Post Residency Bucket List

Well the ICU is mostly what I expected.  I think my biggest problem in medicine is I am just over doing things I do not find super educational (there is learning to be had in the ICU but its hard to do when your role is to do paperwork and field pages for flush orders) and that resemble slave labor (I barely touched actual children…I wrote orders all night long…you could train a computer to do my job)….  Ready to be a human being again.

While becoming a doctor has been the fulfillment of a dream.  Its not the only dream I have. And in 13 months for better or for worse.  I will be done with my required education related to that dream. Thank GOD.

What I want to do in terms of earning money to eat and maintain health insurance in 14 months is unclear exactly. And honestly I have gotten to the point I just don’t care (I mean do obviously I have sent out countless global health applications and tried relentlessly to create my own academic peds/global health fellowship but in the end as long as I get to take care of kids for some percentage of my day to day life, I don’t care the details much anymore).

What I really want to talk about is everything else I am going to do….

I have the following list thus far:

~Sleeping on a regular basis like every night… or at least at some point during the 24 hour period. Beyond being overseas (which is different), I am going to do my utmost to never work in house 24 hour+ call again.

~Finding a church/community that will not stone me for being a pacifist, a children’s/minority/disability rights activist, for thinking women have a role in church beyond raising babies BUT still believe in Jesus….

~On a related note, becoming a part of/forming/etc a Christian woman’s ministry where talk about something other than getting married and raising babies (both of which I would like to do but that I think are not actually my reason for existence (which is of course, glorifying God)).

~I would like to live in intentional community FOR REAL. Not just sort of halfheartedly

~Going back to Romania, find Aurel, Christine and Rapheal. And even if it requires 12 hours on a train, go see Laura’s Grave. Pray there and thank her for the vision she gave me in our short time together. Tell her I became a physician and that I carry her with me every time I speak for our people.

~Going back to East Africa and I would like to take my family with me.

~Live Abroad for at least 6 months but up to forever subject to God, my cartilage and all these other things.

~Writing THE BOOK that I have been talking about for 10 years even if it means I have to tell the truth about how bad medical school was at times

~Spending at least an entire week in the Outer Banks at my Grandfather’s where I eat fresh sea food every night, go sailing with my Granddaddy, losing myself in the Elizabethen Gardens and then waking up and doing it all over again.

~Spending a week with my Paternal Grandparents either on a road trip (they love to drive across country) or at their home. Learn to cook from my Grandmama (again!) and talk theology and writing with my Grandpapa.

~Spend some time with parents. Going on a Father/Daughter trip with my Dad that has NOTHING to do with trying to become a disabled doctor/pioneer/take some nasty exam.  Hang out with my Mom, listen to her and not spending the entirely of time together  with me venting about how much my blank rotation the previous month was the worst thing that ever happened…./her caring for me after some life altering, horribly stressful (for all involved you imagine watching your first born go under anesthesia 25 times+ ) and painful medical procedure.

~Go back to AAMC with protest signs/hunger strike if necessary and say they need to get over their able-ish and put a disabled physician on the committee for disability (GOD FORBID we actually have representation) and be a some what gracious but fierce activist with impeccable credentials (you can’t argue that I am just a med student any more, I will be a board certified pediatrician from of the top programs in the world). (this may or may not be related to the BOOK project)

~GO on a trip with just Emily and Victoria. Even if its just to a Holiday Inn in Vinton (which is like 10 minutes from our parents’ home)

~Go on a medical mission trip with Jessica

~Go visit my friends in Oregon

~See the Grand Canyon (actually going next month a year early)

~Really learn how to cook rather than occasionally dabbling

~Go on a silent prayer retreat

~Write some travel writing type essasys

~Go to Ireland

~Get the Sacred Tuesday Group back together for a crazy retreat/reunion/celebration somewhere (ANYWHERE)

~Help write some transition related stuff for kids with skeletal dysplasia (ok so nearly work related…but I have come to the stunning conclusion I might be the only human being currently alive who actually can/wants to do this)

~Read SMART books that are not about medicine

~Relearn all the theology/religion major stuff that I have suppressed in order to make room for the Krebs Cycle and organic chemistry (worthless)

~Need some sort of theater in my life again beyond the annual Long Family insanity known as MY MOM’S CHILDREN THEATER PLAY WEEKEND

~Figure out my opinion about about the laundry issues of social/theological issues that have come up in the last 7 years that I have not had time to research or pray about fully.

~Successfully plan and care for a garden without having either things die due to neglect or never getting it in all the way due to time constraints

~Go to the San Diego Zoo

~Read all the books on my list (really long)

~Learn to play an instrument (even if Emily says there is no hope for my deaf little ears)

~Buy a hammock, lay in it.

~Go through the phone book of where-ever I am living particularly if its a large city and eat all the different ethnic food restaurants from Albanian to Zambian.

~Make a recipe book of all my favorite Romanian/Russian/British/Scottish/Chinese/Kenyan/etc dishes that I have accumulated over the years from all my travels

~Take a photography class or at least dabble more officially

Longer term goals:

~Get married

~If that doesn’t work out, adopt anyway

~Scrapbook/Journal/DO better keeping up documenting

that’s it for now but this list will be growing over the next 13 months. Stay tuned.

Confessions, awkward prayers, awakened possibilities

Well I told someone exactly how I feel in terms of being a bad evangelical.

It was not my pastor. It was a kind man about my parents’ age who is also a bad evangelical who runs an intentional community.  I am not quite where he is, in that I am pretty sure he simply sees Jesus as a moral teacher. But I so greatly appreciated his story, his life and his willingness to listen to my story.

He told me that he had built his career as a missionary and now has very little to show for it because now he has evolved into a liberal that is no longer accepted in evangelical circles.  His biggest advice was to not end up that way. It will be different from me as a physician but still very good advice.

Literally 15 mins after that I sat in a strange yellow room on a sofa saying I wanted prayer for the choices I had to make.  Two things were abundantly clear to me in that moment.  This guy who is my pastor really doesn’t know me so well and well as a result its awkward. And then I also realized that while he and I on paper have similar theology, our application of that theology is completely different.  I handed them my reference form and ran to PT.

So I stand in the middle of these two extremes.  And for now that is ok.  The reality is for now I am a liberal evangelical and I am ok with that.

Me and My poor quality of life are going upstairs….

I have been in 7-8/10 right hip pain post-call for about a month and half.

Yesterday was Grand Rounds and I was post call. It was on chronic pain in connective tissue disorders….NO REALLY it was.  I slumped in the back, ate my oatmeal and hoped that sleep would overtake me quickly. It was all fun and games while the geneticist gave an explanation of connective tissue disorders. Then the rheumatologist went on about Fibromyalgia and JIA.  I drifted in and out. Then the psychologist got up to talk and went on about chronic pain and patients (our) poor quality of life.  And how much they (we) feel persecuted in the hospital when they come seeking meds and how they pass up activites they would otherwise enjoy and then how there is a higher rate of suicide. They went on to talk about new research studies that were ongoing looking at day hospital treatment for chronic pain. and cognitive therapy.

I sat there in the corner in my imaginary white coat (I never wear one, it scares kids) and shook my sleepy head at this. Its all fun and games until someone misses the point.  Maybe part of why we have a higher rate of suicide and “poor quality of life “is not so much our pain but the medicine we use to treat it. And medicine in the literal and larger sense.

What if instead of taking our chronic pain patients out of society and out of school to be in a day hospital program, we find ways to help them engage in life? What if instead of giving narcotics like candy to our sickle cell population, we tired alternate methods or we at least stop complaining about how they are addicts because WE (the doctors WE) gave them their addiction!! What if we stop trying to make pain less depressing and find ways to make life more worth living? What is our goal, be pain free, or be living our lives?

I agree grand rounds friends, chronic pain is a mind game.

But its some what clear to me that you have never played.

Chronic pain is a series of choices.  Difficult choices. Defining choices but choices never the less.  Every day you wake up and you decide what rules today?  My life or my pain?  Do I fit my pain around my life or fit my life around my pain?  You can tiptoe around on eggshells and slip and fall or you can run and not look back.  You don’t choose to live with pain but you do choose to live to the fullest. TO live with joy. To live with gratitude.

Doctors, all the study show we are actually quite bad at understanding what “quality of life” means to our patients so maybe we should listen to them.

I rolled my eyes and my wheels and took my poor quality of life upstairs to rounds and helped save some lives. Then I went home, had a mug of tea, a long bath and a nap. I woke up and read a book, went to bible study, came home and finished the book.

Like I said me and my poor quality of life…..

The ivory tower has a view

Occasionally I stare down from my ivory tower of my home away from home… my premier world famous childrens hospital into the rainy streets  below and ponder the ironies of where I stand.

I am among a very friendly, although intense community of young physicians who inspire me and challenge me.  They also want to do things like a be a pediatric heptatologist when they grow up or a palliative care/hematologist/oncologist or be a cardiac ICU doctor.  They are impressive and are being groomed to have impressive careers.  Occasionally I get caught up in the mist of it and try to play the game  but win or lose I find myself looking down at those streets and thinking about how different my life will look in 10 years than nearly every other graduate of my program.  Sometimes I don’t know how to fit my career goal into some sort of acceptable academic mold. (Although if I was really trying to FIT IN maybe I would give up the TIE DYE t-shirt collection on call…and actually WEAR my white coat).  WHen people ask me what I want to do with my life….the expression on their face when I say global health doctor is something akin to shock or a sad smile as if to say “We’ll see how long that lasts….”  Then there are my recent attempts into the array of ACADEMIC global health which is just like what it sounds…. a complete paradox. So far it also seems like a mess….its like combining developing world bureaucracy with academic medicine bureaucracy which make s system that makes Africa time look like a New York minute and Eastern European bureaucracy look like excellent customer service… In T-minus 24 months I am supposed to have a plan. I am supposed to live the dream and all that jazz. In a year I need to be turning in applications for either EM or a mission agency.  This is it…this is what I want to do with the rest of my life…but who knew the rest of my life was only 24 months away and who the heck knows how to get there….

Then there is the typical double agent-ness.  Although its been a really good year in terms of my life as a patient. Its a calm before a familiar storm.  The steroid shot is buying me time.  How long is yet to be determined but if I have another winter like this past one I don’t think I will want to go through a third.  So despite the fact I haven’t taken the green machine to work in two weeks, I know I am simply riding a false high that will eventually bottom out most likely sometime like the middle of PICU or worse my first month as a Sr in the ED and force me to come to grips with despite two years of magic I still have a chronic illness and I am facing another life altering 6 months of a massive surgery that will most likely per usual live me with a hgb of 7.5 followed by mild hysteria over how can I work 7 days a week and go to PT 5 days a week and keep my health insurance….so that I can pay for the monstrosity and live to tell about it.  Its most likely going to happen before I graduate.    I may be the doctor now but that does not give me a immunity. I also cant help but occasionally despite how different here is than back home in terms of patient/family care….chiming in with the other half of my life on rounds….and finding everyone staring at me like I have three heads when I suggest we introduce two of our patients close in age and with the same type of cancer…. FOr the love….we can get their parents’ premission first…I am not crazy I just happen to have be a agent from the light side (for we all know that the doctors are part of the DARK SIDE )…on second thought I will go back to updating discharge summaries….ignore me I just work here…

Compassion Found

I am back on the wards after two months being elsewhere. I read back over my last post and marvel at the burnout I had three months ago.  Its not all gone but its better.  I smile at children again, I savor the little things and I am in awe of all that we can do with our seemingly infinite resources with medicine here. And more than anything I care again, I have found my compassion and my heart for this work.  I am in month 12/12 of internship, I have 24 days to go and I will be a 2nd year.

I also have  a new house that will one day have a garden and already has a roommate and a dog. The house has big windows, nooks and crannies and secrets it seem that hide amongst its 100 year old walls. Its also a minutes walk from a little Square where there is several cafes, coffee shops, a post office, a library and  a small park with fountain.It reminds me of being in Barcelona or Paris with the square, the occasional street noise reminds me of Bucharest  but my big back yard, my trees and my big windows remind me of North Carolina (the 80 degree weather is helping too). The history and the big porch remind me of my beloved Virginia mountains. Its a prefect blend of my favorite places. For the first time since moving here for residency, I feel like I have a home and am not merely camping waiting for my life to restart again in three years.

I sing of your mercies…..