rohan) to get there. People are super nice. Beautiful facilities, best advocacy program of anywhere.  Global health is not really set up but very open and int med program is set up. But would have to live in cold, dark city that I almost died in (fender bender).

Minas Tirth: FUN, FUN, warm city. although all the issues of a city, lots of traffic, expensive, occasional flying monster, etc.  nice people, amazing global health, HQ of the CDC, flexible first year elective, shift work (no call except in community hospital), incredibly diverse patient population.  Direct flight to parents’ city in Rohan. EMR!!!!!!! Big downside: two hospitals 15 mins away in city traffic regularly. Good friends live there!!!

Rivenedale: Close to mountains but fun city.  Cheaper than Minas Tirth.  A couple of friends live here too.  Q4 call for 8 mons BUT early check out system, go home by 2PM. AMAZING EMR!!!!!!!!!! (maybe better than the Shire in some ways).  Was interviewed by health commissioner of the state who is a pediatrician, a christian and really cool lady who told me about all the amazing advoacy opps in the area. Could have a second clinic that focused on refugees and international adoption as a second year.  Flexible not hugely structured but active global health program. CHRISTMAS BREAK!!!!! (unlike Edoras)

Edoras: The Golden Hall, ridiculously highly ranked pediatrics program (always in the top 3 in everything) but sort in the middle of no where. Would also require crossing the Morgul Vale (hard in the winter from the Rohan village my parents live in) and NO CHRISTMAS or NEW YEARS time off.  Global health program is FANTASTIC including 2-3 months of PAID TIME OVERSEAS!!, journal club, really active group. The head of the GH program interviewed me, super nice, worked with people I am working with in Kenya, and told me I could do my contunity clinic in a faith based clinic among the poor in the city.  Plus among the best pediatric training in the country and I think they liked me. Downside: In the airport they sell shirts that say Edoras: our cows are made for tipping and no Christmas/New Years with my family for 3 years.  No direct flights to Rohan.

Far, far, far away:  HUGE, SCARY, MASSIVE medical center that is bigger than the city the SHIRE is in.  But is home to the pediatric AIDS corp and have a global health residency that allows you to take an extra paid year to work with pediatric AIDS corp. Got to meet the guy who founded the AIDS corp and really enjoyed talking global health. Have dear, dear friends there and family a couple hours a way. But far, far, far from Rohan and the program is a little overwhelming by pony (wheelchair).  Super nice people though wish it was somewhere closer.

SO Current Rank list:

Fighting for 1 and 2-Edoras and Rivendale

3-Minas Tirth

4-6 Shire? Far, Far Away?  Helm’s Deep?

7-8 Isengard,  Minas Morgul

Thoughts?  (other than the fact that I am big nerd with this LOR stuff)

the neverending story….

The first few months of 1994 had an epicenter: March 31, 1994.  I was 9 and on Jan 14  of that year I had undergone bilateral femur, tibia osteomonies (translation: they cut and broke my legs in three places at the hip, knee and ankle and nailed it back together….translation: legal form of human torture in the name of pain relief…).

It snowed a blizzard the night of the 14th the snow drifts were higher than my sister’s head (she was 3). It was so cold that my parents, sisters and a giant Amish family kept been awoken in the night at the Ronaold McDonald House by frequent fire alarms. They would shuffle out in their PJs, coats and hats and wait for the Delaware fire department to arrive and try not to gawk at Amish nightgowns and winter coats.

Meanwhile I was awoken as well…. in the PICU with hives in a body cast. They thought it was my epidural so they took that out in the middle of the night while the blizzard winds whirled outside.  The Anesthesia resident got woken up four times before they did it…poor guy.   My Grandfather (ever the Top Gun) flew in late that evening somehow to Dover AFB and surprised us all.  I have been told it didn’t happen like this but I remember him walking into the ICU room in his US Navy black and gold winter coat (they swear he was in civilian clothes but my morphine drugged mind remembers this)  .    My grandfather and Dad took the night watches so my grandmother and Mom could sleep and take care of the little girls.  (which turned out to be a snow drill with the Amish times three).

My Dad sang Kum-by-ya to me in the wee hours of the morning once the epidural morphine began to fade and six new fractures and numerous nails started to throb…

and that was just the first night of a 14 day hospital stay. and the first night that I counted the days till March 31.

That the day the body cast came off. I counted the days the whole 10 weeks. We drove up there, they took me to the cast room and sawed me out in about an hour.   My legs were scaly, hairy and now dotted with fresh scars. I had not sat up in ten weeks. To transport me to x-ray they needed to transfer to the wheelchair from the high cast table. They picked me up gently but gravity failed me…I screamed as I came to an almost sitting position in mid-air. My body seared with pain at a position it knew no more.

Turned out the bones still had not healed.  i was not ready for freedom. they hollowed out my cast and made it into a splint which I went home in.  I was devastated.  March 31 turned out to be a terrible disappointment.

Nov 23, 2009.  10 weeks after  total hip replacement (translation: they cut out the top of my thigh bone and jammed a large piece of plastic into the rest of my thigh bone and into my hip socket…translation: more human torture in the name of pain relief).  10 weeks ago I discovered Nov 23 was the end of  the dreaded  hip precautions.  disappointing yet again. I can’t touch my toes…heck I can barely touch my knees. My hips are tight and resistant to the idea that they should now go back to doing what they did 10 weeks ago and more.  My therapist doubled my stretching in honor of the occasion. I came home soaked in a tub for an hour and still feel like my hip flexors are made of cement.

you would think i would learn to expect less…to expect no miracles but rather that all freedom especially orthopedic freedom is not free.  (if only the surgeons understood this).

yet again disappointing. really these surgeons  for all their confidence are more trouble than they are worth at times.

the uglies

everyone seems to like listening to my life stories. the little gimpy kid with the disease no one has ever heard of growing up and becoming a doctor has a nice ring to it.  the stuff on my resume makes me look smart, sane, mature.

but in reality most of it is a facade. none of it is untrue but putting it all in bullet points on a sheet of paper cuts out all the details.  no body likes the details.

the details are ugly. everyone wants to know how my surgery went. but everyone wants me to say it went great. everyone wants to know what being a disable medical student is like but everyone wants me to say its been swell.

I just had a surgery that was basically palliative care. it didn’t cure my disease it kept me from pulling my hair out because I can’t sit still because of the the pain. but the truth is yeah the actual four hours of the surgery went well but physical therapy is a bit of a disaster.  i have what appears to be a three to five year old flexion contracture that is not only tough as nails but if it doesn’t get better is going to wear the prosthesis down much faster than usual (which basically knocks off years of walking).  No one diagnosed this crucial fact…one has to wonder what role it played in the hip pain the first place. no one wants to hear from the little medical student that her transition from pediatric to adult medicine has been fraught with peril, that the adult orthopods are not only ignorant about her pediatric disease but too arrogant to admit it.  I suffer for it not them.

I am getting up at 5 AM, rounding on patients I do not know half the time, writing notes either observing (as in not touching) in the OR or occasionally interacting in clinic till 5PM when I go to PT and get pushed on till I finally get to go home by 6:30 and then repeat. today i repeated plus SWINE FLU.

then I try to prepare for things like my interview on Friday, fall asleep on my computer and then wake up in the middle of the night and worry about the flexion contracture that gives me muscle spasm cramps randomly and frequently that leave me begging for tramdol and has not moved a single degree in the last three weeks.

no one wants to hear that some times I come home and I cry with frustration and pain. no one wants to hear about how some days I absolutely hate my chosen profession not just because it has so few answers for me but because  no one have the balls to admit they have no answers.  Good gosh people just tell it like it is. do you think I somehow don’t know that it sucks?

no see that doesn’t sound all that inspirational now does it…