hot topics.

I didn’t understand what it was for the longest time. I think I first heard the term in 7th grade. We were required to write “topic reports” on some current event in the world, something every seventh grade sociology class makes students crank out. On this particular day, I was waiting in line to talk with the teacher & get the “stamp of approval” on my chosen topic (of which I can’t seem to remember). The girl in front of me got a stern look from the teacher and was asked “Are you SURE you want to cover that topic?” She shot back with a confident answer about how the youth in Asia were so important to her & she’d had exposure to them. She just seemed really passionate about her chosen topic.

Hmm. Weird, I remember thinking. Why is she *so* interested in kids in Asia? I mean, I hear they have dirty water & stuff but so do kids in Africa…why Asia?

It wasn’t until a few YEARS later when I reflected on my witnessed conversation that I realized she wasn’t talking about youth in Asia, her chosen topic was EUTHANASIA. Chalk up one blonde moment for me.

And today I remembered that same seventh grade conversation again. I just started my geriatrics rotation—which is actually much different than I envisioned. I’m a bit of a guinea pig for a “newly established” rotation curriculum (if you can call it that) through the hopsital I'm working with. And because of some scheduling conflicts, I’m working with a case manager at the hospital this week instead of an attending physician.

I was pleased to find out that she is a lovely woman who is quite passionate about her job—not to mention fantastically good at it. And it is actually a breath of fresh air to witness the goings-on behind the scenes of physician orders & patient medical management. A bit of a reassurance, I guess, knowing that I wouldn’t want her job—not to mention the fact that I desperately missed using my stethoscope today (although my back thanked me for the relief from my 10 pound white coat stuffed with instruments & books).

So back to Youth in Asia—err, Euthanasia. Also known as Physician Assisted Suicide, I noticed on my last absentee ballot that it was on the table for passing in Washington State. It is legalized in Oregon & an up-and-coming “hot topic” in many other state legislatures.

To be honest, I’ve tried to avoid the topic altogether thus far in my life, having only vague opinions about the subject—most of which are driven by my faith & the set of morals I’ve established based on that faith. But like many other “hot topics”, my personal opinion is constantly in flux, constantly being molded by the patients I meet, the stories I hear, and the suffering I witness in medicine. And truly, Euthanasia is just a jumping-off-point…there are so many other topics that center around death & dying, palliative care medicine, hospice houses, and other end-of-life issues.

Our culture shies away from death, as if it is some disease to be caught, some preventable & entirely undesirable end effect that the magic of medicine can save us from. But the miracles of modern medicine simply prolong the inevitable—sometimes improving the quality of life, sometimes giving many more decades of memories to families who would have otherwise missed out, and sometimes turning a quickly fatal disease into a process of protracted suffering. What most people don’t realize is that our approach to death is actually a direct reflection of our approach to life.

We discovered that most people meet death as they met life:

some head on, some with denial, & some with passivity.

There is a “death style” as well as a “life style”.

How we die will be an expression of how we have wanted to live,

& the meaning we find in our dying is likely to be

at one with the meaning we have found in our living…

[A] person who has learned how to let life go

may have not only a richer & more flexible life,

but also one that better prepared him for his decline.

–David Callahan

Although I’ve personally been exposed to what I would consider a fair amount of death, some accompanied by irretractable pain & suffering, I’ll be honest in admitting that I’ve shied away from accepting my own death. My faith tells me to embrace it, but I’ve become rather complacent about the whole ‘experience’—perhaps not willing to let go of my life as it stands right now.

And so, I think this rotation will be especially good for me. I’ll share the stories of the patients I come into contact with, those suffering, those hopeful, & those who are excited to meet Jesus. And in the meantime, I’m hoping to get a better grasp on issues that will be important for my future in medicine, issues like euthanasia, advanced directives, DNR’s, & palliative medicine….

And I’m hoping you’ll think a little more about them too...

goodbye's are the hardest.

goodbye's are always the hardest. i used to be good at them. i used to hold in my tears, mask my sadness, and move on. perhaps it was because of the constant transition i experienced in childhood, travelling from one home to another at least twice each month; transitioning from one extreme to the other, mom's house to dad's house, the city to the country.

i used to joke about how "some day" we just knew it would make me stronger. because as a young teen, there were so many times i just cried. cried that no one else could understand how i felt. cried because i felt so alone, so prematurely independent. and cried, because i couldn't fathom stability in my constantly changing environment.

but that "someday" is here. and i can't help but smile looking back at God's provision. i don't think that today's transitions would be nearly as easy, as smooth, and as hope-filled had i not been in that valley so many years ago. it is so clear now that hindsight is always 20/20--that God really is in control of all things, no matter how dark the night may seem. and often times, He provides little "treats" , of unexpected time together, an extra $20 for a date, unexpected gas money, or an injection of grace that make my heart flutter with gratitude.

i've been thinking a lot lately about the past two years. i told my mom on friday that i couldn't fathom doing it all over again...and i am so grateful that i don't have to. life right now seems crazy and i'm longing for the days when jon & i won't have to be on the lookout for yet another separation...but in the meantime, God is filling my gratitude cup...

*gas prices have gone down here, making my weekend drives of 4 hours one-way much more affordable :)
*i've found myself happily occupying my time with what we have already instead of wishing for things to jump into my shopping cart
*my geriatrics rotation scheduling was messed up by my school, giving me a 3-day-weekend this weekend!! (which equates to one extra day with jon!)
*God is slowly but surely calming my heart about the upcoming year...and each day i'm reminded that this life is less about me & more about His Glory
*our friendship with one another is the strongest it has ever been :)
*i'm looking forward to the next year & am setting goals for myself for when jon is away...

there are so many more things to be grateful for :) i bought the book i mentioned last week--and it really is a great reminder that this country was founded on humility & faith. i'm hoping our thanksgiving season is full of the same.

sugar cookies.

i don't like crunchy cookies. not at all. my grandpa did, & i'd bring him batches of cookies that i had burned--err, purposely made crispy for him. but not me. and so you can imagine my joy when we came upon this oh-so-soft sugar cookie recipe. a recipe so yummy i honestly couldn't believe that they came from our kitchen & not one of those little pre-made-pop-in-the-oven packages.

Soft Sugar Cookies

1/3 cup butter or margarine

1/3 cup shortening

3/4 cup sugar

1 teaspoon baking powder

1 egg

1 teaspoon vanilla extract

2 cups all-purpose flour

preheat oven to 375. Beat butter & shortening on medium-high for 30 seconds. Add sugar, baking powder, & dash of salt. Beat until combined, scraping bowl. Beat in egg & vanilla. Beat in as much of the flour as you can with the mixer. Sir in remaining flour. Divide dough in half. If necessary, cover & chill dough for 3 hours or until easy to handle (we didn't...they turned out fine).

roll 'em out on floured surface.

bake for 7-10 minutes or until edges are firm & bottoms lightly browned.

a princeth.

"i hear there is a princess in here that has been injured!!"

"yeth. that'th me!!"

raising her hand above her blonde hair blue-eyed face

"well what happened, princess?"

"i th-tuck my princeth wand in my eye."

"what?? why did you do that?"

"becauth."

"does it hurt?"

"yeth. juth a yittle bit...when i b-yink"

"well lets look at it..."

"hehe...it'th puypule."

"yes i can see that...you're whole eye is purple!"

[mom nudges me...'purple is her favorite color']

patient advice.

she was 92. admitted for high blood pressure. she sat happily munching on her pancakes & syrup, savoring every sugary bite. had it not been for her gray hair swept up in a bun on top of her head and her wrinkled sun-kissed skin, i might have mistaken her 4'9" frame for that of a 10 year old--she was just so intent on those pancakes.

i had to wait until she finished...she refused to let me take the tray from her before she was through. and so i waited. and in the meantime i asked her what her secret was--to living to the ripe young age of 92, keeping the heart of a child, the health of a 20-year-old, and a mind as sharp as a tac.

"eat a good breakfast",

she said.

that is it? that's all? are you sure?

i responded.

"oh yes",

she replied,

"and never stop doing what you love."

MORE than enough.

i had a good day. a really good day. i bounced out of the office today at 4:59pm, relishing in the joy that those little snotty noses & smiley faces brought. i held babies. i got hugs from little princesses. i talked "Wall-E" with a four year old. i found monster trucks inside rib cages. and i went on treasure hunts for belly buttons.

the innocence of it all is almost overwhelming. and i love it. i think i could do this for the rest of my life...i *really* think i could do this everyday and still love it after 30 years.

and yet, i'm acutely aware of the tradgedy, heartache, and alienation some of these kids feel. because guess what? sometimes i feel it too. and sometimes life seems too unfair to be driven by God. seems too unkind to be guided by the hand of a Lover. and too cold to be held close to the heart of the One who died for me.

but then, on days like today, i remember that despite the circumstances that may swirl around the billions of people on this planet, they are here...alive. and then, on days like today, i feel more than grateful that life itself is MORE than enough.

read this....you'll feel it too.

pumpkin.

dear starbucks,

my hips just wanted to thank you for bringing back my favorite drink of all time. it will go down in history as "the one" that grew my pantsize into the double digits, "the one" who slowed me down on the treadmill at the gym, and "the one" at the forefront of my mind at the beginning of each day during the fall season.

i'm wondering if you might consider selling a packet of "weight redistribution" next year alongside this yummy beverage--i'd like some of the blubber i'm gaining on my rump to travel a little northward, if you know what i mean.

i'll have you know that i've been a faithful customer this month--and last, too, since you publicized those small cups of lust you call Pumpkin Spice latte's. i've downed four of them in total, with plans for many more in the upcoming weeks...at least until you bring eggnog latte's back. at which point i will write you again thanking you for blubberizing my body for winter.

sincerely,

your almost-too-faithful-pumpkin spice latte-customer

shaken.

I knew I’d see tragedy at some point during this pediatrics rotation. The innocence that smiles back at me each day combined with the many evils of this fallen world make for some predictability in the destruction of livelihood experienced by some of this world’s youngest.

It is hard to imagine such destruction here. In this country, full of medical technology and a justice system that although somewhat flawed keeps most child predators behind bars. But the destruction exits. And about a week ago, its hard-knock evidence walked right into my exam room.

My preceptor warned me before I went into the room. But I wasn’t prepared for what I was about to see. How could I be? My mind couldn’t fathom the actions taken against an innocent child by a grown, supposedly-loving parent.

He was just over 6 weeks old. The grandmother held him close, protected from the critical eyes of the world by a blue polka dot blanket. I noticed on his chart that he was well underweight for an infant of his age. He didn’t cry. Didn’t grunt. And in fact, had it been on a busy street instead of in a pediatrician’s office, I might have guessed Grandma was holding a doll.

But she certainly was not.

I asked her to put him on the orange exam table so I could better look at him. And as soon as his head popped out of the polka dotted blanket, I knew that this child was different. Not born different; born quite perfect, in fact. A premature entrance into the world by about 2 weeks, his lungs first inflated when he was just over six pounds. His head was speckled with chestnut colored hair, APGAR scores were above 8; just a short stint in the nursery brought him into the arms of his parents at home.

Most babies are loved from the minute they take their first breath; I’ll be bold enough to assume this innocent little boy was as well. Most are doted over, caressed, and comforted; and the fortunate ones are kept clean, warm, and well fed. I can’t imagine life with a newborn—but when the time finally rounds the bend for us, I’m not expecting it to be a walk in the park. Parents have every right to get frustrated, exhausted, and overwhelmed.

Which, for as much as I can assume, his parents did. But someone, one of the ones that was supposed to be doting and loving and care-giving, crossed a line. Something must have snapped. And it only took three seconds to change this child’s life forever.

He lay restless on the exam table. His unfocused “doll eyes” rolled backwards as I tried to get him to follow my dark figure against the bright light. The beginnings of hydrocephalus were evident from his very large, overly rounded head. Reflexes hypertonic. Neck flaccid. Abdomen protuberant. At over 6 weeks of age, he was the size of a small newborn. He didn’t exhibit the typical suckling reflex, nor did he turn his head toward stimulus. On the orange exam table that seem to envelop him in a color too bright for the dreary world he would live in, he seemed as small as a child’s teddybear. And as he lay there, flaccid & non-responsive, I couldn’t help but think about how he might have been just a few weeks earlier—the happy, normally developing baby he was discharged from the hospital as.

He was shaken. At just a few weeks of age, someone close to him stole his ability to develop as a normal child—stole his ability to see, eat normally, control defecation. He suffered numerous seizures, one lasting over 20 minutes. There were 6 spots in his brain that showed active bleeds on the CT scan. And even a few weeks after the incident, rib fractures were still detected on chest xray.

Shaken Baby Syndrome is something I’m only supposed to read about in textbooks. The retinal detachment. Increased seizure activity. Whiplash. Hypertonicity. Poor feeding habits. Altered growth patterns. It is something that only happens to the “worst” babies, right? Something that doesn’t happen in my neighborhood, to the children born healthy with full potential to someday change the world?

But the little boy that lay before me had taken the brunt of the world’s tendency toward evil. And even in five years, he will likely still have the developmental level of a 9 month old—if that. And in ten years, he will still be wearing diapers and eating pureed food from the hand of someone who will hopefully love him.

Despite the tradgedy that literally rocked his world, I have to remember that jesus loves him. That God has a plan for his life. And that He still works miracles. This little boy will likely never speak full sentences and the chances of him walking unassisted are slim. But in a world strewn with misfits and sinners, his physical limitations will forever be a reminder that this Earth is not our home. The braces that may someday encompass his legs will be cast off. The blurred vision will someday become clear. And the broken & betrayed heart will someday again be made whole.

Just wait, little child, just wait.

holiday bustle.

i can't believe it is october. and i really can't believe we are almost halfway through the month. where did the time go? and WHAT IN THE WORLD have i been doing??


i'll readily admit that i'm the type that likes to dream-up big plans for the holidays. maybe i watched too much of Tiny Tim's family as a child--all huddled around a humble Christmas table, their family unity prevailing over the excessively commercialized holiday season. and in the midst of all my dreaming, i seem to have lost track of time. because wow, i checked the calendar this morning while i was writing in patient's charts and would you believe that it is the MIDDLE of october?


i have christmas gifts to make. and things to organize. and presents to buy. and things to wrap (well, actually, jon does the wrapping because my present-wrapping skills resemble that of a preschooler). and cookies to bake. and recipes to try. and...and...and...


isn't it amazing that already i'm getting overwhelmed by the amount of "work" (which i really thrive in) that the holiday season involuntarily brings? and yet, i'm finding that as time goes on, my heart longs for a holiday that is more raw...more native...more Christ-centered.


i heard about this book last year. and i still need to order it. because, quite frankly, it may be a nice reminder of what the true Thanksgiving holiday is about. the lavish spread we feast on each year hasn't always been the tradition. and i think this book will be just the reminder we need about humility, a hearts true thankfulness, and the overflowing storehouse of gifts God has poured out on this country.

and then just today i found this new thanksgiving tradition. and although jon & i don't have children yet (give us a few years, mom), i think the year-round reminders to be thankful may elevate our awareness of just how blessed we really are.

so i'm going to try my best to approach this holiday season with a calm, and ever-so-grateful heart. with the love of family & friends, an incredible relationship with my husband, and the immense magnitude of God's grace & forgiveness in my life...there is still a bounty left to be thankful for.

i think i'll start tonight :)

twins.

Born twins, they’d developed to be to very independent individuals. One had been sick earlier in the week & was visiting the office again with his brother, now much bigger than him.

He recognized me right away, as did his mom, & I was greeted kindly at the door.

His twin brother, I was informed immediately, was autistic. The mom warned me that chances were slim I would get a good exam on him, given his behavioral apprehension toward strangers.

So with solid reassurance from his much-smaller twin brother, I approached him gently. And as we looked for green monsters in his ears and listened for Thomas the Tank Engine in his chest, he relaxed. Totally relaxed. I let him listen to his heart. He got ahold of my otoscope and took advantage of the chance to shine something very bright directly into his brothers eyeballs.

We had fun. He said two words to me the whole time and otherwise used nonverbal signals to communicate. It was obvious he was on the higher end of the autism spectrum in functioning.

And he was sick. And I left the room to get my preceptor so she could confirm my findings.

When she finished her exam, she left the door open to the room. And no sooner than her and my feet left the room, our little nonverbal patient jumped off the examining table and ran to the door frame. He opened his arms as wide as the would spread, looked directly at me, and screamed,

“I LOVE YOU!!”

The shock on his mom’s face was priceless. And my heart melted and splattered all over the ground, right then and there.

No doubt that right behind him was his now-fully-recovered twin brother whom I’d seen earlier in the week, yelling the exact same thing.

Needless to say, they made my day.

daily {pixels}

if i ever live in chicago, this photographer is SO getting my business. in fact, if i owned my own jet, i'd just fly to chicago and have her take pictures of my now-non-existent children. or my toes, whichever seemed more reasonable on that particular day.

i'd like to know what she does to those eyes...they are all natural (or so she says). :)

a seed of fear.

For the time being, it’s almost more than I can bear. I’m a planner—I think that is well established by now. And I’m a worry-er—also well established. And being both of the above makes me embarrassingly needy at times, filling my head with nightmare-ish thoughts and plunging me into a spinning pool of “what ifs”.

And I’m here. I’ve been plunged. My head is spinning. My heart is needy. And my calendar needs to be filled in for July 2010.

But it’s in the patience that character is developed, or so I’m told. And it’s in the waiting that the heart grows fonder. And it’s in the downs when we appreciate the ups, in the cold of winter when we most recognize the value of the sun’s warmth. And in the depths of the unknown lies the yet undiscovered comfort of the Lord’s embrace.

Great acts of faith are seldom born out of calm calculation.

It wasn’t logic that caused Moses to raise his staff on the bank of the Red Sea…

And it wasn’t a confident committee that prayed in a small room in Jerusalem

for Peter’s release from prison.

It was a fearful, desparate, bank of backed-into-a-corner believers.

It was a church with no options…

And never were they stronger.

At the beginning of every act of faith,

there is often a seed of fear.

–Max Lucado

best reason for hospital visit

What brought you into the hospital today?

"Bipolar.

My teeth.

And I was murdered yesterday...."

- patient admitted to CCU with toxicology screen positive for PCP

drive time.

i was driving yesterday during my now-weekly 240 mile journey between "home" and "WV" and realized how much i'll miss my time in the car.

kind of weird for me to be admitting that i'll miss living so far away from my husband (which please don't misunderstand me, i won't). weird for me to want to sit on my ever-growing rump 8 hours each weekend. and weird for me to have grown the desire to rebreathe the same air for 480 minutes four times each month.

but my drive time has grown to be a time of solitude. a time to listen to the Lord speak, to listen to podcasts, and to communicate with friends & family i otherwise would not make as much time for. and perhaps more importantly, my drive time has become a weekly journey of faith. i catch up on sermons, NPR, and oodles of podcasts. i listen to new music. and i create new conversations--depending on my cell phone battery.

as i pull out of our driveway in NC, i'm always tempted. tempted to turn around and give this up. tempted to choose the easy road in our lives right now and avoid the trials, temptations, and frustrations that come with living apart from a loved one. tempted to skew the loving words jon has spoken, tempted to let my frustations and anticipations build to the breaking point. and more times than i'd like to count, i've been tempted to believe that this wasn't God's plan afterall.

but every time. EVERY TIME, i arrive at my destination 4 hours later with a calm heart. one that has been personally touched by God's hand; one that has been reassurred that this is the road we are traveling right now...and that soon enough, there will be an exit.

bodily fluids.

There were two of them, and two red-heads of hair fashioned mullet-style greeted me at the door of the exam room. One, around age 7, sported think glasses with royal blue frames. The other, probably 5 years, sported lizard green glasses frames. Their faces speckled with freckles, I could tell they were happy to see me.

As soon as my foot crossed the threshold, it was like a motormouth competition over loud speakers exploded in the room. The jabber was almost more than I could bare. And both of them were getting wildly out of breath trying to out-speak the other.

And then it happened.

Between breaths, the 5 year old was temporarily silenced. And his blue-framed mullet-style 2-year-older freckled red-head brother shouted out at the top of his jabber mouth lungs:

HE VOMICKED!!!!!!!!!!!!!!!!!!!!!!!!!!

The 5 year old sat there stunned, seeming slightly embarrassed after what his almost-twin brother announced to the entire office (and probably the two adjacent to us). And after my ears stopped ringing, I realized that they might have heard him in China.

Which is right around the time when Mr. 5-year-old informed me, also at the top of his voice range, that "the “vomick” was green & chunky & had his hamburger from dinner in it."

Thank you. I guess that’s what brothers are for, huh?

well.being

i've been indulging lately. in guilty pleasures. like poptarts. and licorice. and when i found out Hershey's makes Pumpkin Spice kisses, my stomach flipped with joy inside my abdomen.

and i'll admit that i haven't made the best choices for my own health lately. not eating balanced meals. each much too quickly for gradual digestion. and mostly not listening to my body when it is telling me its tired or hungry or too overwhelmed with food.

i found this post today on this incredible blog. the woman inspires me--with 6 kids & a farm to oversee, it makes my work days sound like walks on the beach. or walks through snotty-nosed-kid alley, take your pick ;)

and so today, i'm sitting in the guilty chair. perhaps similar to the "time out"chair i used to be forced to sit in. and i'm going to try my best to take better care of my body--to eat better, to exercise more regularly, and to get restful bouts of sleep at night.

here we go....

weirdest question from a patient...

"How old would you be if you were fat?"

-patient

a belly.

best pain complaint

How long have you had this pain?

"Long time, I reckon."

What have you taken for the pain?

"A damn lotta nutin'"

a monday to remember

8:42 am: arrive on floor to check patient labs.
8:46 am: walk into patient room to complete history & physical exam.
8:50 am: patient able to identify herself, tell me where she is, the current year, and the President of the United States.
8:52 am: patient says she urgently needs to see Herman, her boss, who comes home with her each night. Herman wears dark glasses and plays cards with all the men in her house at night. Apparently he wears dark glasses so that the women can't see him in the garden.
8: 56 am: patient informs me that i am bipolar. and that she has been married forever, since the beginning of time.
8:58 am: patient wets the bed while i am interviewing her.

9:30 am: patient found half naked in the doorway to her room.
9:56am: patient found in the hallway, partially dressed with her hospital gown hanging wide open in the back. patient holding telemetry monitor, pretending to "take pictures" of the other patients with the monitor.

10:30 am: patient found completely undressed in room, leaning over side of bed. she claimed she was in labor having Herman's baby.

11:45 am: patient given drugs to calm her down.

1:35pm: patient found in hallways again, with "camera" in hand.
1:55pm: patient informs nursing staff that the Green Beret's are going to get them. she also informs attending physician that her husband is actually her boyfriend. and that he wears a Green Beret.

2pm: patient given Ativan.

...we call them "super psych"....

september weekends

conversation.

Four heads covered with silver hair bobbed up and down inside the room where the man lay. The women were deep in conversation, perhaps reminiscing about last evening’s 5 o’clock news or the weather that afternoon. One sat in a wheelchair, her distended belly protruding above the metal handles of the seat. Another sat in a chair near the corner, quietly nodding in agreement. But I couldn’t quite make out what they were saying from my perch at the nurses station. All I knew is that they were in that man’s room for a long time.

I could only see his legs. Large, matted with hair. His feet covered with hunter green fleece socks—not the teal green kind that the hospital issues. And he just lay there. Still. Asleep, I presume. His IV drip beeped every 10 minutes or so, indicating the bag that loaded liquid into the vein on his left hand was nearing its last few drops.

I watched them for awhile, at least ten minutes while the attending made phone calls & filled out patient charts with new orders for mediations, labs, and imaging studies.

While I stood there, constantly shifting my weight so the pains in my feet wouldn’t grow too intense, I couldn’t help but wonder who they were in that man’s life. Sisters? Aunts? Friends?

To be that group of aging women, gathering around a beloved friend in a time of need. Consoling a friend in a time of pain, uncertainty, and intimidation. And simply being there, as a hand to hold, an ear to listen, and a mouth to make conversation.

It’s an incredible thing in the hospital to see someone surrounded by people. Incredible almost more than family is the immediate community that flocks into the patients room bringing monetary gifts of flowers, teddy bears, and “get well soon” cards. Most gift-bearers hand them awkwardly to the patients, not knowing exactly what to say in a situation as dire as many face.

And perhaps that is what struck me about this group of women. They brought nothing. No freshly cut $5 flowers from Walmart stood on the shelves. No premade Hallmark greetings were placed in the metal card holder mounted on the wall. And no awkward gestures passed between them and the patient. They just brought themselves…and a bit of conversation.

So that is where I found them. In conversation. Perhaps reminiscing about last evenings 5 o’clock news, or the weather that afternoon. The words exchanged reminded the patient—and me at my perch near the nurses station—that sometimes busy chatter means more than words can adequately describe; it means that you are surrounded by people who care deeply enough to miss this evenings 5 o’clock news, who value the importance of community enough to look at the afternoons weather through two panes of glass on the second floor, and who cherish something as simple as a conversation.

a hand in healing...

I never believed I would be one of those physicians who had a “god-complex”—who thought that life & death was determined by their hands, and who played with the livelihood of their patients at will. And actually, I never believed that I’d be one of those physicians who was emotionless when delivering bad news, or who felt little-to-no empathy for patients scared, discomforted, or in pain.

But I am becoming one.

It’s not something I’m readily admitting on a daily basis. Not something I’ve even realized quite enough to surrender it to the Lord. But today I noticed that my emotional bank was drained just a little bit more than yesterday, which was a little more than the day before.

When I walked into the room of the forty-something year old man, I had no reaction. No empathy and less compassion than I would have expected even two weeks ago. He lay in bed, chest rising and falling much too fast for adequate oxygenation. His skin pale and clammy, we arrived to deliver the news of his transfer to a cardiothoracic surgeon in another city. He needed surgery…quickly. We’d found vegetations on his heart from years of IV drug abuse. And now, with his quickly-decompensating condition, his body could no longer withstand the stressors on his heart, lungs, and joints from his years of drugs, smoking, and hard labor. The only emotion I could muster was a small smile of pity because afterall, he was just another patient.

His voice, broken up by shallow breaths, was quiet. There was no dispute from him, no resistance to the serious news we’d just delivered. A dry mouth half opened between two sunken cheek bones, his only request was to see his nurse, who would enter the room shortly to change the urine pad that protected his bed.

Medicine & Christianity clash, no matter how you look at it. Many claim they clash educationally: that looking at the complexities of the human body somehow points away from a Great Creator and toward random design. Others claim they clash ethically: putting physicians’ beliefs above the patients’ own in order to gain wanted results. And still there are others, like me, who struggle with the clash emotionally.

The God who created the heavens and the Earth, who made man in his image—intricate in design & function; the Creator who gives life to all living things & moves mountains at will; that Being told me to LOVE, to have COMPASSION, and to look at each of His Creations as my brother or sister & treat them as such.

But I can’t.

I can’t wake up each morning and empty my heart (and my eyes) into each patients ailment. I can’t go to bed each night, struck with worry about the state of affairs of each body wearing a hospital gown. And I can’t go on with my days wondering about the eternal destination of every face I see. I would be emotionally drained, spiritually vacant, & physically exhausted.

The balance between Christian compassion & medical intervention is not so easy to find. The lines blur. There are too many gray areas to count. And many nights when I trudge back to my apartment, I’m left with conflicting thoughts about that fragile balance between compassion and distance, empathy and emotional-removal.

Truth be told, I don’t know if there is a balance. The scales sway in one direction and then the other, toward generous emotional sacrifice and then in the opposite direction nearing selfish emotional protection. Maybe it’s the method of finding equilibrium—not letting the scales tip too far or stay too long on one side or the other.

But then again, the compassion from God—the Ultimate Healer—is unending.

My grace is enough for you.

When you are weak,

my power is made perfect in you.

–2 Cor. 12:9

Grace, rain down on me today, tomorrow, and through the conflicts of my faith. Help my compassion to be never-ending, my love to be overflowing, and my healing be for Your glory.

someday when I learn....

It seems like an impossible large task—to know as much as physicians do. I know a lot of knowledge “comes with experience”, but I’m experiencing right now, aren’t I? My fear is that this year will pass…next year will pass…and I’ll still be walking into patients rooms with my head spinning & my knowledge bank crying out in terror “I DON’T KNOW HOW TO HELP YOU!!!”.

I have to keep in mind that this is only my second rotation. I’ve officially been out of the classroom for 10 active weeks. TEN. [And can I just say that it seems like decades?!]. But my overbearing tendencies to look toward the future are being just that again: overbearing. I’m thinking about how much time I don’t have left instead of how much time I do. I’m thinking about all the pages of textbooks left unturned instead of the myriad of highlighted words that stain the pages of the books that sit on my shelves. And I’m thinking about what the future might bring instead of how I’m going to handle it.

I’ll be honest: the next 22 months is a calendar of gargantuan intimidation. Where will I live? Who will I rotate with? Will Jon be okay? What will happen afterwards? Will I even get any interviews for residency? WHAT WILL MY LIFE BE LIKE?

Here I go again, dreaming of my crystal ball. Wasn’t it just last week that I was talking about trusting God more this year? ...

best dietary modification report

Have you been watching your diet like we talked about before? What have you been eating?

"Yes. I reckon I de-id.

I've been eatin' some mooora those veg-tables.

And I been eatin' me some of that sal-mens.

I do reckon I like them sal-mens."
-patient report on dietary modification, diabetic f/u visit

sick.

It was another hard day yesterday. Not because of the patients. But this time, I was the one that was sick. I’d had some indigestion for the two days prior, originally attributing it to something I ate. But on Monday morning when I woke up with stomach cramps, I knew it was something else—perhaps a friendly little virus that decided to set up camp in the rugal folds of my intestines? Probably.

I tried to tough-it-out. I tried to make it through the day. But I knew the day was off to a bad start when I had to use the restroom three times before and after one patient. Finally, my attending told me I looked sick & that I needed to go home.

His instructions were followed by at least 7 hours of sleep and a bowl of chicken noodle soup. I’m sticking to the B.R.A.T. diet for the next few days (bananas, rice, applesauce, and toast).

Kind of a crummy way to end such a great weekend? Or to start a new week, whichever way you look at it. I’ve gone home (to NC) each weekend so far & hopefully will be able to keep up the trend. With deployment on the horizon & away-rotations all over the country, Jon & I are trying to soak up as much time together as possible…

death & the hospital.

The hospital does things to people. It makes sick people sicker instead of encouraging healing. It causes people to revert back to childhood, appearing psychotic when the sun goes down (interested? Look up “sun downing”). And under one industrialized metal roof, it tends to highlight the joys & tragedies of life.

I was exhausted this weekend. And despite my physical exhaustion from a week of emotional transition, it seemed I was more than emotionally exhausted.

My patients came from different backgrounds. Enjoyed their place in different socioeconomic brackets. Regularly ate different foods for breakfast—the man in room 207 preferred pancakes & grits while the woman in room 368 insisted on eggs with salt & pepper beside one plain piece of white toast. And most of all, my patients made me open my textbooks to vastly different chapters with the slew of ailments they were admitted for.

I’ll be the first to admit that I didn’t consider myself a normally emotional person. I was able to detach my frontal lobe when necessary, reattaching it only every once-in-awhile to let out a good cry…or something of the sort. And I could say that it is all jon’s fault—that he is the one who makes me cradle my frontal lobe like its my beloved teddy bear. That he is the one that is causing all this emotional turmoil when I arrive at work each day—he is responsible for the growing collection of wet Kleenex in my pocket when I leave patients rooms with tear-stained cheeks. That I fell in love with him, causing my girl-crying-hormones to come out of hiding.

But if I blamed it all on him, I’d be lying to myself.

Because in addition to all those things that the hospital does, it also stirs up my emotions & leaves my brain spinning in utter exhaustion each night when I try to close my eyes. I try to imagine the patients in their homes. The smells. The sights. The sounds. I try to imagine them surrounded by loving family members, instead of the silence that pierces their hospital rooms. And I try to dream up all the beautiful places they’ve been, the fulfilling lives they’ve lead, and the belief that sustains my imagined faith for each one of them. But sometimes, my imagination only takes me so far….

And when I try to imagine farther, it ends up being make-believe.

I lie in bed at night & try to dream up fairytale lives for my patients in an effort to quell my own uneasiness about their transition from life to death. Inevitably, I’ve started thinking more & more about my own death; the death of my family members, my parents, my husband. My mind spins for what seems like hours…at which point I reach for the almost-empty Kleenex box that was newly opened last Sunday. And eventually I fall asleep to a pillow, moistened by my own tears of fear; evidence that despite my hard-knock façade, these realizations have biopsied the core of who I am…and what I believe.

I’ve never really faced the reality of my own death before. And although rather morbid, this Internal Medicine rotation is not only challenging me medically, it is also challenging me spiritually. It is causing me to ask the hard questions—the questions that, three weeks ago, I thought I had solid answers to. It is causing me to reflect on my own life and realign my priorities. And it is causing me to engage my own human reflex by scooping up my feelings & thoughts & priorities & life & putting them in my OWN “safe bag”—one guarded from negativity & the prospect of tragedy infecting my household.

Try as I might to resist sleep at night, God opens my eyes each morning with a new reminder that HE is ultimately in control. And when my feet hit the floor, God reminds me that HE has lessons to teach me this year. When my eyes focus & I sit down with my Bible, HE has consistently given me verses like this each morning:

“Now we know that if the earthly tent we live in is destroyed, we have a building from God,

an eternal house in heaven, not built by human hands.

Meanwhile we groan, longing to be clothed with our heavenly dwelling,

because when we are clothed, we will not be found naked.

For while we are in this tent, we groan and are burdened,

because we do not wish to be unclothed but to be clothed with our heavenly dwelling

so that what is mortal may be swallowed up by life.

Now it is God who has made us for this very purpose

and has given us the Spirit as a deposit, guaranteeing what is to come.

Therefore we are always confident and know

that as long as we are at home in the body we are away from the Lord.

We live by faith, not by sight…

so we make it our goal to please him, whether we are at home in the body or away from it

…Therefore, if anyone is in Christ, he is a new creation,

the old has gone, the new has come! "

-2 Corinthians 5: 1-7, 9, 17

I know God is trying to teach me to LET GO. To GIVE IT UP. And to TRUST HIM. But as you well know, TRUSTING is my biggest struggle.

Perhaps this is the year of breakthrough.

best past medical history

"For a period of two months, patient said she wasn't feeling well.

She reported that she felt like killing people.

She is feeling much better now."

-Physician SOAP note

{as if that should make me feel better}

daily {pixels}

i'm kind of in love with these photographers. and by "love", i mean that i feel kind of sad when i can't check their blog.

why??

because they are amazing. because they have darn cute kids. because they have an incredible eye through their lens. because they capture moments i've never seen in photographs before. and because they are honest, hilarious, & crazy cool in each of their blog posts :)

i'll miss these days.

little did i know, but our time together this summer would really change the attitude of our weekends this year. before living together, there were times that i felt we were "making up" for lost time on the weekends, spending the majority of our days on-the-go & most of our nights hurridly talking through conversations we might have had during the week.

but i think we've relaxed a bit. perhaps its just that we are comfortable around each other now, that we've been married over a year. or perhaps its because our attitudes towards life are changing & we are taking the time to slow down and enjoy the moments of solitude we have on the comfort of our own couch.

whatever it is, i LOVE IT. because it makes for a great weekend :)

golf. homemade wheat pizza with fresh vegetables from the garden (the crust & everything!). bbq with friends. movie night. errands. and time together. i gosh-darn-love saturday & sunday!

daily {pixels}

that little light in their eyes? its called catch-light...and it is the subject of jealousy to any photographer you talk to.

i get lucky sometimes...and it slips into my photos. cloudy days are best. high ISO + low shutter speed makes for two very alive eyeballs on the other side of the lens.

but if i could just nail the interaction--that moment-in-time LOVE that glows from her pictures.

...working on it :)

a man born blind.

I reviewed his chart before I entered the room. Admitted to the hospital last night, his lab tests were dismal. Low WBCs. Anemia. Urine sedimentation. Bilateral lung infiltrates. Blood cultures pending, although they would likely be positive. All the evidence pointed to severe pneumonia & sepsis. His body would shut down without medical intervention. Infection would take over, stopping kidney filtration, dropping his blood pressure, & finally affecting the other important organs inside his Earthly cage of skin, muscle, & bone.

As I stood up to put the blue binder back in the metal holder, I noticed a sign on the sliding glass door. Printed haphazardly on a sheet of white computer paper were the words “Patient is blind & deaf”. An announcement to each passerby: FEEL SORRY FOR THE MAN INSIDE THIS ROOM.

The blue checkered curtain that now hung between his sleeping body & my own ran vertically from floor to ceiling. Hung to protect the patient’s privacy; it was a bit of an oxymoron, based on the scarlet letter that hung just two feet from where I was standing.

His half opened mouth & emaciated limbs greeted me at the edge of the curtain. Tangled in a pile of sterilized white blankets he looked peaceful with legs bent & strung sideways beneath the mound of cloth that was meant to keep him warm. Long, thin arms were folded across his chest, moving slowly with the rise & fall of his respirations. Silent, labored breathing filled the room alongside the beeps of his IV drip & low whistle of the oxygen supply that was slowly feeding his ever-failing lungs.

At 52, his hair had already grayed. His protruding jaw & tightly skinned lips exposed the poor dentition that had carried him through his meals of applesauce & bananas since infancy. His skin was shiny, hands strangers to the rigors of a life of labor & physical work. With overgrown cuticles, the small pieces of lint & dirt that nestled themselves underneath his fingernails were the only evidence of mobility I could find.

But really, I didn’t blame him. He’d been born deaf & blind. Unable to see the face of his mother, who was now clearly gone from his life. His deafness had prevented him from hearing the sweet sounds of music, the laughter of children, and joys of the Holiday Season. Imagine. Never hearing Christmas bells, the harmonious tune of flute, or the soft “I love you” of a mother’s whisper.

At that moment, though, I was grateful he was deaf. Grateful that his condition prevented him from hearing the constant beeps & whistles & bells that fill the sterile corridors of the hospital. Grateful that his condition protected his confidence from hearing the nurses’ sour-faced pity about his gravid & quickly decompensating state. And I was grateful that his eyes didn’t carry visual stimuli to his brain; that he was blind to the metal bed cage his body rested in, blind to the worn white walls of his hospital room, and unable to see the look of shame in my own eyes when I first moved the curtain aside.

You see, I judged him. Immediately. I questioned his usefulness in this world. I questioned what God may have been thinking when he allowed the creation of an innocent child who would enjoy a life of only darkness & silence. I questioned the government’s provision of this man with monthly checks that undoubtedly skipped the intended recipient & went into the bank account of his then-absent caregiver. And I questioned my opposition to a child from my own womb that could someday be born without the joy of two of life’s most gratifying senses.

But at that moment, God intervened. And I was overcome with emotion. Careful not to contaminate my face, I had no choice but to let the few drops escape from the corners my eyes. They landed on the lapel of my pressed white coat.

The sounds of beeps & whistles became the shouts of vendors & chatter of people along a street in Jerusalem. The blue checkered curtain, a wooden fence & the tile floor a cobblestone street, my feeble patients bed had turned into a hand-woven rug. It was a busy street. And suddenly…

Walking down the street, Jesus saw a man blind from birth.

His disciples asked, "Rabbi, who sinned: this man or his parents, causing him to be born blind?" J

esus said, "You're asking the wrong question.

You're looking for someone to blame.

There is no such cause-effect here.

Look instead for what God can do.

We need to be energetically at work for the One who sent me here, working while the sun shines.

When night falls, the workday is over.

For as long as I am in the world, there is plenty of light.

I am the world's Light."

He said this and then spit in the dust, made a clay paste with the saliva,

rubbed the paste on the blind man's eyes, and said,

"Go, wash at the Pool of Siloam" (Siloam means "Sent").

The man went and washed—and saw.

–John 9:1-9

And then I knew. Look instead for what God can do. This happened so that the work of God might be displayed in his life (verse 3, NIV).

This man with nothing to say, this patient with nothing to give, reminded me of God’s promise to us. That this body is not eternal, this rib cage that holds our beating hearts will not be the vessel that carries us into eternity. That this life is not the end—we have something much greater to look forward to. And that these joys we experience each day are gifts.

Most of all, however, that this man has been able see. His entire life, He’s been seeing the world’s Light. And the uncomprehendable babbles that later came from this man’s mouth just might have been praises—gratitude to a God who is finally taking him home.

best occupational report

What do you do for a living?

"I'm a hillman--I sit on the hill"

-patient

the first day.

arrive at hospital by 7:30am.
stand by door of medical staff office for 30 minutes.
get mentally lost in hospital corridors with guide.
call P.A. Brandon to follow for remainder of the day.
10:15am: take history from toothless man who happens to be your first patient; write soap note about how patient was entirely noncomplaint, told me to "go away", went to sleep 5 times during the H&P interview, & smelled like rotten garbage.
11:15am: see second patient, a 80 year old man who hit on me.
12:25pm: meet WV woman in elevator whose name is "Bunny"
each salad from the cafeteria where the lunch lady refused to give me more then 1/2 tablespoon cottage cheese.
12:35pm: physically get lost in hospital on my way back to the library from the cafeteria.
12:45pm: find library; scarf down 1/2 tablespoon cottage cheese & small salad.
1:15pm: search 2 hospital floors for attending, who is no where to be found
2pm: meet two other WV woman, whose names were "Barbie" & "Star"
3:27pm: let off for the day.

and then the tears came...

i'm off. already. and its only 4:27pm. its kind of glorious, actually. this rotation should be interesting, to say the least. a learning experience, i am certain...my enjoyment level throughout the journey is what is still to be determined.

to say i'm still emotional about moving here is a bit of an understatement. i was more emotional yesterday than i have been in years--and after jon left i am fairly certain that i not only raised Kleenex stock value, but i probably also swallowed my body weight in snot & tears. so yes, i did greet the mirror this morning with red, swollen eyes (good thing it was picture day, huh?) & a stuffed up nose. and i also did meet the tissue box this morning (& this afternoon) with just a few more tears that needed to escape (notice the mound of kleenex).

i'm learning how to depend on God again. i looked at my "daily inspiration" calendar today and mr. max lucado had this to say....

When you recognize God as Creator, you will admire him.

When you recognize his wisdom, you will learn from him.

When you discover his strength, you will rely on him.

But only when he saves you will you worship him...

Before your rescue, you could easily keep God at a distance...

Then came the storm...Despair fell like a fog...

In your heart, you knew there was no exit...

Suddenly you are left with one option: God.

And i'm at that one option. i'm at that point--between a rock & a hard place where the only option i have is to turn my heart over to Him, to surrender my soul, my tears, and my heart...and discover the grace & comfort His embrace can bring.

but it is the surrendering part that i have trouble with--the giving up & letting go where i get hung-up.

i don't have an option this time. i can't quit school at this point (although days like today i gladly would). jon can't move from NC. and my heart is wretching because this is not what i had envisioned for us....so i'm here. left with my kleenex box & my only option: GOD.

new land

the move has been made. new land. new city. new people. new hospital. new apartment....and one very sad me.

jon left wv today to drive back home. and NC really has become home over the past 3 months. and what a BLESSING this summer together has been. it solidified our marriage, our commitment to eachother, and our ability to tolerate each other for more than 3 days at a time :). it was a breath of fresh air after so much time apart. we are praying that these next 2 years, with all their unknown events, go quickly. and we are praying even more that God will open doors to a residency where we can be together & carry out His plan for us.

it is all a bit intimidating....and a lot emotional, at least for me today. jon is so supportive--i don't deserve him most of the time...but that is for another post entirely :)

i'm excited to post pictures of this very weird-hick-town in the upcoming weeks/months. jon & i laughed yesterday when we walked into the grocery store and heard in the thickest WV accents "y'all come back now, y'hear??". weird billboards. weird store names. weird road-planning....but people are kind. life is slow-paced. and the hospital should be fun....

since parents will probably want to see, here are some pictures of the WV homestead until May 2009....

{the view from the entry hallway}

where did the time go?

people told me i'd be asking that question. but i didn't believe them. my elementary-school head couldn't wrap itself around the fact that, someday, summers wouldn't last 5 years. and Christmas break wouldn't be all about Santa & grandma's chocolate cookies. and then my middle-school brain couldn't wrap itself around the fact that someday i'd want to have a break from my friends for longer then 3 days at a time....or that just like recess ended when 5th grade closed & bras entered my closet, summer break would someday end & a husband would enter my life. and even in high school, i still didn't understand the full extent of just how fast life would fly by me.

but it does. it does fly. it does fly fast.

and so now i'm left wondering where the time went. the time when these two women blossomed. the time when they were still wearing Cinderella panties & eating Mac&Cheese each day for lunch. the time when their world's were still innocent & pure--when their friends weren't falling for cultural norms & when their minds weren't struggling with the temptations that high school inevitable brings. i'm wondering where the time went. the time when pink frills & oversized bows filled their closet. the time when their walls were painted with rainbows & trees. the time when they'd fit in my lap.

and i have a feeling that life will only start to spin faster. and soon enough, i'll be saying this about my own kids, reflecting on these days & how fast they are going.

thank the Lord this life doesn't end when our hearts stop beating. :)

best record of allergies

"Patient is allergic to cocaine...

causes him to 'breakout in handcuffs'"

-Physician record of patient allergies