anna in med school

Before scrubbing in for a cataract extraction, a scrub nurse begrudgingly handed me my preferred scrub size after asking me twice whether or not I was sure I wouldn’t be more comfortable in a larger size.  Then she said, “Are you sure you’re not having twins??”

Me: Why?  Do I look particularly large for 8 1/2 months?

Her: You look…huge.

Me: <overly apparent eye-roll> Thanks.  I’m flattered.

She didn’t get the sarcasm.

What I really wanted to do was unleash my bitch and tell her flat out: “Look, I’m one day shy of being full-term.  And at 28 pounds heavier than my normal weight (some of which I insist must be water weight considering my 2+ pitting edema in my ankles), I think I still weigh less than you, nearly 5 inches shorter than I am.  You work in health care.  Haven’t you learned at some point how to talk to a pregnant woman without making her feel like a fat cow?”

I swear, I’m normally a pretty nice person…

Nothing feels better than walking out of a shelf exam to this in my inbox:

I hope this note finds you doing well after your peds shelf!  Congratulations on completing it.  You worked hard and slept little, while managing to work out, eat well and love me – you are amazing and I’m very proud of you.

I’ve been thinking recently about the differences between med school now and how it was like 30-40 years ago…I’ve heard horror stories.  It was cutthroat, and it must have taken the strongest type of personality to survive it.  The culture has changed in ways I can’t begin to imagine.  Yet med school is still one if not the most challenging thing I’ve done.  I am profoundly appreciative of the daily support I receive from my husband, my family, my friends and colleagues, faculty, physicians, mentors, staff, and countless other members of the community (like recently the baker at town hall coffee who cut up an apple for me because she was worried that I hadn’t eaten enough during a day’s worth of studying).  So, simply, thank you.  Thank you very much.

Just gave my last topic presentation at my peds outpatient site–pediatric conjunctivitis…give me a ring if you kid wakes up with his eyelids sealed shut and crusted over.

Now I’m in the library.  Compression stockings are on, belt is loosened (significantly), and I’m about to buy my second caffeinated drink of the day (don’t judge me, my kid’s nearly fully ripe).  2.5 more hours here, then I’m done for the day, and I’ll likely pass out as soon as I get home in the hopes of destroying tomorrow’s shelf exam.

In less than 20 hours, I’ll begin enjoying a more relaxing gestation.  I have LOVED peds, but I cannot wait!

Wish me luck!

I guess it wouldn’t be the full peds experience without catching something from the kiddos.  Well played, little ones, well played.  I feel like my head might just pop off my body, and I only have tylenol and tea as therapy.  In less than a month, I’m ordering sushi, downing a strong drink, and throwing back all the cold remedies I’m not allowed to have now…not all at the same time, don’t worry.

In similar news, I was examining a little tike with possible scabies last week.  As I was reassuring the mom that contracting scabies had nothing to do with her parenting and nothing to do with poor hygiene, her child jumped on my lap and proceeded to climb all over me.  When I got home, I bee-lined for the shower as soon as I dumped my laundry in the hottest water our machine could produce.  Let’s hope I don’t also find larvae nestled in my skin next week.

In the few minutes before this weekend’s prenatal yoga class got started, the moms-to-be were talking about what they and their partners were doing for Halloween costumes, how they were going to incorporate their bellies into something that was funny, cute, maybe a little crass without being overly offensive.  As I thought out-loud, “I really hope I don’t make it to Halloween,” (I would be at 42 weeks…pretty sure I would beg for induction sometime before then) I looked around the room.  I am, officially, the “most pregnant” woman in my yoga class.  What happened to all the 38- and 39-weekers who were kicking it this summer?  (Yes, of course they delivered by now…but weren’t there some others in-between?)

Either paraphrasing or directly quoting my friend Anne, when she came to a similar realization prior to the birth of her daughter: “Shit just got real.”

Oh hey, one of my favorite things about the middle picture is that it shows off the circulation in my forearms and hands.  Next time you see a woman in her third trimester, take a look at her hands–that’s a marker of the 50% increase in blood supply.  As John said when he was palpating the backside of my hand, “Dude, I could jam like 100 IVs in that vein.”  Thanks, babe, that’s only mildly terrifying…can’t you just hold my hand like a normal partner?

Thanks Ivor for being well read and knowing about stuff:

In a survey of 5704 physicians, pediatricians rated significantly higher than internists in job, career, and specialty satisfaction.  General pediatricians are more satisfied than all other physicians regarding their relationship with patients and personal time.  (Shugerman et al. in Pediatrics Vol. 108 No. 3)

And then, according to Dr. Callahan at CHOP, pediatric emergency medicine docs enjoy the highest satisfaction of all.

Boom!

Maybe my favorite class for my Masters was in the Law School: “Marriage, Culture, and the Imagination.”  My final paper argued something regarding the creation of marriage as a means for society to have some control over how we conceive and raise children.  Needless to say, I came away from the class with very conflicted feelings about the idea of marriage.

I still don’t have a true understanding of the institution; I doubt I ever will.  I never felt as though I chose to “get married”; I felt like I chose to be married to John–if that makes sense.  It felt right and good.  I wish that after three years I would have something a little more weighty to say, but the concept of marriage is still ethereal to me.

What I can say is that I love my husband, I love my marriage, truly, a little more each day.  Although we lived together beforehand, and had already loved each other through sickness, struggle, and massive amounts of debt, being married changed our relationship.  It’s a slip of paper, a written and verbal agreement in front of our family and friends, a recognition by the state of Virginia…a promise that we are partners, family to each other before any and all others.  And it makes a difference.

John, happy three years!  I have loved every minute.

Photos by the overwhelmingly talented and fabulously hilarious Julie Napear, taken during our engagement, at our wedding, and at the recent wedding of close friends/family.

One year and two years.

I equate the provision of the occasional cake for breakfast with good motherhood.  I’ve mentioned before that my mother was a terrific cook.  Her kitchen was quintessential healthy Mediterranean long before it became “a thing” (an almost fad diet) in the states, before Mireille Guiliano’s French Women Don’t Get Fat (the concept that someone would even write this book would probably elicit an eye-roll or several from the foreign-born matriarch of the house).  Everything in moderation…including moderation.  Which meant that we never denied ourselves our piece of chocolate, our glass of red wine, our parmigiano reggiano.  It also meant that for one day a year, on my birthday, I could eat cake for breakfast.  (During the rare moments when my mom actually felt the need to justify this parenting decision, she would state that her homemade cake was at least as healthy as the pop tarts with which other parents sent their kids to school.)

Well, Friday was not my birthday, but I indulged anyway…and I think my mom would have approved, as this gluten-free girl has gone without cake for the last several birthdays.  It was the day after another anatomy team-extended potluck, turned into informal baby shower.  We had the best feast.  Apparently, my friends were in cahoots with the hubby, asking him about dinner menu.  I can honestly say it was the best dinner I’ve had in months, and this has been a summer of fabulous eating: sparkling cider; caprese salad with extra basil; fennel and citrus salad; make-your-own personal gluten-free (with homemade cauliflower crust!) pizza; chocolate-covered raspberries and strawberries; best-of-summer fruit salad; soy vanilla ice cream; and flour-less chocolate almond cake.  Thank God the meal was plentiful and the cake was rich, so there were leftovers for me to sneak home to be consumed a mere seven hours later!  I just wish I had snapped pictures of this exceptional spread and the chefs that created it.

But I did get a picture of the baby-shower related game that, despite my concern for all things competitive (I get mean when I “play”), I actually enjoyed considerably.  Hint: it was very med-school-y, and it involved blindfolds:

Just stating the obvious: I love my friends.  Very, very much.

After three weeks of caring for some seriously sick kiddos, this past week of mostly well visits has been a welcome reprieve.  While I think I’m more of an inpatient kind of girl, a month of clinic every now and then, or an afternoon or two a week of outpatient is a sweet deal.

First of all, the schedule is simply lovely: arrive at the office at 8:30; take 30 minutes for lunch; leave by 5:30 at the latest…and that’s a busy day.  (This is definitely not to say that all outpatient pediatric experiences are like this…to the contrary, most attendings in private practice are feverishly swamped.  But, as a student, things are a lot cushier.)  As I enter my 35th week of pregnancy, I’m overwhelmingly appreciative of the extra time allotted for sleep and study–oh God, I’m horribly behind on studying.

Two: at a tertiary care center, it’s easy to forget that rare diseases are rare, that not every child has a catastrophic  illness or injury.  Not all children who have asthma have to be admitted to the pediatric intensive care unit for days in order to make sure they oxygenate their blood.  Not all children who have a fever have bacterial meningitis.  For me personally (and somewhat selfishly), it’s nice to be reminded that there are so many healthy, happy children out there.

Finally, outpatient peds is a fairly unique environment for providing true preventative care.  Parents love their children and, for the most part, they’re pretty amenable to changing behaviors, considering suggestions, and making some hard parenting decisions if it means their kids will be better off.  Sure, we’ve all seen parents who refuse to get their kids vaccinated, who could care less what and how much food their kids consume but, although they’re a loud minority, they still are very much the minority.  The challenge is much more a battle of resources.  It’s hard to argue with the fact that cheap foods are often not the healthy ones.  And it sucks when you and mom are in agreement that her child needs to get outside more for stimulation and exercise, but the neighborhood is far too dangerous to allow for it.  So, in the mean time, we have things like WIC to provide healthy supplemental foods, and Brighter Futures to provide (among other things) a book to take home for every child who comes in for a well child visit.  It’s something.

Oh, and this is funny: I think I’m starting to develop age preferences.  Right now, I’m totally digging 4-month-olds and teenagers.  4-month-olds will smile responsively and make all sort of fun vowel sounds.  Teenagers will, sometimes, talk shockingly openly about their sex lives and their completely untempered, borderline lofty life/career goals.  Love it.

I just finished my three weeks of inpatient pediatrics on the Heme/General Peds service at the Children’s Hospital of Philadelphia, affectionately called “CHOP.”  There’s just something about a children’s hospital…it does something to people.  John once remarked that even the assholes he knew peripherally during residency would morph into not only tolerable , but kind and accommodating people while on their peds rotation at Boston Children’s.  One of my senior residents, when describing her love of CHOP, commented that the attitude was even written into the HR agreements–all staff understand that it’s their duty, which they feel compelled to uphold, to be as generous to their patients and fellow workers as possible.  She sees it in the night janitorial staff, for example, who will often go out of their way if they notice something in a patient’s room that’s at all possibly disconcerting.

As a student, I’ve been blown away by the residents.  I can’t imagine how busy and stressed they must be.  Yet they are the only residents with whom I’ve worked who I have literally never heard complain or be negative, and they somehow still always find the time to go over presentations with me or provide me with teaching points.  They’re not saccharine, they’re just nice.  It’s part of the pediatrics culture, and it’s heavily engrained in the CHOP institution.  I would love to see how the HR contracts actually read, wondering if they’re anything to the effect of: “Thou shalt not be a pain in the ass, even if you’re on your 30th hour of call, have had children vomit and defecate over you, have had parents scream at you for keeping them waiting two minutes while you were saving someone’s life down the hall…all the while the pesky med student is perpetually asking ‘What can I do?  What can I do’  like an annoying chihuahua yapping at your heels.”

This is premature: I think I might want to be a pediatrician.