anna in med school

This post was not intended as a complaint.  Still, I wanted to qualify the light-hearted mockery of the situation since I hit “publish” the same day this thoughtful article hit the stands.  The latter is a beautiful contribution to the discussion about the choices of women who carry a mutation in the BRCA1 gene.

I don’t know what I would do.  If I’m honest with myself, I think I would opt to have my breasts removed after I was done having children.  Ovaries are more tricky.  On my Ob/Gyn rotation last year, we met with ovarian cancer survivors, all of whom had their ovaries and uteri removed, launching them into “early menopause.”  It’s kind of gentle terminology for what happens to your body when it abruptly loses a crucial component of a delicately balanced hormone supply.  It affects your body in more ways than we understand.  I don’t know what I would do.

But, similar to Jolie, I lost my mother early (at 57 to liver cancer).  Unlike Jolie, I’m not at an increased risk of developing cancer.    I’m very, very lucky that I don’t have to choose painful surgery, months of reconstruction, a body that’s not entirely my own, and perpetual hormonal instability in order to lessen the risk of death while my children are still kids.  Jolie is confident that she made the right choice for her and her family–either way, any decision at which those with the BRCA1 mutation arrive, it is so brave, and so constantly thought-provoking.

It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.

Alternative title: anna’s tatas on display in the most unflattering way

For the first three weeks of my psych rotation, I’m on the dual diagnosis unit at Presbyterian, where patients are treated who have both a substance abuse issue and some other psychiatric disorder.  It’s a fantastic learning experience.  But, on a ward where you require a key to get in to a linen closet-size hallway bathroom and there is exactly one break room for all staff, you can imagine that places to pump are limited.  And Presbyterian is an old hospital.  With decade-old sugar packets and rancid peanut butter jars lining the cupboards of the break room, I would not be shocked to see a rat, or at least a cockroach, scurrying across the floor.

This is where I’m pumping between patients, crouched behind the deep dish-washer sink.  I’ve hit my head three times on the damn paper towel dispenser.  My attending has gotten a full-on view of my cattle-like breasts at least twice.  And I think I’m starting to get carpal tunnel due to awk pumping positions.

The first time my attending saw me pumping, he turned around quickly and apologized emphatically.  In an effort to make him feel not so embarrassed, I thoughtlessly stammered, “Oh!  No no, I don’t care at all!”  To which he replied, “But I dooo!!!”

Fair enough.

(Side note: I have received nothing but support and encouragement in my efforts to continue breastfeeding.  One of the therapists recently offered the use of her office on another floor, I just haven’t been able to take advantage of it due to time constraints.)

Right now, my experiences have only added a little extra comedy to my days back in clerkships.  But they have made me think about what I’ll choose if I have infants while in residency.  I’m thankful for the wealth of options I, and more women, have.

For the first time in maybe two weeks, bonita Aurelia slept until 5am.  At 6am, Vovi woke up and we had a peaceful Sunday morning coffee together.  At 7am, she told me to go back to bed, and I slept another blissful two hours.  I woke up to a smiling husband and well-rested daughter wishing me a happy first mother’s day.

The day wasn’t perfect.  Our girl is still visibly and audibly pissed to be not quite feeling like herself and, to add insult to injury, she has seven more days of the an unappealing emulsion of amoxicillin.  But we had a few moments like the one below, the photos of which I’m letting distract me in the midst of memorizing the side effects of different anti-psychotics.

Happy Mother’s Day not only to the mothers but to all who nurture, teach, love in her/his own way.  xoxo

Just as I thought I was getting the hang of this whole “working” (“training”?  ”grad-schooling”?  ”being educated”?) mom thing (with a TON of help/support/love), I end rounds to find 11 missed calls and 9 text messages.  Ari was at daycare with a fever of 102.  John was tied up at work intubating folks and saving lives.  And Vovi, wonderful caretaker that she is, was stranded at home, as she does not drive.  Before I had even learned of the problem, John had ordered a taxi service to pick up Vovi and take her to go rescue our girl.

The last couple nights have been rough.  She responds well to Tylenol but, when it wears off at 2:30am, she lets out the most agonizing cry!  As I tried to calm her, pulling out all my Ari-specific mom tricks that normally work okay, she wailed in my ear as though in response: “Mom!  This is decidedly NOT fucking okay!”  I’m sorry, love.  We’re working on it.

Hoping to get you back to baseline in record speed:

Supermom, isn’t she?  What you don’t see is her commuting from Virginia to NYC to finish rabbinical school while writing her dissertation in her eldest’s first year of life.  Or her traversing land and sea, from Israel to the States and back, multiple times a year with two small children by herself, often while simultaneously battling a sinus infection.  Lauren runs 8 km before her kids wake up in the morning, makes homemade popcorn, sets up a new educational theme weekly, brings so much love to the world as wife, mother, daughter, sister, friend, rabbi, mentor and so, so much more.

So tomorrow I’m channeling her…her strength, thoughtfulness, and immense capability.  Our babe is in bed.  Clothes are washed.  Bags are packed.  Breasts are pumped.  And I even managed to review something about anti-epileptic drugs.  I am hoping that, despite studying painfully little these last couple weeks, I manage to not completely embarrass myself on the neuro shelf tomorrow.  Please wish me luck!

Today was easier than yesterday in that my patients were less critical.  One teenager with ADHD suffered from hypersomnolence…hadn’t seen that one before.

But the day was long and the ending was a rather rough awakening.  We had a review session with the director of the neurology clerkship, an adorably, brilliant, slightly eccentric woman who reminds me fiercely of Professor McGonagall.  (To present a small sliver of her personality, she always keeps a huge bowl filled with chocolate candies in her office and, with it, displays a graph showing the correlation between chocolate consumption per capita per country and the number of nobel prizes won by country.  She apparently always buys her candy from the same place, and always many, many bags at a time.  As they rung her up recently, looking at her skeptically, it occurred to her, “They must think I’m crazy.”  Adorable.)  Considering that most (all?) nights I come home, hang with my daughter, eat dinner with our family, put her to bed, then pass out before I’ve gotten through one clinical vignette, I shouldn’t be surprised by how poorly prepared I am.

The brain.  It’s pretty vital.  I should learn more about it.

Feeling defeated, I got on the train, which smelled like cigarettes, to go home.  John texted me asking for an ETA since I was cutting it close to dinner time.  I gave him a better estimate when my second train departed.  Only after I handed the driver my transfer ticket and stumbled off the train did I see them waiting for me on the platform.

I’m sure you’re bored with all the recent baby pictures and videos, but try to make it to second 19.  Best homecoming!

It’s exactly what it sounds: a team of medical professionals “rounding” (essentially going door-to-door, presenting patients, and working out the plans) on all the stroke patients at the Children’s Hospital of Philadelphia.  Stroke is not a common pediatric diagnosis, so the fact that we have rounds devoted to this patient population speaks to the unique glimpse of medicine CHOP provides.

I know it’s a rare thing, but that gives me little peace (not that I am the one who should be comforted) when I’m standing four feet from an exhausted mother, holding her whimpering toddler, who is neurologically destroyed.  It’s such a contrast from my happy, well daughter who greets me when I get home.  I’ve never struggled so much to keep it together.

One of our patients suffered a stroke as a result of a disease I didn’t think I would see in this context during my training.  Haemophilus influenza (h. flu) used to be one of the greatest causes of bacterial sepsis/meningitis in young children.  Since the vaccine came on the scene in the 1990s, we’re taught that it’s been virtually eradicated as threat of invasive disease.  Vaccines aren’t 100% affective, which is one of the reasons we rely on herd immunity.  I think I’m pretty granola, but it baffles me when parents choose to not vaccinate their children out of fear of some erroneous association with cognitive difficulties, when they’re essentially putting their children (and those of others) at risk for potentially much more devastating neurological sequelae.

Article on the physician who started this controversy…