New home

Smokey loves being a country dog. The darkness is a stark contrast to the constant buzz of city street lights. And quiet. At night not a sound other than a frog croak or cricket chirp. Gone are the hospital sirens, car doors slamming and occasional gun shot. Our new home has a screened porch overlooking a pond. There are weeping willows along the bank. About 100 yards from our front door is a boat ramp with marsh access. With one small road leading to this area Smokey has the privilege of running off leash. Earlier this week he met two Black Labradors who live nearby. They jumped and ran together..... for a 86 pound Labradoodle life does not get any better than this.

My favorite part of our new life is the in-ground neighborhood pool. It is surrounded by over sized deck chairs, tables with large umbrellas, oyster roasting open fireplace and grill any man would salivate over. The shallow end is zero entry with jets of water that shoot up, indeed fun for the little ones.

If I swim from one end to the other I think it is about 20 yards. Not exactly regulation but you cannot beat swimming under the sun (or moon) walking distance from my house. The water is gentle and healing for my sore hips and back. Almost like magic the sore spots melt away after floating and stretching in the water. I am still wearing a normal swimsuit but the boobs and belly are pulling tight. I wonder if the baby is learning to to love the motion in the water?

Two nights ago my swim was shared with a large frog. Apparently he found the pool most delightful as well. Lap swimming with my goggles on I could see how graceful he moved through the water. A big frog kick, glide, kick, glide, kick, glide. And funny, there were noticeably fewer little critters buzzing over the water surface.

Moving Day

No way to tread lightly here. I haven't blogged, really in months. Those close to me have seen changes, bold but gradual. Don't be startled- the comprehensive update in bullets- I am leaving this city for the beautiful eastern coast, taking a faculty position at an University, uprooting my husband, having a baby in December.

The movers are packing, literally right now. Our life in boxes, the usual order dismantled- including wireless router. I am grateful for an unknown gracious neighbor from whom I am pirating WiFi. With my recent sad goodbyes a good friend told me I need to start blogging again. Especially since I am moving away and leaving so many dear friends behind. So here I begin again.

One big concern, and a reason I have been silent is the veil of anonymity. I really like writing about my life, feelings and relationships. As I leave training and become a real "professional" I need to either write less specific or go deeper under cover. Probably not a good idea for my patients to find my blog. Haven't completely reconciled this yet- but fully intend to post updates and pics of my new life here.

Times are changing.

It is happening all over the hospital. Fresh eyed young students arrive in their perfectly pressed short coats. They have just spent the summer studying for Step I of the boards, and can hardly conceal their excitement to touch real patients for the first time. Bewildered slightly older young interns wearing equally unstained long white coats, with pockets stuffed with crib notes. How to run a code, what dose of sleeping pill to give, normal lab values. Their arrival is like a breeze of fresh air.

Not too long from now the med students will look like hell- suffering their first post call days. When every cell in the body is SCREAMING to lie down and close the eyes, and it seems impossible that such torture will become a new way of life. The interns will no longer look frightened. With long lists of patients, hours of notes to write and endless check boxes to fill they will become engrossed in their daily tasks. They will awaken sometime in next Spring- and realize 10 months have passed.

On the flip side are the dinosaurs. Like me. Ten years ago I first set foot into the hospital. A decade of training. When I look around I remember the hospitals I entered and eventually conquered. Incomprehensible the number of patients I have laid my hands on. And then those who died, whose families I counseled. From the confidence of thinking you know everything, to the painful realization you do not, then pretending confidence (not to worry the patients), gradually evolving to the place where you really do know a lot and can do a lot- competently.

Yes times are a changin'. It is a new beginning.

Back in the Saddle

More news actually. Today was my first day back doing procedures- since my hip surgery. I was a little anxious about being able to stand the whole morning- I can remember how grueling these clinics were last year. I would dose up on Motrin before and during the busy schedule. And today, NO PAIN! None. I am so relieved.

An two patients told me after their heart biopsy that it was the BEST one they have ever had. Quite a compliment from transplant patients who have basically had any and every procedure under the sun. So I feel pretty pumped up.... I am good, I've still got it, and I'm back!

On the road

I am officially on the interview trail. Must tell you it is SO much better this time around! They had a limo waiting for me at the airport, then delivered me to the hotel where I was given a suite. A suite! As I stretched out on the king sized bed with the high thread count sheets I called my husband. In remembrance of the difficult interview tours for residency and fellowship. Where I had to pay for every flight and hotel. I think I am still paying.... the cost was tagged onto my student loans... which are no where close to being paid off.

True there were some exciting adventures.... teaming up with a perfect stranger to drive 6 hours from interview A to interview B, then sleeping on no-longer-strangers couch a few day later for interview C. Being snowed in at Raleigh-Durham, forced to stay extra night at a shabby Motel 6, sick with fever and rigors. What misery! No story quite like Dr. G's (my OB/gyne). She came upon a laboring woman at the airport, and delivered the baby into her interview suit coat.

So I am keeping my mind open and hopes up to find the right place.

Report from Lobby Day

American Heart Association Lobby Day was Tuesday.

I crawled over Capitol Hill with 700 others, wearing red- and a fancy heart pin with LED lights that flashed on and off.

We lobbied for greater funding for NIH. Did you know that during the Clinton administration NIH funding was doubled, but then cut sharply seeing a flat line over the past five years. Accounting for inflation, we are now at a level of funding lower than we would have been without the increases in the 1990s.

NIH funding supports the majority of health related research. In my mind, this is very important because the alternative is drug company sponsored research. Pharmaceutical development is also important, but always driven in the direction of profits. Who would study the use of vitamins in the prevention of heart disease- the NIH that is who!

Last year only 12% of research proposals submitted were funded. That means 78% of scientists (people with MD and/or PhD) received a failing score- and were sent packing. Can we really afford to lose this much talent?

Furthermore although heart disease and stroke are the #1 and #3 killers in every state in the Nation.... of NIH dollars only 7 and 1% respectively are spent on heart research! We deserve a larger piece of the pie.

So Lobby Day was a success. I got to meet my favorite Senator and our Congressman. I spent the day with grateful patients. Far away from the hospital and research lab, I spread the word about something I care about- and got a little smarter through the process.

In a moment of introspection how did the state of research funding affect my decision to leave science? As generation X-ers we are blamed for being motivated by recognition and always looking out for ourselves. I am sorry, but after 12 years of extra training I cannot accept a job equivalent to what I could have done when graduating college with a BS in Chemistry in 1996. It is because I care that it has be so difficult for me.

In the District

This weekend an exciting trip to Our Nation's Capitol- where I will participate in the American Heart Association Lobby Day.

My brother (JkC) lives in DC, and works as a lobbiest for a National Health Care Organization. Saturday was near perfect. We headed to Chinatown and had a fabulous brunch al fresco.






Then an adventure at the Spy Museum, where we participated in Operation Spy. JkC and I, along with 8 strangers investigated, decoded, interrogated and cracked the case- saving the world from nuclear annihilation. Highpoints- when I found the secret door to enter the exhibit, as we quickly became better acquainted with stranger teammates as we dove left and right (twister style) in attempt to escape the path of search lights. Near miss- crouching down to evade capture then realizing I was in complete darkness with nothing to pull my self up with (quads just aren't as strong since they were detached at their insertion).








Then drive out of the district the in in-laws house. There we had a delicious dinner and relaxing evening. My friend at work commented that it was weird to visit in-laws without your spouse. My response- well you will think it is REALLY weird then that I am brining my brother! How lucky I am to be so close to my brother- we really enjoy each other. Wondering how this came to be- is it because we were forced to do chores together, "Mom why does he always get the easy part!" or struggled to share a bathroom, "I can't believe my brother takes longer to get ready than I do!" My little brother turned out to be a really fun and interesting person- and now that he no longer fears me pinning him down to tickle him (he is now much taller and stronger) he feels much more comfortable around me too.

New Steps

Reading over at Life of a Busy Little Bee, Jen is approaching a gap. Plans are tight for the rest of the school year, followed by an array of options to be punctuated by a major life event- A Wedding!

Thinking of my summer- the end of my fellowship, an unknown next step. Seems huge. My rather sudden change of plans and fresh job search. Are we moving? Will be in academics? Private practice? Considering the radical re-alignment I do feel at peace. As if saying no that will not work for me, and getting off the train that was barreling in the wrong direction was a critical step. A needed moment of clarification, pause to unify my gifts and desires.

And then there is the husband, "Just try something else for a while, and if that doesn't work move on. It is never the END of the world." Well said for a man who may again be following his bride across the country.

Not a mommie blog

In case it feels like EVERYONE is having a baby- you are right. Your sense is correct. They are.

In October of 2006 I had Halloween circled on my calendar. My husband and I were whispering back and forth about our little goblin. My first pre-natal visit scheduled for October 31st. We held hands in the waiting room. My urinalysis showed trace blood. From that moment on my husband and I experienced the visit dramatically differently.

Dr. G is my OB. She and I became friends in 1998 when as she was a year behind me in med school. Dr. D is her partner. D and I met in 1996, our first year of med school. She and I played Volleyball together- we were quite good- winning the intramural league.

For me the blood was foreboding- of course G reassured with her voice but her eyes shared my worry. The ultrasound showed a gestational sac- but measured half the size I expected. Still more reassurance, not received as my concern grew. Outside the room G finished her charting, returned with my US picture. Her hand shook as she gave it to me. June 16 was the calculated due date. Congratulations she said. Everything looks good- but let's have you come back next week to take another look.

B and I spent the week like the one before. Occasionally I would mention my worry- and he would question whether I was being rational. He honestly (bless his heart) had no clue of the trouble. I followed his lead.

One week later we returned and the final diagnosis was made. Missed abortion- miscarriage. This time G had not words, just tears in her eyes. I can remember shaking when getting dressed then stepping out of the door to find both D and G. Across the hall I stood in their office and we made a hug circle. How uncomfortable the med student must have felt that day- a young man wishing he could disappear as three women, two his attendings sharing a very emotional moment.

How alienating (and shocking) this experience must be for most women. For me I had some warning and then was surrounded by two doctors/two dear friends when accepting the news. I was sad, but also felt an agony. Anticipating the time that must pass before returning to this same point, with another chance for life. Little did I know that a broken arm and major hip surgery were in my future, pushing motherhood even farther away.

Life does go on. And as expected for young female physicians in our 30's the baby making goes on too. How many more first birthday cards I will send and baby showers will I plan? No need to seem like it doesn't bother me- no need to hide that I feel left out. Just moving forward.

Upside Down

When babies are very young they have the Moro reflex. It is also called the startle reflex. After hearing a loud noise the throw their little arms out and wave them back and forth. This is an involuntary reaction, and fun to elicit as a med student rotating in pediatrics.

If only there were an involuntary response for the shock that comes with the little surprises of adulthood. My conditioned response includes anxiety and worry- both old friends that I would rather be without.

Sixteen years ago I set a goal. Become a doctor. Four years of college, four of med school, four of residency and now four of fellowship. I made it. I am a doctor. A fairly specialized one at that. So how can it be that I have no earthly idea what I will be doing three months from now?!!

Listening to my heart of hearts. Deciding the bedside is better for me than the bench side. Next tossed out of this "Top 10" medical school on my little bottom. Oh boy. No I will not starve to death. I am certain that I will find a job. It is just difficult to pick yourself up from disappointment, and wrap yourself up into a presentable package to peddle around.

The first step to decide you are on the wrong path. Next step to find the right one? This time I am seeking joy.

Out for dinner

It is a warm spring evening. B, Smokey and I walked over to the neighborhood cafe and had dinner on the sidewalk. Then we took the long way home in order to pass through the park. The trees are beautiful with their spring buds, and daffodils have sprouted everywhere. It feels so good to be able to walk without pain. My mind and body take a long exhale together.

Fateful step

Last Monday. My first day back in heels..... conquered the massive convention center. Back to the hotel at the end of a successful day- change into a cute black dress (and sensible black flats) ready for a fun night out in Chicago. Confidently stride out of my hotel onto Michigan Avenue. Rainy gloomy spring weather, typical of the Windy City. A warm evening, but wet from a day of rain. Three blocks from the restaurant. Thinking about the exciting people I met that day. Thinking of the big events in the upcoming week. Thinking of the nice glass of red wine waiting for me. Thinking of plenty things, except my step.... and whoa, right foot out, left foot back, hands in front, down I go. No, not the hokey poky. It was me, biting it on a wet sidewalk in Chicago.

A deep breath later, surveying the damage. Left hip- still there, no pain, good. Left knee, planted into one of those metal grates, ouch. "Honey are you okay?" a tall lurking man says voice straining to hold back a chuckle. "I don't know" I stammered as I stood up slowly and walked off a little less confidently. Pausing at the next street corner, surveying the damage- deep cuts in the knee. Considering the options, now two blocks from the restaurant I decide to seek the solace of friends- expecting other cards fellows assembled for the drug rep dinner.

I step into the restaurant with blood running down my leg and eyes welled- only to find instead of a group of friends- my program director and the drug rep. Welcome they say.... still not yet ready for complete sentences I get out.... can't- stay- dinner.... and the boss quickly realizes something is wrong. Now quite embarrassed about my state I accept his offer to hail a cab and I am on my way back to my hotel.

I find a Walgreen's. Purchase bandages, neosporine and as any girl would do in that situation- a pint of Ben & Jerry's for dinner. Nursing my wounds bloody and emotional I find solace in chocolate fudge brownie.

So I made it home safely. My knee looks rather gnarly, and my swim and bike routine has been suspended for the week. My hip was a little sore for a few days- but no major damage. Another lesson in humility- so much for big girls don't cry at work- all for sure I will recover from in time.

Physician Scientist: BUST

So I have news... that I am kinda anxious about. Looks like my days as a basic scientist are numbered. I am looking to make a change in my career plans. Tossing in the hat, there will be no K award application (although it is almost finished!)

I was supposed to get a faculty position last year. The division director was an the phone with the credentialing people- when it fell through. (NIH funding technicality, cannot be on training grant and see patients independently) Before my surgery I was told January 2009. Last week I met with the boss again- and the plan changed again. Now IF I submit a paper by this fall, I will probably be offered a Clinical Instructor position starting July 2009. I will have to do another fellowship year (yes 5th for those who are counting) for a total of PGY-9! None of this will they put in writing, and when finally appointed to faculty my salary will be a whopping $80K- no negotiations! BRUTAL.

Why do they do this? Because they can.
Who will ever go into academic research? Breed facing extinction.
What are they thinking? Fossils cannot think.

Now I am a good girl. I love academics, spent two years doing research- hung in there for the rough cards fellowship. But honestly I think this is my breaking point!

So if you trade the money you could make in private practice- the alternative is supposed to be prestige, security and intellectual interest. This "TOP 3 Med School" policy of continuously whipping young trainees lacks prestige and apparently security. Can you believe that I still cannot see a patient on my own and even if I do another 3 years of training I am not guaranteed a tenure track position?!! The last 2 years have been the toughest of my life- so bliss in the discovery of science is lost on me.

Options are:
nationwide search for academic science training/ tenure track position
local/ nationwide search for academic clinical position, heart failure and transplant
local search for private practice (part time?) general cardiology

I am having a little identity crisis right now. It is pretty scary.

One point for the pink team

Watching a professional in action. The men fear her. Stiletto heels, purple business suit and some serious chutzpa. Wow, I have never actually had my picture on a poster before- she said referring to the large advertisement we created for her visit. Yes the poster, the flier for lecture attendees, invite for tea with medical students planned for this afternoon. The details. It is my thing. Chit chat, however for me is a more deliberate effort. Our ride to the hospital from her hotel was casual. I was quite impressed when the people we talked about in the car received props during her talk. She chatted with me, and from my answers... this physician is interested in this, so and so taught me that, etc. This is the business of academic medicine. I suppose you do not become Professor without a significant mastery.

My favorite moment so far- last night at dinner. The indignation from the female faculty members when one of our fellows mentioned that the male fellows undress in our office. They choose to change from scrubs to dress clothes in front of us. Okay I know everyone stands around in their underwear on Grey's Anatomy- but this is real life and the locker room is right across the hall! Perhaps these boys feel more comfortable standing in their boxers surrounded by photos of cheerleaders and women with large naked breasts. Oh yea. This is what is posted in their cubicles.

So I spend time (and talent) fostering mentoring from women in cardiology. Why? Because the more I see of these successful, talented, gracious women the stronger I feel about my career, and life actually. But deeper even- I am out for revenge. Not an ugly kind- but just the type where the underdog good guy (girl) wins at the end.

Brooks Brothers Break-down

Please tell me that this has happened to someone else. This afternoon I cried in the Brooks Brothers dressing room. Idiot. So much for the "not loathing my body" mentality. And for the spiritual balance. Several professional projects coming to fruition, a big business meeting in Chicago this weekend. My larger than normal ass has been in yoga pants for the majority of the winter- and my super cute pant suits just do not fit.

As for the crying, two ladies were helping me. One asked my size, and I said oh I am not sure. I recently had surgery and gained weight, and I am not sure how things will fit. One said, are you on a diet now? Do you plan to loose the weight? Wow that thought hadn't actually occurred to me. Just give me the frickin' size jumbo fitted shirt for me to stuff under my interview suit from 5 years ago and let me get out of here!

A triple latte later I regrouped and boldly entered Ann Taylor. Found a nice black and white woven jacket. Will wear with white shirt and comfortable black pants. Found red jeweled necklace that will pop. Not exactly a suit, but will be passable.

So still reciting the mantra..... I am not my body. Cripes I am almost to the point where I can do enough exercise to get a cardio work-out. In the mean time it is excruciating- I would run and hide- if only I could run.......

Whenever a tragic loss occurs, you can either resist or yield......Yielding means inner acceptance of what is. You are open to life. -Eckhart Tolle, A New Earth

An awakening has been in the works for some time now. My first glimpse of deep spirituality was in high school. In the midst of teenage depression I somehow found my way to an evangelical Baptist church. I was raised in a home very skeptical of organized religion, so church was an odd place for me to flee. I was saved and baptized. Dunking in the holy water, head to toe, Southern Baptist style. There I sensed for the first time a spiritual connection. In fact one day during a call to the alter (which can last upwards of 20 min) I felt that God spoke to me. I had a clear vision of what I was to do, my purpose in life. Healer.

Then the preacher gave genital herpes to my Sunday school teacher, and the affair became the scandal that split the church. It seemed that perhaps my parents were right all along. You really cannot trust those holy-roller types.

In med school crisis in the mission to become healer led me back to church. This time a campus Lutheran Student Center. I thought Luther was on to something, the act of believing is the way to salvation, sans the guilt. Met my husband there. Believed I was again on the right track.

My dear brother had an awakening of his own. Realization that he was born gay, and strength to live his life congruent to his true identity. Never was there a moment that I (or our God avoiding parents) hesitated to stand with him. Inner conversations with God asking why did he make him this way? Why do the leaders of His church not see God's creation of homosexuals to be as beautiful and wondrous as the creation of any living thing? Couldn't much sit through a church service after that.

There were still moments. Discovering the perfect words to comfort a patient. Connecting with another human being deeply, without words. Predicting a reality with intuition, sensing beyond the physical. These moments I still believed to be divine. But where/what was God?

Blogging about my exile to the periphery. No longer able to connect with myself in the role of triathlete, superstar cardiologist, mother. Reading this New Earth book is interesting because Tolle teaches about an inner consciousness. He draws connections to the the world's religions. He suggests that setbacks like my year of illness is a common way that people connect with this spiritual force.

Suddenly "Turn it over to God" has different meaning for me.

A buzz

Not sure what has come over me. Last week was off to a decent start. Suddenly, around Wednesday afternoon I developed difficulty being upright. Lying down no problem, head up, yep there it is again, cloud head. The room isn't spinning exactly, but I feel off balance. Like when you are drifting off to sleep or sip a martini a little too quickly on an empty stomach.

My husband suggested I embrace the gentle persistent buzz. Okay no problem, but it is a bit unsettling. Especially when trying remember how a patient is answering my questions or behind the wheel of my Volkswagen.

The cause? I am not sure. I did stop my medications. The Lexapro perhaps the culprit however my psychiatrist Dr. SM (aka best friend from college) told me a long taper is not necessary. Perhaps instead is was the psychiatrist's two children who visited last week, each with runny noses and low grade fevers. Being home for the winter has has its benefits, one being skipping out on flu season. I succumbed on Thursday and stayed in bed all day, but no improvement. Maybe with all of this not standing and not sitting (therefore lying) my heart forgot how to get blood to my brain. But then there is the fatigue issue. Could I just be tired? If so I have never been this tired in my life. Anemia, hypotension?

Whatever. I am tired of this listen to your body crap. My body is a freakin' lunatic. There is only so much I can take- so I do not plan to take this little development lying down. I doubt I will actually pass out or anything.

The humble (limping) protege

It was a nice affair. My boss (fifteen years my senior) is a cardiologist, scientist, mother, and today Professor of Medicine. They gave her an endowed chair..... with all of the pomp and circumstance. There was a medal, a big one, that she wore around her neck as she gave her lecture.

The chancellor of the university, dean of medical school, chairman of medicine all said that she is an amazing scientist. They had her mother, father, brother, sister, husband, son and daughter stand up. They all were in the audience. For her introduction, "When a brilliant mind meets excellence in education and enthusiasm for discovery........"

It all-together was surreal. In surroundings familiar, I felt like an outsider.... being away for almost two months. Her accolades seemed to belong to a giant. For a moment seeming more like a coronation than lecture. Today she is the star. Somehow managing to find her way atop a pile of ego-centric, contemptuous, impatient, gender-biased men.

Surreal because I know this woman. I have been known to curse her. When she returns my writing nearly all red with edits, sends me back to the bench feeling my questions were ridiculously stupid, chastises me for spending too much time with patients and casually suggests I should repeat the experiment over the weekend.

But she is also the woman who hand-delivered home cooked meal to my house after my surgery.

What a challenge to be a successful woman. Here I am a critic, sitting in the privileged position to advance under her tutelage. Perhaps it reflects my own struggle. To find the right balance between kick-ass cardiologist, healthy/ fit athlete, and caring thoughtful friend.

A love hate relationship with the Professor. A love hate relationship with myself?

Hip Update

I am reaching the 6 week post-op magical date. This is when I stop taking the medications. Anti-inflammatory to prevent heterotopic bone formation. Aspirin to prevent blood clots. Lexapro because I don't want to take it anymore, and I prescribed it anyway.

Update of wound healing...... this was taken last week.


Compared to POD#5 you can appreciate the improvement!


And the wrist? One year of healing, my scar is white, flat and smooth. Secrets?

• Scar massage, rubbing skin to loosen from connective tissue below.
• Vitamin E/Coca butter lotion, applied daily for first few months.
• The SPF 45 sun-block all summer, if fresh scar is exposed to the sun, it will turn pink or blue
  

Mini Medical School 101

Recently I came across the efforts of Fran Drescher (star the Nanny). She is leading the Cancer Schmancer Movement, with the goal of increasing awareness of gynecological cancers.



Her goal is for all cancers to be diagnosed in stage one, when the disease is most easily and most effectively treated. An advocate for women understanding and taking control of their bodies, I applaud her efforts.

In a recent interview she was speaking about screening tests, in particular the use of vaginal ultrasound for detection of ovarian cancer. She was expressing the concern that it is not covered by insurance and therefore not available to women.

Respectfully I would like to clarify this issue. I believe it to be an important one and will be an excellent topic for my 1st Mini Med School Post.

A screening test is only useful if it:

Is capable of detecting disease
Has more benefit than risk
Makes a difference in the outcome of the disease


In the case of ovarian cancer, vaginal ultrasound is not an effective screening tool. The problem is the frequency of false-positive results. False-positive results are when the test suggests an abnormality when nothing is really wrong.

Doctors believe this because in one study (Jacobs Lancet 1988) 5 cancers were found among 5,489 asymptomatic patients who received 14,356 vaginal ultrasounds. In a second study (Andolf et al Br J ObGyn 1986) one cancer was found in 805 high risk women who were screened by vaginal ultrasound, BUT 38 patients in the study had exploratory surgery to follow-up on false positive test results. These numbers (the frequency of disease in a population and complication rate from screening) are used by physicians to determine if screening tests work.

Sometimes people believe that because a test is available it must be good. This is not always true. The well-informed patient should understand this.