Funny

Scene: IR room 30, where nurses are responsible for placing the majority of CCHMC's PICCs*.

Players:
Adam, the nurse.
Amanda, the IR tech.
Jen, the documenting nurse.
Mary, the child life specialist.
XYZ, the patient (approximately 12 months old).
Dr. Leah, the helper (only present because the PICC nurses aren't allowed to advance a wire beyond the tip of the catheter; we get called when they get into trouble).

Casual chit-chat. Jovial. Almost silly. Introductions and time-out take place.

ADAM (prepping the patient's arm): So, Leah, do you have a man in Arkansas?

LEAH (donning gown and gloves): A WHAT????

ADAM: A man?

LEAH: No, I have a woman!

ADAM: Oh.

MARY: That's nice.

LEAH (to Amanda): I don't know if that's what I was supposed to say. (to the room in general): I've got a partner and two little boys.

Casual chit-chat resumes.

Later, flying with my Cincinnati mentor, Neil. I had the controls for much of the return flight. He even tested my skills by putting on blinders so that I couldn't see out of the windows. I was flying by the seat of my pants instruments and dials.

*If you're interested, I can always add more medical acronyms. I can speak solely in jargon when necessary.

Complex

It's hard to get through a day without amassing a new layer of complexity in life. Not only are there more things to do and more fires to put out, there are new ways of listing, organizing, and considering all these new things.

Where to put things has been on my mind. Papers - new leather bag, new file folders. Computer files - new external hard drive, new Dropbox, new Evernote, new PDF readers, new plans for new iPad that should arrive tomorrow. Thoughts - new desire to invigorate the blog not the least. How do I keep up with all the todo lists? How do I take notes at work? [There are so many thoughts.] Projects - how to separate, plan, initiate, and overcome roadblocks?

Just one example (work-related): I have many ideas for improvements once I get back home. How do I incorporate them? Why isn't there a simple way to document and share our operating schedule electronically? What system do I suggest? How in the world can we be HIPPA compliant? Why don't my partners want to use the available resources? How can the freshest member of the group expect immediate change? What will it look like to gain leadership responsibilities over the years? Will I be good at it? How am I going to be in charge of resident education the second I get back, when I've just started my career? How can I teach them while integrating all the new technologies (did someone say iPad)?

My brain just seems to stay busy these days. I've been working on ways to get all these thoughts out of my head. If you were to read a stream of consciousness of my thoughts in a 24-hour period, I'm confident it would take you weeks to get through it all.

And yet. There are moments when clarity is an understatement. Sometimes, my needle goes where it is supposed to go, and I can see it advancing into the kidney on ultrasound, and that tiny little duct is MINE, and I am there in the moment, and the contrast flows in, and the wire passes, and access is granted, and kids magically luckily thankfully get better. There is so much to be said for deep deep concentration that pays off. There is a time when I am operating and nothing else exists. This space of time shapes my days and rewards me and keeps me going in spite of journal articles and paperwork and stress and malpractice and budget cuts and suffering and birthers (for crying out loud).

Stay afloat we must. The journey continues.

Song

Dying Day, Brandi Carlile


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Don't

Another Rossism not to forget, this in text message format from E:

Ross just said "my heart is a little breaking cause Eah is not home."

Well, buddy, mine is a lot breaking. But I'll see you in two days. Then one more trip for you to Cincy, then home. Forever, as you say.

Seems the Braswells are encountering a smidge of that desperate feeling.


- Posted using BlogPress from my iPhone

Location:Madison Rd,Cincinnati,United States

Milestones

Bought my new iPhone 4 today.

Turned Reid's car seat around to face forward. I'm sorry you had to find this disappointing news out on my blog, Erica. He's big.

Experienced the shock of having a debit card declined at the Apple Store. Realized I'm not very embarrassed, actually, given that I am self-assured of my financial stability (in spite of this freak incident) and in a foreign country called Ohio where no one knows me.

The debit incident led to a wild goose chase of fraudulent BofA concerns, phone call remedies via the AT&T kiosk (my old phone had been deactivated without a new phone), a trip to the apartment for alternative credit card(s), and a visit with the Apple store manager. It has been several years since I was without phone access for a couple of hours, but somehow I survived.

It was worth it, but it was kind of ridiculous. I rewarded myself with a visit to the Cheesecake Factory bar for four seasons pizza.

Wall

Something does it to me, and I don't know what it is.

I've been meeting with a trainer every week since I moved here. We do total body stuff, like lifting and jumping and abs. It has happened twice now that I just hit a wall and can't go any more. I feel like I am going to pass out. My muscles will NOT work. I try to keep going so that his impression of me as a weak out-of-shape puny girl is not perpetuated, but then I have to sit down for a second. After about two minutes, I'm OK to get up, refuse his offers to drink Gatorade or quit, and head to the mat for abs.

He says I'm not eating appropriately. Well, DUH. I eat what I want to eat, then I have beer and ice cream. I tell myself that I am trying to eat his prescribed diet of balanced protein, carbs, and gallons of water. I do okay for a day, then I have a four hour case. I stumble to the cafeteria for a sandwich (with chips and a coke). He says eats several small meals a day. I say I am an interventional radiologist who makes rounds, gives lectures, and charts between cases. After a day like that, I head to my burger joint for my only real meal of the day.

So frustrating. Even when there's a will, it doesn't seem like there's a way. I miss being a runner. I miss training for a half. I miss not having to whine about being out of shape. [I miss my favorite jeans.] This moonlighting gig is a bigger problem than I thought it would be. Every other night, I do a work/sleep cycle from midnight to 7. Which means that I can't work out in the morning before work because I'm reading films. On the alternate every other day, I'm loving my sleep because I didn't get it the day before.

Just this morning I talked to my friend who coordinates said moonlighting, and we both want to cut back. If I could do 8 or 9 shifts a month rather than 15, it would make a huge difference. We're going to try that in July, so it's something to look forward to. I thought that I would be up here by myself and time would just multiply. Not true. I'm still a busy doctor, and I'm still whining. More things have to change.

I'm going to eat better before workouts. I'm going to print a running schedule. I'm going to replicate trainer workouts in between trainer workouts so that I'm not starting from ground zero each time. This puny stuff HAS to get better. Above, a visit to the Apple store when family was here in January.

Matters

Have. To. Vent.

Just spent a wonderful evening with coworkers from Cincinnati Children's. Four IR docs, one wife. Nice dinner at the oldest establishment in the city.

I share with Neil my experiences at Sewanee; there are many similarities to his university in Melbourne. There are many many people who can't relate to a Sewanee life, but he gets it. He then tells me he got married in the chapel there, with his wife three months pregnant. His choir buddy arranged magnificent music, and he paid the college caterer with a case of wine. He's is a romantic through and through. We are like-minded liberal individuals. It's a sweet story, and his wife is beaming.

John says his wedding was in the chapel of his wife's high school. Perfect picturesque setting.

KK had TWO weddings, one in India and one here in the US. People came in droves from Brazil to see the US version. The photographer screwed up. The DJ was fabulous. People danced all night.

I keep my mouth shut, because what am I supposed to say?

"I fell deeply in love. It was madness. We barely came up for air. We knew from the beginning. We bought rings in the NOLA French Market years before Katrina. One night, we danced in the rain outside our apartment. We sketched our dream house. We had a small ceremony at our house one evening. Her family wasn't invited. It's been 10 years."

This is why marriage matters. Equality means a million little things and lots of big things. It's not JUST because there wasn't a church, or pomp and circumstance, or acceptance. It's not JUST about inheritance tax. It's not JUST what other people think of us. It's all those things put together.

I'm not a hugely outspoken lesbian on a mission. I go about my life and rarely notice the differences. Sometimes I have to remind myself that I'm gay. It's like I totally forget. But this "venting" is more than refraining from whining. It's about the right things to say and do.

Marriage matters. It matters to me and to my family. It shows the world that we matter and that we're just like everyone else. It means I don't have to sit there smiling at dinner, internally considering the latest news from Maryland and Hawaii. It means my kids could be my kids. It means I don't have to consider Dutch citizenship, or a future trip to Iowa, just to get the job done. It means somebody might take a chance on their own honesty one day, knowing that "gay" can be done well.

Yes

Essentials

What I can't live without here in Cincy, otherwise known as the list of things I enjoy about being here:

Skype
Terry's Turf Club, my Monday night burger dive
Netflix
iTunes (to push back the quiet)
Fun colleagues and IR team
Time to read
Whole Foods
My trainer
My tough Honda Pilot in all its terrain-tromping wonderfulness
Restaurants with bars, so that I never have to get a table for one
The promise of spring; the accomplishment of learning to deal with the cold
Google Maps and GPS

My routines are solid now. I never did live an adult life on my own. Well, there was about a month of medical school before E and I became a we. I think if things had gone completely different in my life (thank God that's not the case), it would look somewhat like what it is now. I get up early, read the news/feeds/FB, make coffee and breakfast, leave for work at 6:50, change into scrubs, work, change out of scrubs, home. The last part is where there are frequent deviations. Many nights I go to dinner with folks from work. Mondays I go to Terry's. Some nights I eat at home. I stay home on Friday evenings. I go to the movies on Saturdays. I wash clothes and take out the trash on Sundays. I mean, this is what people do who don't have families, I guess. There are parts of this that I like. As a type A hoarder of details and plans, this kinda fits my psyche. [You should see the organization of my bathroom shelf.]

I don't crave drama and chaos. I don't love the unexpected.

BUT I MISS THOSE THINGS! Shock of all shocks, to learn some things about yourself. I can literally feel what my kids would feel like in my hands. It is a visceral kind of miss. It is so cliche, but all those good and bad and crazy and ugly things about being a family are so crucial to our beings.

On another note, if you ever get the chance to experience being recruited, enjoy it. It is quite flattering. It probably needs to stop before I get a big head. My humility is really taking a beating around here. OK, not really, but there is a certain allure to the attention. And appreciation. I am so grateful for all the training I've had up to this experience. I was ready to tackle this. I am good at what I do, and I found the perfect job for me. Some kids actually get better when we treat them. All of these things I owe to the people who trained me so well. What a blessing.

No, we're not moving. But my eyes are open to the possibility. I have now seen for the first time another medical system. Another set of rules, routines, experiences, and outcomes. There's a whole world out there!!!! It will someday become very clear that the timing is right for me to chase my career to a new place. When that day comes, I think I'll be ready.

Tomorrow, HOME. Exhale.

Normal

It's hard to believe, but I'm adjusting to my new normal here in Cincinnati. Some thoughts about the first two weeks:

It is colder here than at home, but it's true that expectations and preparation play an important role. When you're ready for it, it doesn't bother you. I have a strange sense of enjoyment when the weather is going to be really cold and snowy. And I'm surprised that the people here aren't more prepared for snow. Roads, schools, grocery stores, etc - they all take a hit just like at home. I've been told you have to proceed a couple more hours north for the true winter-ready folk. Parking outside is not a big deal. Parking just across the street is not a big deal.

The apartment is a good fit. It had been a while since I lived somewhere with radiant heat (ahem, Gorgas), but it sure is nice to have tall ceilings, hardwood floors, and a real claw foot tub. The sun room is a perfect place for my bike and car seats. Going outside and down the stairs for laundry is not a big deal.

The job is great. I am not overly taxed, but I am busy. The days feel complete. I am learning and sharing knowledge. I keep taking Evernotes to try to remember how to set up for and perform certain procedures. The attendings are friends. The techs are fun. The atmosphere is collegial, and they appreciate my sense of humor. Perhaps best of all, the four IR docs let me be one of the guys. We make dirty jokes and go out drinking after work together. Hangovers are not off limits as conversation topics.

The hospital is picky, though. These people scrub their hands three times (we prefer once). They do not one, but three timeouts for every procedure. They go nuts about badges, isolation, and protocols of every type. And the scrubs are kept in a stupid machine that delivers "credits," but woe to those who wear a size "small" and expect to retrieve in the 7:00 AM range. Sheesh.

Technology makes life easy. GPS in the Pilot is used daily. Skype is used daily. Oh, what a difference. I have a nearby Whole Foods, a nearby gym, a nearby Target, and a nearby movie theater. I've read two books and seen two movies already. OK, if you must know: A Moveable Feast, The Sun Also Rises, True Grit, The King's Speech. These are things I don't get to do at home.

It's kind of a simple life. I have with me only what I need, and I prepare my own breakfast and dinner. A lot of nights, I have cheese and crackers and berries for dinner.

My family and I are adjusting well, but it's never the same. I love being here. I just need the best of both worlds to coexist.

Digital

I read hundreds of RSS feeds every day, many of which are blogs of people I know and (more often) people I don't know. Mom blogs, Arkansas blogs, political blogs, news blogs, gay blogs, mac blogs. You name it. I read facebook updates. I even follow like three twitter people. I am constantly reading, reading, reading. I am a book lover with a recently established book club. I am an academician, constantly staying abreast of the latest radiology publications. It never stops. And I haven't even bought an iPad yet - I'm waiting for the second version.

Almost all of these things in my life, with the exception of the old-fashioned book, are new. I didn't have them a few years ago. God knows I wasn't reading journals when I was a resident, even though I should have been. And now, I check the computer in the morning, I check my phone between cases at work, and I often sit with my computer in the evenings. When I'm moonlighting, awake at 3 AM waiting on a CT to download, I see who's posted. And I haven't mentioned a little thing called television yet.

I know this is the most un-original topic of 2011, but sometimes I think I am over-digitized. I might look back on my life and declare standing in line in June 2007 (for the first day of the first iPhone) to be the pivotal point in my life. Seriously, what DID we do before smartphones?

Is my new years' resolution to ditch the digital and spend more time talking to family, taking music courses, drinking wine at art galleries, and exercising? Do I vow to get out and enjoy real life more?

No, I'm much too far gone. I've been thinking of ways to do it all better. Get rid of some FB friends (at least block their posts): done. Delete all FB following that isn't a real live human being (e.g. Barack Obama and Planned Parenthood): done. Pare down the RSS list (even NPR! gasp!): done. Save feeds that list convenient iPad apps for efficient browsing, blogging, etc: done. Get a ReadItLater account, so that I can blast through feeds and save some for a more appropriate time: not yet done.

I've come to the conclusion that technology does more good than harm in my life, and I'm not ashamed to say it. In all honesty, it is quite rare that Erica or I look at one another and give that suggestive "put the phone away" stare. Apps like Todo, Mint, and Evernote have changed my life for the organizational better. I can actually tell you my DEA number and Reid's social security number within about 10 seconds. Hipstamatic and MobileMe Gallery have improved how I save and view images of my family. I shop on my phone so that I don't have to go search for crap, and it makes me a more discriminating buyer. I pay bills in the bathroom sometimes. I can tell you how many miles I ran and biked in 2010 (not even remotely enough). Another saving grace: I'm not a gamer. I play Words with Friends with my mom and Erica, rarely anyone else, and that's it. And I haven't been lost in Little Rock or elsewhere since June 2007. I've been lots of places since then.

So, yes, my screen time has to be monitored in a way. I can't let myself become one with the computer chair, ignoring my life. And I know all about the iPhone moisture sensors, so I can't use it in the shower after all. But I would argue that my life is more efficient, more enriched, and more aware than it was a few years ago. That's why I'm not blogging about a week-long hiatus from technology and how cleansed it made me feel in the end. I'm looking for the next best app.

Before (Part 1 of 3)

Before my grandmother died, she was lots of things:

Classy
Giving
Sometimes irritating
Lover of scarves, leather gloves, and jewelry
Wine drinker
Shaky (years of anti-epileptic drugs' side effects)
Tall
Early riser
Shopper
Dog lover
Laugher
Computer savvy
Chocaholic (really, anything sweet would do)
Budding genealogist
Nervous/worried
Environmentally conscious
Limited in culinary talents
Painter
Detail oriented
Cold cream user
Coffee drinker
Political
Crafty
Breast cancer survivor
Sentimental
NOT forgetful
Country and cosmopolitan at the same time
Outgoing
Secretive
Mother of 2, grandmother of 4, great-grandmother of 5
Widow x 2, divorcee x 2
Engrossed in numerous successive projects
Content
Faithful and prayerful
Adventursome
Obsessed with flowers
Never very well-off
Fiesty and a little vindictive

She didn't really have an easy life. I can't blame her her faults.

We always knew that the tangle of vessels in her right parietal lobe were there, tempting fate. We knew she should have, could have bled and died long ago. We didn't know it would be on a Saturday, or that it would happen right before my mother's eyes, or that the preceding days would have been so precious and joyful. How could we have?

Overdue

Musing

Why can't a gas station credit card reader not tell if I'm using debit or credit? There's ample technology involved in the transaction to be able to discern.


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Wagon

I fell off the blog wagon after all that January drama.

I am enjoying a Sunday afternoon with my computer, playing catch up and planning how much more there is to do. Including taxes. If I get that done, it'll be huge.

We are having an open house now; the family is sleeping while I do my solitude thing. Pa.ndora, Goog.le Reader, Face.book, etc. I'm so web savvy! I know how to put dots between popular words so creeps don't find me!!!!!

Dory has heartworms and is undergoing treatment. She had her first shot Friday. It makes us feel like horrible moms for letting her get sick. Now she has to be super calm for six weeks. Good luck.

I am going to Cincinnati for 6 months (January-June 2011). So that's decided. I picked the 6-month, direct-flight, normal working hours, no-call option. Shocking, really. So I plan on my first real paycheck at the end of July 2011. There. It's out there. We can make it.

Ross is into costumes: Darth Vader, Jedi, dragon, Spiderman, pirate.
Reid is trying out rice cereal this week. Sitting up a little bit. LAUGHING. But mostly very serious. Nursing eighty times a night. Chomping on fingers. Squeezing his toes.

D

We are in big D. I wish it were for better reasons. We left early this morning and had a really good trip with the boys (i.e. they didn't scream in their seats, no major spills, no bad weather, etc). Erica's mom is with us to help with them. Reid has to be with Erica for feeds, obviously, so we couldn't leave them at home. But they can't come to events with us, so Margie is taking good care of everyone.

The visitation was horrible. We are drained. I'll never forget it as long as I live. The best part was seeing how much Audra needed Erica and was glad to see her.

Our hotel is a little shady and smells like French fry grease. But I am a cheap skate and found it for 58 on hotels.com.

Quick

A quick post since I've broken my resolution and missed yesterday.

I had good reason. A friend of ours from Erica's residency class, Audra, lost her baby Thursday to SIDS. She was Reid's age. We spent our evening last night planning our trip to Dallas and talking. No time to hop in front of a screen.

I was actually off yesterday, so I had lots of good Reid time. Ross went to school. We went to my dad's new place to meet him and my aunt Becky, who will be decorating. He moves in a week if all goes as planned. We also went to see Mom at school. He was a hit and loved the attention. E met us for lunch at Bossa Nova (always a treat). Then the boys had check-ups. Reid had four shots and a rough evening.

Today I head in to round on a couple of patients, then we just plan some home time.

And no, I am no pregnant. Geez. And I can't adopt my kids in AR. It's just that I would like to work to change that process, ask if there are loopholes, etc.

Rough

We had a rough night. Too much going on. Ross had a friend's birthday party tonight, and it was fun but set us back a bit. Weeknight excitement can do that. It somehow became 10:00 really fast.

We got NO precipitation, which I hope you remember was properly predicted here last night.

Reid has a persistent cold. How long is too long? Why does his cough sound so horrible? Has he peed enough? Does he need medicine? Why am I married to a pediatrician but have no clue how to settle our worries about these kids?

This morning I woke up dreaming that we had all been in a plane crash. I was trying hard to find the boys in the aftermath, which was quite a drawn out process. I finally got to this Catholic girls' school in a densely forested neighborhood. After finally finding the lobby, I stood at the desk while the nun started telling me that I had to fill out a form to remain on campus. I begged her to help me find "my boy." I kept saying it over and over again. It was like Ralph Fiennes in "The English Patient," when he can't get back to Katherine because they think he was (and he was) a spy. Only seemingly more dramatic. The other weird thing: One of my future partners was on staff at the school. I'm not going to tell her.

I think I harbor separation anxiety. One of my goals (New Year's Resolutions?) is to make progress in the land of Adopting My Kids. I could at least try.

Remember

I try to think of things during the day that would be great to post in the evening. There seem to be so many.

And yet. Here we are, with not much to say. About a year ago (almost two years), I read two books in short succession that each employed a narrative technique that involved little stream-of-consciousness sentences such as: "And yet." Even so." "Still." I always think of those books when I write something like that. It was super effective and made an impression on me. Great transitions. Richard Ford's "The Lay of the Land" and "History of Love" by Nicole Krauss.

On the radio this morning.

I hate tumor board in general, today's tumor board in particular. I always sweat and get a headache to be walking that plank.

It may snow tonight, so the whole world is in hysteria mode. Me, I have chosen to ignore. We go about our business. Ross throws a fit to go to bed, the breast pump in the other room whirs, and Reid devours his conglomerate fingers.

Fifth

Here we are at five days in a row. See, I could do it.

To answer: yes, my mom was temporarily sick. H1N1 for a week, followed by a secondary pneumonia that required hospitalization. She was really sick but made a full recovery. My dad met me in the ER. The three of us were alone together for hours on end, for the first time in several years. It was good considering the circumstances. Then it was bad because it got complicated. They made a movie about it; did you see it?? Meryl Streep even drives a Highlander.

Today was crazy at work. I got finished a little after 7 (that's radiologist speak for late). Erica had already made dinner and accomplished baths. I swept in for the final hurrah, read books, then they crashed. I don't remember sitting today, but I must have for a few minutes at a time. I did eat. It was a fun day.

I am still really frustrated with PICC lines in babies. It is the most technically challenging but banal of our procedures in IR. Bread and butter. Several a day. Technologists standing around tapping their toes. But the smaller the baby, the more difficult. Sometimes I feel like I'm gaining ground, but then I'll have trouble with a few. Like today. It is so frustrating to be in this position. Board certified, mid-year fellow, experienced, looking at another fellowship for these types of procedures, and totally screwing it up. I am capable of so many things, but that doesn't matter when I'm at the plate for one of these little kids. It WILL get better. My mantra.

I am learning so much. As the only fellow in the department, people bring me their interesting cases. They ask me questions. We look stuff up. I kind of know all the kids in the hospital - at least their images. I may never see them face to face, but I have them memorized. Lest you think it is all hard PICC lines, this is a most rewarding year to get to experience.