Welcome to Ohio

I love Ohio. I'm starting 3rd-year rotations next week and we are settled into our new apartment. Now I await board scores. G-d-willing I passed. Other than that, this no-stress time in my life is fantastic. I have slept more in the last week than I have in two years. It's wonderful.

One block from our home is a park. It's like going to a United Nations conference. The diversity and camaraderie are amazing. Everyone is so nice. People are exactly who they want to be or are becoming who they want to become. It's such a unique area. Love it!

I'm very excited to serve the patient population here. I like that I will get to meet so many different types of people. I get the opportunity to learn not only medicine, but how to care for people on a very individual level. From the Amish, to Orthodox Jews, the Urban black - it's all here.

I'll let you know how it goes. My first rotation - rural medicine.

I the meantime - I'm going to go get some coffee.

Retard

Retarded. Slow. Someone who is retarded is slow. Someone who is a "retard" is a moron. No, not the definition of moron, a person with a mental age of 7-12, that's probably the definition of the person using the word "retard." Said "retard" is usually doing something that is considered stupid or otherwise uncool - often considered moronic. The standard moron is generally someone who would be concerned with appearing cool.

I challenge that your average retard - with an IQ of below 75 is probably operating at a higher mental age than your average moron.

The moron is concerned, because their mental age is probably permanent. However, they don't fully realize this. The moron will go on to live an utterly average life, always thinking he is better than a retard.

A retarded person, well before the moron, understands love and kindness. A retarded person does not understand hate. A retarded person excepts differences and embraces them. A retarded person is usually very gifted - in ways many people above a 75 IQ can't understand. It's a little too complicated for us. Example - a retarded person sees someone who is sick, dirty, homeless, possibly mentally ill lying on the sidewalk. The retarded person will note that this person needs some water and something with which to clean up. The retarded person, without hesitation, will offer help. Trusting completely. Knowing how to help. Loving unconditionally. I dare say, the entire country would be a veritable utopia if it were run by retarded persons and not morons.

Yet we are ashamed of retards. We look away, embarrassed by their utter disregard for our seemingly important conventions.

I'm thinking about this as I study congenital abnormalities and I'm faced with too much reality. Abortion. What do we do when we know the child is retarded? Abort. Not always. Certainly not, but often. Why? Really. Why?

I'm not with false hopes. I know that trying to get a child with Down Syndrome to understand that you're going to the park at 3:00 and it's only 10:00 is extremely frustrating. They have no concept of time. You will be asked 10,000 times if it's time to go to the park. No, you can't hug that stranger. Why? I don't know, it's weird.

I beg of you to say, "no" to all the prenatal testing. Cystic fibrosis? Abort. Really? Yes. Blue eyes. . .hmmm. . .risky. . . I joke because I'm uncomfortable.

Give the kid a chance. Are they going to cost us money? Of course, but so does the drunk, the illegal immigrant in the emergency room, the homeless person, the elder. . and on and on. I don't think you have that choice. Can't handle it - try adoption. Worried about your body getting all out of shape - try changing your insides instead of your outsides.

If they were meant to survive, they will. If they were meant to die, they will. Even if only for a few hours - they felt love. Everyone deserves at least that much. Please erase the word, "retard" from your list of insults.

The image was a very easy search. You may have laughed. I hope you'll go back, look at it again, and realize it wasn't funny. That would make you a recovering moron.

Elixirs!

Okay, I must confess - I am a sucker for elixirs. Teas thrill me! I love putting together combinations of plants and voila - instantly healthier! Do I really believe that the kombucha fixed my week-long belly ache? No. Do I think that teas formulated especially for my girl-parts are going to make my plumbing healthier? No. What about things to increase memory? No. On and on and on. . .

It's the principle of the thing. The most gorgeous placebo. It works for me. I feel better. I am able to center my body and let it do the work of healing. Superstitious? Absolutely.

I have a kiddush cup that is called the four rivers. On that cup are 64 words written from the four rivers of Gan Eden. One who drinks from this cup, according to Kabbalistic teachings, is granted the secrets and blessings of healing from sickness - mental or physical, and infertility. According to Kabbalistic tradition, King Solomon learned these secrets from Gan Eden. I bought it. I promptly got pregnant - something I wasn't supposed to be able to do. Did the cup help? Doubtful, but it fed my placebo-addiction.

Why is our fascination with elixirs and placebos so alluring? Because it works. It works, because our bodies are exquisite in design. Leave it alone, focus, let it heal. Of course medicine is a great help - a life-saving help sometimes, but not always necessary.

It is a matter of trust. Trusting our bodies. Trusting ourselves to know when we need outside help. Which brings me to my soapbox - obstetrics.

For 200K years we've been able to keep the species going. Amazing! Hand washing was a great idea. It cut down on a lot of unnecessary deaths. C-sections, too. However, somewhere along the way we got lost, and we've never attempted to get back. We think we are improving outcomes, but we're not. We have entire generations of women who think they can't give birth without a doctor. And entire generations of doctors who are too afraid to say that obstetrics has become a sham. A type of, shall I say - quackery.

Why? Because if someone dies, the doctor is going to get sued into bankruptcy or worse yet, lose their license. We have forgotten that even in the best of circumstances, sometimes people die. But obstetricians rarely have a mother or baby die. Correct. The best midwives have the exact, even slightly better statistics.

Intervention is absolutely necessary sometimes. The real art is in knowing when to use it. In the meantime I encourage you to be realistic, honest, and drink more tea.

(the photo is from theinnershaman.com - no, I don't think these work)

Borrowed Time

I have a friend who is battling stage 4 pancreatic cancer.

There is no stage 5.

Battling is not the right word.

I'm deeply troubled by this, because she is my age. Not because I see myself in her place, but because she has so much more left to do. She has so much talent. She is absolutely an original. She really thinks, which is such a rarity these days. She is an artist. She is a midwife (in training). She lives completely off the land. Or rather, she did. Now she's living with her parents and going to doctor's visits while trying to remain true to herself.

Is it the Tong Ren that is shrinking the cancer or the two sessions of chemotherapy she agreed to undergo? Is the special diet her alternative medicine practitioners have her on that is reducing her cancer and inflammation markers to normal levels? Is it her unbelievable strength that is helping her body combat such improbable odds? I have no idea, but it's got her doctors wondering. She has done the impossible - her doctors are asking about her alternative medicine practices, because they are completely shocked that she's not only not dead, but improving.

She's got physicians thinking outside the box. Is that the point? Has she done what she was put here to do? I don't know, but it is impressive. All I know for certain is that she is remarkable and I would miss her terribly if she were to die.

Every night when I lay my head on my pillow I reflect on how fortunate I am to have Jason and Helena in my life. I always thank G-d for the day and ask for just one more day with them. Please, just one more day. This ritual reminds me that we are mortal, and helps me to always re-evaluate how I'm doing as a wife and mother. If you were given just one more day, how did you do today?

Kol Tov.

(The photo is from a BBC News article about pancreatic cancer - it's a pancreatic cancer cell)

We are Dealing with People Here. . .

The other day I was attempting to fill my car with gas. It was extremely cold outside and the card reader wasn't working and I was getting increasingly angrier. Finally, after three attempts I went into the station. I was prepared with a, "What the Hell?" kind of response. I waited while one women counted out her drawer and another put in hers. A shift change. Awesome.

The lady greeted me with such kindness and explained that the satellite was frozen, and that's why it wasn't working. She chatted a bit about having worked there for 20 years. We talked briefly about how things had changed since she started. She told me that a few years ago she would have just climbed onto the roof herself and fixed the satellite, but that was no longer legal. They were waiting for the satellite company to come and fix it. She talked about how fortunate she was to have such good employees and that she liked talking to customers. I had completely forgotten to be pissed off. I finished filling the car and headed home.

I hadn't really thought about it, but we really don't talk to people anymore. In fact, I'm so awkward on the phone that I dread making or receiving phone calls. I prefer email and text messaging. Almost every business call I've made recently is automated.

What do we, as future physicians do with this kind of patient? How do we handle ourselves? Is anyone well-versed in small talk anymore? Are we too "chief complaint" driven? I will not further complicate the matter with a discussion of time, because that will get me full-circle back to my original emotion - anger.

We are not solitary creatures. We are not meant to be alone. In fact, those that spend their lives in solitude are rarely well-adjusted. So why have we created this way of living? Why are we in such a hurry? I have one theory - money. The faster we see patients, the more money we make. Stupid, huh? Our job is to heal people or make their transitions into death as smooth and comfortable as possible. How can we do that if we don't know how to communicate with one another? We live all over the country, on small plots of land, using the internet to avoid each other. This will not end well. I can't find the exact quote, but I believe it was Sir William Osler who said, "If you listen long enough, the patient will give you the diagnosis."

"Next."

(The image is artwork by Andy Goldsworthy)

A Perfectly Different Baby

Five down and two to go. Quarter five is now over. I didn't do too badly considering everything my little family has gone through in these last few months.

We knew when I got pregnant that I may not be able to carry her to term. We knew I might miscarry. When she was born five weeks early we were told she might have some brain damage due to her not receiving enough nutrition and possibly oxygen while I was pregnant. We knew she might have brain damage when her tiny four-pound body got bilirubin levels of twenty. We knew she might have cerebral palsy when she had sustained ankle clonus at two months. We knew she might have a seizure disorder. Now we are pretty sure she does not have cerebral palsy, but she might be autistic.

This all happened during fifth quarter. I did not fail even when I spent evenings playing with our Helena. I did not cry, because I love my daughter and will help her with whatever challenges she faces. Wasn't I even a little sad? Only occasionally, and then I am sad for her. I want Helena to enjoy her life and have every opportunity to thrive. She can do that even with a disability.

So does she have a disability? We don't know. The signs are there, but then again at nine weeks - Is she nine weeks old or developmentally only four, since she was born early? If she's only four weeks old she is nearly on schedule. We wait. We wait until she is six months old. That's a long wait.

My baby doesn't look at me. She doesn't smile much. She is very much in Helena's world. She loves music. She loves tummy-time. She loves to be tightly swaddled. She can stare at her grandma's quilt for hours. Is she disabled? I don't know. We wait.

People ask me - What can we do? I want you to look at my daughter. Hold her. Talk to her. You'll see - she's precious. She's perfect.

A New Baby, A Pile of Tests, and Contentment

We are well into 5th quarter, and it has definitely been a busy time. Four weeks ago I had our daughter - a full five weeks early! After much drama and a week-stay in the hospital, we all came home and are doing well. Needless to say I didn't study that week. At all. Nothing. I thought I was sunk academically. However, I took five exams the following week, got caught-up and am now doing fine. I couldn't just let myself fail. I've come too far to just give up. Thankfully I have the world's best husband who made it possible.

In two days we have our second neuroscience exam of this quarter. It's not that neuro is particularly difficult. In terms of understanding the material, it isn't too bad. What's extremely challenging is remembering all of the pathways and putting it all together with increasing piles of information to hopefully sort out, in the end, what is wrong with the patient. I'm a little worried.

A lot of people think that I am somehow super-human for having a baby in the middle of 5th quarter and not failing out. It's like all things in a person's life - whatever pile is before you, you must either sort it or clean it. ;)

And now, after much sleep-deprivation, I will go to bed and get up tomorrow and study all day. I will take mini-breaks to kiss and hold my baby girl and talk with my husband. Really, I have an almost perfect life.

Interesting aside - as one gets further into medical school it starts getting easier. The classes don't get easier, but one acquires some duck-like skills and allows things to just run off. You do what you have to do when you have to do it and yet still make time for what's important. That's the difference between first and second year.