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!

Final Presentation Treasures (a teacher's perspective)

I love teaching.  One of my favorite parts of teaching 7th grade last year was recording some of the crazy things they'd say or do and sending the lists to my immediate family.  I would laugh so hard at those funny little students and their approaches to science...ah, the good old days! I may even share some of those from last year on the blog sometime.

A sad thing about teaching at this community college is that there are fewer of those occasions full of fantastic quotes and experiences (or if they're there, they mostly make me sad about this place and these poor kids) but this last week we had some true gems.  I had my Intro to Biology and Human Ecology classes do final presentations for the last day of class, and so here we go.

Introduction to Biology - the assignment was to do a 3-5 minute group presentation on an organ system of the body.  Basic info about it, 3 fun or interesting facts about it, what things can go wrong with it, etc.

-The group that did the digestive system starts listing their fun facts.  Then... "And fun fact number three is that once my horse had a stomach tumor!! And it weighed 8 pounds!  Hey, does that count as two fun facts?"

-The lymphatic system group consistently referred to lymph nodes as "lymph noids" the entire time.  Noids.  As in the Noid from Domino's Pizza back in the day.

-"The average human body contains enough bones to make a complete skeleton."

-The skeletal system presenter proudly points to the scapula (shoulder blade) of a skeleton and says, "THESE, you guys, THESE are the clavicles!"  (False.  The clavicle is the collarbone.)

-"Hey, do you think pirates suffer from arrrrrrrrthritis?"

Human Ecology - this was a bigger group project where they were trying to convince the class to agree with them on a hot-button issue relating to humans and ecology.  They were not allowed to lie to do this, there was a paper and research involved, etc. etc.  They further had to fill out a form that evaluated their performance as a group where they got to comment if they felt that any member of their group didn't do their share of work.  Quotes below come from either their presentations, papers, or self-evaluations.

-A girl puts up a poster for her presentation which says this (and only this): "PETA.  Sexist hypocrites or animal rights organization?" (Ah, I love my job where this happens.)

-PETA girl proceeds to give each class member a paper on which an ad for PETA has been printed. (Be advised that many of PETA's posters are rather sketchy.  Some are more than rather sketchy.  Now we all have one of our very own.)  "Sorry, guys, if I don't have enough for you.  I got kicked out of the library for printing this stuff so I didn't get them all."  And then, lucky us, we got to keep our sketchy PETA ads as a memento!  (Spoiler: they appear to be sexist hypocrites after all.)

-Preserving the Bengal Tiger presentation: "When at the Knoxville zoo, I seen Bengal tigers starve.  I seen 'em starve from no food and starve from no water."  (At the zoo? Maybe they didn't happen to have any food left when you passed their enclosure...?  Or maybe the zoo is actively killing them. I hear their pelts are valuable.)

-Bengal Tiger paper (which was 8 pages long instead of 3) had a compelling concluding paragraph: "In conclusion, our opinion is very useful because it shows that the information that we presented on Bengal Tigers is that they should have a really good home and not have to lose it also should have plenty of food and water and everything else that should be provided for them."

-A self and group evaluation: "I was really stuttering, sorry."

-One of the Bengal tiger self and group evaluation: "I feel like we did really well because you always try to come to a tiger's rescue at all times no matter what the situation is."

-The anti-vax group presentation did not contain a single fact about vaccinations.  I'm not even sure if it was anti-vaccination or just anti-having-required-vaccinations.  Either way, nothing they said was true.  (I'm hanging my head in science teacher shame.)  However, they had an amazingly compelling presentation, which is, I suppose, one of the advantages to avoiding actual research.

-The final sentences in the euthanasia paper: "Doctors do not create lives therefore it should be illegal for them to take lives! The Bible says 'thou shalt not kill' so lets' be LIFE SAVERS not life takers!"  (They did pass out Life Savers to the class for their presentation.)

Don't students just make you smile sometimes?

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.