Counting

5 years ago, right before I started med school, was the first time I really counted the omer.  Most other years I hadn't been able to make it past day 3 or 4.  And by counting the omer I mean that successfully managed to count until the last week or so when I purposely gave up because it was making me increasingly anxious.  Beyond anxious even. As I was counting up, I was simultaneously counting down to my departure from [the place that I most consider to be] home.  I moved out of that place the day after shavout to begin my medical school journey.  The process of counting grew too overwhelming and so I made the decision to give it up.

This year, with Passover scheduled to begin super soon, I am growing increasingly excited about counting the omer.  Between sundown tonight and shavout I will turn 30, graduate medical school, move out of the place where I went to medical school, figure out where I am living in a new city, [potential even put an offer down to buy a place], and begin the transition to the place of my residency.  I will sign my first real contract and submit forms for my medical license.  By doing these adult-ish things, maybe I'll actually begin to feel like I'm 30.  I will also visit the above mentioned home, my biological home, the place where I did my research year, the place of my med school, & the place I will do residency.  I will spend some time camping in the woods, take a road trip with the person I adore, and celebrate an exciting life event with my cousins.   Plus, who knows what adventures are in store?

I'm pretty excited about counting this omer, indeed.

In 2013, I ...

... survived a 2,122 mile road trip with my mom.
... survived another 926 mile road trip by myself. 
... flew 55,032 miles.
... conducted some pretty exciting research and created life-long mentors.
... presented said research at 3 different conferences.
... had frivolous fun during the research year. 
... read A LOT of books (thanks to checking out kindle books from the public library).
... completed a whole bunch of knitting projects!
... watched my classmates match into residency and graduate medical school.
... had my heart broken into splinters.
... finally, after over 6 months, am beginning to feel my heart mend.
... celebrated with multiple friends as they [finally] gave birth to very much desired babies.
... grew comfortable riding a bike and then completed a 70 mile bike ride.
... moved back to the South, and found it better than I remembered. 
... reconnected with old friends and made many new ones.
... embraced the last full year of my 20s. 
... stepped out of myself and took chances  - with mixed outcomes.
... began to internalize and eagerly anticipate the excitement that 2014 promises!

Happy New Year ya'll!  May 2014 be full of blessings and dreams come true!

Tears for a life too short

I can't stop crying for a boy I never met, but who's story I have been following for the last year and a bit.  He was diagnosed with AML at 6, his battle chronicled in poetic detail,  and died over shabbos. 

He was a superhero.  His parents, Rabbi Phylis and Rabbi Michael, are beyond superheros.  Time and time again they have gone above and beyond to bring good into this world.  Throughout this whole process they seem to always keep others in mind, trying to give back to those they encountered every step of the way.   It is this selflessness that continues to inspire me.  Even in circumstances horribly beyond imaginable, goodness and light can be sought.  There is always work to be done. "36 rabbis shave for the brave" St Baldrick's fundraiser is underway, now in Sam's memory, with a lofty goal of raising $180,000.

Sometime around the beginning of medical school I remember reading a study that doctors tend to be much more uncomfortable with death than the rest of society.  We may be comfortable with our own mortality, favoring much less invasive end of life care, but we can not except it for others in our lives.  I don't remember where I initially read it, but in times like this, I wonder about it.   Are we predisposed to medicine because we want the tools to stop death, or does medical training teach us that death is failure?

Regardless, 8 year olds are not supposed to die.  Parents are not supposed to bury their children.  For all that love Sam, z''l, and for all the others' who have had to bury children prematurely, my heart breaks for you.  I can not even begin to imagine what you have been through.  Know that I will try to carry your tragedy into my practice as a doctor - hopefully making me more compassionate, empathetic, and aware of the limitations of my art. 

Sub-i self evaluation

1. I want to be the best sub-I they have ever had, to be perfect
2. I get loquacious when I'm nervous
3. I seem to always be nervous during my days on the wards
4. When I get loquacious, I tend to talk about myself or tell personal stories that relate to whatever is going on
5. I'm pretty sure no one wants to hear these stories & I should just shut my mouth
6. But then I get more nervous, and more loquacious
7. Even when I make a conscious effort to not be loquacious, I still manage to over talk & over share
8.  I blame it on being an extrovert & wanting to connect --> I want to connect to people
8.  I LOVE obstetrics and get excited that I get to be doing this
9.  My excitement makes me seem young (according to the PGY2 who couldn't believe I'm older than him because I'm so "eager")
10. Partially because I love what I'm doing, and partially because I don't really know anyone in this city, 14 hour days at work are amazing but weekends off are proving rough
11. After this experience, I would highly recommend doing aways in cities where you have connections.  Without such connections, this feels way too isolating and more nerve-racking. 
12. I try way to hard to seem smart, knowledgeable, & capable which makes me less of all 3 of these
13. If nothing else, my goal is to at least be helpful in order to make my residents' lives easier
14. It is pretty difficult to be useful at a new institution where you can't even find your way through the hallways of the hospital or figure out how to use their computer system
15. I am far from perfect
16. I strongly believe that only perfect sub-Is honor, and therefor there is no chance I will honor
17. I fear that high-passing my sub-I(s) instead of honoring will mean that I don't match in OB/GYN
18. Again, back to #1, I wish I was perfect

The wheels on the bike go round and round

I did it!  I rode 65 miles on my bicycle over the past 2 days.  Sure, I walked some hills, and swore as I struggled to ride up others, but I still managed to do it!  I gained confidence on the downhills and learned to appreciate the modernity of flat roads through cow pastures.  There was only one small, almost comedic, fall off the bike on the second day when I was way past exhausted.   And you want to know what?  I got up and rode 16 more miles afterwards. 

All and all it was a beautiful weekend and a successful ride.  I challenged myself to do something I never really could have imagine doing before.  I gained confidence on my bicycle.  I embraced being completely cut off from cell service and email for a full 3 days.  I ate copious amounts of delicious food that was very locally produced and cooked with intention, in a room full of Jewish environmentalist.   I led a tisch Friday night that filled my spirits with songs, torah, and blessings.

At one point over shabbat, I realized that I was very much surrounded by the community that I have built over this past year.  This research year really has brought a lot of unexpected joy and connection.  Such a wondrous experience to end a year of personal growth.  I feel so very grateful.  Sore.  And grateful. 

Now, what next big ride should I train for next? 

Goal: stay up right, don't get hurt

The charity bike ride is this weekend.  It will be the biggest physical challenge I think I’ve ever attempted.  That is assuming that I ride more than 20 miles.  Therefore, I’m terrified.  I am so touched that my friends and family have donated so much money to support me, which I interpret to be either because they believe I can do it or they are in shock that I’m even trying. 
 

Seeing as I was basically a non-bike rider at the start of this (not learning to ride a bike until I was 19, never having ridden more than 2 or 3 miles at a time, and not having been on a bike in 3 or 4 years) I have 2 main goals:

1)      Stay on my bike

2)      Don’t get hurt

Actually, as long as I don’t get hurt, I’m not really sure staying on my bike is even that important.  The full ride is either 80 miles or a 120 depending on the course you choose.  My housemates are all doing the shorter 80 mile option and so that’s what I’m planning on too.  Even if I only make it one day, 40 miles, that will still be a new achievement for me.  Need to focus on small victories and not be disappointed when I don’t complete all 120 miles… that can be next time, right?

I just want to have fun.  Really, I want to not be anxious about this ride and to have fun.  Sun, endorphins, friendship & comradely, a post-ride massage scheduled – this really could be fun! 

Passing stones

I'm pretty sure I had my first kidney stone this weekend, which also means this weekend went nothing like it was planned.  The presentation was classic: sudden onset severe flank pain radiating into my pelvis, nausea without vomiting, clamminess without a fever, and urinary urgency.  Of course, the pain started on my way home from work on Friday night, right after all the doctors' offices and urgent care centers had closed, and right before the start of shabbat. 

 I went through the differential: kidney stones, pyelo, appendicitis, hemorrhagic ovarian cysts, ovarian torsion.. but was very aware that the pain was primarily flank pain.  I called my med school roommate to calm me down, talk through the differential, and come up with a plan.  800mg ibuprofen, hydrate as much as possible, use a heating pad, reevaluate in a few hours.  The pain escalated but the heating pad made it bearable.  Our shabbat dinner guests arrived.  One guest encouraged me to call my PCP to talk to the on-call doc.  It turns out my own doc was on-call, strongly felt that I was passing a stone, and advised I go to the ER for IV fluids, stronger pain meds, and a confirmatory CT scan. 

A friend drove me to the ER.  We waited an hour, in which the waiting room became increasingly filled with people who appeared to have all types of communicable germs.  I couldn't sit comfortably or stand in one place and so I paced in the corner.  I hadn't yet even been triaged.  I wished I wasn't such an honest person, knowing that had I reported my chief complaint as chest pain + SOB, I would have been seen immediately.  I freaked myself out about a CT, about exposing my ovaries to needless radiation.  And so after an hour I checked myself out of the que and we left, knowing that either it was a stone and would declare itself or something would get significantly worse and I would be back.

The next 24 hours were a slow mix of adjusting the heat pad, re-dosing on NSAIDs, drinking as much as I possibly could, peeing, sleeping, and trying to read a book.  Not how I had planned to spend shabbat.  My urine turned cloudy a few hours after the pain began- furthering my suspicious that it was a kidney stone.  And then, sometime last night, the pain stopped.  It has left my body sore and exhausted, wondering if maybe I made it all up?  That's the downside of not having a confirmatory scan or seeing a physical stone pass... now I always get to wonder if it was a stone or not.  Really, could I have imagined all of the last 36 hours?  And it is a pretty compelling story indeed...  But, the true question is, would I believe a patient that came in and told me all of this? 

30 things before 30

I turn 29 very soon, very very soon.  Here is my bucket list of things I want to accomplish before I turn the big three-zero.  I'm posting it publicly to keep me accountable.  I imagine that a lot of these things will absolutely happen and some will not.  What fun would it be to have a completely obtainable list?  Here is to a year of adventure and personal growth!

Health:
1. Challenge myself physically (current plan is a 120 mile bike ride)
2. Learn a new sport or exercise
3. Have an a1c < 7.5
4. Learn to consistently use, and fully utilize, a CGM / my dexcom sensor
5. Loose the last 20 pounds to fully get to my goal weight

Career:
6. Have a manuscript published
7. Finish my MPH requirements
8. Get a job (match into residency)
9. Graduate medical school (should happen within a month of turning 30)

Community & family:
10. Send at least one real (snail mail) letter to a friend each month
11. Call my grandmother more
12. Reach out to my borther
13. Reach out to my cousins
14. Be more patient with my mom
15. Talk to my dad

Religion: 
16. Create a ritual for clinical practice around performing births & abortions
17. Say yes when asked to lead kiddish
18. Read from the Torah again
19. Davin in shul at least once a month
20. Wrap tfillin at least once a month
21. Join a chevra kadisha

Misc:
22. Address my fear of heights
23. Travel to a new place, besides residency interviews
24. Renew my scuba certifcation
25. Go on at least 1 date every two months
26. Do at least 5 touristy things in the city I go to medical school in
27. Spend a night out dancing without caring that I can't dance
28. Learn embroidery 
29. Stop wearing clothes that I've had since high school
30. Relearn Spanish

And one for good luck:
31. Save the world 

2013, mixed feelings

I have totally mixed feelings about this New Year.  2012 was an emotional roller-coaster.  The death of my grandmother, a rather jarring car accident, 2 trips to the Emergency room (as a patient), all the emotions of 3rd year clerkship, a hard break-up, then meeting someone new (and extraordinary), deciding to take a research year, moving to a new state, 2 cross country road trips, a trip to India... it has been a BIG and overwhelming year.

2013 was supposed to be the year I graduated medical school.  A huge part of me wishes it still would be the year I graduate medical school.  Instead, it is now becoming the year I figure out 4th year electives, begin residency applications, and try to *hopefully* get a publication out of all this research.  Ideally it will also be a year full of seeing my family, nurturing my relationship, taking better care of my health, and finding time to have fun.  Maybe I'll also make some art and learn some Spanish. 

Technologically Adverse

Playing with the iPad I was given for hanukah is reminding me exactly how technologically adverse I really am.  Any advice of how to use an iPad to streamline my life and optimize the potential of it?!  Please advise liberally!

Sundowning

According to wikipedia: "sundowning, also known as sundown syndrome, is a syndrome involving the occurrence or increase of one or more abnormal behaviors in a circadian rhythm. Sundowning typically occurs during the late afternoon, evening, and night, hence the name. It occurs in persons with certain forms of dementia and psychosis, such as seen in Alzheimer's disease. Although not widely surveyed, sundowning has been estimated to occur in 45% of persons diagnosed with Alzheimer's disease"

I feel like my current emotions reflect a sundowning effect.  I seem to get more frustrated, more teary, and more depressed as the night wears on.  My guess is it relates to the point in the evening where I used to trade in studying to video chat with the [now ex-]girlfriend.   I have cried more the last few nights then I have over the entire past year combined.  I have even succumb to sending desperation text messages to her before I could think better of it.  Thankfully my lovely roommate has agreed to take my phone away before I belligerently text her again.  My emotions are unyielding as my new reality begins to sink in.  I'm nearly as emotionally liable as my patients on the inpatient, locked, psych ward. 


The hardest paradigm shift to accept relates to my future.  I no longer have a magnetic force pulling me towards residency in a specific geographic location.  I no longer have a built in support system that will accompany me to wherever I happen to match.  It is both a relief and a curse.  It takes some pressure off of the decision to take next year off.  However, I used to be able to tell people that I was hoping for certain residency programs because it would allow my partner to have a job though I also used to worry that I'm not competitive enough for the state she is BARed in.  Now I worry that I wont match in a location with a viable singles community, a community with dating options.  How many cities are there that have large, intellectual, activist, queer, Jewish, communities?  When ever I would freak out about not matching, and ramble about some crazy scenario of scrambling into some super conservative [and boring] location, she would affirmatively respond that "we'll be okay there", "we'll make it work".   I don't know that I can do it on my own.  


At the conference last weekend, when I was asked over and over again where I was hoping to go for residency, I fought back tears while trying to explain that my perspective was recently flipped and I no longer know.  I'm pretty sure that all 1000+ conference participants were exposed to my verbal vomit about recently being dumped.  I sincerely hope that I can pull off a slightly more composed persona at the conference I'm going to this coming weekend, though I'm not holding out much hope.  When my current psych patients respond like I have been, they get dinged for over-sharing and missing social ques.   At least I still have my insight and perspective intact.  I am learning first hand that a very fine line divides the process for accepting a major life change and the diagnosis of a mental illness.

Appearance (aka my mom was right)

Blow drying my hair and wearing makeup really does make a difference with the way patients interact with me.  I'm treated more like the 27 year old I am,and less like a high school student pretending to be an adult. This is especially true when I'm wearing scrubs.  However, while I can rally to add an extra 10 minutes to my morning ritual for makeup and hair, I'm pretty sure I wont be swapping my danskos out for high-heels anytime soon.

Need an answer

Today, for the first time in my 3rd year clerkship (or at least the first time it mattered) I was asked WHY I want to go into ob/gyn.  Normally they just ask what you're thinking about going into...

I fumbled and felt like nothing I said was sufficient.  It almost seemed as if I was sucking up to the 4th year resident who had asked. 

My old answers:
-I'm passionate about women's reproductive health
-I wrote my undergrad thesis on pregnancy & birth through the lens of medical anthropology which is what brought me to med school
-I want to be an abortion provider
-I like surgery, but would prefer having more continuity of care than gen surg offers 
-The more I learn about embryology the more fascinating I find it
-It was between ob/gyn & peds but it turns out that I like surgery
-I think women are being short changed by a lot of current ob/gyns, and I know that I can offer better

And my new answer:
-?????!

A day of firsts

Today's been a day of firsts:
*my first time scrubbing into multiple consecutive surgeries, 3 to be exact.
*my first time using a scalpel on living human flesh.  Gross anatomy was the first time I had cut into other types of human flesh.  
*my first patient died, as in a patient I had followed from the very beginning of her hospital course to the very end.

Driving home I kept thinking about a comment a friend made to me when I started med school: "Keep a journal because medical school will change you.  You'll want to look back and see how." It is days like today when I realize how very right she was.

the dark side of peds

Over the past few days I've increasingly been exposed to the dark, depressing, and horrid side of pediatric care.  Parents who abuse their children either directly or through neglect.  Caregivers who can't look up from texting long enough to answer my questions.  Parents who ask how soon they can go home with complete disregard to the fact that their child is sick enough to warrant being admitted to the hospital.  Caregivers who overtly, and horrifically, abuse their children. I want to scoop up all these children and protect them.  A tiny infant, a sweet little toddler, a loquacious mini person, all of them.  I want to wrap my arms around them and bring them into my home.  I want to be able to promise them that there is better out there, that they deserve to be loved and have the right to be a child. 

I seriously envisioned myself adopting the sweetest little 2 year old yesterday, a 2 year old that will be spending way too many days in the hospital for the horrors he has already experienced in his too short life.  I imagined myself sitting by his bed day in, day out, as he overcame this event and regained a childhood.  I had a vision of what my life might be like if I did take him home.  In that moment, a decision was made.  I will foster and/or adopt children at some point in my life.  There are way too many little ones, and not so little ones, that need safe and loving homes.  There are way too many horrible parents and caregivers out there and not nearly enough safe refuges. 

My heart hurts.  I'll never forget the signs of evil that draped this small child's body.  I hope I also don't forget the angles who took him in.  I'm seeing the good and the bad of the system.   Currently, it seems the bad is winning, and I'm quickly growing jaded.  My faith in humanity is becoming scared by the abuse case that never surmount to anything, with the child being placed back into an unhealthy environment because there is no where else to put him.  The parent who is unable to afford a necessary medication, even when it is on the cheap generic list, but is fully occupied by her very expensive phone.  The disengaged parent who is depriving their child of maximal growth and development through their lack of interaction.  The child that was abused in foster-care; the place that is supposed to be safe after experiencing neglect or abuse in their biological home.  How am I supposed to pick myself up from all of this?  How can I make a positive difference in this world with such a cruel reality?

3 questions

Today we had a lecture on MD compensation and productivity.  A very wise man, who is the business brains behind one very large local physician group, posed 3 questions to us.  He explained that he posses these same questions to doctors finishing residency and those early in their career.  If they can follow a path inline with their answers, he believes all else will fall into place.  I personally think these questions are good for anyone regardless of your professional track, so please feel free to answer in the comments section!

1) What are you good at?
2) What do you enjoy doing?
3) What do you feel called to do?

My new goal:

is to either do a marathon (at least half) or triathalon by the time I graduate from med school... A bunch of my classmates ran this morning and made me realize how much I WANT TO DO IT TOO! I want to be that cool! I'm totally falling for peer pressure, as well as a desire to do something substantial while creeping through my education.

The complication is that I'm very much a swimmer and not a runner. I'm not quiet sure how to breath on land! When to start, where to start?

Rethinking meat

I'm seriously considering going vegetarian (again). At 13 years old I went vegetarian as a first step in wanting to be kosher. I continued to eat kosher fish, but gave up all other meats until I was 19 years old. When faced with kosher turkey at a friend's thanksgiving dinner in college, I excitedly gave up my vegetarian identity, opting instead to do my best to find "happy" kosher meat (knowing where it comes from, free-range, etc).

While in London over winter break I started to reconsider meat. After going to a few different shiurs on kashrut I started to seriously think about what being kosher means to me. I also started to grapple with the fact that it is VERY difficult to find local/ethical kosher meat, and that killing an animal in a kosher way may no longer be the quickest/most humane way to do it. Then, today, I unintentionally ended up watching Oprah's episode on going vegan. As part of the episode, Lisa Ling goes inside a slaughter house to show the process. I think that watching those few minutes of footage were enough to get me to go vegetarian again.

I'm not saying that eating meat is wrong or that we, as humans, shouldn't eat meat. Nor am I saying that you, dear reader, shouldn't eat meat. I'm just not sure that I should keep doing it. Watching the way the cows were being processed reminded me way too much of gross anatomy lab, a class that I was VERY uncomfortable with for so many reasons. I realized that given the choice, I would never choose to slaughter, skin, or butcher a mammal in order to consume it. I'm barely comfortable taking raw meat out of the package in order to simply cook it! I strongly feel that I have no right to eat something that, in its entirety, makes me this uncomfortable. Vegetables, tofu, even fish; these are all things that I will take ownership of destroying for my own nourishment.

This is not a decision I am going to make lightly (this time around). So for now all I can definitively say is that I'm in the contemplation stage of returning to vegetarianism.

Growing pains

My heart hurts a lot after a really wonderful, yet intense, weekend. A friend came to visit, which allowed for fun times in the city I don't normally make time to enjoy. There was adventure and laughter. There was a lot of conversing too. I feel a little bit like I've been broken into hundreds of tiny pieces. She challenged me on a lot of my personal self views. She also forced me to think critically about what I want from the next few years of my life and how I might want to prioritize my experiences. I just dropped her off at the airport, and cried the whole way home.

As disheartening and frustrating as these conversations are, I recognize it as a golden opportunity for personal growth. In order to be the leader that I hope to become, I need to learn how to take criticism. This opportunity for reflection is a rare jewel which should be embraced. Just as long bones hurt when they are stretched too fast, no significant personal growth can happen without a bit of struggle.

Forgivness

So this essay kind of sucks. The month of (Jewish) holidays which just ended means that everything I've been doing has been somewhat half-assed. However, I still thought I'd post my second personal development essay of the year:

Being an observant Jew, my religious doctrine requires that I take an annual visit to the land of forgiveness. Our rabbi’s suggest that we spend the month before Rosh Hashanah preparing to ask for forgiveness from our peers, and then actually engage in the process during the10 days between Rosh Hashanah and Yom Kippur. After weeks of thinking about and asking from forgiveness from others, Yom Kippur, the day of repentance, is spent in synagogue asking for forgiveness from God. Having engaged in this religious practice since the age of 13, I have grown familiar with asking for forgiveness from peers.

The same Jewish doctrine requires that if you are not forgiven the first time you ask, you must ask for forgiveness twice more before you are let off the hook. This illuminates two different points about the process. The first that it is important to sincerely ask for forgiveness sincerely, and with enough to commitment to give your peer time to actually forgive you. Secondly, it is the others person obligation to forgive you. A process that is not always quick and easy. Though even if they don’t, you are still eventually able to move on with your life.

My actions that require asking and giving forgiveness have matured as I have aged. Actions of talking back to my parents and hitting my brother have evolved into spiteful break-ups with significant others and prioritizing myself before my family. While maturation is a good thing, the increased stakes of life’s decisions means that there is more room to seriously hurt people and to hold grudges. Misjudged actions now seem to have more significant consequences. I also realize how cathartic the process is. Holding grudges is never healthy and tends to drag me down emotionally. It prevents me from fully moving forward from the actions of my past and from becoming a better and more mature person.

One of the areas of forgiveness that I have yet to acknowledge in my life is forgiving myself. It used to be that I could use my past mistakes and self-frustrations as motivation to push forward. However, the longer that I hold onto these past experiences and negative memories, the more they weigh on my sense of self. As I am growing older, I realize that holding onto mistakes that I have made previously is airing more on destructive than productive. These memories can help fuel the fire of self-criticism. I am now realizing that I need to learn how to forgive myself, and embrace my past mistakes, through concentrating on the personal growth they have catalyzed.

The other area that I need to work on, or at least start to consider, is forgiving the mistakes of my classmates. Over the past year I have realized that I hold myself, and my classmates, to a very high standard. While we are full time students, we are also already out in the world playing doctor and interactive with many members of the community. As such I expect us to present ourselves as professionals. When a classmate does something that presents them self as less than professional, whether it be disrespecting a professor, blowing off a service learning commitment, or getting drunk and proudly posting pictures of the experience on facebook, I loose respect. These are grudges and opinions that for better or worse, I hold onto. I am just starting to realize how much I (internally) criticize such behavior. While it motivates me to present myself in a different manner, it also requires a lot of energy. I am starting to consider what I should do about these emotions and how to forgive behavior that I don’t really have a right to judge in the first place. Maybe it needs a mixture of forgiving their behavior and forgiving my own judgment.