To All:

May 2012 see you happy and healthy.

To my children - I love you a lot. Just know that as the next year will be a bit crazy, for reasons beyond our control.

To my sweetie: I love you. And I'm STILL younger than you.  ;)

Merry New Year. I'm off to fix our favorite meal - homemade pizza for dinner. Hopefully, I'll stay awake for the ball drop this year!

joke

So a surgeon was rounding at the hospital and needed to catch the elevator before it closed. He stuck his foot into the door, it opened up for him. A medical student on the elevator asked "Why the foot?"

Surgeon replied, "I don't use my foot to operate."

Next floor, an internist waved his hand into the door. "Why the hand?" asked the student.

"I don't need my hands" replied the internist.

Next floor up, the orthopedic surgeon used his head to open the elevator.

Universal Studios

I'm a Harry Potter fan. So is the hubby & our daughter. Yes, we had to go to Universal Studios to see HP World of Wizarding.

We get there early & head for HP first. It is a level of detail that true geeks would love. Had fun at Ollivanders buying a wand. Drank butterbeer (it's very good!), wandered through Honeyduke's and bought Bernie's Every Flavor Beans. I am VERY good at finding the gross tasting beans. Hubby was wondering why I kept running for the trash, as he didn't get a bad one.

Next, went to Jurassic Park themed area. The flume ride is super cool. We're floating around for awhile, enjoying the gentle dinos. The boy (who was sitting next to me) was enthralled. Then we hit the building. We went up a loooooong ways. My hubby (who hates long drops) is giving me the stink-eye. Then the boy sees the T-Rex and it looks like we are headed straight for its mouth. He looks at me completely seriously and says "We are going to die!"...right before we plunged about 100 feet down the flume. We got soaked (this will become a recurring theme of the day).

We then wandered into the gift shop and bought yet another stuffed dinosaur for the boy. Downstairs is a pseudo-museum with exhibits and animontronic dino babies. We watched an egg crack and a dino come out. The boy thought this was the coolest thing ever & talked up the staff forever. Later in the exhibit, my daughter mentioned that the hatchling dino was a robot. "Is not!" "Is too!" "Is NOT!!! That's a REAL dinosaur, right Mom?"

The Popeye ride has a sign that says "You will get wet." What it REALLY meant is that you will look like a drowned  rat upon exiting the ride. Your jeans will be plastered to your legs, your t-shirt can be wrung out, and your dignity will be shot. It was FUN!

After naptime in the hotel, we come back to explore Dr. Suess's world. While waiting in line for the overhead tram, I decided Dr. Suess was like Eischer on acid.

Ate dinner at the Three Broomsticks. More butterbeer!

Leaving tomorrow to head for our hometown before going back home. Been a busy week & a lot of fun.

Animal Kingdom

GO TO THE LION KING AND NEMO SHOWS!!!!!!!!

They are wicked awesome! Ballet dancers, puppeteers, acrobatics...wow. The girl said that the Lion King show was her favorite thing all week thus far.

Nemo always makes me cry. It's that whole parenting thing of wanting to protect them and how far one would go for your child.

Oh, and the dinosaur ride WILL scare the crap out of your kids. It's not the ride, it's the animatronic T-Rex chasing you.

My feet are hurting after 3 days...

Magic Kingdom

I am crazy. MK in a day?

Head over to Adventure Land. Last year, the kids LOVED the Aladdin ride, so it was the first thing we hit. Last year, the spitting camel was working and the kids took WAAAAAAY too much joy in aiming the carpet so that the parental units got wet. Camels today were only drooling, not spitting. No wetness for me!

Walked onto Pirates of the Caribbean.  Yep, walked on. As in no wait. Awesome! No, we are NOT buying a toy right now, it's early in the day! Splash Mountain was down.  :( So we rode the train. Did you know that it is a steam engine that goes through ~200 gallons per hour? Yep. We were on the ride where it got refilled, which was interesting.

OK, off to Tomorrow Land. Why, oh why do my kids remember the lame-o People-mover? Because that is what they wanted to do next. Can't convince anyone to go on Space Mountain with me. Wusses. We then go to the Speedway, where the girl proceeds to prove that she should not be driving. I then challenge the kids to Buzz Lightyear. I get 41K points...beating them both. Old lady still has something!

Go back to the hotel to eat and rest. This will hopefully prevent a meltdown like one child had last night at dinner.

Now off to Fantasy Land! We hit the Mad Hatter Teacups, where evidently the plan was to make Mom as dizzy as possible. It was so much fun, we did it again without having to wait in line (WTF is up with that?). I stagger off to sit. We split up for awhile, the boy & I going back to the racetrack and DH and DD doing something else. Dumbass hubby turns off his phone, so it is difficult to hook back up again.

I then insist on Small World, telling the kids it will be fun (LIAR!). Gave them an earworm...made worse by the damn ride stopping in the middle and having to listen to that damned song in German over and over and over and over and over...you get the idea.

We end the day at the Haunted Mansion...I remember this scaring the crap out of me as a kid.  It's cool as an adult. Had the boy in my car & he was fine with it.

Back in the hotel room, beer opened. Life is good.

Seaworld

First park we hit is Seaworld. This was a hit last year, where we got this monstrosity:

We vowed that it would never happen again. So first rule before entering the park was "No giant pink whales are coming home with us." We also forbade them from playing the games.

We went to the stingray area. Evidently, they eat shrimp. Expensive tastes.

We then fed the dolphins. They like herring. They also like blowing out of their blowhole directly in front of me to get me wet.

Seaworld has a kids water playground, where we went to next. The kids ran around and got wet while the grownups sat.

Next was the show at Shamu stadium, where we saw many orcas working hard to ensure everyone in the splash zone was wet. Yes, that included us.

Back to the kids area to ride some gentle rides.

My unadventurous kids wanted Olive Garden for dinner. It was easier to go than to try & convince them to try something they had never heard of...especially since we could see the signs of a tired meltdown coming on from our daughter.

Both have sacked out quickly. Cans of beer are now opened for the adults.

I am crazy

First day of vacation. Traveling with the kids to Orlando. Flew at the ass-crack of dawn out of big airport, which is a drive.

I hate turbulence. With a passion. Got a lot of it on the first leg...bad enough to cancel the drink cart!

And then the layover in O'Hare. Why, oh why do we land at gate "as far away from our next flight's gate as is possible while still being in Illinois"? Get used to walking kids!

I love my son, but he did not stop talking the ENTIRE flight between Chicago and Orlando. My ears are tired.

Hotel has pool. Hot tub is broken. Oh, well. Hubby took the kids down so I can nap...

Not my fault

OK, so this patient saw me in the grocery store today...and proceeded to scream that I was the cause of her divorce while following me through the store. No, ma'am, your husband finally decided that he had had enough, not that I operated on you 4 years ago. I can guarantee that an old surgery is NOT the cause of your divorce.

There was a reason I discharged you from my practice...because you are a level 5, bat-shit crayzee who sucks the soul out of everything you encounter. Life is too short to have to deal with people like you.

I'm nerdy even by med school standards

My final rotation in medical school was radiology. And you can probably guess the reason why.

Anyway, the site I was at had a large number of us...all 4th years who had matched and were counting down the days until graduation. So we had these weekly lectures with cool images.

One abdominal film goes up. The attending asks us what we see. I promptly say "Bezoar."All of the other students are staring at me with a WTF look.

"That's right! How did you know?"

I didn't want to admit I knew it from reading Harry Potter...

Thanksgiving

My favorite holiday. It's direct - the name says it all. Thanks. Giving. No expectation of gifts, no going around asking for treats. Just family and friends, sharing thanks and reflecting upon the year.

For my loving husband, I give thanks. For my two kids who are the light of my life, I give thanks. I am grateful for a roof over my head, clothes on my back, and food in my stomach. For friends who listen when I need help, I give thanks. For the dog who sheds everywhere, I give thanks. For my wonderful in-laws, I give thanks. For my nutty family, I give thanks.

Happy Thanksgiving to all out there.

Copied from ABOG's site

Please visit The Foundation for Exxcellence In Women's Health Care  

A direct copy and post from ABOG. I'm feeling the exxcellence.

;)

Too young

She was there with her partner, another young gal anxiously holding her hand. A foot was tapping as I walked into the room.

Only a year younger than me. The gyn-oncologist started to speak. Telling them that her cancer had returned. I stayed in the background, just a mere resident, trying to absorb how to break bad news.

Tears filled her eyes. She asked about treatments. Her partner just squeezed her hand even harder, unable to talk. She wondered about her child.

A few months later, I'm on weekend call for gyn-onc. She's in-house with a bowel obstruction. Hospice is consulted.

I read her obit later that month.

Talk about dedication...

Bet you didn't know running for office would involve this!

Crap.

Surveillance scanning and cystoscopy has revealed a probable recurrance.

Ureteral cancer.

Having biopsy on Friday. I'm driving up to care for mom.

Advice for residents

Never, ever, never tell an attending that s/he is the "Stupidest person to have EVER graduated from med school."

It will land you in the department chair's office so fast, your head will spin.

Not that I may know from first hand experience or anything...

Halloween 2011

Ready for trick-or-treating! Mom lays claim to all Reese's.   ;)

Growing too fast

The boy has lost 3 teeth in the last 2 weeks...where did my little baby go?

Facebook

I'm a late convert, having finally joined a few months back...more so that I can keep up with former coworkers/friends.

But...BATSHIT FUCKING NUTZ patients are not going to get the OK to be my FB pal. Now, I do have some former patients as FB friends. But they are all level 1s (see this post) and some I knew as a person before she became my patient.

Last thing I need is a level 4 or 5 knowing personal info about me!

Anatomy fail

1. The ovary and the uterus are NOT the same.

2. No the baby will not come out of your anus. "You mean there are 4 holes?"
"Four?" I'm really confused.
"The pee-hole, the sex-hole, and the poop-hole. So the baby comes out the 4th hole?"
My cheeks that day were bitten raw to keep a straight face.

Med school memories

I have to get the previous post further down the page...hurts to see that picture.

Anyway, I got married on a Saturday. Started medical school on the following Monday...that's right less than 48 hours later. Oh, and we had to move into the apartment. And how was YOUR honeymoon?  ;)

So the first week is orientation. Meet people. Meet the gal who has become my BFF...we even did residency together. We were in each other's deliveries. We're godparents to each others' kids.

So the first week of honest to god classes, we get the stereotypical firehose. 4 hours of lecture in the am followed by 4 hours in anatomy lab in the pm. Unlike others in my class, I had prosected before...and had prepared by bringing an old T-shirt and a pair of sweats to leave permanently the locker room. I knew I would throw them out at the end of the lab class. Never brought them home. Always changed out of them ASAP after class.

So that first Monday after lab, I come waltzing into our apartment. I am still a newlywed and my sweetheart is standing at the door, waiting for me.  I go up to him, intending to kiss him when he wrinkles his nose and says "You stink."

From then on, I was to shower ASAP.

9+ years

Is not nearly long enough. Good-bye, Rip Van Winkle, our beloved black lab. You made life better for us. I will miss your enthusiasm for all things regarding food, squirrels, and tennis balls. I already miss those slobbery kisses that you gave unhesitatingly. I woke up this morning without you staring me in the face, which was different. We will never forget you. The overgrown galumpus, with a tail that was constantly wagging.

Someone once told me that there are happy labs and smart labs. You were by far the happiest dog I have ever had in my family. Many good memories of watching you run around, chasing the kids and being chased by them. Of the boy getting many french kisses from you...and going back for more. The girl, when she was just a toddler, watched the Kentucky Derby and tried to use you as a horse the next day. You didn't care, she was your buddy.

You and food! You learned pretty quickly after arriving at our house where the prime spot was at the dinner table...underneath the high chair! Cleaned up the carpet better than any vacuum. You were also known to grab at food left within reach...and your reach went pretty far. I think I'm still annoyed by the loaf of homemade bread you took from the counter as it was cooling.

All from a dog who wasn't supposed to be ours. When we went to the adoption fair after moving into our first house, I had told hubby "No puppies. I do NOT want to deal with puppy issues, I want a housetrained dog." While he filled out the paperwork to see if we were good enough for adoption, I took the girl (who was only 2 years old) down to look at dogs. "Puppy!" "There anudder PUPPY!" We stopped at a cage with 6 puppies...and the runt of the litter was placed into my arms. A little fluffball with a nose and ears sticking out of the fluff. And injuries from his big brothers and sisters that were infected so he was on topical antibiotics.  When hubby found us, he saw me cooing over you. "Honey, we found our dog!" You know, 9 years later, he is still laughing at me for that one.

You are loved. You are missed Rip.

Thank-you

State medical board of my great state for sending me 2 letters of renewal today.

Thank-you for wasting my tax dollars. I'm planning on only renewing once.

Awesome (or awful) ad

So last weekend, I was watching Comedy Central with DH. Weird Al was on! Then they showed Jeff Dunham's latest stand-up show. It was in the middle of this show that we came upon the awfulest awesomest TV ad ever. Marvel in the glory...especially around the 1:15 mark.




A backhatch? How AWESOME IS THAT?!?!?!?!?!? God, we were crying by the time this commercial ended.

Book Review

Now that I'm not working, I have time to (gasp) read for fun. It's been a long time coming.

And I have taken advantage of it. One book that I read recently is In Stitches by Anthony Youn, MD.

Autobiographies are a difficult thing to write. You want to be thoughtful, entertaining, yet true to your past - which is not an easy balance of things to do. And Dr. Youn manages. His is a story that many people can relate to - the need to simultaneously honor and escape your past, the need to excel and the work involved in doing so. He is honest enough to admit his flaws, again not an easy thing to do.

Doctors will smile as his wit draws pictures of med school that others will swear are exaggerated, but we know are not.  We all have his Nancy in our memories.

He evokes growing up in small-town Western Michigan well. And as an MSU grad, I loved the memories of E. Lansing...although I tended to hang out at Harrison's Roadhouse instead of USA Cafe.  ;)

And we can all enjoy his growth from boy to man. It is an honor to share in that journey. Read this book!

The mother's whine

Kids, when I tell you to share...

I DON'T mean the pharyngitis from hell.

XO,
Mom

First One

They say you always remember your first one. And for vaginal deliveries, this is mine:

Intern year. I was on a gyn service for the July month. Gyn interns were also on the L&D call schedule. My first call was July 4th. Dr. Smith was the in-house attending for the day. Obviously no inductions were scheduled for that day but some came in in labor.

I obviously was COMPLETELY clueless. Not only did I have no fricken' idea about this doctoring bit, I had no clue about anything on this floor. Thank God we had good nurses that day (who REALLY hated July). I'm also really happy that it was Dr. Smith on for my first. I don't think anything could phase that man.

So, the patient had managed to deliver her child. And we're awaiting the placenta. Dr. Smith tells me to pull a little on the cord. So I did. Just a little. Nothing happened because, well, I was so terrified that my "pull" was about as strong as a gnat's would be. Smith smiled and said "Pull like you mean it." So I did.

And evulsed the damned cord.

Smith just looks at me then with a smirk on his face said "Well now you did it. Go after it!"

"What!?"

"Stick you hand into her uterus and manually remove the placenta." Which I did, after giving him the WTF look.

And that was my first delivery.

Take two

Got a phone call from the school nurse (and, no, not the world's greatest;)...the girl child has a fever of 101.

:(

I repeat:

I HATE IT WHEN MY KIDS ARE SICK!!!!!

Ch-ch-ch-changes

Am finally free from work. And still waking up at the crack of dawn because of school bus pickup times.  :(  But I don't know where my cell phone is and I don't care.

Hubby has leads on jobs coast-to-coast (and international!). I'm looking up real estate stuff online. I have my favorites, but the job will have to be right for him (although moving back to Boston would be wonderful...have lots of friends there in the metro area). Have also decided not to move during this school year for the kids' sake.

Decided to do some locums work while our plans are fluid. Have one set up for after the new year, filling in for a maternity leave. If it works out well, may continue to do only locums & not set up a permanent practice. I have to admit, having freedom to say "Screw it" is a privilege.

Have a family vacation to Disney set up for the holidays. We may never again have free time like this to enjoy just being a family, so we are taking advantage. The kids are a perfect age - old enough to walk on their own, not need naps but yet young enough to still like us.  ;)

So this is what a sabbatical is like.

Someone has WAAAYYY too much free time...

And uses it awesomely. I'm semi-obsessed with Harry Potter. I also LOVE Broadway musicals. My newest obsession is Book of Mormon. This video happens to combine the two of them in a great manner.

Joke

Everyone knows doctors are greedy assholes only out for money:
Where to hide money from a...

Orthopedic Surgeon: On the patient's chest.
Surgeon: In a book.
Pediatrician: On a geriatric patient.
Geriatrician: On a baby.
ER Doctor: In a woman's vagina.
OB-Gyn: Near a male patient.
Pathologist/Radiologist: Near any patient.
Plastic Surgeon: You can't hide money from a plastic surgeon. ;)

Sick kids

There is nothing worse as a parent than a sick kid. My boy woke up this morning with a temp of 101.9. He looks sick, feels sick, and just needs rest, tea, and lots of love.

I HATE WHEN MY KIDS ARE SICK!!!!

I would rather be sick myself than to see either one of them ill.

Going to fix homemade chicken noodle soup for supper tonight.

Winding down

Letters have been sent to patients. They are not happy. I'm running into folks everywhere, some begging me to reconsider, some thinking of following me wherever I end up. Everyone has been so kind. Small towns are a weird thing...can't go grocery shopping without seeing people I know very well.

DH has leads on several jobs...I'm jokingly pushing for the one in the tropics. Literally. He thinks I'm nuts. He's right, but not for that reason. It's going to be an interesting few months.

Because we Michiganders kick ass

I vote for him to get tough guy bragging rights.

Obviously...

Whoever designed THIS shirt wasn't thinking.

Pisses me off.

Another year...

School starts in a few hours. I now have a middle-schooler. I'm not old enough for that. My baby is in 2nd grade. HE'S not old enough for that!

Time is flying by.

High School Reunion

So where did all of these old, fat people come from?

Just asking...cuz I'm one of them. :(

School Supply Shopping

So it's that time of year again...where I open my never-ending wallet to buy stuff.

Get the lists. The usual suspects are on the second graders - crayons, pencils (yellow #2), scissors (WTF do they need to put scissors on the list every stinking year? Can't they just keep the one I got last year?), colored pencils, etc.

The sixth grader has a specific scientific calculator to buy. They also want pens and pencils (but don't specify the color of the pencils). We have pens up the wazoo here. For some reason, I have a ton of insulin pens - I like them because of the lanyard to carry it around my neck. I also have my special stash of Prometrium pens, which I DO NOT SHARE. I hate the drug, but these are fine, fine pens. I'm down to only a couple left of those pens. :(

So I tell the girl that I am not buying her pens. Gifted child that she is, she promptly asked "Why?"

"Have you SEEN our junk drawer? There are hundreds of pens in there!"

"Oh, yeah."

I promised not to send her to school with a Viagra pen.

And Grumpy - Staples.com has free shipping for orders over $45. It wasn't hard to hit that mark with my kids. No more craziness like last year! ;)

And still another FYI

Monistat does NOT come in cherry flavor.

Did it

Turned in a letter of resignation. I feel so much better. My husband is thrilled. The kids are happy that Mom will be home more.

Who knows when I'll work again?

Senior resident memories...

I had an awesome attending for my final year gyn-onc rotation. The man was an excellent doctor, surgeon, and all-around good guy.

So we were consulted at small hospital in suburban area of town affliated with big medical center for a pelvic mass. He took the phone call in the morning and we pulled up the films in the office. Yep, a big honkin' pelvic mass. Appropriate consult from admitting service.

I get sent over to SHISAOTAWBMC to do the H&P and get the paperwork done. Shit, she's had multiple laparatomies (double digits!) for Crohn's Disease. Her abdomen looks like a Munchhausen's patient. Our collective hearts sink.

Surgery get scheduled for the next day at 5 pm (Whisky Tango Foxtrot! I'm not on call that day...which means that on my rare non-call days, I'm going to be at the freaking hospital until god knows when doing the case!!!).

Make the midline incision. Concrete sub-cut tissue. Bowel, omentum, and fascia are all fused into one big fucking mess. After an hour of dissecting, I hear "I have no fucking idea what I'm looking at."

"That's NOT what I want to hear from you because I have NO FUCKING idea what I'm looking at, Sir!" I answer back. I'm one of his pets, so I can mouth off to him and not have my ass handed to me.

He smiled at me, and said "Well, the buck stops with me. Let's just go slow."

I got home after 11 that night. It ended up being a benign cystadenoma, but it was 15-20 cm in size IIRC.

Another FYI

1. Smoking a joint while driving into the hospital because you think you are in labor will not help with the contraction pain.

2. If you roll a joint in the hospital, you are probably well enough to be discharged.

Just FYI.

Smooches,
Your OB

I honestly think I'm cursed

So hubby & I are going out of town tomorrow as an anniversary getaway. Just got off the phone with Hotels.com - the hotel can't honor our reservation because it got flooded.

They were really good about rebooking a nearby place and giving us credits for future use.

My in-laws just arrived for babysitting duty. :)

Love you

13 years now...and you still aren't sick of me?

Happy anniversary, Sweetie.

Procrastinating

Don't want to clean out upstairs closet.

:(

PR is back!!!

And it starts in only about an hour!!!


YAY!!!! Crazy people deluding themselves into thinking that they have made some beautiful work of art when the midwesterners are all saying "But her ass is hanging out!"

What can I say, I wear mom jeans. ;)

RIP Aunt Evelyn

4/24/26-7/22/11.

She was the last of the generation. A remnant of my grandma's cohort, she was 6 years younger than my grandma. They were the only two who lived north of the Mason-Dixon line, she settling in Chicago and my family in Michigan. Out of my grandma's 8 siblings, she was the one I knew the best.

As a child, we would go to her house every year for Thanksgiving, making the 4 hour trek to Northbrook. Her corn pudding was wonderful. I learned to make "Magic Marshmallow Puffs" at her house. Wine was plentiful as was the food.

I would occasionally be sent to Chicago to visit her alone, taking either the train or Greyhound. We touristed the town...boat tours, Sears Tower, the beach along Lakeshore Drive. We would go to Marshall Field's and window shop. Play tennis and then stop for ice cream. Road trips to Great America and to Wisconsin.

I last saw her a few years ago at Em's funeral. She looked nothing like the vibrant woman in my memories. A LOL, somewhat cranky and confused as to why the family has gathered again. Alzheimer's is a cruel disease.

She's been dwindling the last few months, with the last couple of weeks being a mercifully quick decline. May she rest in peace.

Soul searching

So my hubby is in the job market. His field is very small, meaning the market is tight. He currently is an instructor at a local college but not tenure track. And he wants to be tenure-track.

That means moving, in all likelihood, next academic year.

I'm not against this. The office the last few months have been awful. I now hate going to work. Not because of the patients, but because the administration dumping more work our way, the other doctor being difficult (at best) to work with, the patient load getting to the point where I feel completely and totally overwhelmed. My contract is coming up soon and I may say the hell with it and fail to renew my contract.

And I don't know where we'll end up. So I'm looking into locuming, since we will need some income. I've poured over the budget, seeing how few days I need to work to keep us afloat. My CV is now updated. I've signed up with some agencies.

It's scary stepping out into space. I'm glad that we're relatively frugal and are savers. It gives me options that I wouldn't have if I had lived it up like many of the other docs in town do. But it's still scary losing the safety net.

I haven't cut loose yet...but if not for hubby's career, then for my sanity and family life. It's getting to be just a manner of time.

PITA

ABOG and its damned MOC.

Over half done for the year, but still. What a hassle. And $$$$$.

Just another tax on a doc.

What's more pathetic?

Me trying to reread Harry Potter and the Deathly Hallows tonight before seeing the movie tomorrow or having to fight with my hubby to get my book in the first place!

;)

Medical Truism

If the resident tells a friend "I had the coolest case last night" then you can bet good money that the attending is saying "I had the WORST case last night..."

Wow

My little girl will be gone for a week at camp. I'll drop her off this weekend.

I know that she is growing up and becoming her own person. There are times I'll catch a glimpse of her and marvel...wow. Who is that cute young lady? Look at those legs that go on forever!

My job as a parent is to make myself obsolete. And I send her off to camp to help her have a taste of independence, before she needs to be out on her own. But I still think of her as the little 5 pounder who never slept and ate constantly...some things never change.

Differences

So last night, I was waiting to start a section and the anesthesiologist and I were in the OR waiting for the patient to arrive. We both noted it was July 1st...and were glad that we were in rural fly-over country hospital instead of Mecca. I was the least experienced person in the room, having graduated from residency 5 years ago.

We were both musing about intern year. He's significantly older than me, but the themes were similar. Sheer and utter fear that first day. The thrill of being able to write orders. Feeling overwhelmed. The weirdness of signed the MD after our names (I don't do that anymore...my signature has degenerated into my initials).

He told stories of his attending snoring during a case his first month.

I talked about the first time I held a scalpel...July 2nd, 2002. I was the intern on the gyn team and was scrubbed in for an abdominal hysterectomy. The scrub nurse was told to give me the scalpel and I was told to make the skin incision and then put the scalpel down on the Mayo.

My first reaction was "ARE YOU FUCKING NUTS?!?!?!?!?! I could HURT someone with that thing!!!!!!" But I didn't say anything and suavely took the scalpel (all the while trying not to shake) and placed it on the line the attending had drawn. Took a deep breath and cut.

Evidently not even remotely hard enough. I didn't even get into the dermis! The attending looked at me and said "You CAN cut more than one cell layer at a time." And he put his hand over mine on the scalpel and we did it again, this time exposing the yellow balls of fat lying just under the skin.

And now...I still respect the scalpel, but it feels natural. It's a part of my life. As are the Mayo scissors, the hemostats, the pick-ups. I can use any of them with either hand. I like the ritual of slapping them into my hands, ready to use. The dance of gowning and gloving is almost as formal as a waltz with people moving and presenting parts at precise times.

Quote of the day

From my nurse : It's cereal day. All of the fruits, nuts, and flakes are out!

Too true, too true.

:(

Embracing my inner nerd

Downloaded the newest Weird Al today.

3 1/2 weeks until Harry Potter 8 comes out.

Yes, I am a nerd.

Head of the Hydra

You get one PIA patient delivered...only to have another one pop up. So you always have a frequent flyer, just the name changes.

And Hercules's method of killing them off is generally frowned upon. ;)

You know it's a bad day...

When by 10 am you are wearing your 3rd set of scrubs and have taken your 2nd shower of the day.

:(

You can hate me...

This is the view from the back door of our vacation rental recently. Got the whole family including my mother out here.

:)

Friday, we flew. And flew. And flew. Damn, that's a long flight. Good thing United has showtunes to listen to on the flight. :) Got to the island, got the car, drove to the house and collapsed.

Saturday, we explored the town of Hilo. Went to the farmer's market, got fresh fruits including the sweetest, juiciest pineapple I had ever eaten. Grilled out for supper. Used the house's pool and hot tub. Life is good.

Sunday, went to Volcano National Park. THIS WAS FRICKEN AWESOME!!!!! Kileaua is stupendously huge. The lava tube was a fun hike. No surface flow, but still a sight. Pele is quite the artist. Then we drove to Ka Lae, the southern most point in Hawaii, and by extension, the US. Crazy folks were jumping off the cliff into the water (probably about 30-40 feet).

Monday, went exploring in the Puna region. Went to some volcanically heated pools and swam there. Grilled some Ahi for dinner, along with some fresh veggies that we got Saturday.

Tuesday, went horseback riding on a ranch in Kohala. This was amazing scenery. My horse's name was Ula and when we were introduced all I could think of was "Ula dance again!" from The Producers. Ula, evidently, had some strong ideas about how SHE wanted to spend the day. As in she did NOT want me on her back. She bucked and pranced and shook. It's been 25+ years since I've been on horseback, but my legs remembered...adduct them. :) We then went to a luau for dinner. Both kids were impressed by the fire dancing. I introduced my daughter to the concept of eye candy. We both agreed on who the hottest male dancer was.

Wednesday, we did nothing but hang out at the house. Our legs needed to recover.

Thursday, we explored Puna region some more. This time we went to the eastern-most point to check out the purest air. Hiked to tidepools. Explored Hilo some more.

Flew home yesterday...looooooonnnnnnnggggggg flight, made worse by the fact that 2 kids sitting next to me were out of control AND THEIR MOTHER WAS SOUND ASLEEP!!!!! I spent most of the ride correcting them, taking back my son's toys that they had just taken from him, and generally being annoyed by other people's parenting skills.

I don't wanna be on call tomorrow.
*pout*

Snake Eyes

11. Eleven.

My dear Baby Boo, I can't believe it. May 25th, 2000 was the most amazing day in my life because I got to meet you. And now you are 11 years old.

I am proud of the young lady you have become. You have a kind heart and obviously try to take care of everyone (human and animal) that you meet.

From this:




To this:




Happy birthday, sweetie.

Intern memories

We were required to do one month of inpatient internal medicine. As you can probably guess, this was a VERY unpopular month for OB.

I got lucky - my month was February - shortest month, which meant one less call night of medicine. My team consisted of an awesome attending, a great resident, a FP intern who had a family emergency mid-month and left the service, and last (at certainly least) a medicine intern who wasn't competent to count her fingers, much less care for patients. Our resident had her hands full dealing with her daily fuck-ups.

So after the FP guy left, I got his load and mine. Plus extra call (should have taught me to gloat to the other interns in my class that I got the best month). The resident decided that on weekends the other intern and I would each take one day. I would always round with the attending, and the other intern would round with both the resident and the attending. So one weekend, I was rounding with the attending. We had a patient with some electrolyte abnormalities...his mag was low. And we were discussing replacement. The attending looked at me and asked "Do you know how to dose mag?"

I looked right back at him and said "The way I give it would give YOU a coronary! But yes, I'm comfortable giving mag."

He just laughed and put that order in the chart. He was awesome - he rounded on 2/3 of the patients and wrote the stupid notes himself because he saw the load I was trying to do.

Going back

To my original name for vaginal hysts: God-damned vaginal hysterectomies.

My back is feeling the pain from yesterday. I'm sure the assist's is as well, since we both were moaning by the end of the case. I'm proud of getting this one out, due to combo of many factors to up the difficulty factor of the case, but the uterus put up a fight. :)

Question

If moms aren't supposed to get sick...

And doctors aren't supposed to get sick...

Then why the hell do I have a temp of 102, a cough that wracks my whole being, and generally feel miserable?

Thursday, when I was on call, the charge nurse suggested a hot toddy. Thank god I have this weekend off, because I have been in bed 98% of the time.

ugh.

Of interest

If the hospital's PEDIATRICIAN knows your name, than you have made too made visits to L&D during your pregnancy.

Over 20 visits and we still have over a month to go for this gal...

It's going to be a loooooonnnnnnnggggggg month...

Funny times

Had a great delivery last night. Multip, 2 pushes.

I put baby on mom's belly, just like I always do. Hanging out, waiting for the cord to stop pulsing so I can clamp it. Mom, dad, and new grandma are oohing and aahing over the young boy, who launches his first piss...straight into mom's mouth.

Grandma is doubled over laughing, My stomach hurts from laughing.

I need new reading material

So I'm reading the latest AJOG (gray journal). I turn the page right as my hubby comes up behind me. The page I turn to is a case report of vaginal evisceration of bowel after a fall.

It has a picture of the congested small bowel coming out of her vagina.

Hubby sees the picture. Hubby is now grossed out.

I'm laughing.

Did you know

That I birthed a superhero?

:)

Spring Break

Kids' impressions:

1. Pools are THE most important part of any trip.

2. You know you are from a small town if being on the 22nd floor is a big deal.

3. Cartoon Network shows Looney Tunes in the middle of the day! AWESOME! I tawt I saw a puddy cat!

Any questions?

Patient, upon being asked if she planned to stop smoking cigarettes: But I stopped the crystal meth! What more do you want?

I have to admit, I didn't have a comeback for THAT one.

Family

Can't live with them, can't kill them...tempting though the thought may be.

My mother and sister are at it over something extremely stupid. I do not want nor need to be in the middle...but there I am.

I'm considering changing my phone number...but then my email would be overloaded.

:(

Ugh, forms

So I renew my state license in even years, my hospital privileges in odd years and my DEA license every 3rd year, and my boards certification yearly.

Anyone else confused?

Elegy

For one of the forgotten ones.

A body was found yesterday morning here in town. I heard this morning who the supposed victim was, police confirmed her identity today according to the online version of our local paper.

I work with the forgotten ones. The ones people gloss over. MR/DD. Drug-addicted. Dirt-poor...and the cycle of poverty continues generation after generation. She was one of these. Her family had been in town for generations...and for generations had been known as "them."

But she did not deserve what the word on the street said happened to her (lets just say I have insider info...one of my last appointments today was her cousin).

Sometimes, looking at the hot blue hair, the poor dentition (a common P.E. finding on my H&Ps for surgery), we have to remember that behind it is a gal...not too different from myself.

There but by the grace of God...

Things this OB-Gyn hates

In no particular order:

1. HELLP syndrome

2. Stage 4 endometriosis during hysterectomies.

3. Repeat c-sections

4. Abruptions

5. C-sections under general

6. IUFDs.

7. Cancer

8. Floppy, grey babies

9. Shoulder dystocia.

10. Severe post-partum hemorrhage, where you end up in the OR after a vaginal delivery.

11. Severe pelvic adhesions while trying to do a surgery.

I've done all of these in the last couple of weeks. Some more than once. Some patients combined several of these into one craptastic case.

Dear OR Gods

Thank you for the awesome day! My favorite assists, interesting cases, ABBA in the background...

I left my first case with a BIG grin on my face and a real sense of accomplishment. This is what surgery at its best is - healing with steel. It wasn't an easy case, but it was a fun one, challenging in the right way. And my patient will feel better than before.

A win for all involved. The two assists (vag hyst) were both saying that is what they love.

Dear Patients,

When I ask you in the pre-operative consult if there are any medical problems that I should be aware of, your bleeding disorder is included in that.

Please don't tell me as I am leaving the room "By the way, a doctor tells me I have a bleeding problem."

And then when I ask if you know the name: "No."

And then when I ask if you bleed too much or clot too much "I don't know."

For some reason, as a surgeon, I CARE ABOUT THAT!!!!!!!!!

Fortunately, you knew the name of the blood doctor and I could get a letter from him.

*facepalm*

Yes, this has happened to me recently.

Spring is HERE!

March madness is on the TV (YEAH BUCKS!). Crocuses are flowering. Daffodils are starting to poke up through the ground. We were able to fire up the grill yesterday for the first time this year. And the boy has (finally) mastered riding a bike without training wheels.

YEAH!!!!!

NO!, part 2

Dear Idiot ER Doctor in smaller hospital next county over:

Yes, I understand that the gal in your ER sees my partner, Dr. Johnson. But you are telling me that she is orthostatic, hypotensive, and blood is pouring out her vagina. I will NOT accept an unstable patient from a 45 minute drive away, so please call Dr. Smith at your hospital. She has GYN privileges at your hospital. And yes, I completely understand that she sees my partner. She could possible DIE in transit. Call Smith.

I needed to repeat that multiple times before he understood no means no.

sigh.

The OR Gods

Are just as pissed at me as the call gods.

:(

Every few months, I operate on someone with a BMI significantly north of 50. I always hate myself in the middle of the case and the next day when my back is killing me. So WHY do I get temporary amnesia a few months later when another shows up needing something? And I then agree to do the case?

I'm nuts.

Great kid quote

So my boy just lost his front tooth. Now he lisps (which makes me laugh) and it's frustrating him.

"Mom! I can't thay F-wordth!"

*snort*

Another one

just walked in.

Shoot me now. PLEASE?

Call gods

Are extremely angry at me right now...I'm thinking of offering up my first-born to try to appease them.

L&D is still hopping...I'm in double digits for weekend deliveries now.

ER has me on speed-dial.

Having my car parked (and since it's a small town, all of the L&D nurses know all of the docs' cars) with flashers on at the hospital entrance this a.m. was not a good way to greet the incoming day shift nurses.

Night shift did not appreciate seeing me in surgical hat and booties when they walked in this evening.

I sign out tomorrow at 5 p.m. THANK GOD this was "spring ahead" weekend...

I'm tired

We average 2.7 deliveries/day at my hospital. When I left, 7 had been done (4 by me) and I still have another one laboring.

There are no open beds on L&D/postpartum right now.

Here's hoping the labor goes relatively quickly so I can get some sleep tonight.

What part of no do you not understand?

Phone call last night:

Caller: Yada, yada, yada, pain. Yada ER CT showed ovarian cyst of 2 cm. Yada, yada, yada, sees Dr Johnson (my partner). Yada, yada, yada, need pain meds.

Me: I do not prescribe pain medicines for anyone I have not personally seen or examined.

Patient: But I'm in pain!

Me: I do not prescribe pain medicines for anyone I have not personally seen or examined.

Patient: Well, what are you going to do for me?

Me: If you are in that much pain, go back to the ER. Otherwise call in the morning for an appointment with Dr. Johnson.

Caller: But I can't afford to go back to the ER! Can't you call in a little something?

Me (feeling like a broken record by this point): I do not prescribe pain medicines for anyone I have not personally seen or examined.

Caller: Can you call Dr. Johnson and ask him what to do?

Me: He is not on call tonight. I am and I will not call him. Also, I can tell you that he will not call in pain medicine for anyone, so that's a dead end as well.

Caller: Well thanks for nothing.
Click.

Any bets on getting a complaint from her?

Bad morning...

One lethal anomaly, 3 miscarriages, and 1 ruptured ectopic in the office. All. Before. noon.

ugh.

I think I hit my quota of badness for the month in just those 4 hours.

Quote of the day

My nurse to a new patient, for whom English is not her native language: Are you sexually active?

Patient: I walk a lot.

Whirling vortex of CRAYZEE

Pretty much sums up my day. Oh, and there was stoopid in there as well. Between the staff and my patients and the phone...

ugh. Hopefully tomorrow will be better. I'm just asking for my patients tomorrow to have functional synapses. It'll help a lot.

Have a great...

Single's Awareness Day.

;)

Can't you tell I hate Valentine's Day?

Thinking about where I am

Career-wise.

I'm 5 years out from residency. I'm far enough out that I don't have the jitters when I'm in the OR like I did when I first started out. I was terrified to do laparoscopies.

Now scopes are my bread and butter. Do several a week. Rarely decide to convert from scope to open.

Vag hysts were evil. I hated them, they took a couple of hours and I would struggle. Now, I do several per month. I still hate them, for technical reasons - visualization, access to structures I need. I now whine if they take more than 45 minutes. But I'm now good at them...and I'm now the only GYN in town who does them on a regular basis - everyone else does total laparoscopic hysts pretty much exclusively.

I think surgically, I'm at the top of my game now. I've learned little tricks and tips on my own - even told my old GYN-Onc mentor a trick I figured out.

In terms of practice style, I'm close enough to residency to be up-to-date yet have experienced enough to have evolved the begininng of the "Gut feeling."

Experience. Experience. Experience. And that is why we practice.

Am I pathetic

to like Taylor Swift's music?

Whining

I graduated from medical school in 2002. 9 years ago. Did a 4 year residency (aka poorer than dirt for 4 years while working my ass off).

Just sent in my payment for my student loans. I still owe nearly 70K on them. It seems like they'll never go down to 0.

:(

Snowed in nerds

Make these cookies:

Ugh!

I'm on a kick of pushing with patients for hours (5 - yes FIVE - in one case) only to end up calling a section for arrest of descent.

And yes, I've done everything I know to get babies to descend - position changes, laboring down, etc.

UGH!

And now the heads are well wedged into the bony pelvis too, making getting the kids up and out not fun either.

UGH!

It's a rough life

Here are my two mutts, in a typical day.

Man, I wish I was a dog. :)

Part 2, mouths of babes

So we're watching iCarly on Nick when a commercial for the movie Secretariat comes on. My kids loved that movie and my daughter started whining that she wanted it.

Now, we're a little bit behind technologically speaking. We don't have an HD TV or a blu-ray player. We just got a Wii at Christmas. We do have a combo DVD-VHS player. The commercial specifically said the movie was coming out on blu-ray.

The boy looks at his sister and says "We don't have blu-ray. We have yellow-ray."

Out of the mouths of babes...

So my son has chapped lips and was complaining last night. I told him that after supper, I would put some Vasoline on it.

"Gasoline? Why gasoline?"

The rest of us were cracking up.

700 Club!

I'm now a member! The 700 gram vaginal hysterectomy club - which is a very large uterus indeed - the average uterus is around 50 g give or take.

I'm aiming for the kilo club...5 years out from residency and getting better and braver with every difficult surgery. But it also comes from having good assistants - I had my favorite first assist and an excellent scrub tech. Both of whom could anticipate what I was thinking (other than the typical #$%^&&$%#$#). I had said pre-op to the first assist "We'll just go slow and steady and know our landmarks...it's going to be a bitch of a case." Now, normally, I'm a fast surgeon. I know that the surgery desk sorta counts on my room being the add-on room on Wednesdays, since I usually finish ahead of schedule. But yesterday, I finished right on time (my first case was done an hour faster than expected, but this case took an hour longer than booked). But surgery done right is better than surgery done fast (both is best).

We ended up with a completely detached uterus that would not fit through the vaginal incision. We spent more time removing fibroids and cutting the uterus into pieces that would fit than we did actually detaching the stupid thing!

It's one of those cases where you hate yourself in the middle of the case (WHY did I schedule this one like this?) only to feel really good afterwards.

Timing

My family has exquisite timing. Always have. My mom knows just when I've jumped in the tub so she can call then. My sister can sense when my head hits the pillow and then calls. You get the idea.

I had NO IDEA that our ER doc is related to me! She called last night just as I sat down on the toilet.

:(