two!!

17 Oct

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I’m pretty sure she still sometimes equates “two” as simply “more than one,” or “that which I can hold in both my hands.”  She frequently uses this understanding as an effective bargaining tool: “Would Ari like a piece of chocolate?”  “Two please!”

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Last night we were wrestling/cuddling on our bed, and I marveled at how long and childlike Aurelia’s become.  What happened?  When did you turn into such a little girl, embracing your role as big sister and protector?

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When did you become so curious and excited by your surroundings?

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When did you start to learn what it means to be a friend, and all the sticky concepts (like sharing) that come with it?

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Happy second birthday, Ari!  We love you so tenderly and fiercely, as is true to your toddler spirit.  We are so fortunate and proud to have you as a daughter!

 

 

first interview

16 Oct

Long exhale…

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I am: Competent.  Capable.  Prepared to work hard to become an excellent pediatrician.

I had my first interviews today.  I was nervous and happy, and I hardly slept last night (nerves + that dreaded four-, now five-month sleep regression), but I think they went okay.  I’m trying to settle in to the fact that I’m not going to know anything for over five months, but something (hopefully a job) will likely work out.

With our babysitter still available, I was able to take a quick nap this afternoon, and the fog lifted.  We took a family walk–our home in Charlottesville is a stone’s throw away from a busy three-way stop where buses often pass, so it’s basically Ari’s own personal heaven.  Then we were lucky enough to share some wine and toblerone with Anne and her family on her birthday!

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Sweet friendship:

DSC_6891 DSC_6897And, Evie, when we return to our home in Philly: sleep training, it’s happening.

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so many feelings

12 Oct

Oooph.  This week has been a professional emotional roller coaster.

For those of you who know me personally or have been following this blog for a time, you know that I lean a bit toward the neurotic.  For example, some physicians were speaking near me about how this year there are more med students applying in pediatrics than there are positions.  As I looked visibly concerned, they reassured me.  I, in turn, rationalized that a little worry is what often keeps me out of trouble.

When applying to residency, I was careful.  I asked for letters of recommendation and started my application months before I could submit it.  I had my husband, mentors, friends, and colleagues read and critique my personal statement and my CV.  I scrutinized over the wording to the one-sentence answers of some very basic questions, some of which resulted in multiple emails between me, the registrar, and the director of student affairs.  And, when I submitted my application using a somewhat confusing and not always user friendly online system (which crashed the day we were allowed to submit our applications), I triple, quadruple checked that all my ducks were in a row, that my application had, indeed, been submitted, that every document was uploaded properly.

But I had this nagging feeling.  Though I had been offered some interviews, looking at the status of my application last week, something seemed off.  Finally I noticed a big problem: a very important document had not been assigned to the programs to which I had applied.  So, I had applied to programs, but the application programs had received from me was incomplete for over three weeks.  I still don’t know what happened.  Was this my error or that of the system?  My tendency to worry, to be a little neurotic, generally keeps me from making this kind of careless error.

I was tearful, disintegrating into an insecure mop in front of several residents (and possibly an attending) who were with me in the workroom as I discovered this error.  I feared that, seeing that my application was incomplete, residency programs would simply pass over my application.  I corrected the mistake, texted a few choice friends who generally give good advice on life, spoke with my mentors, and contacted the programs to let them know of the glitch and that my application was now complete.  My spirits were raised somewhat when I received an interview approximately 30 minutes later.

And then Step 2 scheduling happened…

There is a practical component to Step 2 of the boards (it’s called Step 2 Clinical Skills, or Step 2 CS), where a med student experiences 12 encounters with standardized patients that test the ability to perform a history and physical exam, medical decision making, and interpersonal skills.  It’s only offered in five cities, it is incredibly expensive, it takes forever to grade, and it has a high pass rate.  Penn offers its own version of this exam, also with 12 patient encounters taking up the same amount to time, but with a higher fail rate.  I passed this Penn rendition in April of this year, so I have not been stressing about Step 2 CS.  Many of my friends took it in the spring of their fourth year, and a lot programs only require that you complete the exam prior to graduation.

I had some trouble finding a window to take the exam and, as I was trying to cram as much as possible into the fall semester, I opted for a January test date.  Not 24 hours after I realized my application gaffe (in the middle of the night, actually, while feeding Evie), I discovered what I also should have noted months ago during my research into programs: that one of my programs requires the results of Step 2 CS long before I’ll be notified of my results.  (You can imagine the behavior that ensued at, oh, 4am.  My husband is a saint, I tell you!)

So now John and I have this crazy email alert system set up, ready to pounce on the next available test, in case someone bails last minute.  (Hey, if you feel like giving up a test date, will you let me know?  I bake!)  I might just fly to L.A. or Houston (two of the random cities other than Philly where the test is offered) on a moment’s notice if need be.

On the plus side, my lucky suit (my only suit), which did not fit so well around my birthing hips when we left for Charlottesville, miraculously fits again now.  And not a moment too soon; my first interview is this Wednesday!  The bad news is that I have one day to get it cleaned and a hem fixed.  I frantically whizzed to the mall during nap time today to buy pumps and hose, and am now starting to feel a bit more prepared.  (Pumps: still not a comfortable shoe.)

And then there’s this, sent by my love to cheer me up, in response to the question, “What would you like to tell mommy”:

the best possible day

11 Oct

When I entered medical school, I thought I wanted to go into geriatrics, in large part because of the profound impact my experience volunteering at a hospice group had (has) on me.  My youngest daughter will always allow me to think fondly the first hospice patient I cared f0r.  Her name was Evelyn, and she was a force of nature.

Though the idea of facilitating what might be end-of-life care for pediatric patients shakes my core, I’ve often wondered whether I might still one day work in palliative care.   This recent piece by Atul Gawande in the Times has been on my mind:

Medicine has forgotten how vital such matters are to people as they approach life’s end. People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.

Peg, however, got to fulfill her final role. She lived six weeks after going on hospice. Hunter had lessons for four of those weeks, and two final concerts were played. One featured Peg’s current students, all younger children; the other, her former students from around the country. Gathered in her living room, they played Brahms, Chopin and Beethoven for their adored teacher. A week later, she fell into delirium and, a short time after that, died peacefully in her bed.

John just ordered Gawande’s new book, Being Mortal, and I am looking forward to when I might find a time to delve in.

On a similar note, if you haven’t read and watched the story of Brittany Maynard, I have no words:

belly button specificity

30 Sep

We’re in Charlottesville!  On Friday we packed up the family and moved down to Virginia for four weeks so that I could do an away rotation at UVA in ambulatory peds.  We are thrilled to be here, but the process of getting down here was brutal, made worse by the fact that Ari was febrile for most of the weekend and I wasn’t feeling so hot myself.  But we are all on the mend and settling in.

We rented a lovely cottage-like old home not too too far from the hospital.  John is taking two weeks of vacation (though he is working hard to tie up [or tie together] a number of research projects and academic obligations), followed by a week of CME (continuing medical education) so we can be together.  The last week down here with the girls will be a bit of a scramble, but I have an overly generous friend swooping in to help out!

Day one pediatric primary care pearl: If a small child comes in complaining of a belly ache, when asked about the location, he will almost always point directly to his belly button.  As the stated location becomes further and further from the belly button, there is increased likelihood that there is true underlying pathology.

And regarding my heart: I am, now as always, so grateful for a loving husband who is an awesome father, two daughters somewhat willing to take things in stride and make adjustments, and nurturing, thoughtful, and trust-worthy childcare.  Particularly with Charlottesville making national news recently, I have been having anxiety about leaving my girls with new caretakers, neither of whom I had met prior to this Sunday.  I don’t think my kids could be in better, more loving hands.  (If anyone is looking for childcare in the Charlottesville area, let me know, I have some recommendations!)  Knowing that they are safe and happy has allowed me to focus on my education and take full advantage of the privilege it is to be here.

It helps that the caretakers aren’t shy about snapping pictures:

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women’s health elective

24 Sep

I started med school truly believing that I was meant to go into either geriatrics or women’s health.  Things change.  Since I am now most certainly going into peds (at least I hope some of the programs to which I’ve applied consider my application), I tried to cram as many peds electives as possible prior to Evie’s birth.  But now I’m at the tail end of my clinical requirements–I literally only require three more days  of clinic in order to graduate–so I decided this block to scratch an itch.  As a candidate for the Certificate in Women’s Health at Penn, I am required to take one elective in women’s health, but there are a number of reasons why I wanted this elective, for me:

  1. Personal interest: the female body, it’s not simple.
  2. On the first day of our reproduction course (first year), the course director said something to the effect of, “There will likely be, in one way or another, women involved in your life–mothers, sisters, wives, daughters, friends.  And, as a medical professional, you will be counsel to them.  It’s crucial to know the basics.”  Perhaps I shouldn’t be asked for advice regarding health care, but some do, and I am overwhelmingly flattered (especially since I’m married to a real authority).  I guess that roughly 85% of questions I field right now are ob/gyn related: My gynecologist says I have to have a colposcopy–what’s a colposcopy?–the description sounds terrifying.  Is it true that I can’t lift more that 35 pounds while pregnant?  Hey there, I’m having contractions, when should I go to the hospital?  Although I can always play the student card–as in, “this is just what I’ve learned, and you can’t take it as real advice, what do I know?”–that’s not going to fly as well when I have (hopefully) an M.D. next to my name.
  3. Approximately half of pediatric patients are female, and adolescent females in particular (not to mention younger girls experiencing precocious puberty or abuse) require some of the same health and preventative care as older women.  I think what I’m learning this month is hugely applicable.
  4. There was a period of my life when I thought ob/gyn was the field of medicine for me.  As much as every peds elective I’ve completed has reinforced my desire to go into pediatrics, I wanted a women’s health elective to affirm that I do not belong in that field.

I’ve enjoyed the last 3.5 weeks tremendously, though feeling a bit spread thin at times juggling family, now convinced that we will need more (likely live-in) childcare lined up during my residency.  And I do feel convinced that ob/gyn is not field for me, but I’d like women’s health to be an integral component to my pediatrics practice.

Oh, and I’m now terrified of my bone health.  When women hit 30, they’re no longer building bone as rapidly.  And all those years of multivitamins and calcium supplements have not been shown to help.  Today I bought my first container of Vitamin D3, 1000 IU softgels.  It’s a necessary component of bone health.  Although we get it from the sun in the summer (if we show skin outside), an endocrinologist once told me that, in the Northern hemisphere, we could lie naked outside all day during the winter and still not absorb enough Vitamin D.  I am also paying more attention to how much calcium I get in my diet–45% daily requirement in a cup of almond milk!

Since I’ve been awful at posting, a few from our last-day-of-summer romp through Chanticleer:

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Oh goodness, either my arm or her neck just isn’t long enough for a proper carrier selfie…she looks concerned:

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submitted!

16 Sep

Yesterday was the first day we could submit our applications for residency.  The website went down at some point during the day and, by the time I returned from clinic, it provided a cryptic message that it was temporarily out of service and would likely be opened again at 9am today.

I reviewed my application one last time while pumping in the colposcopy room this morning.   I sincerely hope that I (and my fellow supporters who were kind enough to read over my application) caught all typos; by lunch time, I couldn’t critically look at my personal statement at CV any longer.  I hit “submit” at 12:48pm.

Now I’m just hoping.  Hoping that programs will want to interview me, despite a less than ideal step 1 score.  Hoping that I’m received well at interviews, that I appropriately show my passion for pediatrics and for the programs to which I’ve applied, that I appear confident without crossing the line to arrogance, that I show myself to be a capable future physician.  Hoping that I’m overwhelmed with joy on March 20, 2015, because I was offered a job.

Please, wish me luck!

And, speaking of capable, look who keeps working to improve herself in the roles of big sister and helper, insisting on carrying her sister’s milk to daycare…

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