Spin

I wasn't shopping for myself. I promise. But. It was Barnes and Noble, and the new paperbacks looked so inviting. So pristine. So enticing. One book was a creamy color, and I picked it up. I read the first sentence. And then, despite definitely shopping for a specific book for a specific person's birthday, I purchased this creamy one as well. I didn't even read what it was about. I'd not heard of it before. (Also, I don't do this sort of thing, um, ever. In libraries, sure, but purchases in a bookstore completely on a whim? No, unfortunately, no).

I've been too busy (sleepy) in my downtime to read much for pleasure. Last night, though, I read the first chapter. And, I recommend it to each of you. At least the first chapter. I honestly don't know when I'll have a moment to read the rest, but it's sort of teasing me, not unlike birthday cake or a swing set, and it might be sooner rather than later.

The book: Let the Great World Spin by Colum McCann

[The first sentence: "Those who saw him hushed."]

Daily.

Okay, I understand that my current job has a certain level of power and privilege to it. I get that. Sometimes, it's hard to remember as a resident, because I am on the lowest stump on the doctor totem-pole. Anything I do can be overridden by an attending or senior resident. (This is certainly a good thing; it's how the system works).
But? Secretly?
There are some moments where what I do is so satisfying. Because it is definitive and useful when a lot of the practical side of pediatrics is a leeetle nebulous sometimes.

Examples of recent such moments(thankfully punctuating the many many more moments of feeling a little incompetent or useless or cog-in-the-malfunctioning-wheel-esque):

1. Calculating nutritional needs for tube-fed kids. Omg. It's just math. And watching them grow. How much do they weigh? What do they do during the day? How sick are they? How much to they need to grow? What kind of formula do they need? How many calories per ounce? How many calories per kilogram do they need? How much fluid do they need? Do we need to condense the feeds to give the number of calories per ounce in order to stay within the total fluids per kilogram per day?
Dudes, we just answer those little questions, and voila: growth.
(Of course, figuring out the whyyyyys is the more interesting and challenging (and ultimately the more rewarding or frustrating part), but sometimes it's so nice to just Know something. And then Do it.

2. Circumcisions! This is not the time for a debate on the pros and cons of circumcision. We leave that up to parents to decide. But when they want one for their son, it's such a satisfying little procedure. This is probably also not the place for details, but we numb the area adequately and it's so cute to see the baby just chill with a pacifier in his mouth as we stretch, stretch and snip snip.

3. Lumbar punctures. Spinal taps. This may be needed for several reasons, but the most common by far (in babies) is to look for any signs of infection in the cerebral spinal fluid (CSF). We can just snag a few drops of CSF from a spot between the vertebrae in the lower back and whoooosh: answers. It's not complicated, uncommon, or even that exciting. But, um, there is a sort of triumphant feeling when finished. (I'm still waiting for what's called a "champagne tap," when there are zero blood cells obtained, meaning it was, well, perfect. I've gotten down to One blood cell (affectionately called a "Starbucks tap") or close several times, but that crystal-clear perfection awaits...

4. Explaining medicine to 4 year olds. Recently, a wee girl had hurt her arm. I looked at it and explained each step of my exam. At one point, "I'm just feeling along the bone now. This hard part here in your arm and in your hand and in your fingers is bone. Tell me if it hurts." Etc.
After finishing the exam, I had to step outside of the room for something, and as I walked out the door, she shouted,"Hey! I think I got some bones in my legs too!"

(Anatomy lesson learned. Awesome!)

McSweeney's

Perhaps the best Christmas gift I received last year was a subscription to McSweeney's Quarterly Concern. To call it a literally journal seems grossly inaccurate, but how else to describe it in a just a few words?
Every three months or so, it arrives in a bubble-wrapped envelope, or (this issue) in a giant ziplocked bag. And each time, I'm sort of awed and turn the pages preciously. Remember Christmas morning when Santa was definitely Santa? Or the new box of crayons with the perfect perfect tips? This is one of the few things in my adult life that gives me that same feeling. Every tiny detail (the copyright paragraph, the return address label) is a work of art. No, really.
Their website (http://www.blogger.com/www.mcsweeneys.net) provides more regular doses of whimsy (and genius), but nothing quite compares to the thick palpable paper and the words that literally had me saying last night (staying up too late, curled up in bed, wondering whether or not I would cut up the page that had paper cut-out instructions for building a tiny rocket), "Wow. This is just. Lovely."

Spoiled

One of my favorite facts in pediatric medicine:

It is impossible to spoil a child under six months of age.

If she cries, and you hold her, it's a good thing.

If he won't sleep and you soothe, this is also good.

(It seems obvious, doesn't it? It's just so nice that there need be no worry for spoiling, which is, of course, very relevant a few years later).

Babies need to learn that they can trust the world (their parent) to provide the wee things that are the most basic of all . . . food, warmth, safety.


A second fact, that tickles the brain: By age two or so, when kids look in a mirror they reach for their own face/body and see their reflection doing the same, they understand who the reflection is. Not too long before that, they reach for the mirror instead. Who is that babe?

Tunes

Excellent album, a few years old: Boxer by The National.

A homemade video which suits. I'm re-loving this band.

And, this from They Might Be Giants:

This, friends, is a fun song to have in one's head. Related, because, honestly, I never totally got it: http://en.wikipedia.org/wiki/Plasma_(physics)#Definition_of_a_plasma

Call

One of the most classic components of a medical residency is call. It involves an extra long shift, spending the night in the hospital, covering for patients, emergencies, new admissions. (etc)

mFor my program, it is a 30 hour shift every fourth day/night, arriving at 7am and going home at 1pm the following day. The first time was a little brutal. I hadn't figured out a system to compensate for foggy-headedness and tired feet. Every call since then (plenty) feels like an epic adventure, not excluding foggy-headedness and tired feet. Upon arriving home after each call, I am torn with a primal desire for life's most basic human requirements: sleep, food, a shower, often a need to pee, and contact with someone who loves and/or knows me as a person.

These are all things I try not to think about too much while working (it gets depressing, really), and it's not hard to do when so quickly entrenched into the stories and goings-on of a hospital and all the many lives it holds within.

A few other small thoughts, coping mechanisms, perhaps:

1. Stairwells. I play a game with myself. The first 24 hours of any call, I always take the stairs. It keeps me warm (the hospital is cold). If I need to pause and take deep breaths and try to keep things in perspective without, well, crying, the stairwell is a good place. They're often empty. And, for the last six hours of work, taking an elevator is literally a gift from above. Such a treasure to just float from one floor to the next with the touch of a button.

2. Pleasantries. Sometimes a tiny hi at 3am (or an enthusiastic double fist-pump) to a stranger in a long hallway is just enough to propel oneself to the other end of the hallway. Just sayin.

3. Careful careful careful everything. I learned very quickly to be thoughtful and methodical in answering patient questions, in making my to-do lists, putting my signature anywhere, examining someone sick. How easy it is to perform routine tasks mindlessly! Only recently have I thought about extending this to "real-life." Maybe it's not necessary with adequate sleep. Maybe it's exhausting to think through every tiny action. I do not know.

4. Silliness. It's one reason I'm grateful to work with children, and thus other adults who also work with children. There is a slight whimsy that finds its way into wee interactions. One of my patients was recently diagnosed with some infection (ahem), and I walked into the room wearing a facemask and gloves and a blue sterile gown over my scrubs. I'm sure it's a little terrifying to see such a sight early in the morning, especially if you're 6 years old and in a strange place. "Hey," I said, "I got this new outfit to wear for you." She giggled and giggled and it made my morning.

5. Cell phone. Text messages to and from the outside world are so grounding, so wonderful. Oftentimes, I only get to checking my phone at 5 or 6 in the morning, in that funny sunrise transition time that I used to think only existed in the world of slumber parties and final exams. How life-affirming it is to see 1 or 2 little hellos. And to be able to respond before diving back in for a few more hours.

p.s. I'm quite sure there will be more posts on this topic, as it still (still!) a crazy experience each time. and I still can't wrap my head around all the whys and hows and whoanellies involved.

. . . Still Rock n Roll . . .

Public radio is the one entity to which I consistently donate a few dollars. Various health causes, Girl Scouts, homeless shelters etc have also received time/money on occassion, but public radio is something that tugs me in a primal way that nothing else does. That being said, is there anything more infuriating than fundraising drives during a traffic-y commute? This week's pleas led me to explore other radio stations. Which led to one that plays rock (sans commercials) during rush hours. Um, sweet.
I think most of the stuff was at least four years old, though among the Killers, Weezer, and Strokes, was the newer Metric and the way older Billy Joel. We all have our favorite genres of music. There are operas that have made me cry at the sheer heartbreaking beauty, there is bluegrass that has caused me to stand in awe, there is techno that results in a sort of pumped-up permagrin, and some pop brings out a sense of pure funfunfun. But, and this was hard to admit, because I do love a lot of music, nothing quite reaches that same sense of groovin energy-supplying fluidity as a great rock song. Or album.

May I recommend revisiting aforementioned artists? And maybe even suggest Metric's "Help, I'm Alive," as the perfect wake-up song, especially for these earlier dark mornings, if one needs to get out of bed before one is ready?