The Miracle of Birth

so today was a crazy long day. the doc i'm with was on-call for new admissions in the ER last night (for patients unassigned to other docs), so we had a bunch of admissions to do first thing this morning. then i went and shadowed a PA in OB/GYN for a while at a different hospital, then came back and saw more patients and ran around like an unproductive chicken with its head cut off. (although i wonder how many headless chickens actually get stuff done).

so i've determined i don't like chest pain and bloody bowels enough to do internal medicine all the time. i just want more and more to do women's health. that's it. i promise that i word this differently when i'm talking to potential employers, but the truth is, when it comes down to it, i just want to deal with women and their broken hoo-ha's and baby growing/hatching. one way or the other, i have to find work in it. i think that waking up every day to work in that field would make me feel really accomplished and happy.

and on that note, i saw a commercial last night that referred to "the miracle of birth" and i was thinking- the way that humans are created and grow and most often come out as little perfect human beans is truly miraculous. but the actual BIRTH? i know i've talked a lot about how gory it can be- but the word "miracle" makes me think of pastoral scenes of angels singing and lambs frolicking and stuff. in fact....

a "miracle," as defined by Webster, is " An extraordinary event manifesting divine intervention in human affairs" and its origins are from the latin word 'miraculum' which means 'a wonder or marvel.'

a google images search for "the miracle of birth" gave me lots of helpful pictures such as this hyah below and other cutesy baby pics and links to several animal husbandry sites, a placenta cookbook (don't do it), and even one link to a very strange hair metal band.

but in the births i've seen there is much more stretching, tearing, moaning, screaming, panicking, aching, and even hitting and biting than there is singing and frolicking. 9 months is a long time to grow a parasite inside of you as it zaps your resources, stretches every ligament and muscle you have, maybe even separates your bones and compresses your nerves....then when you start feeling like you can't stand it any longer, you can look forward to multiple hours of ripping pain such that you've never felt...so bad that when we ask a patient to classify their, say, heart attack pain or hemorrhaging brain pain, we ask them to use labor pain as a '10 out of 10.' and to top it all off--- when you're FINally contracting and pushing successfully and bearing down hard like you're having a bowel movement- you might, in fact, have a bowel movement- often with eager family members cheering you on/videotaping the whole ordeal.

charming.

so, i guess i tell you this not to scare you into celibacy or anything, but just to reiterate how challenging birthing is and how important it is to have a comforting, competent person (me) at the bedside. there are so many opportunities to positively effect the experience of women in labor. and this is why i want to be part of this incredible process. for as unholy and gruesome as it can seem, the outcome is absolutely amazing. so much so, that women (those crazy and sturdy, durable and heroic beings) often choose to do that whole thing i listed above MORE THAN ONCE.

now that's a miraculum.

The Most Efficient Way to Give Yourself a Stress Ulcer/Myocardial Infarction

...whenever i say "infarction" my husband laughs. because we are a house full of mature adults....

:)

well, my big angry cumulative exam is done. it was a bear, as i knew it would be. 360 multiple choice questions, took about 4 hrs to finish. i took a few stretch, pee, eat breaks during it, which helped, but still by the end my vision was blurring. i just get bored and antsy. and maybe sloppy as a result. i will need to do some marathon training for the boards (same # of ??'s) so i can be vigilant for the duration. i didn't do awesome, but i passed w/ enough margin that i think i'll be fine on the boards after putting intensive study into it for a few weeks in august. for the program, i have only 1 more exam to complete- which is the week of graduation in august and is a practical exam where we show our physical exam skills on fake patients and read xrays and such. sigh.

i am SO looking forward to next summer when i'll be lying around by a pool somewhere, not a worry in the world, thinking back on these 2 summers of stressed-out studying and anxiety over jobs and licenses and stuff.

actually, since i plan to be a filthy rich successful PA by then (in less than a year and despite much accumulated student debt, naturally), i'll actually be out tanning by my OWN new pool (maybe filled with champagne, i haven't decided). yea, that's it. and i'll have my gardener, harold, fanning me with palm branches and my personal assistant, bridgette, bringing me fresh guava margaritas every 30 minutes.

yep. that's exactly how it will be.

...i was told recently by an aficionado of my blog that i can seem somewhat hard on myself regarding school and learning, and tend to be hypercritical (so brace yourselves, here it comes again)...but honestly, when i don't know answers, it worries me not for my grade or getting my license, it worries me for how i'll be under serving my patients if i don't have the body of knowledge to know how to diagnose and fix them. people keep telling me i'll 'learn a lot on the job' over the first few years, and i'm sure that's true. but i worry about those patients i'm seeing during this learning period and how they won't get as good of care as they should because i'm a rookie. i don't think there's any way around this, it just is one of those things i choose to dwell on. :( to comfort myself, i keep chanting, "you've learned so much, you've come so far, you can always ask for help, you can always look stuff up...."

plus, i'll have the added pressure of making sure i'm competent enough to keep the big-money making gig i get so that i can support harold, bridgette, and the rest of my growing entourage.

so, PHEW, i am relieved that test is done. but, YIKES, i still have much anxiety about the future. i'm working more on the job hunt this weekend. no interviews yet, but some good leads. and i'm going to shadow an Ob/Gyn PA next week and pick her brain on how to proceed w/ my career from here. so that'll be good.

great. now i'm craving a margarita. but i still have to make it for my own stupid self as bridgette has the weekend off. oh, and is a figment of my imagination. that, too.

¿Drogas Son Malas, Bien? An Ode to the Brilliant George Carlin and the Stone Cold Crazy Amy Whinehouse

had a good day today. i saw a post-op patient this afternoon on a 'simple consult' and there was actually a whole lot going on- kind of a crisis scene when i got there. and i didn't panic, but was able to sit back and assess the situation and by the end of it, the nurse practitioner and nurses were turning to me for answers. and, miraculously, when i opened my mouth THINGS THAT MADE SENSE CAME OUT. i turned one way and TOTALLY SAID SOMETHING NOT DUMB and then turned the other way AND SOUNDED JUST LIKE I HAD A CLUE. i was like a ninja, slicing through lab values and HAY-YA!- ing through volume status problems, making orders and writing consults and asking questions and....well, frankly, being damned impressive. :)

i might be exaggerating just a wee bit....but it was really fun. i felt like a real live PA. even just for a minute. and even if i did it with help. i came home all happy and energized.

and this was after a devastating morning when i found out that george carlin, one of the all time most awesome sarcastic, cynical and crotchety americans, a legend of comedy, a successful writer, and a brilliant actor, died yesterday of heart failure at the tender age of 71. i'm weeping to myself on the way to the hospital today thinking of him in "jersey girl"in that end scene in the bar when he talks so eloquently and touchingly about aging and...sniff...mortality....i can't find a link to that scene, so if you want to watch it, you have to endure over an hour of ben affleck first, but suffice it to say, it's worth it for GC's monologue. he's also a fabulous priest in "dogma."

i don't know if they've released exact cause of death yet, but i heard rumblings that he'd been treated for congestive heart failure in the past. if this was an MI (myocardial infarction = heart attack), between his death and tim russert's, we're about to get a whole lot of celebrity propaganda on heart health. foundations will be popping up everywhere.

in the case of GC, from what i've heard and he tells us through quotes, his lifestyle certainly wasn't conducive to cardiac health. he smoked a lot of lots of things, drank, and used prescription drugs ("To be intoxicated is to feel sophisticated, but not be able to say it."). he also enjoyed eating and indulging, even after he was being treated for heart probs ("Heart disease has changed my eating habits, but I still cook bacon for the smell") and loved on women ("The main reason Santa is so jolly is because he knows where all the bad girls live."), although i think he had pretty strong marriages. and then there was his fierce mistrust of faith and religion and generally dour attitude toward humanity and the planet at large ("If someone loves you and they leave and don't come back, it was never meant to be. If someone loves you and they leave and come back, set them on fire."), which certainly could add stress. so i hope he had more peace within him than what he displayed on the outside to make us laugh. i thought he was funny and smart and great and i'll miss him.

so that bit of celebrity health news made me sad. but does it make me evil that this piece of celebrity gossip made me laugh? are you kidding? she has emphysema at 24 yrs old????? emphysema is one type of chronic obstructive pulmonary disease and is usually found in old folks who have smoked cigarettes for many decades and have obliterated their lung tissue. how many fields of coca plant has she smoked to give her the lungs of a 70 year old navy man? impressive. everything about her just screams Mad TV sketch of bad girl rock star. i mean, assuming at least 1/2 the reports we hear on her are true, she ingests drugs and booze instead of food, and you KNOW her liver has been desperately waving the white flag for a while now and clearly she just doesn't have any reserves for when her body starts shutting down (not like our own hot mess ,courtney love, on this side of the pond- she can survive ANYTHING). but emphysema? wow.

Yo Mama So Fat She Ate Jenny and Craig

alright, so none of us love everything about our bodies. most of us can pinch an inch and aren't totally thrilled with the number on the scale. i myself could use a little less muffintop-ness and some good ol' fashioned suzanne summers' butt sculpting.....(when the scuba dive shop owner guessed my weight the other day, i was appalled that he would guess such a high number... and then impressed with his accuracy when i weighed myself the next day. d'oh! maybe he should have been a carny worker.)

ANYway....i have more conversations with patients, friends, colleagues every day about weight loss than anything. all the zillions of diet plans out there , new globo gyms popping up on every corner, theories on health and weight and the different cultural aspects of body images.....there really is a lot to say about it. (and i'm not EVEN going to get into the whole underweight= pretty model/celebrity thing where the winner of America's Next Top Model this year was lauded for her courage to overcome adversity in life as a freaking SIZE 10 plus size model...here i'm just talking about weighing to much).

we in america have a lot of health advantages over other places- clean(ish) air and water, abundant agriculture, excellent health care and even some preventative health care, and lots of research and public awareness on both healthy living and risky lifestyle choices. but i think maybe we have a bit too ample a supply, are sedentary with all of our leisure activities and time-saving shortcuts and have skewed our perspective of what body size is 'normal.' believe it or not, 66% of americans are overweight (BMI 25-29). and a full 1/3 of americans are clinically obese (BMI >30). these criteria are defined by BMI (body mass index), which you can calculate for your own self, if you're curious. the definition of morbid obesity varies, but is considered by the W.H.O to be a BMI of >40. for example, someone who is 5'9" and weighs 275# is clinically morbidly obese.

so because most americans are overweight, most of the patients we see at the clinic and hospital are overweight/obese. some are even hundreds of pounds overweight. a "normal" middle-aged patient seems to have at least an extra 30-60 pounds. but there are regular folks, professionals with active careers and busy lives lugging around an extra 100+ pounds. clearly, the higher the BMI, the more associated problems, but all extra padding has its consequences....all of the following health problems (comorbidities) have proven association with being overweight:

-diabetes -high blood pressure -high cholesterol -coronary and cerebral artery diseases (heart attacks, strokes) -peripheral vascular disease -sleep apnea -asthma -joint problems -some cancers -fertility issues -erectile issues -the list goes on

....which means the good news is, losing the weight can bring back health! i love the show "the biggest loser." it's a reality show where contestants are competing to lose the largest % of body weight. i remember one particular success story for the discussion of his medical status- he was a guy in his 40's who was maybe 120 pounds overweight and on something like 8 different meds/day. in losing 100 pounds he cured his type II diabetes, asthma, and hypertension and greatly improved his cholesterol levels. losing that much weight is not an easy task, to be sure. but he just gave his heart, kidneys, brain, eyes, EVERYTHING years of healthy living. and notice i said "cured" instead of "treated" since he is by all definitions rid of those problems since their underlying source was his obesity. amazing.

so....how's weight loss happen? after all, we still have to eat for survival since we haven't yet invented some sort of nutritionally dense pill formula to get us all our daily nutrients (thank God!)....so it's not like other addictions/indulgences....it's not like we HAVE to have cigarettes or cocaine and that stopping them all together will harm us. so how do we do it... what is moderation? is that like 3 homemade chocolate chip cookies instead of the 12 that i would like to eat? is that like cooking in olive oil instead of lard? is that like foregoing bacon for celery?

this is already the longest post ever, so i'm not going to go into too many details. suffice it to say that a low fat, low calorie, high fiber diet with aerobic exercise a few times/week is a good start. i think i've shown you my love for the weight watchers program before. i really think those lessons are good ones for life, but there are other good programs out there, too. diets where you starve yourself from all of one food group don't usually last, are painful, and often have negative health consequences. balance really is key. leave me a message if you want to talk more about any of this.

but i do want to make note that while fast food gets a bad name, our portion sizes and fat/calorie content in restaurants in america is shocking. honestly, there's a new burger at that royal burger restaurant called the Loaded Steakhouse Burger (Angus beef, cheese, loaded baked potato topping, bacon and steak sauce) that contains 55 gm fat and 970 calories. if you're on a 2000 calorie diet (which is way too much for most of us), that is 100% of your daily fat allowance and almost half of your daily calories. and are you full after that? is that enough to 1/2 satiate you for the day? and it's not just the big ticket items....it's the sneaky things that will get you....there are 290 calories in a large regular Coke, and (this is a travesty, but true) 370 calories and 11 gms fat in a little mini value size chocolate shake. yikes!

so that's what's on my mind. i am taken aback by the patients who will pay to take a dozen meds a day and consider bariatric surgery (gastric bypass) but won't go for a walk or cut back on food intake. they're killing themselves and going broke to support their weight, basically. it's sad. and frustrating. and i really don't mean to be insensitive- i know there are no quick fixes and that weight loss/gain can be a vicious circle and that often times there are social, psychological, and historical elements involved. but let's try.

ONE LAST THING, i promise. my husband is my hero. i know i've bragged about him before, but it's compulsive. i can't help it. he is 30 and at about 22 decided to take his lifelong obesity into his own hands. he was 90 pounds overweight at that time. through a vegetarian diet, weight watchers and exercise he has lost 70+ pounds. it took every bit of those 8 years and when he started, he could only walk/run 1 mile at a time. now he has competed in several 5 and 10k runs, a triathlon, and is currently training for his first full marathon (26 miles of insanity). he can't let up, always has to be diligent, but he's kept the weight off. he is young and healthy and fortunately has no health problems associated with his obesity, but he really did save his own life. impressive.

alright. ENOUGH! (....don't even let me get started on smoking...we'd be here all night.....)



**if you're interested in the money side of things, emedicine says in their article on "Obesity" that: "The annual cost of managing obesity in the United States alone amounts to approximately $100 billion, of which approximately $52 billion are direct costs of healthcare. These costs amount to approximately 5.7% of all US health expenditure. The cost of lost productivity due to obesity is approximately $3.9 billion, and another $33 billion is spent annually on weight-loss products and services."

I'm Moving to Canada

or, perhaps, i'll leave the planet all together, because this cannot bode well .

Au revoir Ovaries, Hello Heart Failure

and so i'm starting back into primary care tomorrow. this is my final rotation before graduation. amazing. 8 wks in internal medicine. it's great timing since i have a comprehensive exam in 2 wks. it's been a few months since i've done primary care (ER to psych to Ob/Gyn), so i'll have some reviewing to do to...both for patient care and in test prep.

the job hunt continues for an ob/gyn job. i'm making headway and have been in touch w/ some great folks who might be able to point me in the right direction. lots to do in the next few weeks. i'll keep you posted. if nothing else, i look smokin' hot in my new suit, so i'll at least be dressed to impress on interviews. maybe i should do like the method actors at auditions and show up in scrubs and surgical gown with a fake baby under my arm. think that would help my cause?

had a great weekend with my family for father's day and while almost drowning when doing scuba diving training. we were in a little inland lake that was something like 47 degrees down at the bottom where we were, but i didn't actually come close to drowning. i did lose a mask, break another mask, get lost in the muck, surface in a panic, and swallow approximately 3 fishtanks full of lake water, seaweed and wee little fishes....but no worries. it was overall a good experience that i'm glad i did and am done with. i hear tell that diving in the carribean is a slightly more comfortable experience than doing drills in a frigid, muddy lake. so i'm not swearing off this crazy hobby yet. we'll see.

Busy Little OB

while finishing my last week in Ob/Gyn elective, i've been mailing and emailing my CV around town, completing the *&(@# EKG exam, and starting to study for a comprehensive exam we have coming up, PLUS snotting all over myself with this sinus infection. i've been drowning myself in chicken(less) noodle soup and herbal tea and decongestant hoping that i'll be plug-free for scuba diving this weekend. in an inland lake. that's cold. and green-bottomed. and fish peed-in. i'm really excited about that. :)

things are great. i've loved this rotation and feel that, although i still have a lot to learn, i've really found my niche in medicine with Ob/Gyn. the doc i'm with is fantastically kind and a great teacher. and it's fun getting to know some of the patients on routine visits. mostly for prenatal visits, which toward term happen weekly or every other week. maybe more fun for me than them, since they're 8-9 months pregnant and now that it's 1000 degrees outside and we're in a typhoon, they don't seem all that comfortable leaving their houses to waddle into the office. no deliveries this week. c-section last week where i did a lot of suturing and assisting and am still a little high from the rush of being in the OR.

my challenge now is to find a way to be able to do it all as a PA. deliveries, prenatal and annual visits, assisting in surgery, all of it. i'm still researching my options and my state's limitations for PA's. i'm even considering further education to make me more of a tour de force(ps).

:) we'll see.

next i go back to primary care with one of the docs i was with for internal medicine. 8 wks of that and then i take a few more ball-busting exams and i graduate. (gulp).

Defecating Oneself.

not actually. come on, do you think i'd actually admit that to you if i had? (i totally would). but i just signed up to take my licensing board exam in september (some 94 days from now) and i graduate in august (some 73 days from now) and i plan to have a panic attach roughly soon (5 minutes ago). and once again, i feel like all my classmates have jobs for real or jobs for probably and i have jobs for nothin'. it'll happen, and i'm in no real rush (see above really big numbers) but i feel the pressure. and i'm not a big fan of the job search/interviewing process. it's a little painful. i know this is not unique to me- and i actually represent pretty well, i think....but it's still nerve-racking. i'm thinking about just putting out a full page spread in our local paper or commissioning a billboard for the side of the highway. so if you're relaxing with the paper and a cup of coffee or are driving down the freeway and you see a huge, frantic smile on a soon-to-graduate PA-student, it might be me. i'm considering captions for my ad like "New and Eager-to-Please PA- Will Consider Being Paid in Goats." or "If You Love America, You'll Hire Me." or "Experienced OBGYN PA Has Smeared Hundreds of Paps, Yours Could be Next!"

what do you think? a little too forward. maybe i'll just write some emails for now.