Giving Thanks

Me and our niece (God-daughter) Ashlee.

I could list a million and one things I am thankful for, but it wouldn't be a complete list, just the first million plus one. I could hardly sleep Tuesday night after the great delivery. I was anxiously anticipating seeing my other half the next day. Up and at 'em early I was and we made our 6 hr journey to Council Bluffs IA to see my hubby and his family. Our first order of business (at least that would be appropriate to mention) is to get our new rings. When we got married we bought our wedding bands and work rings -solid white gold rings engraved with our special saying inside. We didn't want to ruin our pretty wedding bands and my cute little diamond ring working as paramedics when we wed. Well, Shawn has misplaced his white gold work ring and instead wears his Tungston steel ring I gave him we we got engaged (it's indestructible) and my ring is worn so often that no matter how often I get it re-dipped it's yellow by the end of the month. So we decided for our 2nd anniversary we would get new Tungston work rings. We pick them up in December - can't wait!! That night we met up with his folks, his sister's family and kids for dinner, relatively uneventful except that I was completely embarrassed multiple times by comments about things I wouldn't have talked about at a table with a 4yr old and 8yr old. Thanksgiving the next day was pretty neat. Shawn's parents, me and my mom, his sister and husband with their two kids (one of which is our God-daughter) and a family friend of theirs with their two boys. Lots of food, wine and good times. I played a wii for the first time and although I was beaten badly by a 3 yr old in mario kart it was still fun. Our evening was topped off watching Kung Fu Panda with our niece and nephew although we were to only ones awake at then end of it. My mom and I went shopping in the black Friday mess after taking Shawn to the airport. 36 hrs with him just isn't enough but it's better than nothing. I was glad he went home when he did and picked up the little ones - Wrigley was super sick when he picked them up which resulted in an emergency vet visit last night four medications and ear cultures and an E-collar (which she won't wear). I need to be home with my little ones and my big one. It's too hard on everyone for me to be gone like this and it's only been 3 weeks. Shawn has been doing such a great job doing everything at home and has even managed to swing by the house during work hours to check on the little ones.

I said my mom and I went shopping on black Friday but we didn't spend thousands on Christmas gifts like my mother in law and we didn't hit the stores at 4am either. We just went to a couple places looking for just a couple things and then we hit the fabric store to buy yards and yards and yards of fabric marked 50% off. I have some how been coerced into making my first quilt (to add to the 4 generations of quilts I will inherit one day), so I had to pick out 15 different fabrics, my mom is making a quilt with me so there is 15 more fabrics and we decided while we are just whipping out these quilts we should make one for grandma too - another 15 fabrics. I'll be happy just to finish cutting all the pieces of mine. All the way back to grandma's we stopped at different places to look for more fabric trying to find the perfect fabric patterns and colors to complete the collection for our new masterpieces. Wish me luck.

36hrs may not have been enough but I am thankful for that small amount of time to spend with the person I love more than anything in the entire world and I am grateful he made it home to save our Wrigs. 4 more weeks and I am back home for 4 days. I hope they go super fast and then I will give thanks for that too.

pictures of the pups on Halloween. Long over due but I miss them lots.

moving up in the world

Full day of clinic topped off with a delivery just after the last patient. Great timing if I do say so myself. It was baby #3 for the lady who did it without an epidural woohoo! what a stud. Beautiful baby girl. Had I known I would have been a more active participant in this delivery than the last I would have 1. worn a mask - asked where they were. 2. asked for some shoes covers and 3 dried my hands a little better after scrubbing. But it wasn't until my preceptor said "put your hands there" that I realized it was too late for the above mentioned items. So I can't complain that when I was drawing cord blood and I withdrew the needle I was spurted on my pink socks - I'm just glad they weren't my argyle ones. No one seemed to notice and when I changed I took off my socks and stuffed them in my pockets. I didn't deliver the babe myself, caught the butt and tugged and delivered the placenta. yay. I think I am moving up in the world.

I reaffirmed some of my feelings about parenting and life in general I guess with someone of my patients today. 1. a hyperactive 15 month old child (and overweight by about 30lbs) should not be fed candy to try and calm him down, really it doesn't help the matter - no wonder he doesn't like to eat veggies, and no smarties do not count as a food group (seriously who feeds a 15month candy?). 2. just because your friend's sister is a RN and has fibromyalgia doesn't mean that you, a 55 year old male has it too especially since you have no trigger points and the numbness and tingling in your toes and legs are more likely attributed to your uncontrolled DM (believe me fasting sugars between 160-220 are NOT controlled). and 3. Medication for depression only solves part of the problem as do medications for hypertension and hyperlipids - you actually have to make some effort to help yourself. pt "no I don't have to eat well or exercise they have medicines for that" hmmm. I bit my tongue to not say anything too off color or chastise them and 4. you know you smoke too much when the papers you bring in to show the doc smell so badly of cigarette smoke it makes the hallway and room smell too.

I didn't get to see the dogs play today, I'm bummed, but I do get to see Shawn tomorrow!!
www.barkzone.com

Dirty Dancing

So I've been doing this Zumba class for about 2 week now. My Monday night class is actually somewhat a workout but my Thursday class is fluff and ass-shaking more or less. If I wanted fluff I would dance around in my grandma's living room. There is something to be said about group classes, there can be a lot of people in one room who are suppose to be doing the same actions but in tonight's class there was some heavy recruiting from the main gym to get people to try the class - great idea except there were a lot of people in one room, not doing the same actions looking completely confused and to top it off, the lady next to me was dancing in my dance space! If you've ever seen the movie Dirty Dancing you would know the when people are dancing, it is essential to stay in your own dance space. I don't mind dancing close to other people, in fact it's reminiscent of my dance team days in college but the people I was dancing close to then knew what they were doing and didn't dance in my space and sure didn't whack me occasionally when going to wrong direction swinging the arms the wrong way. The least I can say was my Zumba class was more dirty disaster than dirty dancing. If I didn't get out of work between 5 and 5:30 I could attend some of the other classes that sound interesting and more, um advanced and less booty shaking. After Thanksgiving I suppose.

Shawn has caught up on his sleep I think finally. He spent the afternoon with our niece and nephew. Wish I could be up there hanging out with them but all in good time...Wednesday is only a little over 24hrs away! YAY!

Clinic flew by today. Some interesting patient histories to accompany the patients: a 5 yr old who at age three was diagnosed with malignant pancreatic cancer - now in remission and in for a sinus infection - um wow. A 40+yr lady with Dandy Walker syndrome (I had never heard of this syndrome: http://www.ninds.nih.gov/disorders/dandywalker/dandywalker.htm ) in for a pap. She has two children in their 20s who are perfectly normal. There were a couple others too, but can't remember the entire gist of it all, so I will save them for when I do remember.

Fighting the Urge

It's hard to fight the urge...especially when it would be so easy to give in. I gave in partially this morning by sleeping until noon hoping more rest would fight off the looming illness in my head and throat. I'm a firm believer that once you give in to the idea of getting sick - you will. For the record - I'm not getting sick, just cycling through a multitude of fun symptoms; headache, body aches, sore throat, nasal drainage. I don't have time to be sick right now, I have to make it through 2 1/2 work days to Wednesday afternoon when I will be driving to IA to visit my hubby and in-laws. I can't believe are finally in the same time zone, although truth be told I wish I were going back to NW but beggars can't be choosers and I am just very grateful to be able to see Shawn, no matter where he is. If he could have stowed away our 4-legged furbabies the holiday would be complete but at least I can watch them play on the webcams at daycare.
So until Thanksgiving passes, I will be fighting the urge to be sick and so for all of you patients out there and family members, cover your mouths and wash your hands, this holiday is about giving thanks, not your colds and strep throat.

Special Delivery

My phone rang at 9pm last night - it was the doc telling me our OB pt wasn't dilated more than 2 - maybe tomorrow "we'll get a baby out of the deal" (one of my docs commonly used phrases). I went to bed around 11 and my phone rang again at 12:20 - "she at 9." I said" let me throw some clothes on and I'll be right up" (in retrospect this sentence doesn't sound good in or out of context, but hey I was rocked mid-sleep cycle). I wasn't sure what to wear but threw on a pair of corduroy pants, a nice shirt and my dress shoes. I was there and in the room by 12:30 - not too shabby. I go changed into my scrubs - which looked ridiculous with my brown dress shoes and pink and white argyle socks showing from my buckle shoes, and my hair was a dry-sweat mess from the workout earlier in the evening (would have taken a shower but grandma didn't want me using any new towels until the next day since she just washed them and didn't want a single dirty towel). The mom-to be looked radiant, you wouldn't even know she was in labor. After 2 hours of pushing and a grade 3-4 episiotomy out popped a beautiful 8.5# little girl (much bigger than anyone thought). I was scrubbed in, but didn't do anything but massage the uterus after delivery for about 10 seconds. Oh well, I've helped deliver a couple before - but it would have been cool. The new dad almost lost it and passed out when the birthing coach had him look at the head of hair popping out of his girlfriend. I just can't imagine delivering babies gets old. How fun. The new parents were in shock and awe - new dad talking on the phone to his basketball buds - "it was just insane! the whole thing just crazy! I have a little girl." I may have been exhausted to make a house call at 7:15 this morning to a quad with hemorrhoids the size of a small head of cauliflower - no joke, but it was totally worth it to be there early this morning to watch the family pace as they waited for the first grandbaby and the expectant parents finding strength and endurance and bonding with their new little one. sigh.

It's a small world

There's nothing more awkward then rounding on your grandma unless it's taking an aerobics class from one of your OB patients with a class filled with people I have also seen -I've managed to accomplish both this week. Do I get extra points for that? Even if I did I am so done with Typhon I wouldn't take the time to add it on to my patient list anyway. I brought grandma home from the hospital at lunch time after rounding on an OB who hopefully will deliver in the next 24hrs. I will be sleeping lightly in the anticipation of a phone call to jet up to the hospital and catch.

I don't think I could live and practice in a town this size - I don't mind running into people I know here and there, but not everywhere: wal-mart (greeter, cashier and lady at the fabric dept), Applebee's - hostess, at the gym (on the treadmill, eliptical, free weights and in my exercise classes) and when my mom drug me to the Elks' lodge last weekend for a fish dinner. I feel like everyone is watching me and I'm sure most have met my grandma at one time or another (she chats up anyone within ear shot) and I'm sure they've formed opinions at some point too. I'm also not from a farming background so although I try to pretend like I understand the trials and tribulations from those working 16hr days in the fields to get the milo and grain packaged and take care of the livestock north of town, I probably really don't have a clue.

Last night my mom drove 2hrs from where she works and lives during the week to take me out to dinner - to celebrate my 2 yr anniversary with Shawn. It wasn't the same, but it helped not being alone on my anniversary. I also found out today that I can skip clinic next Fri (after turkey day - it's only a half day anyway) to run up to IA to see Shawn for 2 of the 4 days he's in town - YAY!! I am so ready to see him and my in-laws and niece and nephew and sister in-law. I love Thanksgiving!!

I've almost finished with Typhon - from the last rotation thank goodness, at least if they go to check it I will get a majority of the points I hope - it should make up for the lack of perfectness on my paper.

Conflict of Interest

I am frantically trying to squeeze this short note in when I should be up at the hospital with grams. I suggested she go to the ER yesterday w/ her 3 days of facial pressure, hoarse voice, sore throat cough and then the n/v/d. Long story short (and after disinfecting the ER room from the previous patient myself) she was admitted for hyponatremia (119) and an infection. IV fluids and a little azithromycin. I will finish the story later, I realize now as I start to write, I can't in anyway finish this story in 5min, not even in bullet form. But I am proud of mysefl for keeping my mouth shut for the most part about how these crazy small towners practice medicine out here...oh Lord, ship me to KC if I get sick. More to come...

Long Road Ahead

It's been one week, and although it moved along pretty quickly, I am realizing I have a long way to go and at this point I am not even sure it's worth it - the time away from my husband, the expenses, the strain this has put on everyone, including me. It's not just being homesick, but my whole way of life has been upset for the last 18months and for another 9months yet. The way I eat, sleep, play, the whole nine yards. I keep thinking it will get easier and better, but truth be told it's not. I am also realizing why I love the NW so much. It's so different from what I grew up with and Shawn and I have adapted quite nicely to way we live together and away from the Midwest but this whole experience has just upset the basket of apples. I'm not a big fan of change once I find a rhythm for something I like to stick with it. I realize being here for just a week, that won't be the case. I guess I just needed to vent. I am ready for this journey to end. The problem is, Shawn and I don't have a normal routine. Since we started dating I have been in school, and although I worked too we've moved so much that we haven't had any "us" time in a really long time, we don't even have our apartment unpacked from our last move. Once I graduate it'll be time to work (a lot to pay off those stupid loans) and we'll both be working lots to buy a house and another car and pay off my loans oh and kids (which were the first priority when we got married suddenly seem to be on the back burner) - I swear it's never ending. When is it time for us to just sit down and breath, enjoy each other, enjoy the rest of the world? There just isn't enough time for us to do everything and unfortunately it seems that the one thing being sacrificed right now is us and honestly, that doesn't work for me. And as I sit here, staring at my pile of papers to add to Typhon I see it's going to be a long road ahead.

Zumba

These week went by pretty quick. Tomorrow's Friday!
Today I finally saw patients by myself - sort of. I saw a patient got the scoop (met mostly with - uh is the Dr. not in today because I can reschedule by the patients) then he went in to see the patient. i was right on track what I was telling patient - he repeated nearly everything I told the patients, so I am well on my way I think. I don't know how many times I overheard a patient ask the nurse rooming the patients "I don't know why someone would ever become one of those PAs or NPs and not go to medical school" usually followed by1. "they must be lazy" 2. "they must not be smart enough to go to med school" and 3. "why see a PA when I can see the doc?"
Sigh....
I saw everything from Well Child Checks (made a new mom cry when I said her kid looked like a million bucks) to HTN checks to a guy with a unidentifiable rash (even to the derm doc). It was a long day but a good day - complete with a drug rep lunch who spent 2 minutes talking the whole time saying "here are my drugs, take note pads, we won't have those come January. Want seconds? thirds? boxes for dinner tonight?" We had a catered Mexican lunch - it was awesome!
Dictating two of my patients not so awesome. He told me to just do two today, and see how I do and if I feel comfortable I can do more tomorrow.
Tonight I went to din with grams (although seriously not hungry after lunch) I had to eat light so I wouldn't be full for my group exercise class. I am not a huge fan of group classes - especially the choreographed ones: "Here we go! And 5-6-7-8, work it out ladies.... feel the burn" and so on. I get embarrassed, I feel like everyone is watching me look like complete retard in my uncoordinated long limb fashion. I took a class called Zumba. The commercials look cooler than it was - our instructor didn't speak the entire time - unless it was in Spanish. 85-90% of the class were overweight Latina women - including the instructor. The remaining 10-15% stuck out like a sore thumb...but it was still fun. I salsa'd and mambo'd my way to thinner thighs and sculpted abs. I may have to try another class in addition to this one and my cardio and weight lifting time - I am going to be exhausted. Maybe this will help me sleep.
I'm ready for Friday.

So sleepy

Holy cow, I feel so tired you would think I had been up for days on end. I can hardly keep my eyes open when I'm not moving. Thank goodness it's a half day (well actually I some how managed to escape going to the nursing home today - I had to do some things for grandma and check on her - I couldn't wake her from her snoring slumber this morning - she must be tired too). I hated to pull the grandma card so early and skip out on a great opportunity, but I did, end of story. I have to catch up on Typhon and sleep. I don't know how my husband stays awake after working 24hrs, 12 off, 24hrs and 12 off and now 12 on and in between the last shifts he had to drive back to Hillsboro, pick up the pups and get them bathed, get himself bathed eat andd find time to sleep. Bless his little heart for doing such a great job! He's my hero!

This morning was a CME meeting via teleconference by a Croatian pediatric hematologist/oncologist out of KU med who wasted 38 of the 60minutes trying to figure out why we couldn't see her screen - my doc was actually counting and making snide comments pretty regularly, I tried not to laugh out loud - but it kept my eyes open and he had us leave about 20 minutes early when the ophthalmologist started asking pointless questions.

And if you're in the area - you should check out "Guys on Ice" from the looks of it - it's not for the manly man. (A musical with men, only men singing about wearing snowsuits and other snowy things - riveting I'm sure - I'll let you know how it goes, sounds like I will have front row tix thanks to grams)

Lunch ime - yesss!

Slow Start

i think I am still catching up form my last rotation - actually I know I am, I feel like I am dragging, in fact I think it's showing too. I didn't know what to expect day 1. Everyone seems to know my grandma (and I am sure if I wasn't her granddaughter they'd all give me her opinion about her). Expectations were sort of explained to me, but there are still lots of questions I have about what to expect. These week is getting to know the ropes, where things are and get an idea about the schedule (which changes everyday). Tomorrow rounds at 7am, CME meeting at 7:30, clinic at 8, Kiwanis at 12-1 and then off to the nursing home in an even smaller town to see a few patients, we may even have a housecall. We do lots of neat things in the clinic (like our own treadmill this am and I will get to help deliver a baby in the next week)- I am hoping I will snap out of my funk and be able to take it all in - there is still no way of knowing when I will get to be on my own - I think he thinks I don't know anything. He tells me what EVERY drug is, even the obvious ones. I am the 1st PA student he's ever had, but are the NP students he's had really that dense? He wants to try giving me one type of patient at a time, one week all the HTN, then DM then sore throats and cough etc and I will be dictating my little (well big right now) butt off.

A long story short about the the "scandal" going on in the town right now: the current hospital (which is three circles smooshed together) is run by the Dominican Sisters. Nothing against the Catholics but lets face it, in some areas they aren't willing to be progressive (if that's really the correct word) on some issues and dealings. There are other issues too but it anyways... So some of the docs in town, including my preceptor, decided hey, we opened a surgical center across town a few years ago, so why not just make it into another hospital - on our own. (scary doom music enters) And so they did, well have started too. Today's clinic was interrupted from 11-1 when we were suppose to go to the building site , the docs were going to sign the last beam to go up on the building frame have a BBQ and enjoy the company of one another - sounds like fun! And I am sure it would have been had it not been 30 degrees outside, overcast and blowing wind since it was outside in a temporary circus -like tent not tied down and without heat. Thank goodness I grabbed my coat, hat and scarf.

And by the way my grandmother just yelled "dicks" as in Ft. Dix for her crossword puzzle she's doing right now. I've never heard her shout answers out before, this could become very entertaining. Off to catch up on Typhon and more homework. I worked out tonight, it felt great not to workout but to burn off some stress, homesickness and any other pent up things. Oh and 1 week to our 2year anniversary.

Kansas

I made it, finally, to Great Bend, KS. What? Never heard of it? It's in central KS, it's home to one of the greatest moving Christmas light decorations in the country (well at least it's on the circuit and hey it's a small town). I've never actually lived here, but my grandma does and my KS drivers license says it's my permanent address and it will be home until February 13. My mom lives here on the weekends too, so basically 3 generations of stubborn, hardheaded and strong women living in a small house that isn't much bigger than our apartment in WA with as much stuff to fill the whole street of houses. I can't complain, a lot of my stuff (like form my wedding) is here too so some of the boxes lining the single hallway belong to me. My grandma's house has a lot of great memories for me, the smell makes me nostalgic (not to be confused with nausea). I played catch with my grandpa with his old baseball glove in the front yard, I've baked with my grandma in the kitchen, here is where I learned to sew and crochet and many holiday meals eaten in the cozy dining room. There are pictures crammed onto every possible surface, my grandma is so proud of her 3 grandkids (although I swear I am her favorite - if grandmas could truly have favorites). I am so grateful to have the next 3 months here with my grandma even though I know there will be some tough days ahead and some living adjustments to be made for sure not to mention that my preceptor is her doctor and just about everyone else in the town's doctor too.

Yesterday I flew into the KC airport which is about 5-6 hours away. My mom picked me up took me to have a steak dinner and then took me shopping to get a couple more sweaters to endure the cold here that I really don't miss in the NW. We stayed a motel we stayed at when I was younger and we were fleeing home for safety. I did homework (although no Typhon yet - maybe tomorrow we can start that.) It was weird to be in my hometown even if it was for 24hrs. Everything has changed - I thought it was a large suburb before, now it's so much bigger. I didn't recognize half of the new buildings. We went to church at Shawn and my (and my mom's) home church. I wish I could transplant it to the NW. Shawn and I use to drive 3 hrs form Omaha to go on Sundays just to drive another 3hours back after closing benediction. Our pastor married us in Omaha - she drove up and back just for us - it wouldn't have been the same without her. After church we swung by Costco and picked up a couple essentials then hit the road.

I'm glad to be here with grandma - but it's not home. I miss my Shawnee and I miss the little ones. I miss my bed and the smell of our apartment. I miss the weather and my snuggle time - there is nothing that can replace snuggle time, not even my miniature hippo dowsed in cologne. Shawn is visiting his parents over Turkey day, I really hopes he can swing down 8hrs away and see his wifey, that would be amazing.

I'm ready for tomorrow, don't know what to expect but I am ready to start this rotation, 6weeks at a time. Good Night Zuppie, I love you.

Sad day

I am packing to be gone for 5months, how do you fit everything into 2 suitcases? We found out this morning Wrigley has cancer - we'll know more in December. Yeah, I'm really motivated to start the next rotations.

6 days, 7 nights

I'm leaving on Sat for KS. I am very very very sad already, but trying desparately not to let it taint the week. I get cranky when I anticipate sad/bad things. I am squeezing in all the snuggle time I can with the pups and most importantly with Shawn. I can't believe this rotation is almost over already.

We saw SAW V yesterday, not nearly as good as III or IV but filled in some gaps which was nice, I am ready for the finale - SAW VI - next year. We ate dinner at the Crate House up on Terwilliger. It was good, you pay for the view but a lovely birthday dinner and topped off with Sheridan's - yum.

Shawn and I sent our ballots in - Washington and KS respectively. I'm pretty sure mine won't make it to KS in time, but then again most the people in that part of the state run unopposed and it's a clearly red state - I doubt my ballot would have been a swing vote for any instance, but at least I feel like I did my patriotic duty and voted.