SOAPBOX

President Obama’s budget as it stands will substantially slash pediatric graduate medical education (PEDIATRIC RESIDENCIES) and funding for all of our nation’s childrens hospitals on Sept 30. The current plan would force many smaller pediatric training programs particularly the primary care based programs to have to close their doors to new residents. Larger programs would have cut their numbers and cut out benefits and educational funding for research and care for the underserved. It also cuts crucial funding to all childrens hospitals many of whom (like mine) give care to children who otherwise would have limited access to care. Ironically we desperately need more pediatricians in the US, particularly primary care doctors yet this plan would make it nearly impossible for us to expand our numbers and would in fact CUT THE numbers of pediatricians that graduate every year!

My patients don’t have a buck and they don’t have a vote, they can’t buy their own health insurance/health savings account/or even barter a chicken in exchange for their care. So no matter your opinion or political affiliation, stand up for your children and grandchildren (Not to mention all my people who always get the shaft any way (all the gimptastic, disabled kids who need health care so they can grow up and become politically incorrect pediatricians if they want)).They are the future voters, physicians, teachers, politicians and citizens of this country. They are also the patients whom if we don’t provide care for now will be the future citizens on disability, medicaid and welfare.

Please help me support children! Please help me by clicking on the link through the National Association of Childrens Hospitals and sending a letter through their program to your representative. (it will link you to the right people in your area through the link and it took me exactly 125 seconds) (or if you have more free time than me and feel inclined write your own letter). Make sure to note your local Children’s Hospital or a Hospital that has made a difference in your life or the life of your child or grandchildren!!!!!!!

HELP KIDS!

Love,

Amy

(just another American voter who just works 90 hours a week to takes care of other people’s babies who apparently are just not that important)

Transition Epic Fail

So the hip is going and I need a steroid shot. Ideally I would like to go to Baltimore and have my surgeon see me and do it. It takes about two minutes and it works for three months. He wipes the site with a etoh pad, shoots a fluro image, shoots me up and then puts a band-aid on.  Painless, effective and totally worth it.

But I was a good girl.  I made inquires and I found a surgeon right here in town who not only has experience with the injections but has experience with transition cases due to some special interests in perthes etc.   So I move around my life and manage to get an appt yesterday fully prepared to get the shot and be back before my clinic started.  He walks in, comments ” Your left hip looks fine (because a  hip replacement at 25 is totally fine). Your right hip has some deformity and arthritis (YOU THINK?) and yes I can do the shot.”

…in the OR (which means I get to pay for the OR TIME)

……at 7 AM (heart of rounds)

……..and you need a physical (another hour of missed work and ITS A SHOT I am not getting sedated and I AM 26 years old and other than ortho issues I have never been sick a day in my life…I never even had so much as a pneumonia)

………..and you have to come see me “post-op” (and yet another hour of my life)

:::Look of disbelief:::

“I don’t know how your doctor did it but thats howe we do it, its cleaner, more space for the fluro arm. “

(Cleaner…for the love its a shot like a vaccination…lets not make this melodramatic  and SPACE FOR THE FLURO ARM…we have them in the tiny little ORs in Kenya, ok you don’t need much space)

I tried to plead as a resident for a better time….no one seemed to care.  I tried to plead as a 26 yo to waive the physical requirement…he says anesthesia is who makes that call (BUT I AM NOT GETTING ANY BECAUSE ITS just a shot).

it was an epic fail. Failure to understand where I was coming from, failure to understand that the purpose of this procedure is not to relieve my pain ultimately but MAKE ME MORE FUNCTIONAL AND MISS LESS WORK.  Failure to understand that maybe OR time + three doctor appointments would max out my insurance’s patience and put a hardship on my little post-grad budget.

so in the end I am settling for pain patches and an appt prior to flying out to Kenya in Baltimore with a surgeon I trust who will not charge me up to a 1000 dollars for a shot that if I had a fluro arm I could do myself.

heck maybe I can just sneak down into the fluro room at work….at 3 AM no one would notice.

just kidding.

Its the circle….circle of…

Fall down. Get up. Fall down. Get up. Fall down. Get up. Fall down. Get Up.

Just keep smiling. Just keep smiling. Just keep smiling. Just keep smiling. Just keep smiling.

Fall down. Get up. Fall down. Get up. Fall down. Get up. Fall down. Get Up.

Welcome to the world of chronic illness. It a series of failures…I mean victories.

You go from sailing above it all filled with gratitude and in awe of the normalcy of your life. You marvel at the beauty of being able to get through your day with ease, without pain or torture or a series of endless decisions that will alter the course of your life.   TO scraping yourself off the bed just hoping you can make it to the bathroom without falling over or depending on the situation passing out/etc.    Some times the fall is a slow slide where you can igore the signs, sometimes its a cliff that you fall and find your hurled to the bottom of the canyon.    You can try to find something hold on to cushion the fall or let you sit on the hill for a little while waiting for the land slide.  You become an expert at denial and justifying away the signs because the last thing you want to do when five minutes ago, an hour ago, last week, two months ago you were living at the top in the glorious glow of what life should be is admit that its back or that you are here again standing in the canyon or half way there looking up at the rock face you have to climb back up.

There is nothing in this world as humbling as the human body capacity to fail. and lack of human ability (particularly that of individual involved) to control it  I would know….on multiple levels no less.

Fall down. Get up. Fall down. Get up. Fall down. Get up. Fall down. Get Up.

I watch it. I live it. I study it.

You would think that after 26 years I would not wake up feeling like I just lost my best friend when this happens but I do. I feel isolated, lonely, anxious and at times a little frantic.  Frantic to be able to predict what happens next and frantic to do whatever I can to get back to the top and pretend like I never had to come back here to the bottom.   And then I feel ashamed even though I know its irrational. I feel ashamed to be in the way, to be less than a 100%, ashamed that somehow I again was not able to make it work even with all the efforts somehow in the end I still failed to hold on.

Its irrational, its futile and no one talks much about this stuff in medical school but in the end to me its the defining experience of chronic medical problems.   And sometimes in the other half of my life, I look into the eyes of sweet children and I see there just below the surface a longing to be free of the cycle or at least be allowed to talk about it…to confess it.

For just a moment they want to not be the hero that everyone around them applauds them for being or not be the withdrawn or the demanding kid with behavioral issues, for a moment they could just be allowed to say they are tired, that they are weary of the procedures, the plans, the protocols and the exercises that are required of them and just for a moment be allowed to choose sanity and scream and wail and say THIS REALLY SUCKS.

and then be allowed to move on.

so yes world having no hip cartilage sucks.

having no hip cartilage and working 90 hours a week really sucks.

having multiple joint replacements before I turn 30 or have a REAL job sucks.

and that my friends is a victory.

saying it out loud.

Here we go again…

I want to understand biblical womanhood…. not feminism or fundamentalism. I want a worldview that is not a reflection or deflection of our culture but rather of joyous redemption. Why does this have to be such a struggle?

I heard a sermon this weekend, the first sermon I had heard in a month, on biblical manhood. It was actually decent. He discussed how men have lost a sense of purpose, have a prolonged adolescence and a lost a sense of value for women and children. And frankly any pediatrician with half a brain has to affirm all of this.  But then at  the bitter end, it all went wrong.  The elder started talking about providing and dependents on his taxes and then he went there.  He said, “If given the choice nearly all women would stay at home and care for their children.”   I nearly stood up and marched out in a huff of self-righteousness as a young women physician not only for my own choices but because he had dove into the pool of fundamentalist, SBC BS clothed in biblical language.  What he intended was not nearly as important as what the congregation heard.

First I refer back to this from 2009 in which I previously spoke to the subject.   and then I echo my last paragraph…

Could you imagine a woman would shrewdly crush the head of a foreign general (either figuratively or literally, diplomatically)? Or could you imagine a woman so strong and wise that a general refuses to go to battle without her? Could you imagine if there was a woman like Esther who would go before the governments of nations where genocides, other hate crimes or gross human rights violations are happening and convince them to stop? Could you imagine if women would support their elderly, widowed family members like Ruth rather than sending them to nursing homes or griping about them? Could you imagine if women of the world fought back against violence toward women and children like Tamar? Could you imagine if the women of the world embraced the children born unplanned or unwanted? Could you imagine if women in nations where there is no freedom of religion quietly yet openly worshiped and ministered like the women at the tomb? Could you imagine if women stepped up as leaders yes pastors, ministers, teachers in places where there is no faith or where faith has died?

How different would our churches be?

How different would our families be?

How different would our world be?

…if every woman got up from the mud of our world that exploits women and their bodies and brushed off the dirt of centuries of fear and ignorance hidden in church tradition but lacking biblical substance and embraced her calling…whatever that calling may be from motherhood (yes even the stay at home kind…love ya MOM!) to ministry to beyond.

how desperate our world is for biblical womanhood….how desperate…

This is what I want.   I am tired of apologizing for my extra X chromosome or my kooky religion. I want to find a place where they can coexist as they were intended to in harmony.

Drowning

Last night I had  a dream that I was drowning in a enclosed space.

Key sign that my intern mental health might be fraying.  I think I am reaching the breaking point.  I wish Kenya was next month.  I need it to remind me why all of this is worth it.

What I am drowning in:

• See Previous entry:  choosing between my fading passion and what I actually enjoy….and am building passion for…find freedom in not being defined by my differences but not losing who I am in the process…small stuff really…
• Its February, its snowing and icing and I am done with it.  Its not going to be past freezing today.
• My right hip is on the cusp of dying and I am ok with it, at least more ok with it than last time. I have confidence in my surgeons. But my schedule is a night mare and because I am not a 100% WHEN I want to do it so I don’t know how to go to the chiefs. Plus admitting to my bosses is harder than admitting it to my friends. We all know that last time I end up admitting this with tears rolling down my face in the psych copy room. Yeah I suck at admitting weakness.  Not to mention that even after that there is the question…can I do this living alone in OHIO???  My support network in NC was huge and varied.  Nothing technically ever happened  that required roommates to intervene but is really safe to live with the risk of not having anyone… but how to I place an ad on Craig’s list…HI I need a roommate to be there when I get a shiny new hip so if I fall and do something crazy someone will be there to pick up the pieces…
• I feel like I suck at my job which is mostly not true but my burnout is not  helping my morale or my confidence.
• I miss home….yes I am falling back into the 8 yo away at summer camp mode.  I dream about being back at Wake, I miss the intimacy, I miss not having to explain things and more than anything I miss my friends particularly their diversity in that many of them are not doctors.
• Speaking of which I MISS MY CHURCH even though it  doesn’t exist as I knew it.   I miss the freedom, the lack of formalities, I miss eating bad Mexican food every Sunday.  I miss doing life with SACRED TUESDAY, the small group we created without any guidance but out the desire to know one another and laugh at life and the questions we didn’t always understand.  I miss being able to curl up into the corner of the coach and just be or occasionally cry as long as I needed to about the dying patient, my dying hip 1.0 or the joy of it all.
• I feel like I am missing out.  My sisters are both living at home right now one because she is doing a her student teaching and one because well she can’t handle college away.  NOW I KNOW that I pride myself in my independence and I do. But  I love my family and its hard to talk to them on the phone and listen to them all hanging out and laughing while I am here in 20 degree weather by myself in OHIO looking at erythema toxicum all day (it  is a completely benign newborn rash that is meaningless).
• I miss Romania and this above all is the most futile.  I know I can’t be a doctor there. I cant get excited about Kenya in April or Zambia vs. Cameroon vs. Togo for next year. Or even the Ukraine….I just want to go and sit in a corner in a crumbling hospital building that I have memorized every inch of with a scarf over my head and hold a baby and not care about his erthema toxicum even though I know eventually would miss the medicine right now its killing me and I just want to love children without having to analyze their every freckle.

Now I have to go to work.  But there is the list as it stands.