“This is an example of a potentially poor outcome.” the nurse told me matter-of-factly. I look down and see tiny hands grasping mine and bright eyes exploring my face.  My medical training registers the curl of his fingers, the shape of his eyes and the dimple over his lip that defines his diagnosis. But I don’t see a poor outcome. I see a child. I also see myself.  25 years ago I was the baby in the nursery who was thought to be a poor outcome.  I have a disability that stems from a genetic bone disease that I was born with.  I am a patient and a student doctor. My disability was my first attending and it is my constant board exam. It has taught me compassion, humility and grace throughout my life and even more so in medical school.

Just like my classmates:  I take call, I write notes, I learn how to do procedures, I deliver babies and I rotate through all the required specialties.  I do this by using a manual wheelchair to round, an amplified stethoscope to auscultate and a stool to suture or assist in the OR.  Unlike most of my colleagues I can sit down next to my anxious or weeping patient and relate to what its like: to undergo anesthesia , or receive bad news from their doctor or go through rehab after a trauma or a major surgical procedure or even be denied health insurance.

I have never had a patient who didn’t want me to be a part of their care because of my disability but I have had many thank me for sharing my own struggles and stories. I have occasionally encountered an attending or a colleague who was skeptical. But in the end in nearly every situation by the end of the rotation I found that we have learned from each other’s perspectives and become better physicians.

As a patient, as a disabled individual I am a member of one of the largest, most underserved minority groups.   The disabled community makes up 11% of the US population but less than 1% of medical school graduates. I am grateful to Wake Forest for catching the vision and realizing that physicians with disabilities have something not just to learn but also to teach.   I believe my patients are grateful too.  They know that I provide excellent care. They also know most of all that I do not see the labels of illness or disability or poor outcomes, I see them first and foremost as human beings like myself.

He introduced me today as an important part of diversity at Wake Forest and a national advocate for medical education for the disabled.

awesome.

last week we decided that there should never be another me but this week we love me…….

in summary our current disability policy is biopolar.

And really if I am half the parent she is one day, I will be happy with myself. Not only did she raise me to be a self sufficient, miraculously tall and unusually driven (possibly to the point of insanity) dwarf/gimp, she raised two other remarkable young women. She cared for us, she disciplined us, she loved us,  she prayed for us. and she fought for us!

Mom rocks my world.

Happy 50th Birthday Mom!

Maybe its because I love its people. I love to sit on the bus or the tram or the metro and watch people. Romanians are proud and always dress up to go outside their house. They are fiercely protective of their children (yes a bit ironic) and although they don’t smile enough for my liking at times when they engage you they are warm and will probably invite you to dinner.

Maybe its because I love the children. I am back at the baby hospital again this time. I could spend all my time there and be perfectly happy. These children resilience, their beauty, their capacity for love when they have not been loved has always given me a window to the divine yet also of the silence desperation of the orphans.  I thought it would be harder being close to the end of my training but its better somehow. Even though I at times know the grim statistics these kids face, I also know of their potential first hand. I cling to that at times because I believe they cling to it too. They know what they want beauty and love over despair.

Perhaps its because I am an American and optimist that I see such beauty in the mist of such drabness and pain. I probably sound hopelessly naive but I am not as much it may seem. I know the dark side I am just surprised that there can be such dichotomy.

I hate to admit this but I need Romania far more than Romania needs me. This place has always been a place of such spiritual and emotional renewal for me. I think its how simply I live when I here.

Leaving Roanoke in less than 24 hours to drive to Dulles to fly to EUROPE.

Leave for Romania from Spain in T minus 11 days!!!!

so happy right now.

New photo site for the year of insanity:

http://amyadventuresabroad.shutterfly.com/

There’s tarnish on the golden rule
And I wanna jump from this ship of fools
Show me a place where hope is young
And a people who aren’t afraid to love
This world has nothing for me and this world has everything
All that I could want and nothing that I need
This world is making me drunk on the spirits of fear.
So when he says who will go, I am nowhere near.
And the least of these look like criminals to me
So I leave Christ on the street
This world has held my hand and has led me into intolerance
But now I’m waking up, but now I’m breaking up But now I’m making up for lost time

Caedmon’s Call

Today I was minding my own business in the NICU workroom helping the new residents get used to the crazy NICU computers and mucho important facutly member walks in the room. He talks to the fellow and introduces himself as our incoming attending starting Thursday to the residents. Then he notices me with my feet hung over a chair, list in my hand, hair falling down, scrubs stained with strawberry juice from lunch.

“You’re our AI, wonderful, I read your paper I have been meaning to talk to you. So have you decided on peds?”

I sit there with my mouth hanging open confused. I had had one interaction with this man, he complimented me on my surgery essay (read here) which was published in the school’s journal. I remember only because our student body president took me aside and asked me if I knew who I had just spoken to…I shook my head. He mumbled a important title that was lost on me beyond that he was mucho important. That was 6 months ago.

YES! I have commited to Peds! I said. What paper are you referring to?? My surgery essay?

No, no it was an abstract. About physicians with limitations.

I nearly fell out of my chair. The abstract is not a secret but it sort of is.  The only faculty member who knew about my submission to the AAMC (American Assoc of Medical Colleges (a large group of mucho important people who are the gatekeepers to med school nation wide) Annual Conference) was the guy who teaches our professionalism class.

“Oh yeah…I wrote that.” I stuttered. “I don’t know whether it will be accepted or  not  till July.”   He responds, “It has come to my attention we have turned down at least one highly qualified candidate who is now going to Hopkins because of  their disability.  I am interviewing candidates for a new Dean of Admissions (the old one is retiring), the one we select will be announced next week. I am only interested in choosing someone who is absolutely committed to rewriting our Technical standards.” (Technical standards are the PHYSICAL (non-academic) requirements for medical school, they are one of the BIGGEST BARRIERS to disabled doctors.  My school’s TS are atrocious…so bad that I shouldn’t have been admitted under them however I had a faculty member write me a letter of recommendation and I was one of the top five in my pre-med class at the same institution…its hard to turn down one of your own)

audible gasp from Amy.

“I want you as a consultant for the project, along with J (alum who had a spinal cord injury his 3rd year at my school),  T (current upper level int med resident). You’re the experts.”

“I would love to…”

“Excellent, we will chat more, what are your thoughts about Dr. X  (mucho important person directly involved with med school stuff)’s feelings on this, I am not sure he is on board…?”

“Um…(dude he just asked me my opinion on the freaking Dr. X who in part  controls my future….but who I have secretly believed he is not a believer forever now)  Dr. X has always supproted me…beyond that I don’t know.”

“yeah I am not so sure about Dr. X either.”

(holy crap what have I gotten myself into)

“I am very excited to have you on the NICU team and for your future in peds and I am glad to have you on broad for this project, See you on Thurs.”

So I got home and looked the guy’s title up…he is only the Sr. Dean of the freaking school. (4thish from the top of the little medical center prymaid).

I am thrilled but also a little freaked out….this guy knew nearly secret information about me and had insight into my thoughts on a VERY controversial subject The rebel in me is a little annoyed, the activist in me is singing.

also have to become the best darn AI by Thursday in NICU history….no pressure….

This weekend my spinster Aunt got married at 47 to a widower with 4 kids. It was a beauitful ceremony filled with the excitment and joy surrounding any wedding. But there was saddness too, sadness for a mother who died before seeing her children grow up.

I hurt my knee at the wedding. I didn’t do anything but I woke Sunday morning with a hot, swollen knee that felt like I had torn something to bits. Last week I dislocated my elbow… I’m a  bit of a rheumatological mess right now. I’m in love with my work, the babies and peds in general but i am in constant pain. Its been a long winter.  I do believe that the hip’s death spiral is putting undue pressure on everything else.  I have resigned myself to surgery in March of 2010. I am dreading it, the idea of going back to the place I lf behind a decade ago is scary.  but I am grateful for it.  That there is a light at the end of the tunnel! Its a beautiful thing.

and the truth is I want to get on with my life, with doctoring babies and dancing at weddings and loving it.  thats a beautiful reason to be willing to take the risk of surgery.

Its all comes back to bacon and a kid named Tony.

Cardiology is better with an adult beverage in your hand.

All the colorful language I use I learned from Dr. Chatterjee.

GI Joel is the coolest block director ever.

If you eat Polar Bear Liver you will kill your own liver

Reindeer do not have gallbladders

Do not eat your hair.  It will cause a massive obstruction in your GI tract over time.

Vulvanman and godzilla are friends.

That’s the straight poop. (Its all true)

Don’t play with guns.

Don’t play with bricks.

Don’t play with hot water.

Don’t play with knives.

Don’t play with nails.

Don’t play with toothbrushes.

Don’t eat Mr. Potato Head parts.

Don’t play with cars.

Don’t play with lawn mowers. Actually lawn mowers should just be burned.

One nut is better than no nuts.

Never underestimate the high frequency of less than one in a million.

Med students are man’s simplest tool the wedge. Its always our fault.

Anything smaller than a a baseball can be stuffed into nearly any body orifice.

Delivering babies is not a sterile procedure.

The uterus might be the most amazing organ of all time.

My parents’ home is NOT a substance abuse facility.

Its easier to apply for disability with many diseases than it is to find a job with insurance that will cover said disease.

One should never see cats in the ICU but one may occasionally actually be right about being paranoid that the FBI is tracking you.

Electroconvulsive  therapy is shockingly anti-climatic

In the end it all comes down to fluid.

how you die matters.

bagels taste better at 2AM.

I am on pg 417 of Smith’s book.

Informed  consent is a relative term.

Cancer sucks.

It looks like a rt bundle branch block…it is a rt bundle branch block.

When it doubt it congestive heart failure. When its not CHF, its probably HIV and if its not HIV its probably TB.

Messed up kids have super messed up parents.

Everyone is addicted to something…the question is how quickly will it kill you.

You can actually exnucleate your eye with your own hands.

Never underestimate what can happen with anyone with eyeballs in a mile radius of small, sharp,pointy objects.

Cameras in the workplace just scare the crap out of everyone.

All bleeding stops.

Adults need something to do in the hospital other than stare at the walls and ponder their fate.

SKIP BO is an excellent example of a better activity.

Losing the ability to walk. Difficult. Losing one’s ability to feed one self. Difficult. Losing one’s ability to commuinicate Difficult. Losing the ability to think, relate to the world.  pricelessly horrible.

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