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.

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.

Transition State

….What colors do you want your kitchen to be?  Sofa bed or day bed in the office/guest room? Which car insurance agency to do you want?  What is the interest on your student loan?  What is Ohio’s policy on handicapped parking? Have you thought about investments???…

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.

Traditions…..memories….nostagia

My family loves traditions.  Making our family Christmas gifts, singing off key on each other voice mail on our birthdays,  the annual cousin Christmas play, dying eggs at Easter, red velvet cake on my parents’ birthdays in Feb, Red Lobster for my sister’s, advent calenders, trivia at the dinner table, lunch after church and I could go on. We mark our milestones and holy days as a family with joyous rituals  always remembering years before variables on a common theme.

Preparing for major orthopedic surgery in my family has familiar rituals  too because its been a somewhat frequent occurrence in our lives.  Some are very practical, some are down right silly.  Its been  a while but one would think it was just last year if you watched how quickly we all fall into the roles we know so well. My Mom sets out arranging things even with me signing consents and doing most of the arranging now she still finds ways. Dad reassures Mom, me, himself with daily pronouncements that everything is going to be ok.  Emily and Tori shuffle in and out of the dialogue offering books, chocolate and wanting to know long i will monopolize all of our lives (my primary question as well) particularly my parents’.

I go to the library stock up on books,  DVDs, audiobooks,  stock up on food. As I packed my car this morning. I  packed pillows. I went to target and bought new undergarments and socks. I found my one pair of shorts that I own and stuff them in my suitcase.  I plan the traditional ‘last meal’ via google and decide on wine and crab cakes (it is Maryland after all).  All the paperwork has a folder, all the appointments are made and all the necessary items are purchased.  I then of course am now taking the traditional joy ride which has expanded considerably since childhood with my driving ability and all terrain vehicle.  This time it will include a week of visiting, going to the beach and general traveling.

And just like with all rituals and traditions…I remember.  But they are strange memories as I suppose all childhood memories are to some degree when we looked back at them with  adult reason and knowledge. The last time I had major hip surgery I was 13 and although some times I thought what it would be like 10-50 years from now, most of the time I just wanted to be able to go through a whole year of school without having to be on home-bound.  I wanted to get through a Spring where I didn’t break a major limb to pieces over something ridiculous like walking the stairs.  I wanted to be able to stand for a whole play or walk my dog or go hiking with my family like I had when I was younger (5 yo- 10 yo). Frankly, my life was pretty awful between the pain, the social isolation and lost of the abilities to do many, many things I love. I was begging for surgery.  It made so much  sense.

But now my desires are so much bigger, I haven’t been ‘sick/injured’ from Kniest in a decade other than an occasional minor mishap. I have traveled the world, graduated from college, live independently, drive a car and do crazy things like ski and play doctor.  And I don’t want to stop any of those things, moreover I want to do more like live overseas, complete a residency, get married, have kids, raise them, etc,etc…  Handing over my life to the hands of a surgeon is so much more difficult now. The stakes are higher, the leap is so much scarier.  Its not about just making it off the ground it, its about finding my way back to  the lofty altitude I have been cruising at for the last 9 years.

The roles are the same, the rituals are the same but the dance is so much more complicated than I remember.