The long road to medical school

This is what Luca does when I take a nap

2012-02-12T08:25:00.006-05:00

Well, that didn't seem to be a problem at all

2012-02-11T11:08:00.001-05:00

We tried pumping for the first time this morning. I got roughly 2 oz from my left boob in ~10 minutes. Since it was a trial run, we stopped then, though I think I'd have gotten more if I'd kept going. I just did the one boob because I wanted to make sure I had something left over if she didn't want to take the bottle when we fed her later.

Then we gave D a bath and we washed her hair which she actually seemed to enjoy! She likes the warm water I think.

:-)

I still feel like I need Luca's help bathing her though. She's a very slippery little piglet.

Then I let Luca feed her from the bottle. I think we may need a slower flowing nipple because she had gone through all 2 oz in about 4 minutes. We just used the Medela bottles that the pump came with, but I think we may try a different kind for future use. She let out a HUGE belch when she was done. What kind of bottles have other people found useful?

Then I popped her on my right boob, and she ate contentedly there for another 15 minutes or so.

I think I may start pumping 1x per day so that Luca can take a feeding for me. Not sure how the overnight feedings will work, since I don't want to wake up engorged. Any advice on how to do this?

Now she is sacked out again in my lap.

In other news, we may have solved our childcare dilemma. I don't want to jinx anything, but we got an acceptance letter from a University City daycare yesterday for an April 30th start date, and Luca and I are going to tour the facility next Thursday. I've already seen it and I liked it when I went in October, but I want to get Luca's approval also. This is the one that my neighbor used to sit on the board of directors for, and she recommended it HIGHLY, though it's not the one that most of my med school/doctor colleagues use.

Cross your fingers for me that it all works out!

No love for the lady docs!

2012-02-10T11:13:00.002-05:00

When I was in the hospital post c-section, I was visited by a lactation consultant. I think they come by to see everyone where I gave birth.

Fortunately, Miss. D caught on to the whole latching and sucking thing relatively quickly, and we didn't really need too much help. Phew!

(Knock on wood of course!)

I had heard so many horror stories of breastfeeding difficulties, and I was worried that I'd have problems too. Not taking anything away from people who do have problems (or placing blame or whatever), but I just wanted to throw my own case out there as an example of someone for whom things did go pretty smoothly. It IS possible. NOT everyone has trouble, so if you're expecting a baby and worried that you might have problems breastfeeding, take comfort in the knowledge that you might not as well. Hearing a couple of stories like my own helped me relax about it, at any rate.

Anyway, the lactation consultant helped with D's latch, and informed me that I was going to have problems with sore nipples (which was true, but they were short lived) if I didn't fix her latch (she fixed it herself once my milk came in). Gave me some useful advice about not worrying about it too much if on occasion I fell asleep while nursing (she said it was basically inevitable and I shouldn't beat myself up about it).

Then she asked me if I was a nurse, which in retrospect was probably a complement. I said, no, I was a med student, but thanks. Then she said she was surprised the breastfeeding had gone so well, since in her experience doctors have the most trouble of all of her patients because of their type A personalities.

HAHAHAHAHAHHAHAHA!!!!!

(Ok, I totally have a type A personality also. But can I say? I thought this was pretty funny.)

She went on to comment that her patients who were doctors over the age of 35 had the most trouble at all, and probably the only thing that had saved me was that I'm only 34. And furthermore, cardiologists and radiologists had far and away the most problems with breastfeeding and were the most challenging patients that she worked with.

Anyway, I thought it was an interesting view into how doctors are perceived by other providers. I know we make difficult patients, but one rarely gets to hear about our shortcomings spelled out in so much detail! Maybe I got to hear it because I'm a med student.

*****

Please stop reading here if you don't want to read about me gushing about how cute my child is.

So, Miss D, as a 2.5 week old infant, does not have good head control. Obviously. However, her verbal and motor skills are improving. This morning at 5AM when Luca was changing her, she was howling as though she was being tortured (as always). Then when Luca brought her over to me, I said, "Hey D, do you want some milk?" Crying stopped IMMEDIATELY. Eyes opened totally wide. Staring straight at my rack. Then she cooed. When I took her from Luca, she then did this thing where she hurls her face into my boob with her mouth wide open. She usually misses the nipple, but lately her aim has gotten a lot better.

Luca commented that he was jealous, and that he wished that HE could have that effect on little D. I think this means we may try pumping this weekend so that he can try feeding her a bottle. I think that would make him happy. :-)

Eek!

2012-02-10T09:13:00.001-05:00

My paper came out online a couple of weeks back, and since I'm corresponding author, I've started getting contacted about it.

Eek!

ANYway. I got a call while nursing D this morning, and was like, "Please don't start crying! Eat child, eat!" the entire time. She cooperated (thank you sweetie!). I suppose I won't be able to count on that for much longer!

Guilt-mare

2012-02-09T13:07:00.003-05:00

I had the most horrible nightmare the other night. It was a few years from now, and D had finally gotten into daycare (I wish I were being hyperbolic here). So I sent her. And then I found out that all of the other children and teachers ignored her at the daycare, and she felt very lonely.

And there was NOTHING I COULD DO ABOUT IT! I felt this overwhelming sense that she had trusted me and that I had let her down.

Wow, did that feel like crap.

I suppose this was my introduction to a new genre of nightmare: the guilt-mare.

Fun times.

*****

In other news, we found out that D got into Luca's work daycare at the end of March. That of course caused me to panic a bit because that would mean she'd leave with Luca at 6AM and come home at 7PM, and I would practically never see her. It would be an ok option for once I start residency (because goodness knows I'll see her less than I want to then anyway), but not now! It's too soon! I'd really prefer a childcare alternative that allowed me to spend a *little* more time with her during the day than 3 hours, since I do have that time to spend with her now, and will until I go back to med school land a year from now (gulp).

Sleeping

2012-02-08T18:08:00.004-05:00

Ok question to the parents:

How many layers should Miss D be wearing at night?

I sleep in a long sleeve flannel shirt under a sheet and two fleece blankets, and on top of a towel. I occasionally get cold at the end of the night. Luca sleeps with fleece pants, a t shirt, a sweat shirt, and under a down comforter with a flannel cover. Luca is always cold. No matter what.

We've been putting her in a short sleeve cotton onesie, a cotton gown, and a fleece sleep sack. I wonder if she is cold. The reason is that we'll pick her up to feed her, and when we put her down in the bassinet, she'll be screaming within 10-15 minutes every time.

All. Night. Long.

I am thinking (though I could be wrong) that if it were just cuddling or sucking she wanted, she scream much sooner, but what do I know. Both of those things do calm her down, but then she is on top of me, and I am warm when she cuddles or eats.

Usually she's not in there long enough to tell if she's really cold (her hands and feet are usually coolish when we pick her up compared to warm when we put her down), or if she's just hollering because she'd prefer to be cuddled.

Given what Luca and I wear to bed, I wonder if she's underdressed though. Everything says "Your layers +1."

What did your infants wear to bed in the winter? Do you think she's just crying so that we'll pick her up? She sleeps great during the day in a cotton gown and swaddle blanket (with her arms left out), but usually I'm downstairs in the kitchen with the space heater going all day, and it's about 5-10 degrees warmer and much less drafty than our bedroom. Note that without the swaddle blanket she howls the same way she does upstairs.

Suggestions? Too many clothes? Too few? Anybody try using a heating pad or a hot water bottle to warm up the baby's bed before putting her down (obviously removing said hot object when you do)?

Update: Last night we put her in a short sleeve onsie, a fleece footie, and a fleece sleep sack, and she seemed a lot more comfortable. She slept from 9:30-11:30, 12:30-2:30, 3:30-5, and 6-7 (I really should give up on that last segment as the girl is usually raring to go at 5:30 in the morning, but I just HATE getting out of bed). It was a big improvement over what we've been doing. It's probably the first time she's ever gone 3 hours in between feedings on any consistent basis overnight.

Committee

2012-02-07T19:46:00.001-05:00

I'm trying to set up my committee meeting for sometime April - July. It's amazing to me that even 6 months out it's impossible to find a date that works for everyone.

I talked to daycare #3 today. Well, more like they called me back and conducted a one sided monologue about how they couldn't tell me when we'd get off the waitlist because all of these horrible parents who say they're interested and then change their minds at the last minute. That there was no way I could expect to be given more than 6 weeks notice if we got a slot. It took all the restraint I had not to tell her that the reason all these "horrible" parents back out at the last minute is because it takes 4-8 weeks to find and hire a babysitter/au pair, and that if she can't tell people sooner than 6 weeks before a slot opens I'm not terribly surprised that parents flake out on her at the last minute. Bleh. I don't know what we're going to do.

And my in-laws are coming at the end of March. I'm actually really excited about this. I think they'll be a big help with the baby, and hopefully will enable me to get some work done. I still need to figure out what my aim 3 is going to be about.

I took Miss D for a walk today in the Ergo with the Boo. It was FIFTY degrees out. Really nice. When we got back we had the biggest projectile poo explosion ever all over my sweatshirt, and then she peed all over the changing table and herself. So of course I had to change her clothes, which she HATES. All the while she was screaming, completely furious, like she was getting whisked away by a terradactyl. It was so cute! She makes my heart melt. It's funny how projectile poo has become the highlight of my day.

It's almost 8 and she's wide awake, and she's been pretty alert for a lot of the day. I'm hoping this bodes well for sleep tonight. Cross your fingers for us1

Sleep when the baby sleeps (TM)

2012-02-06T17:16:00.002-05:00

When I did my trauma surgery rotation, which was one of my favorite rotations,* we were required to do one week of nights. And the nights went from 5PM to 9AM the next day, which if you're counting, is a 16 hour shift without much time in between.

The thing was, if there were no traumas, you could sneak off someplace and go sleep. Some students (I heard) tried to sleep in the trauma bay. Others sneaked off to someplace else. I found that the medical student lounge was exactly a 2 minute walk from the ED, and went there. As long as I went late enough it was always unoccupied.

Now, some students (I am told) felt that if they got a "sufficient" amount of sleep over night (say.... 4 hours or more) many felt compelled to do something productive the next day rather than sleep more. Others felt compelled to study all night in the trauma bay. And I have to say, the former of these options was at least a little compelling to me since there were two nights that week that I actually got more than 6 hours of sleep overnight. Which is almost a full night's sleep, but not really.

Rather than succumb to the temptation to be productive the days after a glorious night of trauma nightfloat sleep, I'd get home and then go to bed. Again. For 6 more hours. It was glorious. One could argue that I could have really screwed up my circadian rhythms by doing this. One could argue that had happened already. Regardless, it was a really smart thing for me to do.

Similarly, with Miss. D, today I tried Sleep When the Baby Sleeps(TM) and lay in bed from 11:30 - 1:30 (probably slept for 30 minutes), and then from 2:30 - 4:30 (probably slept for 90 minutes). This to make up for the 5 or so hours I got last night (max) since Miss D is a nocturnal piece of work.

We also had D's 2 week weigh in today, and found that she's over 9 lbs! Go D! While in the waiting room, we ran into the Emergency Medicine clerkship director whom I've blogged about running into before. It turns out that not only do his wife and I share an Ob/Gyn, but we also apparently share a pediatrician. They were very nice as always, and later I felt a bit bad because I realized that I forgot to introduce Luca. Hopefully they'll chalk that up to exhaustion though.

:-)

I worried fleetingly that sleeping during the day would mess with hers or my night sleep... but then I realized it's messed up anyway, and 7 hours of sleep in a 24 hour period kicks the ass of 5 any day.

So now I'm waiting for my poor exhausted husband to come home. Today was his first day back at work. In the future I'd really like to ensure that he gets more than 5 hours of sleep per day also so that he doesn't get into a car accident on the way home. I think we may need to put him in the back bedroom in order for that to happen however since D wakes up and cries every 90 minutes or so.

*I think I liked it because it was one of the few rotations where I actually had a job. Also, since it was my last rotation of the year, I knew a little bit and could contribute to the team. And finally, I knew I wasn't going to be a surgeon, so that took a considerable amount of the pressure off, which meant I was a lot more relaxed than on my previous rotations.

Days and Nights

2012-02-05T19:22:00.001-05:00

I can't believe our baby is 2 weeks old! The time has gone by so fast.

Tomorrow Luca heads back to work, but only after he takes me and D to the pediatrician in the morning for our week 2 weigh in.

D slept really well today, waking up to eat every 3 hours or so and being generally very very charming. Normally her "awake" time is from 7PM until 1AM, so I expect she'll be up and raring to go soon enough. It's always a shock to us when we go to bed at 9:30, but can't get any sleep before 1, given how well she sleeps during the day, but by now it shouldn't be. I have hope that one day, when she's no longer reversing her nights and days, she may become a good sleeper AT NIGHT. Until then, I'm going to try to be more nocturnal, and nap during the day to make up for what I can't get at night.

Since Luca has to get up so god awfully early most mornings, we're going to try something new where he goes to bed at 9 or something, and then I stay up with D until 11 or 12 or so, or until she finally starts to settle down. I just woke up from a 90 minute nap, so hopefully I'll be able to make it that late without feeling like total crap. Then tomorrow hopefully she'll be sacked out from going to the pediatrician, and I'll be able to take another nap in the late morning. Cross your fingers for me!

We're also going to try an extra layer of clothes for her. We've been trying not to overdress her at night (SIDS risk) but it occurred to us that she usually starts howling about 5 minutes after we put her down, coinciding with the time it probably takes for her to cool off. Plus she sleeps well downstairs where it is warmer. So, we'll see if that makes a difference at all.

Anyway, apologies for all the baby-care minutia. I know it must bore the crap out of some readers who are used to med school/PhD school related anecdotes. One thing that I thought I would mention.... So the pediatrics clinic we go to a resident clinic for the local Very Illustrious Pediatrics Hospital. We chose it because our we know several people who go and who like it. And so far, we like it too.

But wouldn't you know? Several med school classmates of mine who graduated back in 2010 and matched into Peds work there now. It's a little weird, but mostly kind of cool. I can't believe that they're more than 1/2 done with residency by now. It's crazy how fast the time flies. Not sure how I'd feel about having them as my dr for the day.... but presumably that will happen at some point so I should probably just get used to the idea. Fortunately, most of the people I know who matched at Peds at this institution I'd be more than comfortable with (I think) with them as my -- or my child's -- dr.

Progress

2012-02-04T19:19:00.008-05:00

In addition to a bath today, while Luca was taking a nap, D, the Boo, and I took a 15 minute walk using the Ergo. As per Ana's suggestion we used the infant insert, which keeps her in place. It was about 45 degrees out today, the Boo needed a walk, and I felt reasonably good, so I figured I'd try a couple of blocks to see how it went.

I'm still a little bit terrified that she will suffocate in there, since she doesn't have good head control yet (obviously) and her head ends up resting against my chest as I carry her, so I neurotically checked that her nose had good clearance 20 or so times during the walk. She was fine (of course). The only change I would make is that next time I plan to wear my sneakers instead of my slippers. The bonus to no longer having swollen pregnancy feet is that my feet now swim in my slippers, which not more than one week ago were formerly tight. I wouldn't want to trip!

I also have started running models for my Aim 2. Don't worry! This basically just means that I set my program to run after changing one variable, and then let it run for 24 hours (until it's done). I will have to actually interpret the results at some point (and also write some more code that calculates confidence intervals), but those things will both require more brain power, and hence I am putting them off until later.

Luca went grocery shopping today and got a bunch of things I can try for snacks these coming nights. Hopefully something will work for me. I did notice that Quaker Chewy Granola Bars are a different breed than they were several years ago. Now they are less chewy and more.... sticky and hard? I noted they no longer have trans fats, and I'm assuming that's why they taste different. Boo! I suppose I will get over it. They're still good.

And, during the marathon breastfeeding sessions I finished Confessions of a Shopaholic. A more perfect piece of chic lit could not exist for such purposes, and I subsequently purchased (and plan to start tonight) Shopaholic Takes Manhattan. Yay! Thanks to Fizzy and C for suggesting these to me! And also yay Kindle for allowing me to read and turn pages with one hand while I hold the baby with the other hand.

Any suggestions for TV to watch on Netflix? I recently started Ugly Betty, which I'm enjoying, but could use some other alternatives in case I get tired of it. I've watched and enjoyed How I Met Your Mother, Dexter, Breaking Bad, Weeds, Mad Men.... which is to say I have pretty typical taste for a 30 something woman. Any suggestions would be most appreciated.

And last, for those of you who have completed residency AND had a baby, I'd like to conduct an informal poll: which was harder. My PI told me that being a MICU fellow was much harder than having an infant at home, but well, he's a man and I suspect that his wife did most of the work with the infant, if for no other reason than she's the one with the boobs. Obviously I haven't done residency or fellowship yet, so I don't really know though. What was your experience?

So tired

2012-02-04T12:12:00.002-05:00

Last night we went 90 minutes between feedings. Which were 45 minutes each. This morning at 6:30 my husband got up and snuggled D in the glider so that I could have more than 50 minutes of uninterrupted sleep.

File this one under, "Oh F***. My husband is going back to work on Monday. How am I going to manage without him?"

I got up at 9:30. Am still very sleepy, but a lot better than before. Even Luca looks like he needs a nap today, though.

Luca reported that D might have been fussing because she wanted to be held rather than because of hunger. I buy that since she doesn't always root when she fusses. She fed once since 6:30 this morning at 10:15 or so (it's almost noon), and is still totally sacked out in my lap. When I was pregnant, the morning was always her "quiet time." I need to figure out how to incorporate this into nap time for mama also. Maybe get up with her at 5, which is her active time? And then go back to sleep at 7? We'll have to see.

I also think I need to be eating more over night. I keep losing weight. I'm down from 156.1 lbs at my pregnancy zenith to 132.7 lbs this morning, and I have NOT been dieting. I feel really drained in the morning when I get up, and I have a headache most mornings, which I suspect is because between the marathon overnight breastfeeding sessions and night sweats, I am really dry. I think I need more calories, but I feel too tired to make myself food a large part of the time. I've been eating dinner at 6 or so, and then don't get breakfast until 9 or 10 the next morning. One reader suggested Carnation instant breakfast shakes (which I am a big fan of). Maybe I'll ask Luca to buy me some when he goes to the grocery store today. Or maybe some crackers and cheese or something like that.

We're going to give D her first bath this morning. I expect lots of screaming. She is not a big fan of being naked, and even less of a fan of being wet. It should be interesting.

She is the best baby though. We are so lucky. Even if she makes me crazy with tiredness at 1:30 in the morning.

Daddy's little girl

2012-02-03T10:02:00.002-05:00

Yesterday D, Luca, and I had a research study appointment. It took about 2 hours to collect all the various samples and complete all the various questionnaires. D was very good. She didn't even mind the blood draw.... but that probably had more to do with the glucose drops she received during the process than anything else.

When we got home she slept for several hours. Which kind of threw off our schedule for the rest of the day. And night.

Let's just say we went upstairs to go to bed at 8:30, but between repeated feedings and changes, didn't actually go to sleep until almost midnight. *Somebody* was wired (and it definitely wasn't me).

Despite all this, Luca and I had the following conversation at about 3:30 during night feeding #1:

Luca: She lost her umbilical stump!
Me: Aw! She's getting to be a big girl.
Luca: She's so cute! And all she's going to do is grow up and never be little like this again.
Me: She'll be awesome in other ways when she gets bigger, sweetie.
Luca: Still, she's really great NOW.
Me: Well, we could have another one if you really want.....
Luca: Just one more?

We'll see, sweetie.

Gluttons for punishment we are, I am telling you.

THANK YOU

2012-02-02T09:39:00.000-05:00

For your comments yesterday. SO helpful. In particular, I wanted to thank Susanne, who suggested sleeping on beach towels to help with the sweats. Last night we tried that, and we were able to sleep from 10-12:00, 1-3:40, and 4:30-7. I sweat like usual, but the fuzzy towel was absorbent and prevented me from waking up because of it, resulting in longer blocks of uninterrupted sleep.

I don't feel *perfect* today, but Oh so much better than yesterday!

Who says girls can't wear blue?

2012-02-01T15:11:00.001-05:00

Last night sucked

2012-02-01T11:41:00.001-05:00

I've been trying to fill D up on milk before we go to bed so that Luca and I can get 2 hours of uninterrupted sleep right after we go to bed. The problem is I'm not sure it really matters since my night sweats have been drenching the sheets multiple times per night.

Take last night for instance:
9:00 - Start final feed before bed
9:20 - Finish draining boob #1, Luca changes D
9:30 - D gets started on boob #2
9:50 - Turn off lights, go to bed
10:50 - Wake up in pool of own sweat. Change sheets + clothes
11:50 - Wake up in pool of own sweat again. Change sheets + clothes, feed + change D. Luca starts acting pissy because he has to get up to change the sheets.
1:00 - I finally finish feeding D, go back to bed
3:00 - D wakes up again to eat, eats for 45 min
5:00 - D wakes up again to eat, eats for 40 min
6:00 - D wakes up again to eat, eats for 20 min
7:00 - D wakes up again to eat, I feed her / pass out while feeding her. I have no idea how long she stayed latched for.
8:00 - Luca gets up, does God knows what
8:50 - I wake up, pee (with D screaming the whole time -- poor girl!!), feed D for 50 min (and actually has to do right boob, left boob, and then right boob again, sitting on the floor of the bathroom waiting for the shower to heat up so that she will stop crying long enough for me to bathe)
10:00 - Luca finally appears. Says, "Wow! She slept from 5 this morning until now? That's amazing!" Informs me that since he didn't want to wake me up, he held off on doing laundry (Screw you, honey).
10:00 - I come downstairs, pass D to Luca so I can eat my first food since 6PM last night. Luca skypes his parents for the 10th time in 10 days (I am not exaggerating), while they coo at her and cry while watching her on camera. I reflect that my own parents would never dream of showing any sort of emotion towards me or their granddaughter.
10:30 - I point out to Luca that dog has not eaten or been out to pee since 8 last night. Luca continues to skype parents. Gives me list of things to add to our baby registry on Amazon since his parents want to buy us stuff. (Not sure why he can't do this himself.)
11:00 - I go upstairs to use the bathroom. Luca decides that he too, must use the bathroom now. Ignores me when I ask him what he did with the baby. Repeatedly. Dog is going berserk. I emerge from the bathroom with my pants around my ankles, am relieved to find that he has her in the basket in the other bathroom with him.
11:20 - Luca has shit fit because D poops on his hand while he's changing her. I want to strangle him and burst into tears. It feels so unfair to me that he's allowed to lose his shit over something like that when he's had 3 more (at least) hours of sleep than I have, and hasn't even taken the dog out yet.

Meanwhile, I've found out that (as per my previous predictions) there is no computer for me to skype into for our team afternoon meeting at school. It's not *that* important that I attend, but I kind of wanted to so that I can remain somewhat in the loop over the next several weeks. It pisses me off, because it took a great deal of effort for me to get my PI's secretary to even consider bringing a computer to the meeting, and she of course did the absolute minimum, and now -- as I told her might happen -- both computers that she could use are being used by other people. I could teleconference, but my PI doesn't want to have to pay for it.

It just makes me feel like shit that nobody is willing to work WITH me here. At this point I don't think today is a great day to start doing this, but I still feel screwed over, and that if I don't insist, it's going to get even harder for me to get anyone to do anything for me while I'm out on maternity leave.

And I want to kick my husband's ass for abandoning me in the BR for 2 hours this morning, and completely neglecting the dog so that he could have a friendly chat with his parents for the 5,000,000th time this week. Of course I feel like I can't say anything at all because I feel like he thinks he's already he's already done so much to help, and besides, I'm going to have to manage all of this stuff myself when he's gone at work 14 hours per day starting next Monday.

And I know that if I say anything at all to ANYONE (in particular my parents), they will just say that I'm "hormonal" or "too demanding" and that I am really lucky to have such a wonderful helpful husband, and that I should try to suck less myself. At least that's what my internal monologue tells me. Come to think of it, that's what my father ACTUALLY told me the other day. Twice.

7

2012-01-31T12:06:00.005-05:00

Seven.

That's how many ounces D gained between Thursday's bilirubin check and yesterday's week 1 weigh in. Only 6 oz more to go until she's back up to her birth weight.

Luca commented that if I'd gained 1/2 a lb in a week, I'd freak out. I pointed out that in fact this would be reasonable since 1/2 a lb for D is the equivalent of 7% of her body weight, which on me would be more like 10 lbs. Which would be COMPLETELY REASONABLE to freak out over.

I am really hungry a lot of the time, and I think I need to institute an overnight snack so that I don't feel so drained when I get up. Luca has nicknamed D our little vampire.

To get her to sleep a little longer, last night I tried extending the time between her 2nd to last and last feed by 40 minutes (from 90 min to 2 hrs 10 min) before we went to bed so that she'd be a little more hungry and would fill up more. Instead of immediately attaching her to my breast the minute she started fussing at 8:45, I played with her and rocked her until it was almost 9:30. And well, it seemed to work. But then when she latched she was completely voracious, and I felt really guilty for making her wait at all. I am gathering that this guilt thing is something I'm going to have to get used to....

In other news, I seem to have peed and sweat (especially at night) off 20 lbs in the past week also. And I've found that I kind of like the way my post-partum belly looks, now that it is mostly deflated. Even if it is a little saggy and wrinkly, and my belly button is completely deformed. It feels like a well earned battle scar. Add this to the list of things that I thought I thought I would mind, but don't at all.

We had night #2 of sleep x wake-up to feed x3 last night. With D in the co-sleeper doing 2-3 hours of sleep per stretch. I fully expect her to regress and cry inconsolably for at least part of the night in the near future (probably the night before Luca goes back to work... haha) but for now I am so ecstatically happy that she was able to do this.

I think I prefer her in the co-sleeper to the bed at this point, if for no other reason than that it enables me to (selfishly) sleep with the blankets pulled up to my ears wrapped up like a burrito. With her in the bed, we must dispense with the blankets so we don't accidentally smother her.

We've also been reconsidering childcare options. I think daycare is still our first choice, but realistically we probably won't get off the wait lists at two of the ones we're considering until September, or maybe even January of next year. The third, which we also really liked, told us in September of last year that May was a possibility, but who really even knows whether that is realistic or if they were just saying that to get us on the hook.

In any case, we need to figure it out, and soon, since arrangements tend to take time to get put into place. If it's going to be end of summer or perhaps even next winter, we're going to have to hire a babysitter. Then the question will become whether it would be better to hire an au pair or to pay a local person by the hour. Since we have an extra room in the house, and my schedule is pretty flexible, I'm almost leaning towards au pair, in part because it would cost less (~20K compared to ~35K for comparable hours from a local babysitter), and in part because of the flexibility. Plus, we may end up needing to hire an au pair eventually anyway to orchestrate AM drop offs and PM pick ups when I go back to med school in 14 months. We'll have to see.

I also have to admit that after spending some time at the pediatrician's office, I am kind of squiked out by all the germs there, and fear that I would have similar feelings about daycare. You can practically see the germs leaping off the fomites into Miss. D's nose while you're sitting in the waiting room. Not that my house is immaculate by any stretch, but at least those are MY germs.

It's really lovely out today. Maybe I'll even go for a walk OUTSIDE THE HOUSE. Next lunch for D, and then lunch for me.

New kinds of puzzles

2012-01-29T16:17:00.001-05:00

Luca got a week of paid paternity leave from his job (which is now over) and is taking next week off as well unpaid. After that, he'll be back to leaving for work by 6AM and returning home (usually) by 7PM.

I am terrified. How on earth am I going to manage all the stuff that needs to be done without him around?

It's not like there's *a lot* of it, or that any of it is really all that difficult to do. I basically have to feed and change the baby 100x per day, and walk the dog once. I've even hired a dog walker to do that middle part.

The problem is all those other things that come up that require the use of both of my hands at the same time. Like having to use the bathroom, eating, and showering. Or things that I realize need to occur while I'm feeding or changing the baby. Like getting a glass of water for myself, or fetching another onesie because D's diaper leaked all over her current one and the stash we keep by the changing table is out.

Do you have any idea how difficult it is to pull down one's (sweat)pants with one hand, change one's pad, and pull up one's pants? All with a squirming and crying baby in the other hand? Avoiding this situation requires planning, since you can't just leave the baby unattended on the changing table or on the bed/co-sleeper. This means that I really need to remember to bring her basket upstairs with me *before* I decide to try taking a nap with D so that when the need to pee arises three hours later* I am prepared.

In other news, we just woke up from a GLORIOUS -- UNINTERRUPTED -- THREE HOUR NAP with D in the co-sleeper (not the bed), and me unconscious in the bed next to her. The only problem with it was that it was ONLY three hours long, and now that D has eaten (actually, she's eating right now), I want to go back to bed.

Here's hoping that this new skill of D's (sleeping not on top of me) generalizes to sleeping at night as well.

*Do you realize how amazing it is that I can once again go for three hours without peeing?

Going home from the hospital

2012-01-28T18:57:00.000-05:00

Co-sleep

2012-01-28T10:56:00.001-05:00

Thank you thank you THANK YOU for all your advice regarding sleeping and breastfeeding Miss D at night. Someone (I think it was Larissa) pointed out that passing out on the couch with the baby was probably at least as dangerous as sleeping with the baby in the bed, which is totally true, and I think helped sell Luca on the idea.

And I also want to apologize for snapping at Liana about already having a co-sleeper. Six months ago I didn't even know what a co-sleeper was, so if anything I should be impressed that she knows of their existence at all.

The issue with the co-sleeper is that it is located 3 feet away from me, which in D's mind is an unacceptably far distance. In fact, anything over 12-15" is too far in her mind. Thus, our problem. We've decided to try to have her spend more time in the bassinet during the day to get her used to not being in constant physical contact with us, and we suspect this will help. However this will probably take a little time.

Last night went much better. Luca and I went to bed at 11:30 after feeding D from 10-11, changing her 3x right before bed (for 3 poops spaced 15 minutes apart -- she is a machine). We put her *in the bed* next to us in her sleep sack, since she usually starts bawling inconsolably if we put her in the co-sleeper. Within about 30 minutes, she started rooting around my chest. I held out hope that maybe she'd fall asleep since she'd literally finished eating 30 minutes prior..... but then the sobbing started so I decided she probably really did need to eat and I put her back on my boob.

She remained on one boob or another, eating or sleeping (but mostly eating) from 12 last night to 6 this morning. Child loves the boob. However since we were feeding in the side-lying position, after she got a good latch I was able to snooze a little too while she ate. And since I have a giant blister on one nipple (am going to try the Lansiloh and the hydrogels this weekend), I can assure you that it was NOT a deep sleep.

Luca got up at 7 and offered to take D downstairs so I could have some real sleep, but she started crying and rooting around again, and after 30 minutes brought her back up to eat some more. We eventually got out of bed a little after 9.

I guess all of this explanation is to say that it would *actually* be impossible for me to get up out of bed to feed D at night because I'd never actually make it to the bed in the first place if we did that.

Anyway, this probably all sounds horrible to you (especially those of you sans kids), but I basically got 10 hours of light, off and on sleep last night, which is more than I've gotten for a week, and I feel completely glorious today.

I have a couple of goals for the day which include:
A) Tummy time
b) Alone time in the bassinet
c) A short walk OUTSIDE THE HOUSE (it is 50 degrees and lovely out, and I feel like I should take advantage)

In other news: I peed off 10 lbs of fluid over the past two days, and I can *almost* recognize my feet again. Also, I no longer have an outie. Yay!!

A couple of people have asked how the Boo is adapting to all of these changes. And I have to say, despite all of our concerns, she has actually been pretty awesome. I got progressively worse about giving her adequate attention and exercise over the course of my pregnancy, and I think that this has made the transition easier. Ha.

She finds D interesting, especially when she cries, but not in a bad or aggressive way. Mostly she just comes over to sniff. The "leave-it" command and the "look" command have been especially useful. She is way more interested in treats than in the baby. This morning when Luca took D downstairs, I invited Boo up on the bed. When Luca came back, she was snug under the covers, and neither of us had the heart to make her go back to her bed while I fed D, and Boo couldn't have been less interested in her.

I think the only thing that Boo really hates is that D keeps her up at night with her crying. Boo is a lady who appreciates her beauty sleep. On the plus side, a tired Boo is a well behaved Boo, so I really can't complain there either.

Peds

2012-01-27T22:10:00.001-05:00

Little D had her first visit to the pediatrician yesterday, and it went well!

It was during this visit that I realized something: I LOVE breastfeeding.

I already knew that it made me feel close to D, and that I was still enjoying it even though she's made my nipples sore (seriously. Ouch.). But during the visit, she started to get a little fussy, and since it was time to feed her anyway.... (I mean let's face it, she's 5 days old, any time she wants it means it's time) I just whipped out a boob and popped it in her mouth.

Then the doctor came in, and we did the full history with her eating. She was quiet and content. And when we got to the physical exam, she was a little sleepy and very relaxed, and barely cried at all. Even when the doctor tested her Moro reflex.

Things were a little more awkward when she started howling again as we were waiting to get blood drawn so she could have her bilirubin checked. There were a bunch of people in the waiting room and I felt like I should at least attempt to cover up. I am not coordinated enough at the process to both get a good latch AND be discrete, but with some help from Luca we were able to pull off something that was probably just modest enough. I didn't actually care THAT much though. It's amazing what being a little tired and showing your vagina and breasts to the entire world during L&D does to a girl's sense of modesty.

Anyway, while we were there, a woman who looked to be about our age emerged from an exam room with an adorable 12 day old baby. The baby's mom was a few steps behind her and was probably about 16 or so. It made me feel so sad. I wondered whether grandma and mom felt the same way about their baby as Luca and I feel about mine. Then I felt really guilty and judgmental for thinking that at all. I mean, why wouldn't they feel the same way? On the other hand, teen motherhood is clearly not optimal for anyone. I don't know.... I'm chalking it up to the hormones, but that's mostly because I don't know what I'm supposed to say about these things. Everything that comes to mind seems condescending, judgmental, and counterproductive, so perhaps it's best if I say nothing at all.

Then we went to Chipotle, where I wanted to seriously smack the excessively perky girl who makes the burritos. She remembered Luca and me, and I guess was trying to show us that she knew "our" order. Except that I got something different than usual, and was feeling poozely from my excursion, my hemoglobin of 7.something, and my recent surgery, and I didn't feel like laughing at her comments, which are annoying even when I'm not feeling like garbage. She tends to get a little confrontational if you don't go along with her act. Suffice to say we got out of there quickly, and fortunately before I said anything offensive.

I spent most of today in the house feeling much better than yesterday, but still completely unprepared to face the real world. A walk around the block was about all I could handle. I have to keep reminding myself that I'm still only post-operative day #5, and I'm allowed to feel like crap and not want to talk to anyone.

Cartoons

2012-01-27T11:48:00.000-05:00

I also wanted to take this opportunity to put in a plug for Dr. Fizzy's blog and recently released book. I haven't read the book myself yet, but if it's anything like her blog (and I am assured that it is), I think most people who enjoy reading MY blog would probably like it also.

Enjoy!

Ah Caverject

2012-01-27T11:38:00.000-05:00

In honor of the talk I'll be giving at a conference in May on my research, and since I'm not my usual entertaining self these days, I thought I'd link a recent post from Dr. Grumpy's blog from a few days back.

And yes, apparently the story is completely true.

Tired

2012-01-26T18:56:00.003-05:00

As I woke up from a 1.5 hour nap (glorious!) and feel so so much better, I recalled with amusement a conversation I had with my brother in law about 5 months ago. It was the first day that we arrived in Italy, and we were out at dinner talking about pregnancy and babies.

My sister in law primarily wanted to know if doctors in the US chastised women for wearing high heels during pregnancy in the US. I really wouldn't know.... I can't remember the last time I wore heels.... Apparently this is something that they do in Italy however, and as woman who wears 4 inch stilettos to the grocery store, is of primary concern to my sister in law.

My brother in law was hung up on how much work babies are. He said something to the effect of, "They eat every four hours! And that's from the beginning of one feed to the BEGINNING of the next one! There's no time in between to do anything else at all!"

And well, yes. This is basically true. Except four hours is for formula fed babies. For breastfed babies it's more like 2-3 hours.

And it's not like that rule gets extended if your baby is a slow eater. Nope! If your baby takes 60 minutes to eat, and she's eating every 2 hours, then you only have 60 minutes to sleep or do whatever after it's over to do other stuff.

Except that's not even really true either. Because sometimes (often) babies need you to soothe them in between feedings as well. And since you're supposed to feed on demand, often we find that our baby (who from this point forward will be called Little D) will start rooting around already hungry 15 minutes after finishing her last meal, so in effect she has been eating every hour for about 30 minutes a session.*

Don't forget that this behavior is around the clock. So... sleep? What is that again?

Also Little D does not like to sleep anywhere except for on top of me. Including in her bassinet. You can put her down, and she will start whimpering after about 5 minutes, and after 10 this will have escalated to desperate sobs. I am *hoping* that she's just been a little chilly, and tonight we're going to try an extra blanket under her sleep sack to see if that helps at all.

I am not optimistic. The middle of the night was her active time when I was pregnant, and there's no reason for that to no longer be the case now.

Brief, but important side bar: When I was in the hospital I noticed that I would often fall asleep while breastfeeding. The lactation consultant assured me that this would happen, and that as long as the baby wasn't in danger of falling or being squished, it was nothing to worry about. This made things so much easier! When it was 3AM, and little D was fussy in her bassinet, I'd just translocate her to the bed with me to feed her. We'd do a side lying hold (remarkably easy for us to master -- haha big surprise since the mom is lying down on her side for this hold!), Little D would nurse, and I would "relax."

Just so you know "relax" is code for "pass out completely for like, an hour while the baby eats." But nobody said anything about it while we were in the hospital, probably because when they saw me, I'd be awake. Probably also because D was eating off and on more or less continuously 24 hours per day and any reasonable human being knows that parents -- even parents who are doctors (to be) -- need to sleep sometimes in order to be able to do things like.... oh I don't know, remain alive?

When Luca and I figured this out, we felt like we'd figured out the secret cheat to some video game.

Why do I say that? Because while falling asleep while nursing is permitted if it's unintentional, if you do it on purpose it's called "co-sleeping." And, well, only bad parents who don't care if they roll over and squish and kill their babies would ever do something like that on purpose.

So apparently, even though my child eats more or less continuously throughout the day, since I know I will fall asleep when I nurse in the side-lying position, I am actually supposed to get up out of bed and sit in a chair to nurse -- for 60 minutes or perhaps even all night if necessary -- in order to prevent myself from falling asleep while nursing or while holding Little D.

Honestly, the thought of doing this made me a little sick to my stomach.

I immediately starting concocting ways to get around this prohibition. What if instead of going to bed, I "slept" sitting up on the couch? Then when Little D wants to feed, she could just lie on my chest like she does during the day (when I have been known to nod off as well, I might add). But, since she is *on top* of me, and because I am technically sitting and *not* lying down, it doesn't count as co-sleeping, right?

Haha, I'm sure that would be frowned upon as well. Still, Luca and I just woke up from a 1.5 hour nap on the couch where I did exactly that, and we feel so much better now it's not even funny.

All this is in support of my theory that -- at least where doctors are concerned -- if something tastes good, feels good, or generally makes your life easier, then it's probably dangerous or at least bad for you and probably you shouldn't do it.** And there is yet another reason I have a hard time seeing myself doing primary care.

Anyway, this phase is not going to last forever, I know. And Little D is so completely amazing in every way. We are so happy to have her and can't believe she is all ours.

*Yes my nipples are starting to get a little sore. Nothing too horrible yet, but when she starts nursing, things are a kind of ouchy until she gets going. I will say that Luca is a little jealous that he can't breastfeed too since to him she seemed very bonded to me from when she was only a few hours old, and for the first couple of days she would howl any time he held her. I'm happy to report that she now appears to enjoy falling asleep on him as much as she likes falling asleep on me, and now I am the jealous one because he doesn't have to have sore nipples.

**Haha!! It's a joke! I'm kidding!! (sort of...)

The Birth: How it went down

2012-01-24T21:55:00.001-05:00

Sorry for the lengthy absence from the internet, dear readers. I finally had my baby on Sunday 1/22. She weighed 8.85 lbs and was 21.25 inches long. I am still mastering the art of typing while breastfeeding, so I apologize in advance if this post ends up having a lot of typos.

So on Saturday in the morning, I worked on some STATA code, and got my first loop to run. Then in the afternoon, I hung out with my friend M from med school in the afternoon. We talked about a bunch of things, some baby related, some not. She left at about 5:30, and then Luca and I had dinner and watched How I Met Your Mother reruns.

At 9:30 we decided to walk the Boo. We'd had freezing rain all day, and it being West Philly, a lot of people hadn't bothered to salt or shovel their sidewalks, so the going was a bit treacherous. Still, it felt good since I'd been cooped up inside all day. We got home at around 10, and I felt this pretty strong cramp in my lower back and abdomen. It wasn't horrible or anything, it was just different than the cramps I'd had before.

So while Luca went and did the dishes, I watched a little more tv. About 15 minutes into the show, I felt kind of a pop and a squirt. Like I'd peed on myself, only I hadn't been moving around so I was a little surprised that this had happened then. I went upstairs to the bathroom to clean up and pee, and more fluid came out, but not THAT much, so I still wasn't sure whether my water had actually broken. When I came back down to finish my episode, it happened again. And now I'd started having regular contractions, but not that strong.

So, this was all at about 10:20 Saturday night. Between 10:20 and 11:00, I kept having mini-contractions, so I alerted Luca to what was going on and decided to take a shower (best decision EVER). We'd been told to wait to come in until my contractions were 60 seconds and 3-5 min apart for at least 1 hr. Mine started off at 60 seconds each at 2:30 apart, and just kept getting stronger.

So, at 12PM we came to the hospital. And I was 100% effaced, but only 1cm. So I waited for two hours so they could see whether my contractions were actually doing anything. Wow were those a painful 2 hrs. But the baby looked great on the monitor.

2 hrs later I was 6cm, so I guess I really was in labor,

:-)

Then I got admitted, and as soon as I got back to my room, my water broke FOR REAL. I have to say though that I had enough pain that the fact that I was sitting in a giant pool of amniotic fluid didn't bother me in the least. I requested an epidural, and was told that there was a line and that it might take as long as 3 hours to get one, which at the rate I was progressing was likely going to be too long.

I did end up getting on about 90 minutes later. Holy mother of God were those a painful 90 minutes. If I'd had to deliver without one, I suppose I could have, but WHY on earth I would have wanted that is beyond me. I also discovered why they tell pregnant women to breathe a particular way: screaming does nothing and actually made me feel worse.

The anesthesia resident gave me an absolutely fantastic epidural. I still felt some pain and pressure, but the edge was taken off. I could still move my legs and feel them, but had very little pain. I was 9 cm by the time they were done and told to nap/relax. I think the labor floor was pretty busy on Sunday and they had several emergencies, so I waited relatively comfortably and took a nap sitting up trying to dilate the rest of the way to 10 cm.

At some point it was determined that it was time to push. Which I did for three hours. They tried rotating my baby in my pelvis (not fun -- I can only imagine REALLY not fun without an epidural) a couple of different ways to get her to come out, and tried having me push in several different positions, it was determined that her position was unfavorable for a vaginal delivery. She wasn't in any distress, but she just kept getting hung up on my pubic bone. So we decided to go forward with a c-section. Since both ORs were already busy with other patients and my baby wasn't in any distress, I took a 2 hour nap, and then they got me ready to go back. I needed it. At that point I'd been awake for almost 40 hours straight and was feeling a little loopy.

The c-section was a lot of pushing and pulling, and not the most comfortable thing in the world, but really not a big deal at all. I just remember feeling really cold and shaking a lot, which was also due to the anesthesia. It took 7 minutes from skin incision to having her out, and I could hear her strong cry from behind the blue curtain. Then someone called out, "It's a girl!" and I remember feeling so happy. The pediatricians worked on her (APGARS 9 and 9), and my husband got to hold her. It was a little surreal -- I kept thinking WOW I'm a mom now, but it didn't really hit me until I got back to the room.

We got to do skin to skin contact right away, and tried to get her to latch on my breasts, which she did on the third try! This girl is a champion sucker, that is all I have to say. We did the left breast and then the right, and my friend M came down from the 9th floor where she was on call that night (M is a resident where I gave birth) to visit me. She was so sweet, and it was awesome to be able to have such a close friend and my husband in the room right after delivery. Then my parents came and the nurses bathed our daughter while she was in the room with us. She HATED the bath and cried like she was being tortured. My dad took a video of it, and you can just see how furious and indignant she was.

Then my parents got to hold her, and we talked for a bit while I waited to regain feeling in my legs so they could transfer me to the post-partum floor. Luca also cried a couple of times, which was really sweet. My husband is such a cutie.

Then my parents went back to the hotel and we transferred upstairs. She roomed in with us that night, which turned out fine in the end, since she was so sleepy from just having been born, and we breastfed her a bunch of times.

I am really happy with my experience. I had the most awesome L&D nurses and the Ob/Gyn resident who took care of me was really great also, and the nurses on the post-partum floor have been really helpful as well. In fact, we've probably only met one provider we didn't like so far, and that very well could have been because we aren't sleeping all that much at this point yet and have gone through periods of tired & crankiness.

Things that have surprised me..... How much I love breastfeeding her. Luca even said that he was a little sad that he is a man and doesn't get to do this. And I agree! Maybe it's all the post-pregnancy hormones talking, but I love the way it makes me feel. I got lucky and she started off latching like a pro, so my nipples have not been that sore yet.

I was surprised at other parts of the process too. I was surprised that my labor was as chill a process as it was, even though ultimately we ended up with a c-section. I got a lot of useful coaching (though no cheering!), she was just positioned a little transverse, and so could not descend easily. I was surprised that I didn't care that Luca was the first one to hold her, or that he ate several meals in front of me and I didn't care at all even though I was NPO or ice chips only. I was surprised at how well I was still able to move my legs with the epidural, and I was surprised at how controllable my pain was with breathing only before I got it (though I would still never choose to go sans epidural -- it is truly an amazing technology!). I was surprised at how nice and helpful all of the staff were, and I have to say vis a vis being told I was fat by the outpatient people? I would TOTALLY go through this again if I got to have such a wonderful L&D experience.

I have also been surprised at how much I love taking care of my daughter, and how relaxed it makes me feel. I don't even mind when she cries, and though I'm certain I will mind at some point, it's been really satisfying to figure out different things I can do to soothe her. I love skin to skin time. I love that last night I figured out how to do the side-lying hold and could kind of doze off a bit while she ate. My little girl has a champion appetite it seems and is just as awake and alert at night as she was when she was on the inside.

My only curiosity is this: Do you ever feel this way again if you have more than one child? Or is it different with every one? Luca said today that he had started thinking, "We should have done this YEARS ago!" to which I said, "Well, we probably could have done it one year earlier, but I think it was nice to have a year or two to experience just with each other after I'd switched from MD-land to PhD-land.

So, that's where we are! Tomorrow we're likely going to get discharged home, and that's when I'm guessing the real fun will begin. Wish us luck!

Here's a picture of her right after she latched on for the first time.

Yes, she went into labor after all

2012-01-22T22:43:00.000-05:00

Luca The Husband is temporarily highjacking OMDG's blog to happily announce the arrival of their brand spanking new baby daughter.

Labor was, well, laborious,but mom and baby are doing well.

High-five to the anesthesia team for a kick-ass epidural and to the L&D nurses for being awesome.

Gazillions of pictures to follow shortly.

The blog will return to regularly scheduled posting as soon as OMDG gets some R&R.

Thank you all for the well wishes!

Luca

No I am not in labor

2012-01-20T15:35:00.001-05:00

This is what I tell my parents every time I call them these days. Because when they pick up the phone, you can just hear the anticipation on the other end.

Last night I had 3 hours of Braxton-Hicks contractions lasting 60-90 seconds each 3-4 minutes apart. Not painful at all. Just annoying. They went away after I ate some dinner and watched a little tv. I actually slept reasonably well last night.

This morning, I texted my husband at about 7:45 after I'd showered and eaten breakfast.

Him: Did you get my note?
Me: What note?
Him: That I took your cellphone charger to work with me. My battery was low and I needed to charge my phone. I wanted to make sure I didn't miss your text if you end up needing to go to the hospital today.
Me: Aw you're so considerate, honey! Just so you know, this means I will definitely NOT be going into labor today. Thanks A LOT!
Him: Well, you know if I hadn't brought the charger then you definitely WOULD have gone into labor, and I would have missed your call.

We both agreed that the probability that I will go into labor tomorrow is higher than today because Philadelphia is scheduled to receive snow.

I swear we are both scientists and we never ever engage in magical thinking.

*****

Yesterday I found out that my abstract had been accepted for an oral presentation at my May conference.

On the plus side: Yay! Oral presentation > Poster only!
On the minus side: F-ME! More work to do before May!
On the plus side: Maybe having to do this extra little bit of work will mean that I'll actually be motivated enough to get this paper out.

The reality of what I have to accomplish between now and this time next year has recently hit me. In order for me to graduate by 5/2014, I need to defend my dissertation by 3/2013. Since my biostatistician will be out of the country on sabbatical starting 3/7/2013, I officially have my oh-shit date.

Between now and then I have to:
1. Complete Aim 2 of my dissertation (which I only just started working on last week)
2. Do above oral presentation for other project, write manuscript, and submit
3. Design from scratch Aim 3 of my dissertation
4. DO Aim 3
5. Write up my dissertation

I love it when people tell me that I really should just be relaxing right now. That now is the time to be taking it easy, and relishing the unencumbered life of a not-yet-parent. But I can't afford to -- I have too much to do!

Because really? #1-3 need to happen before 6/1/2012 in order for me to realistically have a shot of completing everything by 3/7/2013. Ok, Aim 2 doesn't have to be completely done and submitted, but it needs to be pretty close. Subtract out 8 weeks of maternity leave, and that doesn't leave much time at all for getting this stuff done.

All this with the little booger refusing to be expelled from my uterus. My concentration levels are not at their finest right now. Today, I'm trying to make myself learn how to write loops in STATA. It's coming along, but OF COURSE not as fast as I'd like it to.

Now the painless contractions have started up again. No, no, they're not distracting at all! Maybe at next week's appointment they'll strip my membranes and I will go into labor, and we can at LAST get this show on the road.

It's not about the cheesecake

2012-01-19T16:12:00.002-05:00

I have a neighbor who I like, but rarely see since it's winter and neither of us spend much time outside these days. She's great. She has a big dog that the Boo gets along with and we used to have her and her boyfriend over from time to time under the pretext of a doggy playdate. Then they got a second dog who does NOT get along with the Boo, so we stopped having the playdates. Now we don't see much of each other at all.

It's really a bummer! She's such a sweetie, and I always enjoy talking to her about the house, the dogs, school, the garden, the boys, etc. And every time we see each other we say we really ought to do this more often.

So on Tuesday, since I was working from home that day, and since I thought she might be home not working, I texted her to find out whether she wanted to come over for a slice of cheesecake.

She replied that she did not want any cheesecake since she hadn't exercised in two weeks. But thanks for offering!

I didn't really know what to say. After all, I wasn't *really* asking her over to force cheesecake down her throat, I was asking her over just to chat for a little while.

So I assured her that she had nothing to worry about vis a vis eating too much cheesecake, and suggested that after I give birth perhaps we can start exercising together (we've been on a couple of runs in the past, and it's been fun), and I still got rebuffed!

Sigh.

Should I just have told her that actually I was just texting her to find out if she wanted to hang out for a little while, and that the cheesecake was just a pretext? Gah! I don't know. It just makes things awkward since now I don't know if she didn't want to hang out at all, or if she really just didn't want to be force fed cheesecake.

This "making friends" thing can be so confusing sometimes!

The real reason

2012-01-18T17:55:00.006-05:00

I've blogged before about not wanting med students in the room when I give birth. And a lot of people have said, "Of course you wouldn't! I wouldn't want my classmates looking at my vagina either!"

And yes, that is part of it. Especially my vagina while in the process of giving birth.

But the real reason has nothing to do with modesty as much as it has to do with decorum. See, I don't expect to be especially composed while I'm in labor (unless I get the best epidural of all time -- which, hey! A girl can hope, right?). And I just don't want my classmates saying, "Wow, OMDG was CRAZY when she was in labor! You should have heard the things she said! And the way she screamed at her husband? It's a miracle that he doesn't divorce her."

Ok, perhaps I'm being paranoid, but that's the the real reason. And.... not sure what else there is to say about that!

Things I am Looking Forward to About No Longer Being Pregnant

2012-01-18T03:41:00.002-05:00

- This bullshit! I've been lying awake in bed for 1.5 hours now for NO REASON.
- Being able to sleep without my hands going numb
- Sore PIP joints due to edema
- Being able to roll over in bed without completely waking up and having to readjust everything
- Sleeping for more than 60 minutes consecutively
- Putting on my shoes without having to sit down
- Not having to plan my day around how many times I have to change my socks
- Being able to stand the entire time I'm showering without feeling at some point that I might pass out
- Being able to walk for more than 1.5 miles without developing a sore back and having to sit
- Not feeling my knees ache every time I stand up
- Having my feet no longer be swollen -- I've had to loosen the laces on my sneakers twice in the past two weeks. Scratch that. LUCA had to loosen them because I couldn't reach my own feet.
- Being able to find a comfortable position while sitting on the couch
- Being able to eat sushi, cold cuts, stinky cheese, and have a glass of wine
- Being able to pick things up off the floor without doing a plie
- Hugging my husband without having to twist sideways to do it

I'm sure I'll think of some other things, but right now the insomnia is what is pissing me off the most. And yes, I know when we have our little bundle of joy I won't get as much sleep as I want. However at least then I will be up FOR A REASON.

OMG cheesecake

2012-01-17T08:31:00.004-05:00

As a side note, Luca and I made our first cheesecake yesterday afternoon. It was lemon flavored with a graham cracker crust (the one from the Bittman cookbook). And OMG, it was... no IS, A.M.A.Z.I.N.G.

So light and fluffy! I was worried about the step where I had to fold the beaten egg whites into the rest of the batter, that I would end up deflating the whites, but this didn't end up being a problem at all.

We decided not to go with the sour cream topping. We made that when we did a key lime pie recipe a few months back, and it was really good, but this time laziness prevailed. And the long and the short of it was: it wasn't necessary.

We'll definitely have to repeat this experiment. Who knew cheesecake would be so easy?

Recipe -- The brief version
- Preheat oven to 325 degrees (my oven runs cool, so we preheated to 340) -
1. Separate 4 eggs -- put the whites in one bowl and the yolks in another.
2. In the bowl with the yolks, use an electric mixer to make the yolks creamy.
3. Then to the yolks add 24 oz. plain Philadelphia cream cheese (3 bricks), the juice from 1 lemon, 1 cup of white sugar, and the zest of 1 lemon.
4. When the mixture is smooth, mix in 1 Tb of white flour.
5. Use the electric mixer to beat the egg whites to the point where they stand up in peaks by themselves.
6. Fold the egg whites gently into the egg yolk - cream cheese mixture.
7. Pour the contents into a pre-made graham cracker crust shell (you could always be fancy and make this yourself if you wanted to).
8. Pop in the oven for ~1 hr, until it starts to brown slightly.
9. Cool on counter top, and then after 30-60 minutes, cover with plastic wrap and pop in the fridge until it's fridge temperature (we let it sit overnight).
10. Eat for breakfast the next morning.

Interrupting

2012-01-17T07:16:00.001-05:00

A few weeks back I did an information session with a prospective MD-PhD student in my department. It wasn't an interview, and the session was purely provided so that he could meet current students in his prospective department and ask us questions.

Long story short, it was fine. My department provided doughnuts (woo!), and it only took up about 30 minutes of my time.

But you know? I thought the kid was kind of a douche. First of all, he approached the sessions like he was just interested in selling himself. Every phrase he uttered seemed like it was designed to convey, "I am awesome," to us. Which, I mean, ok it's an interview. But it was so fake! It came across more as, "I am smarter than everyone including you," than as, "I have so much to offer this place, including you." Plus, it's pretty irritating to have a conversation with someone that consists of them essentially repeating to you how smart they think they are.

Second he had a list of questions that were germane to basically nothing about how the department actually operated, and served to primarily allow us to talk about how great [my school] is. A bunch of softballs. As a result, he got no useful information whatsoever. We never got to tell him about the coursework, or the mentorship, or the funding, how medical school was integrated with the PhD work, the fact that he'd have to write a grant to pay for himself if he came here, or what it was like to be a student in this department at all.

Finally, and possibly most annoying of all, every time I (or any other woman he was speaking to) opened her mouth, he would interrupt after we'd been talking for, oh.... about 5 seconds. Before it was even possible to answer his question or to provide any nuance. I thought it was just me, but then I saw him do this to another woman 5-6 times in a 3 minute conversation. After he did this to me a couple of times, I stopped caring whether I ended up giving him useful information, and started counting down the minutes to when the session would be over. And I'm sorry, if you do this to people, it conveys -- whether you mean it or not -- that you don't actually value the information you're being given, or the person who is providing that information to you.

Ah well, as I said it wasn't an interview, so my opinion does not matter at all to the admissions process. But I guess for those of you who are interviewing for anything in the future, make sure you listen as well as you talk about yourself. Being smart isn't enough. You have to be able to show people that you can play well with others, and that you don't think the world revolves around you. And especially, nobody likes an egotistical med student.

Ok.

2012-01-16T13:12:00.005-05:00

Well, I think I can say now that I am officially tired of being pregnant. Even though I'm having regular contractions (which are only mildly uncomfortable if at all), they are doing nothing. Cervix is still closed.*

Luca and I have this three day weekend and we can't do anything! All of our baby-related errands have been run, and we really don't want to go shopping just so I can spend some money on stuff I don't need, or to a museum where I'd have to stand all day. I can't stand for very long without getting dizzy and short of breath, so those kinds of activities sound like torture to me.

And I am NOT doing work today. I already spent a good part of Saturday working on my models. I've gotten all the school work done that I wanted to before I gave birth. Any work I'm doing now is on new projects. Which is fine. It's just a good stopping point's all.

Pre-pregnancy on days like this, we'd go for a run, go out to a pub and get a burger and a beer, go climbing or swimming. We did go for a 2 mile walk this AM with the dog (which really was lovely), but now what? I'm tired of watching movies on Netflix. I don't feel like reading. And I have an Ob appt. at 2PM where I'm sure nothing will happen.

I think maybe we'll bake something when we get home from the appt. Of course, I won't be able to eat any of what we make.... haha**. Maybe we'll order in Indian food tonight or something.

It seriously feels like we're never going to have this baby.

*Update -- Just kidding. Now I'm at 1cm, 50% effaced, soft. Progress from Saturday, for sure. And yes, I know it's no indication that labor is imminent or anything like that.
**Of course I will eat it. The Ob/gyn can go right ahead and bite me.

Oh yeah

2012-01-15T12:39:00.003-05:00

I passed my oral candidacy exam. One more hurdle behind me on this long, LONG, road.

Trying to be Salman Rushdie

2012-01-15T11:36:00.001-05:00

Yesterday evening I fell walking the Boo, and got to spend the evening in the ED being monitored. Woo!

While I was there, I read some more Cutting For Stone. And I have to say I'm having a really hard time getting into it.

It sort of feels like it's trying to be this big epic involving a health clinic, the coming of age of two boys, with the backdrop of Ethiopia. Kind of like Salman Rushdie did with Midnight's Children (except there was no health clinic pretext, and Midnight's Children took place in India).

Only Cutting For Stone is just not as good as Midnight's Children. I find myself not giving a crap about any of the characters, or what happens to the health clinic or to Ethiopia. Pretty much the only parts I've found interesting have been the medicine and surgical references. Kind of like, "Ooh! I know what that is." And then we move back to the twins or Hema and I find myself not giving a shit again.

The only issue is that a number of people have told me that this book is The Best Book They Have Ever Read(TM) and I feel somewhat obliged to at least try and finish it (I'm at 37% now).

Not sure why I care.... after all I think I'm basically the only person alive who liked "Look at Me" by Jennifer Egan or "Cat's Eye" by Margaret Atwood, and that doesn't make me like those books any less.

So this morning I downloaded a bunch of books off of Project Gutenberg, which at very least, even if I don't like a single one, at least were free. And I bought "Confessions of a Shopaholic" which, hey -- I know it's not high literature -- but at least it isn't trying to be.

Hopefully I'll find at least one of these books to be enjoyable.

More pregnancy pictures.... and the Boo

2012-01-14T10:08:00.004-05:00

Luca has been experimenting with his new camera, and last weekend we took a bunch of pregnancy/Boo pictures.

This one is a little cheesy since I'm standing on the bed. But, the light was the best in this room, so we did what we could with the space. Check out the eye contact from the Boo! If only she could always be this obedient!

The classic "Look at my bump" pose.

And another.

Believe it or not, the Boo does this on command (treats help!).

For Christmas this year, Luca got one of his photographs of the Boo and me printed on canvas. Here I am holding it. (Again, check out the eye contact from the Boo. Such an obedient doggy!)

And finally, one of the Boo on her bed, which is located practically underneath the chair I sit at when I work from home. Just because she's so cute!

As a side note, I recently realized that if I go past 41 weeks and need to be induced, my induction date will be on 2/3. Which means that I could conceivably have this baby on 2/4, which is my ex-bf's birthday. And that SIMPLY WILL NOT DO. Ok kiddo? Are you listening? You need to come out (preferably) before that, or if you absolutely must wait that long, after that. Deal?

Switching Gears

2012-01-13T15:56:00.003-05:00

I submitted my revisions on Tuesday, and my paper was officially accepted by 12PM on Wednesday! Woo!

And now I get to switch gears and start working on my myriad of other projects.

Earlier this week I created a new dataset for my Aim 2, and now I'm in the process of running a bunch of models. This morning I set up a bunch of batch jobs to run on the grid, and I'm basically going to ignore them and work on other stuff until they finish running, sometime in the next week(?) or so.

Unfortunately, I think I got one of the slow processors, so I may have to run my jobs individually on my school PC sequentially instead of simultaneously on the grid.... (not that any of you all really care here -- just thinking out loud, folks!)

Then our data programmer returns on 1/20 (from a TWO MONTH VACATION.... bastard), and I'll need to give him a list of variables to create for me that I'll need to run as well. It won't take him long, I'm sure, but he'll probably also have requests from other people who have ALSO been waiting for two months.

And then there is the other paper that I've been sitting on (again) for months. There are a couple of things that I need to fix from my old analyses, and then I have to think about a better way to spin this paper to make a more compelling story when I submit it. I have some ideas, but of course all are somewhat time consuming. Something to mess around with using one hand after I've gotten the hang of breastfeeding maybe?

We'll see.

Learning by doing

2012-01-13T09:07:00.004-05:00

I was talking with a friend who recently returned to clinics after a year out about an elective he was doing. He said the elective was ok, but that they didn't let him do anything, and at this point he felt ready to move on. To actually be part of the team. To have a job.

And this, friends, is one of the things I disliked most about being a medical student, and in particular about being a clerkship student. You didn't really have a job. Nobody would tell you what they expected you to do, but yet perfection was demanded from the outset. On rounds, you were expected to stand there, looking like you were completely enthralled by whatever the attending was saying even though 25% of the time you couldn't hear. And in the moments when someone actually spoke to you (which were few and far between) you were expected to come up with something brilliant / fascinating to reply with, which would impress on them that you were the best and smartest medical student ever, and deserved honors. Oh and my favorite part was when residents and attendings would address you as they would a small child.

I think one of the reasons I loved my sub-i (and my neurology externship) was that I was actually permitted to see patients on my own, write notes, and you know, use my brain. I really like having a job. And occasionally, someone would actually listen to something I had to say about a patient. When that happened, it was AMAZING.

But now I hear that they're going to get rid of the sub-i???

Let me clarify a bit. So, one of the things that was special about my med school was that when you did a sub-i you actually replaced an intern on the team. You carried the same patient load as an intern, and you did everything that an intern does. At many schools they have an externship instead of a sub-i where you are an extra person on the team, rather than a replacement. It's considerably less intense. At least though, you still have your own patients.

I guess they're getting rid of it because of a) scheduling issues that came with work hours reform, and b) liability reasons.

But still I see it as kind of a bummer.

I guess with the new arrangement, you'll still be able to "do," you just won't be doing as much as before. Ergo, learning will be slower and there will be more downtime.

Sometimes I find myself really looking forward to getting back to the hospital. To seeing patients, and checking off boxes on (endless) to do lists. To running around all day and feeling like I'm actually getting stuff done. But then I hear stories like this and it sounds like it's actually just going to be a huge letdown.

Other interesting tidbits from the Failure Panel

2012-01-12T11:19:00.002-05:00

Everyone agreed that having a manuscript rejected, or not getting a grant, remained disappointing even as they got farther along in their careers.

Most of them had been scooped at one time or another. At the time it seemed like an insurmountable setback, but in the long run it hadn't mattered so much.

They said that it was ok if a field/line of research had more than one expert, and that sometimes it was good to have competition and conflicting points of view on one topic.

They encouraged everyone to have multiple lines of research/projects cooking at the same time in order to spread the risk in the event one didn't work out. One panelist remarked that not all PIs are good at providing this for their mentees, and it was up to the mentee to seek out other lines of research. Still not sure how to go about doing this....

Many of them had kids during training. Some of them experienced guilt. Three of them remarked that the guilt actually got worse as their kids got older and could verbally express disappointment at various things their mommies couldn't attend. The same three said that while it was hard for *them* to hand off their babies during training, their kids didn't remember this at all, and had seemed to suffer no ill effects from it.

One expressed that it was annoying that women got extra time added to their tenure clocks when they reproduced as junior faculty members. They'd had their kids during training and couldn't benefit from that perk, and their kids were still a big time commitment even though they were no longer babies. This made me feel better, as I will be in that situation when I am a junior faculty member. I realized that I wouldn't be alone!!

Two remarked that even if you have a spouse who is completely dedicated to doing his share of the house/kid work, during the first year it is basically impossible to have a 50/50 split because men do not lactate. After that it gets easier. Both commented that they felt like wet nurses during the first year of their children's lives.

Not all had experienced discrimination / unattractive commentary from their coworkers / program directors for having kids, though they knew women who had. Those women tended to be in smaller residency programs where coverage was harder to come by, or in procedurally oriented programs where there were similar issues. It's worth noting that among the five panelists, three were in peds, one was in neurology, and the fifth was in derm. (I thought the neuro lady was awesome as usual.... maybe I should hold off on crossing that specialty off? *Sigh*!)

They said that everyone makes a big thing out of publishing in Nature, Science, and Cell, but that there are very good papers that come out in "lesser" journals as well, and you shouldn't rake yourself over the coals too much if you don't have as many Science papers as the next person. Just focus on doing good science.

They all said that if they had to do things over again, they'd freak out less. Freaking out accomplished very little, and everything has turned out ok in the end.

They said that even the most confident appearing people probably have at least moments where they doubt themselves, and that you shouldn't look at other people's confidence as a sign that you're doing worse than they are.

Ouch!

2012-01-11T09:27:00.006-05:00

Yesterday I mostly studied at home. After a while I couldn't take it anymore, and went to school to attend this year's Failure Panel, where female faculty members talk about their successes and failures throughout their careers, and give us advice about what they'd do differently (perhaps "Failure" panel is the wrong term....). Last year I organized the same event, and it went really well.

Anyway THIS year I feel I came to it with different perspective than last year, perhaps for obvious reasons. Haha.

There were a number of things that struck me. This post I will tell you all the first one (because I am in a hurry and need to walk the dog and get to a meeting!!).

So, there was a cardiology attending, and she told us stories about how she had her first baby during 4th year of med school, and her second during her second year of fellowship (she fast-tracked*). Cards is a pretty procedure intensive fellowship, and is HARD. You spend a lot of time on your feet. She was proud of the fact that she took all her required call THEN (rather than the following year), and worked hard all through her pregnancy.

When she went into labor, she was on a CCU rotation, and it was the middle of the night. And she continued to receive pages after she'd been admitted to L&D. (More than the L&D people, she noted with some pride.)

Anyway, the point is, a lot of female doctors really want to be hard core. To be seen as superhuman. To show no weakness. I will admit that part of me wants a similar dramatic story about how I worked my butt off until I went into labor (and I WILL, only the work I'm doing now doesn't require physical exertion, call, or all nighters). But the truth is, it's all a bunch of BS. Physically, I don't think I could do what she did, and you know what? I don't think that makes me a worse / less dedicated person or physician-to-be. And people shouldn't HAVE to have the dramatic story in order to be taken seriously. Your work, and how you are to work with, should speak for itself.

I can tell you from my own experience that the first two trimesters were not a big deal (though probably could be if you have especially bad morning sickness or something). But the third trimester REALLY knocked me on my ass. This is probably in part because I've had a cold for the past 5 weeks or so, and before that (when I had contractions at 30 weeks) was under the weather with something else. Before I would hear stories about how women would go into labor while in the OR -- while they were OPERATING -- I'd be really impressed. Now I hear those same stories and it makes me feel ill to even contemplate. This is because I cannot stand in one place for more than 30 seconds without getting sick and dizzy. My legs hurt (sciatica, shin splints, and tendonitis). I really WANT to be that hard core woman who is able to run a marathon up until I drop the baby, but the truth is, I am not, and can never be that person. I have come to accept this. If you can do this, more power to you, but I don't think that working like that until you deliver should be the expectation for everyone.

She commented later that some people have praised her for working as hard as she did until she delivered. But other people have told her that she shouldn't brag about how hard she pushed herself because it just sets the bar that much higher for other women who come after her. As in, "So and so did XYZ, you should be able to do that too." But for what? You're incubating another human, it's natural to feel like crap sometimes, and sometimes you really need to take it a little easier for the sake of your health and the health of your baby. That shouldn't be viewed as slacking off!

My attitude about all of this is the following: Sometimes you really do HAVE to work that hard, and sacrifice your body and your health a bit for your career. But when you don't, why do it to yourself anyway? It's like when my classmates in med school would brag (yes, that's what it was) about how little sleep they got. WHY??? I slept very well on my clerkships and it paid off big time. I'm sure I'll have to work hard later and sleep a lot less, so why torture myself now if I don't have to??

And also, for those of you who've never been pregnant, or who've been blessed with incredibly easy (and somewhat unusual) pregnancies, remember that it's not easy for everyone. It can be incredibly physically challenging. Have a heart. And I suppose that goes for other medical/family crises too. Be kind to your colleagues. The world is a much happier/better place when people try to accommodate one another than if they are constantly worried about being taken advantage of.

As a side note, now my contractions hurt more often. And they are on the top of my uterus, rather than just on the sides. Still not so bad, but maybe things are starting to cook? Or.... maybe not.

*If you want an explanation of this, let me know.... like I said I'm in a hurry this AM.

Stroke Surgery

2012-01-10T16:18:00.006-05:00

About halfway through the class I was TAing last semester, a study came out showing that vascular surgery to prevent subsequent strokes had similar mortality* as medical therapy in patients who had suffered a single ischemic stroke. The student's report of the study was fine, and it was a great study to present to the class, but I was disturbed by commentary she made at the end of her presentation.

In particular:

1. That is was a *good* thing that this study showed no difference between medical and surgical+medical treatment, because she is sick of studies that find that more costly treatments (rather than the current standards of care) are better for patients. That this null finding was a point scored for non-interventionism.

2. That the authors of the study most likely had ulterior motives (like being able to make money off of performing more surgeries), and she was glad that this null result meant that they wouldn't be able to do that.

Gosh, where to start.

So first off, if you have one stroke, you have a 20% risk of having another shortly after the first one. And furthermore, strokes -- especially second strokes -- can lead to permanent disability and death. I think it would have been great news to hear that the surgery reduced stroke recurrence because I think in general, reducing disability and death are positive things, even if doing so costs money (that's why we do cost-effectiveness rather than cost-saving research in general -- because often to get better health you have to spend more $). Maybe she was suffering from the misconception that only old people have strokes and they're gonna die anyway, so why bother? In any case, I found it troubling that she couldn't see this other important side of the issue.

And second, sure, neurosurgeons or vascular surgeons might end up with more patients had this study shown that the surgery worked... but so what? If a surgeon ends up with more cases because we discover a procedure that helps a lot of people, I'm not sure how this is a bad thing. I was bothered by her idea that this research exists solely for the purposes of enriching doctors, and not for the purposes of helping people, and also the idea that doctors should not be compensated for performing services that benefit patients.

Anyway, her commentary highlighted the bizzaro thinking that a lot of apparently well educated people have. I tried to explain why I didn't see the null result as a resounding victory for medicine, but I don't think she wanted to hear it. She probably assumed that as a future doctor I was biased as well.

:-P

*It could also have been incidence of second stroke, I can't remember at this point.

Practice

2012-01-09T15:22:00.004-05:00

Today I had yet ANOTHER Ob appointment, because all the slots for later in the week were full, and not only had the baby grown 1.5cm since last Friday, but I had also put on 4 lbs. If you want to get all technical about it, that's 6 lbs. since 12/30. My feet were really swollen a few days ago, but not so much today, so I really have no idea where all that weight is going, but I didn't get a lecture on dietary indiscretion, so I am just not going to worry about it. It's not like I can do anything about it anyway.

However, that and a report that the baby had been moving less that AM bought me a non-stress test. Which I have to say, wasn't nearly as bad as I thought it was going to be. I was in and out in less than 40 minutes, and still had time to make it to the weekly Critical Care research meeting where one of the fellows on our team was presenting his ideas.

So, the baby is fine. And it turns out I am having contractions every, oh..... 6 minutes or so. Mostly I'm not feeling them, but sometimes I get this achy sensation in my upper abdomen and lower back. Kind of like mild menstrual cramps. So, now I know what *that* is. It's definitely less uncomfortable than the contractions I was having at 30 weeks though, and they're pretty easy to ignore.

Everyone at the drs office keeps saying to me, "You're ready to go! Any day now," and Luca keeps asking me, "Do they mean, like THIS WEEK?" I keep telling him that their definition of "any day now" means between today and three weeks or so from now, and NOT that he should be expecting me to go into labor imminently. I'll admit that part of me wonders this also though.

I also ran into my PI who promised me that he'd take a look at my manuscript today. I thanked him and said that indeed, it was my preference that I submit it before I have this baby. He thought that was a swell idea.

Cleaner

2012-01-08T11:10:00.007-05:00

As a Christmas present for Luca, I told him that I'd hire a housecleaner to do a deep clean before the offspring arrives. And then, as per the recommendation of a friend of mine, I decided to use a particular company. I hired them SPECIFICALLY because she said that they came when she wanted them to.

So, regular readers may remember the various barriers to having a housecleaner that I have cited in the past, and which prevent me from hiring them. Ever.

1) You have to pick up before they arrive.
2) Luca usually "forgets" to help, and therefore I have to scramble around in the 2-3 hours before they get here doing this myself (especially not fun when 9 months pregnant).
3) Oftentimes they will only come during regular business hours.
4) I have to tend the dog while they're here.
5) They don't come when they say they will, so every single time they come, I have to waste a whole day running around picking up, and hanging around the house waiting for them.
6) Often they won't commit to coming at a particular time until the day before they arrive, so you have to block out your entire day to accommodate their schedule.

This time, I was assured by my friend that #6 would not be a problem and that they would come when I wanted. Score! So I called to set up the appointment after receiving an estimate.

I told them Tuesday would work. And then, I ASKED them what time they'd be coming.

"Oh, we don't set up the schedule until the day before, so we'll let you know when on Monday."

Hi. Unacceptable.

You'll "Let me know?????" In other words, you will tell me what time is convenient for you when it is convenient for you to do so, and I will have forgo planning anything else that day until you get around to making your schedule. And then I will have to wait for you to show up so that you can do your thing. If you show up on time, which I will be very very surprised at.

And now I'm left in this position where I am confined to my house all day Tuesday. Fantastic.

We will therefore not be hiring this company again either. I am willing to make this accommodation just this once because I promised Luca I would get the house cleaned as a Christmas present. However, this is NEVER happening again. Ever.

Who has the time to just sit at home all day waiting for housecleaners to show up? Because my schedule's about as flexible as they come, and *I* don't have the time. No wonder the cleaners think we're all "kept" women who don't work, and treat us accordingly. Because that's the only kind of person who's actually able to do this.

Vaccines

2012-01-07T08:12:00.010-05:00

About a week ago, I shared an article on facebook from the New York Times about herd immunity and why you should vaccinate your children. It was written by a woman with CLL, and I felt it was pretty non-controversial, as far as this sort of thing goes. And I got a number of "likes" and a couple of comments from some people that led me to believe that they didn't agree.... but whatever.

And then yesterday, some crazy girl that I knew from undergrad posted on my wall challenging me about the veracity herd immunity (she called it a myth). She said that because some vaccines don't last for an entire lifetime, herd immunity didn't exist.

It saddened me. She has a PhD in biology (NOT immunology or microbiology, it's worth pointing out), and she's been on the SAHM track for about 5 years now. It turns out she recently started this Natural Medicine company too. Well, more power to her. But frankly I wasn't interested in getting into a big debate on facebook with someone I barely know anymore about an issue that I consider mostly settled. Though I could in theory do this, I don't have time to wade through the literature for the purposes of finding the 1,000 most compelling articles supporting my case, especially when she has the memoir of Andrew Wakefield enshrined on her mantle.

So not worth getting into it with someone like that.

It's like talking about abortion with someone who's views are different from yours. I'm not going to change my views because of anything you say, and you're not going to change yours because of anything I say. The entire conversation is a waste of time and serves no purpose other than to make everybody mad, and fuel pointless righteous indignation.

So anyway, I told her I didn't want to debate her. That I had neither the time or interest to engage in a public debate. But guess what -- she wouldn't let it go and kept posting incendiary messages on my wall. So I called her a quack and unfriended her.

Jesus. THEN she started sending me messages saying that she obviously knew the vaccination literature better than I do, and that she was obviously right (and had SCIENCE to back her up), as evidenced by my refusal to engage her in a facebook wall debate.

I asked her how she could possibly make the claim that I knew nothing about the vaccine literature* since she has no idea what I do for a living, and set about figuring our how to block messages from non-friends. I finally figured it out, but not before she sent me FIVE more messages calling me a small person, immature, uneducated, etc..

What a freaking waste of time.

Dude. What is with some people? I suppose on the positive side, I know not to let my infant anywhere near her unvaccinated kids. Too bad not everyone tatoos their beliefs on their forehead like this. It would make protecting my family a whole lot easier.

And I did figure out how to block messages from non-friends, unfriend someone, AND block someone from friending me in the future. Thanks Mark Zuckerberg for constantly moving these functions around so I have to relearn them every time I want to change my security settings.

*Which is patently hysterical. I am an epidemiologist and have almost completed med school, and my husband is a virologist who is heavily involved with vaccines.

Writing Things Down

2012-01-07T08:09:00.003-05:00

At my last Ob appointment, after I told the NP I saw that day about my oral exam and my manuscript submission, and all the other things I wanted to get done before the arrival of the offspring, she said to me, "You really ought to write some of this stuff down so you can show it to your kid when he grows up."

Haha, indeed.

If only she knew.

:-)

To do...

2012-01-06T12:24:00.004-05:00

Manuscript revision: Completed (for now) and circulated to co-authors.

Next: Lunch.

And after that perhaps I'll start creating my datasets for Aim 2 of my dissertation? It's so cool to think I'm finally starting a new project. Of course there still is that other paper hanging over my head.... which really needs to be completed at some point in time. But since the models for Aim 2 are likely to take a month or so to run, I was hoping to get that all set up before I went on maternity leave.....

Over the weekend we'll be doing a lot of house related tasks:
- Fire up the chest freezer in the basement
- Do big grocery shop for staples to eat right after the kiddo is born
- Pick up house in preparation for house cleaners next Tuesday
- Wash the dog
- Set up the co-sleeper
- Finish packing hospital bag (it's almost done, I just need to put everything into a bigger bag since the glorious bathrobe my friend M gave me does not fit in the current bag)

I'm sure there's other stuff to do too that I'm blanking on at the moment.

Baby is really pressing down on my cervix today = ouch. Hold tight, honey! Mommy really needs to submit this manuscript before you arrive....

Summary to Ob Visit

2012-01-05T15:10:00.002-05:00

No lecture about my weight -- Woo!

Had an ultrasound to confirm that the baby's head is down. It is. (No wonder it feels as though I am carrying a bowling ball around in my pelvis.)

She remembered to ask about my oral candidacy exam! I was really impressed.

(My statistician told me this morning that in her opinion I'd passed, and that the exam wasn't supposed to be about having my Aims perfectly developed and planned. It was supposed to be about my ability to think on my feet and answer their questions, which she felt I'd done. So, though it's still not official -- yay!)

I told her that NOW as long as I don't give birth before I can do the final submission of my accepted manuscript (which I should be able to complete in the next day or two), I should be ok. Maybe I could even get started on Aim 2..... but that would require remaining pregnant for a couple more weeks.

She laughed and said that wasn't what people usually said.

Anyway, they were all booked up next week except for Monday, so I guess I'm going in after 4 days. Oh well. Maybe I'll even give birth before then.

Poll

2012-01-05T08:30:00.003-05:00

This morning I weighed 151.7.

Last Friday I weighed 149.

I'm pretty puffy this morning. For me.

Anyone want to vote on whether I'm going to be lectured about my obesity today at my Ob appointment?

As a side note, I got permission to take Tylenol Cold & Flu last week at my appointment to help me sleep (Tylenol Cold was recommended). I didn't ask for permission (Ha. I know better than to do that.) it was volunteered.

Except.... Tylenol cold uses phenylephrine, which doesn't work. Oh.... perhaps it makes me a little less likely to get dizzy when standing for long periods of time. Because it's a freaking PRESSOR. But it does literally nothing to relieve nasal congestion.

Don't you think if I were going to expose my baby to a medicine that is potentially harmful, I'd only want to do it if the medicine were actually effective?

Anyway, Luca's not going to be there, so I think the odds of getting a lecture are range from 60-80%.

Anyone want to vote?

Oral Candidacy Exam

2012-01-04T08:23:00.006-05:00

So I had this oral candidacy exam yesterday? And.... I have no idea how it went. It didn't feel like a slam dunk, but I'm not sure it was supposed to.

And then there was the issue with my Aim 3.

As you may recall, sometime during the first week of December, my entire Aim 2 got scrapped. Not because it's not a good / necessary project to advance my field, but because there is no freaking way the project is going to get completed over the next year.

So, my aim 3 became my aim 2, and I had to think of a new aim 3.

This posed some problems. My PI and I had some ideas about what we should do for the new aim 3, but none were fleshed out fully, and the idea he liked the best has some pretty major flaws, though on the surface the idea seems like it could be really really cool. I proposed another idea at a meeting we had on 12/14, but he wasn't familiar with the method, and while I still think it could be a really cool paper, it's one of those things where we're going to have to chew on it for a while before we decide we want to go with it.

Which left me with the problem of how the heck to write up aim 3 in my proposal: 1) As the severely flawed but superficially cool sounding study, or 2) as the new but unfamiliar study.

Bear in mind this was due on 12/19, so it's not as though I had oodles of time to work on it. Also, I didn't want to make my PI angry by cutting his cool-but-flawed project completely... and I also didn't want to present something completely novel that he'd never seen before. So I ended up writing a compromise.... which had problems, but it is what it is.

So anyway, I feel like the exam was going ok until we got to Aim 3. At that point we'd almost run out of time, and my committee agreed to stay for an extra 30 minutes so we could go over it, which I was really grateful for.

I got some EXCELLENT feedback on it. Of course, they completely trashed the flawed study, which was... awkward. One member proposed an alternative study, which might be really cool, but I have to think about it some more before I'll be willing to commit to it. They liked the unfamiliar study, but again I think everyone needs more time to mull that one over (including me).

So the upshot is, I have no idea whether or not I passed. In retrospect, it was probably too early to have this exam, but on the other hand there was no way for me to know that until about two weeks ago, at which point it seemed too late to postpone it. And I got some great feedback on my Aims. I kind of wish I had more opportunities to meet with my other committee members because I always learn so much when I do.

So, if I were them, I'd make me re-write my Aim 3. Who knows if that's what they'll decide though. Hopefully they'll let me know soon.

At the end of the meeting, I got an email saying that my paper (project #1 of my dissertation) had been conditionally accepted at Very-Important-Journal pending minor revisions. Which is AWESOME. Now I'm working like a mad-woman trying to get the revision out before I give birth and my life gets even more crazy.

Jury Duty

2012-01-03T17:24:00.004-05:00

As if life couldn't get any more fun and exciting, I just received a summons for Jury Duty on 1/31/2012.

As you may recall, I am scheduled to give birth on 1/21/2012 (or 1/24/2012), and could very well be in the actual process of giving birth on 1/31/2012 -- who knows!!

I did note that there is a place where I have to mark whether I can mentally or physically perform the functions of a juror, and I believe that the answer to that question is no. Not sure how the state feels about that though.

Has anyone else been in this situation before? Could I get a letter from my Ob stating that I am due to give birth then and can't serve?

Oh also, what about pumping while I am serving. Is that going to be a problem if I end up serving later on in the year? This isn't a contingency I'd ever really given much thought to before...

Any thoughts would be most appreciated.

Why won't people listen?

2012-01-02T10:03:00.009-05:00

Yesterday, Luca and I were out walking the Boo, when we passed by our friends' house. We really like them, and they just had a baby a few months ago, so talking with them is also additionally highly instructive. Usually.

Anyway, they invited us in to say hi.

We hesitated big time.

In addition to a baby, they also have a dog. And while he is a very placid calm dog, the Boo is not. Particularly when inside a house or other confined space with another dog. And we really didn't want the Boo to attack their dog. Especially when they were trying to tend their infant. It's never been a problem in the past, but we recognize that it could happen, and we'd really like to avoid that situation.

They insisted it wouldn't be a problem though. Repeatedly. As we insisted that it wasn't a good idea. Repeatedly.

Why couldn't they have listened to us????

And so the Boo cried and whimpered, and repeatedly tried to lunge at the other dog who just stood there 5 feet away. And she made the horrible gagging/choking noise that comes with wearing the gentle leader that sounds like a growl to pretty much everyone who doesn't know her.

And of course then we had to endure the, "You should really take her to obedience class,"* comments as well as the, "You must be really worried about what she's going to be like with the baby."**

Gah! Drives me crazy, I'm telling you.

You know what, people? Next time maybe you should listen to us when we tell you our dog is not good with other dogs. I'm tired of having to fall all over myself in an effort not to be rude in situations like these, and then feeling powerless as the Boo gets needlessly worked up and agitated. (And she HAS improved -- she calmed down *immediately* after we left. Before she would have continued acting crazy for at least 15 minutes.)

I honestly don't know what to say when this happens. I've tried explaining that a) dog aggression is not the same thing as people aggression, and b) that she's not actually growling (she's snorting and crying), but I can tell that they just think I'm making excuses for her behavior, and that they are judging me. Which makes me want to tell them to go fuck themselves (of course I don't). Maybe I just need to be more assertive and just walk away when presented with these situations... but then I'm afraid they'll think I'm rude then also.

Would it be so horrible for them to have said, "Oh, it's not a good time? Let's get together later then!"

No. No it would not have been. And this whole situation could have been avoided.

Why can't people just listen???

At least I've gotten better at saying no firmly to strangers (who want me to let their toddlers pet the Boo) -- rudely even, if necessary (and it is often necessary). It's a lot harder when it's someone you like though.

*Has YOUR dog attended a year's worth of class? I didn't think so.
**If you must know, we are somewhat worried about this. However since there isn't much we can do about it at this point, hand wringing incessantly isn't something we're interested in starting. Plus, I always find it ironic that the people who ask me these things have DOGS THAT HAVE ACTUALLY BITTEN THEM IN THE PAST, but yet seem to get off on making patronizing comments about my dog's behavior and how awful it is, as well as my apparently shitty skills as a dog owner.

New Year's Resolution: Clean the House

2012-01-01T09:39:00.006-05:00

With the help of Miss Boo! Maybe.

As adorable and highly trainable Miss Boo is, I think we may have to hire a cleaning person instead. Sorry sweetie! Though as Luca points out, she is already excellent at cleaning the kitchen floor, and bringing all of her toys to her bed.

Just 5 days (by LMP) or 8 days (by ultrasound) until I'm 38 weeks! Luca's parents said to him last night on skype that they didn't think I had three more weeks to go. Haha.

We'll see. I'm still in denial about this whole "having a baby" in a couple of days-weeks thing.

2011 in review

2011-12-31T16:51:00.007-05:00

Ana posted a year in review over at her blog and I liked the idea so I decided to do the same here.

January -- Return from Christmas at my parents' house in CT. Find out I'm pregnant. Enjoy extra attention and affection showered on me from Luca. Get period a week later, and while I'm disappointed, see how devastated he is, which makes me feel worse. Start my final semester of full time class for my PhD, including a class on Outcomes Research which I love. Decide I want to focus my career on policy research. Put thesis project aside to start side project that my PI (temporarily) finds interesting.

February -- Get pregnant again! Finish side project, which PI no longer finds interesting, wondering out loud why I haven't made more progress on my thesis project. Grrr..... Luca is happy about the pregnancy news, but not as optimistic this time.

March -- Lose 2nd pregnancy. Really start hating class. Take Control Unleashed with the Boo, whose behavior improves immeasurably, at least in the class setting. Work on class, which takes up way more time than it should.

April -- Finish semester. Finally. Manage not to fail Operations research class and actually get an A, which in retrospect, it's an MBA class, why in heck was I worried, again?? Get pregnant again at the very end of the month, only this time I don't realize it.

May -- 34th birthday. Go to Outer Banks NC for "vacation" where I finish off my final projects for the semester and prepare a poster for the ATS conference I'm going to. Take pregnancy test which I swear is negative, but Luca thinks may be positive. I overrule him and have a margarita and raw oysters that night, and get my "period" the next day. I feel vindicated. I go to ATS the next week in Denver which goes swimmingly, but I feel like I've been knocked on my ass and retreat back to the hotel for a nap every day at 3PM. I attribute this exhaustion to jet lag and a cold I am getting over.

June -- I have my third positive pregnancy test, and then get my "period" three days later during the Department of Medicine Research Day. I take and finish the last class I hope to ever take for my PhD (crossing my fingers!) and start studying for my qualifying exams. And for real, get officially cracking on the first manuscript of my thesis, now that I've set aside the other "interesting" project that is no longer interesting. Luca and I start doing rock climbing on the weekends because we're bored with our exercise routines and I decide if I can't have a baby, then at least I'll get strong again.

July -- Almost finish manuscript but have to put it on hold to study for my qualifying exams. Study constantly for 4 weeks or so, and relearn a bunch of stuff that I never get tested on but which actually turns out to be quite useful. Go to see reproductive endocrinology because of 3 consecutive pregnancy losses. Wait for period so I can do day 3 labs. Period never arrives, and I conclude that I must be pregnant. It turns out I'm 13.5 weeks. Feel like the stupidest medical student ever. I call Luca to tell him the news. He is ecstatic, but never is as affectionate to me as he was after the first positive pregnancy test, and refuses to tell his parents because it could be bad luck.

August -- Studying for quals, prenatal labs and appointments out the wazoo, take qualifying exams (10 days of my life that I will never get back, and I don't think they even read the grant I had to write when they graded it -- we certainly didn't get any feedback on it if they did....). Go to St. Louis for my swim buddy's wedding, and have my first manicure and pedicure ever. Go to Italy for "vacation" while Luca has job crisis #2 on the year, and is a total basket case for the entire vacation. I hide in the bedroom and read 5 books.

September -- I return from vacation, finish my manuscript for thesis project #1 and submit it! I start TAing a class, which initially annoys me, but it turns out that I really like teaching undergrads. I start preparing my protocols for my oral candidacy exam.

October -- Revise and resubmit received for manuscript, which I am ecstatic about because all of the points are addressable. PI is more pessimistic. Keep working on my orals protocol. Belly really starts to pop at the beginning of the month and I feel fantastic. Things start going well with my PI and the rest of the project team, and at long last I feel I'm getting somewhere.

November -- Committee meeting goes well. Try to finish up analysis for previously abandoned paper, but then have to do revise and resubmit instead, and re-abandon previously abandoned paper. Submit IRB amendments for projects I ultimately will never do. I feel like I was working all the time that month but for the life of me I can't remember on what! Start and finish a bunch of projects on the house.

December -- Scrap third aim in the week before my oral candidacy exam protocol is due. Whip together other aim. Complete revise and resubmit. Submit continuing review documentation for grant with brand new aims and hope nobody at the NHLBI minds. Finish TAing. Catch two colds. Feel really enormous, and amazed at the same time how quickly time has flown since I found out I was pregnant. Think more about what I really want my life to be like and procrastinate by looking at real estate prices in various areas of the country on zillow.

Overall, I'd say the year improved steadily as it went along. Hopefully this trend will continue next year. I can't believe I only have 14 months of PhD-dom left, and then I'll return to med school. It's just crazy!

New Years Eve

2011-12-31T11:35:00.005-05:00

This year, Luca and I are planning on extending our 6 year long tradition of cooking a nice dinner (minus the wine this year) and going to bed by 10:30. Do you all have anything fun planned?

I woke up this morning and puked my guts out! It was mostly water. Otherwise I feel like my cold is finally going away. The baby's head is lower in my pelvis this morning and I can feel it when I'm sitting now, as well as when I stand up and walk around. Not comfy!

Luca immediately googled vomiting at 37 weeks and freaked out. "Oh my God you might be about to go into labor!!!" he said.

Yeah, right. At yesterday's appointment, my cervix was thinner, but still closed. In any case, the baby *better* not arrive until after my candidacy exam on Tuesday. I don't want to have to prepare for that all over again.

Which, incidentally, I have no idea what I need to be doing to prepare for this. I wrote my protocol, and of course will not receive any feedback on it before the exam. I literally have no idea what people are going to say or ask me, and frankly most of them have never administered a candidacy exam before, so in fact THEY probably don't really know either. I'm really only afraid of what my statistician will ask me since a) she is a statistician, and b) she has done this before.

I'm kind of anticipating a committee meeting on steroids.... and if this meeting goes as well as my last committee meeting in November went then I should be ok. But then again, most of them have never seem my third aim before. Add to the fact that my PI didn't want me to do it the way that I think it needs to be done based on what a more experienced investigator told me a few weeks back. So of course I had to write it up the way my PI wanted it. I'm anticipating that my other committee members may pounce on it as wrong. Good times.

So to prepare, I'm reviewing my protocol. Again. Going over my slide deck. Again. Reading through the literature (some more). Making sure that I've read all the papers my PI has forwarded to me over the past several months.

Convalescing.

It's been hard to get really motivated or stressed out about this exam. I mean, what would happen if I failed? I suppose I'd have a better idea of what to expect next time.... It's not as though my progress on any of these projects would stop. I'd simply give birth, re-prepare, and then re-present in 4-5 months, with (in theory) more completed work behind me, and more opportunities to receive guidance on what they think I should be doing differently. I have to have another committee meeting in 6 months ANYWAY, so would it really be that much more of a pain? I don't know. Of course I'd like to avoid that scenario....

As for New Year's Resolutions, I'm not so into them, but I'm hoping to strive for the following:

1. Continue trend of eating more salad and vegetables, which I started during pregnancy.
2. Keep up better with the literature in my field.
3. Sleep as much as possible.

Other than that, who knows what the next few months will even bring, so it seems silly to give myself a bunch of resolutions that may end up being completely unreasonable.

Is it me? Does it matter?

2011-12-29T21:29:00.008-05:00

Tomorrow is another Ob appointment. Hopefully this time will be ok. I only had a salad for dinner, and as of this AM, I'd only put on a pound since 2 weeks ago....

A couple of months back, I ran into an EM doctor and his wife at the clinic. One of my favorite EM doctors, if you must know. The person who made me think that maybe I wanted to do EM. But then also made me think that maybe I didn't. It's complicated. Anyway, he offered to give me a ride home from the clinic, which was especially nice since I live almost 2 miles away and the walk had started to suck in a third trimester kind of way.

I bring this up because one of the things we talked about was how I (and his wife) liked the practice. I said it was ok, but that it felt a bit like assembly line medicine. His wife didn't feel the same way (supposedly), and they recommended that I ask for specific providers when I came in so that I could develop a relationship with someone and would hopefully not feel that way anymore.

I haven't done that, and here's why:

1. The clinic seems to rotate who is "on" every month or so. So I don't think I'd end up having the option of seeing someone specific even if I did want to pick.

and

2. Probably more importantly, I'm not going to be able to choose who delivers my baby (see #1), so I feel like it behooves me to get to know as many of the providers as I can before I show up at the hospital in labor.

Still, I wondered if I was just being really hypersensitive about this whole thing. So I asked Luca after one of the visits he accompanied me to what his impression was.

He said: Well, she spent the entire time looking at her computer and typing. I can see why you feel like she doesn't care about you.

I hadn't really thought about that, and it is true. Usually, we have about a 15 second introduction, and then whomever it is goes straight to the computer to (presumably) read off whatever numbers they have on me.

But I think what bothers me is the lack of humanness in the interaction, beyond the computer. The introduction will always be something that I don't really know how to respond to like, "How's the baby doing." I don't think they've asked me how *I'VE* been feeling once. Or if they have, it's been in such a way that I can just tell a lecture or some empty platitudes will be forthcoming if I tell them, "I've been really exhausted," or, "I haven't taken a normal crap in a month," or, "I'm worried that my PI is taking all of my interesting projects away from me because I'm pregnant." Or if I do bring something up, they're likely to address me in a confrontational way, like the Dr did 2 weeks ago about my due dates.* It's like they've lost all ability or interest in interacting with me as a person, let alone a person who has a brain.

Several of you have suggested that I switch practices, and I really do wish I could. But the thing is, a lot of people I talk to say that they like this practice, and I wonder if the problem is really that my expectations for human interaction are too high. I know that I will get high quality medical care at this practice, and to me that's what matters the most. I also don't have confidence that anywhere else I go would be any better.

I guess I just wish I could have some of the touchy-feely sensitive doctor stuff as well. Is that really too much to ask?

****

*As a side note, I located my copy of NMS Ob/Gyn to make sure I was right about how one dates a pregnancy. The section on this was written by my very own Ob/Gyn preceptor from 4 years back, who -- wouldn't you know -- is a dr at the practice I am receiving my care at now. In fact, I could have seen her as a patient tomorrow, but I decided that would be awkward, especially since I always got the feeling that she wasn't very fond of me when I was her student.

And as it turns out, you're supposed to use the LMP unless the 1st trimester ultrasound is off by more than 7 days, or the second trimester ultrasound is off by more than 14 days. Since my LMP and ultrasound are discrepant by 3 days, that means we're supposed to be going by my LMP.

So there.

Anyhow, after I read this, I fantasized about bringing my textbook to the clinic tomorrow, and having a discussion with the Dr about it. Ha! I doubt that would have gone over very well.... but it was fun to think about, anyway.

God I must be a horrible patient.

:-)

Baby Game

2011-12-28T21:03:00.003-05:00

Ok guys, this isn't typically my sort of thing... but I thought it might be fun to conduct a little contest wherein you try to guess the baby's:

1. Birthday
2. Sex
3. Weight

The person who guesses closest in each category will receive.... um.... nothing? Mention by name (with link if you have your own blog) on this blog? Same for the person who gets closest overall, plus my eternal admiration of your psychic powers?

(Any suggestions on non-sucky prizes would be appreciated since I don't have any idea how these things usually work.)

Now, to level the playing field a bit, some disclosures:

LMP: 4/16/2011
Due date by LMP: 1/21/2012
Due date by 13.5 week ultrasound: 1/24/2012
Typical cycle length: 24-28 days

I weighed 7lbs 10oz when I was born, but my mom smoked. She weighed 9 lbs 6 oz when she was born. I have gained somewhere in the vicinity of 24 to 29 lbs so far, depending on whether you believe that I didn't put on any weight in my first trimester. My GCT was 117 fasted.

Looking forward to hearing your guesses!

Now I'm off to pack my hospital bag.

Not zero

2011-12-28T09:22:00.005-05:00

One of the things that annoyed me most when I worked in business was the insistence of upper management that we achieve an error rate of zero.

First of all, such a rate is *actually* unachievable (something about calculus and limits and asymptotes and all that) though possibly achievable theoretically.

Second of all, if you were to try to achieve an error rate of zero, you'd expend an inordinate amount of resources doing so that would be most likely better spent on something else.

And finally, in trying to achieve an error rate of zero, you'll create perverse incentives, which may cause people to partake in other unattractive behaviors in order to game the system.

(Sorry this is so unscientifically phrased.... it's been a while since I tried to speak econ.)

The problem was, if you raised any of these points in a business environment, and suggested deciding on what the optimum error rate should be, some doof manager would decide you were just lazy and "not a team player" and that would be it for you.

And now you're wondering how this is related to my research.

I went to a talk on hospital readmissions last week, and there it was again. A guy was talking about ways to reduce the 30 day hospital readmission rate to zero. They were identifying patients who had a "high" probability of being readmitted using available hospital admission data, and "targeting" them in order to reduce readmissions. He'd come up with a model that had a sensitivity of (drum roll please) 25%, which basically means that you cannot identify these patients using his data. And he'd "designed" a fancy Excel spreadsheet tool (oooooohhhhhhhh!!!!) that allowed him to fiddle with the numbers in an expedient way in order to determine whether or not an intervention program would save money.

(As a side note, lesson #1 in my career was that many managers are easily impressed by things like one's ability to manipulate an Excel spreadsheet. No, not by your novel thoughts, but by your ability to make Excel dance. Yes, that is disdain you are picking up upon.)

Ok, let's put aside the fact that he wasn't even looking at cost-effectiveness, and that there were no confidence intervals around the numbers he was producing, or the fact that his model could not predict shit. What disturbed me the most was when the only economist in the room (who is a brilliant brilliant man) said, "The optimum readmission rate isn't zero," and this guy replied, "The optimum PREVENTABLE readmission rate is at zero."

I swear, it was like talking to a wall.

Which made me realize that the guy giving the presentation truly had no idea what he was doing. Or if he did, he had been so steamrolled by some moron manager he worked for that he was actually unable to understand the point the economist was trying to make, or at least felt he couldn't acknowledge such a point in public for fear of angering some higher-up.

It also gave me a chance to reflect on the fact that several people have recommended this guy's career trajectory to ME, and made me want to cry just slightly. I'd much rather be thought of like the economist....

Anyway, none of this is to say that quality improvement is a bad thing, or that we shouldn't try to do better. It IS to say that there is a reason (actually reasonS) that I ran screaming from the business world.

And also, I'm wondering whether a six sigma approach might work as alternative.

Snot disease -- BE GONE!!

2011-12-27T21:26:00.005-05:00

I am really hoping I'll be able to sleep for more than 60 minutes at a time tonight. Last night between the pregnancy induced night sweats and subsequent sheet changes (x2), peeing every 1-2 hours, and stuffed up head + cough, even though I was in bed for 12 hours officially, I still felt like I'd been hit by a train when I got up this morning.

I did finally start putting together my slide deck for my orals next week though. It sucks, but it's just a first draft so it will get better.

And tonight -- Benadryl. Even if it just knocks me out and dries up my nose just a little, it will still hopefully be better than the last few nights have been.

I feel shitty that Luca has this week off, and he has spent it playing host to my parents and nurse to me. I wish I were better company for him. Hopefully things will improve over the next couple of days. This cold has made the last one I had a few weeks back look like NOTHING. I hope I don't give it to him, though given the amount of snot I've produced I would be amazed if he doesn't succumb.

Fortunately, the offspring seems unfazed (said as I receive a couple of good solid kicks to the liver). Just 25 days until my due date (28 if you go by the week 13 ultrasound). Crazy!

36 and counting

2011-12-26T10:42:00.003-05:00

My parents were visiting for the weekend, and just left. It was nice seeing them!

For some reason we argue less when they're here than when I visit them. I think I've observed this before. This was even the case this weekend despite the fact that I came down with a bad cold AGAIN (second cold in three weeks -- awesome), and Luca had to do a lot of the food prep. Fortunately, we went considerably less elaborate than over Thanksgiving. Also, Luca is a great host/nurse, and gets along well with my parents. I am very fortunate to have him.

Also fortunately, we still have abundant leftovers which means less work on cooking this week.

Since we finished painting the basement (FINALLY) hopefully we'll be able to put some of our stuff back down there this week, including all my med school books, epi books, and the chest freezer that came with the house.

We're also hoping to inventory the stuff we already have for the baby, and compare it to a list of stuff we're told that we need, and fix the discrepancies.

Luca is also insisting that I pack my hospital bag, which I believe to be an absolute guarantee that I will not give birth for another 5.5 weeks. To a 10 lb baby.

Also, I need to create the slide deck for my oral candidacy exam next week, and remind myself of the projects I wrote about planning to do. Not to mention the methods I said I'd be using. Sobel test? What is that again? I think I may hold off on starting that for another day or so, or at least until I can remain upright without feeling like I want to lie down again for more than 5 minutes at a time.

Stupid cold.

Sleep

2011-12-24T17:14:00.003-05:00

My parents are visiting for Christmas. I actually really like it when they come see me in Philly. For some reason we seem to fight less than when I go to see them in CT. Perhaps I regress less to my adolescent self. Haha.

Last night my mom told me that she was a 9 lb 6 ounce baby. My grandma was neither a) obese, or b) diabetic, so this was all genetics. I was only 7 lbs 10 oz, but MY mother smoked throughout her pregnancy with me. If she hadn't maybe I would have been a 10 pounder myself.

So last night I went to bed at 10, and then at 2AM I woke up and just lay there paralyzed with fear thinking about having to squeeze a 10 lb baby out of my vagina. Without an epidural (if my platelets are too low that day). I lay there awake until 6AM.

It sucked.

Fortunately I got to take a nap today. Thank goodness that after my orals in a week (a week!) I'll have a relatively low key couple of weeks before I (hopefully) give birth to a (NOT TEN POUND FOR GOD'S SAKE) healthy baby. I know I'll sleep less after the baby arrives, but at least then I won't be lying there paralyzed by anxiety about my future fecal and urinary continence.

Have you hugged a med student today?

2011-12-24T03:00:00.005-05:00

Now I'll grant you, some med students (like some people in general) are entitled little snots who think that they know more, deserve more than they do. I'd like to think students like this are the exception rather than the rule, but what do I know anyway. I mean, I don't think *I'm* an entitled snot.... yet I've met people who assume I must be based on the fact that I grew up in Manhattan, or because I attend medical school.

But I digress.

Anyway, there was an article in the NYT about how Vanderbilt is trying to make med school more humane by ~~forcing med students to partake in team building activities~~ being more like "Hogwarts." They're trying to prevent burnout from setting in. Which.... is basically impossible.

A bunch of doctors and med students wrote comments saying that the problem with med school was the workload. That drinking out of the firehose of information to cram into your head for 4 years was what made med school hard.

I call their bullshit.

What makes med school hard is that it's the first time in your life that you're treated as less than a person. On a consistent basis. Over at least a year, and probably longer if it continues into residency.*

And I can tell you, I've worked some pretty dehumanizing shitty jobs in the past, but NOWHERE else have I worked where it is ok to pretend you don't know, or not bother to learn the name of someone who has been on your team for four weeks.

I was talking to a 4th year that I'm doing research consulting for yesterday, and he told me that he realized how low his expectations for being treated like a person were when an attending he'd been working under said to him, "Good morning John! How are you doing today," and he was completely shocked. He said it felt amazing.

That's so fucking pathetic, I don't even know where to begin.

I remember on my Ob/Gyn rotation, asking the resident what cytotec was (we'd learned it as misoprostol in didactics, and that's what all the textbooks said, so how the heck should I know!), and the resident said to me, "Oh my GOD I can't believe you don't know what that is. What are you, stupid or something???" scoffed loudly, stomped out of the room, and then would not acknowledge my presence for the rest of the week. The WEEK! Did I mention that the room was full of other people? Yeah, she was a gem. (Hi Candace!!)**

I eventually did find out what cytotec was. Not that it mattered since I was never permitted near a patient on that rotation.

So the next week, I had a different team, and one of the residents took me aside and started explaining how an induction worked, and actually said the words, "We use cytotec to ripen the cervix. Cytotec is just misoprostol." I literally almost teared up at this person taking the time to talk to me like a person, taking the time to explain things. I wanted to hug him and thank him. But of course you can't because that would be weird. What would you even say? "Thank you for taking the time to say one sentence to me like a normal person?"

I wrote him a good eval anyway. Not sure these things even matter.

So I guess my point is, you don't need Hogwarts-like contests between contrived teams to make med school a more positive experience. All you really need to do is to say hi once in a while and address the med student by name. Once per week maybe.

Or maybe just once ever.

*I'll let you know about that one, but from what I've heard, it does.
**Her real name.

The hardest thing about med school

2011-12-23T09:34:00.005-05:00

For me, anyway, is realizing that nobody cares about your opinion. Even if you're right. ESPECIALLY if you're right.

In the hospital I could take it. At least there I knew that I didn't know what I was doing. Of course then your attendings tell you to be more assertive, to state what you think and why. So you practice doing that. And then you get a new attending who tells you that you're arrogant for stating what you think and why. Who thinks medical students are better seen and not heard. But even that I could deal with since the hierarchy is so entrenched on the wards.

Now I'm in PhD-land.

I sit in meetings several times a week with doctors talking about health care policy. This is a field in which I am getting my PhD, and in which many of them have no experience at all. And they still they assume that they must know more than I do, when I've been doing research longer than many of them have even been doctors.

Because all they see is that they are fellows. To them, I am still a mere know-nothing medical student.

And people: I am good at what I do. This policy thing? It's my calling.

A couple of them listen. Generally these are the fellows and attendings who have been around for at least a year or two, doing this research along side of me. It's a joy to work with them. A real pleasure.

It's the others that make me want to put my head through a wall.

I used to try to give constructive feedback on their projects, which is the entire point of having these meetings. So they can get feedback so that their projects stop sucking. And in general, they'd smile and make some patronizing comment to me like, "Thanks for your input little medical student!" in a voice like they were speaking to a small child.

Once one of the fellows said he'd really like to talk with someone more advanced who'd made a career in translational research work. I suggested he talk to a specific person who has a reputation for being a great mentor, has been a great mentor to me, and who is a rising star in his field. The fellow did the body language equivalent of the pat on the head, and then he turned away as though I wasn't standing right there giving him the information of a valuable contact.

So now I just sit back in these meetings and listen to them as they design utter crap research. Why should I share my ideas with them if they're going to blow me off like that? They'll just remember the idea 6 months from now, and think it was their own anyway.

I might as well keep the ideas for myself, for my future R01s.

No I am not praying

2011-12-22T17:24:00.004-05:00

The bus stop on my street pretty much has a sign, but not much else. No shelter, and certainly no bench. So, as revolting as it may sound, I've taken to kneeling on the sidewalk while I wait for the bus.

What! If I stand for long periods (i.e. more than 30 seconds) my heart rate starts to go up and I feel like I want to pass out. And there's not even anywhere to lean really, and even if there were, kneeling works so much better. Increased venous return and all that.

I've been doing this for the past month, and very few people have said anything at all to me. Well, there was this one woman who asked if I was ok, and I said thanks for asking, but yes I was fine.

Until this morning, when not one, but TWO people asked me if I was praying.

Come to think of it, I was facing west.

Anyway, I assured them I was not praying, but was just very pregnant and didn't want to pass out.

Ha. I must look pretty ridiculous kneeling there on the sidewalk.

Oh well. It's better than the alternative.

We got new sheets!

2011-12-21T18:28:00.004-05:00

Luca and I don't really exchange gifts at Christmas, per se. Mostly I compile a list of stuff I/we want but wouldn't normally buy for ourselves because we consider it too indulgent, or because we are too lazy or cheap to just buy it when we think of it.

A good example of this would be a new camera. We'd really like to get one before the offspring arrives, since our current camera takes like 60 seconds to recharge every time you use the flash. (Unacceptable!!) But it seems really indulgent to buy a new one since we already have one that works. We haven't gotten one yet, but may see about it after Christmas is over.

But we did get new sheets! And they arrived today. Fancy percale (whatever that means) sheets that are pink with polka dots. Luca picked the color. I can't WAIT to try them out. And we got a new bathmat that will hopefully match my bathroom tile a little better than the current one.

Who knew I'd ever be a person who would get excited about bedding.

For Miss Boo, we got her a "fancy" squeaky toy with -- count them -- TWELVE squeakers. I am looking forward to Christmas just so I can watch her destroy it. It's gonna be awesome.

Crabby Crab

2011-12-21T09:27:00.004-05:00

These past few days I've been a giant crabby bitch.

I know, I was in a good mood Friday - Sunday. But things change.

There are two reasons for this change.

1. I turned in my oral candidacy exam proposal, and though I have more work I could be doing, I DON'T WANNA DO IT!! (stamps foot)

2. I stopped sleeping well. Again.

You may recall that about a month ago, I was feeling really worn down. Ever since I got pregnant I've been getting up to pee 3-4 times a night. Usually I've been able to fall back to sleep no problem. Then there came a time, right around the 6 month mark, where I'd start waking up and couldn't fall back to sleep. For 2, sometimes 3 hours.

Now, it's not like this never happened to me in the past. I suppose it probably happens to everyone. But when it happens to you 3-4 nights in a row, and then you ALSO start having problems falling asleep, it gets to be kind of unpleasant.

So in order to compensate, I started going to bed earlier and sleeping later. Lately, my typical sleep pattern has been as follows:

Bed 10PM
Wake up 12:00
Wake up 2:00
Wake up 4:00
Wake up 5:20 (Luca's alarm)
Wake up 7:00
Get up 8:00
Sometimes if I could, I'd stay in bed even later. It helped, but not enough. Not as much as uninterrupted sleep would have helped. And if it was one of those nights when I couldn't fall back to sleep, that would usually happen between 2 and 5AM.

But then, last week, I found myself sleeping from 12-4:30 completely uninterrupted. I honestly can't explain why this happened, since after all, I'm getting bigger, not smaller. But I did. And it was glorious.

So I set about telling my friends, all childless, about how awesome I felt and how great my sleep had been that week. I found myself uttering phrases I never in my whole life expected to escape my lips like, "I slept 4.5 hours IN A ROW, five WHOLE DAYS in a row, and it was GLORIOUS!!"

What was their reaction?

Every single one recoiled in horror. It's worth pointing out that one of said friends is a second year resident, and she was *still* horrified. I have to say it made me feel better. It also made me realize how f-ed up my sleeping had gotten, and that I was tired -- not because I was getting fat -- but because I was sleeping like crap.*

Of course my streak ended this Saturday night. The first night wasn't so bad. It never is. Even the second night was ok. But by the third night, I was getting seriously cranky. I felt so tired when I went to bed, but somehow, still couldn't manage to get comfortable or sleep for more than 1-2 hours.

Anyway, last night I was finally back to my old sleeping pattern. Still no 4.5 hour marathons, but at least I had no problems falling back to sleep. And I feel so much better. So, please excuse my crabby nature over the past few days. That's what happens when I don't sleep enough.

*I'm sure I will get some comment that says one of the following things:
"I haven't slept more than 4.5 hours total in the past 5 years. You have no idea how good you have it. You should stop complaining."
"You are so screwed for residency. When I was a resident......"
"Just wait until you have the baby. I remember when I....."
"How on earth did you make it through medical school. I only sleep 4 hours per night, and I am fine."
Please note that these sort of comments will not be appreciated, and may be deleted.

Thanks!

The Management

Can I say?

2011-12-20T15:37:00.009-05:00

I'm really tired of people assuming that the Gentle Leader is a muzzle. It's bad enough that I have a pit mix -- I get tons of nasty looks and a wide berth on the street under normal circumstances when I walk her. But the gentle leader seems to provoke actual negative commentary.

So today we went to the vet, and since I figured that we'd be sitting in a waiting room with a variety of other animals, I figured that the Gentle Leader was a prudent choice under those circumstances.

Today there were FIVE kitties in carriers waiting to be seen by the vet as well. FIVE. in basically a 12'x12' waiting room. For 40 minutes. Miss Boo is really bad with cats. I think she would eat them if given the opportunity (fortunately most cats are too smart for this to happen). So of course she got really worked up and tried to lunge at the kitty carriers, and panted and cried, and was generally difficult to handle.

And I will admit that when she pants with the gentle leader on she makes this snorting noise. Unfortunately, many people mistake this for a growl, and have a tendency to comment to that effect. Which is really awesome.

One lady (with three cats) decided that it would be appropriate to have a loud conversation about how awful pit bulls were right next to me.

Another lady with a standard poodle mix of some kind (Miss Boo actually did growl at him at one point when he stared at her and started getting too close to me), was clearly freaked out by her. She practically tripped over her own feet trying to get out of the way as we were leaving the office. I think she was afraid the Boo was going to attack her dog, but for the record, the Boo completely ignored him. She was way more interested in the cats.

I'm just imagining the commentary that ensued after we left.

Anyway, other dog owners: Do you find that people ask you whether the gentle leader is a muzzle, or whether your dog bites when you walk him/her using one? I used to try and educate people when they asked me this, but I've gotten REALLY tired of explaining over and over to a group of people who is just going to think I'm making excuses for my vicious dog anyway. I'm tempted to just start telling them, "Yes she bites.* STAY AWAY," and then moving on but I'm afraid that would just make things worse.

Thoughts?

*She's never bitten anyone I know, but that's besides the point.

*****

In other news, this is the vet that gave her doggy papilloma virus with a non-sterile cautery tool. We only use him for routine vaccinations and care since he is really cheap. Otherwise we go to the expensive bougie vet in Ardmore. They have better hours, and don't tend to give me lectures on "wasting money" on my dog. Haha.

So today, I asked for some acepromazine for long car trips since the Boo pukes in the car on trips over 60 minutes. He wanted to know where we were going, and I said, nowhere at the moment, it's for later in the year. I'll probably go to my parents' at some point at least once. And he was reluctant to give me any! Did he want me to come back for another visit I wonder?

And then the front desk lady refused to give me a copy of her vaccination record, saying that she could fax the kennel or day care or what have you a copy if they needed it. It was total bullshit! All sorts of services require this sort of documentation, and this vet is not always open. What a pain it's going to be to have to call them up to have them send a fucking fax every time we need it!

I wondered if they were afraid that people were going to defect to other vets, who invariably require the vaccination record.

So, today I told Luca I was done with them, and that from now on we're going to Ardmore for everything. Period. The end. Bye bye Dr. Littlejohn!

Study

2011-12-19T11:25:00.002-05:00

A couple of people asked about the research study I signed up for on Friday. I went in for my first visit this morning* to sign consent forms and give urine and blood samples. From what I gather, it's looking at how mode of feeding (breastmilk, cow based formula, or soy based formula) affects endocrine development of babies.

So, my participation requirements:

1. 3rd trimester urine and blood
2. Urine collection in 2 days to be FedExed in
3. Birth visit while in hospital (more urine and blood + questionnaires)
4. 2 week visit (breast milk sample, questionnaires)
5. 12 week visit (more breast milk, questionnaires)

In exchange I get up to $155 to compensate me for travel, time, and bodily fluids.

My baby also participates. Most visits require some or all of the following:

Body measurements, physical exam, urine, blood, swabs of genital area, ultrasound of thyroid, ovaries, testes.

And there are a bunch of visits.

1. Birth visit
2. 2 week visit
3. 4 week visit
4. 6 week visit
5. 8 week visit
6. 12 week visit
7. 16 week visit
8. 20 week visit
9. 24 week visit
10. 28 week visit (final visit for boys)
11. 32 week visit
12. 36 week visit (final visit for girls)

In exchange you get all the formula you need to feed your baby if you're in one of the formula arms, or a breast pump if you're in the breast feeding arm.

You also get "an allotment" of diapers if you're in the breastfeeding arm. I was told that I should expect several large packages, and that I'd need a car to get them all home.

You also get $875 in cash for your visits if you have a girl, and $725 for boys.

*As a side note, when I went to the security desk to get my visitor's badge this morning, even though I said I was a visitor here for a research study, the guard asked me if I had a hospital ID. I said yes, and then she confiscated it! Fortunately, I basically never go to that hospital and plan on doing mostly adult medicine electives in the future, but in theory I could sign up to do some sort of clinical activity there at any time that would require my ID. Plus, it was my best picture out of all my hospital IDs, so I was a little annoyed that she took it. It's not as though it would work anyway. Good thing I'm not planning on doing peds! Otherwise I'd have to get a new ID, and that would be a giant PIA!

More Baby Name Stuff

2011-12-18T20:19:00.003-05:00

Also, last night Luca and I watched "Cat on a Hot Tin Roof," which had been unavailable on Netflix for years, and then finally appeared in my instant queue about 6 months ago I think. Anyway, it was AWESOME. Luca had some trouble understanding the heavy southern accents, but he managed to stay awake for the whole movie, which I think means he liked it too.

We briefly considered naming the offspring "Brick" after the Paul Newman character. They just don't make movies like this anymore these days, and well, I think it's not a bad name. It's better than Aiden anyway....

We then toyed (again, briefly) with naming the offspring after one of the University of Chicago Nobel Prize winning economists. Fogel, perhaps. Or Milton. We decided Coase wasn't that pretty, but August was nice for a boy or a girl. Then there were Simon, Arrow, Prescott, Sargent, and Lucas, or even Ted. I vetoed Becker though because I thought it sounded too much like "Pecker." When I suggested Levitt (even though he hasn't won a Nobel Prize), but Luca said he was too big an ass. To which I replied, "All economists are asses. That's what I like about them!"

Anyhow, all this is related to the movie we saw last night because after we moved on from economists, we thought we could go *extra* snooty and do playwrights instead. Which is where we ended up.

Our poor offspring! Hopefully he/she will like the name we saddle him/her with. We've at least put a lot of thought into it!

Sorry for totally geeking out on you all here. Sometimes I just have to get back to my UChicago roots, is all.

Oral Candidacy Proposal....

2011-12-18T19:57:00.003-05:00

SUBMITTED!!!

I celebrated by helping Luca paint the basement.

Next:

(1) Create Power Point presentation for meeting on 1/3.
(2) Finish manuscript I've been sitting on for 6 months.

Then I'll actually be able to start the projects I've outlined in my proposal. Isn't that crazy?

I'm also hoping that over the next week or so, Luca and I can finish the basement, and then reorganize all the crap we have stashed all over the house. End goal: to get the house organized enough so that we can hire housecleaners to come and clean before the baby arrives.

And we have to meal plan and grocery shop for my parents' arrival on Friday. I think my dad is bringing the ham that we were originally planning on having over Thanksgiving had we gone to CT then. Don't worry, dear internet, it's been frozen this past month. At least I hope it has been.

It has been, right dad? If you're NOT bringing the ham, can you please let me know!

Also, I'd like to make some Christmas cookies.

But yay! I can back off the gas at school for a couple of days. Whee!

Discoveries

2011-12-18T12:31:00.007-05:00

This morning it was 30 degrees out. So, while Luca read over my oral candidacy exam proposal, I took the dog for a walk. And since it was cold (and since I am too enormous to wear my own coat), I wore Luca's coat.

It is a marvelous coat. It is so light and fluffy, but still warm and cozy. And is a man's XL. I don't even want to think about what I must look like in it.

And lo, I discovered that I could still run! Very slowly at first. It was more like trotting. I would trot 1 short block, and then walk 1 short block. I'd forgotten how much I like doing aerobic exercise in the cold. And it was low intensity enough that I didn't really even get winded, and the abdominal/pelvic bouncing was kept to a minimum. Not sure how well the baby liked it. It definitely woke up and squirmed around a bunch during the walking segments.

Unfortunately, the bouncing was not so minimal as to prevent my keys and phone from being jostled out of my pocket somewhere along the way. And of course I was wearing my hat and could not hear when it happened. I didn't discover this until I got home, and then (I think understandably) I freaked out.

Fortunately, Luca was home, so we used his phone to call my phone, and it turned out some lady had picked them up on her way to church. So we ran. All the way to the church on 50th and Baltimore, to go get them from her.

Damn we were lucky.

It was at this time that I discovered that not only can I still run, I can still run FAST. The jostling is minimized if I run on my toes and take lots of little steps. Isn't this was the Vibram 5 fingers shoes are supposed to do to your stride? Who knew you could get a similar effect from pregnancy!

It felt GREAT. Also, because I freaked out and yelled, the Boo was scared into submission, and didn't pull on the leash the entire way. Good Boo!

Perhaps I will have to try this more often. Or not. We'll see.

UPDATE: My shin splints are now back with a vengeance. Dammit! I suppose this is evidence that the athletic trainer in high school was right: The only way to make shin splints better is via rest. :-P

My Law and Order addiction can be useful sometimes

2011-12-18T09:38:00.003-05:00

Every so often, I start looking at boy baby names. Again. Because I can't seem to find one that I like.

Today I came across this one: Ryker.

Now come on people. I know you were probably going for tough and manly with a dash of sensitive. But did you HAVE to name your child after New York's main jail complex? Now I'll grant you, that is spelled with an "i", but it's still a bit like naming your son Alcatraz. Or Folsom.

Today as I dragged Luca for our walk

2011-12-17T15:42:00.006-05:00

As he whined about the cold, and about the dog's behavior (which actually was quite good today -- thank you gentle leader!!), and about how dirty the house was, etc.

I said, "Look honey, do you WANT me to have to push a 10 lb baby out of my vagina? Do you want me to be able to shi!t normally ever again in my life? And more important perhaps, do you want me to have a really really floppy vagina? No? So quit yer bitchin'."

So, he did.

(This, by the way, is why I married him. I don't think I could stand being married to some prudish man whom I couldn't say these things to. You're awesome, honey!!)

A Visit From the Goon Squad

2011-12-17T14:45:00.005-05:00

I also recently finished A Visit From the Goon Squad by Jennifer Egan. Her book, Look at Me, is one of my all time favorites, though probably a bit dated at this point. I liked Goon Squad too, but not as much, which is probably as much my fault as anything else.

The book reads like a series of short stories about different characters, that are all linked together. A minor character in one story will be the main character in the next story. And all in all I found that each story was highly readable, well written, and entertaining. There was great character development. I like the way she writes.

The problem for me was that, since I only have time to read for maybe 30 minutes a day (on a good day), I found myself not being able to remember the context in which characters had appeared in previous chapters, and what their significance had been, and thinking, "I really should go back and re-read that section, because I think this part might make more sense if I did," but then not really feeling like doing it.

Also, the power points that go along with the story don't come across super well on the Kindle. I wish they'd done a better job with that. The power points really seemed to bring things together. I just kept feeling like I was missing the bigger picture of Goon Squad as I read it.

I do feel like I'd want to re-read it if I had the time. If or when that will ever happen, I do not know. *Sigh*

At least I felt like I was reading "high quality" literature for a change.

:-)

It was definitely higher quality than the Hunger Games anyway, which don't get me wrong -- I LOVED that series. But Goon Squad was more like a fine red wine, whereas the Hunger Games are more like crack.

Next: Cutting For Stone, at the recommendation of Amy and ABB. It's a doctor book (which normally I eschew), but I've heard such good things about it, I decided to give it a try anyway.

Harry Potter

2011-12-17T14:13:00.008-05:00

Luca and I stayed up last night to watch the last Harry Potter movie. While neither of us ever read the books (and never will), we found at least the first couple of movies in the series to be entertaining.

This last one was.... meh. Luca basically predicted what was going to happen in the first 5 minutes, and was completely right. So it was predictable. Also, Luca liked the special effects, but those kinds of things have never really done it for me anyway. Maybe my meh-ness has more to do with me not being able to sit still for 2 hr movie anymore in general, but in any case I found myself wanting to turn it off 1/2 through so I could go to bed.

Which is to say, I guess I'm glad I saw it so that I know what happens, but it was far from awesome.

In other news, yesterday the Ob told us that we needed to watch all of our adult movies before the baby arrived, because after that all we'd be able to see would be kids movies. It took a moment for us to realize that she meant that because of the cursing and adult content in regular movies. This hadn't really occurred to me. Do people really worry about this??

Good thing I've mostly stopped watching movies anyway.

As we were leaving I said to Luca, "Well, at least she didn't recommend that we go out to eat for date night!" That would have really annoyed me.

:-)

As a side note, we've been watching "How the Earth was Made," on Netflix recently. It's been pretty educational, probably because I know nothing about geology. (I'm just imagining a series called, "How your body works," and finding it to be horrifyingly oversimplified and wrong.) Also, I think I like it because each episode is about 45 minutes long, and you can totally not pay attention during most of it, and still get the main points.

Perfect!!

I'm in a good mood today

2011-12-16T13:38:00.004-05:00

Luca stayed home with me for my prenatal appointment, and he finished painting the basement while I did some online Xmas shopping. I know, the pinnacle of productivity I am, with the writeup for my orals supposedly due at the end of today. Soooooooo not going to happen. But! It will happen over the weekend.

It's always nice to have him home with me during the day, even if it's only for a couple of hours.

While I was at the appointment I signed up for a research study on breastfeeding. I am (tentatively) in the "exclusive breastfeeding" group based on what I hope to be able to do, although who the heck knows what's going to happen in reality. In exchange for blood and urine from me and my baby, and something like 9-12 visits over the next 10 months, I get free diapers (lots of them) and a breast pump. Sweet!

Honestly though, I'm not doing this for the loot. I'm doing this because a) I like participating in research, and b) I consider it good karma to be a subject in other PIs' studies. Plus, I really should have the time to do this study over the next year, and it sounds kind of cool. I mean, it's still totally flawed in the sense that people who are *able* to exclusively breastfeed for 6 months are by definition different than those who wind up giving formula, so any result will be biased in this way. But I'll try not to put my Epidemiologist hat on too much. Plus, it's hard to say no to a free breast pump and diapers.

And then, we had the appointment. I knew today it would go well since Luca came with me. He told me that I was good, and it was impossible to tell how angry the doctor had made me at the last visit. (This was probably because I wasn't feeling angry at this visit....) We had a long conversation about due dates.

So, by LMP I am 35 weeks 6 days.
But! By ultrasound I am 35 weeks 3 days.
And I am measuring 36 cm up from 33 cm last visit.

I think she was expecting a fight over the 3 day discrepancy. I basically told the doctor that it didn't really matter to me much which set of dates they used, and if they needed to schedule a c-section or induce me, I would just go by what they thought would be best. I think she liked that.

:-)

I gained a mere pound in the last 2 weeks, which I think helped. Don't ask me how this is possible, because I. Don't. Know. It's not like I changed anything about my diet or activity level. Though, I did make sure *not* to have Chipotle (or anything else super salty) to eat for four days leading up to this appointment. Ha.

And now I should really get to work.

Thanks for all the helpful tips about choosing electives. Really, super helpful guys!

Electives

2011-12-15T15:52:00.007-05:00

When I go back to med school in 15 months(!) or so from now, I'm going to have a limited amount of time to a) remember how not to kill people, and b) decide what field I want to do. Since currently I do critical care outcomes research, and since I loved my medicine sub-i, obviously Internal Medicine is at the top of the list.

However I also really enjoy procedures and being in the OR. I especially liked rounding on the post-op trauma patients when I did that rotation (I know this is not normal), so therefore Anesthesia is on my radar as well.

(Not sure why I never considered Peds, even though I really liked that rotation.... but I never did. And in some ways it seems too late to go back.)

(I also like Neurology a lot, but I'm not so into outpatient medicine, and I want to do policy research, which is a better fit for IM or Anes. If I became a Neurologist, I worry that I'd have a hard time getting any of them to see the value of my non-basic science research, and honestly at this point in my life I'm tired of fighting that battle.)

(I like psychiatry too, but if I want to do policy I think it will be important to do a specialty that already has some cred in that area.)

Anyway, so I was thinking about what rotations I should do to get back in the swing of things. The following came to mind:

- Cardiology
- Possibly a second IM sub-i
- MICU or CCU (or SICU if I decided to go the Anes. route)
- Anesthesiology
- Internal Med Procedure Service (if that is actually an elective, which I'm not sure about)
- Pulmonary
- Renal
- Infectious Disease
- If I do IM, I should probably do an outpatient month also (barf)

You get the idea. Useful stuff. But then I was thinking about the kinds of electives that sounded FUN, probably in part because I know little to nothing about them. Like that I might do after I apply to residencies but before the match because I'd never really get the chance to see them again. So, I started coming up with THAT list too.

- Autopsy
- Neonatal ICU
- Neuro ICU (which I could actually do as an Anesthesiologist)
- Derm

And I wanted to open up the floor to your suggestions, dear readers.

A) What electives did you find most useful to you when you started residency?
and
B) What electives (if any) did you think were fun?
and
C) Would you advise eschewing the "fun" for the "useful"?

Med students at your delivery

2011-12-15T12:55:00.002-05:00

The high maintenance mom at my childbirth classes (who never mellowed out AT ALL) went on a tirade about how there was no way she was going to allow medical students at her delivery during one of the classes.

I was curious, so I asked her why. I mean, she's entitled to her preference, but some people have very strange ideas about the role of med students at a delivery.

She told me that she didn't want to expose her babies to unnecessary cervical exams during delivery. Actually, this was a big thing for her since apparently she objected even to the cervical exams she was receiving at her 35+ week ob appointments when she was pregnant with TWINS. But I digress.

I don't think I laughed in her face, but I could have. I think during my entire 6 week Ob rotation at this hospital I did ONE cervical *or* pelvic exam (including on surgical patients) the entire rotation. And since her delivery was likely to be on the complex side, sure, they'd probably let the med student stand in a corner of the OR. But participate in any way? Hahahahaha.

I did tell her that she had very little to worry about re: med students violating her cervix, but whatever, if she didn't want them it was her prerogative. She sounded like a really bad patient to see as a med student anyway. Really confrontational, really ignorant (but thought she was educated), and really distrustful. As if a med student doesn't already have enough people being shitty to them on that rotation. They'd be better off with a multip who was more mellow about the whole process.

Public

2011-12-14T17:42:00.003-05:00

I was reading a blog post at another site I frequent, and I noticed a post with a very familiar story. As I kept reading, I realized that I knew this person in real life. I wondered if she realized how non-anonymous she was, and wondered whether she wanted the whole internet (and real world) to know what she was blogging about.

It made me think about my own (lack of) anonymity. As I get further along in my professional career, I start to worry about how this blog might be seen by future employers. I wonder how many people read it and hate me. I know that there are bloggers that *I* read whom I find to be less than appealing, definitely, and whom I probably wouldn't hire based on what I've read about them. I'd be naive to think that some people don't feel the same way about me and my blog.

On the other hand, I really like my blog community. It's been especially helpful for getting advice and support about first the dog, and now the pregnancy, and hopefully (soon) the baby also. It's also great therapy for me. I'd hate to give up blogging and lose that. Writing in a diary just isn't the same.

For the moment I tell myself that the benefits outweigh the costs. I wonder how long that will continue to be true.

I also wonder how much time I waste in a given day on the internet and if I'd be better off doing something more productive.

Things to consider....

I just don't know.

Oral Candidacy Exam

2011-12-12T08:53:00.007-05:00

I received an email from one of the secretaries of my committee members that I *must* send my proposal for my oral candidacy exam by 12/19 OR ELSE. It's not as though I wasn't planning on doing that anyway since everyone else wants it by the end of this week. She just had to be the one to send the snarky email.

I don't know what this woman's particular deal is.... When I had my last meeting, the night before I sent out my agenda and got a SCATHING email about how her boss could not possibly be expected to go over documentation prior to the meeting on such short notice. I pointed out that it was an agenda, and that prior review was unnecessary.... and I never heard back. It's all very ironic since I'm not actually even planning on doing the project that this person's expertise was required for anymore, but I don't think I'm going to say anything this time either.

But I digress.

The hard deadline of 12/19 (or this Friday if you're going to get particular about things) means that AFTER 12/19 things should get a little easier. As in, I should have time to a) finish writing up this other manuscript that I've been working on, b) work on the slide deck I'll be presenting for my committee meeting, and c) get everything else in my life done that I haven't been able to in the past month and a half due to pregnancy exhaustion and otherwork. Did I mention that TAing ends the 19th as well? Can I tell you how glorious that will be?

Things I want to do....

1) Get haircut (it's been 4 months, and we all know it ain't happening for a while once the kiddo is born)
2) Take the Boolet to the vet for her checkup and some new Interceptor
3) Get people stuff for Christmas (actually, I've been thinking that online shopping would be a fantastic way to procrastinate this week while I get all this writing done)
4) Do inordinate amounts of laundry
5) Clean the house (ha)
6) Finish painting the basement trim (Luca did the walls this weekend, and it looks fantastic)
7) Organize the upstairs bedrooms that have been serving as storage areas for the basement since we *intended* to paint it 2 months ago, but never got around to it.
8) Pack my hospital bag

Not to mention all the Christmas-y things I *want* to do, but know that I won't have time for (cookies, decorating, meal planning for Christmas dinner, etc.)

We'll see if any of this actually gets done.

I'll just be happy to get my proposal out of the way. Cross your fingers that it happens for me in time!

Dear MD PhD Applicants in Epi

2011-12-10T14:11:00.013-05:00

My department has an MD-PhD applicant this year!

I have always found it amusing that my department aggressively tries to manage our image by ONLY introducing the students to the applicant as a group, and while under the supervision of faculty members in our department. They know that most of us won't say anything that might garner the disapproval of our superiors, and that they will be able to ~~perpetuate lies~~ convey the image they want in this context. Plus, there are currently a lot of us because in one year they decided to admit 4-5 students at once, so it will look like we are a robust, well established department.

DO NOT BE FOOLED.

So. Here's the deal.

First, the cons:
1. Most MD-PhD students at my school are funded by a combination of MSTP funds and R01s that their PI have secured. This R01 funding more or less does not happen in my department. The powers that be do nothing to encourage faculty to write funding for PhD students into their grants, and as such only 2-3 faculty members in the *entire department* are able to fund you by this mechanism. The PhD director has applied for a training grant for PhD students, but so far we have not received one yet.

2. If you happen to be interested in working with one of these 2-3 faculty members (and how could you possibly even know that at this point -- you haven't even started med school yet, how can you possibly REALLY know what you want to do), you MUST get some sort of written documentation guaranteeing that they will pay for you while you are their student. Or else by the time you are their student, they will likely "forget" this promise and screw you over. I've seen this happen.

3. One other alternative source of funding exists: pharmacoepi. However they will only fund you for 1 year, and then they will require you to apply for your own grants. Plus, this particular funding source more or less requires that you promise you will devote your entire career to doing pharmacoepi research. Maybe some med students are willing to commit to this line of work that early in their career, but I was not.

4. If none of the above work for you, you will be required to get your own grant. The most common funding mechanism is the F30, but not all NIH departments have one, so you could end up SOL on this front as well. Even if there is an F30 for you to apply to, know that they are a giant pain in the ass/time suck. You'll most likely need to budget at least 2 months at 50% time to do a good job on this. You'll at least be in the fortunate position of not having to be the first person in the department to apply to this (that was me -- you're welcome -- and you really don't want to know how much that sucked), but it still a total time suck, and is not even guaranteed $. So you may have to apply more than once. Joy.

5. Technically as an MSTP student, you are "guaranteed" funding for up to 10 years here. You could try to press your luck and just not bother to apply for grants, but you will piss everyone off if you do this. The Epi department will try to force the MSTP program to pay for you, and the MSTP program will try to force the Epi department to pay for you. You will be caught in the middle. You will end up applying for a grant anyway, but only after everyone has already labeled you as difficult.

6. There are a TON of required courses. Some of them are awesome (i.e. any and all biostats offerings, advanced epi, outcomes research, clinical economics, and probably some other courses that I haven't taken also), but about 40% of them suck. And by suck I mean a) they require inordinate amounts of your time via class time and busywork assignments, b) they teach you very little, c) they make you want to put your head through a brick wall. Don't say I didn't warn you.

7. PhD students are not a department priority. Master's level students are their priority, and for the most part these are clinical fellows who will have little to no interest in you, your research, the fact that you are going to know more about research than they do. They will most likely see you, and treat you, as a medical student first and foremost. Which is to say that it is likely that they will default to completely ignoring you, or being outwardly rude to you until they realize that you aren't a moron after all.

8. Because of all the required coursework and grant writing, this program really will take you 8 years.

9. We are a very small, new PhD program, with all the problems that can bring with it.

The pros:
1. The MSTP program at my institution takes care of its students so well it's not even funny.

2. They really want you to succeed, and want you to graduate within a reasonable amount of time (7-8 years). If you think it is like this everywhere, PLEASE think again. I know an attending in my field who did an ELEVEN year MD-PhD at my old institution. This problem tends to be worse when the PhD and MD programs are less integrated, and worse with social science departments.

3. If you are a PhD student in the biological or physical sciences, typically the stipend is a lot better than it is in the social sciences (30K per year compared with 18K or some such, and social science depts may not cover health insurance either). When you go to PhD-land, some schools will make up the difference in stipend so that you get paid the same as the other students, others will not. My school DOES make up this difference. I can't even imagine trying to live in Philadelphia in a non-slum on 18K per year, though I suppose people must do it.

4. Grant writing sucks, but getting a grant as a PhD student looks awesome on your CV. Also, it's what you'll be doing for the rest of your life if you go into academic medicine, so you might as well figure out if you like it now.

5. You can totally customize your training program to get exactly the kind of training you want, that is specific to your research interests.

6. The researchers here are some of the best in their fields. Some of them are even good mentors too.

7. The med school here is amazing. The MD-PhD office does a great job integrating the PhD part with the MD part as best as it can.

8. I really do feel like I've gotten the training I need to be a successful researcher in the future.

9. You won't be the first student to do MD-PhD in Epi (that was me), and you can benefit from advice / path-clearing from the people who came ahead of you.

10. Most students in my dept end up with a ton of publications.

11. A lot of the work you do is going to be very self directed since nobody has time to work closely with you on any sort of consistent basis. You will figure out very quickly if research is for you in this way.

12. The biostats department is amazing.

13. Fundamentally, despite all my bitching and moaning, I am happy I came here. I will have great options for my career when I finally finish this thing -- even better options than I would have had if I'd done basic science instead.

So, I have no idea whether this post will reach any of the people it needs to reach, but this is the scoop. I hope it's useful! And for those people applying in other non-trad MD-PhD fields, a lot of the points I raised will most likely be useful for you as well.

Good luck! And perhaps I'll see you on the interview circuit.

Race

2011-12-10T11:14:00.004-05:00

This morning, instead of working on my protocol, I decided to a) give my husband a haircut, b) wash the dog, and c) wash myself. While I was doing this, my mind drifted to policy.

So, one of the ways in which hospitals are currently rated is based on their observed/expected mortality ratio. Ratios > 1 are bad. Ratios < 1 are good. Way back when in the early 90s or something, they didn't used to adjust for patient mix, but now they do. This is important because different hospitals serve different patient populations, and policy people didn't want to penalize hospitals that had complicated patients who might do worse through no fault of their own.

The adjustment isn't perfect, and for (most likely) political reasons, the ranking system is set up so that it doesn't "unfairly" punish small or community hospitals or reward big teaching hospitals. The end result is that more or less all hospitals look the same according to this metric. Woo! Just think of how much money has been poured into developing a ranking system that does exactly nothing.

In the severity adjustment, they adjust for patient severity of illness, comorbidities, age, and a variety of other things that are supposed to reflect the probability that you will die.

Do you think they should also adjust for race?

I don't, and here's why:

If you adjust for something in a statistical model, that means that you will end up making your comparisons across other hospitals with like characteristics. For instance, if you adjust for gender, you'll make one set of comparisons among women, and another among men. If you adjust for race (black or not black just to make things simple for now), you will make comparisons among hospitals that serve a lot of black patients and separate comparisons among hospitals that serve primarily non-black patients.

What's the problem with that, you're wondering. Don't we know that black patients have worse outcomes, even after we severity adjust? (Yes, this is true.) Wouldn't you be encouraging hospitals to turn away black patients if you didn't adjust for that? (Maybe.)

But the problem is, if you adjust for race, you're giving hospitals a free pass to do a worse job caring for black people, for no other reason than that they're black. And is it because some patients are black that they have worse outcomes? Or are there other underlying factors that are associated with being black that causes this population to have worse outcomes? I would argue that the latter is the more accurate picture.

Could you adjust for insurance status instead, so that hospitals that serve a lot of underserved patients aren't penalized for that? I'm not sure. The incentives would end up being similar, except now hospitals would get a "free pass" if they did a bad job caring for uninsured patients. At least you don't wear your insurance status on your skin though, and it would be harder to consciously or sub-consciously treat these patients worse.

Insurance status is a bit of a moot point anyway, since all of these models are based on Medicare data, where everyone has Medicare for insurance already! All that damage from being uninsured before you got on Medicare has already been done.

Anyway, these are the things I think about when I wash the dog.

The snot disease

2011-12-09T08:59:00.002-05:00

Ok this is going to be really whiny, but my husband gave me his cold and I feel soooooo gross!!! No fever or anything dramatic, but there is just so much snot! I've been trying to sleep as much as I can at night in an effort to eradicate this thing, but I fear I'm just going to have to wait it out.

Of course my husband has fully recovered. Damn him and his immune system of steel. I've been eating clementines and drinking grapefruit juice, and they definitely help. I'm going to attempt walking to school this morning again in the hopes that the cool air will help as well.

Just saying, it is not fun to come down with a cold ever. But it is especially not fun when you have the written part of your oral candidacy exam to do within the week, and all you want to do is lie on the couch, but instead you're stuck sitting at your kitchen table doing lit reviews and power calculations.

:-P

Med students on ob

2011-12-08T13:18:00.002-05:00

I found out last night that one of my MD-PhD classmates is going to be doing his Ob/Gyn rotation at the hospital I'm delivering at during the month I am delivering.

Nice guy. Well liked. But also he was the guy who wore the cadaver's omentum as a wig during anatomy lab 5 years ago. The kind of guy who makes inappropriate jokes that are really funny, but that are not ok for girls to make. You know what I mean.

So it appears that my prohibition on med students in the delivery room was well thought out.

We all had quite a good laugh about this.

Woo!

2011-12-07T09:19:00.005-05:00

Last childbirth class was last night, and as a bonus, they couldn't get the video to work so we got to leave 30 minutes early!

Yay!!!

I really haven't enjoyed these classes. I'm not disputing their usefulness. It's just.... they leave me with a sense of dread about the whole having a baby process.

They had a mom come in last night to tell us what the process of giving birth and breastfeeding was like, and she was really really trying to be perky. And.... she was really really not succeeding in convincing me that she was happy. And I swear, if someone tells me about another item I MUST buy or else my life will be ruined. Sheesh.

So internet, I have a question for you: how soon after you gave birth were you able to start working out again (running, swimming, walking even, etc.)? What were the main barriers, and how do you suggest overcoming them? All I can think about these days is how badly I want to go for a run. And while I know that it's going to be at least several weeks before I'm able to after I give birth, any tips would be most appreciated!

Nerds

2011-12-06T09:10:00.006-05:00

Yesterday I was talking with someone who has a penchant for boring me to tears with his obsession with fantasy football about someone else in my department.

"But he's such a NERD!" said Fantasy Football. It was clear by the way he said it that he didn't think the term "nerd" was complimentary.

He continued, "All he's ever able to talk about is his own research! It's so boring! And he's so arrogant!"

"Yeah, but he's usually right, even if that fact is sometimes annoying. And plus I kind of like listening to his stories about his work, even if he does have a high opinion of himself. He's really smart," I said.

"Ugh, but he's such a NERD!!" Fantasy Football exclaimed again.

"Well, maybe I'm just used to that kind of person. That's what pretty much everyone is like at the University of Chicago," I said, leaving out that I usually like nerdy people and find them interesting. Heck, one of the things that drew me to Luca was his knowledge of Latin poets (no I am not kidding). Nerdy is hot.

I thought to myself that I hadn't heard the word "nerd" used so pejoratively in quite some time. And what's so different about an inability to talk about anything but fantasy football, really? Except that fantasy football is not interesting to me, and this guy's work is.

Different strokes for different folks, I guess.

*Sigh*

Sometimes I really miss the University of Chicago.

Of course

2011-12-05T18:37:00.004-05:00

Of course, right in the middle of writing up my protocols for my oral candidacy exam, I have to complete renewal documentation for my F30.

So I get the documents from the grant administrator at my school with a bunch of barely literate instructions. She sent that to me last Thursday with instructions to have it back to her by this coming Friday. Complete with signatures from my department chair and my sponsor. And let's be clear: electronic signatures will not do. I must print out said document, and hand carry it to these individuals' offices which are all over campus, wait for them to sign it, collect the document, and then hand carry it to the next individual.

It's annoying, is all I am saying.

Add to the fact that they are both very busy and are unlikely to be around. Both of them have goddesses for admins, but there's only so much that even they can do.

Did I mention that the person who filled out the form put in the wrong sponsor as well? When I asked her to correct it she just said, "Why don't you just white out the fields and change them yourself?"

Well, I could, but since those particular fields comprise about 50% of the fields on the document, it's going to look pretty sloppy. And on that particular document I can't edit it electronically, so yeah, it really would be me and a bottle of white out and a blue pen. Yeah: SLOPPY. (And really, how hard is it to get this information right? How lazy do you have to be not to look that up? Or at least send me a form that I can modify electronically. Is this really asking too much?)

Did I mention that the other documents are not savable with changes? So basically, I have to put in my information, and then print the documents out immediately. Which can't happen at my house since I don't have a printer here that is high enough quality for this.

Don't you love the administrative hurdles one must leap in the name of science?

I have no idea what will happen when I give this to her late. Oh well. Since she hasn't seen fit to reply to my emails about that, then it's just going to get turned in when it gets turned in. Too freaking bad.

Grumble grumble grumble.....

Swim Attire

2011-12-04T17:04:00.007-05:00

I hear swimming is supposed to be some kind of divine exercise for pregnant women. Unfortunately, my one pieces stopped fitting a while ago (serves me right for buying the indestructible polyester suits). In addition I developed this fear that I would run into someone from my department, and be forced to have an awkward conversation about my pregnancy while I was practically naked and shivering in my bathing suit.

I've since gotten over that fear. Those conversations? Already been (awkwardly) had in the elevator. And it is So. Much. Easier. to end them when it's your floor and the door closes behind you as you exit halfway through some (awkward) sentence.

Also, I can't see, much less shave, my bikini line, and didn't want to give the kids a faceful o' bush because I didn't know it was sticking out.

Also, the pool is cold.

Anyway, last week Luca suggested that I wear one of my athletic bikinis (I have a small rack so "athletic" is the only kind of bikini that works on me). His rationale was my mentor's wife wore a bikini while 7 months pregnant at the department picnic, and our friend wore one while 8 months pregnant to a July 4th barbeque at the neighborhood pool. And both ladies looked fantastic. Well, a lot more fantastic than they would have in a maternity suit anyway.

I was still apprehensive given the bikini line issue. Also, I was worried that the bottom wouldn't fully cover my crack (which is why they have maternity underwear in case you didn't know). So tonight, we tried it out to see if it would be a disaster.

Below are the results.

I think I like the last one the best, and yes I had to lean forward so that I could capture my toes peeking out from underneath my immenseness.

And while I'm certainly no Heidi Klum, I'd like to think confidence goes a long way. Or so I am telling myself. Now, if I could only get my behind out of bed in the morning early enough to get to the pool.....

If I go I will keep you posted.

Baby Center -- Birth Plan

2011-12-04T12:31:00.009-05:00

As per my friend's suggestion, I signed up to get the weekly Baby Center updates. They send a cute email every week that tells you what your baby's development is up to and what to expect with how you feel. It's been nice. They also have a decent baby names search engine. I could do without the articles like, "Danger foods to avoid around the holiday season," but I suppose no internet service is perfect.

Anyway, I was clicking around the site today, and noticed that they recommended writing a birth plan. Now, in the past I've always thought birth plans were asinine, and typically written by granola women who wanted more control than is possible during birth, avoiding all interventions, eating their placentas, etc. However I was surprised to find this template to be very useful.

I won't go through every item on the list, but let's just say that not only were there things that I DID want, but that I actually felt quite adamant about them.

For instance:

- Only Luca is allowed in the room with me. No other relatives. Also, he is not allowed to leave. Ever. (Except to pee and maybe get food for himself.) I might allow a friend of mine who is a resident there to visit while I'm in labor depending on how things are going, but that's the only exception.

- His job is to take pictures and keep the nurse/drs under control. I've found that his mere presence helps with that sort of thing. They tend to lecture less and talk to me like an adult rather than a little girl when he is there.

- I do want to be able to walk around as much as I want. I realize that if I get an epidural, they won't let me. They tried to skirt around this during the anesthesia talk during childbirth class, and I recognize it's a liability issue for them, but I think that being confined to bed for a long time will make me nuts. Therefore I plan to defer the epidural as long as I can.

- I don't really care if I eat or drink as long as I have my Aquaphor.

- It would be nice to have intermittent fetal monitoring so that I can walk around, though I don't know if that will be permitted (which is where having Luca there might end up being helpful).

- I'd prefer to not have my labor be augmented if possible. If it needs to be augmented, then I want an epidural BEFORE that happens.

- I do not want to be coached while pushing.

- Specifically, I have instructed Luca that if the resident / nurse / attending says anything like the following: "I don't want to hear you scream / grunt/ make any noise while you push!! Any noise you make is less energy directed out of your vagina!" as I heard said MANY times during my Ob/Gyn rotation, he is to ask them not to say that. If that doesn't work, he is to ask them whether they think grunting makes Serena Williams hit the tennis ball less forcefully. And if they still can't control themselves, he is to kick them out of the room.*

- NO MEDICAL STUDENTS. These are people I am going to be graduating with, and there is quite simply no need. If I could not have residents at this hospital, I'd do that too, since I haven't met a single senior (female) Ob/Gyn resident that I have not found to be highly unpleasant. However, I doubt I will have that option.

- It would be awesome if Luca is allowed to help catch the baby. I don't know if they'd permit that, but I don't really see why not since they let jackass 1st year "watch a birth" med students who know nothing catch from time to time (though interestingly not actual clerkship students who might be interested in going into Ob/Gyn.... Not that I know anything about that.)

- It might actually be kind of cool to touch the baby's head as it crowns.

- If I have a c-section, I'd like to be able to see the baby be delivered over the blue screen if possible. Also, Luca must be present.

- It might be nice to donate the cord blood, though I'm not paying to do it.

- I want to room in with the baby after delivery 24h per day, and if I can't be there then Luca has to be.

One thing that has struck me as I wrote this is that I realized that I don't trust that I will be listened to when I'm in labor. My guess is that this is related to the fact that I AM NOT actually listened to (or treated like a person, much less an adult) at my prenatal appointments. Hm.

I guess I just don't like being treated like a patient on an assembly line. I never realized how important this was to me before this experience. Perhaps this doesn't bother other people, but it definitely bothers me.

*This wasn't actually on the birth plan checklist, but I remember vividly them talking to patients like this.

All ObGyns are bitches and deserve to die

2011-12-02T12:00:00.009-05:00

Ok, not ALL of them. I ran into my REI Ob in the elevator today on the way to my prenatal appointment, and she remembered me from 6 months ago, and was so nice to me. I think she's amazing.

It's all those other ones.

So, I am currently 32 weeks and 6 days. My weight gain has been 22.9 lbs as of 7:30 this morning according to my scale (baseline weight 125 lbs, current weight 147.9 lbs). Since my last visit 2 weeks ago, I gained 1.5 lbs, (146.4 two weeks ago, and 147.9 this morning). I haven't been walking *as much* lately because it makes me so freaking exhausted -- I get winded walking up any sort of incline, my shins hurt, my abdomen hurts and I get really uncomfortable pelvic pressure, and if I have to stand, I get REALLY winded and feel like I want to pass out.... but! I've still been walking about 1-2 miles every day. It just sucks having to do it carrying a computer on my back.

Well, according to the Ob I saw today, the reason I get so tired walking is because of how fat I am! Isn't that fantastic? I'm glad she is such a smart doctor, and was able to tell me that. Actually, her exact words were, "You have gained 28 lbs this pregnancy, and 3 lbs in the last 2 weeks. That's probably why you're so tired."

I'm sure it has nothing to do with the fact that I sleep like shit these days. It's just my obvious obesity.

Then the lectures started*.

- I need to keep the weight gain to 1 lb per week.

- I need to do at least 30 minutes of physical activity a day.

- I need to make sure I only ever sleep on my left side (not sure where this came from, but I only sleep on my left or right sides, and if they really expect me not to roll over when I sleep, they need to put down the crack pipe).

The only thing I hate more.... scratch that, there is NOTHING I hate more than getting lectures I don't deserve. NOTHING. Especially when I know that if I say anything I will be a) blown off**, and b) possibly labeled as "difficult" or "uncooperative." It makes me fucking insane.

And to think I'd finally relaxed about the whole weight issue and stopped feeling so anxious all the time. Well shame on me for not neurotically bringing my own chart where I've been tracking my own weight at home to every appointment. That will teach me to let my guard down!

I walked out of that bitch's office and bawled the whole walk home. All 1.8 miles of it. I was so upset that for the first time in a month my shins didn't even bother me.

I talked to Luca and we decided that he will be coming with me to all of my appointments from now on. Either that or I won't go at all.

For all of you who can't understand why I find this so upsetting, and wonder why I just can't let things like this roll off my back, and desire to leave comments to that effect (along with a note about how you *only* gained 20 lbs when *you* were pregnant -- you know who you are), please note that I think you are an asshole. That is all.

*If ONLY the lectures consisted of these single sentences! But no, they consisted of several minutes of her talking and me sitting there seething.
**I hate being blown off almost as much.

Dear proud papas

2011-12-01T12:31:00.010-05:00

Dear Proud Papas,

First off, congratulations on becoming a parent! I can tell how happy you are post the birth of your child, and how proud you are of your wife and impressed with how she coped with labor. You're probably feeling a mixture of amazement of the birth process, and thankfulness that you are a man and will never have to go through that yourselves. And I understand your desire to share these sentiments with the rest of the world.

However, there are some things that the world really does not need to know about, and the resilience / stretchiness of your wife's perineum are at the top of that list. Maybe you don't realize that's what people think when you share these stories, but.... it is. Well, at least it's what *I* think. And I know I don't want my husband sharing these types of things with other people when my baby is born, so I thought I'd just throw it out there.

For instance, there is no need to share with the world how your wife gave birth to a 10 lb baby vaginally without an epidural -- without tearing. I know you want people to think she's really tough, and that you're amazed that she was able to do this. But really it makes me think that she has a really loose / stretchy vagina, and perhaps a congenital connective tissue disorder also. And I am 100% positive that your wife does not want people thinking that about her.

Similarly, there is no need to tell us how proud you are that your wife completed a 100 mile bike ride a mere four weeks post-partum. It doesn't make me think she's tough, it make me think, "Wow, she must have had a really easy birth with minimal tearing." Again, not something that I (as a woman) would want other people thinking about me. Perhaps we can chat off line later so I can find out who her obstetrician is, though.

On a related note, I know you think that the colorful things your wife said to you during her delivery are funny. Perhaps the two of you even joke about it now in the privacy of your home. However, as a woman, I would not want my husband sharing the things I said while I was in agony with people I don't know. Maybe your wife is cooler than I am, and doesn't mind.... I'm just saying that *I* would, and that's what I think when you share these stories with me.

And finally, as a woman I find it rather irritating to hear you tell me about what an involved father you are in one breath, and then 10 seconds later you're telling me about how you went out drinking all night with your buddies 5 days after your child was born, leaving your wife at home to tend your three children under the age of 4. You just keep deluding yourself that you "equally share" childcare responsibilities. Not cool dude, not cool.**

Anyway, congratulations again on your bundle of joy. And keep being proud of your wife! Just maybe find other ways of sharing that pride with the rest of the world.

That is all.

**Alternatively, and equally annoying, is when the male faculty members say how awesome it is that their wives are giving birth so that their tenure clock gets extended by 6 more months. And then they act like they do equal parenting.

Going natural

2011-11-30T15:42:00.004-05:00

After a meeting today, we were all getting up to leave, and the attendees for the next meeting started filing in. One of them congratulated one of the fellows on her new baby. The fellow said thanks.

And then....
"So, did you go NATURAL?"

WTF??

Since when is it ok to ask a woman the details of how she gave birth? I would NEVER ask someone I wasn't really really good friends with whether they had a c-section even, let alone what kind of pain control they used.

And let me make one thing clear, these women WORKED together. In fact, I think the person who asked was a subordinate of the fellow, though not another doctor.

I don't know exactly how I would have responded. Fortunately, the fellow had "gone natural" and could say that (because God knows that's the superior way to give birth). But still, I felt that the question was completely inappropriate.

I think the correct response is this: That is none of your business, you nosy bitch. WHO are you, again, and what gives you the right to ask me prying questions about my medical history?

It's just too bad that nobody has the balls to actually say that.

Anything for a piece of cheese

2011-11-29T16:50:00.005-05:00

There's nothing like a high value treat to make a dog learn fast.

Yesterday we received a baby gift from my brother and sister in law (thank you!!) and it came in this huge box. I decided it would be cool to teach the Boo to jump in the box ("get in the box"). It seriously took 1 try, and then she started "offering" to jump in and out of the box in order to receive another treat.

Luca took things a step farther. He taught her to jump into and then out of the box, like a bounce (http://en.wikipedia.org/wiki/Horse_jumping_obstacles) obstacle ("in and out"). That similarly took about two tries.

Apparently she really likes Swiss cheese.

Now, if only she could be as good at learning not to be reactive to other dogs, then we might really be onto something....

Things I miss

2011-11-28T08:59:00.006-05:00

I was talking to some friends the other day about being pregnant, and they said to me, "How do you like being able to eat whatever you want??"

And I said, "Are you freaking kidding me?? For the first time in my life I've had to actually WATCH what I eat! And it sucks!"

The truth is, my pre-pregnancy diet consisted of almost exclusively forbidden foods. Sandwiches with cold cuts, sushi, stinky cheeses. I also have had to add a ton of fruits and vegetables in order to keep the system from getting, er.... backed up. Which meant cutting even more other stuff out.

And then there was the dramatic reduction in physical activity. Prior to getting pregnant, I was walking to and from school, AND walking the dog every day -- on an EASY day. 4-5 days per week I also did formal exercise like running, swimming, lifting weights, or climbing. Clearly that has mostly gone out the window.

I suppose the best part about this change is that I've been able to figure out how to modulate my weight with food. The sucky part is I learned just how little I'm able to eat if I'm not exercising. Now that I'm down to walking 1.5 miles per day since I'm forcing myself to take the bus at least TO school, I'm going to have to eat even less.

Argh.

At least I'm into my 32nd week. And at 23 lbs and counting, while I *could* end up over the recommended 25-35 lbs, it's looking less likely. Phew! Crossing my fingers for no more lectures from that damn NP! I see an actual doctor next visit. I wonder if that's because of the visit to the ED for the contractions I had two weeks ago...... In any case, I'll be interested to see if I like her better.

Other things I miss..... I miss being able to walk upstairs without getting winded. I miss being able to sleep through the night. I miss being able to put on my socks without difficulty. I REALLY REALLY miss being able to go for a run (even though I've never loved running). I wanted to go to NYC with Luca to see an exhibit at the Guggenheim, but ultimately we nixed the idea because we decided I'd probably be completely exhausted by the time I walked to the museum.

I miss wearing cute clothes. I keep getting the J.Crew catalog, and I think, "I really like the cuts and color palate this year. Too bad I WON'T FIT INTO ANY OF IT!!" And shoes. I really want to buy a pair of boots, but there's no point! I have no idea whether it's edema, or whether my feet have permanently spread, but they're definitely bigger. I will need to hold off on any new footwear until I figure out what's going on in that department.

But you know what I like about pregnancy? Last night I was sitting at the kitchen table ~~getting distracted by the internet~~ doing work on a presentation, thinking about how lucky I am to have a husband, a house, Miss Boo, an almost term baby, projects that seem to be progressing at school and a research agenda that I care about at one of the best programs in the country, and that I'm getting along better with my mentor -- really well, in fact.

I thought to myself, "What if this whole academic thing doesn't work out? What if I physically can't work hard enough to do it? (Pregnancy has put me much more in touch with my physical limitations.)" And I decided, who f-ing cares. I loved being a doctor too (well, being a sub-i, anyway), and if I end up being "just" a doctor to support myself and my family, that's ok, and I'm still really lucky. And I have a good 15 years left of being able to do research *I WANT* until the tenure clock runs out, worst case scenario, if that ends up being the way I go. And then I'll still have choices between doctor, policy person, industry. Which are great choices to have.

It was a rare zen moment for me. If I've had to suffer the discomforts of pregnancy to get there, I'd say it's totally been worth it.

Things I would like to get done before the baby is born

2011-11-27T16:33:00.003-05:00

- Get manuscript #1 accepted, or AT LEAST get revise and resubmit submitted
- Get protocols for Aims 2 + 3 of my dissertation completed and circulating before my oral candidacy exam
- Finish manuscript #2 which I've been sitting on for ages and get it submitted
- Recruit two data collectors to review charts for Aim 2, submit IRB for Aim 2, and start data collection (this one may be a stretch)

- My hope was originally to start the analysis for Aim 3 as well, but that may be biting off a bit too much....

At some point I'm also going to have to write a protocol change request for my grant since it looks like we're not going to have sufficient power to do the analysis we proposed. On one hand, it's a bummer that this study won't get done. On the other, it's one less thing for me to do which is the opposite of a bummer.

If I give birth in 5 weeks, I probably won't be able to get all of this done. If it's 8 weeks, it might be more possible.

We'll just have to see.

Turkey Day

2011-11-25T19:04:00.004-05:00

So, my parents came for Thanksgiving on Wednesday, and left this morning. And I have to say, it was the best Thanksgiving we've had in several years, even though Luca and I had to do all the work. Actually, I think one of the reasons it was so awesome is BECAUSE we had to do all the work.

One of my favorite things to do with my husband is to cook with him. He is a great partner. This time, he picked out the recipes for all of the side dishes, while I figured out how to roast a turkey and make gravy (it even came out not-lumpy). We did the grocery shopping together, and I figured out how we should stagger the cooking of each dish so that we could have everything made by 4:30. He made for an excellent sous chef and also kept up with the dishes so that we actually had pots and pans to use for each stage. And he cleaned up afterwards when I had beached myself on the couch. I'm telling you, the man is a saint.

It turned out AWESOME.

The turkey was actually moist. The meat thermometer that my parents gave me for Christmas last year was instrumental in this.

The sweet potatoes with pecans were my favorite dish, probably because they tasted a bit like pie.... I think this was Luca's favorite too.

My mother liked the stuffing recipe so much (Silver Palate -- Cornbread, sausage, and apple stuffing) that she actually requested it. (Hint: we added a bunch of chicken stock to it before we baked it, which is why it came out moist.)

We also had garlic mashed potatoes (instant -- what can I say, I was raised on instant mashed potatoes and have always preferred them to homemade. I know, blasphemy.)

And then there were the Brussels sprouts with pancetta, though if you must know, we just used regular bacon and they tasted great anyway.

We had cranberry sauce out of the can -- YUM!!

We were going to make rolls, but had so much cornbread left over that we just had that instead.

The only flop was peas au gratin. It was an Emeril recipe, and it was so spicy, you couldn't actually taste the peas. In fact, you could barely eat it, and it clashed with the other food. We didn't even keep the leftovers.

We were so full after consuming dinner that we didn't even have space for pie. Which is fine, since I got to consume some today instead. :-)

Miss Boo behaved impeccably. She even refrained from jumping up on my mother, which was a minor miracle. My mother refrained from feeding the dog off her plate (that's my job), and we therefore avoided diarrhea today. Luca and I showed my parents the trick repertoire we make her do before she can get her dinner, and they were very impressed. Hopefully the next time we visit them in CT, and the Boo decides to attack William (their standard poodle), they will recall that the Boo IS in fact very highly trained, and that she is just a bitch to other dogs. There is a difference, people!

And most importantly, we all got along. We didn't yell at each other once, which really is a holiday miracle. Haha. My parents even gave me what I consider to be very useful advice regarding things we will need for the baby. My mom also told me that I was sleeping through the night by 3 months, and that she had no trouble breastfeeding. Which is really a relief. If you read the internet, I think it's possible to come to the conclusion that breastfeeding is the most difficult thing in the world to do, and it was nice to hear at least ONE story of someone who didn't have problems. The sleeping through the night part was a relief too. Maybe Luca and I will get lucky and end up with a similarly inclined baby.

Fingers crossed!

Tomorrow I will be 32 weeks, so only 5-9 weeks of this pregnancy to go. The countdown begins. Up until a week or so ago, it really wasn't so bad. Now however, I am beginning to feel really large and encumbered. The baby is expected to add 3-5 more POUNDS before it comes out, and I can only imagine how difficult that will make putting on my socks and getting out of chairs.

I'm sure it will be tough, but Luca and are are still really excited!

This disturbs me

2011-11-25T12:53:00.004-05:00

http://www.nytimes.com/2011/11/25/us/politics/support-builds-for-premium-support-plan-for-medicare.html?_r=1&ref=health

I have a better idea: Once someone is no longer "useful" to society, why don't we take them out back and shoot them in the head.

It's just ironic to me. The Republicans don't want "rationing" (which already happens, guys) by doctors or the government, but they are totally and completely ok with the idea of rationing by ability to pay in the private sector. Ah well, I suppose that in the future, only lazy people will be too poor to purchase the private insurance geriatric plans.

+1

2011-11-22T18:07:00.005-05:00

Among the great many 3rd trimester symptoms I've been experiencing lately, +1 pitting edema in my lower legs is the newest one. Woo! For those who are concerned, you'll be relieved to hear that my last BP reading was 100/58 or some such, so it appears to just be standard swollen ankles of pregnancy.

Other symptoms include (TMI warning) dyspnea on exertion (basically every time I walk up hill I have to stop and rest multiple times), insomnia (better this week, but probably only because I've been staying in bed 10+ hours a night), difficulty getting comfortable pretty much any way I sit, and constipation. I may have done a geriatrics rotation in med school, but it took pregnancy to teach me the ins and outs of laxatives. Colace and I, we're best friends.

All I can think about is how I'm looking forward to being able to go for runs again. And I don't even LIKE running all that much! I had occasion to run-waddle for a bus the other day and let me tell you it was not pretty.

But all that aside, as unpleasant as these things can be, I sometimes stop and think: This could be the only time I'm ever pregnant. I should really savor this. Things like feeling the baby move (like ALL THE FREAKING TIME), not feeling guilty about sleeping as much as possible, having my husband go out of his way to make things easier for me, when people say nice things to me about how I'm glowing, or how fit I look, and paying me extra attention (I know some people hate attention.... I am not one of those people), may well never happen again.

It makes up for some of the unpleasant symptoms, anyway.

It's kind of like, though I would NEVER want to be a neurosurgeon or a urologist, I tried to see as much on those rotations as I possibly could because I knew I'd never get the chance to see some of it ever again. When I got to drill a burr hole in a patient's skull, or be first assist on a surgery, or help close, I thought about how I might never do this again, and it made the rotations not only bearable, but actually enjoyable sometimes.

So it is with pregnancy. And I'm assuming, so it will be with having a newborn.

And who knows, maybe Luca and I will like it so much we'll decide to have a second after all.

Ha.

I'll believe it when I see it

2011-11-22T10:27:00.006-05:00

Supposedly, the final word on my qualifying exams will be made this AFTERNOON. I know, it's remarkable that this is actually getting done, since I finished taking them 3 months ago.

I was beginning to get concerned since I have to pass my quals before I can do my oral candidacy exam. And my oral candidacy exam is scheduled for 1/3. Even as it is, if I have to remediate any part of my qualifying exam, I'd have to push back my orals. Which wouldn't be the end of the world, but would be a giant pain in my butt.

So, here's crossing my fingers that I passed, and above that, passed without having to remediate anything!

But then, at the rate things progress in my department, as far as final grades happening today are concerned, I'll believe it when I see it.

:-P

UPDATE: I PASSED!!!

Scratch That!

2011-11-20T17:43:00.003-05:00

In light of my contractions last week, Luca and I decided it would be prudent to have Thanksgiving in Philadelphia. My parents live way out in the boonies, and the last thing I want is to deliver a premature baby up there and have him/her airlifted to the nearest NICU. That's just a disaster waiting to happen. Plus I ALWAYS get dehydrated when I go to CT, so I probably would have contractions again.

Well, maybe anyway. We decided that we just didn't want to risk it.

So, my parents decided to come down here!

I don't know what's brought about this change in their interest in seeing me. Perhaps the reality that they will soon be grandparents has finally set in. Maybe it was the blog post from a few months back that did it? Maybe it was that I told my parents that my relationship with them wasn't like the relationships they had with their parents, and that I DO want to see them and have them be part of my life. But whatever it is, I'll take it. I'm really excited to see them again!

So we are cooking.

I ordered a freshly slaughtered (free range?) turkey, which should be killed this weekend and arrive on Tuesday from the Gold Standard Cafe. We're also having some pea - cheese casserole that Luca picked out, baked Brussels sprouts with bacon, sweet potato with pecan casserole, and mashed potatoes. I think we're also doing a cornbread/sausage/apple stuffing. And we bought a pumpkin pie. We made one last week, but this time decided it would be too much work to make another.

I hope it all turns out ok!

Hopefully I'll have my revise and resubmit circulating amongst the various authors by then and I can take 1-2 days off to cook + eat. Wouldn't THAT be a treat?

Because my husband is awesome

2011-11-18T12:34:00.009-05:00

He came with me to my prenatal appointment today. To finagle this, he got up at 5AM (his usual time), and did work until we left for the appt. at 9:30. He even called into a meeting before we left.

I was seeing the NP who'd given me shit about my weight 6 weeks ago, and he said that he would personally yell at her if she said ANYTHING about the fact that I put up 4 lbs in the past two weeks, since 2 of those lbs were from yesterday's 2L of normal saline. Fortunately, she didn't say anything.

He told me later that he could see why I didn't like this particular NP, and that she rubbed him the wrong way too. I have no idea whether he is just SAYING this, or if he really means it, but it means a lot to me that he's willing to show me support like this.

I love my husband.

This whole process has been quite the education for him. He has known for a while now that my Ob/Gyn rotation was the most miserable 6 weeks of my time in med school, and yesterday gave him an opportunity to see why this is the case. I saw several providers during my ED stay, including several (wonderful) nurses, an intern, and then finally a senior resident.

The senior resident came in while I was getting my second bag of fluid after I'd had 5 really obvious contractions right in a row spaced at 2 minutes. I didn't feel anything, but she came in and interrogated me, and kind of yelled at me ("You look like you're in LABOR!") like there was something I should be doing differently, or like maybe I should be more upset. Assuming everyone but you must be completely incompetent = the way of the senior resident.

I told Luca this was what probably happened:
Intern reports on me to senior resident with plan, and then later on my progress post 1.5 bags of fluid. Resident is fine with it. Then she happens to see my 5 big contractions, flips out, tears the intern a new one, and the runs back to see me, probably expecting me to be writhing around in pain obviously in labor.

I had to laugh seeing this from the patient perspective since I just KNOW this is what went down. We looked everybody up online that night and saw that the intern and senior residents were who I thought they were.... I told Luca that it was easy to tell what rank everybody was because the Ob interns are usually pretty nice, but they get progressively mean as they go through residency. At least at my institution, haha.

He agreed that the senior had a personality like sandpaper, though I know she was just stressed out. It's easier to take when you realize what they're going through. Really pretty blue eyes though.

Well, there was some unwanted excitement

2011-11-17T18:05:00.003-05:00

I got to spend the day in the ED today. Woo!

I got up after sleeping reasonably decently well last night (only got up 5 times, and fell right back to sleep each time), had breakfast, and was checking my email. And then I felt this sharp burning pain in my epigastric area.

I thought that maybe I was just sick to my stomach, and was about to have massive diarrhea, so I went to the bathroom. Nada. But the pain was still there, now radiating all over my abdomen. Not as bad though. So I took the dog for her walk. Then it came back again a few times.

In the back of my head I'm thinking, hmmmm.... is this "moderate to severe" pain? Should I go to the hospital? I'm not really able to do anything when it's happening, so it's probably moderate....

So I took off my rings, put the dog in the bedroom, and caught a cab (they actually come by pretty regularly in my neighborhood -- who knew??), and went to the ER.

And it turns out I was having contractions. Woo. But, no cervical changes, so no *official* pre-term labor.

In fact, I'm probably still having contractions -- you could still see them on the monitor -- but after 2L of normal saline, they don't hurt anymore.

My two week appointment with the Ob tomorrow will be a little more interesting than usual, me thinks.

Anyhow, Luca came to the hospital from work and sat with me while they gave me fluids. It was a bit of a wake up call for both of us, both in that we really ARE going to have a baby in 7-10 weeks (hopefully not any sooner than that, though), and we (I) really should try to take it a bit easier. I asked Luca if he could walk the Boo in the mornings before he goes to work since I've been feeling like I want to pass out when I take her these past few weeks. Maybe that will help a little.

So, I had to miss a meeting with my biostatistician, and I was supposed to give the lecture in the class that I'm TAing this semester, which obviously I couldn't do. Hopefully nobody will hold it against me.