The day a doctor told us to go to the ER when we didn't actually have to

Last Friday James was dizzy.  He sometimes just gets dizzy and it goes away, but this was worse than usual.  I was gone to Knoxville that day, and when I got back it was after normal business hours. James asked me to look at his eyes when he lay on his side, and they were kind of scary: he was trying to look straight at my face, but his eyes kept moving side to side, like he was reading.  His eyes also dilated very, very quickly until I almost couldn't see his iris anymore.  I decided that this wasn't a permanent trait I wanted in a husband, so we looked up the closest urgent care we could find since nobody would be open again until Monday.

We drove about 45 minutes to the Morristown urgent care clinic, where the nurse saw us, got James's info, and went to talk to the doctor.  She came back and said, "The doctor says he knows what it is and you need to go to the ER right away to get a CT scan."  We were confused that the doctor wouldn't see us, but thought that maybe he was trying to save us money by not charging us for a visit, so with that ominous set of directions we headed to the Morristown ER.  They stuck James on a monitor and we sat there for typical ER waiting times until the doctor came.

By the time the doctor arrived at 9 pm, James hadn't eaten for 8 hours, and I was feeling uncomfortably peckish myself. They told him upon arrival to not eat anything in case he needed any procedures done.  (Did I mention it was supposed to be our fancy go-out-to-dinner-to-have-possibly-our-last-date-before-baby night?  Seriously, though, this was much more memorable than that would've been!)  But the doctor made up for all that.  She was excellent.  She knew James was a med student, so when she came in she asked him what he thought it was.  He told her he thought it was benign positional vertigo, but with the eye thing he wasn't so sure anymore.  He was right!  She talked to him about how to tell the difference between this diagnosis and other similar ones, reassured us about the eye thing, and had some fun tests where they checked his cranial nerves.  She gave him some interesting pointers on how to make absolutely sure it wasn't a stroke when he had older patients with these symptoms.  She was fantastic.  She told us that we didn't have to come to the ER, and to watch out for that particular urgent care clinic because they had a history of sending panicked patients to the ER for no reason.  What a bummer of a reputation, huh?

We also learned that this vertigo was likely due to spring allergies which led to conditions affecting balance (like stuffed sinuses and excess earwax production in the presence of pollen) and we learned that this chunk of Tennessee is the worst in the country in terms of spring allergies because of all the different types pollen and the way the mountains funnel it together in the air right before Kentucky begins.  Who knew?  Now we do!  And I've never had someone tell me that my husband needs to go to the ER right away. Those are powerful words, folks!  Let's avoid saying that too often; it's not a good feeling.  The good feeling was knowing he was fine, and that he will be good at diagnosing this in himself and patients in the future!

Chattanooga Choo Choo!

Last week was James's spring break, but not mine.  Since I don't work on Fridays, though, we took the opportunity to have one last hoorah trip together before the baby.  We only live about 3 hours from Chattanooga, and the city has a cool-sounding name, so that's where we went.

We figured it was a bad idea to go to Chattanooga and not do anything train-related, so we opted for the incline railway up Lookout Mountain.  The wait to get on said train was about 45 minutes, but when there were two extra seats in an earlier car and James said we'd be willing to help them out, the other passengers took one look at us and let us go ahead.  Ah, the perks of pregnancy.  This railway was pretty cool.  When you got in, the angles of the seats and the superfluous "steps" of the walkway between the seats were a bit off, but it wasn't remarkable.  However, by the time you get to the top, the angles were perfectly upright and the steps formed a staircase to climb out.

You see, this car went from being flat on the ground to resting at a 72.7% grade/incline.  That's pretty steep.  This is the steepest passenger railway in the world!  One mile at an incline steadily increasing until the end when it's almost straight up.  The car had windows on the roof, and if you look in the picture, you can see that the only way to see straight out to the city in front of you is to look through the roof.  There are two cars on the railway that pass in the middle and work on a pulley system.  It's a pretty cool setup.

The railway did warn us that the altitude change might take us by surprise, and we quite enjoyed the idea of altitude sickness at the mountain's height of 2100 feet.  It is a tall mountain in the middle of an otherwise flat area, so the difference in height is fairly impressive, but not all that dangerous to people familiar with other mountains.  At the top of the picture here, you can see here the last bit of track (in black) by the station at the top. See? I told you it was steep!

There was once a Civil War battle atop this mountain, and one of the big problems the soldiers on top faced was trying to shoot cannons at the oncoming troops; when they'd aim the cannon, the cannon ball would roll out because the angle was too steep.  Thus began the American Bowling Association.

We also went to the Tennessee Aquarium.  (Let's be honest: this aquarium is the real reason we chose to go to Chattanooga.)  It was fantastic!  The aquarium is so big that when you get a ticket, you get into two separate buildings - one for freshwater fish (River Journey) and one for the ocean (Ocean Journey).  We started with the River Journey (the bigger of the two).  This was incredible!  You start at the top and circle your way down the whole building.  They had all sorts of fishes as well as frogs, turtles, alligators, crocodiles, birds, etc.  (The top part gets natural light and warmth, so the birds just flit around pooping on people.)  We got to pet big old sturgeons, watch a squabbling trio of brother otters, and there were some incredible tanks deeper in with ENORMOUS arapaima.  My favorite were the paddlefish with their long snouts and their sometimes-opened-and-gaping mouths patrolling the waters.  

James's favorite was the electric eel.  (This was James's first time to an official aquarium, by the way!)  Many places, the TN Aquarium included, hooked up the electric eel tank to some LED lights and a speaker that showed when the eel was giving off any electricity.  We happened to arrive around feeding time, so it was neat to watch Mr. Eel search for and eat his pray and listen to the speakers crackling. At one point in the feeding, one of the other small fish in the tank brushed against the eel's back and spooked him.  The lights and speakers went CRAZY and then....there was a dead fish floating above Mr. Eel.  Dead fish.  Zap.  The end.

In fact, we were so impressed by the freshwater aquariums that the ocean was kind of a letdown.  We got to pet sting rays, and they had a butterfly garden room, and they had some truly fantastic jellyfish exhibits, but their main tank that extended in little pockets around the building wasn't as fun as the big tanks in River Journey.  Yes, they did have sharks and penguins and corals, and they were lovely.  But the electric eel was hard to top!  Both buildings were by far the best aquariums I've been to, and it was very fun.

We also went to Coolridge Park, which connects to Walnut Bridge which is, we were informed, the longest pedestrian bridge in the US.  It's been a day of big deal visits!

We drove home through an enormous and windy rainstorm (it turns out we drove through a Tornado Warning...oh, wow, that season's started again, has it?) but we're back and set for the next while.  When we hear the train go by our house, we'll just smile and remember.

That time we got snowed in for two weeks

Once upon a time it was February and it snowed the first real snow of our winter.  ("Real snow" meaning over 1/4" of snow that lasted longer than 12 hours on the ground.)

This snow occurred off and on for about two weeks.  We never had more than about 6" on the ground at any one time, but it would melt during the days and leave a thick layer of ice underneath.  The corner of the world where we live doesn't have much in the way of plows, sand trucks, or salt trucks to deal with the snow.  It happens so infrequently, they say, that they can't justify buying those.  When I asked a local about it, she said that they usually miss at least a week of school a year all combined.  To me that seems to justify it, but perhaps not.  I've never lived anywhere so completely incapacitated by snow!

Being familiar with snow driving, James and I tried to get out, but the ice locked our cars in, and the local roads were just as icy.  We were stuck.  Once we could chisel our way out of the driveway, if we got to busier roads we were fine and could get groceries.  People in less sun-exposed areas had to drive ATVs and tow sleds to get groceries.  Many people had their power go out or water freeze and couldn't get help since the power company couldn't get to them to fix it.  Luckily, we're on the same power grid as both the power company and the county jail, so any power outages we've ever had have been very quickly resolved! 

Towards the end of the two weeks, we had a nice 50 degree day of rain.  From the snow-covered view before, this is us heading out the next morning after a night of rain (James is discovering where our sidewalk is again):

This is about three hours later with more rain:

I wish I'd taken a picture of the rivers to follow this up, because then the floods also closed some areas and events.  Rivers are still high, but manageable now.  We were just fine on our little hill!  A girl we know went into labor around the time of the Great Rain, and was extremely relieved that roads thawed enough to let her get to the hospital and thus avoid an unplanned candlelit home birth with an inexperienced midwife of a spouse.

All together, James and I both missed about two weeks of school.  (The local public schools missed three weeks!)  James still had lectures to watch at home (they posted last year's lectures so the students wouldn't get too behind), and I'm now rushing to make up lost time in the classroom.  James especially had some cabin fever being stuck inside for so long; I just took lots of naps.  We made snow angels and snowballs once there was enough snow for it (it wasn't really wet enough snow for the snowballs to hold together, so the snowman didn't happen), but once the snow freezes and there's ice below, it's not quite the same to go play in it.  We did try, though!  And had a great deal of fun throwing shards of ice at each other as we scraped off the cars.

The weather is finally back to acceptable spring temperatures, and the heavy rain does let up from time to time so we can have a day of squishy sunshine. 

This Post is About Babies (well, just the one)

This doesn't have much to do with our DO school journey, but it's a story of our family while in med school.  I'm very hesitant about posting this; you may not be interested (you can skip it), but I know that I've scoured the internet for real-person stories for months, and I wish I'd had some true stories and perspectives to relate to along the way.  Maybe someone will find this and it will help them.  I hope so.

Once upon a time we decided to try to have kids.  James was a little more excited about it than I was, but since we knew that it usually takes a woman a few months to ovulate again after stopping birth control, we figured I'd have a while to get used to wanting a baby before it was real.  So off the pill I came.  Against all of my personal expectations, we got pregnant immediately.  We were in Knoxville celebrating James's birthday early and I suddenly felt like I had slammed into a wall of exhaustion, so we headed home.  I joked that it was probably because I was pregnant.  The pill messes with your menstrual cycle when you come off of it, so I didn't know if I'd missed a period yet or not.

I happened to have a cheap little pregnancy test on hand (who knows why), so the next morning I checked.  Next to the control line was a little faint something on the "pregnant" line.  I spent the day googling pregnancy tests, since when you're unemployed and have no car, what else is there to do in these situations?  It turns out that any "something" line is a line, and a line equals HCG which equals pregnant.  It did not happen from my residual birth control pill hormones.  Still unsure, I bought another (better) test, and waited a couple of days to take it again.  This time both lines showed up very, very fast.

"JAMES!!" James, who was studying and didn't know what I was doing, came cautiously to the bathroom. "What is THIS, James!? You said it'd take a couple of months..."  And he snapped this picture.  Smile!  (Oh, and happy birthday, James!)

I have to be honest here and say that the pregnancy itself really has been very mild.  I don't throw up anyway, and some queasiness didn't change that.  Being tired isn't really that bad; I wasn't bedridden or anything.  I didn't show until 20 weeks; around the time I started to feel it.  I've never experienced heartburn before in my life (that I know of; reading the symptoms makes me pretty sure about that) and I still haven't with this.  Crying at random things is actually funny (at least for James).  Back pain isn't awesome, but luckily my husband's semester in his OPP manipulations lab is learning how to treat back pain.  Most of the time I forgot about it.  People must hate me.  I thought we might struggle with infertility, or with poor health.  I am so blessed to not have had those complications that so many others have to fight.  It was so mild that I kept wanting proof - what if I made it up?  What if it stopped being there? What if it was an elaborate hoax with a crazy uterus and fake ultrasounds?

The part about our journey that was hard was insurance and healthcare.  We moved to TN in July, and applied through the proper channels the day we arrived.  There were several mix-ups, and this led to delays and inquiries about delays, so I didn't get insurance until late November.  There were more mix-ups in December leading to our Great January Tennessee Insurance Fiasco, and we just finally got insurance again in early February.  Each delay or mix-up resulted in long daily phone calls on my part to get coverage.  Hormonal, ugly-cry type phone calls.  It's been a nightmare.

So there we were, about 7 weeks along, when there was some bleeding.  This is still in the "it's common to miscarry now" stage, so we didn't know what to do.  Do miscarriages need help?  Will I bleed to death?  We had no insurance.  The doctor's office said that it would cost about $800 out of pocket to do an OB visit, and we didn't have that money.  We're living on student loans, after all.  Eventually, the fear of the situation (for both my sake and baby's) drove us to see if the doctor could maybe just talk to us for under $200.  The doctor was fantastic.  He heard about our insurance situation and did a very, very quick  superficial ultrasound to make sure there was a living fetus and that I was a living mother, etc. etc., and that's all he could do, and he didn't charge us a cent.  But the office wouldn't let us come back until we had insurance, so the first time I had an actual real doctor visit was at 16 weeks.  Then more insurance trouble hit and I couldn't see a doctor again until 27 weeks.  (And now it's a different doctor because of - oh yes, insurance.)  I had no idea what the results were from all the tests and the big ultrasound they sent me for before at 16 weeks.  None. I felt it, so I assumed it was alive, and I hadn't died yet, so that's good.  But I have a family history of preeclampsia and my pulse has been crazy and what if I was on the back swing of kicking the bucket?

People can be nasty about things.  I tried calling all sorts of doctors, insurance representatives, and offices, and mostly I just got berated: "Why haven't you seen a doctor yet?  You really should have.  I can't believe you haven't tried to see a doctor yet.  Oh yes, our doctor won't see you."  That made me feel pretty awful.  People stopped believing my medical history, because if I was this irresponsible of a mother, surely I was lying about smoking/drinking/drugs.  Then there was the refreshing insurance operator man who suggested: "Just wait until you go into labor and then go to the emergency room.  They can't deny you healthcare then."  Oh, okay.  No prenatal care at all, then?  Never mind the bill for this ER visit.  Never mind that the last I heard, I had placenta previa which can be pretty darn severe if it is present at birth and and nobody knows about it.  Never mind that the emergency room he directed me to is at a hospital where they don't deliver babies, so they would have shipped me off to another one which defeats the purpose because of INSURANCE!  I felt so defeated and scared.  I was a horrible mother and both my baby and I would die because of something I couldn't fix or afford to go around.

Finally, finally, we just got insurance set up.  I got my card in the mail today.  Finally, I saw a doctor (actually, a midwife who works with a doctor.  Cool!).  Finally, someone else can look at my high pulse and tell us when to worry and how to deal with it.  No more internet forums with people telling me to just see a doctor.  Finally someone can tell me that the placenta previa is gone and that I don't have gestational diabetes.  Finally James knows his wife isn't on the brink of keeling over, and he knows that our current poverty hasn't killed our child.  Finally I can enjoy feeling it kick without also feeling anxiety. Finally I'm starting to believe it isn't a hoax and that it might not kill me after all.

Oh, and finally at 29 weeks there's an unmistakable half-globe stuck under my shirt.  And it's going to be okay!

Semester Two (so far)

James is now safely two tests into his second semester.  He's past that "I wonder if I can even do this" stage and into the "Well, I did it once.  I hope that's true again."

As we've lived here, James's school mascot has really grown on him.

Once James went to a basketball game with a group of med students to provide the fans with free blood pressure screening.  Presumably this cuts down on the number of fans getting too upset.  ("I'm sorry, sir, but if you don't calm down, we're going to have to check your blood pressure.")  At this game, James got his first glimpse of the school's mascot: Abraham Lincoln.  If you've never seen a giant plush Lincoln do the hokey pokey, then you're probably like me.  It's the best part of the game, though, says James.  There appears to be a speaker in the top of the mascot's hat, but James is hoping he can get it fitted for a mini t-shirt cannon so Abe can shoot stuff to his fans.

Abe aside, this semester seems nicer than last semester: James isn't taking anatomy, so he has a lighter load in terms of lab hours.  His other classes are more detailed and require more memorization than before, but now he has a little more time in the afternoons to do studying and keep up with them.  My favorite thing about this semester so far is learning about all the diseases. The best part of my day is asking James what he learned that day, and hearing about what the Plague was/is: why it was and remains so deadly, where it still happens in the US (watch out, Southeasterners who like playing with wild prairie dogs and their fleas!), how you treat it, how you test for it, how it kills you, and how many species of it there are.  The day he learned about leprosy was fascinating.  I've always been interested by this, and it's fun to hear it but not have to recall it.  I'm living in the best of both worlds!  (Also stay away from ticks.  They carry nasty stuff and I can think of no circumstances wherein they would be a positive, life-promoting human lover.)

As for me, my semester teaching has been lovely so far.  I forgot how much I loved it.  I'm teaching Intro to Biology, Human Ecology, and also Anatomy/Physiology 1 with its lab.  Anatomy/Physiology was new; the teacher who was supposed to teach two sections of it got a long-term sickness, so a week into school the administration asked me to teach it.  I was unhappy about this at first, since it almost doubled my work-time and the number of credits I was teaching.  Part of the point of the semester was to have less time on my feet as I got bigger.  It's grown on me, though. Because it's just a community college, the lab does not involve cadavers, but rather has skeletons and plastic models in addition to computer animations.  I wasn't ready to be in charge of a cadaver lab with my super sniffer nose, and boy did I luck out!  Another great thing about the class is the caliber of student.  Many of my other students (but by no means all of them) are there to fulfill a requirement and are pretty half-hearted about life.  Intro to Biology is not an easy course, and when they hit a hard conceptual thing like photosynthesis or meiosis, I can see some of them retreating inside their heads rather than try.  Attendance is so-so.  Basic abilities, like subtracting 2.5 points from a quiz total of 10 (clearly they earned an 8.5, right?  Or maybe a 6.5?) or successfully typing the date on a paper (Feb 1rst? Right?) are a bit tough. We're figuring each other out, though, and I think we're starting to have more fun in those classes.  It helps that we're through the "what is an atom?" (most of them have never taken chemistry in their life; that's why they're enrolled in biology, dang it!) and the photosynthesis lessons and are into something easier to picture.  I still love teaching, and I enjoy the challenge of these courses and classes, and I'm loving it.

But in my anatomy class, almost every student is there because they want to be some sort of medical-professional in the future that will require not only the class but a good grade in the class.  They all show up on time!  They participate!  They color their little hearts out in their anatomy coloring book.  One of them even has a child who made her use sticky notes to censor the male parts of her coloring book.  It's great.

I think this semester holds great promise for the two of us.

Note: I was just informed, while writing this, that Jim Henson (he of the Muppets) died of Toxic Shock Syndrome.  Another fun fact from the James Med School Collection!

Back to the Daily Grind

You know what's hard? Having 3 weeks of complete freedom to do whatever you want and then have all of that freedom taken away from you because of school starting up again. Am I glad I'm in school to become a doctor? Of course! Do I still wish that there was more free time to spend with Sariah? Oh, most definitely! How many questions can I ask myself and then give the answer right after in this blog? Just these 3.

I hope that this doesn't sound like I'm only here to play the "woe is me; I'm a medical student" card. The concepts that we're learning are really cool. After many years of struggling to understand the difference between humoral and cell-mediated immunity, I can finally answer that question and sound like I know what I'm talking about. Amazing stuff! The only problem with learning really cool things is that there is a ton of little details that go along with it. Thankfully, this semester's schedule is lighter in that I have afternoons free of labs most of the time. We're taking the same number of credits (27.5), but the required in class time seems less. I can't even imagine how things would be if we had anatomy thrown into the mix again. It just gives me the heeby-jeebies thinking about it.

And back to my first point. It's hard coming back from vacation! I know what I signed up for though and all in all, I am extremely grateful to be here studying medicine. What would I be doing otherwise? Probably not breaking an implied promise I made at the start of this blog about only asking myself and answering only 3 questions. Anywho, it's back to the grindstone for me.

The Cashier Chronicles Conclude

I'm not sad about this.  The end of the Cashier Chronicles is the best part of my new year.  Why?  Because I quit my job as a cashier in order to teach biology at a community college!  Hooray!  I'm off to do something I love instead of something I must do, and while I may miss the store, teaching people about how you know if something's alive is much more thrilling.

This video, for instance, makes me happy.  Biology and teaching biology makes me happy.  Much more than scanning groceries.  I should make this song my ringtone!

I shouldn't neglect the last few cashier memories, though.  They're a little more sad in some ways because these all happened between Thanksgiving and Christmas, and the holidays make sad situations more tragic somehow.

-A lady I recognized and saw at least weekly was outside picking through our cigarette butt ashtray thing, choosing the butts with the most left on them, and then started smoking those while her people were shopping inside.

-I asked one girl if she was excited for Christmas.  "We're having it late," she said.  "Because of paychecks and stuff.  Maybe sometime in January."  Her mom looked embarrassed, and I pointed out that this meant she was going to get presents after school started, and everyone would be jealous of her.  She seemed entranced by this idea.

-An 11-year-old(ish) girl had decided she likes me (I haven't been particularly nurturing to her, so I haven't the faintest idea why) so whenever her family comes in (twice a week or so) she'd scour the store until she found me and ask if she could help me.  Unfortunately, she's less competent than another kid who does this with me, so mostly she makes things worse.  Instead of putting bags in customer's carts, she'll line up all the bags on one arm and make the customer take them from her.  When her own mother finally comes through the line to leave, she won't help her mother but whips out a hoard of stuff she's stashed nearby and wants her mother to buy her.  I explained that when it's the week before Christmas, one's material interests are often better served by service to others rather than demands on an already stressed mother with a stretched budget, and things like hugs were a good place to start.  This was a poorly chosen example: the next time she came in, I was unaware of her presence until she came up behind me to give me a surprise guess-who's-suddenly-in-your-space-and-maybe-abducting-you hug.  She is not a small 11-year-old girl.  She chose to hug me around the widest point of my belly, which at that point was definitely showing, and had recently been painful for my stomach muscles (probably just muscles doing whatever they do when a baby pushes through them: that is, failing at their jobs), and there was some yelping and wheezing involved.  She couldn't understand why the hug wasn't working.

-I had two different men in the same week make inappropriate comments and body language with me that, had they been employees, could certainly have been followed up with some sort of harassment complaint.  As it was, it was over almost as soon as it started and there was no time to deal with it then.  I'd seen them both before, and this was at a time when my belly was straining the too-small tshirt the store issued me.  It's eerie to have big, sweaty, dirty men rake their eyes over you and then come up way too close to you, essentially trapping you in your little register area, and make jokes about you to your face, or jeer at you and ask you inappropriate questions.  One of them had his kids with him.  But then they were gone out of the store and it was over before I could do anything.  Fortunately, both encounters were brief.  I'm glad I left before I saw them again.

-The fellow who gave me the jewelry is trying to get me to name my child after him.  (He still does this if I happen to be shopping at that store when he's there.)  "Lonnie is good for boys and girls," he insists.  "It's the least you can do."

-On Christmas Eve, we closed a bit early, and I had the closing shift, which means I stay after we close to mop, clean bathrooms, put misplaced groceries away, etc.  Someone in the men's bathroom decided that that was the day to pee everywhere in their stall except for in the toilet.  People stink sometimes.

-A lady came in with some shabbily dressed people and got them $50 worth of groceries.  She let them go first, paid for them, and then when they left and she was paying for her own we talked.  They were homeless and asked her for some money or food, so she took them inside and got them some.

-Someone told me they appreciate my "Yankee Doodle accent."

-A Little Ceasars opened down the way from our store.  The store's in a little strip mall type thing, like most grocery stores are.  (You know, with a Rite Aid next door and maybe a salon or bank nearby.)  They were hiring and having open interviews.  I arrived at work at 9 am that day and there was a line of people outside the store that went clear to our store (about 75 yards) and some of the same people were still in line at noon.  It's a really hard place to get jobs, so when a store comes that has lots of jobs available all at once, everyone tries for it, hoping they'll be lucky with higher chances.  It's the kind of place where businesses get credits if their employees have certain hardships, and no discrimination laws are enforced, so there's a lot of discrimination against applicants that has nothing to do with ability.  My boss told me he'd probably not have hired me had he known I was pregnant when I applied (which is exactly why I didn't tell him).  It's just that kind of place.