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.

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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.

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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!

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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.

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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.

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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.

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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!

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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?!?!

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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.

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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.

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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.

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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.

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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.

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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.

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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.

Being whole is boring and amazing at the same time

Yesterday was Duncan’s 14th birthday. Despite the fact that he spent a couple of hours doing homework and he’s got a nasty cough & congestion, he had a good day. Duncan is, as I imagine most boys are, a collection of contradictions. He defies stereotyping and every time I remember that, I am rewarded by watching a part of his well-rounded masculinity grow. This year I gave him a bouquet of sunflowers and the exclamation of joy for “Birthday flowers!” and the attention he gave to that gift all day reminds me that flowers are not just appreciated by females. I gave him a funny card, because I like making my kids laugh. But I also wrote of my heartfelt pride for the young man he is becoming, with details and anecdotes. And the biggest, most heartfelt hug I got all day was after he found that card on his bed last night (because I’m busy and frazzled, it didn’t get put out with the gifts earlier in the afternoon!)

Duncan is a whole person, developing a complex relationship with how society demands that men behave. We’ve had a number of joking interactions about how asking for help is a sign of weakness and making mistakes is shameful. I know that these messages are coming through loud and clear from the world outside. I also know that now that as I’m unfolding from the stress of our previous family dynamic, I’m more accessible to my kids as a human than I was before. I yell less, I joke more, I am more flexible and I own up to my mistakes regularly. No longer do I see shock when I respond to a “Why did you do that?!?” inquiry from my all-knowing teens with “I made a mistake.” Their mom screws up, regularly and daily. And yet, she also runs a household and has a very demanding job. So screwing up is clearly not a disqualifying event for adulthood. Neither is asking for help. I am working very hard to show the kids that we are not doing this adventure alone, there is help coming from all sorts of places in our lives.

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It’s raining in Oregon. This is a very good thing.

My mom evacuated from her home in Florida, now it seems that the mighty Irma is tracking along the other coast of Florida and is headed HERE! Maybe my mom is a weird hurricane magnet. :-)

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I’m on vacation this upcoming week. Though it’s been a good, quiet weekend, I feel a little bit of pressure to be doing MORE relaxing, MORE home chores, MORE on my To Do list. I feel pressured to relax more. Which is totally insane. At least I can acknowledge those crazy thoughts for the irrationality that they are. I wish they’d just shut up. Most of my To Dos are administrative life things that require M-F 9-5 time - getting an ID, an eye exam, registering to vote. City council primary is coming up in October. Time to get involved in the new political climate! There are stacks of boxes in the office space that is the loft above my bedroom. I can feel them leering down at me from up there. That is my big home project. I’m glad the weather is cooler, that is the one place that collects heat in my new house. Which is probably why it’s the one place that hasn’t been unpacked yet. Hopefully I will be able to do some exercise this week too. I’m on the very early downside of a rotator cuff injury that has been annoying and debilitating. Not being able to do my usual body-weight exercises has me out of my fitness groove. Not super exotic goals for a vacation, but honestly, the simple joys of grown up living feel pretty sweet.

Fire on the mountain

There’s a huge fire on the Columbia river gorge right now. Many of my FB friends are posting about it so I’ve been seeing articles, pictures, thoughts and opinions about the situation across my feed for the last couple of days. I’m just starting to get a fuller picture of the devastation that this fire is bringing to a beautiful natural resource and one of the most lovely parts of a state that is pretty beautiful at baseline.

This is making me think of the attacks on 9/11. On that day, I was home with an 8 day old infant. I was focused on mastering diaper changes and figuring out how to gently wake a sleepy baby for feedings. I was in a gauzy cocoon of the 4th trimester. Of course we spent the day watching things unfold on TV, but the scope of the disaster did not fit into my brain. Tim had to go into work for some disaster management meetings during his 2 weeks off. He came home with stories of soldiers on the streets of DC, of quiet skies and meetings with Secret Service representatives who honestly said they never wanted to open National airport again. Ever. It still didn’t fit into my brain. It took me a while to catch up to the nation’s trauma because I was shielded on that day by my baby.

I’m not in a baby haze now, but the problems of my own life are very pressing, making it hard for me to process much that is happening outside of my personal existence. I feel disconnected from the world, from things that matter to me. I want to act - against the racism & bigotry that has been given license to freely express what has been fomenting under the surface of our nation, against the political environment that is acting against the best interests of our nation, for the many public health issues that mean a great deal to me personally and professionally. But I’m squarely in a “making the trains run on time” mode - do we have groceries, did you do your homework, what’s my laundry situation, crap when’s payday. I’m mired in the minutia of keeping my family operating, there’s no time for the top of the pyramid. It feels painfully self-centered but there isn’t much to be done about it except continue to console myself that This Too Shall Pass and some day I will have the space to act on my principles. Not acting doesn’t mean they aren’t there.

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This week one of my FB friends posted about the passing of a woman who has affected my life quite adversely. She was a new age guru author person who wrote at least one book (I’m sure there were more, but the one was enough for me to loathe her). The premise of this book was that physical ailments were manifestations of psychological...something. I don’t know what because I never actually read the book. And she wasn’t in any way qualified to be dishing out medical nor psychological advice. She was a voice for “alternative healing” during the AIDS crisis who claimed that a “lack of love” caused people to contract HIV. I really dislike this woman. In hindsight, I can see that her presence in my home was a sign of things to come, 2 roads slowly diverging. I don’t consider myself to be radically or unreasonably advocating for mainstream medicine, but I was too conventional for my partner. Our ideas of how to manage real, chronic health problems were fundamentally incompatible. That the problems were mostly experienced by one of us was not the issue. Rather, it seemed our differing adherence to Ms. Louise Hay’s notion of “dis-ease = disease” was the beginning of a wedge that took years to cause a split. I will confess, there were times that I saw that damn “You Can Heal Your Life” book tucked under a couch or about to fall behind furniture and I just left it where it was. Maybe even nudged it a little as I walked by, tucking it safely out of sight. I have no feelings about Ms. Hay being dead. I have only feelings about what she chose to do with her life and how it affected my own. And I have feelings about unqualified self-help gurus.

16th Birthday - My milestone as well

Today was my daughter's 16th birthday! Despite having to work overnight, it was a good day, packed with Ainsley-centered activities like eating bacon, watching movies on the couch and reading books. We tried to go out to eat and ran into a street festival downtown. It made our dinner plans complicated but it turns out eating street festival Indian food and wandering some crafty booths was just the familiar topper Ainsley needed for her day. On our way home she thanked me for a "good birthday" which made my heart light.

In turn, I would like to thank my dear friends and wonderful coworkers who helped make the day special. Catalina and Diana - I can't say enough how much I value all the love & support you've given me! Lindsay - the gift of the Sky Zone passes was more than just an afternoon of fun for me and my kids, it was a gesture of welcome that touched both my kids' lonely new-in-town selves. Mimi & Lauren thanks for the help figuring out the local options and making the shopping trip logistically possible. 

When I decided to move and do residency as a single parent, I knew that it was going to be hard and that I was going to need a deep bench of support and assistance. I had the idea that it might be easier than the isolating stress I had been feeling during med school - when I was poor and poorly supported - because I would have the space to ASK for help. At times that felt like a horribly naive sentiment but I held out hope that even though things would be hard, they would still be better. 

Having successfully navigated a milestone birthday, I feel like it is no longer doe-eyed for me to say that things are going to be better this way. I didn't do it alone. I couldn't have done it alone. Fortunately it turns out I don't have to do it alone! 

Today was about Ainsley, the beautiful, self-possessed, nerdy, strong young woman who I am so very much enjoying watching come into her own. But it was also about me, the peace of mind that having friends I could talk to, people who could help me, substantively and emotionally, create a memorable day for my daughter. It was a good Birth day for me as well. 

Spatial distortion from the bottom of the learning curve

A week from today I will be on vacation. We get 2 weeks vacation (one in each half of the year) plus time at the winter holidays. Because of my rotation schedule and the kids’ school schedule, I won’t have a vacation when the kids are off of school except for winter break this year. This was a bummer but also a reality of the logistical challenges of organizing resident schedules. We are going to work to coordinate my schedule with the kids’ next year so that I can have some vacation time with them in 2nd year. (I’m profoundly grateful for the lengths my coworkers were willing to explore to try to find a way to get me a vacation during Spring Break. This program is so supportive) This vacation is going to be a stay-cation. I’m going to unpack my office and have a housewarming party. I’m really looking forward to being able to finish that last room that is filled with boxes. I have a whole wall of built-in bookshelves waiting to be filled. A meditation corner that is itching to be set up. A storage closet that is currently empty while its potential contents clutter my space. I’m going to hang art and go for hikes with my dog. It’s going to be awesome.

The L&D rotation was intense, repetitive and high volume. I got to do many things over and over again. In the midst of it, unsurprisingly, I was feeling overwhelmed. I comforted myself by acknowledging that this was not reality - this was not what my eventual career would look like. This was a training environment. One of the differences between L&D and GYN is that, I think, GYN looks a little bit more like a real world job. Mixed responsibilities, some days clinic, some days OR, some days a combination of both. Not a lot of repetition. It is less exhausting and overwhelming but as a learner, that repetition is important for building skills. I improved significantly on post-partum tubal ligations because I did 7 or 8 of them in the 4 weeks I was on L&D. I participated in over a dozen surgical births, either as primary surgeon or as first assist. I started to gain some muscle memory and automaticity in my technique and generally became less terrified in the OR. (Less, not none) The good news about being an intern is that there is so much to learn that even in a less intense, less repetitive environment like the GYN rotation, I have no doubt that I will learn things - from nurses & scrub techs, from listening to attendings & upper levels do the complex cases that are not appropriate for my level of training, from having time to read practice bulletins and committee opinions and textbooks and Up To Date.

Yesterday I made an off-hand comment about the difference between a 401k and a 403b and one of my colleagues said, “You’re a real adult, aren’t you?” I forget how many things I’ve learned about the world in the years between when I was a young professional and today.

I just finished a week of the benign GYN rotation. This rotation has a much lighter patient load in the hospital, which has meant later starts in the morning. It also has me in clinic most afternoons instead of in the OR or working on an inpatient team, meaning earlier release times as well. The flip side of the extra time is being cast about to different locations (outpatient & hospital-based surgery as well as clinic time) and not having a base ops like the L&D unit. BUT, my chief introduced me to the OB Intern call room - a space that is not convenient to the floor (so a bad place to go when you are monitoring patients in labor for example) but is very cozy and complete unto itself.

I’m really bad at letting go. I guess I prefer the sting of painful confrontation over the emptiness of the unknown. Right now I’m struggling with the very modern problem of navigating a social media relationship with my ex-husband and would be co-parent. I am trying to be my best self, to retain empathy, to remember that the person we show on social media is never the whole of our lived experience. But juxtaposing his quasi-introspective public posts about enjoying life in SoCal against the harsh private realities of my and the children’s lives just makes me too angry. I’m too tempted to write snarky comments about issues that do not belong on social media platforms. I’ve tried to unfollow in an effort not to expose myself to triggers that will cause me to think bitter and angry thoughts about the fact that he is behaving entirely consistently with the sort of person he was before we separated (and then dealing with the subsequent anger at myself for entertaining the delusion that he would behave differently after I left him). But as I mentioned I’m bad at letting go. I may have to escalate my digital separation if I can’t muster the willpower.

I'm learning, through this my training, to take things less personally. Many aspects of my work are easier if I can manage some honest detachment. Feedback isn't Personal, Pervasive or Permanent. We need, I mean NEED that feedback if we are going to be able to do our jobs. But it isn’t just the feedback, I’m also working to practice a certain amount of detachment from the patient experiences. We do things to patients, often to improve their health or to manage a dynamic birth process that is not going well. Sometimes the things we do bring about a desirable outcome - a baby is born before the distress is debilitating or a woman successfully VBACs. But sometimes we do things and less good things happen - more bleeding than usual, an injury to tissue that needs to be repaired or a surgical birth becomes necessary. Giving one’s self credit for the desirable outcomes is just as misplaced as beating one’s self up for the adverse ones. I’m working on letting go of ego and holding on to the evidence and Not. Taking. Things. Personally.