Category — Medical / Medical school / career

If you read my tweets (all I do is whine, so I don’t recommend it unless you’re looking to hear about a day that might be shittier than yours, in case that makes you feel better), you know I have seriously been having “the worst day of my life” for about 3 or 4 days in a row now.  Today topped all.  My resident has been out sick, vomiting and having diarrhea, which means I’ve been completely freaking on my own with REALLY sick patients for 3 days now.  No med student even to help out (she’s been sick since Sunday!).  Just me.  And everyday I’ve also had admissions on top of many other really sick patients that I’m just NEVER going to get out of the damn hospital – 2 are in the ICU, the rest are classic internal medicine train wrecks.  I had an ICU admit today and the guy needed to be intubated, but he later pulled out his breathing tube, which was another disaster.  Got that page at 3pm, just when I’d run down to the cafeteria to try and scarf something – but I had to leave my plate of food at the cash register, uneaten, and run up to the Unit to deal with drug overdose guy who pulled his freakin tube out.  Fun.  I had more than 1 public meltdown today, so my face was red and puffy for the entire day.  Every time anyone asked “are you ok,” it was like my cue to lose it all over again.  I look like a pufferfish.  And I feel absolutely horrible.  I have 2 days left to survive, then I’m off this service and life gets easier, much easier.  But I honestly didn’t think I was going to make it through today.  Fleeting thoughts of…well, fleeing. 

There is so much going on with us right now to top it all off, that I’m just having a hard time dealing with it all at once.  Please send good thoughts to Grandjoe, Travis’ dad / my father-in-law / our kids grandpa.  I’m praying he is ok, but also feeling horrible again that someone we love is struggling through something and we cannot be there with him.  Additionally, my kids are all sick right now with respiratory infections.  Jack has a lovely, sensitive gag that makes him barf every time he has a coughing fit.  Fin gets diarrhea anytime she has any sort of illness.  And Shane spikes crazy high fevers.  So that’s pretty awesome.  Travis is on-call tonight, to top it off, so I got home, after my 14hr day of hell, and am flying solo again.  It’s his last call, thank God, and we both finish hospital medicine (him for good, me for 3 months) on Friday.  Just 2 more days of survival mode.  I hope I make it.

Going to bed since my alarm is set for 4:30am as usual and I don’t have any reason to be up late tonight.  Other nights, spending time with Travis is worth a little more sleep deprivation, but since he’s not here, I just need to sleep this bad day off before another one hits tomorrow.  Please pray for Grandjoe.

So I therapeutically wrote a really whiney post a few weeks ago when I was still on nightfloat and decided it was too grouchy to publish, but I’m feeling grouchy again, so I changed my mind and I’m actually going to write MORE grouchy stuff;)  It’s 3am and I’m up checking a patient’s labs from home.  THIS is why I do NOT like internal medicine –> I end up working way past duty hours allows, spending way too much time with patients, and then coming home tired and pissed at myself for being a perfectionist and caring too much (or not enough, as the case has felt recently with my numbness)…along with a TON of other reasons (like I hate taking care of chronic medical probs, providing futile medical care to dying people, and I’ve discovered, frankly, that I don’t like being around people who are really sick with diseases that can’t be fixed).  I also hate being treated like crap by alcoholic and/or drug seeking patients who are taking advantage of the medical system, especially when they come in covered in feces, like the guy I admitted late today.  At least he’s not the notorious “poo-flinger” most residents in my program have taken care of at one point or another.  Because if a patient flung poo at me, I think I’d just walk right out of the hospital and never return.  Seriously, he dipped his finger in his colostomy bag and threw poo at a resident – not joking.

Anyway, I woke up a few hours ago with this episodic cramping and contraction of my calf muscle, something that used to happen in my pregnancy with Fin a lot.  This one lasted a very long time though and I was to the point of tears.  Travis massaged and pounded on it, but the muscle would not relax and now I haven’t been able to go back to sleep because I’m scared it’s going to come back, plus I got to worrying about other stuff, even though I’m freaking exhausted.  It’s been a LONG week for me.  This month, Travis is on q4 overnight call (meaning he’s at the hospital for a 30hr shift every 4th night) with, like me, just 1 day off per week; my current schedule is 6am-7pm daily with 1 day off per week.  The only thing that got me through this week was looking forward to my day off (tomorrow) when we were supposed to be together as a family…but that got screwed up because Travis’ day off got moved to the middle of next week.  I woke up this morning (Trav was at the hospital), had to get ready for work, and had 3 sick, sad little munchkins to pass off to the nanny.  Thank God for our awesome nanny, but that’s still the worst feeling ever as a mom.  Then I had a horrible day at work to top it off and didn’t get home until ~8pm.  Can I just tell you how shitty that feels?!  So tomorrow is my “day off,” and I’ll spend it parenting my 3 sick little toddlers solo.  For my own reflection and therapy, here’s a bulleted list of the shitty highlights from my week (told you I was feeling grouchy):

• taking care of a non-verbal, non-interactive elderly woman whose family denied her the opportunity to die peacefully because aggressive care was demanded
• Seeing my kids on average of 1-1.5hrs per day
• getting called at home (at night) by a resident, scolding me for my medical student’s signout not predicting a patient’s post-op arrhythmia
• hearing my pager go off to notify me of a late admission, just as I was watching the clock thinking “today might be the day I can signout on time” – that happened almost every day this week
• patient going into status epilepticus just as she was going to Hospice and everyone freaking out, including the goddamn hospice nurse who should have been CALMING the patient’s family instead of riling them up
• leaving Jack to go to work when his face was covered in an eczema flare and he was telling me his throat hurt
• finding cancer in a super sweet, unsuspecting patient
• being told I didn’t know what I was talking about by a cardiologist when I read an EKG as the patient having an acute event –> turns out I was right though, unfortunately for the patient
• taking shit about drinking a coffee while pregnant from a patient transporter –> and I actually felt so guilty I threw my coffee out…then I was REALLY pissed

Anyway, if you want to hear me bitch some more, you can read the rest of this post from a few weeks ago.  I wouldn’t read it if I were you, but I’m hoping to read it 1 year from now and be able to say: “wow, that sucked.  Can’t believe what a grump I was that year when my life was hideous and I never saw my family.  Thank God it was only a year and we all survived it.” 

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I have felt very numb lately.  Not so much at home, but definitely at work.  I am missing the emotional capacity, the depth, I once had.  I can hear horrible, sad, awful things from patients and muster a compassionate face, but inside I just feel numb.  Today though, I sobbed.  I did it privately, but I sobbed nonetheless, and strangely, that made me feel a little bit like a person again.  Without disclosing any real information about the patient or family, I’ll just say that as a mom, it was absolutely devastating to watch another mom go through losing her child like this.  Withdrawing care is important when medical interventions are inappropriate and futile, but it is heart-wrenching to think of  a woman writhing on the hospital floor of her son’s room in emotional agony when she learned the ventilators and resuscitative devices wouldn’t change the outcome – her boy was gone.

It is crazy to see death so often that it barely affects you anymore unless there’s something about the story that is all-too-personal.  Every now and then something will remind me of a family member, and I’ll push that back into the recesses of my brain to avoid processing it too heavily.  But this week it’s all been personal.  From learning about the death of beautiful person we knew in real life, who left the world suddenly and tragically, to watching a mom grieve outside her kid’s hospital room when vents were turned off…it’s been heavy. 

One of my best friends, Nick, lost his little brother last week.  I still can’t believe it, and I also can’t believe Travis and I couldn’t be there for him and Hillary at Sam’s funeral.  I feel so freakin terrible about that.  I also just cannot process their loss; it is so tragic and so shocking.  I just read and re-read Nick’s eulogy at Sam’s funeral and sobbed my eyes out.  It might be cliche, but life is so fragile it’s terrifying sometimes.

All is status quo here – going through the motions, trying to survive each day, dreading next week and trying not to think about it.  I start a different rotation with some fairly notorious (in a not-so-positive-way) residents.  It’s going to be a month of VERY long work weeks, and my resident is actually making me stay on Thursday, the day I transition off nightfloat.  So I’ll work all night Wed. and then start a new service in the morning on Thursday and stay all day.  I’ll be back to the 1 day off per week schedule and will be working 80+hrs weekly. 

An update on Jack’s school situation – he’s doing better, starting to transition I think.  There are still some things that  break my heart, and he captured one of them in a picture he made at school today.  All the kids made cats with smiley faces, but his is a coyote with a big frown.  He told me it was sad because it didn’t have friends. 

I told my brother, Jeremy, about that and his response was “aww.  The old sad coyote trick.  Probably using it to get girls.”  My brothers crack me up.  We went to lunch today and while waiting for the check, Jack said turned to the waitress and said “mas rapido, por favor.”  Then he turned to me and said “that means super dooper fast, mom.”  So cute and so cool to watch language acquisition in a toddler. 

Before these pictures are totally out of date, I thought I’d post ‘em.  These are from the weekend before last.  We went up to Beirstadt, one of the 14ers Travis and I have climbed in the past, and hiked around the base with the kids for a few miles.  It was absolutely beautiful – perfect day, perfect weather.  Last weekend was pretty amazing as well, though I didn’t take a single frickin picture to capture it.  I got off work around 5am or so on Friday morning, slept ~2 hours, piled the kids in the car and drove to NM (don’t worry, Travis drove;).  After waking up behind the wheel one morning last week on the way home from a nightshift, my new policy is that I don’t drive until I’ve napped!  We got to see our good friends, Jerry and Rebecca, and their adorable kids.  They moved to Albuquerque for residency and we happen to LOVE it out there, so it was a great trip all around. Anyway, these pictures make me happy.

Jack had a big week – he started school.  Travis was out of town until Monday night, so our nanny stayed over Thursday and Sunday nights (because I’m working nightfloat right now), and I rushed home from work Monday morning to take Jack to his first day.  He was SO excited and did really really well.  That was the 1st day.  Travis got home that night, so we were both able to take him to his 2nd day of school.  By day #3 he didn’t want to go anymore.

I guess the newness had worn off.  But also, Jack is such an emotionally in-tune kid and he’s SO aware of his own feelings and other kids’ that it had become very bothersome to him to watch all the meltdowns around him when parents left their kids at school.  He told Travis that school is a very sad place with lots of lonely babies who miss their mommies and daddies.  WOW.  Nail on the head?  It broke our hearts to hear that, but also made us realize again just how smart he is.  He is 4 years old in a 3 year old program, so he’s one of the oldest.  His teacher has been telling us how wonderful he is, and how much he helps the younger kids all day.  This was our hope – that he’d be a leader in his class, and that by waiting and starting him at an older age, his emotional maturity would allow him to make the most of his school experience.  But we have felt so bad about his internalization of all the emotions there.  I’m sure it DOES feel like a very lonely environment to a kid who is used to being home with his parents and his 2 almost-same-age siblings with whom he has always done EVERYTHING.  There is never a dull, or quiet, moment at our house and our kids are constantly chatting and playing together.  It’s a loving, stimulating environment in which he feels safe.  The transition from our home to his school, where kids learn to wait in lines and sit quietly at their tables during snack time is understandably challenging for him.  I know he’s lonely, and even though it’s only 3 hours a day, I know he misses Finley and Shane during that time too.  He is SO happy to come home and be with his buddies.

I’m trying to keep everything in mind – like why we’re doing this in the first place.  For one, it’s good for Fin and Shane to have the time together to cultivate a stronger relationship.  It also lets Shane and Fin drive their own play and allows them to be little.  Jack is their ring leader, so he dictates EVERYTHING around here from outings to imaginary play.  It’s great for Fin and Shane, especially since Jack is SO damn smart.  But it’s nice for them to just play normal, non-intellectual, little kid games that they come up with on their own from time to time.  And on outings, they can stay in the little kids’ area of the museums until they’re bored, not just until Jack says it’s boring.  Another big reason for Jack in school is because we have #4 coming along in the spring.  It complicates life just a tad and I think it’ll be good for Jack to have school as an outlet.  I had just hoped he would LOVE it from week 1 on.  But it’s an adjustment.  The good news is, we couldn’t be happier with the school or what Jack is learning there.  It’s an immersion program, and he’s already using his 2nd language, which is amazing to see.

I felt so bad leaving tonight; I told Jack I’d be home before he goes to school in the morning and the mere mention of school after a long weekend sent him into tears.  We’re all going through a rough transition time right now.  Shane has been very sensitive and has been crying at the drop of  hat, and Finley is still having some nighttime sleep issues.  Travis has been traveling a bit for his company, and I’m working really weird hours the next 2 weeks.  I come in at 4pm and take admission until 4am, last night I got home around 5:15am.  I slept until 10am and then played with the kids until I had to come back to the hospital, which is where I am currently.  I am really missing my kids and Travis right now.  It’s a weird homesick feeling that I can’t wait to be done with when this year is over.  I’ll leave you with the sweetest poem Jackie wrote for his daddy:

How Much I Love Daddy, by Jackson Good

More than a bird loves his wings

More than a dog loves his milk

More than a sun loves to set

More than a whale loves his spout

Apparently that inspired the poet within Finley as well, so here’s her meathead version;)

How Much I Love Daddy, by Finley Good

I love daddy so much, poo poo.

I thought Shane might want in on the action, but when asked if he wanted to write a poem for his dad, he answered in true Shane form as of late: “my don’t want to.”  We must hear that phrase 100 times a day;)

I started nightfloat on Monday, meaning I am on a month long rotation where I work nights instead of days (and night).  For the first 2 weeks, I work 7pm-7am (in theory, reality is more like 7pm-8am, but this morning I got a late admission and was stuck there until almost 9), then I’ll switch to 4pm-4am (4pm-5 or 6am).  It’s grueling but actually comes out to probably 15-20 fewer hours worked each week.   I come home, try to nap 2-3 hours, then have lunch and play with the kids until their naptimes, when I lay down with them for another 1.5hrs.  It’s REALLY hard on the body, but the bright side is I actually get to see my kids.  By this morning, I was SO exhausted from being on my feet all night and sleeping ~4 hours a day between shifts.  Nights at the hospital are CRAZY busy and I seriously don’t even sit down except in the ED when I’m admitting a new patient.  But the beauty of nightfloat, and the reason I paid one of my co-interns to swap me a wards month for a nightfloat month this spring, is that you get 2 days off per week (we get “weekends”).  Probably doesn’t sound too exciting to people with normal jobs, but it’s one of the only rotations we have during intern year where that happens. 

So I got home ~9am today and don’t have to be back to the hospital until 7pm on Sunday.  The hard part is that my body is so damn confused about what time of day it is, and I can’t quite convince it to sleep right now.  Instead, I’ve decided to post pictures of the last 2 hikes we did – Burning Bear Creek Trail, which was AMAZING, and a little hike we’ve done before in Roxborough State Park, which I love.  Both were incredible, but Burning Bear is my new favorite to do with kids, especially if it’s warm enough to “swim” in the beautiful mountain creek the trail follows.

These are from Burning Bear Creek hike:

And in case you’re not sick of pictures, here are a couple from Roxy State Park:

Jack starts school this week, which is huge.  He’s VERY excited, but every time the topic comes up, Fin becomes hysterical.  She doesn’t want him to go, and if he does, she wants to go with him.  It’s kind of sad that their little pod of 3 is breaking up.  Jack will only go to school a few hours a day (~3), but since it’s in the am, it’ll mean he doesn’t go on morning outtings with Fin and Shane.  They’ll probably struggle without him for a bit, but I’m guessing Fin and Shane will become closer because of it (not that they aren’t close already, but you get the point).  Sad. 

Travis and I are back to daydreaming about getting to a point after I finish derm training (<4yrs) where we can pay off loans and just whisk our family overseas to travel for a few years while doing different types of international work.  We’d homeschool and hire an international school teacher to join us and help teach the curriculum we design for our kids, with tons of hands-on learning Travis and I can provide along the way while we take our kids to see the world and do humanitarian work along the way.  Then we’ll settle in London for 2 years, where I’ll do the Tropical Medicine fellowship before returning to the developing world to practice medicine / tropical derm / and teach at a med school.  Travis is now doing health IT development work in Africa, but hopefully it’ll expand into Asia as well, so lots of possibilities for his non-clinical role overseas too.  We just need his start-up company to do what people are projecting it will, and I just need to survive internship for now.  In the meantime, it’s nice to dream, ya know?

Anyway, I think I might take a Tylenol PM and attempt sleep – I haven’t taken a single pill during pregnancy, and that’s a safe one anyway so don’t worry (Yiayia;).  I think the baby would appreciate some rest.  I can’t even imagine what kind of little monster is lurking within me, but if it’s anything like the last one, I should be resting every second I can!  Speaking of, check out this tantrum, I call it a Fintrum:

Travis wasn’t in town when this happened and Fin gets very out of sorts without her daddy.  It’s kind of an amusing video at first, and then it’s just sad when her little body just gives up and you realize the meltdown was a combo of exhaustion and missing her dad.  I stopped filming and she just collapsed into my arms:(  Poor little monster.  But it does give you a glimpse into how her head can spin around!!  I posted this so I can look back on this blog someday and see the good, the bad, and the ugly.  And of course the beautiful, wonderful, fun, hilarious stuff that happens in our house everyday too.

Thank you to all of you who reached out with supportive words for me.  Right now I need that kind of support.  It doesn’t help me to hear “suck it up, that’s just the way it is.  Lots of us do it, you can to.”  That’s the ass backwards logic that has made medicine the cold environment that it is, and I’m sick of hearing it. 

I was so lucky to have had an upper level resident for the past month that would have never said that to me.  Instead she’d just sit with me after we signed out and hug me while I cried, she’d ask about my kids when she could sense I needed to talk about them, and she’d avoid it when she knew I couldn’t handle talking about them.  She taught me at every opportunity, shared my workload when I was overwhelmed (which she did NOT have to do, being as she was my upper level), impressed me with her humanism, and made me laugh when I just really needed it.  She’s probably the reason I got through last month.  So intern year isn’t all bad I guess; I have come across a few amazing people, like many of you, who have lovingly nudged me on while also letting me know you’d still support me if I decided to go a different way.  That’s the kind of encouragement I have needed in my life lately, so thank you.  To our parents and my grandparents, I really am doing ok, I promise.

Today was awesome.  We made it feel like a full weekend, even if it was just a day.  First, I have to introduce you to a new member of the Good household…I got a cryptic text while I was on-call Saturday and had hoped the snake Travis mentioned would be dead or something before I got home.  Instead, I found it in a little reptile aquarium ON MY KITCHEN TABLE. 

It’s only a matter of time before a mischievous someone “accidentally” lets him out of the cage and he slithers under a couch or appliance. 

So yeah, we have a snake.  His name is Slinky, and he’s a gross little thing Travis and the kids caught on a hike last weekend.  That’s just what happens when I’m gone for 30 straight hours and daddy’s left in charge;)  There’s also a praying mantis, 2 frogs, and a tube full of crickets – all caught by my kids on their hike.  Saturday was a rough day for the animal kingdom.

We did all kinds of stuff today, including getting a preview of the Botanical Gardens’ new kid’s section, which is going to be amazing when it fully opens next week.  We had a really fun scavenger hunt there. 

[Note: in the picture below, you can see Fin’s new sense of fashion – she insists on mix and matching her shoes]

We also walked to a pocket of nearby restaurants to enjoy my fav food – sushi.  Also, my best friend delivered a baby today in a VERY high risk delivery.  Dominique and her baby girl are both doing great, after a very stressful pregnancy.  Thank God.  So today was a wonderful day for many reasons.  Speaking of pregnancy and babies, little Good #4 is doing well.  I started feeling movement early this time, but the first real kick you could feel from the outside of my belly happened 2 weeks ago.  We had an ultrasound last week and we brought all the kids (and Jen, our incredible nanny who has become a crucial member of the family).  The kids LOVED being involved and seeing the baby on the big screen during the ultrasound. 

The ultrasound ended up showing a marginal cord insertion, meaning we’ll have to have another ultrasound and see a perinatologist next month to monitor the baby’s growth (since the cord doesn’t insert in the center of the placenta, there’s a concern that the baby might not get as much blood flow / nutrients, which could cause growth restriction).  I’m not too worried about it at this point, but my experience with perinatologists makes me roll my eyes at the thought of having to see one.  Always ironic when the fields that could really use people with good bedside manner tend to draw the ice cubes, but whatever.

Anyway, here are some pictures from dinner tonight.  We walked a few miles, ate a great dinner, let the kids play in some water, and headed home watching the sunset over the Rocky Mountains.  In the interest of transparency and honesty, this is the secret to getting our kids to sit still at a restaurant so Travis and I can pretend like we’re on a date, even if there are 3 very nosey chaperones present;) 

Every now and then, Shane would pick his head up and say something funny like “cuse me, I farted.”  Cracks me up.

Here’s a beautiful thing: 3 toddlers all finally wearing underwear!  No more diapers (for a few months!).

So it’s 1am, I can’t connect to the internet, but I did bring my computer in case I had a chance to write from my call room.  Looks like there’s no point in even trying to sleep, since my cross-cover pager is possessed.  Might as well write for 5 minutes at a time while I wait for the next train to wreck on the oncology floor (that’s where all my cross-cover action has been so far tonight).

I miss feeling like a mom.  Some days (most, if I’m being honest), I really wonder why the hell I’m doing this.  I don’t like it; there’s very little that I enjoy about my days, other than the moment I step out of the hospital and run for my car before my pager goes off again.  I’m in survival mode, just trying to stay afloat.  My kids, thankfully, are doing much better, but I can still sense their anxiety.  Shane’s is disguised, but it’s there.  He’s more sensitive and he’s actually been saying “my sad mama” every time he sees me.  Fin’s is obvious – she’s become terrified of everything and is constantly on the lookout for the “big bad wolf.”  Seriously, she won’t even go to the bathroom by herself right now because of the damn wolf.  At night is when she really melts.  Jack’s is subtle, but it’s there too.  He’s always asking me about when I have to go to work next.  It’s the first thing he thinks about when he sees me – how long will I be there.

And then there’s the compassion burnout.  I almost ate a patient the other night – I got a late admit, which meant I wasn’t going to make it home in time to see my kids before their bedtime.  When I went in to see the patient, she was on a call and told me to come back later.  My blood pressure seriously shot higher than that patient’s who stroked in front of me last Friday.  I don’t even cry when nice people die anymore, I hardly even feel…anything.  It’s survival mode.  But I miss feeling like a person and I don’t like what this process is doing to me.  The only thing that grounds me every once in awhile (especially after a diet coke;) is feeling this baby inside me kick.  I always pause what I’m doing to put my hand on my belly and just enjoy that little glimpse of a life.  And that brings me back to thinking about my family.  Those are about the only enjoyable moments I can think of in my otherwise very hard, very stressful days.

As I wrote on twitter a few days ago, you know you’re unhappy at work when the drive there seems to fly by in the mornings, yet it seems to take FOREVER to get home at night.  We are supposed to fill out these work hour forms to document the hours we were in the hospital each week.  I decided to fill mine out honestly.  Guess how that went?  Not so well.  It’s no wonder everyone lies about duty hours; it’s just not worth the hassle to tell the truth and deal with the phone calls and the getting your resident in trouble with the administration because you broke work week hours (worked more than you’re legally allowed as a resident).  The best is how the administration then calls and asks questions like “well, what can we do to keep this from happening again?”  And after you tell them a reasonable solution (ie: allow us to stop taking admissions an hour earlier), you come to understand what they are really asking is “how can we get you to stop logging the hours you really work?”  Gotta love medicine.

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So I wrote that on my overnight call last night.  Saturday call is the worst – makes for a REALLY long week.  That was a long 30 hours.  My day off is Tuesday and it couldn’t come soon enough.  I am ok though, probably better than that made me sound!

Amy Mann- I canNOT find your email address but I need to thank you.  Your letter was so touching and totally made my week; I am so grateful for the clothes you sent me.

It sure feels like we lived it a few months ago; as crazy and chaotic as life was then, it didn’t compare to this new life with 3 wild toddlers, a pregnant intern for a mom, and a dad who sporadically travels to a far away coast to wine and dine potential investors.  This week was hard, really hard.  I pretty much didn’t see my kids for 3 days, didn’t sleep more than 5 hours any night this week, and probably cried 6 of 7 days.  <sigh>  I am really sad to say I don’t like medicine very much right now, and I hate what I’m having to sacrifice to be in it.  I’m tired of missing out on my kids lives to be at the hospital watching people die.  It’s depressing on both fronts.  Internal medicine is not really my thing.  About 75% of internal medicine patients are over 75, and that is not really an exaggeration.  And I’d say 75 would be on the young side for the hospital service I’m on right now.

On top of other stress, I had an exposure yesterday that really freaked me out…a possible infectious disease that, as a pregnant intern, I have been afraid of encountering.  After researching shingles in pregnancy, I think my risk of badness is extremely low, especially since I’ve had chicken pox and even if I hadn’t, it’s still not likely my pregnancy would be affected.  But it was enough to make me worry for a few hours yesterday and have to spend a little time looking it.  I didn’t need that. 

Today was my day off.  It was an AWESOME day off, all the way until this evening when Fin fell off a chair at Chipotle and cracked the back of her head open.  I didn’t realize she’d hit her head until I scooped her up and felt something wet spilling onto my arm.  I was pretty sure we were going to have to take her to the ED for stitches, but Travis and I got the bleeding to stop without that.  Fin is the toughest little thing on the planet, thankfully.  She just wanted to eat her burrito and drink a “beered” (beer) to make her feel better;)  So we went home and did just that.  Before you call CPS, Finley thinks Izzy with lime in a frozen mug is a beer, so it’s all good.  [what you can’t see in the picture, nor could she, thankfully, is the blood matted hair on the back of her head]

As for the good parts, we went to the Dragon Boat Festival today in celebration of Asian Pacific heritage.  We’ve gone every year we’ve been here and we always love it. 

Travis’ mom is out here with us, which is a great thing for the kids and has been very helpful to us too.  Travis left for Boston at 3:30am on Friday morning and came back at 2am that night, so she was here to help our nanny, Jen, with the kids that very long day until I came home. 

Anyway, the festival was fantastic.  Afterwards, my MIL and I had a chance to run to the mall while the kids napped today and I finally got myself some pants.  It’s weird how fast this pregnancy is going, but I swear, it’s been ALL OF THE SUDDEN that this huge belly has popped out of nowhere.  I’m 21+ weeks now and the belly band over my regular dress pants is becoming uncomfortable.  And because I have such incredibly kind people who read this blog and offer support, I have had people send me maternity clothes too!!  Can you believe that?  I am SO grateful, I can’t even begin to tell you. 

So, after the Chipotle drama, we did a fun little dessert craft with the kids.  Worms in mud.  If you don’t know what I’m talking about, just get some gummy worms, chocolate pudding, and oreos.  Let the kids mash the oreos with mallets (they love that part), put them at the bottom of a clear plastic cup.  Then put a chocolate pudding layer on top.  Last, have them drop the worms in the mix and stir it all up.  It was disgusting to watch, but Jack, Shane, and Fin had such a blast searching for and eating their worms and the mud / dirt.  Especially since they’re still obsessed with pretending to be baby birds!

Here are a few other pictures from the past few weeks that I’m just now getting off my computer.  The first couple are from my day off last week – took my MIL and the kids up to Boulder Creek on the most beautiful day and had a wonderful time.

My kids have been playing “doctor” a LOT lately.  The role playing is adorable, and Finley goes around saying to everyone she meets, “I’m a dot-tor.”  Sadly, I kind of hope my kids are only role playing and I never hear any of them say that for real.  Maybe that’s just intern year talking and I’ll change my mind down the road, but for now that’s how I feel and I’m just being honest about it. 

I love this picture of my Yiayia and my Finley:

That’s all for my stream-of-consciousness ramblings tonight.  Sorry if it was a downer…again.  Hopefully I’ll snap out of it soon?  Like next year when I’m no longer an internal medicine intern?!!  Ahhh, just got keep banging my head against this brick wall for now.  I’ll eventually crack it.  The wall I mean. 

Hope you all are doing well, and I hope you understand why I’m so out of touch if you’ve emailed me in the last few weeks and I haven’t responded.  Almost forgot – PLEASE check out our SkinnyKidz sale!!!  LOTS of our belts are on sale as we get ready to bring in our fall prints, which are adorable, btw.  Don’t forget to check it out. 

Nothing in medicine is more painful, more torturous, more heart-wrenching than providing futile medical care to a patient who is suffering.  I am not talking about a person who carries a terminal diagnosis but is still coherent and choosing to pursue experimental treatments, even if they are hail mary options.  I’m talking about the patient who is no longer mentating, who needs modern medicine to breath for him and a tube to feed him, who is developing decubitus ulcers all over his body from laying in a practically vegetative state, who moans if the ativan and morphine wear off, who has to have the suction jammed down his throat to remove the sloughing mucosa from the back of his dry, blood-crusted oropharynx, who is barely recognizable because fluid has left the intravascular space and pooled in every dependent area of tissue, leaving him swollen and water-logged.  I’m referring to the patient whose family members STOP visiting his bedside because even they can’t stand to look at him like that anymore.  Yet they still want everything done to keep him from dying. 

Talking and pleading with families in the most compassionate way I know how becomes a frustrating effort when they continue to believe a miracle might occur.  In one breath, they realize that if God wanted a miracle to occur, he would make one occur.  But in the next breath, they aren’t confident enough in their God to allow us, the medical team, to stop prolonging the patient’s suffering and just leave it up to God. 

I know it often takes people a long time to come to terms with a family member’s death.  I don’t ever want to be in those shoes because I can’t imagine how painful it must be.  I never know the people I take care of before they became ill, but for me to show up and see them in a state of suffering day in and day out while their families debate pursuing aggressive, futile medical treatments, is really hard.  Our 1st obligation as physicians is to “do no harm,” but I can’t think of anything more inhumane than prolonging death under those circumstances.  Yet, in this country, we are virtually powerless and our hands are practically tied.  We aren’t able to say “I’m sorry, I cannot / will not put a feeding tube down your father’s throat because it will only cause him more discomfort and there is truly no benefit to him.”  In an ideal medical world, I would be able to say “I’m sorry, but it would be against the medical oath I have taken as a doctor.”  But we don’t live in Europe, we live in a highly litigious country where doctors are puppets out of the fear of a lawsuit.  So we go on torturing patients when they’re families demand us to.  And we bring in palliative care, case managers, hospice, the ethics committee, and so many other people to try and help us make our case.  But in the end, we bend to the families’ wishes and allow the antibiotics, the feeding tubes, the blood draws, the suctions, beeping alarms, the rib-cracking CPR, the defibrillator, the breathing machines to continue to prolong suffering.  It’s truly disturbing.  And in the end, the patient dies a painful death, and all that is gained goes to insurance companies – the  hundreds of thousands of dollars our futile care costs. 

If you don’t have a living will, even if you are 30 years old and healthy as can be (believe me, I’ve had this patient who was hit with something out of the blue too), sit down with your family and talk about these things.  Everyone who sees these patients always says “please don’t ever let me go like that,” but it’s so hard for the family members left behind to make such huge decisions when they haven’t explicitly had these conversations with their loved ones before tragedy befalls.  No one wants to be responsible for saying “ok, withdraw treatment and let him/her die in peace.”  So everyone defers making a decision, and the patient just lingers and suffers.  Something to think about.  Here’s a site to help you think through these things if you haven’t before: http://www.yourcommunityhospital.com/LivWill5wishes.cfm