humility

I'm not on call tonight. No one can call and ask me impossible questions, no 3 am driving to the hospital for tiny preemie twins, no setting my alarm in the morning. Don't get me wrong, I love my job. I've just been feeling kinda tired.

Tonight, I have time to eat cheesecake, snuggle my dogs, watch TV and catch up on my favorite blogs. So, I just read a post from Michelle Au's The Underwear Drawer, which is hands down my favorite medical blog. She doesn't post as often as she once did, but I still love her blog. I often go back to old posts. They bring me back to the harrowing adventure that is medical training. Today, she listed five books that she would recommend to medical trainees. The two I've read are great, and the other three I'm about to order on Amazon.

The main thing I took from the column was that you can never be too humble. My boss reminded me the other day when I got a little snarky with a colleague. He isn't perfect on the humility front, but he's definitely at least as far ahead as you would think fifteen more years of experience would put him.

He tells me my mistakes when I miss them, and I learn from him and the mistakes. Sometimes it takes more than once. I've been lucky, none of my medical mistakes have caused any permanent harm, as far as I know. That possibility of causing harm is definitely a source of an undercurrent of fear, and abject terror at times.

The humility thing is hard to learn. I was definitely born with my fair share, and have plenty of failure to remind me to be humble. However, to get to this job you have to be successful--at tests and courses, at interviews and procedures. You have to have done a bunch of stuff right. Then you go and train at "the best" places, and it reinforces your unearned confidence.

Anyway, I'm working on it... Realizing I might be on the wrong track earlier and asking for help, because I am far from perfect. The other thing I'm working on is not interrupting people and not being too emotional when I'm tired, hungry or just frustrated. Seems like basic kindergarten stuff, but it's stuff at which I fail.

Well, go Ravens! Hope you're having as relaxing of a night as I am.

Time again for my twice a year post...

What a slacker. In my defense, the last 6 months have been a little busy... Started first real job July 1st, got engaged July 2nd, married October 6th, first Christmas as a stepmother, took my neonatology boards, and *poof* here I am. There is no next thing, no more steps to finish.

Married!

For as long as I can remember I've been waiting for the next step. Finish SATs, finish high school, MCATs, college, med school, step 1+2 boards, internship, step 3 boards, residency, pediatric boards, fellowship, neonatology boards. I'm no longer waiting to finish anything. I guess it's time to start my life.


It makes things finally feel real to be finished with all of those milestones, and the more I think about the more proud, and less adrift I feel (assuming I passed those miserable neonatology boards, we'll see...). It also makes me feel a little more pressure to be better at life. I'll be 34 next month and I feel like a student still on most days. While I'm actually doing my job, I feel like a grown up doctor; but even at lunch I feel like the kid at the table. It may be partly because my boss was one of my mentors when I was a resident. He was with me the first time I did a lumbar puncture on a newborn, and I can still hear his supportive voice giving pointers. I guess he and I will have to get used to our new roles as colleagues.

Anyway, time to rally the troops for a jam-packed Saturday--morning hike for the people, dogs to swimming in afternoon, and dinner with a great friend tonight. Oh, and I'll try to post more like weekly, instead of semiannually...

Sometimes it's the little things L does that make me so grateful. Pumping gas, sharing his breakfast, parking close to the cart return at Costco, making me laugh all the time.

vaccines

(picture from privatepracticeinsider.com)

WARNING!!! My personal opinions about a controversial subject below!!

So I just finished watching last night's episode of Private Practice and all I can say is WOW. I'm shocked Hollywood took a pro-vaccine position, especially with recent activism by Jennna McCarthy. I'm a pediatrician, and I'm also a scientist who does brain research relevant to autism, so I definitely have formed some opinions on the vaccines/autism debate.

Vaccines are the only things doctors do that make people more healthy. Prenatal care? Doesn't improve infant mortality. Advice to lose weight? Still fat. But vaccines save lives. Incredible numbers of lives, and also spare untold pain and suffering from communicable disease. Hell, we even have a vaccine that prevents cancer now.

The autism/vaccines link has been researched quite thoroughly, without finding a link. I'm not going to bore you with the science, but I vaccinate my dog (who I love more than anyone in the entire world) who has had an ANAPHYLACTIC reaction to a vaccine. Yes, she almost died from a vaccine, but carefully and under close veterinary supervision she is vaccinated. Another testimonial... I got the Gardasil vaccine even though I'm in an age group that is low risk, and I paid four hundred dollars for the privilege (while I was a poor, underpaid trainee).

So, back to the episode of Private Practice. The mother in the episode knew that her child had autism, and was diagnosed at the usual age of two. She knew her son had received vaccines, and the two events were temporally related. However, even in the face of the critical illness of her non-autistic son with a vaccine-preventable disease, she chose not vaccinate her only remaining healthy child. Cooper (pediatrician character in show) then vaccinated him against her wishes, which honestly is probably assault. He should have gone through the proper legal channels, although I'm sure the character in the story was convinced that time was critical. The child had been exposed to the disease from which his brother was dying, and likely had the same genetic susceptibility as his brother.

Pediatricians who have seen children suffer and die from vaccine preventable diseases have intimate knowledge of the blessings of safe and widespread vaccination. The most frightening thing is that with growing numbers of unvaccinated children we are losing "herd immunity." When only a small number of children were not vaccinated, they were protected because almost all other children were vaccinated. Therefore they were very unlikely to encounter the organsims that cause vaccine preventable diseases unless they travelled overseas. Now, that protection is waning as more children are unprotected. As pediatricians, we need to do better at communicating the risks and benefits of vaccination to parents, so they can make truly informed consent.

If you have questions about vaccinating your child, talk to your pediatrician.

For the American Academy of Pediatrics information about vaccine safety click here.

For a comparison of the risks of vaccines versus the risks of vaccine preventable disease click here.

For a handout about vaccine safety click here.

Also, you can vist Vaccinate your baby for more information.

recovery

The water is really calm this morning. As usual, my heron is fishing off the dock. When I was walking back to my desk I saw trooper 1 flying by so a snapped a quick picture. My point and shoot is good for taking pictures of people, but doesn't take good close up distance shots. I can't get a good picture of my heron with it, or nice landscape pictures.


It's been two weeks since my donor nephrectomy, and I'm feeling much better. My incisional pain is only a rare twinge when I lift something too heavy or turn and reach for something. Driving still makes my incisions hurt, but not as bad as a week ago. Most doctors recommend no driving for two weeks after donor nephrectomy, but the resident told me one week, and that was the instruction I followed (only because I live alone and I need to get to the hospital, grocery store, etc). I would recommend waiting the two weeks if you have that luxury.

I saw the urologist earlier this week and he gave me my activity instructions: No running, swimming or lifting more than 15 pounds for four weeks, no sit ups for six weeks. Apparently the fascia is 70% healed at the six week point. I took a 35 and a 45 minute walk yesterday for a total of 2.7 miles around my new neighborhood.

My mom was readmitted 7/12 to adjust her medications after only two days at home. She's still there but doing very well. The kidney seems like a champ, with serum creatine in the 0.9-1 range.

It's been hard to get unpacked between visiting my mom and feeling VERY tired. Everyone warned me that I'd be tired, and they were right. For the first week and a half I could be tough and have marathon days of unpacking, shopping, and hospital visits, but now I can only do one thing in a day. I have been prioritizing exercise above other activities, and I'm hoping to keep that up when I go back to work. I've lost 22.5 pounds (21 lost in the three weeks pre-op, regained due to fluid, and lost again post op) mostly because I haven't had an appetite since Nathan and I split up. My appetite is slowly returning, so I joined eDiets to help with some ideas for healthful meal planning. I chose eDiets, because they had a Mediterranean option, and the NEJM just had an article this week that showed benefit in weight loss and markers of inflammation. I'll let you know how it goes.

Well Mom's nurse just called and they've run out of one of her medications that the hospital doesn't stock, so I have to run in and drop off a few doses.

Peace

whirlwind

well, the last two weeks my life have been topsy-turvy. i left my husband, moved into a new house on the water with my two rottweilers, and donated my left kidney to my mother. i feel like a ship in a bad storm, waves crashing from all directions.

i was with my husband for almost nine years, and married for nearly seven. i don't think the internet is the place for the details, it's just too personal. i will say that it is very, very hard, even if you're the one leaving for all the right reasons. my husband wasn't a monster (or even close), but the relationship was not good for me. it had become the major source of stress in my life. ultimately, his refusal to allow me to save my mother's life by donating my kidney is what tipped me over the edge. it's a little sad that i wasn't strong enough to do it unless there were such incredible stakes, but it is what it is.

right now i'm sitting at my computer, looking out at the chesapeake bay, watching a blue heron fish from the end of my pier. my beloved rottweilers are with me, napping as usual, and just being they're usual adorable selves.

i keep crying, but i'm never exactly sure why... mourning my separation from my husband, worry about my mother in the hospital, physical pain from my donor nephrectomy, stress from moving, loneliness. there are just too many reasons to pick one. i know i'll be fine, i always have been, and the outpouring of love from my friends and family buoys me up in this storm.

best day EVER

I had the amazing experience of flying in a helicopter from Baltimore, Maryland to Morgantown, West Virginia about a week ago. It was the most fun I have ever had. I had a grin plastered on my face from the moment I found out I was going, until I fell asleep that night. It's hard to pick a coolest part, but I loved the helmet with earphones and microphone for talking to the pilot, medic and nurse, I loved taking off and landing, I loved how close we were to the mountains, I loved wearing a flight suit and saying "Roger that." I loved everything about it.

It turns out, that before I ever wanted to be a doctor, I wanted to be a pilot. Before that I wanted to be a fire truck, but I was only three and my dad was a firefighter. I loved planes. My dad took me to a park next to National Airport (now Reagan National) where we lay in the grass watching planes take off and land. Together, we assembled a model of an SR-71 blackbird. I even took a "physics of flight" class in the fourth grade. Sometime after fourth grade, my interests shifted toward the biological sciences, and here I am, a neonatal ICU doc and a neuroscientist who wants to fly.

The trip was to pick up a patient, who thankfully was very stable, allowing me to thoroughly enjoy myself. The scenery was beautiful on the way there, bucolic farmland, forests, mountains. We took off from the helipad on top of the Children's Center, and flew to Frederick to pick up a map because the pilot didn't have a map of WV. Then we flew through (and among) the mountains of Western Maryland.

While we were packing the patient up, Syscom called to tell us we had 30 minutes, because thunderstorms were closing in from either side of the city. Two minutes later, they called back and said to be on the helipad in five minutes, a tornado was headed our way. That certainly got us moving. Just before trooper 1 got to the helipad it was pouring rain, buckets and buckets. Luckily, the rain let up some when we loaded the patient and ourselves into the chopper. We had a full load of fuel for the long ride back to Baltimore, so the helicopter had some trouble taking off. We hovered over the helipad for minutes that felt like hours, then the nose tilted forward off the edge of the building and we caught wind that took us into the air.

It didn't take us long at almost 200 mph to outrun the bad weather, and the rest of our trip home was beautiful. Returning to Baltimore was great, seeing familiar landmarks like the Bromoseltzer tower, and the hospitals where I have spent the last ten years.

Best. Day. Ever. I mean it.


(Helicopter photo from MSP webpage)