Come Live With Me, and Be My Sweet Fluffy Ball of Love

Every month in my life right now is a new beginning. Every month, I start over at a new job. Every month, I get a new boss, a new workplace, a new kind of work, a new population of patients, a new boyfriend. And usually, a new place to move.

Just kidding about the boyfriend.

However, not this month! This coming weekend is, truly, a free weekend! I continue my rural rotation for another month and have only one thing to study for... a drug list for Dr. King and I'm golden.

The main priority for today is to search for an apartment. One thing has been blatantly missing from my life these last few months: my cat. For the previous year she had been my constant loving companion; the last few months, she has been living with Ashlie and Lewis as I move all around. Which she loves.. :/ But I miss her and I'm ready to cohabitate with her sweet fluffy little ball of goodness once more. And, as it seems everyone I know has a pet-free lease, it appears I'm going to have to find something by myself for at least the next 6 months.

So, the apartment search begins. Once it is completed, the job search will begin. As the Indian man on the plane said with a smile... the world is my oyster. I hope cats like oysters.

Marlow Is Busy

Apparently, Marlow isn't as slow as I'd thought it might be. All the old folks are getting sick in their nursing homes, high school girls are needing their sports physicals, everyone in the hospital has to be followed, oh then there's the free clinic; and did I forget to mention Dr. King's clinic where we work 40 hours every week?

Marlow is definitely where its at. It being the work.

Mr. Lucas Strikes Again

I'm always forgetting to put new pictures of us up. Here we are a few weekends ago at Quartz Mountain. He went for a climbing thing and I was there for a women's retreat. Here he is in action, making me breakfast. What a sweetheart!

Beautiful Marlow

Well, time is flying. The spring has come and spring in Marlow is one beautiful thing. Everything here is green and the trees lining Main Street are old. There are gorgeous multicolored wild flowers all along the drive from the hospital in Duncan to the clinic in Marlow. Bright little flowers and old, beautiful trees lining the street of your new town in the rain... I'd say its a treat.

I got here on Sunday night after a not-small detour which included me getting to visit the Wichita Mountains once again. They are beautiful at sunset if you are driving in from the north. I hope I can go out there a lot on this rotation, but we'll see. Supposedly the hours for this stint are somewhere in the 9:30am to 9:30pm area. It looks to be no lie, so far.

I think I like small towns. The people here seem almost the exact same to me as everywhere else that I have been so that's no different. The hospital I get to live at is nice. Dr. King, my preceptor for May and June, is a great person and a good doctor. More good news... there might be someplace to go horseback riding around here that lets you gallop on the horses. People in small towns seem like they might be more likely to let you gallop on their horses than just make you stick to boring old trail rides. I'm keeping my fingers crossed and looking into it.

On a more personal note: I need a break. I feel worn out.

Creep, Creep, Creep...

There is something that has been creeping up on me like a sneaky little insect. Something I have been thinking about a lot lately but trying not to. Something that is much more difficult to be rid of than brushing a bug off your leg on the Fourth of July. And that thing is... graduation.

Supposedly, we are to start looking for jobs this summer. Supposedly, I am to fill out applications and ponder salaries and paid vacation. Now I grow up and start deciding what I actually want to do. In someone's mind, I am an adult, and have even the remotest idea where I want to live and settle down. (And in some far away fairy tale land, I am also studying for our board exams.)

Reality: I am laying on the couch eating an ice cream sandwich and watching Sahar take a little spit bath.

Its kind of like having two lives. One in which I go to the hospital every day, do histories and physicals and patient care plans with some traumas thrown in; the same one in which I graduate in 8 months, settle down with a great job and have a very good life surrounding by loving family and wonderful friends.

Then there's the other life, in which I continually think of being back in dusty Kandahar, riding camels in the desert and laughing with nomads under tar-colored tents. Or Ecuador, treating brown-faced little children in a medical clinic by day and riding rusty old bikes on the beach by night. Or Haiti, sleeping on roofs, delivering babies on the clinic's dirt floor and hiking to waterfalls; petting purple sea urchins then riding to islands on ancient, patchy-sailed boats.

Ahhh... I still have no idea what to do.

Happiness. Flowers. Mountains. Lederhosen.

This is Mr. Lucas. He was pumping water while calling himself Lars in a German accent and talking about lederhosen. And so you can see why Mr. Lucas brings my heart pure joy. :) When I'm with him, I'm just about as happy as I can ever remember being. He is a genuinely thoughtful man with a cheerfully contagious disposition. You would really enjoy meeting him.

We went to the Wichita Mountain Wildlife Refuge last weekend. We did a little trail run out to a tall thin rock with two large boulders balanced on top- aptly named Crab Eyes- and climbed up on top. Its one of the most beautiful views in the whole park, or so says Mr. Lucas. Then we grilled out shishkabobs and later hiked to a waterfall with a couple of his climbing buddies. Then watched the sunset on Mount Scott- which I have concluded is THE prettiest view in the whole park. If you live in Oklahoma, and you haven't been, you have no excuse- the mountains are only an hour and a half away from the city. It is worth it.


Our delicious lunch. Yummy sweet potatoes not pictured.




He even brings me flowers.

A Lot Going On

Seems like there has been a lot going on recently. My brother had appendicitis again and a second surgery to take out his appendix again (strange, right). I went up there this past weekend to spend some time with them. Now he's still having some problems and laid up at the hospital in Des Moines so be praying for him.

The ER is still going great! I love it there so much. Its really a joy to get to go every week. This week I traded one day of ER for a clinic day Friday, so no four day weekend. That has been one of the huge blessings of this rotation- lots of free time! Which, I am finding, is very fun to spend with my architect friend. More on that later.

So, the schedule is going to be a little odd until August, so here it is one more time:

March- Oklahoma City
April- Edmond
May- Marlow, OK
June- Marlow, OK
July- Shawnee, OK

Marlow is in the middle of nowhere. About an hour and 45 minutes from the city. So, I will be a little nomad for the next four or so months. Ahh... its been nice to be settled for so long. Now its time to uproot and migrate again.

Psalm 19

The law of the Lord is perfect,
reviving the soul.
The statutes of the Lord are trustworthy,
making wise the simple.
The precepts of the Lord are right,
giving joy to the heart.
The commands of the Lord are radiant,
giving light to the eyes.
The fear of the Lord is pure,
enduring forever.
The ordinances of the Lord are sure,
and altogether righteous.

'In his presence is fullness of joy, and at his right hand are pleasures forevermore.' -Ps 16

Awake Late

Sometimes it is hard to sleep at night.

Especially if you stay up until 7:30am roughly 42.857% of the week. I am not complaining though, because the Job is wonderful. I couldn't be happier at the ER. Tonight at our girl's group, someone had a word for me. And the word was, concerning the Job and the hospital and the patients:

"You have been tailor-made for this."

I know that it is true. I have often thought that myself.

8 Years Is a Long Time

Yesterday, the sweetest guy in the world took me out. Its been a really long time since I went on a date on Valentine's Day... eight years to be precise. This person is just simply amazing. We went out to a place called Red Rock Canyon and he taught me to rappel. Being a mountaineer for the last 16 years he is pretty good at it; I can't believe how much fun we had.

If you have run out of ideas for dates, I suggest finding a strong, good-looking architect who loves to climb and ask him to take you to the mountains.

Saying Goodbye to Griffin

The cute Italian resident was nice enough to give me today off, so my psychiatry rotation at Griffin is officially over. I was surprised at how much fun and how enjoyable this rotation was. I'm a little sad (not because of the resident :) but because I really became attached to some of those patients. I'm going to miss them and all their crazy shenanigans which brought so many laughs over the last month!

I will miss Miss T, whose only criteria for discharge was that she take a shower. She thought there were demons in the 4th stall to the end so we were always trying to convince her to take a shower in the first stall. But, after weeks of antipsychotics and psychotherapy she told us, "Basically what I'm telling you is I'm never going to take a shower at Griffin Memorial Hospital." Okay, Miss T...

I will miss Mr. J, who left his nursing home because he was "going to follow the train tracks to Egypt."

I will miss "Wolfvy," who first thought he could predict and pinpoint anything happening anywhere, at any time, all over the world, and email the people involved to warn them. And that his wife had sextuplets that all died within 15 minutes of being born. And that he'd had hundreds of surgeries to replace all of his bones with titanium, which is the reason he now gets struck by lightening so gosh darned frequently!

One person I will not miss is Miss L, who was the most annoying patient on the face of the planet. When she came in, she saw the treatment team and we asked her if she knew why she was at Griffin. She gave us THE meanest look in the world and said, "You want me to tell you again? They... ripped... my... ARM... OFF!!" She also constantly hallucinated children and believed that her residential care facility was using them to hand out the medicines. So she definitely wasn't going to go back there until they instituted some safer distribution practices. And that the owners were castrating all the male residents and then throwing the remnants at all the other patients. And that was just completely unacceptable. She was a tortured woman... who will no longer be torturing me. :)

One Year Later: A Tribute to Cyd

It was exactly one year ago today that our dear friend Cyd was abducted in Kandahar. One year, and we have still not had the opportunity to hold a formal memorial service or funeral for her. So I would like to take this opportunity to write out a memory of Cyd I have, that no one else ever knew.

My first trip to Kandahar was in 2005- I stayed with Cyd and her two roommates for about a week. We had great fun during that time and there are many memories impressed on my mind from that short period; however, one stands out.

Every night of the summer, Cyd slept on the roof, on a small cot, under a mosquito net. She loved to sleep under the stars. I loved that roof, because it had a view of one of Kandahar's strange mountain formations just off to one side. Most nights that week, we went up to the roof and looked at the mountains and the stars. So it wasn't unusual that my last night in Kandahar, we again found ourselves on the roof after sunset; but this time we sensed the time was precious. So we lingered there for hours, talking and praying and singing together into the early morning. Cyd had a beautiful, resonant voice that rang out like a bell. We cried and talked over so many things. Sometime after one she finally left me up on the roof and went downstairs to sleep, because the first chill of fall had just arrived. I knew I was leaving for Kabul in the morning, and didn't know if I would ever come back. I stayed up on the roof for a few more hours, singing softly and basking in the beauty of the Kandahari night, staring at its millions of stars. After drifting off sometime later, I was suddenly startled out of sleep; and freezing, went downstairs to bed.

I have never forgotten that night with Cyd. What an unusual woman! That she cherished and found beauty in such a place, and somehow instilled it in my heart too. I will always love you Cyd; I wish we could sing on your roof tonight.

The Cute Italian Resident

So... there's a certain very good-looking young Italian doctor that happened to have a PA student assigned to him for the month of January. He immediately intrigued this student with his kindness and dark head of curly brown hair. Which she stared at the back of most of last week. However, since she has absolutely no idea how to attract a person of the opposite gender, (and possibly due to some rule about preceptor relationships the program made up pointlessly, without single students in mind) she admired him quietly from approximately two feet away in her chair as he interviewed crazy patients. I know because she's a really close friend of mine.

Then this week, just before lunch she began texting someone. He immediately looked up and said with a grin, "Who are you texting, your boyfriend?" She just smiled and said no. And sort of blushed because those are exactly the types of questions savvy females are able to take advantage of without replying in monosyllables. Although, she felt a twinge of hope because that's one of the first questions someone asks when they are interested, right?

Then his phone rang, and after he hung up, she decided to make a joke and said, "Who are you calling, your girlfriend?" But then he said, "Yeah."

*Sigh* .... nevermind.

A New Roommate

It has been over 2 years since I last had a roommate. However, following a short hiatus in Edmond due to a flooding incident right before New Year's, I now again live in downtown OKC. The days of Deep Deuce are over; my lease was up on December 31st. I am now staying with a friend until my rural rotations start.

My new roommate is awesome! I just love this sweet girl. She is a pediatric resident I met on the PICU rotation. She's also from Pakistan. Because she basically works 90 or more hours a week, unfortunately there's a lot she has never done in Oklahoma. For example, while on the prowl for food tonight and she pointed at a store and said, "What is a Braum's?" Needless to say, she was soon eating some Oklahoma dairy cow produced ice cream. This is going to be fun. And also will be a good transition- since she isn't home too much and I am not used to having someone home.

In other news, two of a greatest people on earth got married last night. Congratulations Danae and Nao!

Baby Jonah

Beware: a very long story follows.

Due to HIPPA, no one is allowed to share medical information together with a patient's name. So the following story is true but the sweet baby has an alias. This story is one I have been thinking about for the last month and one with which I am just now coming to terms.

I had been at Children's Hospital a little over two weeks when I showed up to work one Wednesday morning and was greeting by our sweet, smiling upper-level resident, Kim. I'd had two asthma patients the day before who had both been discharged, and so was coming in with nobody on my plate. Immediately upon entering the residents' office, Kim informed me that she had a baby for me to follow. He would be the only patient I saw that day, as his case was complicated. His brief history is as follows:

Jonah was born seven days previous to his admission to the PICU. When he was four days old, his mother took him to the doctor, because she was concerned about constipation. The doctor noticed that Jonah had a low oxygen level on room air. He admitted him to the hospital in Lawton where he was started on some antibiotics.

That afternoon, Jonah's mom noticed his eyes crossing, lips puckering, and legs stiffening while his oxygen levels continued to fall. That evening, he had an episode that the mother recognized as a seizure. One and a half hours later, he had a second seizure lasting approx 3 minutes. Medflight was called to transport the baby to our hospital in OKC. Upon arrival, the paramedics found that his heart was not beating. They proceeded to intubate him and gave him chest compressions. He had another seizure en route to the hospital.

Then Kim paused and she said, "This is the part of the story that is so sad."

Kim was the resident on call the night Jonah came. Upon arrival at the PICU, Kim examined him, wrote an admission note, and was about to leave the room when Jonah's mom mentioned to Kim that she had painful, vesicular lesions on her right breast. Kim examined the lesions and realized that they were a primary outbreak of herpes.

There are only a few reasons that a person should not give birth vaginally. One of them is if the mother has a vaginal infection, because as the baby goes through the birth canal, it will mostly likely contract the infection. If it is a bacterial infection, like gonorrhea or chlamydia, it can be treated. However, if it is a viral infection, there is very little that can be done. Tiny infants also have virtually no immunologic defense against infection, and therefore, when they contract viral infections, it is very easy for the infection to get into their blood and spread to all their organs (called sepsis). It is very serious and frequently ends in death.

So that is how it came to be that Jonah contracted herpes from his mother. The mother had no idea.

Kim immediately got cultures of eye, skin, nose, trach aspirate, blood, urine, and rectum. And also of the mother's lesions. We already had a pretty strong suspicion that Jonah had sepsis due to disseminated herpes; when the cultures came back a few days later, the suspicion was confirmed. Everything was positive.

I went in to see Jonah that first day and he didn't look too bad. He weighed almost seven pounds and had little tufts of blonde hair. He did have some bruising from where they'd put IVs and lines in him- mostly around his umbilicus and thighs. With a blanket on, you could almost think he looked normal. (Apart from the tube going down his throat.)

However, when I got to his chart... wow. This baby was complex. Most of my other patients had their vitals and other stats monitored every hour. Jonah had everything normal plus more monitored every fifteen minutes. His chart was blackened with tiny little numbers. This was going to be complicated.

He also had every lab known to man done every four hours. The main things that concerned us were his kidneys and his liver. Here is why:

If your liver stops producing certain proteins your body needs to make blood clots, you bleed easily. When you have a lot of IVs and lines, you need the your blood to clot quickly. If it doesn't, you receive a LOT of blood products. Cells, plasma, and all these clotting proteins. Your medicines can also only be concentrated so much. In other words, you get a LOT of fluid going IN.

If your kidneys stop making urine, its very hard to get rid of the fluid that you take in and that your body naturally makes. What do we do for people who have kidney failure? We give them dialysis. Dialysis, however, requires a big hole. And its pretty easy to bleed a lot out of big holes, so if you are going to have kidney failure, you need your liver in good working condition, making all the clotting proteins it is supposed to make.

So, either your liver or your kidneys can fail, but it is really bad news if both stop working. So basically, my job every day was to do all the math on Jonah's intake (all the fluids, medicines, etc going in) and his output (urine, blood, vomit, etc), as well as looking at all the labs every four hours and all the medicines he was on and figure out if his liver and kidneys were going to start working.

So initially, we knew he was in liver and kidney failure. He wasn't producing any liver proteins, and so we had to continually replace all of them, so that he wouldn't bleed out of his lines. However, this meant that that in the first 24 hours of his hospital admission, he was given almost a liter and a half of fluid. That was equal to half of his dry weight. However, his urine output was practically zero (hence the kidney failure). So, lots of fluid going in, nothing coming out: Jonah began getting puffier.

So although his liver was shot, we knew the one chance he had to live was if his kidneys began working again. Throughout his 9 day stay in the ICU, each day I went into work wondering whether the Jonah had peed at all overnight. If so, he was going to have a chance to get rid of all the fluid we were pumping into him, and have a chance to survive.

However, every day, when I got to Room 8236, the chart that awaited me had bad news. Each day, the first thing I raced to was the urine output column: 40 milliliters in 24 hours. Ouch. His daily input was hanging around 900 to 1,500 milliliters- he was gaining around a liter of fluid a day.

By the end of nine days, he was bigger than an overweight 9 month old.

The thing that killed me was that none of the doctors ever really told his parents how bad it was. One day, they were taking a much-needed break down in the lobby and saw me leaving. His dad pulled me aside and asked hopefully how he was doing. That particular day, he had been bleeding immensely out of his umbilical line and we almost could not stop the bleeding. I had no idea what to say. Shouldn't the doctors have let them know how close to the edge he was?

Each day, Jonah looked worse and worse. My second to last day of the rotation, one of the attendings told me that Jonah had the worst case of edema he had ever seen. Jonah's whole-body edema was so bad that he even had chemosis, a condition in which the water accumulates under the whites of your eyes and makes you look really freaky. Not that his eyes were open; his swollen lids spared his parents from seeing it.

The last day of my rotation, I showed up almost 30 minutes late due to the OU parking office accidentally shorting me one day of my permit, hence leaving me without a parking spot and scrambling to find one on our cramped campus. After I walked into the resident room, I grabbed an exam sheet and headed over to 8236. He had looked so ghastly and awful the night before. Did he pee??

As I approached the room, I saw a huge crowd of crying family members gathered around the doorway. I turned around, threw the sheet into the trash and walked back.

Over night, the attending had informed Jonah's parents that after 8 days of liver and kidney failure, the chances that he would recover were basically zero. Although he was on a lot of pain medication, he was probably still suffering. That kind of edema would be incredibly painful. And so, they took him off all his drips and the ventilator early that morning. He lasted on his own for almost five hours before my arrival. After I'd seen the family crying, I sat down in the resident room for a moment to think. Jonah died less than five minutes later.

I went in to hug his parents. After coming in to see him every morning of his stay, I had a lot of internal emotions toward the parents and had prayed for them a lot. They looked awful and were sobbing. Although Jonah was so swollen, I grabbed his little hand. You could still see the softness of his little tufts of golden hair. Oh...

And so my very last duty on that rotation was his death summary. And so, this is why I can never work in a children's ICU and also... why I continue to eagerly anticipate the day when there is no more suffering.

A New Year, 2009!

Isn't a new year such a refreshing feeling? I have written 2008 at least a couple of times already. Stopped and realized.... it is 2009 now! Ahh... mostly, its a chance to start again. And who doesn't love that?

2008 was full of kindness and good things, but it was all mixed with a lot of sadness. I can't say I am sad that this year is over. I am so excited for the new!

I did some research on New Year's resolutions on the internet and I am now planning to stop smoking and lose 50 pounds. Anyone else with some New Year's Resolutions?

Cast It Into the Fire: Part II

Ever since our cardiology test finished last fall, there is a phrase I use to refer to times of incredible stress which are quickly followed by periods of immense relief. These are Cast It Into the Fire moments. In my mind I always see Frodo laying down, panting on the rock when its all over.

This year's award goes to: the Children's ICU rotation and its ensuing termination. P. T. L. this month is freaking over. Now if only I could mindlessly stagger over to some deserted alley and collapse in an irresponsible heap for the next month...

26 Will Be More Fun Than 25

Thanks everyone for being so sweet on my birthday!

I haven't even sat down to think about goals for the next year, because there's one Very Big Goal I have been working on for the last year and a half. Its only just now we are reaching the cusp of the calendar year this goal is to be accomplished: 2009. (Cue sound of me panting like a dog...) Oh, the pure ecstasy!

In other news: sometimes, even when I am incredibly tired or should be studying or doing any number of other things that would be wiser investments of time, I spend an hour or two reading the blogs of random strangers. It is truly one of my favorite pastimes and definitely the main reason I am grateful that Al Gore created the internet. So the other day I was reading one of the most hilarious blogs *ever* and... I realized that part of the simple allure of this girl's writing was that she didn't take herself too seriously and was able to accept her own flaws gracefully.

As a true Type A who has only become more rigid with the passage of time... I confess I am envious of this girl. To be able to accept my faults effortlessly and with grace and humor; ay ay ay. Help me Lord! I suppose that is a big enough goal for 26.

She Got a Hippopotamus for Christmas

My mom used to tell me the craziest things. My sister and I thought she made them up to entertain us. As an adult, I've found out she was usually right. She told me the following story awhile ago and I always wondered about it; turns out Wikipedia confirms her love for the strange-but-true once again.

"I Want a Hippopotamus for Christmas is a Christmas novelty song written by John Rox and performed by Gayla Peevey (10 years old at the time) in 1953.

Peevey was a regional child star of the Oklahoma City area. According to legend, this 1953 hit was recorded as a fund-raiser to bring the city zoo a hippo. When released nationally by Columbia Records the song shot to the top of the charts, and the city zoo got a baby hippo named Matilda. In a 2007 radio interview with Detroit-based WNIC radio station, Peevey clarified that the song was not recorded as a fundraiser originally. Instead, a local promoter picked up on the popularity of the song and Peevey's local roots, and launched a campaign to present her with an actual hippopotamus on Christmas. The campaign succeeded, and she was presented with an actual hippopotamus, which she donated to the city zoo. The hippopotamus lived for nearly 50 years."

If you saw the hippos at the OKC zoo before 2002, you too saw Mathilda, the hippo Peevey sang about and got for Christmas. Sorry for not believing you Mom...

In His Name All Oppression Shall Cease

The hospital was pretty dang depressing last week. Its just depressing when you only have two patients- and then one goes brain dead and the other you take off the respirator. The world's deepest grief should be reserved for these parents.

But there is another part of it that is actually relieving; when these little chillins are relieved of their suffering. We pretty much see them in the worst physical state on earth. Sedated, intubated, and everything in the world going wrong with their little bodies. Its enough to make you realize how compassionate taking them off a ventilator truly is.

The moment comes when they take the tube out, and then what you see with your physical eyes is a tiny girl, turned a little blue, chest silent, heart no longer beating. The whole family is crying around a dark hospital bed, and she is gone. But if you close your eyes...

She is in a green field and a cotton dress, barefoot, running toward a man ready to scoop her up in his arms. The ribbons in her hair are streaming in the wind and there is a gigantic smile on her shining face, all creamy and pink-cheeked.

You are the one left standing in the dark hospital room, and she is freed.

"The righteous perish, and no one ponders it in his heart; devout men are taken away, and no one understands that the righteous are taken away to be spared from evil." - Isaiah 57:1