medicine

I did my internal medicine rotation a year ago; but life got really full and I haven't written anything about it yet. I spent one month doing outpatient internal medicine at HMC (the big county hospital downtown), did one month of inpatient at NW (a smaller community hospital) and then went back to HMC for another month of inpatient. I wanted to share my experiences with the first time my patient died.

The first time I met LG, she was basically obtunded in the ICU. It was my first day on my inpatient month at NW. She was brought in to the ED for vomiting. Turned out she had a small bowel obstruction. Luckily we were able to treat it with medical management, she perked up quite a bit and was transferred to the floor the next day. She was a lovely woman. Very pleasant and quick with a joke. She reminded me a lot of my sweet Grandma Evelyn. However because she already had problems swallowing, she ended up aspirating quite a bit after vomiting and gave herself a nasty pneumonia. Her O2 requirement wasn't coming down and we couldn't let her eat. I met with her daughter and we had a conversation with LG. We asked her if she would like us to continue doing all that we could do to keep her alive (possible intubation and IV nutrition) But before she agreed, she looked over at me, touched my arm and in her sweet high pitched shakey voice asked, "Well, Mother, what should I do?" I remember feeling a mix of gratitude and confusion at that statement. Gratitude that she would regard me enough to ask my opinion and confusion because I wasn't sure she wasn't delirious. Anyway, I mumbled out something about honoring whatever she chose. In the end, it was decided that we would not treat her pneumonia anymore. We would just give her oxygen and morphine to keep her from feeling like she was drowning and let her pass away at home. 

The night before she was supposed to go home, I went in to see her one last time. I awkwardly told her how much I had enjoyed getting to know her and that I would miss her. She kept her eyes closed and didn't respond. So I left. I went to finish a bit of charting and then headed for the lounge to grab my backpack and hurry home to my family. I had to pass by her room once more on my way. My heart broke as I heard her crying. Alone. I wanted to go to her but I wasn't sure what I would say. I should have gone to her. Because I probably didn't need to say anything. But I didn't go to her. I hurried and grabbed my back pack and ran down the stairs as fast as I could.

Noah came to pick me up that night. It was pretty late and he was worried about me taking the bus home. As I hopped in the car, he made some comment about the confusing parking lot and how they must want everyone to die in there. Upon hearing Noah's lighthearted joke about death, I couldn't keep it together anymore and I started to cry. I cried for lots of things that night, but mostly because I felt ashamed.

The next morning I went to the hospital and to my surprise she was still there. She was no longer responsive and the plan to let her die at home was abandoned. Her daughter came. She was walking from the elevator to her mother's room. I was sitting at a computer near by. She saw me and ran to me, giving me a hug. Then, almost as if embarrased, she let go, hurried a greeting and left to see her mom. That hug meant the world to me. This was my first patient to die. I wanted the daughter to know that it mattered to me. That her mom mattered to me. The next morning she had passed. I saw her daughter one last time and finally mustered the courage to say what I had been feeling. I told her daughter that I really enjoyed getting to know and taking care of her mom. Her daughter's eyes glistened, she thanked me and I left.

As an outsider, death is not easily negotiated. I felt like I had to express my feelings on someone else's timetable because I was the medical student, not the daughter. Yet, it was important for me to be able to mourn with her loved ones because though I knew her just a week, I loved her too.

La Norita, mi vida, mi hijita

Life with Norah is always a surprise and always fun. Well, usually fun. She is unusually determined with a lot (A LOT) of energy. She has a strong sense of self and at times can be quite aggressive and at others quite sweet. Below is a picture of her getting ready to decorate our gingerbread house before Christmas.

Norah loves pink, sparkles, ballet, princess dresses, hearts, cupcakes and ice cream cones. In fact, these topics comprise about 90% of our conversations. She wanted to make pancakes one evening and I thought it might be cute to try to make shapes. (a la Mike Hurst after sleepovers way back in the day.) Well, she was the one who thought of using the cookie cutters! Then she decorated them with sparkly pink heart stickers and put them on her sparkly pink heart plate. We weren't allowed to eat any of them.

One morning she was bored of her breakfast cereal and started drawing on the table with her spoon and milk.

As I mentioned above, Norah really loves ice cream cones! She seems to do everything with passion. I know all toddlers live at the extremes of their emotions but Norah particularly seems to be driven and have an opinion about things. We went to the doctor the other day which Norah is terrified to do. She was really afraid but instead of clinging to me for help, she put both hands on her hips and leaned forward shouting at sweet Dr. Cathy, "NO! I the doctor. You not the doctor, I the doctor!" I, of course, try my best to not allow this behavior but sometimes it is so funny to see such a little person with such spunk that I have to turn my head and laugh so she can't see me before I correct her. Another example is when my parents 130lb dog Porter got a hold of one of Jonas' bottles. I hear her start yelling at him so I turn to find him slinking off with the bottle. Norah looks at me a says, "No, I get it." Then turns to Porter and while tackling him yells, "Porter, you a bad dog! Don't take Baby Jonas' bottle!"

Norah was determined to be a ballerina in this picture. I guess she already knows the importance of pilates to a dancer?!?

Norah is a challenge. She tests my every last nerve. But, when she strokes my face as I tuck her in bed I am filled with a deep rooted love and joy that resets me for the next day. My little Norah, I love you! Thank you for being my daughter!

los hermanos

I think my favorite thing about being a mom of two so far is seeing how much my kids love each other. Even at just 10 weeks, Jonas' face lights up when he sees Norah. And whenever Norah hears Jonas cry, she drops whatever she is doing and runs as fast as she can to him yelling, "Baby Jonas, I coming, I coming Baby Jonas!" And once she arrives, she strokes his little face and tries to calm him, "Baby Jonas, you okay, you okay. I here, I here."

Jonas Abraham Read

Our sweet new baby was born on November 11! We are all doing really well and the past 8 weeks have flown by. Norah is adjusting well and things have settled into somewhat of a routine again.

This sweet baby is simply a gift. He is a great little nurser and sleeper. From some of you who may remember my little Norah as a newborn; she was neither of those things. Everything this time around has been so much easier. Its hard to say if its due to experience or circumstance; probably both.

His arrival was a great blessing. I woke up early Friday morning with some mild contractions. I was elated to have gone into labor on my own this time. I made Noah miss his bus because he hadn't packed any of his things for the hospital bag yet. Labor kept progressing and by 4 o'clock I called Noah and told him to catch the next ferry home. He arrived home and was a little frustrated with me that I hadn't called my midwife yet. Especially because my contractions were 5 minutes apart and we were at least an hour away from the hospital because of the ferry! Noah called the midwife for me but when I down-played things she suggested we wait a bit longer. I think Noah was listening to the spirit (and my mother) because this made Noah very, very nervous. He insisted we catch the next ferry right after dinner. So off to the ferry we went, which left about 10 minutes late.

I didn't want to walk about the ferry in labor so we stayed in the car. (Not a great idea either.) With each contraction I would breath so hard that the windows completely fogged. They would clear just in time for another one. We finally arrived in Seattle at 7:55pm. My labor was really starting to pick up by this point with contractions coming every 3-4 minutes. I compared this labor to my previous pitocin labor, and hoped I would be at 5 cm at least. We got to the hospital and I was so shaky I could barely walk. Thankfully the ER triage nurse recognized the urgency of the situation, allowed us to skip the paperwork and called for an orderly to hurry us up to the child birth center in a wheelchair. I have no idea who the man was who took us up, I never saw his face. But I remember the urgency with which he walked. And I remember him reaching down and rubbing my arm during a contraction on the way, as if to say that I could do it and that we were almost there. I really appreciated his gesture then and now.

We got to the room at 8:23pm. The nurse told me to get on the bed. I had a good case of the grumps and responded "I don't want to", but knowing she was going to check my progress I did anyway. Much to our surprise I was at a 9 1/2! My midwife Robin hurried in. I remember feeling very scared and overwhelmed by how fast everything was going but Noah was a great support. I couldn't have done it without him. So, holding Noah's hand a few minutes passed and one more contraction then it was time to push. (Mind you no one was gowned or sterile; and I was still in my street clothes!) Once I felt the urge to push, I think something took over my body. It was pretty remarkable. My water broke with my first push and just a few pushes later Jonas was born. Just 13 minutes after we got to the room at 8:36pm.

Part of me feels slightly embarrassed that we cut it so close. But honestly, my pitocin-induced labor with Norah was so different than this labor; I truly did not appreciate how far along I was. However, Noah was inspired that night to get us to the hospital. If he hadn't looked so worried I wouldn't have conceded to go when we did. (I was determined to avoid being sent away and have to labor at my brother Dickson's house.)

But the rest of the night was almost magical. We were both so relieved and shocked that it was over so soon. Little Jonas was perfect and I felt fantastic. (Mind you with this labor I didn't have an IV, a foley catheter or an epidural!) Little Jonas looks just like Noah to me, with blonde hair, darker blue eyes and Noah's triangle nose and square little jaw, my handsome little prince.

yes, but how

I found a quote the other day that I wish I could turn into a tea. I would distill it and force my daughter to drink it everyday. I want her to understand what this quote means. It has taken me 30 years to understand this. I want to teach her so many important things, but I am not quite sure how.

I suppose no one is as handsome or as beautiful as he or she wishes, or as brilliant in school or as witty in speech or as wealthy as we would like, but in a world of varied talents and fortunes that we can't always command, I think that makes even more attractive the qualities we can command— such qualities as thoughtfulness, patience, a kind word, and true delight in the accomplishment of another. These cost us nothing and they can mean everything to the one who receives them. —Elder Jeffrey R. Holland

For me what this quote is really about is self acceptance and service. Its about not being perfect and doing our best anyway. There have been so many times in my life when I wanted to do something but didn't because of some fear of inadequacy. Only now in motherhood am I recognizing my own misgivings for the true threat that they are to my personal growth and happiness. Because how great is it when we are unsure but try anyway! However, it is more than likely that Norah already knows this. I just need to help her not forget as she grows up.

Halloween

Norah wanted to be a ballerina, a princess and a fairy. I think she is swayed by anything pink.

defeat in the name of balance

Today, I felt defeated.

For lots of reasons but these are the big two.

I have three weeks left of my third year. For those of you unfamiliar with the endurance obstacle course that is medical school, third year tends to be the hardest. I get tired a lot, and with so much to do, more often than not I find my focus is not quite as sharp as it should be.

For example; today my patient was found to have inoperable pancreatic cancer. I came home and told Noah about it. Then I laughed because he didn't notice he was jaundiced. Strike one.

I gave Norah a bath before bed. Afterwards she started shouting at me, standing naked and wet on her changing table, that she did not want to wear a diaper. I told she she had to and she hit me on my face. I was furious. We have been trying SO HARD to keep her from hitting. (Luckily though, so far she only hits me.) I went to put her in her crib, still naked and wet, for a time out. I wasn't gentle enough in my fury and she bumped her head. I'm not sure she was actually hurt as she was frightened by my reaction. Strike two.

I had a fantastic attending on my medicine rotation who shared a piece of wisdom with me. He said the best indication that you have found a balance between family and medicine is that you feel like a failure at both.

I'm not writing this post for sympathy. I just want to express that everything is not always bright and shiny. Sometimes it just sucks. And sometimes I like to let life suck just for a while before I shut down my pity-party and force myself to keep smiling until I actually feel like it.