November: The Bad

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When I was younger I read A Child Called It by Dave Pelzer. I was enthralled. I was fascinated by child abuse and couldn’t wrap my mind around how things like that could happen. Fast forward to now when I see child abuse regularly in the Children’s Hospital. November was one of the hardest months I’ve had yet, because of the tragic social situations children wind up in.

Neglect. Neglect is one of the worst forms of child abuse in my opinion. Not that you can rank them very well… But to me, not caring and being indifferent is in many ways worse than physically harming someone. At least with physical harm there’s some passion behind it. I’m not sure if that makes sense or if I’m communicating that well, but I just don’t understand it. I can understand other forms of abuse. Until you have a child, you can’t fully appreciate how difficult it is to be a parent. It’s difficult to lose your independence and have to change your day-to-day one hundred percent. It’s difficult to deal with the stress that having a child places on your relationship with your family and with your spouse and everyone around you. It’s difficult when your friends don’t understand why you can’t go out or be spontaneous anymore. It’s difficult when no one understands (or so it seems). I myself have had to find support through different Facebook groups of other moms going through exactly what I’m going through. I have learned that mommy guilt is a real thing, and mommy-shaming is made even worse these days with crafts and different competitive ways to measure how good of a mom you are… Mostly based on the number of crafts you do & the amount of time spent at home with them. And that’s just in my own socioeconomic class. The kids I’m taking care of often come from disadvantaged situations, so there is very little access to resources and education to prevent the tragedies that occur. I can’t imagine worrying about caring for a child while simultaneously worrying about where my next meal is coming from and if I can afford a winter coat and shoes.

But I just wish that people would consider another option. If they don’t want to be parents anymore or if they truly are indifferent, I wish that they would just drop their child off at the nearest Quiktrip or fire station or anywhere that has a safe place logo on it. I wish I could plead with them and reason with them and tell them I understand. I know it’s hard. I know what it is to be up all night and crying and exhausted & still have to go to work the next day and perform at a certain level. It is exhausting and horrible some days. And it isn’t all giggles and sunshine and cute chunky baby rolls. “I get it,” I want to tell them. I want them to know there are people out there that would take care of their baby if they thought they couldn’t do it any longer. I want them to know that there are resources in our community.
I want them to know that there are other options than neglect & abuse. Unfortunately, I don’t ever get the chance to voice that opinion until it’s far too late.

I worked the first weekend in December and after one particularly horrible social situation, I went home and found myself curled up in my bed, crying my eyes out while holding onto Adelaide. I’m not going to sit here and say that I understand on a different level now that I did it before I had kids (even though that’s really true, but I wouldn’t have believed you before I had her). But I will say having a baby the same age as a baby in the hospital that is at the hospital for injuries related to abuse rattles me to my core in a way that I hadn’t experienced before. It is so hard to go home and take care of my own baby when there are babies suffering at the hospital. It’s difficult to separate myself and not worry & stay up at night thinking of those other babies.

When I was a medical student, it was no different. I was equally enthralled by child abuse and fascinated at how things like that could happen. I wanted to know more about the social situations and more of the details. I didn’t understand why we weren’t allowed in the patient rooms where these stories were happening. I remember asking myself “wasn’t I here to learn? Wasn’t I here to gain from this experience? Why am I being barred from going in to those rooms?” Fast-forward to residency. Now I have no choice but to learn from these situations. And every single time, I wish I could go back to Med school. I wish I could go back to where I wasn’t allowed in the room. I wish I could go back to where my fragile emotions were protected by those that came before me. I wish I didn’t have to come home and bear the burden of the stories. I wish I didn’t have to look at my own baby and think “why did you get so lucky and they didn’t, simply because they were born in a different situation?” While everyone else is pointing the finger of blame and voicing anger directed at the parents/abusers,  I try to stop myself & think “how has our societal system failed them? Where were their family and friends to rally around them when times got tough? What could we have done as providers to prevent this from happening?”

I don’t have the answers. But I think routinely challenging & asking myself these questions, and allowing myself to be angry about these situations and emotionally moved is the only way to make real change. I sure hope there’s a solution and that it comes swiftly.

November: The good.

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First off the Cubs won the World Series!! We hosted most of my family at my house for the last 3 games, which was exhausting after working 13 hour days, but was definitely worth it. I wouldn’t trade the memories of watching those games with my family for the world! My fellow residents didn’t act too annoyed when I wore a Cubs shirt to the hospital instead of scrubs, and they even put up with me watching the entire Chicago parade after the big win, with tears welling up in my eyes.

November was my first month of inpatient peds. “Inpatient”= in the hospital. I work on the general floor, so basically if your kiddo goes to the ER and gets admitted to the hospital, I take care of them. If they go to their doctor & their doctor admits them to the hospital, I take care of them. If they go to another hospital in Oklahoma that isn’t equipped to care for them, they’re transferred to our children’s hospital, and I take care of them. Let me start by saying there’s just something special about working with only girls. I spent my month with 2 other girl interns and 2 senior residents.

One of my senior residents is a sister for the Catholic church. Another intern & I spent the better part of our month together grilling her on how she became part of the convent at our hospital. I was completely fascinated by the ins and outs of her daily life. Her & I bonded over our shared love of Advent (she had no idea Methodists celebrate it too!) and our love of bacon cheeseburgers.

An intern I worked with in the hospital had a baby in August. Having 2 breastfeeding moms on inpatient service for the month presented itself as a unique challenge for our teams, but it worked out beautifully. Our program is super supportive & allowed us to get our perfect rotation system down. We alternated times & got to use the call room freezer for our stash, and even got to use a secret stowed-away hospital grade pump! Even though this was her second child, we bonded over having new babies at home and the joys/struggles of everyday life. She’s hilarious & speaks her mind about everything, and is addicted to coffee to a slightly greater degree than I am. We took daily coffee breaks together & giggled about entirely inappropriate things.

The other intern on with me for the month happened to be my “residency bestie.” For whatever reason we got super close and just kinda clicked from day one of orientation. We met last year during my peds audition/interview for this program, but didn’t keep in close touch for the rest of 4th year. Anyway, we take turns babysitting the other’s kid from time to time and spent the month of November mourning the election results, watching Finding Dory, fueling our coffee addictions (with the other girl too!), and had a great time being sassy together.

My other senior resident in November is the epitome of classy attitude. She always has a witty comeback & a fresh view on a situation. She talks to herself, making for a constant stream of “huh? Oh, you’re not talking to me” comments throughout the day. She also loves Adelaide and calls herself Adelaide’s bestie because she can always seem to get her to smile. We bonded over selfies, lack of sleep as the month dragged on, our slap-happy goofiness, & our love of bacon in the mornings. (Cheers to you, caramel surprise!)

Our night team was awesome too- an intern & a senior, both who came in fresh every night with new jokes when we had tough days and funny stories from their crazy night shifts when we came back each morning for sign out. They were hilarious to work with, too, and sign out often went late because we were all laughing about some crazy event that had happened.

Since Thanksgiving fell in November again this year (ha), we had holiday hours. My residency splits holidays awesomely- we either get a week off for Christmas or a week of for thanksgiving. It flips every year so it’s fair. The holiday week you work is split fairly so that everyone only works 4-ish shifts. So, instead of working Monday-Friday, I only had 4 shifts. On thanksgiving day, we wore turkey & pilgrim hats during rounds and the kids & families loved it. And because our patient list was so small on thanksgiving day, I got to go home early! (which is unheard of in most residency programs!) I got home in time to critique David’s cooking of the bird & add my 2¢ on how everything should be set up, and got to host a wonderful dinner with my family & in-laws.

Seriously, the residents I worked with in November were such a fun group of people to work 12-13 hour days. We were constantly laughing from sign out in the morning to sign out in the evening.

Our attendings were amazing too. One brought us peppernut cookies which were delicious. 2 others were cool enough to dress up for thanksgiving with the rest of us with our turkey hats & pilgrim hats. We were able to have 2 separate birthday parties for our attendings & sister. I made a funfetti cake & an apple pie cake (link: http://www.bakeyourday.net/apple-pie-layer-cake/). We decorated the call room with balloons & streamers two days in a row & everyone enjoyed the desserts I made! We also had a running list of hashtags/inside jokes such as #isabella #watchgameonfleek #icanteven and my personal favorite… #VSSAF. One of our attendings constantly used the phrase “struggle bus” and “womp womp” and “I can’t/I can’t even” which all quickly became part of my daily vocab. We had so many laugh-til-you-cry moments that I lost track!

Pediatricians have been accused of being the fluffiest and happiest of specialties which is mostly true- but my goodness, I challenge you to find a more sassy, aggressive-in-a-good-way, and sarcastic group of residents than the people in my program. I seriously doubt you can!  image

 

The humbling act of parenting: my built-in ego manager

image.jpegI’m now several months in to residency and finally feel like I’m getting the hang of things. For starters, the computer system no long eludes me most days! Dr. Beeson is growing on me. I’m adjusting to my new identity slowly but steadily. The casual glance down at my badge & a subtle straightening of the spine instills a certain confidence.

I feel like I knew what I was “buying” when I started residency. 2 of my close friends in other residencies have asked me if I regret this line of work because they do. I really don’t. For the most part I am enjoying residency, despite the long hours and tough social situations I see daily.

I was on pediatric surgery in September. It was a good rotation because it showed me as a general pediatrician when to refer to surgery urgently and when something could wait. Having my history with anesthesiology, I was thrilled to be in the operating room again. I missed it, but every day was reminded in subtle ways that I made the right decision for me, choosing peds over anesthesia. I liked seeing the pediatric surgeries, but I didn’t get to do much hands on learning, which is what I prefer. They had enough people in the OR without me being there, so I often felt I was in the way. I joked with my family that I didn’t think I had narcolepsy until I started this rotation, because standing in a warm operating room and not doing much with your hands can make for some sleepy mornings! I tried to read every night on the most common pediatric surgery cases and tried to be interested in the lab values and testing our patients had. Mostly I just kept my head down and enjoyed the good hours and the extra time I got to spend with Adelaide when I had the occasional half day.

October was my clinic month. Our resident-run clinic sees a very underserved patient population. Truly the “least of these.” I know I said I wanted to serve the underserved in my interviews and even back in my Med school application, but in real life it’s tough. The question I’ve most struggled with is how do I go home and leave my baggage at the door? There’s no way anyone from my day-to-day life can handle the burden of knowing these patients’ stories, and patient privacy laws make it so that I often can’t share much detail of any patient story. It makes it very difficult to deal with, keeping them to myself and never being able to talk through them with my support system. So I make light of them. I joke about it. Because how else can I cope?

Another thing I noticed on my clinic month: my experience being a mom myself is making me a way better pediatrician. I’m not sure why I thought I had to keep my private life out of my clinical practice. For the first few months of residency, I hardly ever mentioned Adelaide to my patients because I didn’t want to make it “about me.” But I have found since I’ve started sharing my own parenting experiences I have connected with so many more patients. It’s really awesome to connect with families over shared parenting experiences, especially with families who come from totally different backgrounds than I do. One example is that I showed up to clinic two weeks ago with spit up all down the back of my shirt. I had no idea until my Attending mentioned it. I was mortified, but laughed it off & told my next patient about it & was able to connect over how our kids humble us when we think we have it all together! Plus there’s just something humbling about going home and wiping another person’s butt- if it was ever a question, these things definitely keep my ego in check. I have patients that now request to see me because of the connections we’ve made over shared parenting joys & downfalls. It’s a truly wonderful feeling! I have more to write about my November month of inpatient hospital pediatrics, but for now, this will have to do!

Balancing Act

imageI know I am WAY late writing this so I apologize! August was my month working in the newborn nursery. I love newborns and the senior resident I was working with was fantastic and taught me so much I didn’t expect to learn, but this month challenged me in many ways. It was supposed to be one of our “lighter” months, but for me it ended up being a tough month.

I had to take my medical boards (purposely scheduled them for this “lighter” month). Adelaide got croup and stopped sleeping through the night. And we had more DHS referrals than not for our newborns, as well as a spectrum of other complex social & legal issues like HIV+ moms, complicated adoptions, a surrogate mother, and women with little to no prenatal care walking in off the street and delivering their babies. Despite all of those challenges, the thing that was so difficult for me was to take care of other peoples’ babies when all I wanted to do was go home and take care of my own.

I was asked numerous times by people “How do you do it all?” The thought never occurred to me, because honestly, do I have a choice? I can’t wake up and not take care of my family. I can’t decide to sleep through the night- I have to wake up and pump or feed Adelaide, or I’m physically in pain. I can’t ignore Adelaide when she’s barking like a seal all night and having trouble breathing (I have to turn her humidifier to full blast & stay awake and formulate the fastest drive to the children’s hospital ER & figure out who in my residency is working in the Peds ER tonight & get their number in my phone ASAP). I can’t decide not to show up to work when I’m upset by a difficult case or when I’ve stayed up all night worried about my own baby or about a baby we sent home with a mom who has very little access to resources to care for her new baby. I simply have to “do it all.” What other choice do I have?

We went to dinner one evening to celebrate a student’s birthday. I was on call and got 2 calls as I carried Adelaide and her huge diaper bag into the restaurant. A med student who was working with me said I was like super mom- balancing Adelaide in my arms, holding her teething toy, and putting in orders while on the phone for a new baby at the hospital. It was flattering- isn’t that the ideal? Isn’t that the goal we put in front of us, to ‘have it all’? But it wasn’t true.

On a good day I feel like super woman- doing the mommy thing, doing the doctor thing, seeing my family and friends regularly, making time for my marriage. But on a bad day, I don’t feel like super mom or even adequate mom. When Adelaide is sick and cries when I put her down because I have to work, I feel awful. When she’s running a fever and I have to drop her off at my mom or sister’s house instead of daycare, I feel like I’m giving the job I should be doing to someone else. Often times I feel isolated. I’m constantly stepping away from my patients so I can pump. I also miss out on lunch table talk with my colleagues, which is often the most debriefing for difficult situations that we get, so I can pump. I had to miss a delivery because I had to pump, and I even missed a twins delivery because I had to pick Adelaide up from daycare. It is so difficult to balance everything. Impossibly difficult. But I keep going and the world moves forward.

So for now I’ll continue putting one foot in front of the other. I’ll keep trying to learn as much as I can both medically and about the crazy balancing act mommy physicians face. As long as Adelaide wakes up and greets me with a smile everyday, I’ll keep working. To set a good example for her and show her that being a working mom doesn’t mean I have it all or can do it all or that I don’t have bad days- but that I keep going in spite of that.

Contentment

imageWell, I’m a doctor now! Similarly to third and fourth year of Med school, we have month-long rotations in different areas of the hospital- but instead of being broad, it’s all pediatrics…with the exception of the rotation I’m currently on: OBGYN.

Since I’m not an OBGYN resident, I’m “off-service,” basically meaning I’m not in my comfort zone. There’s a psychiatry resident & an internal (adult) medicine resident with me, so we’re all off-service together. Since I’m a pediatrics resident, my typical day includes seeing teenagers who come to the OB clinic for birth control or for prenatal visits. It’s sad, but the pregnant 16-year-olds don’t even phase me anymore. It seems normal to me now. Now the crazy thing is the 13- & 14-year-olds we see. It’s strange how a paradigm can shift so quickly.

This month has been pretty easy for me so far. I don’t have a packed-full schedule. I don’t go to deliveries at all, so my most stressful moments involve getting the electronic medical record system to work and making sure my orders and e-prescriptions are valid & go through. It’s nice to have this “safe” month without much activity before hitting the ground running. I’m using it to study for boards next month & learn the computer system. But it’s also conflicting. I see these crazy stories from my classmates about doing chest compressions, dosing intense medications, saving peoples’ lives, nearly making life-changing mistakes… And I’m altogether relieved, jealous, anxious, and content.

Relieved because I’m not quite ready for that intensity. Jealous because I want to be the life-saving doctor! I want a crazy story to tell! Anxious because that WILL happen to me, and just like my classmates. I won’t be prepared. I won’t have all the answers. And content because for now, I’m ok studying for boards in my largely unoccupied days and easing into this “new doctor” thing. I’ve always been a “test the water before jumping in” type of person, so this transition has been just what I need.

I’m not sure I could’ve dealt with the stress of becoming a new physician if I hadn’t had an off-service rotation. Because the biggest life change for me in the last 3 months wasn’t becoming a doctor, as it was for many of my classmates. That was overshadowed by everything else we did. We bought a house. We moved back to our hometown where I haven’t lived since I was 18. I’ve had to adjust to life here as an independent adult. We’ve had to adjust to seeing family twice a week instead of twice a year. And the biggest change of all- to my life, my marriage, and my identity- was that I had a baby! I’m dealing with coming off of my post-graduation summer break/pseudo maternity leave. I’m learning how to be a working mom and balancing how often to pump at work so I can still breastfeed at home. We just started daycare with her last week and it was really difficult for me to leave her. What if she rolls over or starts to crawl and I miss it? What if she hates it there? Or possibly worse, what if she loves it and prefers her daycare teachers over me? So, in addition to becoming a physician and all of the other wonderful changes, it has been a very conflicting, intense, and overwhelming time for me.

I’m grateful to my program for unknowingly giving me this time of transition that not even I knew I needed. I’m sure if I had started on a tougher rotation I would’ve made it work. But I’m grateful I don’t have to. Easing into being a working mom and growing into my new roles has been ideal for me. I’m cherishing my evenings and weekends with my little girl. I know when my tougher 16-hour-long shifts start, I will look back on these beginning days and wish I was back here. So for now, I will soak up every smile and giggle Adelaide gives me, every longer-than-expected lunch break that I get to drop in and visit her, and every morning that I get up a little earlier than normal to cuddle with her before getting ready for the day. I’ll savor our time together now because it won’t be long before I’m also posting about my big mistakes, near-misses, & 80+ hour weeks

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On Becoming a Mother

Many people have asked me what it was like to become a mother April 8. I find it really difficult to come up with a concise answer because I don’t believe that’s when I became a mom. Yes, that’s when my daughter was born. But I think becoming a mom was a much, much longer process than the events of labor & delivery.

Recently my husband refilled his medication. He takes it because he has a congenital heart defect and has had 2 open heart surgeries. He’s just 31 years old. The last time he refilled his medication, I said to him “wow, next time we get this filled, we will have a baby!”

We have been through so much together. I thought open heart surgery would be the toughest thing that we’d weather, and in many ways it was. But now I’m a mom. And now he’s a dad. And our relationship is forever changed by this tiny 6 pound miniature version of us that is so entwined into both of our hearts that we’ve both found ourselves randomly crying just looking at how beautiful she is. It’s strange because he and I are the same people, with the same quirks and conversations and beliefs and dreams, but everything in our world is 100% different.

Not only did we just have a baby. We moved cross country. I graduated medical school and became a physician. I’m starting my first job in July.

So, really, I think I started becoming a mom when my husband and I first discussed expanding our family. When we started trying & when I got my + pregnancy test- the hope, the fear, the insecurities, the relief- all of it made me a little more of a mother. Then we started seeing the heartbeat on the ultrasound monitor and saw our little baby moving, practicing breathing, and sucking its toes. We had a special heart scan done to make sure the baby didn’t have my husband’s heart condition. We started receiving gifts-toys, clothes- to prepare for the arrival of our little bumblebee. I would argue all of these events were part of me becoming a mother.

Then April 7 came. My water broke. It was a trickle and I was unsure what to do, so I consulted with an OBGYN friend who advised I go to the hospital. “Just in case,” she said. I was convinced they’d send me home- after all, in the medical world, first time moms are often made fun of for thinking they’re in labor when they aren’t. Around 4pm, they swabbed me, confirmed my water had broken, started an IV, and told me, “you’re having a baby before you leave here!” I called my mom and started crying. I wasn’t ready to take the final step in becoming a mom. I had 3 more weeks until my induction date. I had plans to nest and make more crafts for the nursery. I needed to pack for our big move. And I had to plan our class party for graduation.

Unbeknownst to us at the time, going into labor 3 weeks early was just the first in a series of unplanned events! My OB had gone on vacation, so he wouldn’t be there to deliver the baby. The doctor on call would. He assured us it would be 24-48 hours before the baby came. My mom scheduled the first flight out for the following morning. I took a walk around the unit to try to get my labor to progress, and ended up dilating from 1 to 10 in just a few short hours. None of the medical staff- doctors or nurses- could believe it was my first baby because my labor was so fast! Because of that, I wasn’t able to get the epidural I asked for… I felt everything when I tore. And because of some difficulty hanging a bag of medication, the local anesthetic they injected for my repair had worn off… So I felt everything there too. Our baby was born at 2:35am. They laid my 5lbs 4oz baby on my chest and said congratulations. Since it wasn’t my OBGYN delivering me, they didn’t realize that we didn’t know the gender beforehand. I frantically looked around the room and asked, “what is it? what is it?!” “It’s a girl!” the Attending announced. I can’t describe the joy that washed over me at that moment. We hadn’t found out the gender and I truly didn’t have a preference. But since everyone except for 2-3 of my close friends and family thought it was a boy, I started thinking it was a boy too. I was shocked when they announced she was a girl! We named her Adelaide Ariana. She was, and is, perfect.

Fast forward to now. Adelaide is 8 weeks old.

We have had more joy, laughter, tears, frustration, tests of our patience, and delirium than either of us ever anticipated. From massive blowouts to literally crying over spilt breastmilk (pumped), I believe I am still becoming more of a mom each day. Driving cross country with a newborn was rough. Dealing with the frustrations of moving on top of having a new baby was even tougher. The sleepless nights during her first growth spurt, the nighttime meltdowns, moving then hopping back in the car for a long trip to Missouri for graduation, writing a speech and fulfilling my class president duties while making sure she was fed and happy, walking across the stage at graduation and praying she didn’t have a meltdown so my husband didn’t miss my big moment… the list goes on. Life is so different now- more difficult in ways we never imagined to be sure. But it’s also more beautiful than ever before. She rewards us every morning with a smile that melts our hearts. Motherhood isn’t glamorous but there’s nothing more beautiful. I feel so blessed to call her mine and to have added the title “mom” to my identity.

Strokes, brains, and the mysterious part of medicine

Other than the occasional bad day (see last post), Neurology is really interesting. It’s the study of the brain and spinal cord. The brain has always been so mysterious to me. I was excited when we started our neuro class in 2nd year… Then disappointed when I realized the more I learned, the less I knew since it’s such a vast field. After 4 weeks of perfecting my neurological exam and seeing patients with a gamut of neurological deficits, I can say the brain is even more mysterious to me than before!

For starters, my doctor was the stroke director at the hospital, meaning she saw most of the stroke victims and was often on “stroke call”… On top of seeing patients in her private clinic. “Stroke call” is being on call when someone comes to the emergency room with stroke-like symptoms & the doctor has 10 minutes to see and evaluate them. This made for interesting, fast-paced days when we were seeing patients in the clinic & had to somehow get over to the ER in 10 minutes to evaluate a stroke victim! In her clinic, we saw migraines, seizures, and a gamut of other neuro defects.

Outside of being a super effective and likable doctor, my attending was amazing. She is doing research to have a neurological sign named after her. She was full of life advice and short one-liners that I will carry with me as I start my career. Some examples: “physicians kids are a rare breed. You have to give them good INFLUENCE, because they’re born into a world of AFFLEUNCE.” “I have no patience for rude patients. If you want to see me, you need to grow up and learn some respect.” “If you aren’t right yourself, you aren’t gonna be right as a physician. You can’t take care of other people if you don’t first care for yourself.” “Always remember the Good Lord has your best interests in mind, even if they don’t make sense to you at the time.” “Sometimes you’ve just gotta cry it out. It’s ok to be human. Show those emotions.”

Some of the coolest cases I saw: amarosis fugax, which is when there’s a blood clot in one of the arteries going to the eye. When we learned about this condition in med school, the key symptom was that patients would say it “felt like a shade was being pulled down over their eyes”. Imagine my surprise when a patient used those EXACT words to describe his symptoms! It was fascinating. I also got to see a patient with trigeminal neuralgia, a neurologic defect of one of the nerves in the face, where the slightest touch like a hair or the wind blowing would send electric, searing pain across the patient’s face. I got to see thrombectomies for stroke treatment, where they go in through your groin blood vessels & up to your brain & pull the blood clot out. It is an incredible life-saving procedure. I saw patients with encephalopathy (brain infection) due to mosquito bites & viral infections. We also got to do electromyograms, which test the time it takes for a nerve stimulus to cause a muscle to fire. If you have bad nerves (due to diabetes or another neuro disorder) the time it takes the nerve to “talk” to the muscle is longer. It is a really simple test to check for a potentially serious disease process. I got to see a heartbreaking case of a patient with Parkinsonism due to agent orange exposure years ago. I saw a woman with an abscess (bacteria accumulation) around her spinal cord, causing paralysis and sensory deficits at a certain level. My doctor even quizzed me to see if I could guess where the abscess was based on where the woman could feel my touch and where she went numb. I saw a woman as pregnant as I am who had a frontal cavernous malformation, which is a deformity In a collection of thin veins in your head. This deformity made it dangerous for her to have high blood pressure or to have a natural vaginal delivery- the increased pressure could cause the thin veins in her head to burst. I also saw a case of hemiballismus as the presenting sign of a stroke. My doctor had only seen 4 in more than 40 years of practice! Hemiballismus is where the patient has no control over an extremity and that extremity thrashes about uncontrollably. We were able to treat the patient & watched her regain control steadily. It was really interesting how these conditions that used to be deadly can now be medically managed safely!

Some touching stories I encountered…
We had a 50-something year old man who had a middle cerebral artery stroke. He developed swelling in his brain which we were luckily able to manage with medication instead of having to open his skull to accommodate the swelling. The heartbreaking part was that he was so young. His parents came to visit every day & reported that of everyone in his family, he had been the healthiest. He followed a strict low fat low salt diet. He exercised daily. He was up to date on all of his health maintenance exams. And after treating his stroke & swelling he wasn’t improving. We had to transfer him to a rehab center & hope for the best. He still couldn’t move half of his body and was unaware of where he was or what was wrong. It was awful.

Another case was a woman in her 80’s. She had recently gotten married to a childhood crush after they had both been widowed. They were adorable. She had the same stroke as the man above, but improved remarkably better than any of us had hoped. The second day we saw her, we were unsure if she could understand us because she wasn’t responding to our questions… Then her new husband walked in and said, “hi honey!” Her eyes brightened up and she gave us the biggest, most proportional smile ever (important in people who have had a stroke! No facial droop!). My doctor & I both teared up. It was so amazing to see, especially since we weren’t sure she was “all there.”

For every touching story, we had a crazy story. I understand patients who want to abuse pain pills or drugs or alcohol- but patients who come to the ER faking a stroke do not make sense to me. The drugs we give to treat are basically just blood thinners… Nothing exciting at all. But we had multiple patients whose “stroke” symptoms wouldn’t match the distribution of the brain’s vessels. For example, one lady was holding a newspaper up with 2 hands… When we walked in, she immediately dropped one arm to act like it was paralyzed. We also had a guy holding his arm to his chest as if it was paralyzed and when we distracted him by telling him to raise his leg, his arm magically regained function. My doctor said aloud during one of these exams that the patient scores a 10 on the CAF scale. The nurse wrote it down & asked us afterwards what CAF stood for… My doctor busted out laughing & said “crazy as f!” Haha!!

It was nothing short of an interesting and challenging month. I will not soon forget my incredible experiences with the patients I had the privilege to see & the physician who invested in one of my last months of medical school education!

In the words of Oliver Sacks, “If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it.”

How fascinating the brain can be!

Crying in the Bathroom

Sometimes medicine sucks. And sometimes it’s on your birthday. I was having a wonderful day, complete with fake mimosas and flowers and homemade breakfast sandwiches from my hubby. I got a free coffee from my favorite place on my way to the hospital. My phone was blowing up with well wishes and happy messages.

Then I had to see our 65 year old patient.

He came in last week with stroke like symptoms, but brain scans showed a mass. It appeared to be a Glioblastoma multiforme, aka the most deadly and swift of brain cancers. He and his family were in denial, and who could blame them? He was young and healthy and hadn’t had any symptoms prior to this. Over the weekend, he had a biopsy taken of the mass which proved our worst fears… And yesterday, he realized what his condition meant. He was sobbing as we explained the options to him, and he kept repeating “take care of my sons”. I was blinking at the ceiling trying not to cry, but when I looked at my doctor, my strong, independent, intimidating, straightforward, no-bulls**t doctor, she was crying. I immediately excused myself to go to the restroom… And proceeded to cry alone in the bathroom.

I wish as physicians people allowed us to feel. Everyone wants their physician to be perfect- able to diagnose, answer any question you might have, be the strong one in the situation while somehow remaining empathetic and sensitive, but not TOO sensitive… It’s extremely difficult to live up to the high expectations society, and honestly we ourselves, hold us to. Luckily I have some amazing family and friends that are able to lift my spirits when times get tough. I also think it’s really, really cool to be held to such a high standard and to meet or even exceed it. It’s such an amazing field to be in and it’s such a privilege to be part of peoples’ most intimate and vulnerable life moment. I honestly can’t believe I’ll be a physician in 2 short months!

*note: patient age and other identifying information has been edited to protect patient identity!

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I MATCHED

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I never gave an update! I ended up ranking pediatrics over anesthesiology. It was a tough decision- one that involved many sleepless nights and hundreds of convos with friends, family, and the hubs.. but ultimately, I made the right decision for me and my happiness.

And I’m happy to say that I matched to my #1 choice: Tulsa Pediatrics at Oklahoma State!

While it pains my little Sooner heart a little to think of wearing black & orange, I am THRILLED to be moving close to my family and in-laws and friends, especially while bringing a baby into the world!

 

I started adult neurology this week… I’ll give an update soon because it’s super interesting stuff!!