TY stands for "terrific year"

My intern year, for all practical purposes, has come to a close. Time really is a funny thing. On one hand I can remember orientation, my first day, and my first call like it was yesterday. On the other hand, when I recount my rotations month by month and think back to those slow moving, somewhat depressing winter months, there were times I couldn't wait to be done. But what I find most interesting and so very typical for me, is that as this experience fades from present to past, I am feeling a sentimentality that those of you who listened to me complain during the "low times" woudn't imagine possible. Why at the end do those low times, the challenges and frusterations seem to regress to the very back of my memory, while the fun times, the friends, the people of the hospital, the pleasure of routine and familiarity, dare I even say the intrigue of medicine and taking care of people, stand out to me the most and overshadow the rest? I guess it's like childbirth. First comes the agony, blood, sweat and tears, then you hold the baby in your arms and it's all forgotten, so much so that many women go on to have more children! I am excited to begin my ophthalmology training, and after nine years of higher education to finally focus in on what I will be practicing on a daily basis. But saying good bye to West Sub is bittersweet. It is yet another reminder (will I ever truly learn these lessons?) to live fully in the day that I have, that my life is now and that no tomorrow is either guaranteed or necessarily better than today, to make the most of the opportunities and the relationships found in the daily routine, to appreciate things more before I realize how good it was in hindsight. So to you West Subers reading this, thanks for a great year. You were the people I looked forward to seeing at work and who actually made it fun, who made me laugh a lot and helped me make it through; you were the best part of this intern experience and what I will miss the most.

The 3 stooges.

Vagina Halloween and 3 of the funniest people ever.

I love you honey bunny!

En route to "Sex and the City"

Two Charlottes and a Carrie.... it was fabulous!

My baby balcony garden

Thanks to our wonderful and generous Mom and Dad Landes, we spent a gorgeous day at the local farmer's market and various other stores buying patio furniture and several additions to my first attempt at potting flowers. We now have our very own little balcony garden, a place to drink morning coffee or tea, drink evening tea, read, talk, a place to just BE outside. More pictures to come as our garden blooms and flourishes, pending my maternal care and attention :)

My Birthday Weekend

As said by my friend Jen, "bust out the eye cream, Aliswan is getting old!" Yes, I turned 27 on Sunday, but took the liberty of celebrating and indulging and enjoying friends the entire weekend. It all began with a massage on Friday after I got off the hospital post call.

I also bought this groovy birthday dress.

Aaron, Dave, and Greg from college along with their lovely wives/fiance Katie, Lauren, and Jen made a weekend trip to Chicago. We ate dinner at one of my favorite restaurants, New
Rebozo, where our dinner was accompanied by hugs and kisses from the chef as well as a tower of ice cream covered in Lucky Charms for my birthday. Notice how the guys are strangely coordinated. Then we went to Pete Miller's for jazz and rang in the 25th at midnight.

On Sunday we spent the day with one of my very best friends Emily and her husband Jeremy, in town from TN. We went to see the Indiana Jones movie and then had a leisurely dinner out. Hopefully in the next 5-10 years we'll both be back in the homeland and hanging out like that on a regular basis. Emily is one of those friends that you don't even have to be doing anything with, just being together is fun and easy. It meant a lot to me to spend the day with such dear friends. Another strangely, unplanned, coordinating combo.

Marc finished his week of finals on Friday, so it was a time to celebrate for him too. He did an amazing job again in his classes, and after a semester of much hard work and discipline, he was able to take the entire weekend off from studying and work. What a great feeling. I loved having him around the whole time and was glad he could get to know some of my favorite people better. I woke up from my post call nap on Friday to find those flowers at my beside. He writes the sweetest cards, and our favorite incense he bought for me was so strong it nearly smoked us out of the apt! Birthday gifts and Christmases pale to the gift that is my husband!

hey ya'll

It's been a great week. I'm on vacation, and so my Mom came to visit for 5 days. We had a blast, as usual, and here's some of what we did together:

-went to my fabulous gym
-went to Devon street with my friend Ami for a delicious Indian lunch and where my Mom bought a gorgeous sari (there you go Ami, an official shout out to you!)
-then the 3 of us went to see Marc play in Les Mis, it was so good (hey Cedarville friends, remember when we saw it for the first time together? I fell in love with it then and love it even more now. That was such a fun night!)
-went to church and then out to eat at Carnivale (the best skirt steak ever) with our friends Joel and Vicki
-shopped, of course
-walked around outside, just enjoying the wonderful spring weather
-walked a dog from the animal shelter
-had Ami over to make us Indian Chai tea, the real deal, ooooh and aaaaah'd over her wedding pics
-tried out some new recipes
-went to my ballet class
-watched movies and stayed up late, it was like a 5 day sleepover!

I'll post a picture of us on the way to the airport, both wearing my Mom's bright lipstick (I just wanted to see what it would look like on me), she's a very colorful person!

Last night I hung out with some peeps from work, they are hilarious. And the guys were cool to let Ami and I play dress up. You'll have to see the pics.

P.S. For those of you asking about how boards went, they were long but over! It went fine I believe, I was pretty ready to take it. It feels so good to be done because from here on out, every test I will take will be just ophtho, no more gen med stuff! Thanks!

So I'm having problems getting the pictures on here, I'll try again soon.....

My first turkey

A slightly traumatizing experience- involving gibblets and pliers and feathers and strange body cavities- but ultimately a delicious and rewarding experience!

Home sweet home

Remember the days of spring break, Christmas break, summer break, random Monday holiday breaks? Those were the days! But I felt as excited for my adult in the working world week of vacation break as I did about spring break as a kid, and boy was I ready for it!

I flew to Ohio on Saturday after a 4 hour delay at the airport, but I didn't mind because I was on vacation. I read People magazine and pretty much did absolutely nothing, fantastic. I spent the week running around with my mom- spa time, shopping, cooking; staying up late watching movies- Ann of the Thousand Days (the old and even better version of The Other Bolyn Girl), Around the Universe; got my teeth cleaned and cavity fixed by the best dentist in the world, my Dad; also spent some good time with my brother Dave and Meme; went to Wasabi steak house with everyone and had some good sushi; saw my friend of friends Jen; played with Max, our strangely cute dog who was very happy to have me around; and went to a beautiful Easter Service at our church, Hudson Community Chapel. Ohio may be a little dopey compared to Chicago, but having family around and a church like HCC to go to would be enough to bring me back.

Thanks family for a wonderfully fun and rejuvinating week at home! I love you and miss you always!

Will someone please tell me...

what is the benefit of being a "goody-goody"? When it comes to amoral issues, does it matter? Do people notice, and if they do, do they care? I think life as a goody-goody is harder. It's filled with more self-imposed guilt and more getting screwed by the not goody-goodies who are ready and willing to let the goody-goodies pick up the slack. I've always played by the rules and live in fear of getting caught the moment I break one. And you know it's the good ones who will get caught. I was told it's just part of who I am. Well I want it removed. My friend teases that I should join her club, "Ask forgiveness, not permission." I was also told that I will get bolder as I get older. But I'll say it here first, stop screwing me!

A first for everything

Last night on call, I was called for the first time to pronounce a patient dead. I've seen patients die before, and I've been involved in torturously heroic codes where 99% of the time the patient doesn't make it. For some reason in that circumstance death isn't quite as moving. I suppose it's because in my mind the patient as in the person might have been gone long before any of one us says it's so. This patient last night was a DNR patient, which means none of the chest thumping, etc. There were no calls overhead that sent 20 people running to the patient's room. Instead the patient was surrounded by family, and ironically an outside hospice nurse who was evaluating the patient for hospice. Someone noticed, "I think he stopped breathing." And with that he gently and quietly and peacefully entered eternity. I found him curled up and padded up and covered up in bed, as if he had been sleeping. It is so unfortunate that not more people spend their last moments in this way. Although I only spent a short time with the family, it was obvious how strong, bonded, united, and loving they are. Something in my experience that is not seen enough so that you really notice when you do see it. As strange as it sounds, I would have rather stayed with them than do anything else that night.

Is this a downer post? I'm sorry. I wish that I could write great things about how proud I am and how much i love my children, about puppies and cake decorating and house decorating and vacations, but that's not my life yet. Firsts for another day.

Canine maternal instinct

I just sobbed because a dog on the Animal Planet had to be put to sleep. I would be the best dog owner.

Lost

I've really been wanting to write something lately in hopes that forcing myself to put thoughts into words would bring clarity and help settle my mind and emotions which have been all over the place these days. I didn't want to complain about how burned out I've been at the hospital or how this winter has over stayed its welcome, so I just didn't write because that's all that would have come out. So I start here instead: I want something to change in my life, and I can't seem to put it into words yet. But it has something to do with wanting my life to have real meaning, to be and do things that are purposeful and that have lasting value, not once in a great while but everyday. If I had only one more year to live, what would I do? Should I not be doing that now? Do you ever know what you need to do and yet can't muster up the determination and commitment and energy to follow through even though you want to? This is probably not making much sense- that's fine because I'm still a little lost myself.

The Luckiest

I'm the luckiest. Lucky (blessed) to have the friends that I do. I just got home from the wedding weekend of Greg and Jen England which also turned out to be a Cedarville friend renunion. By the way, I was either going to title this post "the luckiest" or "wish those annal fissures didn't hurt so much." You definitely had to be there at the "wish" table to get that one.

Greg and Jen had a beautiful wedding ceremony. Truly, it was beautiful. The service focused on the grace of God and what a perfect example of marriage we have in Christ and the Church. This was delivered by our very own "pastor Dave," and what a special thing for one of Greg's best friends to perform their ceremony. Greg and Jen wrote their own vows, and I was so touched by what they said. Especially Greg, after knowing him for so many years, and hearing how this woman has changed his life, how much his heart is committed to her and to God, and what an impact he has had on Jen's life. I know I'm not his mom or anything, but I'm so proud of him.

This morning we got together at Ang and Ryan's for a late brunch. It reminded me of how many of our places we've been to together, all the trips we've taken, cooking for a big group and just hanging out. So many fun times.

One of the countless things I love about my college friends is that we always laugh so much together. I love hearing Eric laugh, and Ryan, who was the first to marry into our group, is somehow the ring leader of our shananagans. Our table was having such a good (i.e. loud) time that I think people probably thought we were the abnoxious drunk relatives that come out of the wood work at weddings, except that we're not related and we weren't even drunk. We seamlessly pick things up like not a day has passed apart. And as sappy as this sounds, I'm going to say it anyways- I'm just so completely happy when I with them. Being with friends who you've lived with for 4 years, day in and day out, who know all the bad along with the good and all your idiosyncracies, it's like being with family, being able to be your real self. And yet being with them makes me want to be my best self. They make me better. I know you're laughing but I'm mean it :)

In addition to Greg and Jen's wedding, we had more news to celebrate. Aaron is getting married to Katie! Another wonderful thing we've experienced as friends is welcoming spouses and children and siblings into the group. It was great to see Deb (remember when you visited Cedarville?), and the boys are all so grown up with their wives. I think us girls should stop "the boys" thing and maybe call them "the guys" now. Jen, Lauren, Katie, Annie, and April are all awesome girls and I look forward to getting to know them better through the years. Our guys sure are lucky!

God has been so good to all of us. I love seeing how He has led each of our lives and all the things my friends are doing and have become. I count you as one of my greatest blessings. I do feel like I'm the luckiest.

So in my imaginary perfect world, we all live the same cool city, go to the same church, and get together once a week at our places for Bible study and snacks. We hang out on the weekends and don't have to do a whole lot to be entertained. Until I can somehow arrange everyone's live to fit my dream world, college reunions (Oct 2008!), frequent trips and girls weekends in Chicago, and weddings will have to do. Thank goodness that Aaron and Katie are getting married this summer, I only have 6 months to miss them all!

I bit my tongue, hard

People really do amaze me. We are all imperfect and utterly flawed, and even knowing this I am still amazed. You see, you take sick, frusterated, stressed, sleep deprived and over tested patients, and you put them in a building with stressed, sleep deprived health care professionals who are under a lot of pressure and responsibility and taking care of multiples of the above described patient, and you get situations similar to mine last night on call.

I admited a young female last night, close to my age, who is suffering from a chronic degenerative disease. She's young and otherwise healthy, has her whole adult life ahead of her, and yet has spent the last 5 years in and out of the hospital with likely much of the same in the years to come. She doesn't work and spends most of her time in bed. That is a very difficult lot to be had. Who would ever blame her for feeling frusterated, even sad for herself, and who would blame her for not necessarily being the "best version of herself" each time she is forced to come into the hospital?

But that's not the entire story. My first encounter with this girl was fine. She thanked me for my help, and when she asked for a cup of water, instead of telling her to turn her call light on I went down the hall and got it myself. I was called back to her room later that night because she had gotten into it with the nurse and said she wanted to be transferred to "a real hospital." The room smelled, it couldn't have been cleaned before she arrived. She complained that she had to wait for her toiletries to be delivered. I told her that I would get them for her and she said that well the nurse did bring them eventually. She complained that her boyfriend wasn't allowed to spend the night. I told them that he could. (He ended up leaving to go home a hour or so later.) She complained that she didn't get a hot dinner (she had just told me she had no appetite), and I apologized that the kitched was closed. We got her a shake and a sandwich instead. I convinced her that it would be in her best interest to stay, because if we tried to arrange a transfer at that hour, she would probably not get any sleep and feel worse. She calmed down, and they thanked me again. She told me that I was the only professional person she had met.

The next morning I received a call that she was yelling and swearing at the nurses, was refusing meds, and had been throwing things all over the room. Her floor was soaked with water and juice and applesauce which she had thrown all over the place. She pulled her IV out. She didn't think her nurse knew how to take a blood pressure, at least not to her liking. She said that she spent all night crawling back and forth to the bathroom because she didn't want to call the nurses for help. She was irrate, she couldn't be reasoned with. I told her that after the attending had seen her that we could try to arrange for transfer to another hospital. Well things post call never work out as planned, so this of course turned out to be my job.

So instead of going home after a 26 hour shift, I stayed to arrange this girl's transfer out of our hospital. After several phone calls, additional charting, and an hour later, I went to her room to let her know that she would hopefully be leaving later today. I had a STRONG notion to also explain, "off the record," that although I can sympathize with her frusteration of having to be in the hospital and that unfortunately she sometimes has to deal with attitudes from nurses, poor nurses, whatever, that if she tried to get along with those trying to take care of her (or another way of putting it, act like an adult), she would most likely be happier with the care she received.

That's not what I said. I told her she was waiting for a bed to open up at the other hospital and walked out of the room and she calmly thanked me. I felt like she was trying to trick me with her new found composure into believing that none of her previous poor behavior had happened. I'm sure she felt justified.

So what would she have done if I HAD said what I wanted to? Would it have "reached her," since she said so herself that I was the only nice and professional person there? Would it have made her all the more upset, just one more thing and person to complain about? Would it have made the rest of the day more unbearable for the people left to take care of her in the coming hours? I'd like to think that whatever her initial reaction that she would have at least thought about it later with some degree of reflection and regret. But I don't think that would have happened.

And that's medicine. Patients do and say whatever they please, and the health care professionals bite their tongues. But I have questions.

Isn't there a difference between what some would call "judging" and addressing unacceptable behavior? Do people ever benefit from being talked to like the adults they are rather than the children they are acting like? Does it benefit people to pretend there is no personal responsibility for the way that they act? When people behave as this girl did and no one says anything, is that the same as enabling and reinforcing that kind of behavior? Would it have been wrong of me to tell her that it's inappropriate behavior to trash the room and swear at nurses, that she might receive better care if she was more pleasant to the nurses, that if she was that unhappy she could walk out on her own and show up at someone else's ER (please, save me the work)? Do social rules/norms that I think apply in the real world not apply to medicine? Is this as screwed up as I think it is? Is there something wrong with me that this bothers me so? Or should I just not expect patients to behave with what in my mind is basic human respect, courtesy, and manners? Or at least not surprised when then don't?

I think medicine should be paternalistic. I think health care professionals should be able to talk to adults like adults. I came this close to calling this girl on the carpet in a professional manner that I think could have been justified. But I didn't. Now I am done with her, oh no, unless she's still there tomorrow morning. Next time I'm in a similar situtation, I'm not sure what I will do.

Math Quiz

What does a long list of patients to see by myself, 2 complications, 3 discharges, 1 rude and out right mean nurse, 1 lost lab result, 1 missing surgeon, 1 really bad sign out, 10 directions being pulled in; minus lunch and getting to go to the bathroom; multiplied by my baseline level of frusteration and distaste for general medicine; squared by the fact i'm on call 30 hours tomorrow and have much of the same to look forward to on monday......equal?

NOT a great day at the hospital.