The End of an Era

Yesterday was the last day that I will ever have to wear the short white coat of a student. Before medical school- and having spent no significant time in a teaching hospital- I was unaware that there were differences in rank based on the length of coat. In truth, different institutions have different rules (At Duke, for example, everyone wears short coats until they finish their residency), but in general medical students wear white coats that hit around the hip (and have extra large pockets for the copious things we have to lug around the hospital halls) and anyone with an MD wears a longer coat. There are other details like attendings wear coats with cloth buttons, but such distinctions are more subtle and I'm not sure anyone cares but the attendings.

So, my coat is retiring and thank god because it's filthy! I have actually washed it occasionally, but it's white. How the heck am I supposed to keep it clean? In France, many hospitals have actually banned white coats, ties, and full length sleeves because as you lean over a patient these clothing items can cross-contaminate. I always roll my sleeves up and I take off the coat whenever I can. Not is it only dirty, but it's quite heavy actually. I think medical school is all about developing stronger neck muscles to combat the weight of a coat that really doubles and a back-pack. When I first began clinic rotations during my third year, I was told to carry everything with me, but my back was not going to survive. Like a hiker on the AT, I slowly thinned my loot and got down to the essentials. Little by little various instruments left my pockets. My tuning fork? Haven't seen it for a year. An otoscope and ophthalmoscope? Leave 'em at home now. Reflex hammer? You can use the end of your stethoscope, or your hand, or a spoon off of a lunch tray (just kidding, never done that). The only things one absolutely needs in their coat are: a stethoscope, a pen light, and the intern bible "Pocket Medicine." Beyond that, you are torturing your neck.



So as I left the hospital today for the last time as a student, I was harkening back to my first semester in medical school- nearly 4 years ago- when we were presented with the white coat at a special ceremony. (See picture above with Beth and Steve. Note: the coat is impeccably clean!) Back then Kyle was still in Colorado and I was living with his folks, madly studying flashcards and trying to remember the krebs cycle yet again. What a long way I have come. Now I know the structure of the body (anatomy) and how it works (physiology) and the natural course of disease (pathophysiology). I know what questions to ask when a patient comes in with chest or abdominal pain and I know how to rule out potentially lethal causes. I know how to write orders, how to communicate with nurses and other doctors, and how to safely discharge a patient.

I've come a long way, and despite that, I'll have a huge leap to make in July. The most patients I've ever cared for at once is probably three and I'll have to jump to caring for 10 of my own patients and covering for 30-40 at night. People say that managing is all about learning to be efficient, but I'm nervous that I'll start to overlook the little things. For example, this month three families made a point to thank me for my humanity and for explaining things to them in a way they could understand. This is the quintessential role of a medical student and one that I have cherished. Having a little more free time than the docs makes it easier to have sit-down talks with families and make sure their needs are truly met. I just don't want to lose that in the chaos of residency. I want to be a humanitarian first and foremost. After-all, that's why most of us have gone into this field.

So here I am, poised on the edge of a steep transition, about to start what is supposed to be one of the hardest years of my life. It's difficult to look back and appreciate how far I've come with that looming before me, but I'm trying. I'm thinking back to that white coat ceremony when I said the Hippocratic Oath for the first time and how the years that followed were challenging but greatly rewarding and I can only hope that the next four years of residency will be the same.

Week 16

By popular request, I am posting my first "baby bump" picture. Here I am at 16 weeks:

Note: I am wearing my new maternity jeans (Thanks, you-know-who!) that have an elastic band instead of a zipper and button. Who knew that they make cool "mom jeans?"
Going to the maternity store was sort of fun. They're so gentle and kind there like they know that at any moment they might be in the path of a pregnancy hormonal rage. They offered me and Kyle water and even had a store bathroom for their pee-happy customers (yes, I did have to use it). In the dressing room, they had a belly pillow that you strap around yourself in order to make sure you can grow into the clothes you try. So weird!

This weekend was gorgeous. Scratch that. Saturday was grey and it rained all day, but Sunday was awesome. Kyle and I walked to the Inman Park Festival, one of my Atlanta favorites and checked out fun art and beautiful homes. Here are some pics around the house I took while the sun was out:

One of two dogwoods we planted with hastas and lenten roses in background:


Porch flower planter:


The house:


Saturday during the rain, Kyle and I watched Food, Inc. Most of the information about the food industry was not new to us, but the images inspired us to try to be better about knowing where our food comes from and supporting sustainable, healthy, cruelty-free food sources. When we lived in Colorado, it wasn't as difficult to buy affordable, organic or natural food, possibly because the demand there is higher and drives the price down. Boulder has at least 5 natural food stores that I can think of off the top of my head... Atlanta is a bit more challenging.

Since we've lived here, we've sort of fallen off the band-wagon of supporting really good food sources. The Whole Foods here is way pricier than in CO, not to mention it's harder to get to. Last night, while shopping at good ol' Kroger, Kyle and I tried to compare and make better decisions. We went with organic chicken and were disappointed to find that although there was hormone-free beef, it was not grass fed. The only cilantro we could find was from Mexico and the mushrooms said Pennsylvania, but I couldn't figure out if that was where they were grown or just where Dole headquarters is located.

We spent a little more money, but I think in the end it's worth it to feel good about voting with dollars. As I continue to focus my attention on these food issues, I'm sure I'll become more savvy about where the deals are for local, environmentally friendly food. Hopefully, that will curb cost a bit.

Our mission is to buy more organic, buy more local, and buy more cruelty-free meat. It's good for the environment, for us, and for the little one.

Week 15

Baby at Week 15:

- The size of a navel orange, about 4 inches long
- Legs are now out-growing the arms
- All limb joints are functional

Mom at Week 15:

- Starting to show such that a knowledgeable patient today said "You pregnant?" while a fellow student, once told the news, said, "Oh, thank God you told me. I've been wondering since I thought I saw something that's not supposed to be there, but you know how it is when you ask someone if they're pregnant and then they're really not and it's really awkward."
- Feeling good in general.
- Dreaming more vividly (I'll omit the details of the dream in which I was "practicing breast-feeding" with my cats...)


Our First major baby purchase: A pimped out REI stroller



I felt like it was a little early to be buying these kind of things, but it was really more the 20% off REI membership coupon that was expiring this week rather than my excitement to baby-fy our house that inspired me to make the move. Now the stroller is sitting in the living-room like a piece of furniture tempting someone to try to squeeze their butt in it (Yes, I've thought about it). Despite the motives, I'm super excited about this piece of gear.

To put it in context: Kyle and I have been using our REI membership and credit card bonuses to buy gear for years. In the past, we've picked up tents, bikes, sleeping bags, running shoes, and all the Smartwool socks one could want. Using the money on a stroller this year seemed like a bit of a disappointment at first (nothing for me!?), but then I discovered what this baby can do...

It's a jogging stroller but with a fully swiveling front wheel, it can be used anywhere. It turns on a dime. It drives better than our cars. The wheels are quick release much like a bike. It can be adapted for infant car seats. It folds up with two quick moves. It's got a great suspension system and comes in sweet colors.

Maybe I'll try to take a nap in it after-all...

Week 14

Finally broke down and bought myself a belly band. Those pesky work pants are just a little too well-fitted and I was having to unbutton my pants under my shirt periodically during the day. What I love best about this product is the woman who invented it got the idea by using a tube top to hold up her pants at home. Brilliant!



Development at 14 weeks:

- Baby is the size of a lemon
- Baby can pee, grimace and suck thumb
- Neck elongates and body becomes more proportional to head
- Liver makes bile and spleen filters RBCs
- Lanugo (fine downy hair) covers body

Security Alert!

As I am a rather private person, I've tightened the security settings on this blog. I hadn't really thought about it, but Kyle posts on so many blogs that there was a link directly from his account to this blog. I apologize if it creates an extra step for any followers out there (Get a gmail account! What are you waiting for?), but such is life...

14 weeks today!

-Sara

Week 13

Week 13 of fetal development:

- Baby is 3 inches long and weighs 1 ounce
- Bone replaces cartilage and ribs develop
- Face matures: eyes grow closer together
- Baby begins to pee amniotic fluid
- Liver is making bile and spleen filters blood cells
- Baby girls already have 2 million eggs in their ovaries at this time
- Plantar and grasp reflexes are working

At the end of the first trimester, all the major organs have been established. During the second trimester, they will continue to grow and develop.

The image above was taken today at the ultrasound used to screen for Down's Syndrome (everything looks good so far!). This is not a great profile shot, but I chose it because you can see Champ's fist up the air around 2 o'clock. It's like he's giving us a "Rock On!" sign. (I use the pronoun "he" just for ease, but I may just as well use she. We'll be finding out the sex in 2 more months.) While we were watching, we saw Champ sucking on her fingers (see image just below) quite a bit and even lick her umbilical cord (according to the tech, though I would beg to differ- eeww!).


We also saw her push with her feet to a standing position (oh my god, there's something standing in my uterus!) for a few moments. The one below is a good one of Champ sitting on his legs.





The tech had me do some coughing to try to get Champ into different positions when I noticed a movement that looked like hiccuping and she told us it was Champ "practicing her lungs." She said that most baby's do this a little later on and it was a good sign that Champ was doing it so early. On the way home, Kyle and I then talked about how funny it is when parents brag about their child's "advanced" behavior, but I was still secretly stoked that our little one is moving right along!

Today's visit was cool because Champ looks so much more like a human baby than a baby alien (at least, I omitted any images that would suggest otherwise). I was also totally overwhelmed by how this little creature is floating and bobbing and sucking its fingers inside my belly! Watching Champ respond to my coughing or the pressing of the ultrasound probe made me realize just how intimately our bodies are connected. Champ feels most of the things I feel. And pretty soon I'll be feeling him move around, too. Seeing it all transpire just made me want to cry with the joy of it.

As for me, I've been feeling significantly better. This is partly because I'm out of the first trimester and partly because I had spring break last week about could finally catch up on sleep (nearly 11 hours every night!). Any queasy feelings I had before are mostly gone, although I can't say I'm enjoying eating quite as much as before pregnancy (despite eating plenty more!). My energy level is up so much that last week I did some landscaping, re-caulked our 3 bathtubs, and did a bunch of spring cleaning. My pants are starting to fit a little tighter, but luckily my past fashions have included pants much too big for me, so I shouldn't need maternity clothes for another month or so.

This month is my last month of medical school. Wow. I'm on a "sub-internship" or "sub-I" in which I essentially "play intern." I get to pick up my own patients and act as their primary physician contact. I'll be working closely with the 2nd year resident and, of course, the attending so I don't do anything too crazy! But truly, this is my last chance to make some mistakes and ask dumb questions while still a student wearing a short white coat. While I'm excited to graduate and finally call myself doctor, I also want to appreciate my last student moments. I feel like I'm reading the last chapter of a good book when I slow my reading down just to enjoy and savor for a bit the fiction that has become part of my background thoughts.

In like a lion, out like a...lion (Kyle)

When I was young my Mom used to say about March, "In like a lion, out like a lamb." I've never thought much about it, assumed it was just one of those southern idioms, and thought it was an obvious meteorological observation: March begins cold and rainy and ends warm and sunny.

Upon doing a little research it seems that, while that is true, it also refers to the relative positions of the constellations Leo (the Lion) and Aires (the Ram or Lamb).

Now that March 2010 is complete, I have to wonder if maybe the stars are a bit off.

Going in to this month Sara and I knew it was going to be hard. I'm in the heart of the HS Ultimate season. Three of the four weekends in March the Paideia Girls competed in tournaments. The only weekend off, a handful of my college friends put together a team to attend a club tournament here in Atlanta. Sara was on the Surgical ICU (SICU) and stayed at the hospital every fourth night. March 18th was match day. And it was the last month of the first trimester for Champ.

On February 28th Sara and I went to Trader Joe's and stocked up on freezable meals. For those of you that know us, you know that is not our typical MO. We like to plan our meals each Sunday, grocery shop together and try to cook most nights.

That night, as we turned the lights off I told Sara, "see you in April." It couldn't have been much closer to the truth. With Sara waking up at 4:30 or earlier half the days, me waking up at 5:30 and not coming home until 7 or 8pm, Sara at the hospital every fourth night, me gone three of four weekends and a houseful of people the one weekend when I was in town we hardly saw each other. Between coaching and EyeWonder I put in regular 90+ hour weeks. By the last week of the month I was hardly functional in my downtime.

The only day I took off was Match Day. With such differing schedules we were forced to process the somewhat surprising news that we'd be moving to Seattle separately. This led to some miscommunication, tense moments and ultimately one of the biggest arguments of our six year relationship. While we are both excited about Seattle and confident that wherever we end up we'll thrive, we communicated about the match and our next steps differently.

I also struggled with coaching at times. The march-loaded scheduled was exhausting for me and the team. Too much time together, spread too thin, a few of my players and I got into it some.

But I maintain that if it's not hard and challenging, it's probably not worth doing. Every team I've cared about has struggled at some point in the season. And dealing with challenges and tensions means you have to understand each others' flaws, thinking and communication. Once you understand that you can fill in those gaps and you become even more successful and able to take on harder challenges. And my relationship with Sara is no different. Sometimes as the tectonic plates of our lives shift it's necessary for an earthquake to occur to reset the equilibrium and increase the stability of the foundation.

And so it goes. March is over. April is here. And, while I wouldn't want to do it again, the lion that was March has hopefully helped prepare us in some small way for the little lamb that we are expecting. And while I really have no idea what it means to have a baby, I know that we are up for the challenge.