Category — Medical / Medical school / career

I’ve been busy as hell, but I LOVE what I’m doing right now – the patients, the diseases, the studying, the procedures, the variety, and the super smart colleagues with which I’m surrounding.  I am happy with my professional life, but the problem of balance still exists.  I knew it would, just didn’t think it’d still be to this extent.  I’m working way too much.  I hate that it’s not at all under my control, and usually also not completely predictable to me.  Still a huge improvement over my intern year hours, but definitely not ideal.  At least I wake up happy, enjoy my day, and come home happy.  It’s better than coming home depressed and defeated, dreading the next day, crying on my way to and from work.  When I think about it, intern year feels like it was SO long ago.  I’m SO glad to have that behind us.

Residency is such a strange experience.  It’s hard to fully explain it to people who aren’t in medicine because it truly is a subculture.  As a universality in residency, we are constantly thrown into situations for which we feel inadequately prepared…to a degree that is almost unsafe.  It’s about constantly pushing the envelope: that boundary between uncomfortable and unsafe, without getting too close to just uncomfortable but also staying just left of unsafe.  It’s a tightrope.  What it creates is a constant state of anxiety…and the embarrassing experience of going to lunch with your attending and a few co-residents when you take off your white coat and your little pill box falls out, dumping its propranolol contents all over the cafeteria floor for patients and colleagues to see.  Good thing that didn’t happen to me:)  Thankfully, the stakes are not as high as they were my intern year, when I was in the trenches caring for people on their death beds, where any slip in the wrong direction after 30hrs of sleeplessness could have been a medical error with huge repercussions.  That was an unsustainable amount of stress for me and a burden I’m thankful is no longer mine.  In derm, 98% of the time my decisions as a physician are not life or death.  Put in more optimistic terms, while they cause significant distress and greatly impact quality of life, skin diseases rarely cause people to die (with some exceptions of course).  In pessimistic terms, I’m more likely to cause my patients’ demise than the disease itself, by using potentially harmful meds that attempt to improve quality of life.

On a lighter note, being a derm resident comes with some fun perks…one of which is cosmetics workshop.  Yes, I have fairly strong feelings about what the focus of cosmetic “medicine” has done to the public, as well as what cosmetic dermatology has done to the public’s image of my specialty.  And yes, I swore I’d never partake in Botox.  BUT, I did.  I did it for the sake of my fellow residents’ education of course:).   No, but seriously, it is the reality that this stuff is actually on my boards so I have to be proficient enough to pass, and I also acknowledge that sometimes “selling out to the man” (who pays well) can subsidize other things that I want to do in my future career (ie: work free STD clinics, volunteer my time at the VA and indigent clinics, etc). 

I digress…anyway, over the weekend we injected each other’s faces, and the faces of willing friends and family members, with Botox and filler.  I have to admit, we had fun.  My program held a round of derm interviews 2 days later; we must’ve looked like the island of misfit derm residents because our Botox was “in transition.”  I think half my face was paralyzed and I had a huge bruise on the other half.  Aside from looking like a battered wife for a few days because of injection site bruising, I think it went well.  I did learn, however, why I have such deep rhytides (wrinkles) in the first place…my dermatochalasis is so bad I have to contract my frontalis muscle just to elevate my eyes enough to have decent vision!  So with those muscles paralyzed, I now need blepharoplasty!  Of course, if my eyelids aren’t saggy anymore, my boobs will surely look out of place!  LOL!  And so it begins…(joking)

Before / After (I wish the picture quality were better – I took the afters just now at home in my kitchen with crappy lighting):

I have gotten a number of emails from people due to the recent thread on APV regarding recurrent pustular outbreaks on the hands and feet of children who have already been adequately treated for scabies.

As I was gently nudged by a few of your requests, I did submit a response to that thread.  Unfortunately, it must have been weeded out by the moderators of the APV group on accident, because it still has not appeared amongst the new messages.  I realize moderating that site is volunteer based and time intensive, I just find it to be a little frustrating to use that resource since there is about a 3-7 day delay to our postings (and in my case, I spent a lot of time typing out a response to the thread on acropustulosis and it was never posted).  Personally, I don’t see the need for a moderator on that site given the extensive process you have to go through to become a member.  I think it’s redundant to check all membership applications AND continue to pre-approve each individual post.  But that’s just me.  Anyway, I’ll respond to that thread here, so if people could pass this along to those APVers who were searching for more info on “recurrent, itchy bumps on the hands and feet of their adopted kids,” it’d be greatly appreciated.

Many of you have inquired to find out whatever happened with my study on infantile acroputulosis.  It was published and the full-text just became available via Epub ahead of print in May.  I do apologize for the delay, but the publication process can take close to a year once something is accepted to a competitive journal.  This article was accepted to the Journal of the American Academy of Dermatology (also known as The Blue Journal or JAAD, www.eblue.org), which is the most widely read and most highly respected dermatology journal.  That is fantastic considering the goal of the research was to increase physician awareness of this condition.  Unfortunately, you cannot access the full article unless you go to a medical library that subscribes (or buy it in pdf form for $31.50, but I think that’s a bit pricey for 1 article!).  If you are interested in the brief version, here is the link to the pubmed abstract:

http://www.ncbi.nlm.nih.gov/pubmed/21632152

The full-text article is quite lengthy and has several images of IA (some taken by me, others by people with children involved in the study), as well as a histologic image of a biopsied case we had.  You’ll also notice Travis is an author on this publication - he calculated all our statistics.

You can at least print the abstract and give it to your pediatrician/family doc if you think your child has this and has not been diagnosed or your pediatrician has never heard of this entity.  In response to 1 specific post on APV, infantile acropustulosis is NOT contagious.  That said, there are other diseases and infections on the differential diagnosis that are, so you really need to verify a diagnosis like this with your pediatrician or dermatologist.

Thank you to all those who participated!!  Hopefully it’ll better prepare pediatricians, family docs, and even dermatologists to recognize this in internationally adopted kids.  The other result of the study you may not be aware of is the coincidence between infantile acropustulosis and eczema (referred to more specifically as “atopic dermatitis” in the article and abstract).  Interestingly, ~50% of kids w/ acropustulosis in the study also have eczema, and an old study showed a similar incidence in that subpopulation.  There’s no cause and effect implicated and the sample size was too small to make any generalizations, just something to be aware of in our kids, and something professionally I find fascinating.

Lately, it feels like I’ve woken up into someone else’s life.  And this someone else’s life is WAAAAY better than mine!  Honestly, I worried I’d never get to say this: my job is freaking awesome.  I know there will be months I’m on rotations that suck, or rather, rotations with sucky hours.  But right now that’s not the case, and the actual work is so fun.  My days are full of variety, from freezing genital warts to biopsying suspicious moles to surgery clinics.  To clarify, I despise the OR, but I do think procedures are fun and derm surgeries typically involve nerve blocks or local anesthesia, not general (patients are conscious, and we’re not in an actual OR)…and there are TONS of them in derm.  Fun, rewarding types of procedures.  I’ve already seen some crazy stuff, even a new case of bullous pemphigoid.

My biggest fear in starting derm residency was that I wouldn’t like my colleagues.  Every field in medicine has its stereotypes, and I do NOT like the stereotype my field is building.  I’ve mentioned this in the past, but medicine specialty reputations are pretty hilarious and most docs would roughly agree on each one’s stereotype.  For example, that psychiatrists are often crazier than their patients.  Neurologists are severe dorks.  Anesthesiologists barely speak English and are socially awkward.  Family docs are pie-in-the-sky dreamers.  Surgeons are a$$holes who just want to cut and have no bedside manner.  ER physicians have ADHD and are adrenaline junkies.  Peds people wear bowties and are sweet but talk with funny voices.  Orthopedic surgeons are meatheads.  Dermatologists are entitled and superficial.  There’s a stereotype for every field, and my fear was ending up in a derm residency program where people fit the “type.”  Anyone who knows me realizes I wear 3 pairs of shoes (flipflops, running shoes, and Danskos); none has a bow on the toe.  I’m not a make-up lover or a fashion diva.  Naturally I worried I would like or fit in with my colleagues.

Still feeling like a family doc at heart, I forged ahead after discovering my love for derm itself.  So as you can imagine, I was HUGELY relieved to learn my program did not match ANY derm divas.  It is full of very cool, very down to earth people and attendings.  I have yet to encounter an excessive ego in our department.  My program director hosted a party a few nights ago, which was SO reassuring to me.  Normal people, fun people, having a good time together and without the hierarchy that’s typical of Internal Medicine and the East Coast.  It’s a very tight-knit program (small size helps that) and there are lots of kids and babies amongst the group.  I know there will be REALLY tough times ahead still, and I’m already feeling overwhelmed by the amount of material I’m supposed to be absorbing on a daily basis, but I can say confidently that I’m very happy with my choice of specialty and program.

And can I just say, having weekends off is RIDICULOUSLY amazing.  What?  All I need to work is 5 days in a row and I get 2 off?!  Done!  Even if they’re long days, that is SUCH a beautiful improvement from the past year of my life.  It’d been 5 months since I’d had 2 days off of work in a row.  Ahhh, so nice to not have that “Sunday night dread” every single night of my life.  No more calling time of death, no more heavy white coat pockets, stethoscopes, rectal exams, diabetes / CHF / COPD management, EKGs, rounds, admissions…the worst is over and it’s up from here.

Last week we had “Spring Fling,” the 1 day a year our hospital functions without residents so we can all have a day off, together, to pretend like we’re normal people with normal lives and regular jobs.  We, the internal medicine program, BBQ’ed at a park with our surgery, OB, family medicine co-workers.  We had beers, play sports, listen to the hippie family docs play their guitars:) and we enjoyed ourselves.  That night was a formal dining event, and our final group gathering before we finish our year and go our own ways.  I said goodbye to mentors, residents, friends, and on the way home, I told Travis that intern year is sort of like labor…once it’s behind you, these weird goggles go on and you remember with fondness and pleasant sentiments what you once found to be a horrific experience.  Travis’ response was “hmm, yeah, I guess it’s similar to how John McCain must have felt when he left his POW camp.”  Hmm.

Anyway, there are a few things I want to reflect upon.  This was not an easy year for me or my family.  There were a lot of doubts along the way, and a lot of things I’m not proud of.  But mixed in with remorse, doubt, regret, stress, failure, and constantly feeling pulled in every direction with very little of me left at the end of each night, I have a few things I’m really proud of.  A couple things I did right and consider huge achievements.  One of those is best described by looking in our freezer, where you’d see this (ignore the rum and the ice cream…2 things that fall into the “not proud of” category:):

Griffin is almost 7 months old, and still breastfed.  If I dry up tomorrow, which I hope doesn’t happen, I’d still probably have enough pumped milk to get him to the 1 year mark.  That took hard work and a lot of multitasking at the hospital, spending extra time awake after each newborn feeding so I could pump after Griffie ate (on my non-call nights when I was actually home to nurse him at night), etc.  Essentially, I sacrificed the little sleep I could have gotten as an intern with a newborn so that I could create this stash for my baby.  Those bags of milk are my trophies and I’m happy I did that for Griff. 

The other thing part I’m proud of is having been a good intern in spite of having gotten knocked up at what most people would consider the worst timing ever.  I did what I thought was best for my family given our circumstances, but I never took a sick day or dumped any extra work on my colleagues.  I never compromised patient care.  I hope, in the long-run, that somehow helps the image of women in medicine by showing the old school, white-haired docs that pregnant women in medicine are not a negative presence in the hospital.  I hope it also encourages other med students, residents, or fellows who don’t want to postpone kids until after their epic training if they don’t want to.  It’s part of paving the way and making medicine a better work environment for women, who, in my opinion, add a LOT of positives to the medical field.  I’ll never forget this one night on night float when I walked into a patient’s room, 7 months pregnant myself, with my pregnant attending and my pregnant upper level resident.  The three of us took no notice, but the patient’s eyes got huge as he said “wow, there are a LOT of fetuses in here!”  We all got a laugh out of that.

He did it!  Dr. Travis Good, MD/MBA.  Those 5 letters were brought to you by a freakin shit ton of debt, a mountain of stress, and 5 years of his professional life.  But there they are, he’s got ‘em.  And they’ve already opened up doors to amazing opportunities he could never have dreamed.  All-in-all, he has no regrets and I’m really proud of him.

Travis’ family came out to celebrate with us, which was awesome and meant a lot to both of us.  The kids were, of course, thrilled to see their grandparents and their Aunt Heather.  We only brought Griffie to the actual ceremony, which was very very long.  Temple Grandin spoke, and she was AMAZING.  Heather got to meet her after graduation and tell her what an inspiration she’s been. 

So, I have a funny (sorta) story to share about Travis’ graduation…the Dean read a little blurb about each student, things they accomplished during medical school, their plans post-graduation (pretty much all but Travis plan to do a residency, so it listed where and in what field of medicine), and then most of them had a line about people they wanted to thank for helping them get this far.  Travis has been SUPER out of touch with his Dean’s office since deciding to be non-clinical and not enter the Match, so when we got up on stage to get ready to walk across (I was with him because I was his hooder – it’s the formal part of medical school graduation when another person with a doctorette hoods the new grad).  Just before it was our turn, I whispered to Travis, “what the hell are they going to read about you?!”  He whispered back “I have no clue, I think I forgot to fill out this form.”  Leave it to Travis to not give a crap about the most important part of the ceremony.  So we walk across as the most irrelevant, random stuff is read about him, followed by “and his and his wife are raising their THREE kids.”  The sound of my jaw hitting stage was probably audible to the audience in the nosebleeds. 

So that’s me, just after putting his hood on Travis (after I’d considered choking him with it on stage), saying “really?! REALLY?! Our three kids. You didn’t bother updating your Dean’s office that we had a 4th kid?!”  and him laughing back at me saying “hmm, guess not.” Oh well.  It was sort of a classic moment.

What he meant to write for his dean to read was: “Travis completed his premed course requirements after he’d graduated from college and a masters program.  He did this by going to school at night, in addition to his fulltime consulting job during the day.  Travis continued on then to multitask his way through medical school and his MBA.  During that time, he also worked several health-related jobs, climbed several of Colorado’s 14,000 foot peaks, ran health projects in Peru, founded an NGO, published several research articles in a major journal, became the incredible father of FOUR gorgeous kids, was the support for his intern wife, the resident chef, the primary caregiver, and the stability for his family.  He thanks his amazing mother who sacrificed so much of herself to birth, breastfeed, educate, nurture, unconditionally love, and raise him to have the confidence that has gotten him this far.  He could never have dreamed up a more supportive or loving mother.  He also thanks his father, who, although initially suggested he look at med school in Guadalajara, always believed in his giftedness and has never hesitated to show how proud he is.  From the sidelines of the soccer field to the audience at med school graduation, his dad has always taken an active interest in the things that have mattered most to Travis and that devotion has been a cherished gift.  Additionally, he’d like to thank his little sister who has been his biggest fan and cheerleader her whole life.  Although he may act like it sometimes, he does not take her love for granted and is sincerely grateful to have such an awesome, fun little sister who also happens to be the coolest aunt ever;)

It’s end of March.  I’m ~3 months from the end.  There’s almost light.  But these are dark times for an intern.  Most interns this time of year have what we call “compassion burnout,” a terrible, but real, condition that happens to even those of us who would’ve considered ourselves as deeply compassionate previously.  But there’s only so many times you can deliver the “C” word before you stop feeling that stabbing pain when you tell a patient they have cancer.  And only so many times you can sit and sympathetically listen to a people’s illogical reasons for wanting a family member to remain “full code,” when you know it’d just be torture (for them and the medical team) if they were to require intubation or chest compressions.  You start despising family members who insist their loved ones are “fighters, and would want to fight ‘til the end,” when you realize your patient wants nothing more than to be allowed to die peacefully but continues permitting aggressive medical care to appease others.  You start resenting the patients that ask anything of you, as their doctor, in the afternoons because it only means you’ll have to stay later…knowing if it were your family member, you’d be asking the same of their medical team to make sure they were getting top care.  You loathe the patients who become anxious at 3am or start having non-cardiac chest pain because any chance you may have had at closing your eyes was just taken from you.  You become intensely irritated when asked to fill out the 50 page stack of FMLA paperwork your patient hands you, even though you once considered yourself a patient advocate. 

I am sometimes ashamed that I find it therapeutic to be part of a group of interns that convenes in the wee hours of the mornings in the computer area of the doctor’s lounge.  It’s there that we sit facing our computers, collecting patient vital signs, labs, test results, with our backs to each other, just venting.  We spew venomous, horribly uncompassionate words, talk about how much we hate our jobs, our patients, our attendings, and then leave feeling lighter to start our dreaded days.  I guess it’s healthier than carrying all that negativity around all day?!  At any rate, I feel bad about it with what little energy I have at the end of the day.  I don’t hate my patients, and I pity admire my attendings who have to do this daily until retirement.  But I do hate my job most days. 

It’s funny.  I always wondered why / how doctors could have higher rates of alcoholism, suicide, and divorce than the general population.  It’s no mystery anymore.  This job shaves years off a person’s life.  Intern year alone probably stole 10 years from me, left my kids in a place that’ll require more healing, threw my marriage into stress it’s never seen, and turned my body into a recycling bin of redbull, diet coke, wine, and vodka.  I’m gonna make it, and so are my kids and my marriage.  But as my mom pointed out, there’s no glory in medicine these days.  It’s a daily sacrifice in exchange for very little respect or reward. 

These are not the Marcus Welby days.  Rather, these are the days of shift work, litigation, and overworked for constantly threatened pay.  I had a debt collector show up at my house last week, informing my nanny I have $120,000 in collections (that was the portion of my loans for which I apparently didn’t get forebearance granted).  As for the personal reward?  Even that’s debatable.  I cross-covered on a patient during an overnight call (30hr shift) the other night who came in critically ill from injecting drugs.  I got paged at 2am saying he was going to leave AMA (against medical advice).  I raced to the scene (it’s the interns’ shit job to try and talk patients out of leaving AMA) and tried to figure out why he was agitated and wanting to leave.  He cursed me out, told me I sucked at life and my job, and that our hospital wasn’t doing $hit for him.  Mind you, this is a patient without insurance, who my hospital treats at a loss.  He threatened me and talked to me in a way that was so appalling.  Normally, I’d have just taken it.  But that night I was exhausted and I’d had it.  So I said “I’m sorry you’re unhappy with your care here.  But I’m not going to BEG you to allow us to treat an infection that will otherwise kill you.  I don’t think I should have to care more about your health than you do.  If you’d like to leave, that’s your choice and your right, so go ahead, though I think that’s a poor choice.” I walked out and was paged about 10 minutes later by an attending telling me to get my ass back in there, apologize to the patient, and convince him to stay.  That’s the reality of medicine as a profession.  It really is a crappy job a lot of the time and the patients who deserve our attention and time don’t get it because it’s taken up by the ones who don’t want to help themselves or just want to whine about stuff.  Damn, that sounded unintentionally republican!  For the record, I have not converted to the dark side!  I’m just jaded and disgruntled.

Please know that I’m not depressed.  No one should be concerned about me, I’m just using this space to vent!  I’m actually doing very well and my resident and co-intern are always telling me they can’t stand how upbeat, enthusiastic, and energetic I always seem, even post-call.  You’d probably only know how much I dislike going to work if you’re aware of how much I love being at home (or if you know me, read my blog, etc;).  And despite the dread that surrounds my work life, I do take good care of my patients and I’m anal thorough in a way that compels me to check in on them from home.   Part of why I don’t like internal medicine is because it’s stressful and hard for me to let things go, even when I’m not technically “at work.”  I’m a worrier.  I really do love my life, just not my job on a daily basis.  So don’t worry about me after reading this (Yiayia!).

Poking my head up to post some pics and let my concerned family know we’re alive.  This has been the hardest week of my life, and one of the hardest weeks we’ve had as a family too.  Unfortunately, I don’t see things getting much easier for a long time.  I worked almost 90hrs this week, and I didn’t even have an overnight call –> my first 30hr shift is this Friday and I’m NOT looking forward to it.  I’ve said in the past that pumping is a labor of love, and I used to find it really annoying.  Well, now it’s the highlight of my days and the only thing I do anymore that makes me feel like I’m mothering my child.  Pretty messed up.

I’m under a huge amount of stress and feel constantly overwhelmed.  It scares me how much responsibility I have and how little supervision.  At this point in the year, I should be a lot more competent than I am, but I feel like I’m beginning intern year all over again.  So I’m always checking and double checking everything I do, like an OCDer turning the oven on and off a thousand times before I can move on.  So I’m HUGELY inefficient and terrified I’m going to kill someone, which is a distinct possibility.  Normally, to overcome incompetence and inefficiency, I’d try to get there earlier or stay later.  But as is, I couldn’t possibly do either of those. 

My day starts at 3:45am, when I nurse Griff for the last time, then shower, pump, pack my pumping gear and finally head out.  I get to the hospital ~5:30am, take breaks every 3-4hrs to pump for 15 minutes, and on regular days, finish anywhere between 5:30-7pm.  Every 4th night is a call night, meaning I’m there closer to 8:30pm unless it’s a weekend night, in which case it’s a 30hr overnight call and I don’t leave until noon the following day.  So, most nights, I get home in time to kiss the kids goodnight, cry, feed Griff, passout ~9:30pm, wake up to nurse Griff ~1am and wake up for good around 3:45am.  Jack, Shane, and Finley are all sick right now.  So lately, at least 1 of them wonders in our room or cries out in the middle of the night because they’ve coughed until they barfed or something like that.  That’s about the only time I see my kids.  It has not been easy for me, or them, or Trav.

In an attempt to try to keep in touch with my kids and let them know I think about them, I still write them letters for the mailbox each day.  I draw pictures, write little poems, etc. and put those in envelopes, usually with some little goody (a sticker, a piece of gum, candy, whatever) in our toy mailbox.  I usually come home to a pile of drawings they leave stuffed in the mailbox for me:)

So that’s my tale of sorrow.  Sorry to be a downer.  The kids are actually doing much better with this than I am, yet again.  Fin has had a bit of a tough time – lots of tantrums and she’s not sleeping well.  But otherwise, Jack, Shane, and Griffie are doing well.  Thank God for Travis working from home, and thank God for our incredible nanny, who is going to move with us to Milwaukee temporarily while we get settled there this summer.  She’s amazing and our kids adore her.

Here are some pictures from my day off yesterday.  It was all wonderful until Shanie started looking really sick.  He’s had bronchitis for >2 weeks and started spiking really high temps again yesterday, so I thought he might have pneumonia…trip to the ER.  Lungs were clear, but his rapid strep was (+), poor baby.  It’s only a matter of time before we all get it I’m sure.  Anyway, here are some pics from the good part of our day altogether (btw, this was not as dangerous as it looks):

iPhone pictures:

We’re going to be ok in the end, I do know that.  And I also know this is the hardest part of my career.  While I know it’s out there, I can’t quite see the light at the end of the tunnel just yet.  Maybe in another 3 months or so.  I’m just too tired right now and everything feels very heavy and stressful at the moment.  I’m so sad about all that I’m missing out on with my kids.  I miss them all day long.

Remember our gang of DC med school friends and spouses?  Our group we jokingly now refer to as the Caca Crusaders?  Well, we had a reunion this weekend in Denver.  We hadn’t seen each other in a ridiculously long time but we were missing part of our gang (Dominique and Kevin + kids) so it wasn’t the same.  But even so, and as usual, we had a blast!  Sarah and Dave (and their little boys), and Brad and Melanie (and their little girls) all stayed at our house so we and our kids could catch up on all that’s happened in our lives since our last rendezvous out here. 

Never mind that our kids were all feverish and sick, they had fun with each other too.  The daddies got to drink beers, play with their iDevices, and talk technology while Mel, Sarah, and I sympathized with each other about the challenging juggling act required to be a mom doctor while maintaining a healthy marriage and some semblance of sanity on top of it all.  After the weekend ended and we were left feeling the post-holiday blues again, Travis and I analyzed why we miss this group of friends so much now that we’re scattered around the country for our various residency programs.  These are VERY unique friendships for us; each of these are couples with whom we partied and had a lot in common BEFORE we had kids.  We became close friends because we were in unique circumstances in our 20’s – it wasn’t common where we went to medical school to be married, and our husbands have always gotten along like they were childhood friends.  It was even LESS common where we went to med school to have kids as a female medical student, which we all did in our 4th years.   So a lot happened in our 20’s and we stayed friends throughout.  We, therefore, know each other in a very different context compared to the friendships we make these days, which are based mostly on having kids in common.  We’ve watched each other through the transition from married life (and medical school) to parenthood (and residency). 

People say college is a very defining time in a person’s life, and for me that was very much the case.  However, for those of us in medicine, our 20’s are almost more defining.  SO much changes about  a person from the 1st year of medical school (when we’re green as hell and hopelessly idealistic) to residency (when we’re burned out and cynical), and even more changes happen from the relative carefree nature of married life to the ultimate responsibility of married life with kids.  Put those 2 transitions together in the same timeframe and you’ve got a lot of major life events.  In the case of the Caca Crusader couples, we all married right before starting medical school, had kids during medical school, and continued having kids in residency.  That’s a lot of transitioning during what would already have been very defining and  stressful periods of our adult lives. 

Anyhoo, all that to say that our friendships with these couples have a very solid foundation.  There’s something very re-centering about spending time with people that know you more deeply and with whom you have history.  It’s refreshing, grounding, fun, and heavy all at once.  We miss being able to see these friends on a weekly basis.  We’ve helped each other through tough times since graduation – infertility, diagnoses, family struggles, marital challenges, regrets over career choices at some points and gratitude for our careers other points, failures, disappointments…and also celebrated with each other through huge successes, surprise pregnancies, adoptions, harrowing deliveries, new jobs, cross country moves, and the overall formation and growth of each of our beautiful families.  I’m hopeful our kids will grow up knowing each other just as deeply and developing an even richer history than their parents’ have together, as it’s a unique experience our kids will have survived as well! 

The Caca Gang (missing Dom & Kev’s kids, Cata, Tomas, and Francisca):

We braved the National Western Stockshow and the adults and (some of) the kids LOVED the rodeo…or “radio,” as Finley calls it.  Here are some fun cowkid pics:

Apparently this is what cowgirls look like when they poop?!…

Jack and Ashlyn:

Sawyer to Shane: “Dude, go that way!”

Ashlyn, Jack, and Bryson trying to figure out how to hotwire the John Deer tractor:

As is evident in the pics, Jack LOVED sitting on the bull:

Please look at the pout-pout face on Jack in the next pic – Blub, Bluuub, Bluuuuuub!  (Btw, if you got that reference, name the kid book)

Mel and Griffie:

Bryson and Finley being silly:

Griff-star being his cute little self:

In line with our traditions, here is our quote list from our 4th annual Caca Crusader reunion.  Be warned, this is R-rated.  We’re not exactly proper when it comes to language or content, but throw us all in a room together and we’re like freakin sailors!

1.    Laurie to Sarah, who is furiously turning a light-up toy on and off: “What are you doing, checking to see if you have epilepsy?!”
2.    Laurie to Travis (with a face of disgust): “Why don’t you go take a shower?”    Travis: “Not everyone here took a shower today, okay?”
Laurie: “Yeah, well you’re the only one who looks like you could fry an egg on your head.”
SILENCE.…..”from all the GREASE?!”
3.    Melanie: “Some lady at Monkey Bizness asked me if I was Finley’s mom. It was just easier to answer yes than to explain the situation.”
Laurie: “Wow, I can’t believe you claimed her!”
4.    Travis (describing a catchphrase answer): “It’s like a cross between pants and a kilt.”
Brad (with a completely serious face): “Yeah, Kants.”
5.    Finley: “I LOVE twayzey twitters.” 
Melanie: “Is she talking about twitter?”
Travis: “No, she’s saying Crazy Critters.”
Finley: “I’m going to learn how to twitter soon.” 
Travis: “I can only imagine the verbal diarrhea that will result.”
6.    Laurie (to Travis, who’d just playfully thrown Griffin in the air): “Trav, you scared the shit out of him! He’s a f#*king newborn!”
7.    Melanie, to Laurie in reference to her choice in husband, “I can’t believe you married this guy!”
Laurie: “I KNOW! I can’t believe no one objected at the wedding. What the hell kind of friends ARE you guys?!?”
8.    Laurie (regarding Finley stealing a Payday candy bar from the Safeway): “She stole the candy, then flashed them her dimples.”
SILENCE.
Brad : “I thought you said nipples!”
Sarah: “Me too!”
Travis: “No, then she’d be using her dad’s AND her mom’s tactic in the same offense!”
9.    Melanie, to Laurie in reference to Henny: “He looks so sad!”
Laurie: “No he’s not, his face just looks like that.”
10.    (In reference to the game of Wits&Wagers) Melanie (after accidentally seeing the answer): “Ok, I won’t vote.”
Travis: “It’s ok, your answer was too dumb to be included anyway.”
11.  (Travis asking everyone to declare their Wits&Wagers points from the previous round) Travis: “Mel, how many?”
Melanie: “none.”
Travis: “haha!  I know, I just wanted to hear you say it out loud!”
12.    (In reference to the game of Wits&Wagers) Travis: “Which would you bet more on, the shaft or the balls?”
Melanie: “Oh, the shaft definitely. The balls are totally extraneous, they really just get in the way.”
Laurie: “Yeah, and you feel like you have to acknowledge them from time to time.”
Sarah: “Yeah, and they SMELL.”
Travis: “I guess Brad had quite a skewed view of the worth of his G-unit.”
13.    Laurie (in reference to the YouTube sensation Antoine Dodson): “Wait, why did he go to an electronics show?”
Brad: “Because a bunch of nerds think he’s hilarious?!”
14.    (On a walk, discussing a medical case involving pregnancy in the setting of a Mirena IUD in which the device was found stuck in the baby’s head at delivery – baby was fine once Mirena was removed, fyi) Laurie: “and we shall name her Mirena, we’ll call her Mira for short.” 
Mel: “MIRA!  As in, LOOK, there’s a F*&%ing Mirena stuck in her head!” 
15.     Travis to me and Mel: “girls, you’ve been nursing those drinks for awhile.  What the hell?” 
Me: “it’s Mel’s fault.  I don’t want to seem like an alcoholic since I made mine twice as strong as hers and drank it twice as fast…but I do have twice as many kids, so I’m sure the math works out somehow!”

Catchphrase teams: the Taint Haters (girls) vs. the Maintaintenance (boys)
Travis’s definition: Maintaintenance: the process of maintaining the taint

Song: “The bed intruder” by Antoine Dodson. “Hide your kids, Hide your wife.”
Drink: “The Vagine” = vodka + Hendrick’s gin + tonic

Travis and I had a much needed date night 2 nights ago.  Our nanny shared a movie night with our “big kids” and Travis and I took Griffie with us down the street for dinner and a few beers.  It was SO nice to actually feel like adults and experience the simplicity of parenting just a newborn.  MAN is that a piece of cake;)  We talked about a lot of stuff, especially Travis’ career and general direction since that’s on his mind a lot lately; it’s all happening so fast for him right now and I can tell his mind is always spinning.  Somewhere in there though, I brought up the question of “did you mean it: are we really done growing our family?”  I know both of our answers logically should be yes.  And that is my answer.  I think.  Still, there was something so sad about hearing Travis say it so confidently, and knowing in the back of my head too…that we are probably done experiencing moments like these:

Above is the amazing birth image I was talking about.  It’s Griffie’s little nogging in Dr. Warner’s hands, emerging (look closely if you can’t see his face at first – it’s on the right).  His first breath was seconds later followed by the most beautiful sound I prayed to hear in the OR.

There are SO MANY things we want to do with our lives.  Our life.  Honestly, adding kids to our family has been the most incredible experience and we love every one of them for the unique dynamic they each bring.  We are the luckiest parents alive.  There’s no adventure more amazing than adopting a child or bringing a life into the world, and we’ve been blessed to have done both twice.  The everyday process of raising our kids is quite the adventure as well!!  But continuing to grow would mean saying goodbye to a lot of other adventures in life.  And as Travis reminded me, life is about chapters, seasons, stages…very often one has to end so another can begin.  So now it’s time to move on with the beautiful kids we have and start dreaming of all the things we’ll do as a family.

There’s just something that’s been making me so sad about closing this chapter, even though I’m so overwhelmed with joy and love right now.  It’s a weird dichotomy of emotions.  I guess that’s the “baby blues” – so much excitement, anticipation, and energy around that one moment when the baby arrives.  It’s incredible.  But then, just days later, there are business calls to take, residency paperwork to submit, bills to pay, laundry to do, and somehow life just marches on.  Ready or not.  We had to reenter reality so abruptly.  I wish it would all just slow the hell down.  Or freeze completely for me right now since I’m just not ready for the world to keep spinning , and neither is Griffie. <sigh>

The baby blues have not been even a fraction of what they were when Finley was born, thank God.  I feel pretty “together” and fairly in control of my emotions.  I’ve cried over silly things a couple times, including 2 days ago when I found myself inappropriately crying over how precious Jackson was in his school’s holiday performance.  I had tears streaming down my face when everyone else was laughing and clapping…that’s when I realized I might be experiencing some post-partum hormones;)  Every now and then I feel sadness creep in just a little – usually over the baby chapter closing, or the thought of returning to work, or sometimes for no identifiable reason at all.  Jack has a little Christmas countdown calendar he made with my mom, and each morning he X’s off another day in December.  And each time I see that adorable little hand cross off the days, I take a deep breath, gulp, and swallow the sadness that comes when I think about the passing time.

As a suspenseful side note, there was a moment in the OR when our OB was closing me up and asked us if we plan on having any more kids just so she’d know if she needed to do an extra layer of stitching in my uterus.  Without hesitation, we both replied “just do it.”  We’re crazy, irresponsibly spontaneous, and sometimes a little unpredictable, but I think we were just playing that one safe.  Because as Griffin taught us, ya just never know.

These photos are just a little glimpse into our newborn and family session with our birth photographer, Kim.  We are so lucky to have had her in the OR with us capturing those precious moments, as well as in our home taking pictures of us as a family of 6.  There’s a sneak peek of our session on her blog too.  I saved a few of my favorites for Griffin’s birth announcement though:)

The picture below cracks me up every time I look at it – Jack LOVES to pose funky, so this was his “sweet move” for Kim’s camera.  Clearly the boy should be enrolled in karate, yoga, or something that requires crazy balance.

In 3 weeks from today, at a maximum, we’ll be a family of 6; my C-section is scheduled for the Monday after Thanksgiving, November 29th.  THAT is crazy.  We’re getting really excited, and starting to panic a bit too.  In the meantime, I am suffering from a severe form of cankles.  You might recall the swelling in my feet/ankles/legs when I was 39wks pregnant with Fin…well, this is even worse.  Behold, my cankles (btw, the “belly button” on my ankle is actually a fingerprint to demonstrate the extreme nature of my pitting edema):

I can’t even believe that is attached to my leg (firmly, I might add).  I have been working weird hours in the ER, and had a several night stretch of the 11pm-8am shift (and another stretch of that coming up).  That pretty much guaranteed I was on my feet for WAY too many hours between the daytime, when I was home with the kids, and the nights when I was rushing from 1 patient to another in the ER.

Speaking of the ER, I came across the best chief complaint I have yet to hear:  “vibrator lodged in place (you know the place), stuck in the “on” position!”  So no matter what your problems are, just know there’s always someone out there who has it worse, like the girl who has to waddle into the ER for help, red-faced, while everyone nearby wonders what that buzzing sound is.