Birth Magic

Once again, I am unsure of what to write. I can't really give details for fear of compromising someone's privacy, but I wish you could see what I have seen.

I have spent the last 4--soon to be 5 and over--weeks working in obstetrics and gynecology. It has been a wonderful experience all around, but by far the most incredible act I have witnessed is childbirth. 

In my four weeks I have been lucky to experience the full range--c sections and vaginal deliveries, planned and emergent, and both spent many hours in the hospital waiting for a delivery and sprinted from the parking lot down the hospital corridors in order to make it before baby did. 

There are a few things that always reaffirm my faith in humanity: national parks, libraries, and now childbirth. What women are capable of is nothing short of incredible. It doesn't matter what kind of birth--an epidural can take away the sharp pain but it doesn't change the feeling of pressure of a baby head passing through a formerly 1 centimeter hole. And the woman getting a c section faces the coldness of an operating room, with only a thin blue sheet dividing them from their internal organs which are now briefly literally on the outside.

The fathers too have been amazing. Supportive and present and weathering the storm with their partner. The whole process is like a trial by combat that you must come through in order to leave with the new life you created.

And the babies! They are so astonishingly perfect. Even covered in blood and purple. Even if they aren't perfect by a medical definition. I can't believe this is how we all came into the world.

We are all the product of untold hours of labor, stretching back in time. In the fields and the forest, by firelight or starlight, in back bedrooms and first hospitals, by candle and operating room lamp. So many mothers and babies died in the process, in this fierce baptism of pain and blood and insane strength to push gathered from somewhere deep within. 

If we could each trace our own history what would we find? How many hours in a thousand years have our mothers and grandmothers and great great great grandmothers given us? How much strength has been passed down?

It is an unspoken legacy we all carry. Look what our mothers were capable of. Look what insane iron magic we are made of. Whatever else happens, how ever else you feel about your day and your life, know that this is your stock.

This is your birthright.  This is your mother. 

The Mockingbird

A few years ago I had a nature blog called "Backyard Safari," where I wrote about trying to find the beauty of nature no matter where you were. My grandfather always enjoyed watching birds, first at the house they lived in for many decades, and then on the balcony of their apartment. 

In 2010 I e-mailed my Grandpa to ask if he could tell me about watching birds, and this is what he wrote back, presented in full, to let him speak for himself:

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“As a child, I was probably only aware of and familiar with robins and sparrows.  Later on, I grew to appreciate the beauty and coloring of the cardinals and blue jays, since they are easily distinguishable.  Then when we lived [at our old house], we had a very interesting mocking bird.  He would sit on the chimney of the house across the street and sing through his whole repertoire, occasionally jumping straight up about five or six feet and returning back down to the same chimney to continue his repertoire.  This could go on for four or five minutes–and the strangest thing was he might even be doing it at 11 or 12 o’clock at night.  During that summer, he also perched on the top of our garage and I would put pieces of apple or grapes on the back kitchen window sill and he would come and get them.  After a while, if I forgot to put the fruit out, he would show up at the top of the garage and wait for his food.  That was the most fun.

I guess I never got into the other birds too much until we moved out here–although we did have a bird feeder [at the old house] which your father installed safely on the top of a pole.  So he fed not only the birds but my continued interest in them.

When we moved where we are now, your wonderful father put up the finch-food feeder and the hummingbird feeder on our deck, both of which have been feeding many birds since then.  So you can credit your dad and mom for my continued interest.  And last year your dad brought the suet holder and suet, so we have a third source for them.

I miss the mocking birds–we never seen any anymore here.  But on most every day we do have goldfinches and purple finches, hummingbirds and cat birds, black- capped chicadees, cardinals, nuthatches, downy woodpeckers and many sparrows or similar types, including the chipping sparrow.  Still a few are a mystery.  It all proves nature is beautiful and a part of God’s plan.”

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Preparing for P2

With only 10 class days left in the semester, the "next year" of our P2 clinical year is now officially more like "next month." I am terrified, but am also getting more and more excited about what it will be like. 

As you know from any post about packing from our trip, I love accumulating and being surrounded by small objects that I might need. I like to think of this as a generally human trait, keeping the wolves at bay, but if you are Subash and caught in my piles you may have a different interpretation. 

At any rate, in the tiny lull between regular exams and finals exams this weekend I put together a little P2-Emergency-Kit to keep in the car or bag or somewhere as we begin this next adventure.

It's pretty simple, and mostly stockings. Some of the places we will be rotating in have rules that you have to wear stockings, not just if you are wearing a dress or skirt but over any foot visible. In order to combat the inevitable "oh my god I forgot stockings" 5 am moment, I bought a super cheap-o set of black and "nude," and then some knee high ones as well. I also have a set of little sock things for flats to stay comfortable.

Next up is a toothbrush, toothpaste, hand sanitizer, tiny deodorant, and lint roller. I actually got 3 lint rollers and plan on having one in my bag, in the car, and with this. It is the only way I will ever make it from our house to rotations without being a walking tumbleweed of cat hair.

Pro-tip: getting a travel deodorant was stupid. A real deodorant is what, 2 inches bigger? And with probably 500% more actual product.

Next comes hair clips and ties. After spending my whole adult life with a pixie cut, this long hair is still confusing to me. I don't know exactly what to do with it but certain rotations, like surgery, it will always be back, and in the end that will probably be the case for most things--long flowing hair just means hair in someone's face when you bend to examine them, or something for people to grab if they are obtunded/a kid/a jerk. We'll see how rotations actually go to figure this one out.

Lastly, you know I have to have a book and pens. For our 4-hour Friday rotations this year I used a small flip memo pad, but I am sizing up slightly with a 5 star college ruled notebook I know will fit in my white coat pocket. 

I also have this "Perfect H&P" book I ordered off Amazon. I haven't really used it yet but it is nice as a memory jog because it has categories for all the information you should be getting from someone. We'll see how it fits into my real life, but it might be good in the beginning at least to get me through those "oh shit" moments when everything important falls out of your head. 

For pens, my go to is the Pilot G-2 0.7 mm. They run out of ink too fast but they are a pen that can keep up with your thoughts, which is especially important when you are trying to balance listening to a patient, narrowing down a differential diagnosis, and getting the relevant info all at the same time.

This weekend I also went on a bit of a shopping spree, as I suddenly realized "oh crap I have to be presentable every day." And not just the old presentable behind a desk or in a lab like I used to do, but "trust me with your health and maybe life" presentable. 

I have been reading this blog by a med student on what she wears for inspiration

http://www.franishtheblog.com/2016/03/what-to-wear-on-clinical-rotations.html

So after yesterday's mall attack I think I am set for the foreseeable future! I have 4 pairs of nice pants, and probably 7 or 8 nice tops in addition to the random piles I already own which may or may not be applicable. 

I got a $7 watch since I need something with a second hand for taking vitals. My favorite part is that the Roman numeral for 4 is "IIII" instead of "IV," a perfect example of "you get what you pay for."

I am still working on the shoe problem. My shoes always need to be close-toed, and for surgery/ER will need to be something that covers the whole foot and maaaybe is rinse-able. 

Lastly, I finally got a full length mirror. I had one before our trip but we got rid of most of our belongings and somehow I just never got one again. Now, though my "if I can't see it it is probably fine" days are over and I need to see what the whole thing looks like!

All in all it was a successful weekend. I could have done this a little later, but i needed some fun happy and this made rotations seem more real. It is good motivation going into finals week to push through and do the best I can.

Bring it on!

P1 Year

Summer semester is flying by! We have ~2 more weeks of class and then finals, and then are officially P2s! 

P2 year is out in the real world on clinical rotations. There are 8 five week blocks, covering family medicine X 2, internal medicine, emergency medicine, general surgery, OBGYN, psychiatric medicine, and an elective. 

There is so much to know, and I'm still just biting away at the edges of everything I'll have to digest by next year's end, but I can't believe how far we have come in 12 months.

We have a "clinical skills" class this semester where we have been learning a range of things from your basic ring removal to how to run a code. My program really goes above and beyond here, and has gotten veeeeery creative in order to give us practice. Abscesses made of tapioca pudding, styrofoam eyeballs dipped in wax and stuck with foreign bodies, not to mention what we practice on each other, from diabetic foot exams to blood draws to injections.

One of the most fun has been learning stitches. Our "simulation lab" made fake skin pieces for us to practice on. Here are some simple interrupted and vertical mattress sutures submitted for judgement:

In addition to the regular work, a classmate and I are doing a research project at our free clinic for homeless men. I have no idea if it is something I am allowed to talk about much, as we are hoping to publish our findings at some point, but it has been really fun to get to be at the clinic more and get to know the men there. They have really embraced us and our work there, and are funny and very insightful into their own lives. It's been great.

This summer semester has been a real grind to get through. There are SO many tests, and so much material to learn. These last couple weeks it is definitely getting to me. For example, why am I awake now at 4 am????!!

The longer the summer goes on the more I can't think of any words I want in coversation--I'll know where I'm going and when I get to the end of the sentence it just isn't there. I'm mixing up letters when I take notes. I've started the coffee maker with nothing underneath to catch the coffee. This post is over 50% composed of just commas and the word "really." 

One classmate of mine went to a rotation with two different shoes on. Another calculated that out of the 220 class days of our P1 year we will have done 157 exams/quizzes and 39 reports.

I can't wait for that to be over and am both excited and terrified for next year. We find out the exact order and location of our different rotations in a few weeks, but I know my first 3 will be general surgery, OBGYN, and psychiatric medicine. Eek!

All this being said, I never lose sight of the razor-thin alternate reality where I didn't get in to PA school at all. Every time I see people interviewing for the program in their little black suits my insides scrunch up. People like to tell them how hard it is but I want to grab them by the shoulders and shout, "IT IS SO AWESOME, I HOPE YOU GET THE CHANCE" before running away to cram for the next test. 

Buses and Trains

This weekend I took a small adventure to Rhode Island. The drive there is always a little rough--Connecticut is some kind of insane wormhole that delays you by two hours no matter what--so I took the bus and the train instead.

Buses I have no great feelings about, but I love taking the train! It always feels special somehow. 

As mentioned on this blog before, I take great pleasure in going on a journey surrounded by a pile of belongings and snacks. For this weekend trip I packed my new art journal book, bag of pens, scissors, glue, photos to cut up, research papers to read, computer, iPod (recently rediscovered with all my old music on it), water bottle, candy, some clothes.

The bus was full of the same people as always--Guy On The Phone, Lady Talking Two Decibels Louder Than Required, Person Coughing On The Back of Your Head. In the bathroom of the bus station a cleaning person banged on one of the doors, yelling "you can't sleep in here!" and in the stall next to me a woman threw up violently. This is just the way buses are.

I transferred to the train at Penn Station in New York, where I entered Train World, a totally different experience.

I don't know what it is that makes the train seen special to me. I like the sound, the big windows, the view of the ugly side of things--the backs of buildings, the graffiti wars, chain link fences. My absolute favorite is train with a table, which I was able to wrangle in the "cafe car" on the way home.

Now I am on my way home. I finished the train journey and am back on the bus, which is surprisingly empty and lacking the usual suspects. It just got dark and I am typing this on my phone screen while I drink a coffee. I can see the outline of the trees along the road. My bag is on the seat next to me tucked under my arm, full of options should I want them.

For now, though, I am happy to sit and watch the silhouettes slip by. 

Into the Fray

This blog post is in honor of my Uncle Tom Newman, who is surely my most loyal reader and supporter ❤️.

As I mentioned a little while ago, I started a two year Physician Assistant masters program. I am now 4 months in and absolutely love it. I have found my niche.

I haven't posted recently, partly because it is an intensive program with lots of exams every week and other heavy experiences as we learn. The other reason is I'm not sure just how much I am allowed to say, ethically and legally. 

We have a cadaver lab. It is a strange experience, to be surrounded by the deceased and actually dissect them, but it is a gift I am grateful for. I have been lucky enough to hold human hearts and brains, and feel the weight of them. I am very conscious of the decision my gentleman made to donate his body for my learning. I can't thank him directly, but I wrap his body up and tuck him in very carefully after every lab, and hope it is enough. 

I can't believe how much we have learned in 4 months. I have a long way to go, and so much more to learn, but already I can see it taking shape, and have been able to examine patients and watch procedures and try to help people.

I also have really enjoyed meeting the other 78 students in my class. We have formed a support network I didn't expect, sharing notes and study tips. On Friday I witnessed my first truly devastating tragic event, and when I shared with the class I received many hugs, and some tissues. 

I just can't say enough good things! I'm so happy to be there. As I posted before, it took almost three years from making the decision to pursue a physician assistant masters degree to actually having all the requirements and getting accepted. The application process was rough, and I still feel so lucky to have gotten in.

My point here is that if there is something you really want to do, it's never too late. After an undergrad degree and a number of different jobs (all of which I DID like, it's worth saying), at the age of 29 I have finally found my true place, where the skills I am using are also the skills I am most proud of having. The trick about life changes is they are rarely a choice between something great and something terrible, instead they are usually a choice between something new that could be great and something comfortable and fine. If you didn't do it, you'd still be happy, but man, if you do it!

I am feeling a little vulnerable at the moment. In some ways, we are spending months learning all the things that can go wrong with your own body or people you love. For that reason I just want to say for the record that if anything tragic happens to me, know that I had an amazing life and I loved it all, and loved YOU all.

That being said, we are also learning all the ways that we can help when things go wrong, and the incredible resilience of the human body and mind. There is so much we can do, and we will do it.

I hope you are all doing really well. I am off to study! 3 exams this week and then final exams all next week. I can't believe the first semester is over, and I can't wait to see what we learn next!

Love,

Kathleen

This Week in London

These last few days have been busy with adventure. I have been trying to make the most of my time here and have ventured out every day to a new place to see what I can see.

Once on our last trip a well-to-do English businessman asked me what my favorite part of London is, and I said "the transportation system." He was disappointed in my answer, but I stand by it. Trains, trams, tubes, and buses, you can get anywhere. The city is so well connected, and you rarely have to wait more than 10 minutes for your next ride. The place we are staying is about 8 miles outside of the city proper, which translates to over an hour journey in to areas like London Bridge and the waterfront, but that hour is easy and is have gotten pretty good at figuring out the main hubs from which other side trips can follow.

There is great pleasure in a latte and a train seat by the window. In this case there was even a table, and I happily watched the fields and brick buildings and graffitied back walls go by. 

My first day out was to the Old Operating Theatre. It was used for poor women mostly, in the early 1800s before anesthetics were invented, and is one of the only 19th century operating theaters still surviving.

I paid 6 pounds to go in (about $10 US) which I never would have done on our world trip. I'm so glad I did, though! By chance, King's Medical College was holding a special lecture for their students inside the theatre on the use of surgery in cancer treatment. I sat down too and listened to the whole thing. It was incredible---the platform where the patient was operated on in the 1800s was now holding a laptop and projector, a screen was hung in front of the place where the surgeons used to (sometimes) rinse their hands in a porcelain bowl, the students and I sat around the wooden rows where medical students used to watch surgeries, beneath the same sign--a quote in Latin that means "mercy before wealth." 

It was an amazing experience, and made me even more excited for the physician assistant program to start in August. 

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I drew all the time on our world trip, but have hardly drawn at all since then. I wanted to get back to it so I google searched for drawing classes in London and found the "London Life Drawing Society" and went to a drop in session for 10 pounds--right down the street from the British Museum, I might add, which was cool in its own right.

I was very nervous about going--what if everyone there is friends and I'm a random stranger, what if everyone there is really good at drawing and I'm not, what if the model looks at my drawing and feels bad about themselves because I drew them poorly, what if I go to the wrong place and walk in and everyone stares at me and and and. Standing outside the door all of my insides yelled at me to just go home and take a nap. I powered through, however, and of course am so glad I did.

 

I've never gone to a life drawing class before, aka nude model. Little desks were arranged in a circle around a table covered with a black cloth. The model had some sort of accident and couldn't come, but to my great surprise one of the other people in the class just decided to get naked and be the model instead. 

While I am by no means a real artist and nowhere near as skilled as most of the people in the class, I was surprised to find I wasn't actually THAT bad. I've always thought that a person's drawing ability was 70% natural and 30% learned, but now I think it's more like only 20% natural, 30% learned, and 50% practice. My ability to draw has increased dramatically in the last year as I just did it over and over again.

The class was a series of 10 and 20 minute poses. It was great experience to have the time to just stare at something and really see what it looked like, how the parts related to one another in space. I had enough time to realize that I have a tendency to make legs too short, and fix it. 

I used charcoal, which I've never really used before. It was so fun! I made the decision to commit to big dark lines, which normally I am afraid of. With the charcoal though if a line went wrong I could just rub it away. 

The guy next to me did this cool thing where he shaded in the paper with the charcoal and then used the eraser to draw. I tried to do this but realized I'm just not skilled enough to get the first line right like the style required, so I drew on top instead and ended with my favorite drawing of the day. It's a style I would never have thought of without going to the class to see my neighbor's idea.

The class also made me feel oddly body-confident and in love with the bodies of all my fellow humans. The man who modeled was very muscled, and it was fun to draw him because you could see the muscles under the skin and it was interesting from an anatomical perspective, but the other two people who modeled first were heavy, and were equally fun to draw because they had swooping curvy lines and just as much detail. I had so much fun, and drawing them felt like a way to celebrate each of them for their unique shape among 7 billion others.

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Finally, yesterday I went out to the Camden Passage antique market, and the to the "Fashion on the Ration" exhibit at the Imperial War Museum.

The antique market was a bit out of my price range, generally, but I had fun wandering up and down the narrow street looking at piles of shiny old things.

I did end up buying this necklace for about $10 US, a souvenir from my adventures.

I ate an amazing "apple and goat cheese" crepe and then went off to the war museum.

The exhibit was 10 pounds, which I don't really think it was worth, although the rest of the museum is free so I suppose they have to make their money somewhere. It was all about how men and women made do during the many shortages of world war 2, and the clever ways they reused items to stay unique and fashionable in a time of crisis.

My favorite examples were of the purses that had special slots to hold a gas mask and luminescent white buttons to give visibility during blackouts:

And the lingerie made from silk maps given to soldiers of the areas they were deployed. The one is from a silk map of Italy a woman's boyfriend had been given while fighting there, which was repurposed by her during the major silk shortages of the war. 

It's been a great week so far. I only have 10 days left before it's back home again to real life. Even that will be okay, though. We have moved to a new town so I can go to school and I don't know anything about it yet, but it seems promising. This trip has inspired me to explore our new town the way I would explore a tourist destination. Walk around, figure out the buses, look for free events, make the effort.

But! That is still ten days away. For now it is off on the next adventure.