James & Dave

Despite the fullness of my schedule with all that is residency, the time set aside for two non-medical, yet equally educational, studies has been so amazing in the past couple of months.  It's incredible how much of an impact a few hours a week can have.  When my eyes open in the morning my mind begins to ruminate on what I'm learning in these groups, and it can't help but spill out into the rest of my day.  I know the intent of any study is to learn something new and hopefully to have a lasting impact, but it is so beautiful when it works.  As I'm in clinic, driving around, delivering babies, or making supper little one-liners pop into my head and once in a while even fall out of my tongue.  "Don't show favortism" even when it's an uninsured, city-call patient.  "What would Dave say if you went out to eat... again?"  I'm so excited to share what I'm learning.

The first is a financial study Jason and I are going through with group of a few other young couples we've been getting together with on Sunday nights.  It. Is. Good!  If you're interested it is called Financial Peace University (or call it "FPU" if you want to sound cool) by the blunt Dave Ramsey.  Jason and I have always been in agreement to be "responsible" with our money, and we've listened to Dave on his radio show for years.  However, this has forced us to take it to the next level, fight about where each dollar is going, and, literally, put our money where our mouth is when it comes to our goals and priorities.  If tithing is a priority, how did we "forget" last month?  If being debt free is more important than a tan, why are we planning a cruise?  It's like exercise: time-consuming, uncomfortable, and slow; but worth it.

The other is a group of women I'm starting to meet on Monday nights for Bible study.  Right now we are going through the book of James (as taught by Beth Moore).  If you think Dave Ramsey is blunt, to the point, and in your face, put on your thick skin for James!  I'm being rocked by his teachings, but I'm also remembering how cool this whole entire book is!  Genesis to Revelation.  It has given me boat load of humility (which I need), but also a renewed awe and hunger for real wisdom.  It's that wierd paradigm in which you fill a void, but at the same time realize that the void is bigger than you thought.  One answer leads to ten more questions.  Like when I eat ice-cream it makes me want to eat more ice-cream.  I get full and more hungry at the same time.

Now that I'm off topic and craving chocolate chip cookie dough, my point was going to be to introduce you to my two new friends: James and Dave.

How I Do It

Easily, the question I am most often asked is: "How do you do it, Susan?"  I usually have a less than adequate answer such as "I don't know, I just do."  I know that's not the thoughtful answer they might have been expecting, but the other answer is long and complicated and most of the time I don't even know.  Also, the truth is, that even though I do it (whatever it is), I don't always do it well.  This morning, however, I feel like all the balls in the juggling act of my life are still in the air so it's as good of a time to figure out an answer.  Without further procrastination, here are a few pieces of my strategy.

#1.  Have a plan.  Some people would call this discipline.  Others would call it being anal.  Regardless, I find the only way for me to get things done is to map it out.  I live and breath by my calendar.  Actually, my calendars.  I know where I'm going and where I need to be.  I used to know what we were going to eat for the week, now we know what we're going to eat for the whole month.  So much time is saved when all I have to do is look at the menu hanging on the refrigerator door and say, "Jambalaya tonight," instead of hum-and-hawing in front of an empty fridge for 15 minutes, then opting to eat out which takes another 30 minutes to decide, 10 minutes to drive there, and over an hour later to enjoy.  Thanks to Dave Ramsey, we also have planned out how we are going to spend every cent for the rest of the month, too.  In my opinion having a plan is freeing.

#2.  Accept help.  This was (honestly, still is) a difficult pill for me to swallow.  If you haven't gotten the picture that I tend to enjoy being in control just reread #1.  However, there is 0% chance I could be where I am, or do what I do, without the army around me.  Right now, streaming through my mind like a slide show are the faces of people who make my life possible.  From the nurses at work to my better half at home they are the reason I can get out of bed in the morning.  Even right now, my mom has my sick little boys for the morning so I could get some things done.  (I'm not sure blogging was what she had in mind.)  But truthfully, this should be bold and in 72-point font because it is that big of a necessity!

#3.  Prioritize.  There is a list of "correct" priorities I could spout off, and then there's the list of "true" priorities obvious by the choices I make every day.  What do I spend my time on?  Where does my money go?  What do I think about?  This is where the rubber meets the road.  This is where I admittedly fail over and over again.  I'm finally back in Bible study and am realizing how starved for it I've been.  My job already consumes most of me, and forcing myself to say "no" to the extra stuff is painful but oh-so needed.  Thankfully, it's getting easier for me to turn the t.v. off, but that hasn't always been the case.  And trying not to replace it with the computer takes some heavy duty conscious effort.  Also, there are still things on my list that haven't made it into the game yet (exercising being one).  Therefore, I still have a lot of work to do, and accountability to have.

#4.  The big picture.  It's no mistake that God has me reading the book of James at the moment.  He reminds me that my life is a mist.  A vapor.  Here today, gone tomorrow.  I can plan, prioritize, and do all I want only if it's His will.  Ouch.  Feel the sting.  I'm not in control, and thankfully, I'm not.  He is.  I get up in the morning thankful for the blessings I have and content that I'm a very small piece of a much bigger plan.

Well, maybe that answers the question a little better than "I don't know" although I feel like it still isn't adequate.  In summary, as Paul says, "I have learned [or, in my case, am learning] to be content whatever the circumstance... I can do everything through him who gives me strength [and who gives me two of the sweetest little boys, too!]"

Job Hunted

Oh man.  Where should we start.  It feels like I'm sitting down for coffee with an old friend who I haven't seen in far too long.  There are a thousand things to say, but it's so jumbled in my brain I don't even know if I can put together an intelligent sentence. 

And although, I could pick any one of those thousand things to talk about, I guess I'll start with what is arguably the biggest.  The elephant in the room.  The thing that keeps me up at night and distracted during the day.  That pesky thing is that I've started the daunting task of... job hunting!  Gasp.  That sounds so professional and so strange coming out of this mouth that has been a student for the last 24 years.  It's scary crazy to be job hunting.  Although, truthfully, "hunting" really isn't the right word anyway.  I, actually, kind of have felt like the prey.

Primary care doctors are such an endangered species, that it puts me in a strange, kind of awkward, situation.  I almost would prefer to be in competition.  At least then, I would know who really wants to hire me.  Me for me.  Not just because I'm a body with an M.D. who can fill their desperately empty hole.  Me because I'm the best out there, not because I'm the only thing they can get.  I want to feel chosen.  Selected.  Desired.  I remember the feeling of getting the internship in high school, the scholarships in college, the acceptance letter for medical school, and the phone call from Dr. O'Dell for the Primary Care program.  It felt good.  Good to be selected, and good to have someone else make the decision whether or not I'm in.

Now I'm the one making the call. Am I in, or am I not in. And, for someone as indecisive as me, it's painful.  So much is weighing into this decision.  Of course there are the professional factors.  Can I do OB? Do I have to cover the ER?  How nice is the hospital?  How bad is the medical community's drama?  Blah, blah, blah...  Then there are the community things.  Where would be go to church?  What could we do for fun?  Etc... And obviously the family stuff is a big deal.  Could Jason get a job?  How are the schools for the boys?  How far is it from our extended family?  My analytical mind wants to know all of the details and then create a spreadsheet or formula or something that would ensure that I make the "correct" decision.  (If you thinks that's ridiculous or an exaggeration, please ignore the fact that I had a score sheet between Grand Island, Kearney, and Scottsbluff when we were deciding on my residency.)

Right now our serious considerations are between Kearney and Grand Island.  I'm meeting with the clinic in Kearney in a few weeks, so we'll see how that goes, and my thoughts on Grand Island change as fast as the weather does.  Central City has been in contact, but Jason hasn't been too impressed so that's probably out.  We've also thought about something a little closer to Omaha, so nothing is off of the table yet.

I'm not done with residency until July 2013, so there clearly isn't a rush.  But if I'm this anxious now, I sure hope I have something figured out by then.  I'll keep you posted.

Hot Tamales

Even though my taste buds were expecting something even a little more delicious, my heart sure did enjoy itself some homemade tamales last night. 

The little creations were a gift from a patient who I met during one of my first shifts in the ER here in Grand Island and who I've been able to follow in clinic over the last few months.  I've been able to get to know her, her grandson, and their story in a matter of about 15 minutes every month.  Despite different languages, ages, nationalities, socioeconomic statuses,  etc... we've kind of bonded.  Maybe it's because we're both women or mothers, or maybe because we both like to eat (and despite that, we've still been able to cut her A1C in half!).  Regardless, I would almost say we're friends.  But now one of my first Grand Island patients is moving away.  Hopefully, she's leaving healthier and better educated about her disease.  And I'm staying here with a warm heart and a full stomach.

(And on a 100% totally different topic... why are all of these horrible cruise ship stories happening when we are trying to plan our first cruise ever for this summer?  Is this a sign?  Maybe God, like Jason, wants us to go on the Lewis and Clark historical tour instead after all.)

Tidbits

It isn't for a lack of things to write about, it's more because of a lack of time to write about such things.  And then, once I get behind on sharing all of my happenings, I don't know where to start.  Now, however, I have a brief, free, quiet lunch hour with  just me and the computer.  So, here's a couple of quick tidbits of the last few weeks.  You'll have to bug me later if you want all the details, because I'd love to share when there's a little more time.

• AEDs work in real life like they do during ACLS training.
• We waited 7 years to see Blue Man group, and got to do it on someone else's dime.  (Thanks Family Practice of G.I.!)
• I'm glad that cardiac stress tests can be normal and reassuring.
• Pink eye has almost run its course.
• To my surprise Griffin didn't pee on the ultrasound tech.  (But not surprised that we'll probably be talking about surgery when we meet with the Urologists at UNMC next month.)
• We've almost met our health insurance deductible already.  Yep, it's only January.
• Jason was in a rare, 1-hour, "shopping mood" last week.
• I found a Beth Moore study again.  Yeah!!  So excited.
• The passenger side door on the Buick is fixed.
• Owen pooped on the potty... only once... and he peed all over the floor and on my leg before that.
• I still love holding up a wet, bloody, vernix-y, wrinkly, freshly born baby and saying "Congratulations!"
• Now, I'm off to clinic.
 

It Poured

The saying goes: "When it rains, it pours."  And it was Pouring last week - with a capital P.

Sunday.  Our punishment for having fun on New Year's eve and not putting the boys to bed at their usual bedtime - or even within a few hours of their usual bedtime.

Monday.  The Huskers "played."  (I actually picked them to lose in the bowl pool, so I guess it wasn't all bad.  Especially considering I'm cleaning house in that bowl pool.  #1, baby!  And, not too rub salt in his wounds, but guess who's at the bottom of the boards... hee, hee <insert evil laugh>.)  

Tuesday.  You heard all about that already, and Griffin's doing just fine now if you're wondering.  I didn't get to post this picture before because it was on Jason's phone, but now I just can't resist.

(That's an IV in his head, and half of a cup decorated with a Thomas
the train sticker covering it to protect it from curious fingers.)

Wednesday.  Home with a sick baby.  6 months to go, and already almost out of sick days.

Thursday.  Be ready.  Here's the kicker.  I was minding my own business at OB clinic when my phone buzzed Thursday morning.  I usually don't hear my phone in the middle of the day, and if I do, I don't usually answer it.  But for some reason, my curiosity with this unknown number got to me, and I answered it.  It was my bank.  My bank? "Are you missing your debit card?"  Crap!  I've haven't been able to find my wallet since before Christmas.  I thought, for sure, it was at the bottom of Owen's toy box, or under the bed, or in a purse, or buried in our junk drawer, or tucked up under the seat in the car.  I just didn't bother to look too hard for it because I knew if I couldn't find it then, I would panic.  Guess I should have been panicking.  "An officer from the Hastings police department called and reported that he found your card in someone else's possession this morning," the banker informed me.  Double Crap!!  That yucky, violated, angry, embarrassed, sick feeling filled my stomach.  Argh.  To make a long story short, it could have been a lot worse.  It took all of a few minutes to freeze all of my bank accounts and credit reports.  Then it took a few hours to file the police report.  So far, our bank accounts and my credit report seem intact.  My eye will be on it closely to keep it that way.  All it all it was another hit to my pride, already aching from Tuesday, and another terrible event in an already terrible week.

Friday.  4:20-AM C-section to start the day.

Saturday.  All day I felt like the weather.  Not hot.  Not cold.  No rain.  No sun.  Just cloudy and dreary.

Sunday.  Today.  Thankfully, I've made it through today unscathed... so far.  Hopefully, this is the start to a much better week.

On the Other Side of the ER

The proof that this blog has been neglected lately is that I didn't even realize it had been briefly hijacked by my husband until yesterday.  I guess that's what happens during the busy holiday season, and thankfully, Jason did a great job in my absence.

Fortunately, and unfortunately, I have some extra time today to write because of a sick baby.  Trust me, it is not fun when my roles of mom and doctor collide - when I'm torn between researching differential diagnoses for a bulging fontanelle versus just rocking the crying baby to whom that fontanelle belongs.

Yesterday, I found myself in that terrible crossroads.  My phone beeped with a voice mail from daycare in the middle of my afternoon clinic.  Griffin had a fever and needed to be picked up.  Sure enough, a fever of 103.  Jason hated to leave his day of exciting meetings (*wink, wink*), but agreed to come home early under the circumstances.

A dose of Tylenol, his humidifier, and some good rest was what I figured my little G needed.  I peeked in on him after dinner as he was whimpering away in his crib with his big, puffy, tired, red eyes.  In an effort to console him I rubbed my hand over his bald head.  It was hot.  As hot as Jason's new chimenea in the backyard, which, at that moment, was burning the box it came in - styrofoam and all.  But, not only was my hand met with the warmth of his fever, it also found a thumping, tense, bulge in place of the soft spot on his shiny pale dome.  As many times as I felt this place as I've picked at his cradle cap or as I've dreamed of the long locks that will surely be growing in, it had never felt like this. 

Doctor mode kicked in.  Mom mode kicked out.  High fever plus bulging fontanelle equals meningitis.  Meningitis equals spinal tap and IV antibiotics.  Spinal tap and IV antibiotics equals a trip to the ER.  But, wait, I've seen kids in the hospital with meningitis before, and they acted a lot sicker than Griffin.  He was still eating, sleeping, peeing, and even cracking a smile in the right moments.  Meningitis? 

Still, I couldn't shake it.  Should I be a bad mom and keep my baby at home with a possible serious infection, or should I be a pathetic doctor and take my own baby to clog up the ER with a virus?  I debated.  I rubbed his head to double, triple, quadruple, 54-ple check that I wasn't making it up.  Before committing a blow to my pride by showing my face in the ER where I worked on the other side of the counter just a matter of weeks ago, and before committing our budget to the blow of an over-priced ER bill (because we DO have insurance), I wanted someone else to tell me I wasn't crazy.  After a few unanswered calls followed by a few returned calls, I had my reassurance and we headed to the ER. 

Honestly, it was weird and uncomfortable to be on the other end of things.  Do I use medical lingo?  Do I look at the monitors or ask about his lab values?  Do I calculate his IV fluid rate?  Do I ask for the T-sheet and fill it out myself?  Ugh, it was awkward.  It was even more awkward when Griffin flashed his big smile at everyone who walked in the room.  Couldn't he at least put on his whimpering, sick face instead of his completely healthy one.  Where did his puffy eyes go?  However, shortly thereafter, they found his temperature to be back at 102.7, and they were in agreement that the bulge on his head was not normal.

It was every one's favorite time in the ER - shift change, so we were told that the doctor taking over would be in to likely do the spinal tap and we would be moving up from the back rooms to one closer to the front.  (Secretly, even though I didn't want G to be sick and I could think of a thousand other places I'd rather be, I was glad that it wasn't just a "It's a virus.  Go home, and call your doctor in the morning" ER visit.)

Then, a dose of Motrin (which I hesitated to give him at home as he's just shy of the magic 6 month mark) was followed by two hours of needle pokes, IV starts, blood cultures, catheters, a fluid bolus, lots of pacifiers dunked in Sweeties, and a chest X-ray.  It was amazing what two hours (or that dose of Motrin) can do.  The heat radiating off his powdery skin had cooled, and his fontanelle was softening up and looking more like the plains of Nebraska and less like the mountains of Colorado.  We discussed the options of continuing with spinal tap, giving a shot of antibiotics, or just watching now that things looked less serious.  I was happy to forgo another needle, and it wasn't too much longer and we were out the door and back in our living room.

It's done.  He's better.  My lesson's learned.  No regrets.  (At least until we get the bill.)