STOP. STOP. STOP.

For just a moment I would like to bask in the moment that I am done with school for all intensive purposes.  Other than three weeks of casual lectures. I am done with medical school.

No more exams, no more adult patients, no more surgery rotations!!!

and now that moment has passed. now we move on to whats really important when you graduate from medical school at 25…becoming an adult.

A real one.

I am bad at it.  For starters…life has been prolonged series of camping trips since well birth…  I go somewhere, I sleep there for a while then I move on. I don’t know what color I want my kitchen or what kind of slip covers I want or where one even really goes to furnish a house… When I imagined myself as a grown up…I imagined a small soviet bloc style apartment or small falling down African house/flat filled with a lot of ethnic art, books, photographs, doctor stuff and stock piled peanut butter in rubber maid containers next to the rubber maid containers of Gideon bibles (in a language that only i speak) and buttons that misguided yet well meaning churches send me and I use as coffee tables. Eventually there will be a husband and kids smooshed in the tiny, tiny flat  too.  I have no idea how to set up house in America especially as a doctor. Apparently doctors are very respectable and have color coordination and matching hand towels. Why didn’t they cover this in medical school?

Insurance…well I have been uninsurable off of my parents’ insurance up to this point. All I know is insurance companies hate me because I was born gimptastic.  There are now like mutliple plans that all cover me now because I have the title of doctor and I work at Childrens.  How do I choose? What’s the difference? Can I just barter brownies for hip x-rays? Is that an option?

Money…never had any of my own…ever.  What little I did have to my name I spend on plane tickets for “camping trips” and food. I have no idea what one does with money that does not go to eating…apparently  one goes to IKEA and buys sofa beds…thats what my Mom said to do.  Then there are taxes and my student loans according to my Dad eats up the rest of it.

Well I have been an adult now for four days. I think I am done. I am ready to retire.

London was beautiful from the air, the english countryside was bathed in white.  My connection went flawlessly and although my flight got delayed a bit on the ground it was a great flight. One I will never forget. I watched the map program every couple of minutes once we hit the Med. Sea wanting to see the coast of Africa as we crossed it. It was beautiful and shockingly different than the coast we left behind in Italy.  I watched the sunset of Sudan and by the time we entered Kenya, I couldn’t sit still with excitement. The last time I did this whole go to a new country/new continent thing on my own I was 19 on my way to Romania. I was considerably less freaked this time around. I got my visa without problem despite the fact I accidentally left my original copy of my yellow fever vaccination in America on my scanner. All of my luggage made it and I was picked up by a kind man named George who took me to the Mayfield guesthouse. The guesthouse is lovely, full of  African art, mosquito nets and people from all over Africa who are passing through. I shared a room with a lovely girl from Ireland who is going to teach in a primary school in the North of Kenya.

I didn’t sleep much but I enjoyed what little I did get. I woke up early since my roommate was on her way north.  Took a shower, felt human and then explored the guest house. We eat meals family style here. The rest of the medical team that was supposed to meet me in London finally made it. Two of them will come to Kijabe with me. While they slept I went to orientation at the AIM office. I also saw Nairobi by day.  The smell is a cross between the humid, thick magic of a Carolina magic and the strange pugant tang that I associte with Bucharest. I am not sure if its a city smell or a developing world smell but it smells like home. Kenya has had two years of drought but its been raining and everything is green and there are many flowers.

Orientation was oddly interesting we talked a lot about the history of Kenya and plans for medical missions here in Kenya. I will write more tomorrow once I reach Kijabe. For now I am exhausted…

853,000 pediatric deaths a year.

this is not swine flu.

this is a disease that is completely curable.  it also doesn’t exist in the developed world.

Malaria.

lets compare shall we…

Swine flu has caused 6250 deaths since April ’09.

3,900 Americans. **

thats the kicker.

80-90% of the malaria deaths are in Africa.

so the next time you see one of those glossy articles about swine flu or five minutes spots about just how bad swine flu is..think about the value of a life.

Every three days the same number of children die as all the swine flu deaths combined.

Does the life of an American child mean more than the life of an African child?

You know the answer to that question and you also know that CNN is never going to report about in a glossy five minute media spot.  Because no one likes to know about dying children

It so much easier to forget they exist.

I too am guilty of this. For the last six months I have taken notes in lectures, carefully masked and gowned and prayed that my little patients would not end up in the ICU.

I took the h1n1 vaccine along with my other classmates three weeks ago.***  We have been chosen, our young age, our knowledge, the investment the state of NC and the federal government has made in us and our daily exposure makes us first in the line at our hospital even over residents and attendings.

Yesterday I was all in a tizzy because I woke up with a fever, body aches, cough, sore throat and my roommate is recovering from swine flu. Student Health was all in a tizzy too as they listened to my history and promptly wrote me a script a 120 dollar script (20 dollars with insurance) for tamiflu.  I am faithfully taking the drug.

Its not what I am doing is wrong. I just can’t help but wonder what kind of difference we could make in saving the lives of children if we had the backing that swine flu has.

What if for every dollar we spent on swine flu, we sent a penny to Africa for malaria cures?  How many lives would we change? save?

Does a death require less grief if no one knows it happens? Or can we be held accountable for the lives we could save and don’t?

I shudder to think of God’s justice and how much it pales our own man made justice.

Somehow I doubt he is going to buy the whole tree falls in a forest with no one to hear the sound excuse….

**(right NOW swine flu is spreading to the developing world more and more, Ukraine and Mongolia are facing huge numbers with the disease. In Mongolia the WHO fears it could overwhelm their health care system but for the last six months while all the money has been spent, all the decisions have been made its been a developed nation disease…I wonder how many vaccines are being sent to Mongolia???)

***(there is a 2-5wk window period for the vaccine to give you full immunity, my roomie got sick at the end of week 2 so I was not fully immune yet)

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.

I’ve tried to substitute with American summer staples like ice cream sandwiches and Popsicles. I went swimming in a clean pool with other Americans. I went to the beach a few weeks ago and am going again. I wore a tank top and and read on my porch. I’ve savored air condition. But it just doesn’t feel right. I haven’t spent a summer in America in 4 years. I don’t know what to do with myself.

Today I hung out in the special needs eye clinic. You know you would think that I would love love love American health care with all its technology and solutions for these kids. It just also makes me all the more aware of how much my people in Eastern Europe suffer. Its as if I do not understand their nakedness entirely until I see the full beauty of clothes. The more clothes I encounter the more I am ashamed of their nakedness.

yeah I keep sort of deep down wondering if I will grow out the whole e. europe thing…like if this will be some sort of phase of my life that will fade out like that time I used to sing in the choir. but it seems to be here to stay, it seems to have taken hold in strange ways.

I think I shall make a cherry pie this weekend when i go home.

On my first day of optho, I find myself explaining my life plan to an attending. I want to be a general pediatrician I explain. He asks me if I know how much the average pediatrician makes. I said yes. He looks at me strangely, you are too smart for that job, do a fellowship, this is a good medical school use your education wisely. I smiled and brushed off the comment but again was struck by how different my conception of using my education wisely was from this respected physician. It wasn’t that his ideas were wrong or less worthy, it was just very different from mine.

doctors yet again such strange people, I have much to learn of their ways before I ever understand them.

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No matter how much charting I tried to do it seems my surgery rotation is a small series of not so comical disasters. They say it happens to everyone and it does but I can’t help but become steadily more aware (…yep I am getting ready to break one of my cardinal rules of life….)how much it sucks to try to figure how in goodness’ name to do this with no cartilage. There is no textbook I can buy that can tell me how to round with no sleep in a wheelchair, write, talk and think all at the same time at 5 AM in dark rooms stuffed with 7 tall able bodied people speaking in whispers that my not so superhuman ears can deciper and all the while remain incredibly enthusiastic. There is also no textbook that tells me how to cut right on the knot every time when half the time I can barely hold the scissors right. There is no book that tells me how to make the scrub nurses stop taking my stool to a place where I can get to it and stay sterile. Also written notes…OH MY GOSH, disaster. Haven’t had a handwritten assignment in 16 years, disaster (ALWAYS wrote everything on the com).

And of course its really hard to not hear all the echoes of all the people who think that disabled medical students are a bad idea. And I look at my average classmates and I nearly just give into the fact that I will never be able to compete. It all seems so effortless for them. While I sit there for the 11th time and try to cut a suture they get it on the 1st or 2nd try. While I run around to keep up on Rounds and get names confused as I try to roll and talk and write all at the same time. They stride so effortless from room to room with perfect handwriting and perfect memories unclouded by exertion . I can’t compete with their able bodies.

Pioneering is actually not half as romantic as it is in the movies or historical nostalgia. Its swollen feet, blistered hands, insecurity and endless mistakes.

Today after I had been released from my duties. I went upstairs to the room of a patient who came in with a abscess in the middle of the night that we drained this morning. It had been a crazy exprience for the kid. We had to do the procedure in the OR under conscious sedation because the mass was near her airway. The child had been sick when we rounded earlier in the day. So after another trauma and procedure I went back up and checked on the little one. I went to the nourishment room and got her ice. I think it was the only thing i did right the first time all day. (or the 11th time for that matter). Maybe all week.

stupid oxen.

My presentation was kind of shaky and rushed and very, very different than the other three. Mine was a narrative with a lot of photographs of children and Eastern European art and scenery. The others were very public health focused, people were cured of malaria, maternal and infant mortality were decreased. There were statistics and evidence based medicine and epi. I had a single slide of stats which were colorful and again bordered by bright eyed beautiful children.  I didn’t cure any diseases this summer, I played Nannie more than developmental pediatrician even.  I was the last presentation of the day. After 45 minutes of public health and EBM, I was anxious and uncomfortable in my semi-sensible looking professional clothling. Who was I fooling? I make a better flower child than a public health officer. peace. love and medicine. woot.

Needless to say I was bewildered when the e-mail came.  I am thrilled, its somewhat meaningless beyond an extra sentence on my CV. But its kind of nice to know that perhaps my class does not think  I am completely bonkers…  or maybe bonkers was easier to stay awake during than sane.
at least I told 100 folks about the plight of my tribe in Romania.

Speaking of med school. ::::drumroll:::: I have never made HONORS in a class in medical school. On Saturday morning I received an e-mail stating my medicine for the under served paper (I wrote about Aurel and the plight of my people in E. Europe) along with three other papers had received Honors. I was thrilled for about 10 seconds. Then I read that all the honors students have to do a presentation in front of the entire class and then the class will vote on the number 1 paper for top honors (a grade that usually doesn’t even exist). I would get Honors in the one class that requires extra work if you make Honors. Also apparently the only thing I am exceptional at is writing human rights papers and taking care of poor people. Imagine that…I majored in Religion. What am I doing in medical school? (I am happy about the Honors really just somewhat terrified of going before my whole class and in the company of our class’ top student and two Ivy League grads and then me the gimpy mediocre med school wonder with a low first tier degree).

The low point of the weekend  was the pharmacy. It was time to refill my Celebrex. So I called Walgreens the night before. And then Rachel and I headed over there on our way to the parables dinner. We rolled up to the window gave the dude my name, insurance card and debit card. The pharmacist messes with the com for like 10 mins and then finally comes back to window to inform me that my insurance company refuses to cover Celebrex until I try Aleve or Ibuprofen (naturally over the counter and thus they pay nothing).  It will be a 156 dollars to refill my prescription. I nearly cry.  I took Ibuprofen as a kid but once I hit puberty it made my time of the month miserable and uncontrollable. Plus Celebrex pain relief is about 12 times better. The pharmacist was nice about it and told me that if my PCP called on Tuesday and told them I had already tried the other meds. My insurance company would be obligated to pay for the Celebrex, their second line drug. He was willing to sell me 4 pills worth to get me through Tuesday.  $16.99 later.  I am paying 6400 dollars a year.  No make that 6400+16.99.

I fumed. If that had been insulin, a Beta-Blocker or Anti-convulsant medication, people could die if they can’t get what they need.  insane. when did my life become a Micheal Moore documentary scene?

but it was a great weekend. it really was     love to all.