au revoir

I'm on vacation now, did I mention that? Well, I am. Just so hopeful med students don't get the wrong idea about how much time one has during residency to run around to the dentist and to driving classes and such.

Tonight, Joe and I are leaving for a flight to London, where we'll be spending eight days, split between London and Paris. (We're actually going to Paris first, so we'll be catching a connecting flight to Paris a few hours after we land in Heathrow, and then taking the Chunnel back a few days later.) I know I hadn't mentioned before that we were leaving the country for a week, but that was all for one simple reason--I kind of forgot. I mean, I remembered, but the planning had started so long ago that the fact that our trip date was finally here kind of snuck up on me. Yesterday, I was like, "Wait, we're leaving for Paris tomorrow? Holy shit, I have to pack!" (Luckily, my wardrobe is so limited right now that packing will take almost no time at all--unpack clean laundry, stuff into duffle bag. Done and done.)

The second reason I kind of forgot we were going is that Joe and I didn't really do the planning. This is a trip that we're going on with my family, so my parents made all the necessary arrangements, from flight to hotel to many things in between. The awesome thing about going on a trip with your parents is that your style of travel is immediately upgraded. If it were just Joe and I going, I suspect that we'd probably be flying Coach and staying at a seedy-ish hotel, maybe somewhere close to the airport. But since we're going with my parents, it's Business Class all the way, and a nicer hotel, maybe even without vermin. I am excited about Business Class for several reasons:

1. There's a fancy lounge for you to sit in at the airport. With snacks!
2. More space on the plane. I mean, not that I'm a great big fat person or anything, but I like having room to stretch my legs.
3. Meals on the plane are served with real silverware! (Still plastic knives, though. Thanks, terrorists.) And there are fancy touches, like tablecloths and wine and a fruit and cheese platter at the end of the meal.
4. British Airways sells itself by purporting to have fully reclining seats in Business Class. Obviously, it's not as comfortable as a real bed, but for crap's sake, you're talking to a girl who, as a Sub-I, once took a nap on a carpeted cement floor.

So we're leaving tonight, and returning Sunday of next week. And Monday, we're both back to work--Joe doing his usual Ophtho thing, and me working nights as the second senior on the wards. So maybe the jet-lag will actually work in my favor.

To anticipate when I come back: pictures, of course. Maybe I will make Joe pose with a giant frech bread and a beret in front of the Eiffel Tower. While pretending to be trapped in an invisible box. That would be awesome. Also upon our return, Cletus exposed! That is to say, I'll finally tell you guys the real named we picked out for the kid. (Hint: not "Horseshack".)

Currently reading: "Walk on Water." I first read this book about a year ago, and started my second read yesterday, figuring that it might be even better after three more rotations total through both the NICU and the PICU. And you know what, it really is. I can't put it down. Again.

head out on the highway

I just got back from THE LONGEST FIVE HOURS OF MY LIFE, also known as the driver safety course required by the DMV prior to taking your road test. Most of you normal driving-types probably already took said course or something similar when you were, like, 14 or something, but since I had never officially taken Driver's Ed, I had to take it now. In some ways, it was good (there was a section about the internal workings of a car, for instance, which I obviously knew nothing about) but being there was just embarrassing, because come on, I'm an old-ass lady. The girl sitting next to me was drawing pictures of unicorns in her notebook, OK? I was hoping I wouldn't be the only old person there--being that it's New York, I figured I'd have a nice complement of older immigrants and prospective cab drivers to even out the mix--but I guess those people were smarter than me and found a shady school where they just give you your little certificate without actually making you sit through the class.

AND, they didn't even show that movie "Blood on the Asphalt"! Everyone that I tell about the five hour class is like, "Woo! 'Blood on the Asphalt!'" So I figured that everyone was required by law to see this gory filmstrip featuring REAL LIFE ROAD INJURIES with BROKEN BODIES what with the blood and guts and all. But they didn't even show it! They did show four filmstrips in all, but they were boring:

• "Mister Smith's Guide to Driving." I don't know if this was the real name of the movie, but it was this really old--as in 1960's old--movie featuring this guy Mister Smith who was supposed to be the Grand High Master of Safe Driving or something. I don't know who got to decide that he was, but I suspect it must have been the same person who decided to put him in the movie.

• "The Final Factor." From the title, I thought this was going to be the blood and guts movie, but it was just a movie about defensive driving, and controlling all the factors that you can so that the "final factor" (the thing that you can't control, like a kid running out in the middle of the street) wouldn't lead you to drive your car off a cliff or something. Also, might I note that this movie said that it was OK for a two year-old child to sit in the front of the car, passenger side, as long as they were "restrained in a carseat," which is actually not cool at all. See, here's the danger in showing totally outdated filmstrips from the 70's.

• "The Ride of Your Life." I think this was supposed to be the fun, PSA-portion of the class, because it featured a million different NASCAR drivers talking about how everyone should wear seatbelts. They talked about it for quite a long time, how even though people might think you're a wuss, you should always buckle up. Which was a cute little anachronism, in a way, because I think the movie was made before the seatbelt laws were passed, and there were all these John Q. Public sidewalk interviews where people were like, "It's my choice, and I never wear my seatbelt. Why can't they just make safer cars?" And then they get into their little car with stone wheels and jog themselves back to Bedrock.

• "Don't Drink and Drive." I don't really remember what the title of this movie was, but it was basically a documentary about this Olympic diver who killed and maimed a bunch of teenagers one night because he was DRIVING UNDER THE INFLUENCE. So don't drink and drive.

The most frustrating part about the class was that it could have easily finished in half the time if the instructor didn't keep repeating himself so much. I know that partially it's not his fault, because there's a set curriculum that he has to follow, but...also, partially it was his fault. Because he was just one of these rambling middle-aged-Italian-Dad-from-Canarsie types who just spun out every single story or point to it's maximum length. And for a resident used to receiving all information in bullet form, this was TORTURE.

INSTRUCTOR
(On being the designated driver when people come over to your house for the holidays)
So, let's say that you're inviting people over to your house for the holidays.

MICHELLE'S INNER MONOLOGUE
OK. Guests. Got it.

INSTRUCTOR
You invite your friends. Your family. Your relatives. Your loved ones. Your co-workers. Maybe some neighbors, if relations are good.

MICHELLE'S INNER MONOLOGUE
OK, party, guests, got it.

INSTRUCTOR
They come in, you offer to take their jackets...they take off their shoes...their scarves...their sweaters if your house is warm...

MICHELLE'S INNER MONOLOGUE
OK, I get it. Party at my house. Moving on.

INSTRUCTOR
What's the first thing you're going to offer your guests after they settle in?

UNICORN-DRAWING TEEN
(Tentatively)
A...drink?

INSTRUCTOR
That's right, a drink. Because it's just the social custom, especially during the Christmas holidays, or...(direct glance at Michelle)...whatever you celebrate. You offer them a beer...a bourbon...an egg nog...a hot toddy...whatever.

MICHELLE'S INNER MONOLOGUE
Yes. Booze. Understood. Talk faster, dammit.

INSTRUCTOR
(Continuing)
A Zima...a Long Island Iced Tea...a martini...whatever. Maybe they have some wine with dinner. Maybe a cordial or a port after dinner. Maybe some drinks in between.

MICHELLE'S INNER MONOLOGUE
OK, people are smashed. We get it. Take their keys, drive them home. Moving on.

INSTRUCTOR
You can't let them DRIVE. Because the ALCOHOL, it puts them into a state of ALTERED MENTAL AWARENESS. Things they would do when they're DRUNK, they might not do when they're SOBER. They're ALTERED. They're not THEMSELVES. So they can't DRIVE.

MICHELLE'S INNER MONOLOGUE
You know, this could all have been summed up quite nicely in one sentence.

INSTRUCTOR
Because when they drink a couple of beers...or a few glasses of wine...or some scotch...the alcohol IMPAIRS their ability to THINK STRAIGHT. And DRIVING is THINKING. So you can't let them drive home from your house, even after they put on their sweater...and boots...and scarves...and jackets...and after they finish dessert and everyone opens their Christmas presents...

MICHELLE'S INNER MONOLOGUE
I long for death.

Well, at least that's all over with now. Next up, more driving lessons, and then my road test, hopefully in early May. Let's hope I won't be seeing any "Blood on the Asphalt" before then.

Currently reading: A million back issues of The New Yorker. Did you see the latest cover, with the pregnant lady bunny getting an ultrasound, and the screen is projecting a picture of an Easter egg? Hee.

the doctor is in

So I finally figured out where to hang my old clinic nameplate.







Step into my office.

Currently reading: A very detailed (and in my opinion, excellent) information page on the Terri Schiavo case, including an overview, a timeline, and an FAQ section that encompasses the pertinent facts in this sad story. And may I emphasize again: FACTS. Thanks to Jason for the link.

snips and snails and puppy dog tails

The other night, Joe and I were just lying there, talking about how our days went, when he suddenly said, "I wish we were having a girl."

"You do?" I had had similar fleeting thoughts, though I never said anything about them because I wanted to seem above all the gender fuss. "Why?"

"Because I think it would be easier." Then he went into this whole long story about this patient he saw in Peds Ophtho clinic, a little four year old girl who he just thought was so smart and so pretty and so good that he just decided that he wanted our child to be just like her. You know, all girly.

"Yeah, I know what you mean." I said. "I mean, I don't have boys in my family, so I don't really know, but I'm worried that a boy is going to be all crazed and rowdy and ADD and running around stabbing people with a toy sword. I want our kid to just be..." I tried to think of the word, "...mellow."

"Yeah," said Joe dubiously, "maybe he will be." After which he gave a skeptical glance at his hand on my belly, which was basically absorbing all the karate high-kicks that Cletus was throwing at my abdominal wall in a rush of post-proandial elevated blood glucose. "Really mellow."

"But you know, not all girls are quiet and well behaved."

"Yeah."

"And not all boys are hyperactive and aggressive."

"Yeah."

"And anyway, who knows?" I said comfortingly, "Cletus might be gay."

"That would be fine. Hey, just as long as he's not Republican."

Currently reading: The New York Times review of the Broadway revival of "Who's Afraid of Virgina Woolfe?" Wow, a rare rave, even more rare in the Albee revival category. The casting is so perfect, also--Kathleen Turner as Martha, Bill Irwin (who I saw in another Albee play, "The Goat, or Who is Sylvia?") as George. I wish we could go see it, but fear the tickets are going to be prohibitively expensive and hard to get for all but the most insider-y and connected of theater loyalists. Well, that and celebrities.

love canal

On Friday evening, I starting having pain in one of my molars. It was like that J. Lo song "Jenny From the Block," because first it hurt a little then it hurt a lot. On Saturday morning, I went to a local dentist who charged me $100 to tell me that I needed a root canal (which I had inferred on my own, even without the fancy dental degree), but that they couldn't do anything about it, because their Endodontist didn't work there except for Wednesdays and Fridays, and either way, he didn't accept my dental insurance. Gee, thanks a lot. Please, can I give you more money for being USELESS?

I was trying to hold out until regular business hours on Monday to book an appointment with an Endodontist on my plan, but after a very throbbingly miserable 24 hours of eating only soft solids and things I could drink through a straw, as well as putting an ice pack on the side of my face where my killer tooth was, like someone out of a damn cartoon, I decided that I couldn't wait anymore, and that the tooth needed to be fixed now.

The problem was finding a dentist that actually worked on Sundays. "Who the hell works on Sundays?" I asked myself. Then I looked within and found the answer to my own question. The Chinese. The hardest-working doctors in showbiz! I knew of a Chinese dentist on my plan (I had been her many years ago as a teenager), who didn't do root canals herself, but had an Endodontist alongside in her practice. And he worked all day Saturday and Sundays! And he just had a cancellation! And could I come down right now to be seen? I didn't have to be asked twice, and jumped into a cab postehaste, thus marking the first time in history that I was delighted about a dental appointment.

You see, I have a little bit of dental phobia. It's never like going to the regular doctor, where they just tell me I'm fine and send me on my way. Dentists only deliver bad news. Like that I have 12 cavities on the left side alone, or that I'm not brushing right, or that my wisdom teeth are growing in sideways, or like now, that I need a damn root canal. After all these years of pain, my conditioned response is to wish that I had no teeth at all, and sneakily avoid all interactions with the dental community. I know, I know, this viscious cycle just causes more problems in the long run, but it's hard to will yourself to regularly subject your body to something so unpleasant. Especially post-call, or on one of your rare days off. But save the lecture, I learned my lesson.

So anyway, the root canal. The whole thing actually took much less time than I thought. I was not thrilled with the idea of having to have a series of dental X-rays to get the job done, but I didn't really have any choice, and anyway, between the double lead shielding and my hands over my uterus (which probably didn't contribute anything additional behind the double layer of lead, but was more a function of my neurosis), we avoided turning Cletus into Radioactive Man. (But hey, what kid wouldn't want superpowers? Maybe we should have trained the beam right on him, give him a little leg up in life, you know?) Between the X-rays, the procedure, so far as I can glean, consisted of the following steps:

1. The novocaine
2. The drilling
3. The filing out of the inside of the tooth with what looked like tiny little saws
4. The poking with sticks (unsure what this part was, maybe to make sure they got all the pulp out)
5. The bleaching (I guess this is to kill the wee germs within the nerve space--I don't know what the solution was exactly, but it smelled like a swimming pool)
6. The poking with other sticks
7. The drying of the inside of the space with little paper cones
8. The filling with dentist goo
9. The packing with other dentist goo
10. The fitting of the temporary cap
11. The old rinse and spit

Shockingly to me, all of this was done with a minimum of pain. I mean, the shot in the beginning kind of hurt, but my mouth was hurting even before the shot, and since the shot was filled with sweet, sweet local anesthetic, I was more than glad for him to jam that sucker into my gum. Come on baby, make it hurt so good.

The endodontist turned out to be a rather young guy who, coincidentally enough, went to dental school and did his residency up at [University Hospital]. This, I've found, is the best connection of all in the medical world, because everyone wants to help you out when they feel like they know you. We spent a good ten minutes shooting the breeze about the hospital and the neighborhood, until he put that dental dam in and all my conversational contributions got reduced to a "uh guh guh huh" or vehement thumbs up or wagging of the eyebrows. (After a while, he caught on and only asked me yes-no questions.)

"So you're going into anesthesia?" He said conversationally, before the yes-no rule was established. "What makes someone decide to go into anesthesia anyway?" I sat there blissfully, numbed up to the gills, in no pain where there once was excruciating pain, and thought, isn't it obvious?

Anyway, I'm going back to see General Dentistry on Thursday to get my permanant filling placed, and maybe to get my permanent crown fitted. Right now, even though the local has worn off my tooth is still a little sore but still one hundred times better than it was before the procedure. I love my new dead tooth!

Currently reading: "Persepolis 2" again. My tooth was hurting so much before that I couldn't concentrate on anything without pictures.

no more school forms, no more books, no more teacher's dirty looks

Today was my last day ever in Pediatrics clinic. After I saw my final patient, I took my name plate down and brought it home with me. The end of an era. Who knows when I'll be practicing outpatient office medicine again? Maybe never.



Not that I'm done with Peds entirely. For various reasons that I'm just too tired and annoyed to detail, the official date of my switch has been pushed back to July, before which time I'll still be rotating through the ER, the wards, the PICU, and wherever else the Chiefs decide to put the most malleable of their cheap labor force (read: me). However, because my old switch date was set for April 1st, and my clinic closed out my appointments anticipating that I would be gone, my two years in Peds clinic ended today.

Part of me is glad about being done with clinic. Just the thought of never having to fill out one of those Department of Education school forms again is enough to make me throw up my hat in the air and spin in a circle, all Mary Tyler Moore style. But it's sad to think about leaving my patients. It's sad to think that I'm not going to be anyone's doctor anymore. I mean, of course I'm always going to be someone's doctor, because duh, that's my job--but it's different being someone consultant, short-term doctor than to be someone's primary doctor, the person you think of when the commercials say "Ask your doctor if Cialis is right for you" or when your gym teacher says, "You need a note from your doctor saying that you can try out for the football team." Those are my patients. I was their doctor. Some of those kids, I've been taking care of since they were born. Now they're walking, talking kids. True, they're not talking a whole lot, I haven't been around that long, but enough to get the point across most of the time.

Now I'm just a free-floating Pediatrics resident. A mercenary. I don't have my practice anymore. All my patients are going to other people. Some of those kids I'm really going to miss. Especially the cute ones that didn't try to kick me in the face or pee on me.

And yet...no more school forms! Woo hoo!

Currently reading: The New York Times review of the new Woody Allen movie, "Melinda and Melinda." Not that it really matters what A.O. Scott says, because I'm going to see it anyway. Much has been made in the decline of Woody Allen's work in the past decade or so, but it doesn't stop me from perpetually pinning my hopes on the next film. And in case you want to know, the best Woody Allen film of the past five years is "Sweet and Lowdown." The worst, a tie between "Curse of the Jade Scorpion" and "Hollywood Ending" (though now that I consider again, I think "Hollywood Ending" wins by a hair, what with the casting of Tiffany "Kelly Kapowski" Theissen and all).

post-call st. paddy's grab bag

It's starting to get a little warmer around here. And I mean warmer as in "no ice, no snow," not warm in the objective sense of the word. A daily high temperature in the mid 40's is not warm. But it's warmer.

Every year, when it gets to the dregs of the winter like this, I think about what it would be like to move to a warmer climate. Not fantasy warmer climate, like Hawaii or something, but just somewhere a little more temperate, like Florida or Southern California. They must have such nice winters there, all mild and such, like Spring all year round. (Except for the parts of the year where it's summer.) And I think about sitting on a lawn during a balmy winter afternoon, sipping on an iced tea and wearing flip flops, and think, that would be nice. But then I think about driving to the strip mall and cleaning the gutters and mowing the lawn and making sure the raccoons don't get into your trash and give your dog rabies. And that bring out all my latent suburbophobia, and I snap out of my little fantasy petty fast.


* * *


I remembered--but only because the Chiefs sent out an e-mail reminding me--that today is Match Day for next year's intern class. Which for me right now is a little bit of ho, and a little bit of hum. Of course it was a big deal when I was a fourth year med student, in fact it was THE big deal, the culmination of everything EVER, or so it seemed at the time. But I often wonder if I would have been as gut-bustingly excited about the match if I had really known what future lay waiting for me. (Residency, that is. Two different residencies, in the end. Many many years of indentured servitude, more like it.) Even last year, I was kind of excited about the Match. Aside from having a lot of friends that were matching a year late (having taken a year off for research or what have you), it's always a nice feeling as an intern to know that new blood is on the way, and this too, shall end. Kind of.

It's convenient that Match Day is on St. Patrick's Day this year, though, don't you think? Why, that's twice the reason to get utterly obliviated. For those of us who drink, that is.


* * *


(OK, don't read this next part if you don't want to think about boobs. And not boobs in that sexy way, boobs in the biological way. OK, I think I just lost 90% of the porn seekers right there.)

I've been doing a lot of research into this whole breastfeeding thing, what with the pumps and storage methods and techniques--and what I've concluded is that while I'm definitely going to give it the old college try (actually, let's call it "the old med school try," which implies more dogged persistence), it's all going to be somewhat logistically difficult. Let's just examine the facts here, shall we?

I'm probably going to be going back to work about 5 weeks after having the kid. I know, I know, it would be nice to have more time off, but that's not really how it works around here. So five weeks. Five weeks to rev up my milk supply, feed the kid, and stockpile some for when I go back to work. Fine. Let's make the rather large assumption for the moment that this is going to work. The problem is, how to keep having boob milk to feed the kid after I return to the hospital? Everything that I've read in terms of successful pumping seems to go against every tenet of the medical resident's lifestyle. Behold:

• "Make sure you get enough sleep." Ha! Moving on, then.

• "Try to pump every 3 hours." Um, OK. I don't really know how this is going to work, since I haven't started with anesthesia yet, but I'm not sure I'm going to have a break from the OR every 3 hours to go pump. We have a 15-minute mid-morning break, and a lunch break, but I think that's pretty much it.

• "Stay well hydrated and have some healthy snack on hand to munch on throughout the day." OK, again, this is going to be hard. Obviously, there is no food or drink in the ORs, so I'm either going to have to chug water before going in there and have to pee rather badly for many hours at a time, or I'm going to have to reserve water and food for my break, during which time I'll probably be pumping, peeing, and eating all at the same time. These are all such pleasant images, aren't they?

• "Stay warm, to help with milk letdown." The ORs are freezing.

• "When it comes time to pump, find a nice, relaxing environment, put your feet up, listen to music, and try not to think about work." I have no idea what kind of space the anesthesia department has for such, uh, private activities. They actually were lovely to me when I told them about Cletus, and gave me all kinds of suggestions about childcare and the like. But a private room for pumping? I have a sneaking suspicion that said room may also contain a toilet.

• "If you work many hours during the day, try to give your baby unlimited access to the breast at night." Yeah, but then...when do I get to sleep?

Well, it all comes down to this. I'm going to try. I'm going to try really hard to make this all work, because we all know that Breast is Best and blah blah blah, I don't need to go through all the research and studies again because for crap's sake, WE KNOW already. (To wit, from Napoleon Dynamite, "Maybe I will, OK? God!") But here's what it comes down to. There are a lot of things to do, and a lot to take care of with a new baby. And the one thing I don't want us to neglect is that fact that we should actually be enjoying the experience. It shouldn't be a schlog, this joyless burden of tending to task after task after task. I don't want to lose sight of the forest for the trees and all. And you know what, this kid is going to turn out great, no matter how long we breastfeed for. I know that in today's overachieving super-mommy society, this has become unacceptable, and people will chase you through the street with lit torches if you even intimate that you're not breastfeeding straight through until age 1, but believe me about the kids--if you love them, they turn out OK. You know, as long as you're not beating them with bats or locking them in closets or anything like that.

So we'll go for it. We'll give breastfeeding it the old med school try, all dogged determination and all that. And if after all the trying and plotting and planning and research, there comes a point where it just becomes untenable for whatever reason to maintain the boob juice output, we'll say "fine" and switch over, and be OK with that too. Because (and I know this is heretical for a Pediatrician to say such a thing, but) there are more important things in life.

(However, any advice or recommendations about breast pumps, schedules, strategies from people who have been in similar work/child situations are welcomed and appreciated. You all have given me really good advice in the past, and I'm indebted to you. Thanks!)

Currently reading: OK, I finished "Deception Point" yesterday, so now I can recap. NASA discovers a meteorite with fossils on it frozen in a glaciar. Fossils from outer space! All these scientists agree that they are SPACE FOSSILS! But they are not really space fossils, they are fossils of GIANT DEEP SEA LICE. The data was FABRICATED to skew the presidential election! But then the scientists realize that they have been DUPED, and then people try to kill them! With ice guns! And they are chased into the Arctic Ocean, and almost die, but then they don't! And they end up on a boat over some GIANT MAGMA SPHERE surrounded by HAMMERHEAD SHARKS that will kill you if they even smell one drop of blood in the water! Did I mention that they got SHOT AT with ICE GUNS? And one scientist escapes certain death by shark attack by PEEING on himself to cover up the blood smell! Also, he is fat and likes to eat a lot, did I meantion that? Because he's a nerdy astrophysicist. But the two other "scientists" are good looking and end up falling in love and DOING IT in LINCOLN BEDROOM in the end. Oh, and also, the evil politician who's running for the presidency accidentally exposes himself in a sex scandal with his hot aide, who is ultimately disillusioned with Washington politics and sells him out. And then in the END end, after the TRUTH HAS SET THEM FREE they drop the deep sea lice meteorite back into the ocean from whence it came.

Actually, when I recap it like that, it sounds pretty much like the best book ever.

the other side of the stethescope

I had an appointment with my OB earlier today. Everything went fine, but I felt like the whole visit was a little rushed--she blew in and blew out, with the standard reassurances that everything was fine, with instructions to come back in four weeks. You know, not like there's really anything to a routine prenatal exam, but this is my first time around, you know? There was a point where I could have slowed her exit a little, when she asked me (hand on the doorknob) if I had any questions--but I didn't have any questions, so I said "I guess not," and that was that. What this really makes me think of (aside from the standard gripes about HMOs and time limits on provider-patient interaction, blah blah blah) was, "I wonder if I'm like that with my patients?" The answer is probably yes. There's so much time pressure at my clinic and so many kids in the waiting room that sometimes when I ask parents if they have any questions at the end of the visit, what I really feel like I'm saying is, "so are we done here?" And I forget that what's "routine" for me may not be so routine for the parents, especially the new ones. Maybe my patients are walking out of my room thinking, "She seems nice, but she's always in so much of a rush."

Now I feel all guilty.

Currently reading: This article about "lotus birth." This is not something I'm considering, just something I happened upon by following a link, then another link, then, well, there it was. For those who don't want to read the whole article, the long and the short of lotus birth is that it's a practice wherein the placenta is left attached to the baby for days after birth, until it detaches itself when the umbilical cord dessicates and falls off. Hey, I'm all for accepting other people's belief systems, and demedicalizing the birth process if that's your thing, but...GAAH! Here, a quote from the article: "The placenta, too, dried and shrivelled due to our salt treatment, and developed a slightly meaty smell, which interested our cat!" Again...GAAH!

that popping sound

In most of the pregnancy literature that I've read (and I don't mean the scientific literature, which I periodically browse just to make sure I'm not killing Cletus dead by partaking in some low-level caffiene intake, but the anecdotal literature) everyone mentions a point in pregnancy where you "pop." That is to say, a point in your pregnancy when your uterus decides DAN, I WON'T BE IGNORED, like Glenn Close in "Fatal Attraction," and busts out of the nice little niche it was sharing with your pelvic and abdominal viscera because it's a big, fat selfish organ and it NEEDS MORE SPACE. At some point three or four days ago, this has happened to me. I have "popped." Like a balloon. Or a zit.



(Compare this to last week to see the difference.)

The positive side of this "popping" phenomenon is that people are finally starting to catch on that I'm actually pregnant, not just that I ate three cheeseburgers for lunch. This generates a certain degree of good will, although it's inviting more unsolicited advice as well. The minus side, physically at least, is that it's gradually putting pressure on my belly-button such that the tiny "hidden" scar from my lap appy is becoming progressively less tiny and less hidden. Instead of being nicely tucked away inside my navel, it's now hovering just above, all hyperpigmented and puckery looking. It's not even a glamourous scar that I can show off, like a scar from a suba-diving accident or a daring mid-air helicopter rescue. This scar just looks like belly button lint.

And also, here's a little photo for those who doubt the destructive power of The Coop:



I stopped by Walgreens on my way home from work and picked her up a little stuffed dog toy. This picture was taken within five minutes of me handing it over to her. She does not seem to understand that tearing apart your fun squeaky dog toy means NO MORE TOY. What, do you think dog toys grown on trees? (Well, I guess they do, if you're the stick-fetching type of dog. Ours is not.)

Currently reading: This article in The New York Times about the plans that the newspaper may have to start charging people for for access the online edition. Gah! No! Can't I just promise to click on some of their stupid banner ads and we can call it even?

finally, a little honesty

I was just in a patient's room, getting ready to TPA her PICC line, when I told her (she's four years old, by the way):

"Now don't worry, sweetie, this isn't going to hurt. And I mean that in a real way, not the fake way that all of us doctors usually say something isn't going to hurt but then it really does. This time, I'm actually telling the truth."

She looked back at me, eyes big as saucers.

Currently reading: "Deception Point." At this point, I'm just reading so that I can finish the book. So then I can BURN IT.

call room etiquette

Did you know I've been on call three out of the past four Fridays? Not that I'm complaining, but...OK, maybe I'm complaining a little.

I have this new post-call dinner treat, though. I picked it up at my local gourmet food-mart (beloved peddlers of intact, non-dusty fruit and ready-to-eat meals) and have been enjoying in for my past two call nights. It's a chicken quesedilla. Which sounds kind of Taco Bell, but you have to trust me when I tell you it's a fancy chicken quesedilla. It comes with cheese and tomatoes and chilis and, uh, chicken (duh) and when heated up in the microwave for two minutes, it bubbles quite nicely into a tasty and self-contained dinner. I think it could actually be even better if I heated it up in the toaster oven instead (microwaving has the unfortunate effect of rubberizing the edge of the tortilla), and had some salsa for dunking on the side--but there's no toaster oven in the nurses lounge, and I'm not prone to carry a little jar of salsa with me to work. I don't like to make myself too much at home while at the hospital. Helps me remember that I actually do get to leave once in a while.

I was sharing call last night with one of the Onc fellows, who I really like as a person and as a senior-type guy, but whom I'm told snores rather loudly. So rather than having to go through the whole "will you take the top bunk" rigmarole and possibly embarrassing him (he seems kind of a conservative, I don't know if he'd be into sharing the call room with someone of the female persuasion), and possibly end up getting a poor hour of sleep anyway, I just avoided the issue altogether and found another call room. The issue of co-ed call rooms rarely comes up, I guess mostly because the majority of the Peds residents are women, and on most services you don't take call with another person anyway. But it happens sometimes. I remember my intern year, sharing a call room at [suburban community hospital] with my senior, Matt, and the two of us lying there, chatting in the dark like Ernie and Bert. (Like Ernie and Bert, of course, there were two separate call room beds, side by side--though Matt insisted that I take the crappy fold-out cot while he took the more comfortable patient bed, because I was the intern. What is this, the army?) Not that it was super-uncomfortable or anything like that, because whatever, we're adults. But it was kind of weird.

But at least Matt was normal about his call sleeping habits. One of my attendings just told me a story about a guy in her residency program who used to strip down to his underwear when he got a chance to sleep on overnight call, regardless of the company he was keeping in said call room. First of all--ew. Have you seen the resident call rooms? Are you sure you want to expose that much skin to the elements? Lord knows what might latch onto you and start growing. Second of all, what if there was an emergency? What if someone coded and you had to run quickly to a patient room in the middle of the night? Do you just go, and start bagging the patient and pushing epi in your boxer shorts and socks? Or do you tell the kid, "Hold on a second, I know you're dying, but I just need to put on my pants first."

Currently reading: A CNN brief about President Clinton's recovery. I walked by a whole row of those news vans on Thursday afternoon, and was amazed by how weird the newscasters sounded when they were talking on camera. It's like how models walk down the catwalk, all exaggerated with their hips swinging and legs clopping. The newscasters use this loud, bluff tone with exaggerated intonations that plays well on TV (I guess, I never really thought about it) but sounds really weird when you hear someone talking like that in front of you in real life. Anyway, I'm glad El Prez is doing well, and wish him the best.

re-discovering the wheel

While I'm always trying to kill or maim as few people as possible over the course of my average day, these restrictions usually just apply to work. You know, in the hospital. With the sick people. But now I'm branching out (again) to the world of killing people in entirely new high-impact ways. I'm restarting my driving lessons.

(Past adventures in my learning to drive can be reviewed here. Kind of sad really, because that entry was written like, four years ago, and here I am still without a driver's license or the wherewithal to obtain one.)

Let it be known that if I had it my way, I would still be sitting on my non-driving ass, taking totaly advantage of public transporation and the driving expertise of others. But I have been GUILTED into learning to drive by my BATTLEAXE HUSBAND, who thinks it is obscene that I'm going to be someone's mom and not know how to operate a motor vehicle in case of emergency.



MICHELLE
But we live in New York! I could just take a cab!

JOE
Yeah, but what if we don't always live in New York? What if we end up doing fellowships anywhere else in the country, where you have to learn how to drive? Not knowing how to drive means that we can never live anywhere other than the island of Manhattan.

MICHELLE
(Evil mastermind voice)
Exactly.


Though I have to say that the man does have a good point about having options, even if it is just the option to drive to Costco in New Jersey with all the other breeder-types to buy some industrial sized drum of peanut butter (or whatever it is that parents buy in bulk). And I also think that my consistently early work hours next year coupled with the one-hour plus public transportation commute uptown at that hour (contrasted with the 20 minute rip up the FDR in a car) makes having the ability to drive mighty tempting. Why, that's 40 extra minutes of sleep! Or, 40 extra minutes of staying awake with a squalling infant, whichever's your pleasure.

Of course, we all understand that driving in New York isn't real driving. Many perfectly competent everyday drivers refuse to drive in this city, citing sanity and the preservation thereof. With respect to driving, as with respect to many other facets of life--New York City just isn't normal. How else could you explain the fact that there's no mention in the DMV driver's manual of:

• The crazy hoards of pedestrians, from the most thuggish of teens to the most well-groomed business woman, nonchalantly darting across the street against the light in the middle of the intersection like they're playing a damn game of Frogger. Do you know what happens to that frog? That's right, HE DIES.

• The garbage truck lumbering the wrong way down a one-way street, head-on towards you.

• The distraction traffic. What do you do when you're driving down a street sandwiched between a bus and another bus, with a Snapple truck unloading in front of you and fifteen people honking in back of you because you're not magically finding a way through all of this? Turn your Batmobile into a plane and fly away?

• The cabbies. Oh, the cabbies. I need not say anything more than...the cabbies. Oh wait, I have one more thing to say. How could they get their drivers licenses and not me? HAVE YOU SEEN THEM DRIVE?

That aside, given that I haven't been behind the wheel since my third year of med school, I think I did reasonably well today. Why, the instructor only had to use his little instructor emergency brake once! And that old lady had only minor injuries! (Kidding. What really happened is that I almost missed stopping at a light that just turned red.) We drove down around Alphabet City, around the Financial District, and then back up. Alphabet City was fine, but I do not recommend the Financial District as a good place to practice common-sense driving under real-world conditions. It's like insanity down there, between the narrow streets and the pedestrian volume (local and tourist) and the general chaos that ensues when you mix cobblestones and commercial traffic. Pretty for commercials, not pretty for my serenity. I think I have to go lie down in a dark room now and think of calming things. Like bunnies. Or taking the subway to work.

Currently reading: Believe it or not (and I'd be inclined towards the "not" were I you, because it defies common sense) I'm still chipping away at "Deception Point." Did I mention how totally sexist this book is? Like how the super-genius science woman has to act all butch to prove that she's smart, and "degradingly" calls the men working under her "ladies," like some sort of fucking high school gym teacher? Ugh.

halfway mark

We're at 20 weeks this week. Twenty down, twenty more to go! Well, hopefully, anyway.





As you can see, I've taken the sage advice of some of my genius readers and invested in a pair of Old Navy jeans two sizes up from my normal. Brilliant! Man, now I wish I had never bought those nasty stretch panel jeans in the first place. The regular jeans in a bigger size look much better, and there's still room to grow, as evidenced by my plumber's crack and the frequent need to keep hiking those babies up as they threaten to slide off the shelf of my butt. Maybe I should start wearing boxers and gold chains, and start rapping about how it's all about the Benjamins.





Thanks for all the advice regarding creating a harmony between Cooper and Cletus, by the way. I think the dog is going to be fine, she's just going to have to learn to deal with some changes is all. Anyway, she'll be three years old in September, which is the age that (we're told) most dogs start to mellow out, so that will make things easier too. We took her with us to Buy Buy Baby this weekend--not as some sort of a test drive of dog in baby world, more just because she needed to get out of the house--and she behaved reasonably well, garnering praise and admiration for her obedience and general cuteness, despite not being one of the multiple breeds of "purse dogs" favored by so many monied New York City dog owners. Of course, they didn't see the part where she tried to steal a teddy bear out of a furniture display and climb up onto one of the upholstered twill gliders so that she could gnaw her prey to pieces. But other than that, total obedience!

Onc call was a strange experience last night, because it was the first time I've ever taken call side-by-side with an attending. And I mean really side-by-side, because she was moonlighting, and therefore took the other half of the service, as well as the other half of the call room. It was like being at the strangest sleepover party ever. She graciously ceded the bottom bunk to me, but I have to say, it was strange hearing her get nursing calls at 2am, and then hearing her clank down the bunk to go examine a patient or go push morphine. An attending getting up in the middle of the night to push morphine? Worlds are colliding! It was disorienting, a total slap in the face to the traditional medical heirarchy--I almost felt like I should subjugate myself and just offer to do it for her, even though the role of the moonlighter is really to act as a second resident on the service, including all the unglamourous parts. (Read: all of it.) Still, she was getting paid $100 an hour to push that morphine, so I didn't feel too too bad.

Currently watching: "Garden State." Not bad. Reminded me of "The Graduate" in a lot of ways, including the part afterwards where I really wanted to buy the soundtrack.

interspecies integration

Today is one of those days where you can just feel Spring trying to break through. Trying and failing, because it looks like it's going to snow again by the end of the week..but I applaud the effort. I took the dog to the dog run for a little exercise, but we had to cut the outing short because she was being a surly adolescent dog, snapping at puppies and absconding with another dog's toys. She doesn't even want to play with the toys, because she drops them right away once no one is paying attention to her anymore. She just wants the things that other people have.

Which brings me to a touchy topic. How to deal with the dog once the baby comes? I say touchy because more than a few people have already asked us if we're getting rid of Cooper because of the new addition. And they asked us all casually, as if such a decision were assumed. Out with the fur child, in with the hairless one. Well, I can tell you right now that the answer is no. We have not considered it, we will not consider it. But that's not to say that there will not be issues with integrating the the two youngest members of the family. Problems that I can forsee right off:

• The dog gets jealous. Even when Joe and I are hugging, she has to run right over, and starts whining and howling until one of us breaks away. I would like to think that she's jealous of Joe for the attention that I'm giving him, but knowing how much she LOVES Joe, I think it's probably the other way around.

• The dog likes toys. If you don't have a dog, you probably don't know this, but many dog toys and baby toys are virtually identical, especially those of the stuffed, squeaky animal variety. Sure, babies don't play with giant thick cords of "dental" chew rope impregnanted with flouride, but unfortunately, there are few baby toys that a dog would not find very attractive. But Coop doesn't just play with the toys. She destroys them. For her, the fun in the toy is ripping a hole in it and pulling out all the stuffing. So fun! Stuffing everywhere! Whee! So I don't know what we're going to keep her from laying seige to the baby toys, unless we keep them locked in some toy chest somewhere, in which case they're no fun for anybody.

• The dog is very protective of the homestead. She could be dead asleep, but if she hears a pin drop in the hallway, she's up and running to the door, barking like a madman. Right now, this is just annoying, but I can imagine that "annoying" won't just cover it when we have a sleeping baby in the house. I would start buying stock in those white noise machines if I were you, because I think we're going to end up with 20 scattered all around the apartment.

This is making it all seem very dire and terrible, like we have some sort of an incorrigible mutt, and we are threatening the very life of the baby by bringing him into the same home as the Hound of Baskersville. But Cooper has some very promising behaviors too. For instance, she's never posessive of food, and she never growls when you get near her bowl or try to take it away. She can be a little touchy with other dogs, but she's always friendly with humans, even very small humans that we've encountered on the street or in stores, what with the tail-wagging and face-licking and whatnot. And she's just generally a good dog. She's goofy and playful and fun, and much of the reason that we got a dog in the first place is so we'd have a nice family dog when we started having kids. I do think that Cooper's going to be that nice family dog. But I'm not saying that she doesn't need a little help to get there. Any advice that the more experienced of you out there may have to offer on this issue I would be more than happy to receive.

(But don't advise us, "Get rid of the dog." Because that's off the table.)

I'm on oncology cross-cover tonight, but since last I covered oncology, I think the hospital has been hiring moonlighters to cover part of the service overnight in addition to the slotted resident. I guess the "safety" arguments finally kicked in, what with a census this year regularly topping out at 30-plus onc patients. So if there's a second person on overnight, that should make my night a little lighter, at least patient-load wise. I'm not crazy about the idea of sharing a call room again, though. I haven't had to share a call room with someone since being on the wards in November, and at that point, the top-bunk-bottom-bunk shakedown was not an issue for me. But now, being somewhat more unweildy and with my center of gravity being thrown off, I think I'm going to have to request--nay, demand--the bottom bunk. It's hard enough for me to roll out of bed now as it is. The idea of tottering down a bunk bed ladder in my socks in the pitch dark is not something Cletus nor I want to contemplate.

Currently craving: Chinese noodles from down the street. I think it's time for lunch.

i don't know nothin' 'bout birthin' no babies

Today was a major errand-running day, to the tune of stopping by Home Depot (for power strips, and to get ideas for shelving for Cletus's room), Bed Bath and Beyond (to get some new accent pillows/dog toys for the couch) and Buy Buy Baby (to immerse ourself in a whole new market of prospective things to purchase). Buy Buy Baby was particularly fun, because we were just trying out everything in the store--ratting all the cribs to check for sturdiness, planting our asses in all the rocking chairs, and pushing around all the strollers like stunt drivers in "The Dukes of Hazzard." One of the salespeople in the stroller section gave a crowd of us a very compelling spiel on the relative merits of the Bugaboo over all others (though not stating the implicit sales hook that the stroller will make you beautiful and popular, and make your child an obedient, sleep-through-the-night-from-birth supergenius), and now I'm a little embarassed to admit that Joe and I are obsessed with this stroller. Especially the orange one. Maybe this is what happens when you don't care about cars. You channel all your energies into finding a really trendy stroller on which you can install rims and ground effects.

I would like to talk for a moment about childbirth classes. Is that what they're called? Labor classes? Push out that piglet classes? Well, either way, you know what I'm talking about, the class that teaches you and your uterus how to have your baby. About two months ago, my OB recommended at my last visit that I call to sign up for the class, because spots fill up fast, and "you don't want to get shut out". I still haven't called. Because I don't want to call. Would it make you think I was a ridiculous person if I admitted that I really don't want to take this class? Like, at all? No desire. No curiosity, no urge to take control, stay ahead of the curve, any of that. Here are the reasons that I don't want to take some baby birthing class:

• I don't want to be all crunchy and granola, talking about my body being a beautiful flower and the light within. I am not into the biology of this whole pregnancy thing. At all. In fact, if there were some non-surgical way that they could extract this kid when the time comes, instead of me having to go through labor, I would totally choose that. Especially if they could do it while I was asleep.

• I spend a lot of time at the hospital. I practically live at the hospital. The idea of voluntarily signing up for a class that necessitates me spending even more time at the hospital during my off-hours is not enticing, to say the least.

• I don't want to be all laying out on the floor scattered among a bunch of other, pregnant ladies, all bloated and breathing heavily, like a pod of beached whales requiring Coast Guard intervention. That's just...no.

• Even though my OB has assured me that she herself (an OB/Gyn!) and many of her MD clients have taken said childbirth classes, there's still a part of me that feels like, "These classes are for civilians, I'm a DOCTOR for chrissake, I don't need some hippy class explaining to me how to have a baby!"

• I have been to many, many, many deliveries during med school and residency, and I have to say that when it comes down to actually popping that kid out, the benefits of said classes are dubious, at least from my point of view (at the foot of the bed).

So of course, I'm being totally unfair to the classes, and close-minded and all that, and why don't I just give it a chance, maybe you'll actually learn something, jackass. Yes, yes, I hear you. I hear what you're saying. I hear what I'm saying, in trying to talk myself into taking the class. But I just don't want to. I don't want to take the baby expelling class. And if that's not good enough, then Cletus can just stay inside there for all I care.

Currently reading: "Reefer Madness." Interesting. We use Marniol for our onc patients sometimes as an antiemetic and to boost their appetities, but I've heard (anecdotally) that the inhaled form of THC works much better.

hasta la vista, babies

Last night was my final NICU call. Possibly ever, unless I get called in for sick call in the Spring, which I obviously hope to avoid. It's a little sad, because really, I don't mind working in the NICU. In fact, I'd take the NICU over plenty of other rotations--the ER, for instance, which I truly abhor. (Sorry, ER cowboys and cowgirls, but I really do hate it. Though it's probably more true that I just hate the ER at our hospital, not the field of Emergency Medicine itself, but regardless of the reason...HATE. The ER.) I was thinking over today why it was that I found the NICU so palatable when so many others hate their time there, and I decided that a lot of it was that the NICU babies are the least difficult patients of all to deal with. I don't mean that they're not medically difficult, because obviously they are, it's an ICU after all--but I just mean they're easy to handle. For instance:

• NICU patients rarely smell bad.

• NICU patients rarely cry and scream and fuss and make a scene. It's the quietest room of 60 babies you'll ever see.

• NICU patients will almost never knee you in the groin or kick you in the gut. Need to draw blood or do a test on a NICU patient? You don't need to call in three nurses and your burliest med student to hold the kid down. One other hand is all you need to keep that kid from moving around.

• Hate it when patients talk back, refuse their meds, or are generally non-compliant? The NICU is the place for you!

I guess the above really just makes it seem like I'm this bossy wench who just wants my patients to do exactly what I want them to do. And who knows, maybe it's true. After all, I have ultimately chosen to go into a field of medicine where most of my patients are going to be rendered unconscious. And in which I'll be doing the rendering. Want to complain about your medical care and how all your doctors and nurses are idiots? Here's a little propofol--how do you like me now?

I got home post-call and took a very, very long nap, from about 1pm to 6pm. Which means that my sleep schedule tonight is going to be all screwed up. One of these days, I should just start setting my alarm clock post-call, to prevent me from doing just that. But the indulgence of the inregulated post-call nap is a luxury that I'm not ready to give up just yet. Plenty of time for sleepless nights to come.

Currently watching: "King of the Hill." I don't watch "The Simpsons" anymore--despite my frequent quoting from the classic era of the show, I think it started to run out of steam around the time that I was in college--but I still love "King of the Hill."

unsolicited advice

I've not gotten a lot of unsolicited advice yet with respect to my pregnancy, because I've mainly only told friends and family about Cletus, and I'm not really showing enough for most other people to guess that I'm pregnant. But today I got a little taste of what's to come. And I don't think I like it.


MICHELLE
(Wandering over to a nursing pod, eating a cup of Japanese rice crackers and drinking an Orange Slice)

ATTENDING
(Eyeing snack disapprovingly)
Are you sure that's good for the baby?

MICHELLE
(Looking around NICU)
Which baby?

ATTENDING
(Glare)

MICHELLE
Oh, that baby. I mean, uh, this baby. Oh, it's fine. See, it's just rice crackers. (Showing her) Rice! And an orange soda. Uh...fruity! See?

ATTENDING
Are you drinking enough milk?

MICHELLE
Well, I'm not really a big fan of milk. I don't like how it tastes. But I'm eating a lot of dairy. Yogurt and cheese and stuff.

MICHELLE'S INNER MONOLOGUE
And ice cream.

ATTENDING
You should be eating dairy. And more protein. Fish is good, you should be eating fish.

MICHELLE
No problem. I like fish.

ATTENDING
The omega-3 fatty acids are very good for fetal development.

MICHELLE
Just had a tuna sandwich for lunch, in fact.

ATTENDING
(Darkly)
But not tuna. Tuna is bad. Because of contaminents.

MICHELLE
Oh, you mean like mercury?

ATTENDING
(Ominously)
MERCURY.

MICHELLE
Well, I don't really eat tuna all that often. And anyway, it was just half a tuna sandwich.

ATTENDING
You should eat salmon. Salmon is safe.

MICHELLE
(Agreeably)
Sure, I like salmon.

ATTENDING
But not Atlantic salmon! Atlantic salmon is contaminated too. You should only eat Pacific salmon.

MICHELLE
Uh...OK. I'm make sure I stipulate Pacific salmon the next time I go to the fish...eating...place.

ATTENDING
You don't want to hurt the baby!

MICHELLE
No, I don't. Now if you'll excuse me, I have some crack to smoke.

(Exeunt)


I know that people are just trying to help, and be nice, and to school me on what does a gestating fetus good. But for chrissake, I'm only going to use reasonable caution in deciding what I eat, and not go all hippy-trippy and Mother Earth, eating only things hand-picked by artisans or caught in hemp nets. At least at this stage, I can play civilian with the unsolicited advice, because I don't know as much about Obstetrics as I do about some other parts of medicine. But I swear, if people start coming up to me after we have this kid and start giving me advice about how I'm feeding/dressing/handling/rearing the little sucker, I'm just going to staple a copy of my "Michelle Au, MD, Pediatrics" business card to their foreheads. And I thought I wouldn't find a use for all the extra Peds business cards I'd have lying around after I switched to Anesthesia.

Currently reading: A discussion if mother drive-bys (or unsolicited parenting advice) on Chez Miscarriage. Thanks to Kim for the link!