Wednesday, September 30, 2009

A New Smile

Roman feels that now, finally, he is truly big.

He lost his first tooth today!

(And we are going to alter the memory of the entire event to have me there when it happened.)

He lost his first tooth, without strings, doorknobs, and heaven forbid, Leathermans. (Don't ask.) He lost it brushing his teeth.

He's been smiling all day. I'm pretty sure it's to drawn attention to the gap in his smile. Which just got cuter than ever.

Screaming Inside

The last couple days have reminded me why I blog.

My thoughts have been running through my head so fast that I'm being whisked along behind them right onto the express towards crazy. They bounce around against my skull, getting louder and louder that I'm not entirely sure people around me can't hear them.

When Hubster and I were dating, I'd often ask him what he was thinking. Turns out, guys don't like to be asked this. And without fail, he would say "Nothing."

I don't ask he what he is thinking anymore. I can read his mood better than the TV menu. And as our relationship has grown, he shares more and more.

But I always wondered about the "Nothing" response. Is it the same as when someone asks me what's wrong, and I say, "Nothing." Because I don't what you to know. Or is it really "Nothing."

How could anyone be thinking "Nothing" when my mind is constantly going. When I'm not thinking about what's for dinner and did anyone get the clothes out of the dryer, and we still need to get plastic bins for the things in the garage before winter, I'm thinking do I really want to fellowship in Pain Management or should I just stick to general anesthesia, and how long would it take to tile around the fireplace, and does Monkey like his new daycare and why haven't I started saving for retirement, and it's been a long time since I've painted, maybe I should try to work in some time.

It's like this ALL THE TIME.

So I blog. I'm not always to get everything out, but at least a little. A pressure valve. At least to thin out the internal crowd.


I'm never sure how much to share about work. Because I work in medicine. I feel that I can't just talk about my feelings and experiences, because I'm "representing my field." Can I talk about depression rates and the horrific grind of residency without you wondering if your doctor is depressed and therefore should they be taking care of you?

If I talk about doubts and mistakes I make in my training, does that make you trust medicine less? If I were to say that I felt 100% my senior was wrong about something, and so I went ahead and did what I thought was right and practically saved a patient, is that good or bad? Interns shouldn't be acting without supervision. What I did would not have hurt the patient, and definitely helped her, while doing nothing may have been devastating. But should I have acted of my own accord? Or should I have listened to my senior? Telling you this, do you trust the system less?

I believe in medicine.

I don't think we always make the right decisions. I know that people are hurt by poor decision making. Bad things happen, both due to unavoidable side effects or due to blatant over sight or negligence. It is one thing when your mail is delivered to the wrong address. It is another thing entirely when medicine is delivered to the wrong patient. Or procedures are done incorrectly.

But I still believe in medicine.

Western medicine doesn't have all the answers. I've seen more patients' pain managed with massage and acupuncture than I have with pain medicine and invasive procedures. I've seen patients defy all odds. I've seen families and patients alike get more benefit from prayer, blessings, meditation, and even withdrawal of care, than they would have from ongoing treatment.

But I still believe in medicine.

I may not agree with my training. I don't prescribe to the old school thinking of complete dedication to the exclusion of the rest of your life. I disagree with the hierarchy that's been created in the system. Training shouldn't involve humiliation, degradation, and exhaustion until mental breakdown.

But I still believe in medicine.

I've seen children walk who shouldn't have, because of surgery. I've seen women hold children they never otherwise would have had, because of medicine. I've seen people get a new lease on life after a heart transplant. I've seen infections cured, pain treated, bones set, and lives saved. Because of medicine.

I believe in medicine.

What I write is my own experience. I have bad days and heart-breaking moments. I battle egos as frequently as I do fevers and low blood pressure. I have been through bitterness, depression, and fatigue.

But none of that will change how I treat you in the hospital, with the best care I can provide.

Monday, September 28, 2009

Pictures of Fall

It is full blown fall now. While most the trees are still green(ish), there are more and more pops of red, yellow, and orange. It has started raining again, after an entire three weeks without rain. I'm telling you, Utah people, that's like a drought here in Iowa. It's supposed to fall below freezing tonight.

Full blown fall.

And we are doing our best to enjoy every minute.

A day at the lake, to have a beach picnic and play in the sand. And never mind that I said keep out of the water.

Leaf piles in the backyard.

More apple picking.

Because somehow we managed to eat fifteen pounds of apples in one week. I did make apple pie and apple crisp and we ate those too. But still, 15 pounds! Well, three of us ate 15 pounds of apples. Roman still insists he likes picking apples much more than he likes eating them.

At least someone loves apples.

Soon, more of the trees will change, and it will be time for more fall walks and drives.

Because soon it will be winter.

But for now, it is fall.

Saturday, September 26, 2009


Blaise, after having an episode of coughing: "I have a coffee (coughing) bean in my throat."

Roman, nearly every day: "So, when I was little..."

Blaise, when I came home after a call night: "Mom! I miss you all night!"

Roman, after learning about water traveling from roots to stems to leaves in plant: "I can't believe I never knew that!"

Blaise, having twisted open an Oreo and having all the creme on one side: "Hey, what's the big idea?"

Play Space

I have a day off today, and am doing my best to not think about what happened at work this week.

So I'm going to get back to what's gone on at home. Because my life involves just as much paint, plaster, and finish nails as it does IV fluids, blood, and lab results.

Probably the biggest change in our house has been our family room.

When we first moved in, this room was terrible. Damp carpet, with moldy tack strips and carpet pad underneath. Seriously disgusting.

Now, it is probably the most used room in the house. Which is funny, considering it doesn't have any furniture.

The first thing to do was remove the disgusting carpet and seal the walls to prevent any more water from coming in. The last thing I ever want to see is more of this...

Worst new home owner surprise: Water damage and mold!

Then Hubster showed his brilliant construction skills and installed a new raised subfloor and the same Pergo that we have since installed in the kitchen. How fast this all happened was mind boggling. Less than two days from carpet out to Pergo in. Amazing.

The walls are the same creamy color as the kitchen. I thought about doing a darker accent wall on the fireplace wall. But when I mentioned it, Hubster gave me that look. So no accent wall.

However, the ceiling is blue. I love the blue ceiling. At first, you almost don't notice it, but when you do, it's hard not to smile. It adds such a playful, fun touch.

This room is truly a family room, meaning a place for the boys to play. So toy storage is a priority. The storage shelf is from IKEA. And I love the red accents.



Notice the blue ceiling?

We plan on adding more red accents. Some red bean bag chairs for the boys. A row of Mondrian prints to the wall.

I love the idea of Modrian prints,
because of the primary colors and
the linear lines echoing the storage unit.

Oh, and a couch. We've already found one we love. A comfy chocolate brown one that even Hubster loves. Now we just have to wait for the red maple in the front yard to start growing money.

We've installed new oak plank stairs that (nearly) match the Pergo.

We are going to tile around the fireplace, hopefully next month. And add a big beautiful white mantle, perfect for Christmas stockings.

I wish I could say that the room is still clean, and organized, and full of simple lines and red accents. But like I said before, it is a true family room. A true play room. So it spends most of its time looking like two boys and no parents live here.

Wednesday, September 23, 2009


As a medical student, I never had a patient that I was taking care of die.

Patients I had taken care of died, but I had transferred off service, days, months, before that happened.

This last month has been pushed and pulled at me more than I thought possible. I have had three patients die this month.

Every single time, I could have kept them alive. Their blood pressure had been stabilized, they were breathing easily on the ventilator. But every single time, despite the fact that I had done my best, despite the fact the patient was "stable," despite the fact that my attending, myself, and the rest of the ICU team had gone over every possibility and treatment plan, the patient was not going to get better. They were lying in the ICU bed with tubes and wires snaking off their body, surrounded by monitors with multicolored blips and beeping fluid pumps. They had everything medicine could give them. And it wasn't going to make a difference.

Every single time, the families requested that we withdraw care.

Devastating strokes that happened in the middle of the night. Traumas that left the families angry and confused. A combination of a million little things that left the patient and the family with no way out.

When it is just me, a handful of ICU nurses, and the patient, I'm fine. The patient, a middle age woman with a non-functioning brain stem, or a young man with a traumatic brain injury, is quiet, sedated, breathing rhythmically with the ventilator. I adjust medications, watch clear fluid and dark blood flow through tubing to the patient. I listen to breath sounds, feel pulses, watch as the medications slow the heart rate and raise the blood pressure. It is quiet, the patient is stable, and I am fine.

Then the family comes in.

They must have just talked to the surgeon, or the neurologist, or the trauma physician. They are crying, some loudly, some silently. Occasionally, there is yelling at the bedside and someone is asked to leave. There is more crying down the hall, because patients can only have a few visitors at a time.

It is no longer quiet, and I am no longer fine.

The nurses are talking to the family, to the weeping mother, the pale sister, the blank-faced son, so I slip away to the back hall, between the linen carts.

I did my job, and it doesn't matter. I can't fix the brain, I can't save the kidneys or heart. I can keep breathing for them, but they will never breath on their own again. I am crying. I approach a breakdown of my own. And it isn't my grief. Everyone I know and love is still alive and healthy at home, and I will go home to them when I am done with this terribleness. I will finish my shift and leave their grief behind me. It isn't my grief, but still I am crying.

I can only allow myself seconds for the wave of sadness. I return to the silent patient and the aching family.

They wouldn't want this, everyone tells me. The surgeon says there is nothing more they can do, they say to me. Yes, they told me the same.

Two at a time, they say their goodbyes. It takes a very long time, yet not nearly long enough.

Three times, we have taken the breathing tube out, turned off the monitors, pulled the curtains around the bed.

Three times, I've watched someone die. It is never my grief, but still I am crying.

Pass It On

Gina gave me this award several days ago, and due to my horrific schedule and the fact that I felt the need to sleep for more than four hours in a row made it so I was unable to recognize the award until today.

Thanks, Gina. Gina, like myself, is the mother of a darling little boy and she's a speech pathologist/teacher. If you're not reading her, you should be.

Okay, now for the rules.
1) Thank the person who gave this to you!
2) Copy the logo and place it in your blog!
3) Link the person who nominated you!
4) Name 7 things about yourself that no one would really know.
5) Nominate 7 Kreativ Bloggers.
6) Post links to the 7 blogs you nominate.
7) Leave a comment on each of the blogs letting them know you nominated them!

I'm pretty sure that over one year of blogging has made it so there aren't too many big things that people don't know about me. (And if there are, no one is going to find out any time soon. Ha.)
But I'm sure that I can think of something...

1. I used to play the flute (and violin, and piano...). But unfortunately, due to demands of school, work, and parenting, it's just fallen by the way. Although, I do occasionally play a few carols around Christmas.

2. I hate dresses and skirts. I have worn a skirt maybe twice in the last year.

3. I kept a journal every day for nearly 6 years. My writing filled multiple notebooks. Now there is a box in our basement full of those old journals and diaries. I stopped writing a little after I got married, and I always felt guilty about it. I think that is why blogging is so appealing to me.

4. After Roman was born, my hair started to get darker. That's when I started dyeing my hair and adding highlights. I don't think my dad knows. Every once and a while, he'll say, "I love that your hair is still the same color it was when you were a little girl." And I just say thank you.

5. I take a LOT of pictures of my boys. I have thousands of pictures on my external hard drive. So, if you ever feel that I have posts with image overload, just realize that I'm holding back.

6. I love books. And I never get rid of them. I have many full bookshelves, and I can't bear to think of getting rid of a single one.

7. I'm still on the look out for the next great chick flick. I haven't liked any since "Return to Me" and "You've Got Mail." If you have any good ideas, I'm dying to know.

And now, for the next part...the nominations.

First, some of my truly favorite blogs (that were not already nominated.)

Tia at Clever Girl Goes Blog
MckMama at My Charming Kids
Christian at ModObjects at Home
Sobrina at Quiet Like Horses

That's four. The next nominations are for people I think are unbelievably creative. Now, if only they would write just a little bit more.

Bonnie at I Think I naC
Emma Lily at What Would David Bowie Do
Trina at Trinabug's Life

Sunday, September 20, 2009


Despite the fact that there were fantastic college football games on television perfect for watching, we got in the car and drove to a local orchard. Where there were apples perfect for picking.

I have always wanted to go apple picking.

And not just because I love apples. Which I do (even though I like peaches better.) But because it is something I want to do with Roman and Blaise. First, so they know that fruit actually is grown (Roman said on our drive over there: I never knew people had to grow peanuts. I thought they just made them somehow.) And secondly, which is always the most important one, because it is fun!

And we did have fun.

I love apples!

At the front of the orchard is a small store inside an old barn full of dusty sunlight and the smell of freshly made apple turnovers. We glanced over the map to see where the ripe apples were, grabbed our baskets, and headed out.

The orchard can be reached by tractor drive or by walking. We opted to walk. Down between pumpkin fields, over a foot bridge, and into the rows and rows of apples.

Over 130 variety of apples!!

Perfect Pick!

(Okay, not all of them were ripe. The orchard has many variety so that there are always apples ready, whether you go picking in August, late October, or mid September.)

The boys were delighted. They ran up and down the rows, picking the apples they could reach.

Please note Blaise's sampled apple

And since there is no charge for "sampling," they did plenty. Well, Blaise did. Roman insisted he only liked picking the apples and had no intention of eating any. Although he did take one bite when I said in that case, we're not buying any. (We were always going to. Because wow, those Honey Crisp apples are divine!)

I"m serious. I love apples, Mom!

So after an afternoon becoming sticky sweet and sun-soaked, we hauled our heavy baskets of apples back up to the store to bag and buy them.

Now, there are 15 pounds of apples on our kitchen counter. Between that and a boy who insists he still doesn't like apples, we should be well stocked for a while.

Friday, September 18, 2009

The High Point

I'm approaching the point in residency I've been dreading.

The point where I'm constantly fatigued. I'm so tired that I can't think about doing dishes, or helping prepare meals, or managing the boys school papers. The point where I'm away from home too much, taking overnight in-hospital call every third night. The point where I feel like I will never know enough, never be able to study enough.

I've known this time was coming. I'm not sure if knowing helps me be more prepared or if it just becomes a self-fulfilling prophecy.

During intern orientation, we are shown a graph of rates of depression during intern year. The rate in June is near zero. By January, the rate is near 75%. Everyone looks at this graph and points to the high point in January. We are then given talks about how to cope during the midpoint of the year, the increasing stress, higher expectations combined with the lack of sunshine.

I am scheduled to be on Trauma service at that point.

Although impressive and terrifying, the peak in January isn't what concerned me most about the graph. The red line we were shown never went back to baseline. The rate of depression, so low among incoming residents, so happy after completing four grueling years of medical school, never returned to zero. The lowest it got was 20%.

The funny thing is that even as I approach that January peak, and boy, can I ever feel myself rushing towards it as my confidence and ability to stay awake while standing are every tried...the funny thing is that this is still better than medical school ever was.

Making Friends

Roman started school several weeks ago. This move and new school makes this Roman's third school in three years.

He attended private kindergarten through his daycare center. Then he attended first grade at the public elementary school just down the street from us in Salt Lake City. Now he is attending the public elementary school right next door to us here in Iowa.

All these transitions make me worried.

Roman is shy, sometimes painfully so. He doesn't make friends easily. He is not a leader in groups of children, much more content to just go along with what other children are doing. Since school started (and even weeks before it did) I kept wondering how he was going to do.

Roman seems unfazed.

The day before school started, I asked him if there was anything he was worried about regarding the first day of school.

"No, I'm not worried. It's everyone's first day."

If only I could have that attitude more often.

Every day since that, I ask him about school. What he did during the day, what his favorite activity was. Between the questions about art class and gym, I ask about friends. Does he know the names of the children in his class? Who did he play with at recess? Has he made any friends?

Last week, he caught me at my worrying.

"Why do you ask every day if I have friends?"

"Because I don't want you to be lonely." That's what I said out loud. But it felt more like I was screaming it in my head. Because I want you to have friends, I want you to adjust well, I don't want you to ever resent me for taking you away from the handful of friends it took you over a year to make back in Utah. And almost like he hears the screaming and the panic, he stops me in my tracks.

"Don't worry. I'm never lonely."

The most natural feeling I have is one of protection. I want to shield my children from everything. From every hurt, from every disappointment, for every disturbing image on the news. I want them to be happy, secure, safe. I want them to have a feeling of belonging. Despite the drive to over-protect them, the boys continue to show that they are adjusting well, that they are happy.

One of the reasons we chose to come to Iowa (among many others) was the quality of the schools. When I was interviewing in Denver, I asked how the schools were. Oh, the schools were wonderful, I was reassured. Everyone was very happy with the schools, there were so many amazing options. Just one thing, I was cautioned several times. Stay away from DPS. Denver Public Schools. Well that's just great. A single family income, surviving on a resident's salary, and I was going to be expected to enroll my children in private school and pay for that too.

The city in Iowa we live in has no private schools. There is a Catholic high school, but half the children attending are not Catholic. There are no private schools to lure the best teachers away. There are no private schools for all the university professionals. Doctors', professors', and lawyers' children attend the same schools as the children of janitors, waitresses, and truck drivers. Without the option to abandon the public schools, families have invested in them, all resources go to them, and the outcome is amazing. The public school system is one of the best in the country.

I received a note from Roman's school today, and I'm attributing it to the caliber of the school. Roman has been enrolled with a guidance counselor. He is going to attend weekly small group sessions that focus on developing friendships. Some of the children in the group are new to the school. Each week, they talk about skills to make friends and good qualities of friends and friendships. They play group games. All with the goal of helping them to know other children better.

It seems like someone else (Roman's amazing teacher) noticed the same thing that has been causing me anxiety. Roman has not made any friends after nearly a month of school.

But instead of just letting it continue and allowing him to continue to be isolated and potentially struggle because of that, they have options.

I'm excited for the weekly sessions. I'm hoping it is the difference we need, me almost as much as Roman. Because he deserves everything I want for him.

Tuesday, September 15, 2009

Room For Boys

One of the things I felt I missed out on raising the boys in apartments was the chance to decorate an nursery. Bug's "nursery" consisted of his crib at the foot of our bed in our first one bedroom apartment.

I did give in once, and painted a beautiful room at one of the places we lived when he was nearly three years old.

Bug's 2 year old bedroom, at apartment #3

It was promptly painted over the minute we moved out. (I knew it would happen...but still...)

So the chance to create an amazing boys room at our new home was exciting. For everyone. Bug had no shortage of ideas.

I want my walls painted like a tiger. I want really, really, really dark green. I want a Batman room. Can I paint one wall orange?

I'm all for letting children have input into the design on their own room. But some of these ideas were just a little too bold for me.

Then one day, Bug announced he wanted a red room. Once he decided that, there was no changing his mind. Although I wasn't sure I wanted an entirely red room.

So I told Bug we would do a red stripe in his room. At first, he was incredibly disappointed. He'd been counting on floor to ceiling, all four walls type of red. Even trying to sell the stripes as "racing know like race cars have" didn't make him happy.

Until we found the bunk bed. We weren't even looking for one, although we had discussed it, since Bug and Monkey were going to share a room. We walked into a wholesale furniture store, looking for a coffee table. And there it was. A red bunk bed. It was beautiful. I fell in love with it immediately. So did Bug. I said that we couldn't have red walls and a red bunk bed, because then we couldn't see the bunk bed very well. "That's okay. Maybe we could just do a red stripe instead."

Just like it was his idea all along.

The BEFORE: Just a typical bedroom

The AFTER (part 1):
We used the same warm tan in all the bedrooms. The trim got the same antique white color as found in the living room and kitchen. We installed new darker brown (clean!) carpet. And then, of course, there are the stripes.

The red bunk bed makes its appearance.

A home for Monkey's entourage

Bug's art desk

The boys' room is the most finished in the house. I think it is a style that works well for two little boys now. And hopefully for two bigger boys in the year to come. And while the walls are not head to toe red, the room definitely is Bug's much wanted red room.

Monday, September 14, 2009

First Signs

Fall comes slowly here. It has been creeping up on me for weeks now. The hint of yellow between the green. The droop of flowers. The tinge of red along the river.

Fall in Utah was so different. First the trees would change, nearly overnight, on the mountain sides. The frost and snow would come soon after. Suddenly the color and crispness of fall would be gone, sidewalks covered in the crunch of brown leaves, trees bare against the sky. And I always felt like I missed it.

Here, it has a slow gradual pace, as if autumn is enjoying itself. Flowers change from purple and blue variety to a yellow and red. Trees take their time, trying to be inconspicuous about the small piles of leaves forming underneath them.

Fall has not yet descended in all her glory. But every day I see more of her.