A holliday mystery

Two years ago we hosted a progressive dinner block party. My neighbor across the street hosted the dinner part. She is deeply passionate environmentalist. Her priority was to host the party without using any paper products. I contributed to effort by offering our back-up dishes which were carried across the street for the party. It was a huge success, many people attended, and at the last minute we ran back to our house to grab more plates. All of our dishes minus the three in the dishwasher attended the party that year.

Christmas and New Years came and went. The plates were not returned. Irritated to be washing the same 3 plates all of the time, but not concerned because we are at work a lot- and it may be difficult to catch us at home.

On a icy Saturday afternoon 3.5 weeks after the party my neighbor showed up at the door. With a nervous laugh she told us she was carrying the plates across the street, the dog pulled the leash, and they all fell, breaking into pieces. All that was left were two dinner plates and a cereal bowl.

It really was not a problem. Still stock at the Crate&Barrel the dishes were replaced.

What was unusual was the time line, the story and the odd delivery of news. Made me wonder if there was more to the story- let my imagination run wild. Late night fight with throwing of dishes perhaps? We will never know.

We did not have a block holiday party last year, but this year my husband and I hosted......

Worst days of a life

Walking over from the parking garage this morning I walked through the worst day of a families life. Three women gathered outside of the Cardiothoracic ICU grief stricken. Who knows what was happening- I just passed by. So this is what happens after doctors deliver news. We are taught to be clear, firm and strong. Compassionate by acting immune to their response- providing a sense of order. The doctor, the one in control, has seen to it that everything that could be done has been done. Their response, whatever form grief takes is allowed, welcomed. On occasion the physician's eyes may well up with tears- the most rare form on tears I am told- tears of compassion. For only a moment, however before rushing off to the next patient. Leaving the family there, living the reality they cannot escape. Played out in the dramas of life each of us takes our turn in the role of physician, family and even patient.

The absent hostess.

Staring at a half empty (full) bowl of chocolate chip cookie dough and glancing at the clock. 11 AM. There is no way that I am going to make it. Out of bed this morning at 9 (should have been 7). Bake cookes, organize kitchen, pick up house, go to the lab, host party. The first three went well. Driving to my house one hour after the party started it occured to me that I work too much. Arriving to a home full of neighbors, they welomed me and said how great it was that I could make it. Meaningful are the hugs and conversations shared with the great people that live on our block. Meaningless are the data collected from the experiment started on Friday afternoon and completed at 445 PM today. On auto pilot it made sense that after my board exam was over I would throw myself into my research. Eight weeks on crutches, a few months without data, a serious blow to my career. Working as hard as I possibly can before my leave is the way I make it okay. In case you are wondering, I do have incite into my extreme nature. Seeking balance is the reason I planned the party in the first place. Too busy to even think about being angry- now that is an improvement.

Angry.

Have you wondered why the periphery? I have been tossed out from my expected path. My friends have jobs, children, and sense of consistency in their lives. I am so angry. Angry that I couldn't have a baby. Angry that I hate my work. Angry that my body is broken. Angry that my relationships are distant. Angry that no one can understand my pain. Angry that I am expected to look on the bright side. Angry that everything is NOT sure to end up okay. Angry that I cannot exercise. Angry that my car is in the body shop. Angry that it is cold outside. Angry that I have to go to celebrate my father when my happy days were ruined by his selfishness. Angry my aunt is being placed in a nursing home at 53 years old. Angry I have no control. Angry there is no joy. Angry.

Science of Joy

There are people who are incapable of being content. Their best day is one wrought with challenge, heroic rising to the occasion, finishing with exhaustion. Lying in bed at night they feel like a survivor and revel in what they were able to accomplish against all odds.

Days with less obstacles are slightly uncomfortable, lying in bed wondering am I good enough, am I important?

Success brings stability and material wealth. Running from the uncomplicated-day-insecurity focus turns toward perfecting the world around them. The simplest becomes complicated, with layers of rules and "correct" strategies. Grocery shopping involves travel to six different stores, in a particular order, to obtain specific items. Efforts to create a "nice" event are so cumbersome all involved become so stressed that no one has a good time. All joy extinguished.

Certain events or milestones in life are expected to be happy times. Birthday parties, vacations, graduations. In my memories I recall being told what a lovely day we had but not feeling it. Happiness felt like anxiety, complication and disappointment over imperfection.

Recently wondering if there is something wrong with me, am I capable of being happy? Others around me seem to be: with a sunny day, relaxing afternoon, visit with a friend. I rest only with exhaustion. Reflecting on my success with the deck stacked against me, indeed exceeding expectations.

To learn joy- childlike contentment. Yes, a skill that will make me a better person. Indeed. Perhaps I should start with a list of ways to describe this joy..... then test methods to achieve it.... maybe then a survey to determine the effect of this joy.... whew I've got a long way to go...... I'd better get back to you on this one.....

Success in abundance

Another little habit of mine, I love to tear ideas out of magazines. I have file folders of these loose pages. When assigned bread for the Thanksgiving dinner I was excited. Directly to the food/recipe stack, Real Simple circa 12/2004, holiday quick breads as hostess gifts.

Pumpkin-Date Corn Bread, Chocolate-Cherry-Walnut-Bread, and the standard Banana Bread a friend's recipe. Grocery shopped ahead of time. Well, okay worked all weekend but sent my husband to the grocery with a detailed list: flour (all-purpose), baking powder (red round can NOT orange box). Made special trip Tuesday night to Hobby Lobby with 10 minutes until store closing found pretty ribbon and fall foliage to decorate. Left work early Wednesday night turned the kitchen into baking central, with three breads in the oven. Success! Toothpicks came out clean, bread set to cool. Minutes later, breads collapsed, insides not baked, total disaster. What separates me from the true homemaker- like my mother who would have stayed up all night to to try again and make it all perfect. I picked up the phone, asked my husband to stop at the store on his way home from the gym.

He is a regular at the Bread Co. When he told the women there our story they loaded him up with five loaves- for free- he was there at closing. They collectively decided it is best to leave baking to the experts. Thanks. He was so proud to have saved the day, and with such abundance!

So for Thanksgiving I will bring one loaf of (tried and true) banana bread, wrapped in a holiday napkin with ribbon AND five loaves of day old bakery bread. Delightful.

But you know, I am really happy. A chuckle from the family will bring more then two perfect quick breads ever could have.

Little Grandma

I do this thing. Conversations replayed in my head, over and over. Yesterday morning I was thinking of the discussion over lunch with my lab-mates about Thanksgiving plans. While fixing my hair in the mirror I blurted out, "If we visit my in-laws we travel out of town." My husband from the other room replied, "What was that honey?" My babbled reply, "Oh I am doing it again-it's nothing."

It makes me think of Casa Geroma, everyone called her Roma. She was my great grand-mother. Her nightly wanderings led to placement in a nursing home, where she lived for 15 years. Her dementia broke my grandparents heart. They were faithful caregivers, traveling daily to the nursing home, feeding her by hand, making sure she received the best care. Her random conversations were endless. Her mind lived in the past, and my child face belonged to my Great Aunt Doris who in real time had wrinkles of her own. As a child I used to weave her comments together into stories imagining who she might be talking about, what they were doing.

I wanted to take care of the residents of the nursing home. My brother and I still remember a developmentally disabled woman, "My name is Rhonda, you want some gum?" We would bring her gum, and join her on her endless walks up and down the hallways. It was there I began my medical training- simple words and gestures to ease suffering, a meaningful connection with a near stranger. Unique qualities for a cardiologist I am told, for me a gift blessed from a great grandmother who never really knew me and a family who shows love by showing up, and doing the right thing.

They are all gone now Great Grandma, my Grandparents, even Aunt Doris. I feel myself slip into helplessness, realizing these orthopedic tools of independence were first introduced to me in that nursing home. The random conversations in my head work to make sense of my trip away from the path I carefully planned. From the periphery the perspective allows me to see my connection to these loved ones.

"To keep you independent"

"Here is a list of assistance devices you will need before your surgery. They are important to keep you independent," instructed the nurse. It sounds like something I would say to a patient- a positive spin. To soften the fear instilled by the news that at 33 years old I will need an apparatus to don my socks and a bedside commode to take care of my business. Had my pre-op outpatient visit today. Locked in for January 16th. Since he plans to approach arthroscopically I will not need to donate blood or take coumadin. He said prepare for 8 weeks on crutches, 4 weeks home from work. Honestly that sounds better than I thought it would be.... but I imagine it will not be a cake walk. I told him how my back killed me studying for the boards, and apparently that is common. Something about the impingement making me sit differently. So maybe I am not totally falling apart.

Healing

My test is behind me. This week I was in Florida at the American Heart Association meeting. Now I am home, in my regular schedule. Looking forward important dates are approaching, but my trajectory is planned. A series of heart to hearts with dear friends & family has calmed my spirit. It just feels like everything is the way it is supposed to be. Very surprising, considering the degree of unexpected turns my life has taken over the past year. Today I am reflecting, considering the fact that usually when experiencing calm I take it as an opportunity to power up. But for now I will rest. Sleep. Get back into the water. Stop drinking coffee all day. Smile more. Heal.

Ibuprofen

Prescription strength ibuprofen. Proven to eliminate inflammation. Worked wonders for my athletic related injuries throughout the years. Why is it not making this pain go away? From physical therapy I learned that my hip injury has affected my gait- and the inactivity has made the muscles of my hips and pelvis weak. So funny twist, funny pain each laughing at the ibuprofen. Arghhhh! I am so annoyed by the pain. I have a massage scheduled tomorrow night with an excellent therapist. Scheduled it last month planning for the exam, now I am very glad that I did.

Count down

Five days until my exam. Let me tell you I had a freak out Friday about Posterior Hemiblocks. What a pain in the ass. Determining the frontal axis on a 12-lead EKG, arhghh! Good thing no one ever dies of an isolated left posterior fasicular block.

Speaking of pain in the ass I woke up with one this morning- literally. So my hip is still there, my blissful denial is also coming to an end. My people are waiting in the wings, ready to plan my convalescence. I am fortunate to be surrounded with support.

Also boycotting Halloween this year. Last year October 31st was circled on my calendar. It was my first pre-natal exam. Me and my humongous boobs dressed up as a sultry pirate. The real fright came when the ultrasound was not normal. Later the bloodbath followed by a haunting. But that was a year ago. I'm just really glad that last year we decided against buying that cute 12 month pumpkin costume off the sale rack.

I am aware of the absence. Absence of excitement and optimism. Yet surprised by the steadfast pleasure in my life- despite the pain, disappointment, physical inactivity and (prolonged) delayed gratification. I think I owe that to the wing people.

The Future?

When away in Cleveland I had a meeting with a special family member. The mother of my brother's boyfriend. My bro and TM have been dating for several years now. I fell in love with T immediately. His presence at our family gatherings always adds warmth. The mothers have had meetings in the past, noteably a fun trip to NYC where they shopped, dined and talked for hours.

Meeting Ms. M made Cleveland feel like home. Their family has been having a difficult time, and with my recent struggles our suffering met mutual understanding.

After a great dinner (good food + 2 martinis) we ambled through a quaint Ohio small town. We happened upon a Forture Teller. It was whimsy for me (later to learn a serial expereince for Ms. M). We ventured up the stairs behind the dark door, the storefront marked by a neon sign in the shape of a crystal ball.

Forty dollars afforded me three questions for the future teller. But before I could get started she offered: Two women who you think are friends will betray you. You will write a book that will be read around the world. There is something in your way, something that you have been dealing with for a long time- you must continue to push forward.

My questions: Will I have children? Yes. A boy and a girl.

Should I have surgery? Trust those who with the answers. Do not be afraid of what you do not know.

Will I find happiness? You will spend a lifetime seeking it, a pursuit with much gratification.


Sometimes I think back to that evening. Was it my fortune? Was it the heartfelt visit with a kindred spirit? Was it the opportunity to look into T's childhood, growing my understanding and affection for my brother's love? Whatever, it made me feel keenly alive. A moment where the surrounding reality met a central peace. Serene and surreal. The memory of that emotion I borrow today.

Where did I go?

Still studying. Board exams suck. Not much else to say- or even think about.

Worth 1000 words

This is a 3D reconstruction from my recent CT scan. You can see how the femoral head does not sit normally in the socket. Also the white marking shows the part of the femoral neck that should not be there. It is this area that causes the impingement. The left hip is labeled, but the abnormalities exist in both hips. You cannot see the cartilage on the CT, the tear was diagnosed by MRI with gadolinium contrast.

Planning a little arthroscopic procedure

Weakness kills in medicine. On a team of physicians the individual viewed as the weakest link is under great scrutiny.

The decision has been made. I need reconstruction of my femur and pelvis. It will correct the femoral acetabular impingement and acetabular retroversion. That is the bad news. The good news is that I will be spared a femoral dislocation, in favor of an arthroscopic approach plus anterior incision. Expect 4-8 weeks of crutches. OR date is January, which the orthropod says is good, to give him "a little more time to gain experience" with arthroscopic approach. I am sure he wishes he hadn't said that to me. But I understand where he was coming from, it is a new technology. Reality is this is a major operation, with major recovery.

At work I have begun to tell colleagues that I need "scope" of my hip to repair cartilage tear. I plan to leave it at that.

From the sparkle

I am trained to understand how infertility affects patients. It is a pervasive source of stress leading to personal and marital conflict. Women facing infertility experience loss of well being because their bodies have betrayed them and they feel helpless in the situation.

This knowledge provides no insight or reassurance. Clinical problems and the emotional response is more transparent when occurring in bodies not connected to your own.

Polycystic ovarian syndrome prevents me from ovulating, makes my complexion resemble a 8th grader's and will save me from starving to death in case of famine. As a teenager I thought it was great to only have periods 4 times a year but now I need drugs to ovulate normally. Since food is a relative abundance survival from famine is unlikely to come in handy- and I am left with a commitment to exercise and reality that if left unchecked I will will be obese.

So desire to start a family got me moving to lose weight. Stupidity led to falling and breaking my arm. Insanity pushed me to run early/ hard post fracture convalescence. Hip pain sent me to PT. Impatience landed me in the orthrapod's office. Protocol prescribed hip films. Black sharpie circled bone in neck of femur that should not be there. Nurse penciled me in for January surgery. Whoa. Log way from the sparkle in my husband's eye and dream of little ones.

Time to stop reading

My comprehensive literature search is over. Understanding of my condition based on the objective radiological data, my symptoms and what is known about treatment for FAI was discussed with my primary orthropod last week.

I still need a CT of my pelvis and AP radiograph to better assess the degree of hip dysplasia. This will determine whether a peri- acetabular osteotomy will be needed. Regardless my surgery date is set for January.

This week has been my best week so far. The pain has decreased, and I have started walking up to 1/2 mile. It seems like improvement. Now that my surgery appointment is on the books, gaging my progress and pain seems different.

Hip bone connected to the thigh bone

My physical therapist is excellent. She has me doing these tiny exercises that kill. I mean, who could believe that lifting your leg one centimeter off the ground could be so challenging? Turns out my muscle groups surrounding my hip are very uneven. This news is surprising, but validating considering the degree of difficulty I am experiencing.

I am searching for a unifying diagnosis- or in other words clarity on how my series of problems are linked. Turns out the back pain keeping me from lying flat is because of my altered gait. My funny walk is because of my tight illiopsoas muscle. The tight illiopsoas is, of course due to the hip inflammation. The inflammation brought on by my fall (probably worse due to running with left arm in a sling) in context of underlying impingement/cartilage damage.

So I will keep doing my baby step exercises. And each week my PT will find a new set of muscles that are struggling to compensate. Falling certainly happens more quickly than climbing back up.

Message for hip community

In my medical training I have watched patients and families deal with illness for years.

Over the past several months the experience of being a patient has changed my perspective. It is difficult to deal with pain, physical limitations and new knowledge of undeniable congenital skeletal abnormalities. Like many of you, I liked feeling strong, powerful and invincible. Dealing with my illness has been a struggle. I have been writing about my thoughts in this blog.

Zoom Zoom

Motofino is a Chinese moped manufacturer. A month ago I purchased a retro style scooter for $1200. A practical decision at the time. My husband's truck (1993 Nissan 210,000 miles) was stalling frequently. He drove my car to work (30 min commute) and I rode scoot. The tank fills up with 1.5 gallons, so about $3 a pop. So far 180 miles racked up on the odometer. Now we are the proud owners of a 2007 Honda Accord (4 vehicles now, if anyone is counting). So what happened to the truck? Well it is still parked in front of the house. Sometimes it takes men a while to come to terms with these things. Suprisingly I do not care. Having a husband who struggles to let go is an excellent quality. Besides he has known the truck 4 years longer than he has known me.

Crazy Busy Explodes

I am just sick. Nausea and dispair. Pediatric fellow late for work calls basic science research scientist husband. He comes downstairs to meet her, she runs to work. He drives car 4 blocks and parks it in usual location. She didn't mention the baby. He didn't look in the rear facing car seat. He returns to work. Seven month old little Sophia is found dead in car 4 hours later.

Too close to home, in more than one way.

Loss

My baby was due June 16th. Every time a colleague mentions their children reflexivly I think about the baby I lost. Seven month old baby, four months older than my child would have been. A sense of loss multiplied.

Similar Stuggles

In medical training others control your schedule. You are kept on a short leash. Pushing your limits despite mental or physical fatigue. My friends who have children share thier sense of guilt. Needing more time for work or home, always balancing the two. When interviewing I met a cardiovascular research scientist who balanced her medical career, laboratory, and family. When asked her advice she responded, "As a female physian you learn to juggle, trying not to drop a ball but knowing it will bounce. As a physician mother you keep juggling but the differece is now one of the balls (your child) is made of glass."

Harsh Reflection

Others tell me how lucky I am. They remeber their pre children days fondly. They say, "How wonderful it must be to pick up and go at a moments notice. You are so healthy and productive, these kids just take so much time!" Bitter for me. Waiting to start a family was a concious decision. Baby while protected in the lab was my plan. Infertility, left wrist fracture, hip cartlidge tear and congenital hip abnormality were not part of this plan. Few can understand the way married with children looks from my perspective. Disaster and loss haults the crazy busy life for Sophie's parents. Horrible pain and loss was not in thier plan. Where does that leave us?

Cleveland Update

With time the board review torture course is over, and also part of my wait is over.

The Cleveland Clinic (3rd opinion) also suggests surgery. The first emotion is disbelief, then two tears, then relief. My research mentor's brother offered the opinion. I had feared that he would be the only one to suggest less invasive (non-corrective) surgery. In that case I might have had less support for a long leave of absence for surgery.

Still waiting to hear from Dr. Nashville. He, after all fixed Izzy.

Izzy and me

"Eleven months ago, Isringhausen slumped at his locker, admitting, "I can't keep going like this." Saturday, he could think of nothing better. Isringhausen didn't require a full hip replacement. Instead, doctors shaved bone from the neck of his femur, allowing him greater flexibility with his left leg." -Joe Stauss, St. Louis Post-Dispatch, August 2007

Jason Isringhausen underwent femoral osteotomy for femoral acetabular impingement last year. It was his second surgery. I can only assume his 1st surgery was to repair a labral tear. Now he is playing baseball, can't beat that (for a n=1 non-matched- non-blinded -non-randomized clinical study).

In was in medical school (my friends agree) I never heard FAI. Now the literature suggests it affects up to 60% of patients receiving hip replacements in older age.

In the 1970's cardiologists were newly diagnosing mitral valve prolapse as thought it was a disorder of epidemic proportions. Years of further study revealed that actual morbidity associated with MVP is very low- and the diagnosis has fallen out of favor. Conversely, the first patients receiving the (arterial) LIMA grafts at bypass did not know what the clinical trials would show...... however now it is proven standard of care. Thousands of lives have been saved by this surgery.

A favorite attending in my training program says about new medical techniques and technology,

"Be not the first, yet be not the last."

Impatient medicine

---- Mortality rate increases 2% per hour in ascending aortic dissection
---- 90 minutes door to balloon time for acute myocardial infarction.

Cardiology Board Examination Preparation Course, not for wimps. Lecture 13 hours each day and the Cleveland Clinic has this ridiculous commitment to healthy eating- so no junk food, coffee or chocolate allowed in the lecture hall. Some kind of torture.

What impresses me when reviewing my chosen field is the focus on rapid evaluation and quick, concise treatment. This is contrasted by my experience in outpatient orthopedics.

Symptom onset 4.5 months ago, physical therapy for 8 plus 6 weeks. Wait and see approach, will it get better? Will osteoarthritis develop? What will the long-term outcomes of currently favored treatment be?

Recognizing that being a patient, when trained to be im-patient is challenging.

Puppy update

This morning I discovered a cachet of toys (raw hide bone and 2 fuzzy squeaky animals) carefully arranged atop of the doggie bed. Happiness is an active playful puppy. Wanna go outside? You had better make way or else you'll be trampled as he bolts down the stairs (oops sorry Owen when Smokey knocked you over!) Galloping back into the house he investigates his empty food bowl, only to gaze up at me, as if to say did you forget to feed me? Gobbling up his 2 (plus a little to grow on) cups of Purina Pro Plan before running upstairs to give B some chicken flavored wake-up kisses. Smokey is better, and against my better judgment returned to Doggie-day-care this week. His dad reported he was ecstatic when dropped off, and returned in the evening blissfully spent. So life goes on. The worst possible scenario averted this time. We'll leave the interesting veterinary cases for the academics, we're glad to have our happy puppy back.

Think much

What do I think?
Well, what do you think I should think?
Why do you think I think what I think?
What does it mean that I care what you think I should think?
What would you think if you had to think what I think I am thinking?

God bless my friends, who listen to my thinks.

Just the facts

Xray and MRI images of my hip show: femoral neck deformity, labral tear, and possible poor lateral coverage/dysplasia

Dr. Wash U said that surgery would be recommended unless I am pain free

Dr. Mayo said at this point I am unlikely to improve with conservative therapy

I have pain daily. It is better with less activity, but consistently have discomfort when walking more than 5 min


Plan of action:
1. Study and take my Cardiology Boards October 31st
2. Do PT exercises at 100%, swim and elliptical as tolerated
3. Request AP pelvic film to determine degree of dysplasia
4. Make appointment to see Clohisy in late Sept, early October
5. Accept I will not have a baby in 2007, grieve as necessary
6. Discuss with PI plan to complete this project
7. Explore career options, translational research vs. clinical track

Girls behaving badly

Folding the laundry this morning I had a moment of clarity. Since my beginning cardiology fellowship in 2004 I have made a concerted effort to help other women interested in cardiology, and foster a network among the female fellows. This is necessary because women make up less than 10% of cardiologists. In the office shared with the other (male) fellows, it is not unusual to find porn posted, and many (even attendings) remember fondly the days when a stripper pole was installed as a joke.

My efforts have faced disappointment, as to my dismay there is dissension among the women training behind me. Frustrated and perplexed up until now, the meditation of ordering the white t-shirts and matching socks brought a new understanding.

Faced with challenges each of us found (our own) way to survive. Mine is trying to create a better atmosphere for the future. A close colleague looks out for herself and hates everyone. Another is flirtatious and keeps the guys off balance by being unexpected. One found support in another fellow, they will be married this year.

We need to transcend to understand that we still have more in common that we are different. Referee I am not, yet the mother in me still hopes to see these beautiful, passionate, brilliant women together.... for unified we could be a force.

Please don't be discouraged

In July 2006 I deviated from my medical training to take advantage of protected time for research. I joined a basic science laboratory. Since then I have learned an enormous amount. Western blot, quantitative PCR, immunoflorescence, flow cytometry, the list goes on. The problem is that with my assigned project (picture of cells), actual discovery or understanding has been difficult. As a novice in the lab I require direction. Doing what I am told gets old, yet whenever I attempt to inject my own ideas often I am redirected. I don't feel like this work is my own, it feels more like a burden. Writing a paper feels years away- I must see things through to completion. With my health problems this year I don't know what I am doing anymore- or better said why I am doing this. Misery at work is familiar, but with my clinical training I always felt that I was improving or at least touching the life of others. When I was young I had tons of direction and no skill. Now I have enormous skill and no direction.

Pain Scale

So how do you rate your chest pain, let's say if zero is no pain at all and 10 is the worst pain ever- for instance like a broken bone? Who knows how many times I have asked patients this. It can be useful- but you are always aware that one person's 8 might be another's 5. But who can imagine what a broken bone feels like- what is un-imaginable pain?

Breaking my arm last January clued me in to a great deal. The regular pain meds (the stuff I often prescribe for pain) didn't touch it. I was so grateful when a friend who was working in the ER came to check on me, then insisted that they give me stronger stuff. Honestly the whole experience affected the way I interact with patients. By facing pain and disability I now have a personal place to connect when people share their fears.

It is quite possible that the torn cartilage in my hip occurred with the fall that led to my broken arm.

After months of rehab to get my arm back, I was relieved to resume my training- to have my life back. Things came to a halt when my left hip began to hurt. The news was worse than I could have imagined. A real injury- AND underlying congenital hip deformity. Personally I am still reeling. Professionally I am still pushing forward- investigating and healing.

Beware the testosterone is climbing....

I boycotted fertility meds in April and joined Prozac nation. Metformin for insulin resistance, they told me my anovulation was because of PCOS. Colomid to ovulate- it didn't work the first time (no ovulation but plenty of hormone craziness). Daily temperatures- waiting for the thermometer to beep before climbing out of bed. Not to mention (the unmentionable) pressure for baby making within a 18 hour window. It should be more fun that this!

My lab tests showed triple the amount of testosterone for a woman my age and size. Here I thought all of my interesting qualities (athletic ability, intensity, interest in cardiology- a male dominated field) were uniquely me. So I have been jacked up on male hormone all along. No wonder I couldn't figure out how to play with dolls or make the cheerleading squad in junior high.

As a new member of Prozac nation I wonder if I should have joined years ago. Certainly less crying and moping. Less anxiety for sure. I can feel despair being replaced by anger. It this a modified grieving process- and I am working the stages? Or perhaps it is just the testosterone again..... my old friend.

Feel free to get lost

Family wedding weekend. Hours of driving around the metro Detriot area with my nuclear family of childhood, reunited and packed into my father's Ford (american made) Explorer. Generally such togetherness would bring anxiety, that was before Tom Tom. Excellent gift from the in-laws, the mobile GPS. Navigating the local highways and family discussions were assisted by the gentle direction, and humor provided by this little contraption. So feel free to explore, even get lost the Tom Tom will get us there.

Multi-lobar Pneumonia

Medline search for canine pneumonia reveals reference to Yersinia Pestis (Black Plague of the 1930s). Bordetella causes "kennel cough". But why such a serious illness in my puppy (15 months old)? Certainly a bacterial infection is likely, but no white count or left shift despite his certain toxic appearance. I looked up combined immunodeficiency- and found the canine model is used to understand the disease in humans, but it is not clear that it occurs spontaneously in dogs. Moral of the story- lit review provides no solace when the illness is personal.

Smokey is my labradoodle. He has been spending the days at the vet, and the evenings under my care. In our living room we have administered subcutaneous fluids. We have perfected our pill swallowing technique. My husband has surprised me. When Smokey came home he gagged with picking up poop, but now manages rectal temps and special TLC like he was born to do so.

Excellent sleep

For the past several weeks I have been having vivid dreams, epic in nature. Sometimes nightmares. Each night I wake up frequently, feeling unsettled and uncomfortable. Last night I got some good rest. No nightmares, no pain this morning. I am giving the hip injection the credit. I almost can't wait for tonight- to sleep again!

We spent years sleep deprived. People would ask how in the world do you do it? It is all about the training- or perhaps simply getting used to living life in a cloud. Post- call you ache all over, crave sweets, feel angry and sometimes paranoid. You sense of humor becomes skewed, and reality seems distant. Your mind and body are telling you to rest, but you power through it. Patients, paperwork, and studying must come before any personal needs or wants. Eating and peeing are luxuries. We spent years like that, it becomes a way of life. When you engage, give it your all, and then succeed it changes you.

Some of my friends still live like this. They are better compensated- but with homes, families and practices the demands are greater as well.

Cortisone--left hip

Last year I was a triathlete. Standing on a podium I received a medal. With my training I was often surprised to find what I could actually do. It peeled away in layers. No running. No biking. No walking. No swimming. At first I asked what exercise, stretch could I do to recover. Now I ask what can I do to prevent surgery. There is no easy way back from here. Three months away from work to recover from hip re constructive surgery. I sought an ortho consultation, he circled a piece of my bone that shouldn't be there. Deformed hips- present all of my life. Do I ask how could this happen to me? Or do I rejoice for the 33 active years I enjoyed. Orthopedic surgery was the ONLY rotation I hated in med school. Funny. Something about the bone saw- never set well with me. PM&R seemed like a silly specialty when selecting a career. Now I go to see one, for a cortisone shot, for a cure.

Crazy Busy

It is accepted as a descriptor for life. I hear it all of the time. Balancing clinic schedules, surgeries, up-all-night calls, dropping at day care, laundry, groceries, the occasional sick kid/pet/grandparent. Living life in constant effort to keep afloat, buying extra time to do something extra for others, never addressing your own exhaustion.

This is not me. It could be, but it is not. What I have was designed to be better, more evolved, unified.

A Beginning

May 20th, 2000. I walked across the stage and they hooded me. We all recited the Hippocratic Oath. My roommate gave a moving speech about our life as medical students. The future was surely bright. We had no reason to think otherwise. When I think of my med school classmates and where they are now, most would say that the future is still bright. But there is something terribly wrong.