Fewer children, more blog posts

This evening I had a massive craving for chocolate. But I don’t have any in the house. The craving was strong enough that I drove to the grocery store with my mind’s eye specifically on a raspberry dark chocolate I am a fan of. I walked through the bakery, considered some dangerous things, turned the corner to the cookies & candy aisle (conveniently located together, right next door). I walked between the mint oreos and the chocolate bars (alas, no raspberry dark chocolate bars). I felt like I was playing with the tip of a knife on my skin. I walked out without buying anything. 

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

Maybe it is a product of the individual, maybe it is a result of where I am in my relationship arc, but right now, I’m falling out of interest in someone I’ve been seeing. This is a perfectly nice person, and someone who is doing interesting things with their life. But if they were to spontaneously not exist on this Earth, the greatest loss for me would be the occasional opportunities to scratch an itch. While I have enjoyed time we’ve spent together, in no way do I crave their attention, time, conversation, company. I have no idea if I will at some point develop those feelings toward another person. I’m sitting with this emotional place and letting it be. I will date when it is fun, stop when it isn’t, and not make myself go out to dinner with someone when all I want is to make a pork chop and hang out with my dog. I have a huge hole in my heart & soul. This is not a hole that can be filled by pouring someone else into it. It has to heal by secondary intention. This is a slower path, it requires me to create MORE of myself to fill the hole. Why isn’t there a Spiritual WoundVac?!? I wonder what my emotional & relationship landscape will look like when I am healed. From where I stand right now, I can’t imagine loving someone else again. I can’t imagine craving someone’s presence in my life. I’m have faith that it may happen, because I have enough trust in the infinite capacity for healing for the human spirit. But I’m not there yet. 

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

My dog has gone completely soft. It was lightly raining this evening and I took him out and he was like, NO I WILL NOT. Refused to walk, tried to go back under the carport. When I managed to get him around the side of the house, he went behind some bushes to a space under the neighbor’s walkway and sniffed around and peed UNDER COVER. He’s completely abandoned his PacNW roots. 

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

A few times a year it becomes necessary to take a chunk of our residency team out of commission. We run skeleton crews and mostly throw the rotation schedule out the window. We call these weeks Freak Week. Some people find their existence stressful. Probably because they have more responsibility than I do. This week, our 4th years are graduated and getting ready for written boards which are the last week of June for all Ob/Gyn program grads. Our new interns are still in orientation. Yep, it’s Freak Week. I’m in clinic 2 days and on L&D for 4 (I’m working Sat but not Sun). Then next week starts our first rotation of the new year. I’ll be a second year on the benign GYN rotation. This week I’m an intern plus. Or a second year light. Everyone is anticipating the move up to the next rung in the ladder.

So, me too, I guess?

Big test starts tomorrow. I am ready. I have been performing adequately on the practice questions, I have worked out the kinks (mostly) for the simulator for the cases (that’s Thursday). I have the address and my testing permit printed out up on my desk. By this tie, much of the prep is pro forma, I know what to wear (layers, comfy), what to bring for lunch (turkey sandwich) & snacks (chocolate for a PM pick me up), how to spend the night before (a tiny bit of studying, mostly resting). In the past, I had an inkling that I wasn’t ready for exams but I took anyway. This was universally a mistake, bourne by my fear of admitting weakness or denial of the possibility of failure. So now I just reflect, do I feel ready? Does the objective data demonstrate that I am ready? Yes, I am nervous, but it’s going to be just fine. I look forward to being on the other side of this.

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

Kids have been gone a week already! I am slowly chipping away at the list of things that I wanted to get done. And forgiving myself for not being nearly as driven as I imagined I was going to be. I’m getting things done, to be sure. But it turns out I’m not nearly as interested in working out in the morning as I am getting an extra 45 minutes of sleep! I’m eating more spinach and fewer carbs (it helps that I’ve eaten everything up not am buying more!). I predict this 8 weeks is going to fly by. It seemed like such an eternity before they left.

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

Apropos of nothing, I have a story spinning around in my head that I recently thought about in a new way. A couple of years ago, I went to a beer festival at Tom McCall park on the Portland downtown waterfront. I was a PSU student at the time and had a bus pass and ended up taking a bus home from the event (this was the days before Uber came to town). If I walked over a bridge and caught a bus away from the event, it would be the bus that took me directly home. It was a frequent flyer so I didn’t worry about when the next bus was coming, I just finished my night and then headed up to the stop on the bridge.

There were 2 drunk guys up there. I think they were also waiting for a bus, maybe they were just fucking around. (You can already see where this is going, can’t you?) One in particular wanted to chat me up. My usual cold, terse responses were not effective in getting him to leave me alone. In fact, they riled up the classic “She owes me something because I complimented her body” responses. He was “just being friendly,” why didn’t I want to talk?!? While he was making me VERY uncomfortable, it wasn’t too late out, it was a well lit, high traffic area with cars and foot traffic. Because of the beer festival, lots of people were walking across the bridge to their parked cars in East Portland. He didn’t touch me. I wasn’t in physical danger. But it was one of the more unpleasant drunk asshole confrontations I’ve ever had.

I haven’t thought about this event very often, and in the rare occasions when I have thought about it, I haven’t thought much about what came next. On the bus, away from the drunks, another guy sat near me (the seat behind mine) and talked to me. He had been at the bus stop. He had been watching what happened. He wanted to commiserate about how inappropriate and drunk and aberrant those guys were. I’m sure he was trying to put me at ease, chatting me up in a friendly, non-threatening, not drunk way.

But lately I’ve been just as pissed off at that quiet, nerdy guy who didn’t speak up while I was being harrassed. Who used my discomfort after the fact to make himself separate from Those Kinds of Men. He was invisible to those guys (though not to me because I had been surveying the terrain and I saw him hovering on the other side of the bus shelter), and he didn’t say a damn thing to endanger his anonymity, his comfort or his safety while I was being involuntarily drunk dialed while waiting for a bus. The more I think about this guy, the more pissed off I become.

Feminism has reached the end of what it can accomplish in the changing of women’s lives. Now if we want our lives to be better, men need to step the fuck up and change things on their side of the court. I’m not here for your entertainment, for your viewing pleasure. And I’m NOT here to make you feel better than the guys who think that I am. Unless you are actively and loudly rejecting that behavior in public and private, you are just as much of a problem, as far as I’m concerned. Time for the men to clean their house. We’ve done what we can to change ourselves. Your turn.

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

I have this little health problem that bothers me very rarely. I take a daily medication to manage it (well, the allergy meds are a crucial part too though for a separate issue) and beyond that, there’s very little I can do. I will either have symptoms or I won’t. There are a few provoking factors but few palliating ones. Once it starts to bother me, I just have to ride it out. If I have to beg out of things, I usually claim a headache. It’s easier than explaining. I mention it because I’m bothered by it today, because of an unavoidable obligations that was a provoking factor. Now I’m begging off some social fun because it will be loud (which will makes things worse) and my head hurts. I’m trying to be zen with the reality of my limitations but it’s hard.

Have I used "This Too Shall Pass" as a blog title before? It probably won't be the last time...

This weekend made me feel really good about my kids being settled in Asheville. Duncan is hosting a series of friends at the pool in our complex, he’s got a core group and they have friends who come too. Only 3 or 4 friends at a time to comply with the HOA policy and they are doing a great job following the rules and being good neighbors while there. On Saturday Ainsley went to Queer Prom, sponsored by a local LGBTQ youth organization. But before that she had a friend come over and help her dye her hair blue. And then this evening she went to an outdoor performance of Midsummer Night’s Dream with some friends (where other friends were performing).

Also I learned where a bigger Target is, and there’s a Big Lots and World Market right next door. So Ainsley got a new Pride tank top (Target has Pride wear and they get so much of our business because of it!) and I found a relatively inexpensive set of outdoor furniture that we put under the carport - 2 chairs, a loveseat and a table. And a nifty outdoor rug/mat as well. All it’s lacking is a citronella candle! I had a portion of my state tax refund that I wanted to use to get some outdoor furniture. I always think of my friend Shannon chastising me for giving the government an interest free loan (that’s what tax refunds are, apparently) but given the tight margins of my life, I wasn’t going to save on my own so instead I’ll just thank them for the service and appreciate my new outdoor space!

Of course, the kids are leaving a week from tomorrow, they’ll be gone for 8 weeks. Just as they are getting really settled in! But the pool with still be here, the outdoor community theatre will still be here, they will come back and maybe plug back into their lives pretty much where they are leaving off right now. That’s my hope, at least. We’ll see. It won’t be as hard as last year!

I got a haircut! I heard about this salon and this gal from a few people, it was very reasonably priced and she cut curly hair very well. It’s funny because I didn’t get a lot of length taken off but when I got up there were PILES of hair at my feet! I have soooo much hair! But now now, now I have a reasonable amount of hair. It’s been about 14 months since I got a haircut but this place is inexpensive, really good, and you can make appointments online so I’m optimistic that I’ll be able to be better groomed despite my busy schedule!

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

This is the kids’ last weekend in NC for a couple of months, mostly they are enjoying being done with school while packing and cleaning at a snail’s pace. I’m distracted by studying for Step 3 so they’ve got some slack to work at their own paces. Their rooms & public spaces are slowly getting clean, laundry is getting done and packing prep is starting to happen.

Unfortunately blogging about parenting a teen means there are parts of the story I can’t tell because they aren’t mine to share. I’m having a bit of one of those times with one of my kids right now. It is something of a big deal but a lot of it will be taken care of by the temporary displacement they are about to experience. I have had more conversations with my co-parent in the last week than probably the last 6 months combined. He was a bit taken aback by the news of teen drama and the notion that that they were going to be out there “just for a visit” was shattered mercilessly. I mean clearly he knew that the honeymoon phase would not last 8 weeks, that there will be snark, PMS, hangriness (dear lord, this family is full of people who are terrible about self-regulating our blood sugars!), irrationality, health problems and moodiness. But knowing that there was a pretty big issue he was inheriting right off the plane, that was harsh. He took it well. I still have to tell him that we had lice and he will need to do head checks next week. I should get on that… :-)

I’m grateful that my troubled child is going to get some time with Dad and that the impetus of the end of the school year stress and the imminent departure was able to unroof some poor coping and existential pain. Admitting you have a problem is the first step right? So we’re on to step 2 now. Fortunately for this particular flavor of problem, co-captain and I are firmly aligned. The messaging will be united and the East coast/West coast plans for addressing the issues will dovetail nicely with each other.

I’m looking forward to having a break. I will miss my kids like gangbusters, but I am also pretty excited to go on dates, clean my house, get some residency shit done, study and get started on my new life as a Second Year Ob/Gyn Resident without the omnipresent distraction of daily parenting.

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

One of the things that is harder about blogging honestly like I was in the beginning is that I feel less anonymous. I know there are people reading this, including people who I work with. I have been hesitating about pushing into this latest soft spot and digging around because I don’t want people at work to think I’m pathetic, that I’m not handling my life as well as I want them to think I am. I don’t want pity, but I want a place to speak truth to my hardship. So don’t pity me, I’m just more honest about the hard parts of life than most people. We’ve all got ‘em. Here’s some of mine.

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

Today I’m remembering what it feels like to be relocated for a year. I remember that I felt like I should be more settled than I am. I remember thinking that I didn’t have the friends, networks and connections I wished I had. I remember thinking I’d feel more settled than I do now. I remember that eventually I realized it really takes a few years (in Portland I settled in 3, it took 3 years to get settled in Portland), more than I wanted it to take.

So today I’m sad that I don’t have friends, I don’t have people to spend time with when I’m not working or parenting. I’m tired of having to do the work to make friends. The constant putting yourself out there, asking people if they are available and for some reason or another not connecting. And working not to take it personally. I’m lonely. Maybe my co-residents don’t invite me to socialize with them because they think I don’t want to. Maybe they don’t want me to. Maybe I really don’t want to. Who knows. But they don’t ask. At least I don’t think they do. Maybe they did in the early months when I was overwhelmed and couldn’t leave lonely kids to have my own life while they were isolated and sad. Maybe I missed it and now it’s too late. There are a few people who aren’t residents who I have connected with, but they all have full lives that were going strong before I got here. Trying to merge into their flow often means they are not available when I am and when they are available, maybe the are making plans with the people already in their lives, but whatever they are doing, they aren’t connecting with me.

It takes longer than a year, that’s what I’m remembering. And that’s okay. It doesn’t mean it isn’t going to happen. It just means it hasn’t happened yet.

This too shall pass.

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

Like I said a few days ago, I’ve been talking with T (that’s my co-parent) more this week than I have in a while. We’re talking a lot about the kids but there have been personal conversations as well. I really missed the easy communication between us. Now that we are not as wrapped up in how much the other has disappointed us or not met our needs, we are able to talk more like the old friends we are. When you’ve known someone 25 years, there’s an ease to talking. And some predictability too. He’s working a lot. Which means he’s skipping meals and being hyper-focused on work. Which doesn’t bother me the way his poor self-care when he’s busy used to. Why did it bother me so much? Because it scared me, if he wasn’t going to take care of himself, then maybe he’d die, or at least not live as long as he could. There was an aspect of my control and co-dependency that was triggered by something as little as him skipping lunch. If he didn’t do it, it was one more thing that I had to do. Did he ask me to do it? No! In fact, we probably would have been better served if I had not taken psychological ownership of things that were clearly his to take care of. Now he tells me he skips lunch and I find that reaction has been deactivated. It isn’t that I don’t care about him, or that I no longer want him to live as long as possible, but that wasn’t ever really a rational fear. We were too closely intertwined. It held us both back. Together we became better versions of ourselves than we probably could have alone when we were in our 20s and 30s. Now in our 40s we are becoming better versions of ourselves than we could while we were together. Not going to lie, watching him become better fills me with pride and deep sadness. It makes me miss those great decades when we were able to grow ourselves together. I’m never not going to be sad that we had to part for each of us to be our best selves. The rough edges to the sadness are slowly smoothing over time. Every so slightly, it isn’t as hard to be sad now as it was 6 months ago.

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

Something great is happening at work: I’m getting good at my job! I did a repeat cesarean recently at which I got only positive feedback. Even with regard to one part of the surgery that I’m still working on. I’m doing everything right, the muscle-mind connection just hasn’t clicked yet. (Getting the baby’s head out the uterine incision is a specific combination of wrist movements, flexing the baby’s head, being a lever and a shoehorn that I understand in theory but just can’t quite put together unless everything is perfectly aligned) On the theme of anniversary reflections, I remember what it was like to do a cesarean last year, I had the stamina to do about the first half of the surgery, then when I had revealed the uterus, I was HAPPY to pass off the scalpel and have someone else finish. It taxed the limit of my stamina and concentration to get that far. Now I can do the whole thing, ask for the instruments, even figure out which suture we are using and how many knots it needs (except PDS, I still can’t tell PDS from monocryl, but I do know it needs more knots!).

And during that same shift, I cut my first episiotomy. This tiny infamous procedure looms large in the psyche of women. In this case, it was a very necessary intervention due to specific details relevant to that patient. And even though I’ve never done one, I realized it was going to be necessary, mentioned it to my attending, who listened to my whispered diagnosis and did her own assessment and agreed with my recommendation. My only reflection is that we did not have time to talk it through more with the patient. That place where babies are on the brink of being born is a tenuous one, it is hard to monitor their heart rates, they often experience the most stress we see and we often have to act quickly to get babies out. Given the totality of the details of that case, the episiotomy was a small matter. In reality (it was only about a centimeter long) and symbolically (there were other things that happened that mattered more to her during delivery). But it was a big deal for me to be able to see something I’d never seen before and successfully evaluate and address it!

Catharsis

I haven’t written much the last few months. In part because I’ve been busy but also because I’ve had this huge 800 lb gorilla standing in front of my view, blocking the flow of any simple, smaller vignettes that might want to come trickling out. And until I get rid of the gorilla (don’t worry, I’m only going to write her away), I’m stuck. So here she is…

I hate the health care system.

This may not sound shocking and it may not sound debilitating but it is tripping me up. I am a “work within the system” sort of woman but right now I'm having a hard time seeing my path. I want to go "Hulk smash!" on the whole damn thing. Which isn't productive for a number of reasons. 

The thing is, I don't feel disillusioned about choosing to revolt from within. I have few illusions about the difficulties that entails. I’m not romanticizing how much of a difference I can make or how much I can even change said system. But the realities of the role of physician as cog in the wheel are pretty fucking demoralizing. In time, I will arrive at a place where I have power and influence (to a limited extent) within the system. Until then, I’m at the bottom of the pile (can’t say bottom of the totem pole anymore, even in hyperbole, since I learned that’s where the important folk go). And the bottom of the pile is a shitty place to be.

During my brief 2 year stint as a public school teacher, we had some union troubles. Just short of striking, we adopted a “work to rule” position for some time. We came to work, we did our jobs, but only what was required by our contracts. The point, I suppose, was to show the powers that be just how much they were already getting out of us.

If physicians were to “work to rule” the entire health care system would grind to a shocking halt. The things that are required of us, they are not actually possible for a human to accomplish.

There’s this thing called the Hidden Curriculum of medicine. People have varying opinions about what exactly this curriculum teaches us but it is the implied undercurrent messages that we absorb as we progress through our training & careers. The problem with a Hidden Curriculum is that there’s no telling what people will learn from it. The lessons aren’t explicit and a great deal of one’s own personal baggage informs one’s lessons from the Hidden Curriculum. Handling criticism, giving feedback, working in teams, managing colleagues and underlings, these things are not taught in medicine but they are key, KEY parts of your work as a resident. If you internalized self-loathing (not hard to do) from the Hidden Curriculum, then you are going to be a crappy manager and mentor. But there isn’t a lot of room (like, any) in the Hidden Curriculum for self-examination, self-reflection, self-awareness. We aren’t encouraged by the system to reflect, just push on through and Do. The. Job.

(Parenthetically reminding everyone that I work at a fantastic residency program where these sorts of things are things we can address, we talk about respect and teamwork and we have opportunities built into our curriculum to reflect with our class and plan as a cohort for the next year. I never violate duty hours, we have great administrators. And I’m doing okay, this isn’t a desperate plea for help or a cry of despair. This is observation, reflection because I’m incapable of NOT navelgazing, this is me coping with the reality of the broader system I am becoming a part of. I’m just writing away the 800 lb gorilla that is blocking my Qi)

My plan will allow me, ideally, to live apart from this hierarchy someday. I’m going to open a community based clinic, it is going to have family medicine services, Ob/Gyn services, birth & abortion care, trans care, it is going to have a community board that helps us run it. It is going to be constructed specifically to deconstruct colonialist, patriarchal, capitalist power structures that oppress, oh, just about EVERYONE. I’ll get there. I’ll have my ideal clinic someday. Because I have a plan, I will have the skills, the connections, the capacity, the social capital and the power to create this sort of existence. I’m really looking forward to it. But to get there I’ve got to get through several years of learning from, working within and tapping into the current resources available for my training (and a few years after that to get financially stable after hundreds of thousands I had to borrow to get here at all). These all require me to work in a system I HATE. Most of the time I’m totally okay with that. Fight the power. From within. Change the system. From within. Often I forget that to do that, you have to KNOW the system. You have to be able to function within the system first. I can do that.

Bye-bye Gorilla.

Some stuff about work

On Fridays we have a procedure clinic where women who have had abnormal pap smears come for next level cervical biopsies called colposcopies. This clinic is busy with lots of patients and often lots of residents. It is an anticipated clinic as well as it is considered a straightforward office visit (we aren’t addressing ANYTHING else usually) and the documentation is easy to get done as you go. Unfortunately for me, I’ve had a bad run of luck in colpo clinic - difficult cervixes: to find or to biopsy. I am NOT superstitious about my work flow (I generally don’t believe the notion of a person being a “black cloud” or a “white cloud” and I’m not afraid to say that a service is looking QUIET for fear that the heavens will open on our heads) but I feel like I’ve been cursed in colpo clinic this year. The interns do colpos during 2 of our 4 rotations so we spend half of the year doing colpos on Fridays. After tiring of always having such a hard time, I have been collecting advice from upper levels and troubleshooting my technique with people. Today for the FIRST time, colpo clinic didn’t suck in its entirety. Of course I’ve had a few easy biopsies, but not even enough to count on one hand. Today I took bigger samples, I squeezed instead of pulled, I turned the Tischler (the tool that takes the biopsies) so it was oriented a particular way relative to the lesion I was biopsying. And I finally get it why people like colpo clinic! Part of my issue is that I can’t believe we are taking tic tac sized chunks out of people’s bodies without any anesthesia. Part of my issue was a steady stream of rubbery cervixes. And honestly my technique was faulty. I can do a stat cesarean section but until today, I couldn’t do a colpo with any sense of confidence. Huzzah! Intern year must finally be almost over, I’m finally getting the hang of it!

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

My kids are almost done with the school year. We have 2.5 more weeks until they are done! A few days after that they are going to SF to stay with their dad for about 8 weeks. That is longer than our agreement lays out but they wanted to spend a lot of time with him, he could manage it and I didn’t want to refuse any of them the opportunity to be together. I’m pretty upset about the idea of them being gone for 8 weeks, I’m going to miss them so much! And because the human mind is a vast and infinite place, I’m also really looking forward to having the break. I don’t get weekends off, we don’t share parenting time, it’s all Larissa all the time. It is fucking exhausting. I don’t know exactly how I’m going to handle it (though I’ve got the dog walking figured out) but I think 8 weeks is enough time for me to be at loose ends for a little bit and then get into a routine on my own.

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

Did I tell you I did a stat c-section recently? A stat is a circumstance where, likely, the baby is not looking great and needs to get born quickly. There are a few things with regard to the prep and the equipment that are different (so we can be ready faster). The surgery is basically the same except you worry less about going through the tissue from skin to uterus carefully and do it quickly then if there are problems, you fix them after the baby is born. And you don’t get to use the nifty tube retractor (it’s called an Alexis retractor and I love it) because it takes too long to set up. We still have time to administer anesthesia, scrub our hands & prep the patient, then we get down to a baby as fast as we can and hand him over to the awaiting NICU team. 11 months ago when I started doing surgery, I could handle about half a cesarean before the adrenaline would fade and I’d wilt. Looks like I’ve learned some things this year after all.

Regarding delivering the baby during a cesarean:

In that stat section, I did everything in the delivery as the primary surgeon except delivering the baby. I probably could have done it but it is a task that takes attention to detail, awareness of passage of time, physical effort and finesse. I started to try but after 10-15 seconds decided to let my upper level do it. There are a lot more things to think about than just sticking your hand in a uterus and lifting a baby out. We make the smallest incision possible (there’s only so much room between the Uterine arteries) and babies can wedge themselves in there in a myriad of different ways and it is pretty important that we flex the head in a way that makes it possible to lift.

On the latest cesarean I did, I explicitly told my upper level I was going to work on delivering the baby until he took it away from me. Having that explicitly stated gave me the freedom not to worry that I was taking too long. I knew he’d take over if it was time. Turns out, I was able to do it. Practice practice practice!

Almost none of this is work stuff, even the work stuff

Sometimes I look at ADHD life hacks and realize how many of these things I have already crafted into my life. Just watched one that suggested:

• Wear a work uniform: for me, when it isn't scrubs, it's black pants, a shell and a cardigan, I love the ease and reliability of it!
• Eating the same thing every day: Right now there are 5 Ball jars of yogurt & 5 sandwich bags of granola in my kitchen!, 
• Apparently hitting snooze causes decision fatigue and makes ADHD brains tired. I don't hit snooze anymore though I do have my AM blue light which helps me with the sleep-to-awake transition. In my experience, changes in body/mind states are hard on ADHD folks, and I struggled with the snooze button every morning when I was a teen and in my 20s, my daughter struggles with it now,
• To reduce strain of thinking of meals, have themed dinner nights (like "leftover mondays" and "mexican tuesdays"): that isn't quite what I do, but I do make sure I have the stuff for a week’s worth of meals and I post the things we can eat on the fridge, then I just have to decide any given night which of those things I feel like making. I often have frozen pizza, wontons, tamales, etc. that I can make instead if I decide the things on the list are too labor intensive for my energy level,
• They had things to say about grocery shopping, keeping a list and all that. I use an app called Picniic that has a number of family coordination tools. My kids are not as enthusiastic about them as I am but I paid for the upgrade so we could all share shopping & to do lists, calendars and other features that I’m still working on maximizing. 
• I also have a bowl where I keep my keys, right by the front door, no thought involved, keys go in the key bowl. End of story. 

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

Working with a private doc in the community today and I saw that he has his own order set in the computer. Got me thinking about my orders and how I customize them and what I’d do it I were writing my own order sets. Some of the things are really technical and not interesting except to other people who need to write orders. But one of the tangents my mind explored was the communication between L&D nurses and doctors, what needs clearance to order and what gets done and then told to me later. I’m thinking of epidurals. It is really common for a patient to get an epidural and then I’m told about it afterward. I wonder if I would like to know this beforehand when I’m in private practice - managing patients who I know, with whom I have a relationship and have had a chance to do some prenatal education. I’m super supportive of people getting epidurals. I just think we don’t do a good enough job talking about how they change labor. I want to do a better job as a doctor and as a patient advocate. I know I’m not a doula anymore and I won’t usually be able to help manage the moment to moment, contraction by contraction experience of labor. I just want to be sure my patients are clear about what they want, what they get and how decisions influence the unfolding of events. 

Clearly this is not a fully formed thought, but it is where my mind went this morning.

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

I’m back in a missing being married phase of mourning. It is tough, and I’m feeling the loss of something that I had for a long time- a partner, a helpmeet, a friend. Someone to roll their eyes at our kids being obnoxious teens with. Part of my pain is due to my own healing, I’m dating, it’s going well, but it is still dating. Getting to know people, deciding when I feel like spending time with or communicating with a near stranger. Also this is an anniversary time, of graduation, of moving arrangements, it was all so fresh and raw and painful last year, and I remember that. I miss what I wanted to have here. And some of my reaction is due to things happening in my coparents life - decisions he’s making and that make me think “if only” and why did he have to decide to do these things now and not 2 years ago, when there was still time. Why? If my study of the human body has taught me anything, asking why humans do anything is a question destined for dissatisfaction. Whether it is inquiring why a body develops autoimmune responses or why blood vessels clog or why the mind thinks anything at all, who knows why? No one knows and asking is just inviting frustration.

But why? Why can’t I have a life, the life I wanted. Why? I am a cope-er, and a survivor and even at times a thriver, so I’m going to be just fine. I’m going to fix things and I’ll be okay. But I can’t stop asking why.

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

Regard something you know about yourself that you just know. You don’t think about it, in fact, it is just there. Your toenails grow, you have all your fingers and toes, knees bend, ears on each side of the head. Something like that. Something that is bedrock to your existence to the point that you don’t think about it.

Here’s what I know: my body is disgusting. It just is. I know this with a fundamental certainty that you take for granted regarding your toes. Sometimes I have feelings about it, sometimes I manage not to think about it, sometimes I even put lipstick on the pig and feel pretty satisfied with myself. I mean nothing in the world is all bad, so my body grew and fed people, has been fit and active, and while it is relatively deconditioned right now it has been capable in the past for sure and I’m sure will be again someday.

Let me be clear: I’m not saying this to garner pity or attention, or to get you tell me your opinion of my opinion or worse, your opinion of my body. I’m not saying this to GET anything. I’m saying it because I’ve only recently realized that this bedrock assumption exists and is different from how other people view their bodies. I spent a few days kind of rocked back by the insurmountable reality of it. I have deeply internalized that while I may be more disgusted with my body right now than I have been at times past, there really is no point in the game when I get to be happy with it, only varying degrees of displeased.

In a way, this is a victory. In the past I have set bars for myself, if I were to fit into those clothes, do these exercises, weigh this many pounds, THEN I would be okay. But now, I realize, that was a finish line I was never going to cross. There is no moment in time where I say that I have arrived, I have achieved the body that makes me happy, makes me feel satisfied. I can stop trying to come up with the perfect set of circumstances under which I will be satisfied. Sure I am disgusted, but I’m also free.

On vacation

I’m on vacation right now. Sitting in my dear friends’ home looking out the window at a sunny day getting ready to go to the beach with my kids. Except it is 8:30 and they are still sleeping! Maybe I’ll go for a bike ride first then wake them up at an hour decent for teenagers.

Yeah, I pulled my kids from school and lied about it. I don’t feel even a little bad. I was vague and the secretary at school filled in blanks to mean “something along the lines of an ailing grandparent” and I did not dissuade him. I said it was a “planned, medical, necessary absence.” Because mental health is you know, medical, and the stress of our lives and the difficulty we have forging connections with things like regular meals and family time is real. My kids and I need to bond, we need to relax. We are going to the beach. We will get ice cream, we will play mini-golf, we are going to do an Escape Room. We got assignments from teachers before we left and they know they are going to spend some time doing homework. But this week is going to be a little break from reality.

Since you heard from me last, I had my Gyn Oncology rotation and an OB rotation. Now I’m on a Benign Gyn rotation. This rotation has me in clinic about half the time and I really like it. I miss being in clinic. I like seeing patients. Onc and OB are tough rotations for different reasons and it was hard to have them back to back. Next year is going to be hard for lots of reasons but one of the nice things about the schedule is that it rotates reliably between OB and outpatient or benign gyn (no Onc for 2nd years, mercifully). We’re switching (back) to 6 week rotations (apparently the 4 week thing was an experiment that didn’t work out) so I’ll have 3 weeks of night, 3 weeks of OB days then 6 weeks of either OP or GYN.

I’m talking about next year’s schedule to avoid processing this year. First step is to see the hole. Maybe next time I write I’ll shine my light down in it. But for now, vacation time.