The view from ZSR 6th floor on the eve of the rest of my life…

7 years is a long time.

I am sitting curled up in one of my favorite places in the world. The ZSR library on the Wake Forest ugrad campus. Its nooks and crannies and huge windows and high callings have facilitated my studies, my imagination and my dreams for the past 7 years.  It was here I studied for my first real exam EVER, memorized latin poetry, poured over novels, drew out organic mechanisms, took MCAT practice tests, discovered libreation theology, painstaking dissected the New Testament and the Koran and eastern European folklore. I learned EKGs and neuroanatomy on the 6th floor. I learned Rheumatology and Endocrinology over in the new wing.  I dreamed of traveling and medical school and later medical missions.  And like most young women day dreamed occasionally about boys and the future and all that is to come.  This place is full of friendly ghosts that remind me of where I have been, who I am and where I am going. Its not just nostalgia and books that live here but a sliver of my identity and the woman I have become will always find a home here.  Of all the places on the Wake Forest campus I think its the place i will miss the most when I finally physically leave Winston in May.

And that is about to come to a head. Tomorrow it begins.  I submit to the powers that be my residency application. Countless cups of tea, late nights, long hours, books, papers, notebooks, itunes, sutures, progress notes and surgeries.  seven years, six pages of resume and essay, five agonizing standardized board/admission exams, four summers loving Eastern Europe and four babies delivered, three years of med school (1 to go), 1.5 degrees, it all been for tomorrow so I can go get a job somewhere in the United States that wants a gimpy pediatrician to be with a strange love for all things from the Black Sea to the North Pole, a more than passionate obsession with disability rights who is in love with children, Jesus and comparative religion.

up, up and away.

Childhood is Sacred

Inpatient Child Pysch is a cross between Jerry Springer and a Jodi Piccoult novel.  It can be a very dark place filled with hopeless situations, broken families and gross abuse and neglect of children. I have learned about the gang wars of Winston-Salem, the myriad ways to get high off crack, marijuana, XTC, acid, glue, you name it. I listened as parents cuss their children out and their children cuss right back at them. I watched parents give up their children to the state and listened to the tears of children whose parents don’t pick up their insulin for their childhood diabetes or take them to doctor’s appointments or leave them on the pysch ward so they can go Disney world or the beach without having to worry about their bipolar kid or their child with Autism complicating their vacation.

But the most important I learned is that play is the thing. No really it is. I’m talking about finger painting, mud pies, water balloons, swimming in a pool, in the ocean, games of tag, checkers,  chutes and ladders, Candy Land, dancing, singing loudly, running through grass barefoot, coloring, drawing, riding your bike,  basketball, baseball, flag football, going fishing with your Grandpapa, making cookies with your Grandmama, running around with your dog in the back yard, wiffle ball, hiking through the woods becomes an adventure, going down the slide, climbing up the slide, swinging so high you are sure your toes touch the sky,  make s’mores  and weenies over a campfire, make believe of pirates and princesses and shipwrecks and hospital (if your parents are in medicine this is inevitable) or army men or playing school, playing with dolls, playing with cars,/trains/trucks, building the tallest tower of blocks, or making a space ship with legos, playing with play dough, dying Easter eggs or sitting down and listening to a story. Sticky hands, muddy feet, paint all down your clean t-shirt,  Easter egg dye from your head to your toe, mud in your hair, clothes soaking wet because you fell in the lake fishing, paw prints on your shorts from playing with the dog, a crown of daises that make you so sure that its made of diamonds and rubies, a sword that to some resembles an dirty stick you found behind a bush, the bad haircut you got after playing beauty shop, the stuff animal whose appendix you tried to take out who needs his stuffing put back in (that is for you Karen)…..

these things are sacred and they are worth fighting for….these are not just obnoxious or silly things…these are the things that teach kids how to laugh, how to talk, how to think and create, how to love and relate to others, to feel confident….these are the things that children who live on the streets (rather they be Bucharest or Winston-Salem) miss out on, these are the things that don’t happen in broken homes or homes where parents are more concerned of their own needs rather than those of their children that become twisted….

Childhood is sacred. Its where we learn everything and can lose more than everything.

so thats what I do in these family meetings and in group thearpy I fight for the right of childhood.

Free Falling

I was sitting on the red sofa in the basement of my house on Wed night for bible study.  I was in my favorite position with my left leg curled under my right one making me corner shaped sitting in the little sofa corner. I was in pain. It was a gnawing, angry, relentless pain that seemed worse than it had a week ago prior to the steroid shot. I was exhausted the pain woke me up several times a night and forced me to change position.  I tuned in and out of the discussion on the temptation of Christ almost startling when my roommate the leader turned to ask me a relgion major related question.  I was physically squirming changing my position every 5 minutes to no avail. In my head a flood gate had failed and my thoughts were swept in a gale of pain and anxiety.  What would happen if I just didn’t want to do this any more? What would happen if I just pulled the trigger and said I want to get this over with it…..What would it cost me? graduation? residency? walking?  What if it went perfectly what would it buy me? No pain? Actually enjoying my day to day life for my last year as a free agent?

As soon as the last prayer had been said I was up the stairs and curled up in my bed with my laptop.  Kaniksha called, I answered and told her what I was thinking.  She pushed me to just do it. I went to sleep (well in theory), woke up and went to school. I sat there on rounds with this torturous hurricane in my brain. In order to do this I would have to break one of my cardinal rules of AMYHOOD. I would have to admit that I was in pain to the point that I did not think I could function at my job or at my life.  I disliked that idea immensely although my dislike was childish it still hurt to have to say that to someone.  SO I sat there with this paralyzing inner monologue and interviewed little children whose inner monologue had landed them in the pysch ward.  As soon I could steal away from post-rounds work I called the PA in Baltimore and left a short, cheerful sounding message on her voice mail. I slid my cellphone in my pocket with a smile. Sure I can try to change this but the odds were so against it working thus there was nothing to panic about. Three things had to happen: A. there had to be a surgery date in the first 8 days of block 6 (Sept 7-Sept 13), B. I had to switch my ED rotation (the only required rotation thus making it nearly impossible to switch because EVERYONE has to do it) and C. have something I can do FOR CREDIT instead in Block 6.   I walked back to the pysch floor confident that I had passed the test.

The PA called me back within 20 mins. I hid in the copy room. It took effort, more than I care to admit, to tell her the truth. My voice wavered a bit but someone by the grace of God I managed to keep a surreal businesslike manner throughout the whole conversation outlining the various pre-operative studies and labs.  She gave me the number of the surgery scheduler who I called and left a voice mail. I e-mailed student services with a bit of tachycardia.  My fellow interns on the pysch floor sent me home early since I had stayed late the day before. As I was leaving I got a completely random and uncalled for  e-mail from the pediatric rheumatologist. I had talked to her previously in the year about doing a rotation with her. It had not worked out. She had been asked to write a review on exercise therapy for kids with arthrits and myositis. She wanted to know if i wanted to do the project. I could most likely get research credit for it.  I nearly melted right there in the middle of the pysch nursing station.  Not only was a research project I could do from it home, it was a first author publication handed to me on a silver platter no strings attached. As I walked outside of the pysch ward I stared at the deep blue of the carolina afternoon with  my eyebrows raised asking GOD what the heck was he doing?

I ran home, laid down on my sofa, tired from not sleeping and the constant gnawing.  I had tried in route  home to call both student services and the scheduler again both had been apparently gone for the day.  I was fustrated. Kaniksha called to cheer me on. Finally at the point I was almost sleep my phone rang at 4:50 and I bolted off the sofa.  Ms Long the 14th has one opening…does that work for you? Holy… its in the 8 day window. Give me till tomorrow. I called student services at 4:55 and demanded a meeting with the Dean for Friday. I got it.  I then e-mailed my class expecting nothing but knowing I had to do this before I saw the Dean. Can someone please, please swicth ED rotations with me? Five minutes later someone volunteered.   The Dean signed off on my swicth, my research elective/leave of abscence for block 6 without so much as a moment of hestitation, in fact he had already done before I even got there on Friday morning.

My parents thought I was slightly manic when I called them…maybe I was a tad bit crazed. Hi Mom, I having a hip replacement on Sept 14 think you  drive me home on Sept 17?  I explained or tried to explain that for once in my life I was excercising some level of self-perservation.   My parents who know me better than most know that this is not characteristic of me…its far to what normal people with chornic pain do. They accepted it although they had a million questions most of which were medical rather than logistical.I had been the one e-mailing and calling the surgery team with my 20 million questions, I was the one who signed the dotted line on the consent forms.  Now in the surreal change of roles I was the one explaining to my parents what to expect.

I’m still not exactly looking forward to it. In fact I’m still sort of terrified but feel oddly at peace with it for the first time since that fateful day in April where the surgeon walked into the room with that knowing gleam in his eye.

On Friday afternoon I headed to Atlanata to visit with friends (including my super, awesome, talented webmaster) and take the Clinical Skills boards on Monday.  I stared at the peds rheum books stacked on my passenger seat, a reminder of the miracle of the last two days.  It rained as I was coming out Charolotte traffic, a blinding sun shower that slowed the resceding traffic to 40 mph.  I stared into the liquid blue and marveled at God’s grace and his occasional firm, gentle pushes off of our mental mountains of pride and fear. And how well he holds us as we fall into whatever ocean stands in the valley.

¹¹ For he will order his angels
to protect you wherever you go.
¹² They will hold you up with their hands
so you won’t even hurt your foot on a stone.

The passage that came to mind…oddly enough it is quoted by Satan terribly out of context in the temptation of Jesus in Luke and Matthew 4 which was the center of the discussion on the red sofa.

Really why I can’t just suck it up and drank a shot of kool aide

I’m a mess. Here I am an almost doctor. I hug mothers who are losing their children, I write orders and call consults and I do procedures and I diagnosis pertussis and stickler’s syndrome in forgein countries without decent resources or back up.  But you put me in the chair on the other side of the exam table and I am a non-believer. I’m skeptic. I’m in denial.

I traveled 14 hours for a steroid shot in Balitmore because I can’t sit still in morning report in more. I have to get up and go to the bathroom every day because I can’t sit for a 45 min lecture. I can’t use the chair on rounds becuase it hurts too much to sit down.  I had to get the steroid shot.  The PA ushers me into the room after 7 hours of shifting my position every 10 mins from North Carolina to Balitmore.  She taller than me like a foot and half. Why is that all orthopedists make me look like the size of a middler schooler?  I feel for my little poeple friends who must have to constantly look up to talk to their orthopedist even when everyone is sitting down.

We talk about school and pediatrics and neonatology and how PAs started in Carolina de Nord. I fiddle and wait for an hour while the attending finishes his case down in the OR. I look at the latex gloves lined up neatly under the cabients above the counter. I have the strangest desire to put them on because that’s what I do when I walk into a procedure room. I note the amt of ccs in the syringe and the type of alchol prep. I want to fiddle with the fluro machine and I read the Joint commission safety guidelines. My Mom and sister sneak in and we play 20 questions the way we used to play I Spy and I would trick everyone with the tiny blue stickers on the ceiling that the navy used to mark ventilation ducts. They go out to find granola bars and I try to read. Finally the PA comes back and asks me “Are you ready?”

I jump up strip at the waist, wrap my lower body in a gown. The attending came in, he is not my doctor I knew my doctor was on vacation. He is young probaly 7-8 years older than me or so. Hestands at the end of the table and asks me what surgeries I have had…4 sets of osteomonies feumr, tibias and 2 humerus osteomonies (among others). Why he asks? I nearly sit up and look right at him so he can see the exploative crossing in my skeptic’s brain. Because I have Kniest Dysplasia I say politely. He has that look the look of WTF is that. It like sticklers but rarer and earlier onset.  And you are in medical school he says as he approaches.  “Yes.” WHere? Wake. What are you going to do? Pediatrics? Where are you going. next.. His technique was not nearly as smooth as my doctor but effective.  The PA holds a sheet for me as I change and apologies ‘the boss’ wasn’t there. I assure her I knew he was out of town and this worked best for my schedule. I told her I wanted an appt with him along my shot in Nov to iron out my last questions about alinginment and stuff. She nods.  I tell her I’m planning for Mar 22 four days after Match Day. She nods, sounds good.  She wishes me a safe drive home and I make a beeline for the waiting room and for my sister and Mom.
On the outside, I am professional and friendly and confidence as if having one’s hip fall apart at 24 is the most normal everyday occurence in the world. Inside I am terrified. Terrified of losing all the things that I love to do, my indepedence from my parents, my ability to travel, my career with my babies, my ministry even silly things like standing up to sing in church and dancing at weddings and mono-skiing. I tell people that walking isn’t everything or being normal isn’t everything but I’m fraud because when its me on the exam table I fight like a angry hornet for these abilities and run like a child scared of the monsters under bed when faced with my own medical  reality.

But the professional in me doesn’t want t to show that, doesn’t want look like a rebellious adolescent afraid of losing some privileges to the point of being illogical and competely unreasonable. So I stand tall and limp away down the elevator, to my car and curl up and watch the mountains pass me by and push the feelings of doubt deep down filed away inbetween infant vaccination schedules and how to treat an acute asthma excerbation or a sickle cell patient with a fever. Becuase there it is safe and ok. There it is hidden in the place where I feel in control and confident and at home.

If I was my patient I would give me a hug and tell me that I was doing the right thing.