anna in med school

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…

I have my neuro shelf this Friday.  As I relearn the distinctions between the various kinds of hereditary ataxias (when one has a lack of coordination of voluntary movements), Brain and Behavior of med school year one feels like a very, very long way away.

I escaped for a few hours this afternoon to try to pound out some practice questions.  When I returned I could hear Ari crying from outside the house.  As I approached from the walkway, I heard Vovi say through the screen door, “Look!  Mommy’s here!”  And I bellowed back, “I’m coming, love!”  And there was silence.

When I got to the door and saw her through the screen, she looked at me with her saucer eyes, and immediately the corners of her mouth turned upward, and she sighed happily.  She rocked back and forth excitedly in my arms once I got a hold of her.  She cupped my cheeks with her little hands.

I think she genuinely loves her time at daycare and with Vovi.  I don’t think she misses me when I’m gone.  But I love that she still remembers me when I come back.

Already, much has changed from the original plan.  Due to a recent health scare, we weren’t sure that John’s grandparents (Avo and Vovi) would be able to help us out while I finished up clerkships.  So a few weeks ago I called the daycare in a panic, pleading that they squeeze Ari in two months earlier than anticipated.  As soon as the director heard “health,” she interrupted me, telling me that they would figure something out.  Really flippin’ fortunate, right?

Little did I know how lucky we would be.  After several reassuring tests and examinations, John’s grandmother seemed to be in the clear, for the most part!  And then she insisted on coming to stay with us.  We were hesitant, but thought we would try things out.  Not wanting to overwhelm her, we compromised: they would come to stay with us temporarily, but we would put Ari in daycare three times a week.

It has been an adjustment for all of us.  We’re four adults and a little one with exploding diapers living all together in a duplex with one small bathroom.  John’s grandparents are living far from everyone they know except us, and they don’t drive.  And our daycare, though wonderful (as I’m appreciating more and more after speaking with residents with kids), has hours (7am-6pm) that are not always conducive to the schedule of a physician and a med student.

Yesterday, for example: John was moonlighting out of town, so I was responsible for drop-off and pick-up.  I cleared it with my residents that I would arrive a bit late and leave a bit early.  Ari was one of two kids in the entire daycare when I dropped her off, and I was still 30 minutes behind even my predicted arrival time to clinic.  Then, on the way home, traffic was so congested, I frantically called my friend and neighbor Steffi, who piled her three-year-old daughter, her parents, and their two dogs (they were at the park at the time) in a car to go pick up a tuckered out Ari.  (It takes a village, right?)  How do residents do it?  Thank God I’m on neuro.

All that said, I honestly cannot remember a time I’ve been this happy.  I still cry most mornings as I walk to the train (Vovi says I have a heart “de pollo”), but I love being back in the hospital (at a children’s hospital no less!), and I look forward to the hour and a half I get with Ari when I get home.  And Vovi insists on making dinner for all of us–we are SO spoiled.  So today I got home at 6:30, immediately snatched up my daughter, threw on my pajamas, made myself a coffee, and enjoyed the last of the sunlight.  It’s heaven, albeit one in which the inhabiters are not-so-photogenic (at some point I’ll do something about her impending bowl cut).

Then again, as long as I have my boo and my babe, the site of Armageddon is also not such a bad place (more on Israel soon-ish!):

We all went wine and cheese tasting in the Golan.  It was an unexpected hit with the littlest.

In my first three days of neurology, I’ve attended a lecture and a morning conference on cognitive neuroscience; both talks focused primarily on how our brain encodes, stores, and retrieves memories.  The process varies by type of memory (short-term, long-term, procedural, etc.).  And then Megan sent me this article and, for the first time in a couple months, I’m wondering how our minds are so capable of forgetting the unpleasant.  My dad once told me that, when you’re sick you clearly remember what it feels like to be well, but when you’re well it’s immensely difficult to recall with any accuracy what it feels like to be sick.  Fascinating, right?

Part of why I chose to document Ari’s birth story was so that I wouldn’t forget the hard and yet, when I reread, I noticed some of the special bits I forgot–like when the pain was so bad that I kept trying to vomit.  A nurse pressed an emesis basin against my right cheek, and I kept pushing it away because the stimulation was too great.  I remember thinking that I would rather vomit all over my face, to the point of choking, than have any one or thing touch me.  I had forgotten this part.

I’ve had a number of friends ask me about whether I experienced any baby blues or postpartum depression.  While I’m not sure I did, there’s a memory I’ve managed to hang on to from the first two weeks.  When recalling, it almost feels like I’m playing a movie clip of a woman who’s not me.  John got home late from work, and I shoved Ari into his arms.  I retreated to the kitchen to throw onions and zucchini, the only food in the house, into a pan.  As John happily watched television with a now sleeping, peaceful Ari in his arms, I sat by myself at the kitchen table, engulfing my overcooked meal, choking between sobs, and watching my own tears fall into my plate.  It was so pathetic, but I truly cannot remember ever being so tired in my life.

I was fortunate to have a band of new moms not only warn me about the challenges but also emphasize that it does get better…and it did.  After Ari’s first uninterrupted night of sleep, the day after Christmas, I remember thinking, Okay, this is okay.  I can totally do this again.  Imagine that, one night of sleep and I was practically ready to get knocked up again.  Since then, literally every week feels better than the last.  For the first time in my adult life, I wish I could stretch time, make this time last longer.

Being away from her for 11-12 hours a day has been another new challenge.  Thank you so much for everyone who has reached out to remind me that this too will get better.  Right now I’m trying to soak up the 90 minutes I have with her at the end of the day.  Walking in the house at the end of the day, greeted by my happy, cuddly girl, is my new favorite.

Photos below from our long supper in Akko, Israel.  A few months ago, I could have never fathomed that she would have let us enjoy this relaxed kind of meal:

Our six days in Israel were some of the best vacation days I’ve ever had, but it feels good to be home.  Door-to-door, it took us roughly 27 hours to get home from Tel Aviv.  Ari was exceptional.  Traveling with her was challenging in the ways we expected it would be (everything took longer, it was hard to keep her entertained/well fed/slept, difficult to maneuver the inevitable mess we all made), but she was a trooper.  We had to laugh about how unsettling it must have been to be briskly scooped up from sleep at 4am and rushed out of the apartment in Tel Aviv while it was still dark: “Oh!  Hi mommy!  Wait, where are you taking me?  Food?  Dark?  What?  Just keep holding me…”

The night of our return was somewhat less successful.  I stayed up until almost 3am filling out forms and getting Ari’s things ready for daycare.  By the time I got in bed (oh, bed!), Ari decided she was still on Tel Aviv time.

A few hours later (yesterday morning), I started back on neuro.  It was hard to leave, but it felt right too.  Then I got a text from John: “Just dropped her off [at daycare], felt very odd,” and I burst into tears in the middle of our neuroanatomy lecture.  I held it together for another six hours, when I silently teared up while observing a small infant get a lumbar puncture.

Today will be better.

Oh my love…

…you make us smile so.  Happiest of birthdays!

(It’s only mildly creepy that we spent your 33rd birthday in Jerusalem.  Let’s not make a thing out of it.  Photos above from yesterday’s adventures in Caesarea.)

Last weekend, 11 of us (12 if counting the little one) gathered to celebrate the upcoming nuptials of four phenomenal women (one of which was there in spirit).  We rented a beach house in Ocean City.  Friends flew in Alaska and Palo Alto and drove in from Ithaca, Boston, NYC, Maryland, and Virginia.  We ate well, laughed without inhibition (except perhaps during nap times–my apologies), snuggled, and even took a run along the boardwalk.  Oh, and we made a makeshift crib out of some beach-y play-pen material, a twin sheet, and duct tape.

We did it!  We made it to Israel with minimal drama.  So far, the Dulles, Charles de Gaulle, and Ben Gurion international airports, Old Jaffa, and lobby of Lauren and Alon’s apartment in Tel Aviv were big Ari hits–SO many bright lights and interesting sounds!

By the end, I was sporting some multi-colored vomit (Ari discovered fruit-flavored yogurt pre-trip) and John was rocking the poop stains (someone might of pooped herself right at the beginning of the descent).  We were all a little annoyed at the woman next to us who would abandon her child to stretch out and sleep a few rows back, and we were in awe at some of the families we saw traveling with 7+ kids under 10.

If you’re planning international travel with an infant, we’re big fans of visiting friends who have children and, therefore, gear!  (Lauren and Alon’s tremendous patience and sense of humor help too!)  It was a wonderful, wonderful thing to not have to worry about sleeping accommodations or strollers–hell, they even rented me a breast pump from the hospital!  Now that’s friendship!