Brief update, more to follow.

I have a few more entries but they need a little time to anonymize themselves. Time washes away details...

I had a stretch of writing but had fallen off recently. I’ve had personal strife I don’t really feel like blogging about. I was going to also say that I have PMS but honestly that doesn’t jive with the timing of my foul mood and in writing this just now I realized that I ran out of vitamins & fish oil a couple of weeks ago and that tracks very well with the timing of my moodiness. Fortunately my next payday will enable me to replenish those stores. I’ve got savings that I could spend but between buying gifts for the kids & the usual beginning of the month bills, I’ll be too strapped to do it before then. Knowing that this foul mood and bad attitude has an end date gives me a little more patience with my surly self. (edit to add: vitamins work! I’m feeling better and very relieved about it. I was starting to annoy myself)

***************

Duncan is studying Chinese this year and he has been very enthusiastic about it. It challenges him because it takes work to learn a new language and he’s frankly not used to working hard to learn things. We’ve had some discussions about the nature of learning and how it is a life skill and not just something he needs to do for this class and this final exam. Even working at McDonald’s, I pointed out, you aren’t as competent as you need to be on your first day. For all his know-it-all teen attitude, he actually heard what I was saying and took my studying suggestions to heart.

***************

We had some snow here last week that made our lives interesting! Kids were out of school on Friday. Unfortunately the bad weather meant the AHS production of “A Christmas Carol” was also cancelled on Friday and Saturday night. I was able to see the Sunday matinee and Ainsley’s acting debut: she was the dead body under a sheet in the scene with the ghost of Christmas Future. She also had significant ASM duties that went very smoothly as evidenced by my not noticing them at all!  

Back in the light

I’m really happy to report my growing competence in the arena of obstetrics. I am on my 2nd OB rotation now, doing a week of night float to start it off. It is easier to manage the administrative and clinical tasks, so much so I’m starting to wonder why it was so hard before. I can check cervixes like a boss now and though I still can’t interpret sutures to determine fetal position, I actually believe it is a skill that is possible for a human to acquire.

***************

Yesterday I had a patient who was laboring on hands & knees and was nearly complete. We all wanted to know if it was time to push. She really didn’t want to get on her back (it hurts a lot, I don’t blame her). So, being the game OB I am, I offered to check her in that position. Honestly, not only could I not evaluate her cervix in that position, it took way more work to find her introitus (opening to her vagina) than I care to admit. The shape change of the anatomy was so striking.

Within the “natural” childbirth community (more on my hatred for that term at a future date) there’s a lot of disdain for physicians wanting women to be in particular positions for birth. As someone who birthed on her hands & knees and no way in hell was I gonna go on my back, I empathize a lot for that position. As someone who just experienced a very unexpected (mercifully quickly resolved) shoulder dystocia, I intimately understand the origin of the OB discomfort with trying new birthing positions. There is muscle memory, application of anatomy & physiology, tried techniques and a variety of experiences that we are building on to take care of our patients. I want my patients to be able to deliver on hands & knees, but I know that if I were to have a patient try that now, I’d be very uncertain about what to do with my hands during that delivery.

***************

I did a really good job of protecting my kids from a lot of the fallout of their father’s choices when we were married. I mean, we were still suck ass broke and that has left its mark, but they really didn’t understand all the problems that were the root of our separation. The mechanics of what was causing discontent in our marriage were pretty complicated and above the radar of even my savvy young teens.

Some things are happening right now that are causing me frustration and bringing me to the realization that one of the downsides of divorce that I had not foreseen is that I am at a diminished capacity to protect my children from their father’s choices. I can’t keep him from messing up things that matter to them. It makes me angry, I feel helpless and frustrated. I will try not to stress about my children’s disappointment before it happens and when it does happen, I will sit with them and just love the hell out of them. And the optimistic part of me says maybe THIS is what needs to happen for him to get his shit together. Fingers crossed, silver lining, all that jazz.

***************

Night float is dangerous! On my penultimate morning after I was bringing a load of laundry down to run while I was sleeping (that my mother wonderfully put in the dryer and folded for me while I was sleeping!). Unfortunately the added complexity of holding something while walking down the stairs seemed a bit much for my exhausted mind. I lost my footing and missed a step, falling quite hard on my backside on the hardwood stairs. Fortunately I fell to one side, not smack in the middle because I think I would have broken something if I had. As it is, I have a colorful 7-8” bruise on my left hip that is painful enough that I need regular naproxen to navigate my day.

***************

My mom stayed with us after thanksgiving to be here with the kids while I was working nights. They were quick to assert they didn’t need Grandma to take care of them and I’m sure that they would have eaten a LOT of frozen pizza and been just fine without her. However, she was able to drive Ainsley home from rehearsal (she’s an assistant stage manager for The Christmas Carol with some significant responsibilities over crew & props) everyday and even my independent kids agreed that the pork chops, hamburgers & spaghetti were worth the hideous intrusion of a foreign responsible adult. I know it was so much easier for me to focus on my work and not worry about them knowing my mom was around if they needed anything. She was here for my last week of nights because it was around the time school started and she was here to help with that. I will have another week of nights later in 2018 on my 3rd OB rotation of intern year. Maybe I’ll stock up on frozen pizza and let them try that one on their own.

I'm on night float right now, forgive any poor editing or spontaneous outbursts

We are in the throes of interview season for residency. Today we had the 3rd of 5 interview days. It is a tough experience on both ends, with both the applicants and the program trying to explain and sell themselves over the span of 18 hours. Later, we will rank our choices and applicants will rank their program choices. Then a proprietary computer algorithm will tell us who our new colleagues are and we will all pretend like it was meant to be.

This process is literally insane. Our program has 4 spots and we are interviewing 100 people. We had something like more than 300 applications. Bigger programs in bigger cities have even higher numbers. Applicants are only limited by their funds regarding the number of programs they can apply to. Which means that people who look really good on paper get a lot of interview offers and take interviews at places they aren’t likely to go. And the people who look less good on paper find it harder to stand out.

I believe that the system needs a serious overhaul (full disclosure: I am in something of a ‘burn it down’ phase right now). There should be a cap to how many programs applicants can apply to. Don’t waste everyone’s time by stacking the numbers.

Many people demonstrate a surprising (to me) lack of scientific thinking when it comes to the Match process. “It all works out” or some variation, is something that you hear a lot. I think that is BS. I think that is “law of attraction” sloppy magical thinking that causes people to feel to blame for their hardships and ignores structural flaws of large systems. I think that it decreases the accessibility of medicine as a profession for traditionally under-represented groups in the field - first generation college grads, low income, members underserved populations, people of color (anyone else see that stat that there are fewer black men in medical school now than there were 30 years ago?). I hate the “it all works out” attitude. It doesn’t all work out. Sometimes people get shitty matches, sometimes they don’t match, sometimes programs misrepresent and sometimes people aren’t who they seem to be in the interview. There are ways the system could be better and having a ‘C’est la vie’ attitude is not helping improve the situation.

***************

Merciful Zeus, I am going to be on night float for the penultimate interview dinner - a more than adequate reason to miss the damn thing.

***************

I am in the throes of a fantastic Thanksgiving weekend! My parents came to town and did some cool things with the kids. We had a great meal and today I only had to work for about 90 minutes. We got a Yule tree since the kids will be heading West 3 weeks from tomorrow. It is a beautiful 7 foot tall fraser fir.

My parents = my mother and my step-mother, it is possible that some of you didn’t know that yet. Now you do. I’ve known Judy (step mom) since I was almost 15 years old. She knows lots of things about plants. She bought us 2 new shrubs for our backyard and she & the kids put them in. Then she taught D how to be a tree surgeon (with technical lessons about tree anatomy included) and the two of them trimmed the huge grandmama of a crepe myrtle I have in my front planter space. They also took out 2 homely looking shrubs that were eating up the best light of the front of the house. And she let A drive her truck 3 times around the corner to the brush pile spot. It was nice to get the practice. And she brought the 2 dogs with her. She has a border collie and a small golden retriever-looking dog. I have many pictures of Duncan trying to pet 3 dogs at once from the last few days. It is endearing to watch him lay down on the rug and encourage a dog pile.

***************

I’m making a point that their father is not a tense topic of conversation. We have discussed the maintenance of traditions, disposition of ornaments, plans for vacation, recent texts, holiday plans. We tell stories of our past that include him as a central character (cuz, you know, he was). I try very hard to keep my tension and disappointment to myself. I am, if I may say, a pretty good compartmentalizer. I do need space to process my divorce (I get it, in therapy), but I also want to be able to talk to the kids about things that matter to them without them feeling like they have to censor themselves or can’t talk about something because of my baggage.

***************

When one delivers a baby, one puts steady downward traction on the head to deliver the anterior shoulder. Whenever I’m doing this, I’m always thinking, “Is this a shoulder dystocia?” and struggling to identify the myriad of ways an anterior shoulder can look when it comes out and how to distinguish a slowly emerging shoulder from one that gets stuck behind the mother’s pubic bone, a dystocia.

Recently I was delivering a baby at an unmedicated birth. As I was delivering, I was thinking about the downward traction and got to the usual point when I wonder, “Is this a shoulder?” Only this time nothing happened. It was, in fact, a shoulder. Fortunately my chief was right over MY shoulder and very quickly identified the situation and I watched (and sort of helped with) the maneuvers that released the baby from the stuck position.

Thinking, every time, “Is this a shoulder?” is a mindset consistent with being an obstetrician. It is my job to rule out the dangerous stuff. I’m part way there. The crucial next step would of course be DOING SOMETHING about the dangerous stuff. This time I wasn’t really a central actor in the “doing something” part of this part of the delivery. Next time, I will be better prepared.

(I feel like mentioning that I’ve had ample training on the maneuvers to deliver a shoulder dystocia. There is a huge difference between being able to list the stats & steps during didactics, doing it on a model in sim lab and actually taking charge of the chaotic room where the actual dystocia is happening. This is why my chief is present at all my deliveries. She usually stands behind the table and watches, proverbially sitting on her hands. But when our patient needs her, she’s right there.)

a variety of things, briefly stated

I realized today that “If it’s not fun why do it?” is the perfect mantra for me for getting into the swing of dating again. I mean the last relationship decision I made was pretty fucking high stakes. Going from that to deciding that I don’t really want to see someone again after 2 dates gave me some not unexpected whiplash.

***************

I had to pull custodial parent rank this week and change some details of my kids’ holiday plans. It sucked. I am grateful that I was able to adjust plans in a way that my kids’ responsibilities will not be significantly disrupted. Because of the nature of travel reservations, I had to act quickly. It was a pretty unilateral move and I hate that it was necessary. We are both of us figuring out how to manage this new dynamic. I expect we won’t have that problem again. I also expect he’s pretty pissed at me.

***************

One of the really great parts of our training is the ultrasound practice we get. We have dedicated resident clinic time with patients getting OB ultrasounds with an amazing US tech who is a pro at OB ultrasound and good at teaching. Today I did a couple first trimester ultrasounds to confirm pregnancy & establish due dates. I’ve done about 15 OB ultrasounds, about ⅓ of those first trimester scans. It is amazing what a difference some practice makes! The mechanics of transvaginal ultrasound are kind of confusing but I really felt like I was getting adept and got some really supportive feedback from the tech who was teaching me. This might be harder than surgery!

***************

My daughter is all but a technicality away from having a learner’s permit (we are taking the paperwork to the DMV on Saturday). And that permit will mean she is a year away from getting a driver’s license. She’s doing a great job with this whole process. She’s going to be a great driver!

***************

So you probably know in theory that the job requirements for a medical resident are insane. The work hours, the responsibilities, the learning curve,the lack of flexibility, it all adds up to a very stressful job. When I add my personal life’s challenges to considerations, it becomes truly inhuman what I’m asking of myself. I’m entering a time when self care is more plausible and I *really* need to make it count. I need to do substantive measurable things to make coping with my reality easier. Because the color is starting to fade from my life and I need to get it back. I’ve already started some of it: taking yoga classes, covering my grey, cleaning up the Samhain/Halloween decorations, spending some time with my kids, making an effort to re-instate family dinners at least  more days than not (surprisingly difficult with 2 teens’ busy schedules). The gyn oncology rotation is over and I’m feeling burnt out. I’m grateful for the time this week to sleep in (8:00 start time FTW!) and gather my wits. Maybe I can avoid losing them so badly when the next rotation kicks in after Thanksgiving.

Here's why you haven't heard from me much lately

I'm midway through week 5 of 6 for my gyn oncology rotation. It is an amazing expereince and I am growing a lot as a surgeon and a doctor (maybe a piece about how those are 2 different things in my mind is warranted). The hours are long and the cases are tough, medically and emotionally. I will pull back the curtain a little if I can, but for now the experience alone is enough for my mind, I find I am lacking in the capacity to both complete my days and write about them.

***************

I have some things I'm writing about work, but they require more polish and time than I have right now. This rotation is something of a bear. I hope I can write more about it later this year when I do it again. The pieces are getting my attention, slowly but surely. I will post them here when I have them fit for consumption. Until then, some insights about my life:

***************

A year ago today, I had an interaction with my husband that left me bereft, stressed out and incapable of functioning. Because it was the weekend, I had a few days to gather my senses, talk to a friend and figure out how to get back on track. It made me realize how close to the brink of Not Coping I was and made me realize that things were not what I needed and frankly hadn’t been that way for a long time. It was the day I realized that I had done everything I could do to save my marriage and that, in its current state, it was unsalvageable. It was still many months before my marriage ended officially, but this weekend was when I realized that I had bent as much as I could for this partnership and I needed to unbend so that I didn’t snap in two. This was the weekend I resolved not to engage in the same destructive conversations without an arbiter present to protect me. It was many weeks before my partner even wanted to engage in these conversations again, and then months after that before he put the work into finding space for us to talk according to my safety requirements. That time gave me space to build my own thoughts and expectations about how those conversations could be different.

A year ago I spent the morning crying in the gym parking lot, talking to friends and mustering the courage to go do some self-care (Thank the gods for BodyCombat!). Even though I’m not much of one for anniversaries, this anniversary is sticking out for me. A year ago it was my birthday.

***************

I have reached a point in my training and within this rotation that I feel actually helpful. I am able to make and implement plans that only sometimes get undone or amended by my chief. I know where to find information to answer questions I don’t have the answer to that are necessary for me to be as helpful as I’m managing to be. This post is not about all the things I need to learn and that I can’t do yet. This post is about how I’m getting better at my job. They may make a doctor out of me yet.

***************

My kids do this thing where they both agree that XYZ situation or scenario would make me flip my cap, or that I would behave in an extreme helicopter-y way - like interrogate their friends or accompany them to something or forbid their participation in an event or activity. I know that I have spent a long time being a “no” person in their lives, being the strict one but also the reliable one, the “psychological parent” as the case may be. I’m trying to decide if they actually hold an impression of me as overprotective and unreasonable as they project me to be, or if it is some sort of weird mind game. I’m going to run with the theory that they are using these conversations as a way to acknowledge my commitment to them and my hard work supporting them emotionally, financially and logistically. Yeah, let’s run with that!

***************

It is truly amazing to me that the organ I see when I do cesarean sections is the same organ as the little thing I see in women in their 60s or older when they are having laproscopic hysterectomies. The former have huge, beefy red, muscular organs that bleed a LOT, have significant bulk for cutting into them and sewing them up while the latter are teeny tiny cute little, pale organs smaller than palm of my hand.

***************

I’m trying really hard not to be a bitter divorcée, both because I strongly desire not to be a cliche in my life but also because I find bitterness to be a fruitless experience that only harms myself. I’ll be angry or frustrated, but I don’t want to be bitter. But as I get older, life gets less surprising. Like discussing with some of my colleagues a recent article in an Ob/Gyn magazine (NOT a journal) about how few het married woman Ob/Gyns feel that their husbands do a bulk or equal share of the household duties. Or when I have an interaction with my ex wherein I feel I have been punished and rewarded based on how he feels about my part of our texts (the only way we conversate these days). I hate that I need him to give me money, and I hate that we are fighting about it. We have a pretty simple agreement, but since when is money simple? So yeah, angry, frustrated, feeling powerless and generally swearing off men as romantic interests. How does that differ from being bitter? I don’t know. It may not. Maybe I just need to embrace bitterness the way I embraced being angry. It felt better afterward. But I don’t think that is the right move with bitterness. I need to think a little bit more about what it means to me to be bitter. I feel like it is a state of being that will impede my emotional health but I’m not certain yet. Maybe it is just me naming emotions I’ve already been having, perspectives from which I’ve been viewing the world for some time. Huh, maybe I am already a bitter divorcée and I just didn’t know it.  

I'll give you 3 guesses which side I'm on...

The hospital that houses our residency program is a powerhouse in Western North Carolina. Several regional hospitals have shut down their L&Ds and we are getting those patients traveling here for their deliveries. But the system itself is not objectively huge, more of a normal sized fish in a tiny pond. WNC is not that big compared to major urban centers of the region or even of our state.

They are big enough, however, to cause some trouble for an insurance company that is trying to strong-arm their contract renewal negotiations. I’ve seen this sort of thing happen in other communities I’ve lived in. The contracts don’t get negotiated substantively until AFTER they expire. That leaves people insured by the company (which I won’t name but its initials are BCBS) out in the cold during the process. Reimbursement of many smaller practices in the region will likely be guided by what happens with this conflict.

October 5th was the end of the contract and things are still heating up. Private mudslinging emails aired, giving excuses not to negotiate and blasting the fighting in the local papers. It is a little like Mom and Dad fighting and conveying messages through their children instead of coping like adults. Meanwhile a large portion of the privately insured of WNC are over a barrel.

There was a huge insurance company media campaign against the hospital and eventually someone from the hospital marketing department convinced the powers that be that it was time to hit back. There have been ads, Op Eds, signs posted around the hospital telling their side of things.

And patient care is already being affected. Fewer surgeries scheduled, women about to have babies are trying to figure out where they need to go and how they should navigate the situation. Because they are being told to drive FAR away for the births of their babies and remember what I said about the smaller regional hospitals closing their L&D units? It’s all a mess.

As the intern...

I have something of a writer’s block. I really want to write about residency and the amazing things that are happening in my day but the things I think to write about during the day are hard for me to muster again when I get in front of my computer. I’m doing a lot of thinking about personal things, there’s a lot going on in my life, in how I’m thinking about and reacting to my life. My kids remain brilliant and shining humans, doing such great jobs with the very difficult tasks of being adolescents, having a busy working mother and being in a new school & town. I want so very much to think about and write about what is happening at work but I’m just not in the head space for it yet.

***************

I just finished week 1 of 6 of the gyn oncology rotation. This is a challenging rotation - we have really sick patients, with lots of co-morbidities (they have more problems than just cancer), they are lots of different ages and at different stages of disease. We spend a lot of time in the OR and we have a lot of management responsibilities for the patients who are on the floor. The is significant learning is in every facet of our day. Interns cover the breast cases, which is fantastic experience that many don’t get in residency.

***************

I’m on my gyn/onc rotation now, and as the intern, you do a lot of breast cases, which is spectacular experience and a really special part of my residency program.

In the first few days of this rotation I have done breast cases for women ranging from their early 30s to mid 70s. One of the most striking things for me, as an intern surgeon, is the differences in the skin of women at different ages. Not the cosmetic, external differences, but the cellular changes. Cutting and suturing skin of women of different ages is different. With younger women you have to put more pressure on the scalpel to get through the dermis. With older women, the layers are thinner and suturing requires more precision to be certain you are in the correct layers.

All this makes me feel a lot better about aging. I mean, I may not like my wrinkles and the subtle (I like to tell myself) sag that my skin has taken on as time goes by, but it isn’t as if I can do anything about the fact that my collagen is breaking down and the cell layers in my skin are thinner than they were 15 years ago. So yeah, I have wrinkles, and I look like I’ve lived a life that could have raised 2 teenagers, and not have been a teen mother either. And sometimes when I introduce myself as “Larissa, one of the new OB interns” people can’t help but spurt out questions about my life before medicine. “You look old to me, I’m curious about why you don’t match my mental image of ‘intern’, tell me intrusive details about your life.” But it isn’t like I can help it. It isn’t as if there’s something I did to make my skin get thin. It just happens. Time marches on. And sometimes, depending on my mood and the setting and the manners of the person who asks, noting that I’ve got “mature skin” gets you an interesting, funny story about my life. And sometimes it just gets you a funny look and someone who pretends not to understand what you are asking her.

***************

As an intern, I have to work with a lot of new, different people. Nursing & clinical support staff deal with a new batch of interns every year and you know there are some who are a little tired of the same mistakes, slow technique, unfamiliarity with protocol. I don’t blame them. I”m fed up with my own amateurishness, and I’ve only had to deal with it once and for a few months! Generally speaking, though, the staff are very supportive and positive about helping us to learn to do our jobs. There is, at least in my hospital, a huge culture of respect. I think hope the douchey intern who disses nurses is no longer a real attitude and relegated to being just a tired, Hollywood trope (I’m thinking of that one episode of Grey’s Anatomy that I watched).

And each attending has their own surgery style, preferences and teaching method. Some are socratic, some are sink or swim, some ask you a question and then stare at you blankly while you fumble your way through an answer. Some are really good at giving positive feedback to the fragile ego of new doctors and others give less ‘sandwich’ feedback but when you get a “perfect” or “just like that!” from them, you know you really nailed it. With a rare few, I feel like it might actually physically pain them to say something positive.

And just like any workplace, some people are easier to get along with than others. Some people don’t gel as a pair or a team, others push your most tenderest buttons. I try really hard to see the Shadowself in my tough interpersonal interactions. Maybe there’s something they do that is a little too familiar in my own behavior? Maybe the way I perceive their treatment of me really feeds that negative self-talk I’ve been trying to overcome since the moment it was programmed? What is there that I can learn, change, adapt, in this situation? And I’m also trying really hard not to knee-jerk react. The hypervigilant streak I have is a mile wide and so easily fed just about any human interaction. I’m trying to sit with my feelings about these interactions and not draw conclusions. To approach them with curiosity. Often I am successful. Well, eventually I am successful. Sausages, laws and mature interpersonal reactions are all very messy in the making.

Back in the saddle

In an effort not to just blog my strife, I want to report that today was a really good weekend.

Saturday the kids & I went for a hike off the Blue Ridge Parkway. I’m starting to embody the characteristic of nonplussed as it relates to teenage attitude. There wasn’t abundant enthusiasm for the idea of our hike but a gentle persistence (warning them of the plan a few days beforehand, not making them do a bunch of food prep or chores in advance and simply not accepting any alternative) allows space for us to do things together even if the kids’ psyches don’t allow them to be enthusiastic about it. By the end, they were enjoying views, playing with the dog & each other and climbing trees and enjoying themselves so much I had to pull the “I have to work tonight I need to go take a nap!” argument to get them to get off the hill at all!

I worked overnight last night and we were BUSY! It was fun! I delivered several babies and got to watch an upper level resident do some things I hadn’t seen before. I definitely get kinda stupid toward the end of the night but I’m starting to be able to do my tasks despite the end of the night stupids. Any chance I get to do manual tasks of surgery - in last night’s case perineal repair - is mostly gratifying with small doses of infuriating - both experiencing and being myself. I can see myself being hard to teach, slow to grasp teaching points, persistent in my pursuit of the wrong way of doing something and it is like watching someone do something potentially embarrassing on TV. I just can’t seem to make myself stop as quickly as I’d like. The best I can do is repair the interaction and acknowledge to the patient, equally tired person who is trying to teach me that I’ve been a bit thick.

Today I slept the heavy, restorative sleep of the exhausted. Menial tasks of meal planning and grocery shopping were achieved with minimal distress and then I joined a friend on a beautiful afternoon at a local establishment for a nifty craft ginger beer and some equally restorative conversation.

Did you know that I have had a housemate? Later I will tell you how I met Al & Rebecca but for now I’ll just say that Al needed a place to stay for some of September and she came to stay with us. She’s a new friend but one of those people you meet and just connect with right away. In addition to the joy, laughter, commiseration and extra help she’s brought to our house, I am so so grateful to have made a fast friend so quickly. In a time when I’m feeling quite unsettled and not fitting into many parts of my life, the fact that I can make a true new friend is filling me with hope for the relocation process. Alas, tomorrow Al & Rebecca’s sublet is available and they will live across town for the (hopefully few) months it takes to build their new house not too far from our place.

It wasn’t just the things that happened (though having enough money to buy groceries certainly lightens my mood!), it was also the peace that I’m starting to feel and not just fake. Thinking about the literal and metaphorical blank spots in my life and planning to start an activity that is just for me when I go to the first Swing Asheville event on Tuesday, it all has me feeling a sense of peace with myself that I very much want to foster and nourish.

Okay, as good a weekend as it was, I still have to be at work at zero dark thirty tomorrow. Time for me to go to sleep.

***************

I have a loose rule that the kids are not allowed to use their phones in the car. I don’t enforce it all the time, especially if we are driving to something lengthy, like when we went hiking. Sometimes I let them pick out music to play but often we just put the phones down completely. This isn’t an entirely popular edict, and I often get huffs and eye-rolls when I tell them to put the device down. But often we will have impromptu conversations, I’ll hear about something that happened at school, we will opine collectively about the stupid drivers or talk about what a drag it is to go about making friends in a new town. Not every drive is like that, sometimes the teen is very upset about having to put their phone down and they subject me to stony silence as punishment. I spend little enough time with my kids, if I’m going to ferry them around, the price they pay is a little bit of quality time with mom. They can play on their phones when I’m at work.

***************

I have been trying to remember how much time I spent voluntarily  with my mother when I was my kids’ ages. I’m pretty sure it wasn’t very much. It tempers my guilt to know that even if I were around more, it isn’t like they’d want to spend the time with me anyway!

***************

Looking back on my last few entries, I realized there hasn’t been much medicine in here! Part of the reason is that I spent a week on vacation and have been processing that whole experience. Additionally, I’ve just finished my 3rd rotation of intern year - the GYN rotation. This rotation is a slower pace, more space for independent learning time, not as much structure as other rotations and not as much responsibility. Here’s the thing - vaginal surgery is HARD! They don’t really let the interns do it. There are non-vaginal surgery things that we can do - hysteroscopies, cystoscopies, retracting, prepping, pre-op-ing, maintaining lists of patients and helping with the busier services when we are available. Additionally, there’s clinic time - I had a few great peds/adolescent clinic days, more ultrasound practice (this is really amazing and warrants its own post), procedure clinic (wherein I lost my fear of cervical biopsies after a few really weird experiences with this clinic during my 1st rotation) and we have a pre-op/post-op clinic as well. (Clinics are traditionally a half-day each, so several days a week I was in the hospital and in the OR in the AM and then in clinic in the afternoon.

Part of why I haven’t written about this rotation is because it is harder to anonymize and composite patients (which is how I tell stories while maintaining patient confidentiality) when there are fewer patients to talk about. My goal is to write about my experiences in ways that would make it hard for even the patient(s) I’m refererencing to recognize themselves in my stories.

My next rotation is a tough one - GynOnc. There’s a lot of surgery for interns, which I’m really happy about. Mostly we do breast cases, which is fantastic experience for an Ob/Gyn program to offer. And this is a very medicine-heavy rotation. Lots of these patients are sick and need chronic and acute management. I’m looking forward to this too. I liked Internal Medicine, except for the lengthy (sooo long) rounding. Once again, Ob/Gyn shows itself to be a perfect marriage of surgery and medicine, making it (obviously) the most perfect specialty of all. If I can stay awake to blog, I expect I’ll have some stories to tell soon!

Self in context

Now that my house is unpacked and the art is up, I’m seeing the places where I have space for more art. Like over the toilet in the powder room on the main floor, and 2 or 3 places in the kitchen. Not fine art locations, but someplace to put up decor that has not yet been added to my life.

Don’t get me wrong, I love the art that I have. Papyrus my grandmother bought when we lived in Egypt. Art that was a gift of love and an homage to my Turkish heritage. A great mother’s day collage. Even the creepy old photograph of the ancestors who go with the beautiful dresser in my bedroom. These things are me and they are mine. But observing that there are places where I get to pick new art has gotten me thinking. If I could choose my style, my colors, my statements, what would I pick? I don’t have a clear answer and the question itself is mostly hypothetical given my current finances not leaving much (okay any) room for buying non-essentials just yet. I’m still saving up for a dresser & some shelves for Ainsley so she can finish unpacking her room. After that, there’s a list of other things the kids & I are hoping to add to our lives. Like a non-inflatable place for guests to sleep.

The process of thinking about what I want and like got me thinking beyond decor and art choices and into other aspects of my identity. Like dancing. I love dancing. Not going dancing - which I think of as the thing people do at clubs and high school dances, mostly a lot of uncoordinated gyrating - but choreographed dancing, with partners and steps and everything. I want more dancing in my life. So on the eve of starting what I understand to be 6 hellacious weeks of Gynecologic Oncology, I’m researching swing and salsa dancing opportunities in Asheville. I have done all but the last step to actually join a swing dance club that has regular Tuesday night lessons (paying the modest membership fee will have to wait for payday). Tuesday is the one weekday day that I don’t have to drive children all over creation for their activities. It’s fate. I’m going to learn to swing dance. All because of the blank wall over the toilet in the downstairs bathroom.

***************

In the movie The Matrix there’s a scene where Neo gets plugged back in so that he can learn some stuff from Morpheus. When he is uploaded to the learning interface, he looks like he looked back in the matrix, not a skinny, bald prisoner of war, no weird bolts on his arms or head. Morpheus called this his “residual self image...a mental projection of your digital self.” I think people actually have these projections in their subconscious. When I was pregnant, I had dreams where I was not and could move freely, twist at the waist, run and swim (and in my 2n pregnancy, run over the tops of rooftops with a machine gun to awaiting helicopters).

My subconscious needs an update to my residual self image. . This morning I had a dream about making a last minute decision to do something for myself. In the world-bending reality of dreams, I decided to take a short 4 hour drive to see dear loved ones who are, in fact, about 16 hours away. I’ve been feeling frustratingly lonely lately and I am disappointed that my schedule and my means make it so hard for me to spend time with people I love. In this dream, I had a side kick, a travel partner, a media naranja who convinced me not only that I should make the drive, but that it would be good self-care for me to do so.

I suppose in the Freudian vein, we are everyone in our dreams so this was just me talking to myself. But at the same time, myself was taking the form of my ex-husband in one of his supportive and loving moments (of which there were many). So I woke up very, very sad to realize that Minneapolis was in fact not really a 4 hour drive away and missing my archetypal life partner. Kind of a downer of a way to start a Friday.

***************

Recently in clinic I had to do a hard but very necessary thing. I had a patient with a reason for visit that was not really appropriate for our clinic. Think of someone coming to an eye doctor for a broken toe or a dentist for an ear infection. But because she was pregnant, the people who were supposed to be taking care of her were reticent to do so. When a person is growing a person in their uterus, doctors seem to forget that the rest of medicine still applies to them. Pregnant people can get cancer or pneumonia or appendicitis. They can need x-rays, surgery or pain medication. Just because they are also pregnant, it doesn’t mean the right place for them to get that care is from their OB. So I had someone who was in a significant amount of distress and needing help. Technically speaking, I was capable of giving her the help she thought she needed. I could have ordered the test & the prescription. I have the capacity to do this. It is allowed by law. But it isn’t good practice. And the things that the patient thought she needed were not the things that would have helped her health in the long or short term. So I had to offer a very dissatisfying plan of care and make recommendations that caused significant distress to the patient. This sucked. It was also the right thing to do. There’s no sanctimony and there’s no judgement. This wasn’t a drug seeker, this wasn’t manipulation. It was honest to goodness hard times. I’m going to think of her for a long time, hoping that she got a resolution to her pain & trouble, knowing that my interaction with her only added to her distress.

Whiplash, Con drop, Rebound

This was a really nice break from the battery powered hamster wheel that is my life. Now that my house is clean, my boxes are all unpacked and my pictures are on the walls, I’m feeling very quiet and sad. I like my kids. I like my house. I want more time to enjoy life. I wish I could keep driving them to school and sometimes even picking them up. I want to travel and drink wine and make art and meet people and meditate and experience joy. I know that I don’t need to do all those other things in order to do the last one, that joy comes to me in many forms. But my life is hard right now, emotionally, logistically. And this week has been a nice rest from the crazy train. I don’t know if I have the strength to get back on.

***************

Gods bless the restorative powers of a Netflix binge, a nap, a dog to walk and a job that I really do love. I’m ready to hop back on the wheel!

***************

I have to decide how much my kids need direction, support and ultimatums regarding their use of their phones and how much I need to adapt to raising digital natives. I’m pretty sure I have things to teach them about achieving focus, working efficiently and minimizing distractions. I’m just not entirely sure how to teach these things in a credible way. They are so sure they don’t need direction, they are very skeptical of any advice that involves using phones less. Like I’m just making shit up so that I can take away their iphones! How to prove that I have their best interests and optimal personal development at heart?!?!

***************

I’m in a really toxic mood and I don’t know what to do about it. I don’t know if it is hormones, fatigue, post-vacation malaise or a sign of something more sustainably dissatisfying about my life. I’m feeling really invisible. I’m missing my context. These new surroundings are starting to lose their polish. No longer is everything new and different. Which is significantly less terrifying. For which I am grateful. But things are also not yet familiar. I miss having real friends. Being a single parent with a slacking ex is very disappointing. It makes me tired and stressed, it makes me sad about the lack of co-parent, it makes me feel unappreciated for all the things I do around the house for two teenagers who are surly and self-centered and don’t want to talk to me. (All of which is developmentally appropriate and in no way the unique characteristics of their personalities.) I feel compelled to defend them even as they hurt my feelings and frustrate me. I need to eat better - there’s way too much sugar in my diet, I definitely need to meditate more. I would benefit from some regular exercise. And probably therapy. Fantastic, my frontal lobe has just problem-solved its way out of this slump. Huzzah. Someone needs to write my frontal lobe a memo and let it know that it isn’t in charge of getting us out of this mess.

***************

It just occurred to me that something that makes me feel unsettled about my performance at work is that there are no grades. How do I know how I’m doing if I don’t get graded?!?! Okay, now that I’ve figured that out, I can untangle the crazy that sentiment is and remind myself of all those years I had jobs with no grades and did quite well thank you very much.

***************

This is a story about how I internalized the meaning of the stage of grief called Denial. I was talking to a friend today, as I am wont to do when feeling unsteady. It was a good conversation with a friend who listens to me complain about and explore the nuances of my life without making the whole conversation feel morose. And then we talk about her life and we tie things together between our common experiences. I was explaining to her that I was having a strong “Is this really my effing life?!?” feeling lately and she named it as denial. I have to say I’ve always been puzzled by this stage. How can one be in denial of something they are grieving? No I don’t have a terminal illness? No my loved one did not get hit by a bus? No I’m not going to jail? But the truth is that it isn’t that this stage is about stating that a thing is not happening, rather it is about the happening of this event not resonating with the rest of one’s expectations and experiences. It tracks, for me, more as disconnect or dissociation but denial is the term it was given by good old Kubler-Ross. It finally makes sense to me.

Vacation

Day one of my vacation was quite productive - I had an eye exam, did some important banking, figured out what I needed to do to register to vote (need a NC ID card first, all set to get one of those this week). The kids were released from school at 1pm in anticipation of Irma’s dregs hitting us here in the mountains. (Power is flickering a bit over the last hour, I can hear the wind blowing over my roof, this seems to be the real deal) And I spent a lot of time unpacking my loft. Getting the meditation space & my altar set up was like getting the best hug from an old friend (hint: his name is Keith). The desk is a *disaster* but in a darkness before the storm kind of way that I can totally handle. I’m optimistic that I will be able to get it done tomorrow. We’ll see.

Despite my continued efforts, my brain is not allowing my logical side to run things completely. Having the space to peruse my belongings also gave me space to feel loss and nostalgia. The grief is fresh, raw and close to the surface. A healed person does not cry as readily as I can be driven to tears. Unfortunately, this is not my first death (literally or figuratively) so I know this pain won’t last forever but also that it won’t ever go away completely. The edges will wear down, there will be space for nuance and subtlety in my reflections. I will be able to remember that I was happy without it making me instantly sad.

***************

Vacation is almost over. There was some unexpectedness this week - my mom came up for a few days as a refugee from Irma. Ironically, we ended up losing power for a day and a half. Since the kids were out of school and there was nothing to do at home, we took the dog for an easy, little hike to Triple Falls in DuPont state forest. Whether or not any particular terrain we are exploring would make a good arena for the Hunger Games is a common topic of discussion when we go hiking so it was fun to be able to explore a forest that was literally the arena. The kids climbed like crazy people on slick rocks because they don’t love their mother and they want to worry her into an early grave. Also it was really cool.

I’ve been peppering my days with the last bit of unpacking and organizing from the move. My loft is now set up and my desk is ready to be used for productive, grown-up tasks. I have always had a theoretical appreciation for built-in bookshelves but now my adoration comes from the direct experience of filling shelves and shelves with books, knick knacks, files, art, photos, etc. I have more space than I have things to fill it!

I also took up needle felting again, attempted to make a ladybug but it turned into a mouse (it was orange colored, but still, that transition demonstrates my challenges as a craftsperson. I am still pretty lousy at taking ideas from my head and making them tangible. I switched to mass producing a bunch of little hearts and I made a little family of jack o’lanterns. I think I’m going to invest in those thick rubber finger condoms - I really like felting but the risk of stabbing my fingers and causing teeny, tiny open wounds that will have hand sanitizer and soap scrubbed into them multiple times a day has been enough to keep me away.

I think it is interesting that at no point in my week did I consider doing this one big homework assignment I have. It isn’t due for a while (It’s a quarterly activity) but when I was in the mix of work I thought “hey, that would be a perfect time to get it done! I bet I’ll even miss thinking about work after a few days” Yeah, I miss work, but not enough to chose lifelong learning assignments over watching TV and walking the dog.

***************

Something important happened this week. After trying to get resolution one way on a problem I’ve been having, I stopped trying to compel action in another person. Instead, I turned to friends for support - emotional & material - as I deal with the continued frustrations. Just that act of turning away from trying to get someone to behave in a way I think they should, in a way I really do need them to behave but they won’t, just that act has freed me from a great deal of anger, frustration and distraction. I’m not necessarily getting my needs met, but I’m no longer trying to get them met in a way I know to be pretty much guaranteed to fail. Doing something different feels very good.

***************

There’s a term in medicine to describe what we do when we do not intervene on a person’s health. We call it Expectant Management. Some people call it Watchful Waiting. In the beginning of medical school when I thought of a point in a person’s health when there was no appropriate intervention, my assessment and plan included some sentiment along the lines of “So, we just do nothing?” But expectant management isn’t doing nothing. Seeing your patient regularly for monitoring is not doing nothing. Being aware of the ways a condition can resolve or escalate, knowing how to evaluate for changes and helping reassure and educate your patient about the health matter in question are not nothing. I couldn’t do it as a 1st or 2nd year med student. As I’m coming into my own as a physician, I’m realizing the value of watchful waiting. I am recognizing that I am actually DOING something during that time. The records are important, the visits with my patient are important, keeping tabs on and being ready to act or declare resolution take skill, knowledge and perspective. Knowing when not to act and how long continue not acting are important clinical skills.

I’ve come to love the term expectant management. I am seeing all sorts of ways to apply expectant management in my own life. When my kids have bad days, are in surly moods, I’m so tempted to interfere, to fix, to cajole, to chat them up. Often they tell me to shove off, and that it is annoying and they want to be left alone. I remember the value of expectant management in those moments. When I miss my friends who are so much closer but still too far away to see in a weekend. When I see my savings account slowly, slowly creeping up (soon I’ll have 3 digits left of the decimal!), when I recognize that I’ve had a string of expenses particular to this time of year, I know that I am going to be able to climb out of this stressful financial hole. It won’t be lottery ticket winning fast, but it will happen. I’m expectantly managing my social life too, I’m making friends and getting a circle of people around me - medical training peers, time of life peers, psychically & spiritually aligned peers. This will grow into something established and familiar, but for now it is nascent and fragile. Expectant management for friendships that I know will mature.

***************

Today I’m hanging pictures! And dusting! You have to be pretty close to finished with things to be at this step of the game! I’m going to make my kids do some housework today and tomorrow and then we will be party ready! I’m having a housewarming party tomorrow evening. It has been a nice goal to shoot for so that I was motivated to clean and unpack. I’m a little nervous - this is my first social gathering in this house, first batch of friends I’m inviting to my space. Tim and I used to throw really good parties. We melded well in our ability to get the house ready (but not be too stressed about it), set a table that was appetizing yet simple, and according to our friends, they were made to feel welcome and enjoyed themselves. I’d like to continue that track record, but I don’t know how much of it was a partnership skill, how much of it was me and how much of it was the friends! I’m not going to worry overmuch about it, but it is a little kernel in the back of my mind. Things are different now, but I hope that this stays the same.