Nashville's temples

On Black Friday we drove down to Nashville to have a mini adventure and go to the temple. It's amazing how much having a child will impact the timing of mini adventures! It was the longest car trip Henry's been on, so we tried to time it so that it would include some of his normal nap times and make it easier for everyone. We...erm...mostly succeeded.

We stayed with some friends who were in our church here last year and then they moved there for their year 3 rotations. James got to see the hospital and talk to someone about rotations, which I think helped him solidify how it works.

We went to visit the Parthenon, which my grandfather says is worth it even if it's the only thing you do in Nashville, and I have to say - it was pretty impressive. Plopped right in the middle of Nashville you have a replica of a Greek temple for Athena (and there's an enormous statue of her inside). I loved it.

Athena's shield

Athena in all her golden glory

Right next to the Parthenon was another statue. We loved the benches surrounding it that had words on such as "integrity," "honesty," and "mechanical." Not all the words seemed to carry the same impact.


We were planning to stop by the Grand Ole Opry on our way back on Saturday but didn't because of...yarn. I needed another skein of yarn that only Joann's sells, so when we saw one off the freeway, we stopped so I could run in and buy it. It seems that at least at this Joann's, their Black Friday event was actually a Super Saturday event. I snagged my yarn and then stood in the long, bustling, holiday-cheery-and-crafty lines and that ate up all of our extra time. But once you've been in line for more than ten minutes, you're committed. I was getting that yarn, dang it. And woot woot, it was half off. Super Saturday! We opted for a local (and not that great) BBQ lunch and Joann's in lieu of the Opry. Next time!

We also wanted to visit Olan Rogers's store (The Soda Parlor) because we love his videos. But with it getting dark so early and such a long drive ahead of us with a Henry who hates driving in the dark, we had to forego that, too. Again, next time!

And that's pretty much all we had time for. On our way there we drove through several of the cities that are core rotation sites, so it was fun to see places we might be assigned to live for the next two years.

Halloween: Han Trio and Meeting Abe Lincoln

For Henry's first Halloween, all three of us dressed up as Han Solo. We were, collectively, Han Trio! We went around all night saying things like, "Never tell me the odds!" and "Who's scruffy looking?"

It was a good thing the church party was a week before Halloween, because Halloween itself fell on a test weekend. This means that James was MIA for the holiday, but never fear! Sariah and Henry went trick or treating with friends.

Out here people don't really go house to house to trick or treat. (Neither of our Halloweens in our area have yielded a single soul at our door. Extra candy for us!)  It may be because houses are so far apart (with no sidewalks or street lights), or maybe the local drug problems make people feel unsafe, but it just doesn't happen. Instead there are all sorts of events where different organizations provide a trick or treating experience. Henry and I went to one such event at James's school. Each sports team (and many clubs and programs) had a table and you would walk by and, in my case, say, "Trick or treat for the baby!" Then you would get candy. I went with friends and their kids, but I felt weird getting candy that clearly wasn't headed for my baby's tummy. I felt less bad when I saw middle-aged adults going through for themselves; I mean, hey, free candy is free candy, I guess. One of the people at a booth grinned at me and asked, "Which of these candies does mom want?" I, of course, chose Reese's. (Seriously, who on earth chooses Laffy Taffy? Pick Laffy Taffy! It's a tooth cement, complete with cavities! Bonus!)

Because Henry's Han Solo costume wasn't as complete as ours (the blaster and holster were not part of his outfit as he would have eaten them), and because we happened to have a baby monster costume on hand anyway, Henry went as a monster to the school event. James stayed home and dressed up as a studious student. Hal and I went with a family with girls, so here we see Henry in a pink stroller meeting the mascot of James's school. Hal is clearly beside himself with excitement.

There was a very long line to get into this event, and by the time I got in and went around collecting candy for...well...myself, Henry had fallen asleep after patting his puffy belly for a while. And that's how Hal spent his first Hal-oween!

The Electric Slide and My Violent Mnemonics

One of my classes I'm teaching this semester is an anatomy lab. Since we don't have cadavers for our anatomy lab, I have to get creative about what to fill that time with. I mean, students can only look at pictures of skeletons for so long.

This week we've been studying different types of motion (different ways you flex or extend your feet, hands, arms, neck, and the ways you can rotate them, what you call each of these types of motion, etc.). I didn't really know how to review this in our lab, though, until one thing caught my attention - the Electric Slide.

You see, last week was the skeletal system. The tip of your elbow is called your olecranon process (uh-LECK-ruh-non) and my kids couldn't seem to remember that. I said, "Well, when you do the eLECtric slide, you use your oLECranon!" and, pleased with myself, I waited for the connection to sink in.  "Um...what's the electric slide?" Fail.

So today to learn these different types of motion, we learned both the Macarena (heeeeey macarena!) and the Electric Slide in lab. It turns out most of my students know neither of these songs nor their classic dances (I'm still reeling at how people can't know the macarena) so it was quite fun. I made them pause every few minutes to tell their neighbors which movements they were using.  Then instead of calling out the moves, I'd call out things like, "Pronate! And supinate!  And plantar flex when you jump! I don't see any inversions out there!" It was a memorable day. I know at least one student took a video of it - watch for us on YouTube! Who knows if the students learned anything, but at least I had fun!

Dancing aside, James would be disappointed if I didn't describe my approach to remembering anatomical features when I teach them. But here's my secret: I don't really have an approach. Whatever crosses my mind when I teach them the word becomes my "this is how I like to remember this word" thing. Some of them aren't so great, it turns out (see the olecranon process above). Some, though, I think are pretty good. And some just happen and it's too late to backtrack. James thinks that I'm unnecessarily violent in these on-the-fly mnemonics, but I think that makes them all the more memorable. Here are my three favorite violent ones: the glenoid cavity, the acetabulum, and the trochlea. Let's see if you can remember them based on my "how to remember this word and its location" tips.

Glenoid cavity: this is the socket on your shoulder that your humerus fits into. Your friend Glen is a big sports fan and always sticks his hands up in the air during sporting events. You get annoyed at Glen. (Glen-annoyed = glenoid) and rip his arms off, exposing the glenoid cavity.  (James thinks I could've just stopped at "Glen's a sports fan who sticks his hands in the air.")

Acetabulum (ass-uh-TAB-you-lum): This is the socket for your hip; it's the part of the pelvis where the femur leg bone fits. Now, old people are prone to broken hips. However, if you're a young person and take acid (take, say, a tablet of acid - acid-tablet-yum = acetabulum) you might be too drugged up to climb stairs correctly - and then you'll fall down and break your hip. Moral: don't do drugs - particularly not acid - because you WILL break your hip.

Trochlea (troke-lee-uh) - the elbow end of your humerus. It's sort of spool-shaped, and it's what your ulna attaches to. You have an enemy named Leah and because she's evil, you decide to choke her (choke-Leah = trochlea) which means you'll put her in a head lock with your elbow.

I promise not all of my tips are violent. But whatever it takes to learn them, right?

TNT: Today's News, Today!

Welcome to TNT (Today's News, Today!), a new Tennessee publication. Headlines and blurbs from the associated press make TNT the hottest issue around!

Headlines from local news correspondents: 

1. Boy Begins and Survives School 

Dr. James has been in school for three weeks now. He had his first test, he's still alive, and he's liking the material (Hearts! EKGs! Blood pressure! Heart disease and how to not get it!). The good doctor thinks it's easier than this time last year, but his interview left us unclear whether that's because he now knows what to expect, because he's not taking the huge old anatomy class this year, or maybe he's just smarter. Continued in a future edition.

2. Sariah's Semester Starts as Expected

Sariah began teaching this week. She's still teaching Anatomy/Physiology and Intro to Biology, but has added a biology lab in lieu of her ecology course. She reports that the first week "went well." More details as it develops.

3. Classroom Mama Drama!! 

After a summer of negotiating for classroom space, Teacher S. has finally found room in the chemistry lab for her biology lab. S.'s lecture room is in upheaval, and its location is still uncertain. Exciting times lie ahead for the unsuspecting students, whose meeting room will change yet again without their knowledge!

4. "Cooking, a Culinary Creation": Cross-Country Visitor Creates Meaty Meals 

In our cooking news, Grandma Jen is in town to help supervise Henry (aka The Mini-Doctor, Mini-Man, or Small Person) while school begins for Teacher S.  A participant in the paleo diet, the grandmother has had largely single-person meals consisting of meat and raw vegetables. Other household members prefer grains and sugar in addition to their meats, but declined to comment further.

5. Phone Scam from Miscellaneous Visitor

Two weeks ago a visitor came into the lives of Dr. James, Mini Doctor, and Teacher S. She was a much lauded-guest, a great friend of Teacher S, and a great time was had by all, but her sterling qualities were doubted after filling local phones with unsolicited fish-face selfies with Mini Doctor. Readers, take appropriate precautions to lock your phones in the event of visitors.

6. STORY UPDATE: If the Boot Fits, Take it Off!

In a much anticipated turn of events, Dr. James has the green light to not only remove his walking boot, but also to resume walking in normal socks and shoes! James commented, in a tearful confession, "It's great. I just wish the swelling would go down." He says it's nice to be able to walk: "It's nice to be able to walk."

James vs. James's Ankle

Once upon a Tuesday night James went off to play a little basketball with some friends at church.  About 10 pm he arrived home. I heard the door open and then James said, "Hey, Sariah, want to see something cool?" The "something cool" was an extremely swollen right ankle, which James seemed remarkably calm about. He acted like he was ready to just go shower and then to bed. But quickly the adrenaline of the injury wore off and the pain set it, and off to the ER we went.

I know you're all wondering how, specifically, James hurt his ankle. There are two answers to this.

James: "It was roughly the last play of the game. The other team got a steal and passed it up to a guy who was alone on the fast break. I ran up to try and block his shot, but I knew that he was going to pump fake. I waited for the fake and, sure enough, he faked the shot. I was trying to get in front of him to have a better chance of disrupting his shot and I jumped off his foot. I'm not sure if I landed on it too, but it's very likely that that happened too."

Sariah: "He was playing basketball. There was a foot involved."

The ER was actually surprisingly fast, for an ER. We got there around 10:45 and were out by 1. The parking was in a sketchy alley by the hospital, which is in a seedy part of town, but we hobbled in, with James hopping and leaning on me while I carried the car seat and diaper bag. Once we were in a room inside, a nurse came in to bring us an ice pack for James. "You probably saw the cops out there by the nurse's station," he said. "Don't worry. But if you hear yelling, close your door, okay?" So there's that.

The doctor told us that James had both sprained his foot and fractured his talus, and that he should use crutches "as long as he needed." This seemed too vague to be helpful, but when we asked for clarification, he repeated himself. The doctor was a mumbler, and I missed a lot of what he said anyway. He was very impressed with the amount of swelling, and he let James look at his x-rays where he pointed out some invisible line we couldn't see and said that was the fracture. 

Fast-forward a week full of learning how to use crutches to James's appointment with his primary care doctor, since the swelling hadn't gone down at all from the day of the injury. (Did you know James had never used crutches before? He didn't know how! Whaaaat!) The doctor looked at the ER doc's report which said nothing about fractures and instead reported a "dislocated ankle." They took new x-rays and the primary doctor said it was not even close to a dislocation, and the type of fracture we were told about wasn't there, but she couldn't rule out an avulsion fracture, so she referred us to a specialist for 5 days later. She gave us a nice boot instead of the little splint from the ER, much to James's pain relief.

Specialists are awesome. One glance at the x-rays and he says, "Yep. Avulsion fracture. And also this spacing here we're gonna watch." After less than one minute poking James's foot and asking questions, he says, "Okay. You've also got a grade 2 sprain, and it looks pretty bad. Impressive pain tolerance, though." He was fantastic. 

It's still very swollen and bruised, and James is having an interesting time trying to elevate it at school, since the chairs are attached to desks there, so he can't just move a loose chair over near where he is. For now he's just taking up two spots in class. Fortunately, he's surrounded by med students who are only too happy to facilitate healing as long as it comes with the story of how the injury happened!

Oh BOY oh BOY!

At one week late with my baby, my I'll-be-a-mom-by-Mother's-Day plan flew out the window. I really didn't want to be induced, because inductions are more likely to lead to complications, more painful contractions, etc., and most of all I wanted to avoid a c-section. The quick-do-an-emergency-surgery idea didn't appeal to me.  Many first time moms are overdue, so no big deal to wait for him to come. Now, in this community, the doctors really don't like to let you go past your due date because so many mothers are high risk. My midwife had to fight some battles for me in order to let me delay being induced - one of the reasons I love her.  But eventually, all big and bloated things must end, so an induction was scheduled for when I was 9 days late.

The night before my 7 am induction I was to report to the hospital at 9 pm for "cervix ripening."  I can't imagine a more off-putting name, can you? Right. At least it's not as bad as the name sounds. Each round of the medicine takes 4 hours, and they gave me 3 rounds before they gave up, since my dilation had only gone from zero to zero.  Plus I started getting grouchy when they'd come to check my dilation. When you're on this medicine, they have to have constant fetal and maternal monitoring, which means they strap these uncomfortable monitors to your belly that aren't so bad at first, but become surprisingly awful as time goes on with them smushing into your independently squirming belly.

I should mention that the instant I got to the hospital and got hooked up the monitors, the nurses said, "Oh!  You're already in labor!"  Hurrah for me!  Labor I couldn't feel!  Bonus! Oh yes, surely I was made to deliver babies.  This is my calling.  Forget teaching! Labor Warrior Woman am I! The contractions were 5 minutes apart, too, so I was on my way!

James, me, and the belly

I started feeling the contractions in the morning, but they weren't awful. They were maybe every 3 minutes apart. At around 11 am, the midwife decided that since the ripening meds didn't work, they'd start me on pitocin to make the contractions a little more intense, since that often helped you dilate anyway.

Enter pitocin.  Bam.  Instant increase in intensity, duration, frequency.  I had something they called "coupling labor," which I'd never heard of.  It means I'd have two contractions immediately next to each other and then the normal break until the next pair came along.  I no longer felt like Labor Warrior, Born to Birth Babies.  About 4 pm or so James pointed out that they weren't giving out any awards for avoiding pain killers, so I got a shot of something I can only describe as delicious and smooth.  I would look at my little contraction monitor and see that a contraction was, in fact, happening, and I could not, in fact, feel it.  Amazing.  James claims there were other side effects on my level of sanity, but I disagree. It was delicious and smooth. And and an hour later, gone.  The nurses told us that it only really works the first time they give it to you (bummer!) and the only other pain control option at this hospital was an epidural, which they only allowed once you reached 4 cm in dilation.  I was still at 0, with my double contractions coming one minute apart.  They told me that sadly, if I were dilating normally, I'd be pretty darn close to having the child, and typically with contractions like that I'd be much farther than a 4, but rules are rules.  Nothing left but to wait.

Around 9 pm or so the midwife came by to talk to be about my failure to progress. My water broke 30 minutes before she came. She knew I didn't want a cesarean.  She talked about how I could try laboring through another night, considering that my water did break, but as overdue as I was, and coming up on 24 hours of labor with nothing, it was unlikely that laboring overnight would change anything, and then I'd have 12 more hours of pain that might lead to a c-section anyway, with potential problems the longer we waited. Ultimately, after discussing it with the other OBs, the consensus was that the baby was almost certainly too big to be born vaginally. The midwife had warned us of this possibility at around 5 that afternoon when I still hadn't progressed, so I wasn't entirely surprised. But I was disappointed in my cervix. Still, I felt oddly peaceful about it.  She left so James and I could decide, and we both felt like this was what was going to happen, and that was okay.  It was kind of emotional, though.  I felt robbed of my chance to do that thing that women are supposed to do, and regardless of the "at least the baby's okay" aspect, it was still hard on me. I wanted to give birth. I had made conscious decisions to try and avoid this situation. My body wasn't adequate to do what women are supposed to do. It's still hard to think about it, and even though I now know it saved both of our lives, I still wish.

James, ready to go into the OR with me

Things happened quickly after that.  I think it's because so often cesareans are emergencies, but man, those nurses were speedy about things and it made it seem like an emergency. Quick: clean, change, move, catheter, hat, pillow, gurney! One blessed thing was that they stopped the pitocin.  Joy of joys!  I could function while contracting again! The contractions still happened but they didn't own me anymore. Around this time I started shaking uncontrollably (apparently that's common), and then I was in the OR. They gave me a pillow to hold while the wonderful, wonderful anesthesiologist lady gave me a spinal block, but a nurse let me hold her instead. I remember that when I walked to the operating table while they set up, I was more terrified than I'd ever been. I really never thought I would die, but the room frightened me, the speed with which they got me in there frightened me, my shaking and contractions frightened me. The lack of an alternative frightened me most of all. I had no choice - the baby was going to come one way or another, and there was no "another" in my case; this was how it was coming.  But eventually the spinal block made pain and fear dissipate.  Ah, glorious.

The operating table was very narrow, and I felt that with one baby kick I'd topple off, belly first. They strapped my arms down, which was also scary, but with my shaking I was kind of glad.  Finally, finally they let a scrub-sporting James come in and hold my hand.

Having a cesarean is a bizarre experience: you can't see anything, and you feel no pain, but you can feel things happening, like stretching and tugging.  It takes about 45 minutes, but the baby was born in about 4 minutes. He was born at 10:41 pm. The baby's the easy part!  I will never forget watching James's face as he peered over the curtain to watch the baby come. ("I can see your uterus!")  The doctor pulled the baby out such that the baby was facing James, so when the doctor said, "It's a..." it was James who said, "It's a little boy!"  The mystery of gender was revealed!  I'm glad I waited to know. It was something to look forward to during labor - an incentive, if you will. James's face was glued to that little guy, and I got to watch James watch them take the baby over to clean it or whatever they do. He kept me updated: "He's big! He's got a little bit of hair!" And then, in what was probably the single most riveting moment of my life, something started crying. This person who wasn't alive was suddenly alive and in the room with us.  This person from my belly was outside it. And he was mine. He came from me.  He was real. I mean, someone was crying in that room, and it wasn't me.  All of this was real, after all.

They let me look at him for about a microsecond, enough to let me touch his cheek, and whisked him away.  (I know it's a sterile room, small hospital, rules, operations, etc., etc., but I also felt that another thing I lost by having a c-section was that moment you hear about where moms get to bond right after birth. They took him away, and I never felt that overwhelming bond mothers talk about. I still worry that I haven't bonded with him in the way I should, had he come vaginally.)

About 4 days old

James went away with the baby, and they stitched me up.  The doctor doing the surgery talked to me about my pelvis as he did so.  The baby's head was big (the baby was 9 lb, 8.8 oz, and he was 21" long) and my pelvis was smaller than expected, and, as the doctor said of my pelvis, "there was no way he was ever coming out that way." His head never even entered my pelvis, never engaged with the cervix: that's why I never dilated. Unless I have a premature baby, I will never have a baby small enough to come out through my pelvis without a c-section. So that door is well and truly closed.  I am very glad that both of us lived, though.  Hurrah for the discovery and relative safety of cesarean sections!

About a week old, with mommy

I'm recovering well, I think. I turned a big corner from "ow" to "wow!" around two weeks after his birth. It was wonderful to have my mom in town to help, since I unexpectedly needed much more help than I'd anticipated, especially with James still taking finals at the time.

I don't really think Henry looks like either of us - but I don't usually view the world that way.  He just looks like Henry to me.  And he's cute! He's not one of those babies that you see and think, "Wow, he's a mini-whoever!" He's just him.

We're not solid on nicknames.  We call him Henry, mostly. Second most common is Hal (James likes that Henry B. Eyring's friends call him Hal, which is part of why we named him Henry to begin with). Occasionally he's Hank. But always he's my baby boy!

OSCE

Since starting med school, I've been asked many questions about the process of school and about what I do every day. Now that I have some sweet, sweet freedom for the next couple months, I thought that now would be the time to answer those burning questions that y'all have in an ongoing series of blogs. This one is about something that I get to go through periodically as part of my training: OSCEs.

OSCE (pronounced ah-skee) stands for objective structured clinical examination. They usually last 15 minutes with 10 minutes afterward to record what happened while we were in there. My school has a corridor that has 10 examination rooms that are set up just like you would find in a doctor's office. I am all alone in the room with my patient, but there is a camera and a microphone in there too so that I can be graded.

They are essentially fake encounters that I have with a real patient that happens to be acting out their problem. I get all dressed up in my snazzy white coat, wrap my stethoscope around my shoulders, and then act like I know what I'm talking about to my "patient". Before going into one of these, you have no clue what the actor (called a "standardized patient" or SP) is going to be complaining of. Naturally there is a fair amount of anxiety before doing one of these. The unknown is unnerving. The patient could complain of anything! Luckily for me, the cases haven't been too complex. The preceptors do try to make it funny sometimes. For instance, I got to treat one Whoopie Goldberg, a middle-aged white woman followed by a Jack Sparrow, a sober older gentleman. It was quite the afternoon.

So in the future, if you have any questions about the process of med school or whatever, let us know and we'll do our best to answer them. Until next time!