Joy in the Morning

Three years ago when I was in the mist of my third year of medical school. I went through a 2 month period where I rarely slept more than a few hours at a time. It wasn’t the call schedule, it wasn’t the stress of residency applications or Step 2, it wasnt even entirely the pain that gnawed my left side at times to the point of tears. It was the creeping waves of anxiety of a young doctor to be who knew exactly what was happening to her in exquisite detail. In my minds eye I could see the holes in the cartilage, in which glistening white bone lay naked and scraped. The dying cartilage and wounded bone making something akin to broken glass in a small tight dark space lacking adequate blood supply for even the chance of healing despite my immune system attempts, in the end the immune responders led to an army of inflammation and pain.  I dreamed about this.  Then I would dream of the OR a place that as a med student I always felt like an escaped patient masquerading as a young student doctor to be. I had a recurrent dream that I was found out, carried down the hall, stripped of my scrubs and then rolled back to the OR screaming that I was just not ready but no one heard me.

Here I was excelling in medical school, living my dream, planning my first trip to Africa and having no idea if I would be physically able to continue in a few months, years. I finally found the courage to get x-rays, a kind rheumatology fellow who I frankly owe my sanity to paged me and went over the films with me gently. He talked me into a steroid shot in which a the radiologist furthered my anxiety with talk of strange anatomy and bone density.  I made an appointment with the hip surgeon who I had met several years earlier and wrung my hands as I studied for Step 2, started my residency essays. The visit upset me even though I knew what was coming and gave me the strange transition of me explaining to my anxious mother what the doctors were saying. He gave me another steroid shot that was amazingly effective and I lived with denial for a summer, went to Romania and pretended that everything was ok. Perfected my residency essay, then my peds AI hit me like a freight train and my denial started to crumble.  My first patient died of pneumonia related to muscular dystrophy in an all night vigil of wailing parents and I was reminded of my sweet Romanian friend whose similar death had rocked my world in college.  Our parallel diseases differed in two major ways, there was a palliative yet potentially close to curative treatment for the symptoms of mine and even when I had no cartilage left…I wouldn’t die.  Visions of a beloved elderly patient with RA who had movement in her hands, was going blind and couldn’t get out of bed flashed through my brain…could I live with that reality?  Visions of the synthetic hip failing because of my bone density and knowing that once we took my femoral head they was no going back, if the prosthesis failed, I wouldn’t walk again.  After the on call vigil, I drove home to the mountains then onward to get a steroid shot.

Within in weeks, I could no longer deny it, the shot failed. I wasn’t sleeping now because of the pain.  It was everything I could do to keep the facade that I was just another medical student. I called my surgeon’s PA and cried in the child psych copy room and told her I wanted to do the surgery now.  (yes I had a nervous break down on the pysch floor…fun yes). Things fell into place, the surgeon fit me in (I am sure he was shaking his head thinking finally I was ready a year ago, this girl is nuts).  I passed Step 2, got my first residency interview and with tachycardia to the 120s, lectured my anesthesiologist on the decreased number of DVTs with spinals opposed to general as they rolled me into the OR.

I was a neurotic post-operative patient but I went back to medical school three weeks later, line danced at 5 weeks, interviewed for residency at 6 weeks, Kenya at 16 weeks  and by the time match day came I was taking the steps two at a time for the first time in my life.

I went through a similar period of denial and anxiety although much milder, fought to get steroid shots in Cincy( Part II, Part III). Epic fail, telling my  chief resident was near to the copy room incident. This time the PA tried to comfort me that even though there was a boat load of hardware in the hip, they would figure it out and I would be ok. I nearly lost my insurance coverage, took the Step 3 and then spoke in DC the week before.  By the time I got to the OR I found myself in a much better place than the previous time, believing that somehow the hip would work despite the hardware weakened bone and that I would walk out of this better than ever.  I found myself telling everyone (yay versed) my bucket list of things I wanted to do with two shiny hips (I remember this prior to heavier sedation but apparently I kept right on going although I don’t remember it). I woke up to the news that miracles of miracles the hardware had not prevented them from using the best kind of hip as expected and I had a 30 year lease at minimal. I was texting everyone I knew in the PACU and thanking everyone from the jainator to God for my incredible good fortune.  My family and I survived me with five weeks of unplanned toe touch weight bearing while the hardware holes healed despite a funeral, a mild incision infection and general angst on the part of a sibling.

And I find myself at 5 weeks post op sitting in an exam room across the hall from where this all began three years ago with the visit (see above). The PA comes in and asks me when I am going back to Africa?  She hands me the films with a grin. There they are, healing perfectly. Her optimism is infectious and suddenly as I remember how fragile it all seemed three years ago.I think back though to my first pediatric death and of my sweet friend Laura who died of a similar diseases (dying muscles and connective tissue…I have dying cartilage and connective tissue) and how in some strange way of the disability tribe I feel I owe them, they expect me not to waste this, to live with reckless abandon.

I am overcome by gratitude this time sans versed.  Nearly in tears.  The attending comes in  says my name, kisses my cheek and says “You’re Done!”  He grabs his cell and proceeds to call my pediatric ortho to tell him the good news. (yay for transition..although it was kind of a weird move)  He draws me my “life plan”  which includes one more visit at 6 months, then no more visits for 2 years.   It doesn’t seem real. No more hip pain, no more hip precautions, an inch taller (much to my sister’s dismay) I can throw away my crutches, 6 weeks of PT and then welcome to the rest of my life.

Mom and I drive back down the familiar spine of our beloved mountains, a little giddy despite the recent family sorrow, amazed at marvels of modern medicine, of grace and of the incredible joy of sweet relief and the sweet ability to dream.

Praise God.

Rites of Passage

Last Monday night I stood in the hallway between A and B buildings on the 5th floor and pondered the end of my career as I know it… The end of intern year.  It seemed like it was supposed to be momentous as if I should stand for a moment in the gulf between the future and past and ponder.  Its was 1 AM and I was on Heme/Onc call and I should have been sleeping but in the quiet  enfolds of the hospital at night I sometimes do my best thinking.  A year ago on the eve of my intern year I was bouncing between butterflies and homesickness wondering how I managed to end up at a program with so many smart people.

I celebrated with my classmates rafting in Indiana and then flew home to join my family at the Lake. It was a dazzling four days of sunshine, brilliant blue skies, green mountains, hiking, boating, good food, family, naps and good books. The trip was a blur, a smooshing of all that is happening in the lives of the ones I love into the four day pause between my 90 hour work weeks. Victoria has own her apartment. My best friend from high school is trying to get pregnant. We discussed it all over french food.  My best friend from childhood is getting a divorce. Emily is buying manipulatives for her classroom, preparing her lessons plans. My best friend from college is starting her internship in Family Medicine. We all went shopping for professional clothes (well Tori went shopping for shorts to wear while scooping ice cream).  And my Dad has decided the time has come to play match maker and has declared he wants grandchildren. Thing seem to be progressing at rapid speeds. I have whiplash from the changes, the leaving behind, the moving forward. There is sadness and joy….so much joy and anticipation of new chapters of life.

I came back to the world I had left except that now they call me Senior.  I am in the ED which is supposed to be what I want to do. Its confusing. I love the ED. I loved my first night in the trauma bay (the privilege of a Sr. resident). I love the speed, the variety and the acuity. But I also like sleeping and the month of ED nights is waring on me.  The wide eyed interns look terrified with every presentation they make remind me of how I far I have come. As I watch my four close friends in the program apply to second year match fellowships in GI, Cards, Pulm.  I feel the vice of pressure to be a rockstar if I want to do ED I have to prove my worth to the department….. I realize how much I just want to be done with the academic rat race that has been my environment for the last two decades.  Decisions, checks in the boxes, you graduate from intern year….now is time to have your life together….If I don’t do ED fellowship that means Africa in 23 months….that is so close…am I ready for that?

I dont know.  There are a lot of things I dont know. But for now I pause before jumping back into the eb and flow of change and moving forward. I pause to say how grateful for how amazing my life is.  For the grace for the last year, for the wonderful people who love me all over the world, for the opportunities to learn the art of medicine and the science of saving babies.  And even for the choices that terrify me but also motivate me to keep treading, keep moving on.  To choose one’s  life work is such a privilege.  To trust God with them is also a privilege.

I rest in that thought.

Where is my compassion?

Its 4 AM.

I am so tired I can hardly move much less make a life altering decision for someone else’s baby.   I am so tired that despite my fleece, knee high socks and scrubs I am shivering. My body aches, my right hip feels like its going to burst and the muscles around the shiny hip are stained.  I am tired to the point that I am short tempered, angry and I can’t remember why I am doing this no matter how hard I try all I can feel is anger. Anger at the child. At the parent. At the nurse. I try so hard not but all i feel is anger. Its not the baby’s fault. Its not the baby’s fault I say to myself.  As I drag myself to the room of another sick child, I can’t remember the child’s name and awkwardly refer to them as “the sweet baby” or “pretty little girl” or “buddy”.  I am covering 60 kids and I am on hour 23 of call and I just can’t bring myself to care beyond just making it another two hours to sign out when my comrades will get there…..and beyond to 7 hours from now when I can go home and sleep in my warm bed….

I look down at the baby, someone’s child and all I can think is how did I get here and why am I going through this torture.  Where is the compassion I had in medical school? Where is the excitement I had in college? Where is the dream?

I am making preparations for Kenya. I am counting down the hours till I can pack up my little CRV and drive across the mountains home for a night, north for a precious and much needed steroid shot and then boarding a plane to take me EAST…..

and then SOUTH. to warmth.

escape.

to more sick children….but somehow in Kenya its different.  Maybe it waking up to the Great Rift Valley with the mist burning off the smoldering African plains, maybe its the craziness, the chaos that is a hospital in rural East Africa, maybe its the grateful smiles of every parent, maybe its quiet morning prayers. Maybe its that life exists on Africa time.  Maybe its that I can’t call for 20 consults.  Maybe its that the internet works ON A GOOD DAY only. Maybe its because for a little while I can be Amy again not Amy the super intern at a top program or Amy who wants a competitive fellowship or chief spot.  I can just be Amy who knows some medicine, who knows what its like to suffer and who works to find some way to bring those things together in a productive way that brings healing. Maybe I can just be.

Its the 4 AM of my 12 month internship and I am tired, cold, sore and angry.

so I do the only thing I know how to do….fly, fly, fly away to somewhere life is harsher yet simpler.   Somewhere that i knew and learned compassion and that I pray will be gracious enough to teach and humble me again.

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)

can’t leave your roots….

So I have been blogging for about six years, seven this May.   And I have done a lot of growing up during these past years. I discovered a love for the world’s children, I discovered pediatrics, I found my independence and young womanhood away from my family, I also found my way out of the church of my childhood that was  dying in legalism and tradition into a faith centered around the gospel opposed to man made institutions, I survived my first major medical endeavor as an adult, I have made huge decisions in terms of education,  faith, life and health that have been my own away from my family.   This year has brought my first real job, my first real house of my own and carving a life separate entirely from nearly everything I have ever known.

But in the end I am still the oldest daughter of a sailor and a homemaker who are conservative and despite their own attempt to break ties Southern Baptists.   I may be a moderate, woman physician at a top notch peds program, with friends who want to have jobs like pediatric heptatologist or oncological endocrinology.  I may go to a trendy, inner city, little church plant that meets in a recreational center, is striving to be intercultural and interracial and sometimes gets a little snobby about those churches in the suburbs. I may be able to quote pediatric HIV statistics, child poverty statistics of Cincinnati far better than I can tell you how to make a casserole or a family meal. I may be able to suture a squirming child’s face far better than I can sew a hem or knit a sweater but in the end…..

sometimes all I want is to be just like my Mom. (or perhaps even more my Mom’s sterotype)

Sometimes I fantasize about being married (and not just in the way that a single girl does this….married in the old fashioned 1950s, Lifeway Christian stores (SBC propaganda), Focus on the Family kind of way)….where I stay at home, go to woman’s bible studies, make cute little cup cakes for baby showers, have babies and raise them.

This is not in any way to belittle my Mom who I think is one of the strongest women I have ever known. And anyone who has met my Mom knows she is a force to be reckoned with in terms of getting stuff done, advocating for children or taking care of anything. Its just on the outside I think most people would assume that I have sort abandoned this kind of life with my choices and if you asked me straight out I would tell you, I love my job and I can’t imagine not practicing medicine.

But yeah  despite all my liberal education and independence I still can’t divorce the fact that there is something to be said for where I come from and I don’t think I can leave that behind blindly.     What that will look like medicine + stay at home Mom + living overseas…not sure.

But sort of excited about finding out.