Good News: I had a really great time hanging out with kids with neurological diseases at camp.

Bad News: I am sucking at neurology wards or at least have some serious lack of interest

Good News: I have 20 days left of big people inpatients in my life…I will be done forever.

Bad News: There are on neuro

Good News: I have a appt in Baltimore to see the surgeon.

Bad News: My Hip has the consistency of pudding per bone density scan today…it was nearly off the chart.  I think if you squeezed it hard enough it would break. No surgeon is going to touch me with a 10 ft pole.

Good News: I have the schedule of amazingness for next year: Romania, Africa, a tour de Pediatrics, Memphis (Urban pediatrics/peds HIV), Peds Ortho in Delaware!!!!

Bad News: I need a 6 month lease which is hard to find roommates for!!!

Good News: ITS TUESDAY and that means Tuesday night fellowship group!!!

crucible

And sometimes things break down.

My computer died this week had to get its hard drive wiped and I had to reinstall all kinds of programs and stuff, thankfully they saved my pictures and my documents and music.

I am jealous of my computer. I wish I could wipe away the clutter in my life, the voices of others, the opinions, the perceptions, the layers, the myths, the mistakes and the perfectionism. I wish I could just selectively choose and have it wiped away. I feel like I am a fish bowl and every one in my life is screaming at me with advice and concern and I don’t know which one of the big distorted faces reflected in my glass prison is not going to eat me.

Dad is yelling at me to stay at Wake where its safe and to be wary of the outside world of medicine where there are no ramps, no electronic medical records and evil administrators who eat fish…I mean gimps for dinner.

My advisors are yelling at me to go for it, the sky is the limit, I can go ANYWHERE, aim high, represent us well they say.

My Dean of Academic Affairs is vocally telling anyone who will listen they want me to stay here (possibly forever…and ever and ever Amen. )

My friends (and my classmates and their significant others) are yelling at me to stop worrying while they themselves daily seem to be begging for anxiolytics, time off and sleep meds.

Two long term adults in my life are telling me to be the doctor that disabled people believe they can’t be.

Disabled people in my life are yelling at me to change things for them.

My doctors are telling me they are willing to do what ever I want to do…just name it. But in their compassionate, beautifully executed, careful, tactful manner they are telling me exactly what I SHOULD do.

My body says its tired and sore and its counting the cost and its sort of like the bailout of the US economy…its getting bigger.

My mind is bogged down by all the voices and the doubt and the exhaustion.

My heart is longing to be free of the fish bowl on so many levels.

My spirit is crying out not for advice or even wisdom but for peace, for stillness, for simplicity.

If only I could just get my hard drive wiped.

less than one in a million

Maybe the other reason the perseverance comment is getting to me is I feel unworthy of it on of top finding it non-productive.  I am trying to make big, big, big health decisions right now that will alter my life and my career. I am no longer a minor so its me myself and I making these big decisions.

The truth is I have to be realistic.  I’m like a football player with a torn ACL that refuses to quit playing football. I will be an intern in T minus 16 months inless I want to be in debt 50,000 for nothing. I want it. I do. Even though I know what it will cost me in cartilage. I want to be a doctor.  So hip surgery is my best shot of internship not becoming a death march for the rest of my joints and my sanity.

When I was a kid I am sure there was ambiguity about what was right in terms of surgery or no surgery. In fact I even remember the conversations especially around the first big one. But I was a kid and I believed in Santa Claus, the Easter Bunny and the Tooth Fairy and medicine. Oh how I believed in medicine.  Now I have become a priest of medicine of sorts and I realize that the magical, all powerful healing wizard behind the curtain is actually an army of humans who make mistakes, have bad days and never eat or sleep but still cut on people’s babies.

I also grew up thinking less than one in a million diseases are way more common than you think because I was less than one in a million and so were my friends.  I could name 20 people who were less than one in a million.  I also was a military dependent which means I got to go see the big shot orthos for free (and by free I mean thank you US Tax payers!). Sure my pediatrician and all the residents had never heard of Kniest or operated on any one with it but my orthos knew about it and had experience with it. I lived in a happy world where I had faith in people who were bigger, smarter and more  magical than me.

Now I am an adult. An adult in medicine no less. Who knows that while less than one in a million is common in my life, in adult medicine you are as prevalent as aliens from Pluto who are protesting its deprivation of planet hood.   Adult Orthos look at me with fear in their eyes. FEAR. from orthopods who have egos the sizes of small european countries.  They look at my flims and audibly gasp (really I watched this…I will dig of the post from 4 yrs ago and link it later) and say bad words which I shall not type.

I do somewhat like the dude in Baltimore that my peds ortho sent me to because he treated me mostly like a human and not as an alien. But he is famous and in demand because he pioneered hip resurfacing in the US.  He doesn’t answer my phone calls or e-mails. This is the procedure I need. He agrees I need it. One small detail he left out when we dicussed this 4 yrs ago (we were dicussing as a future proceddure in the next 3-5 years), he has never, NO ONE has ever does this procedure in a person with Kniest or SED or any related disease. I spent weeks looking everywhere, talking to everyone I know. The truth is out. Cong. hip dysplasia yes.  Chondroplasia (beyond early OA) NO.  Its a new procedure (FDA approved in 2006, in clinical trials since 2000, been in England for a while). And the truth I am tall, so tall.  A LP would be at higher risk for this.  Thats why I am the lucky millionith customer.

Um, wtf? How do people make these decisions? I mean I want the procedure really i do. It buys 10 years of Romania or Kenya or whatever. I want it. But I am also terrified about it.  Because I don’t believe in the magic. I know the raw, carefully calculated and learned skills of medicine.  I know that there are no sure things and God knows that I know that less than one in a million odds happens. And he also  knows that I am good at doubt.

the award that gets old

I remember being in 4^th grade s/p my first winter in plaster. I was the Blue Caterpillar in Alice in Wonderland. We made my wheelchair into a mushroom out of tie-dye fabric. By the time the play rolled around I have been rehabbing for a while and was walking. So I took the fabric and put it around my shoulders as wings and was a butterfly for curtain call like in the Disney movie. Every one in the play got an award mine was Most Dedicated or something along those lines. The director talked about facing hardships or other such stuff when she was introducing me. It was ok but I remember being jealous of the all the other kids who all got things theater related awards like most in character or improv diva, most creative or even most improved actress.

On the last day of 7^th grade we had an award ceremony for our team. I was on the Tiger team. All the teams were some kind of great cat because our school mascot was a wildcat. Several weeks earlier I had been on my way to an honor roll ice cream party behind the school. I started to go down three or four steps and the railing broke. I fractured my lf hip (and its still haunting me all these years later). I was put in a hip spika cast which is basically a medieval torture device with an abundance of cotton padding. This was after walking on the hip for a week because no one including my Dad could find the hairline fracture on x-ray….I also rewrote my part of Templeton in Charlotte’s Web which opened the day after the accident. My Mom took me on the last day of school to the ceremony. Every tiger got an award, a superlative of sorts some were funny, some were how smart you were or what color you always wore or related to your favorite subject or sports team. Mine was…The most courageous Tiger. I remember feeling disappointed and a little embarrassed when they called my name for this award. I was a good student and very active in everything and this was the best thing they could say about me?!?!

I remember being an 11^th grader and going to church camp. I loved church camp. We would stay in college dorms with other kids from all over the US, swim, play pranks, do skits and enjoy watching/participating in the teenage drama and merriment that is 300 teens living together in community. Every year people would audition to sing in worship. I took chorus in high school and I sang solos sometimes at my church. I decided to try out on a whim. I made it. I somehow beat out like 20 other people for a solo I was so nervous, I knew I wasn’t the world’s best singer I just liked to sing here and there for fun. The background music was hard to hear in the giant auditorium. I lost my place a bit although I managed to save it by adding a repeat at the end. I got a standing ovation. Initially I was kind of excited thinking maybe I did a better job than I thought. After the service was over, people came up to me in tears about how beautiful it was me getting up there and all, walking up there without my wheelchair. One of the other churches actually wrote me a letter about it saying how much my Christ like example meant to them overcoming my disability and all. I left camp feeling annoyed and slightly used. I felt like I had been conned into being the camp’s resident POLLYANNA.

Two days ago I went to my post box and pulled out one of the tell-tell white envelopes that mean GRADES. Inside was my internal medicine grades and the all important comments (which will be summarized in my Dean’s letter for residency). And there in 12 point Arial font was the word perseverance as my leading strength. I just stared down with a sense of sincere disappointment. I had worked so hard on my differential diagnosis, my physical exam, my presentations, my medical knowledge. All the things you are supposed to learn on your int med rotation. Heck I may have bought myself hip surgery with this rotation. And all I got was another pat on the head for being the resident gimp. No one cares if there doctor perseveres, no residency program really cares at least not compared to my ability to take care of patients.. The last thing I needed was one more teacher/attending/authority figure to tell me I am dedicated, motivated and persevere almost to a fault. What I need is someone to tell me what my strengths as a clinician are, as a physician. Disappointing…

Flaming red arrows

1. I am committing questionable academic suicide to go to do an away elective in Memphis, TN with a series of free clinics that seek to train the next generation of medical missionaries for the plains of Siberia and Africa in the ghettos of urban America. I will be focusing on peds HIV.  This is happening because of a printer network dying in the library six days ago (while I was printing the final form for a DUKE elective…which i am now giving up for this), a little old lady who was in front me in the grocery store line, some PEEPS (the yellow chick shaped marshmallows), a very annoying endocrinologist, contracpetion for adolescents and strange recollections.  All of which together have to be part of some divine plan…either that or I have finally lost it…Sometime I will write down the whole insane story.

2.  I had a revelation today or maybe more of a personal resolution. I am sick of my lf hip. I am moving from the precontemplation stage to the contemplation stage of resurfacing surgery. Down side I can’t drive for four weeks afterwards (meaning planning it is going to be slightly less complicated than fixing the economy), Up side residency would not be the a death march for my left hip (somewhat literally).  I can’t get to the dude in Baltimore and do all the things I need to do in my life right now so I looked up someone here.  He has excellent training include some peds ortho and hip arthoplasty for young adults. I e-mailed my Rheum for a referral.  heck…I have lost it….I am actually going to an ortho out of my own free will with surgery at least on the table.

3.  I passed int medicine but the word perseverance and some other serious disabled tiny Tim crap  somehow ended up in my freaking summary statement…yet its no where to be found in ANY of my evaluations…i wonder if a certain eavesdropping incidence involving my rheum felow (who is completely innocent because he apologized profusely for it), my lf hip,  gen med and a nameless attending has any thing to do with that….there will be an angsty blog entry about this at some point.

For now I have to go eat dinner…its nearly midngiht. I am so exhausted.