The tale of my left foot

I thought i was doing well

2009-07-01T18:24:00.000-07:00

I went swimming this afternoon after hiking this morning. I am brimming with energy now and so happy to have been active all day and had an awesome lunch with my hiking buddy in between. Plus, it has been one of those days that has made me take pause and give thanks for my life and where I am physically and emotionally now. Here's why.

Whenever I go swimming I choose my lane carefully. Trying to avoid the old people who don't swim in straight lines and the young kids who are playing. When I got to the pool, there was one lane with a guy swimming beautiful clean, easy strokes, at a good clip. My kind of lane partner. I joined him and we pushed each other to keep our pace up. He took breaks, I did speed training, he did a long swim, with the styrofoam training thing between his legs (ie. not kicking), and then he got out of the pool. I was taking a break and noticed him getting out because he carefully raised his body out of the water. He swung his legs over, passively. Then he hoisted himself into a wheelchair, while saying to me "Nice Swim, see you soon." "Yeah, you too," I replied, "take care." I noticed it, I took pause. I hated being in a wheelchair. I feel so much sympathy when I see someone in them now. Especially, someone so young and vital and strong.

I feel like I have made such great strides in the two years since I was allowed to start walking again, but this guy. I know nothing of his story. I have no idea how long this has been his lot. I don't even know his name, but he made an impression on me. I hope he is well. I hope this is temporary and that his happy face isn't just a mask. I hope I see him swimming again.

Good Luck, Mr. Swimming Man. Thanks for making me appreciate things.

Reflections on New Intern Week

2009-06-26T15:50:00.000-07:00

It is new intern week in teaching hospitals all over the country. The bright, shiny faces of brand new doctors who have their degree but only limited practical experience enter into the world of their real medical education and in some cases indentured servitude. The past week I have watched the new interns being toured around my hospital, appearing in the cafeteria en masse all tanned and relaxed appearing. New intern week doesn't effect me too much because we don't let the interns anywhere near our unit. Still seeing them around reminds me of that time 12 years ago when I was one of those bright, smiling faces in a different hospital, but the same deal.

I did a pediatric residency, because I wanted to be a neonatologist. I am unusual like that. I didn't much like general peds, but it was a necessary step. Anyway, as I knew what I wanted to do, I wasn't too scared when I got my schedule and saw that I would start in the NICU. My two colleagues were petrified. I was excited. Even more so because I'd be on call that very first night as an intern. We got oriented, we did our work. We had almost no idea how to do anything, but our chief resident and fellow were very helpful and supportive. We all got through the day, my new friends left, and I stayed behind to take my first call. A very brief time later, I attended my first ever delivery of a 25 week, 500 something gram baby. My fellow did most of the work, but she taught me what needed to be done and how to do several new (to me) procedures that night. That little boy became my patient, my teacher. He taught me so many of the fundamentals that I still use today. I followed him all month and then when he was ready to go home, I became his general pediatrician. He actually made it through his course of being a 25 weeker without any signfiicant complications and by the time, I left residency he was 3 and doing remarkably well. He was the last patient I ever saw in a general pediatric clinic. I still get letters from his mom every so often. I will think of him celebrating his 12th birthday this week. I hope he is well.

This morning watching the new interns at breakfast, I was reminded of that long ago night, and that little boy. I was also reminded of who I was all those years ago. I hope that I haven't totally lost the amazement that I felt in caring for this little tiny baby. Certainly, I know what I'm doing now, and I have been to hundreds of deliveries like his, but he is special to me still. Also, I hope that I will never lose the drive that brought me into this career and that makes it more than just a job.

My dog has brain damage

2009-06-16T12:36:00.000-07:00

I am convinced my dog, Sadie, has brain damage.

Last night, I was eating with a friend outside, when all of a sudden Sadie is facing a low lying brick planter wall with her hackles raised, growling. My generally sweet tempered dog was clearly incensed. The growling continued and escalated, her ears and tails were down as she pawed at the ground, and then started barking. As we tried to control our laughter at my dogs stalking of a wall, I went over to asses the danger. She became frantic that her foe would hurt me. Turns out the "foe" was a small FEATHER. Yep, my brain damaged dog thought I was going to be attacked by a feather.

I certainly sleep better at night knowing what a good guard dog lives in my house.

Who me, I didn't do anything.

Destination: The Far East

2009-06-11T12:23:00.000-07:00

I've done my share of travelling. I've done my share of medical volunteer work, locally and abroad. I've been to Nicaragua several times and had to cancel a trip when I got sick. Ever since then, I've been searching for opportunitites to get back in touch with that side of me that is fueled by being involved in something so much bigger than yourself. I have had many opportunities presented to me over the last year, but for one reason or another none worked out. However, a few weeks ago I was contacted to join CHLA's trip to Mongolia as they wanted to focus on some more maternal- fetal- neonatal health issues this trip. The trip works with my schedule, works with my plans and so I'm in. Plane tickets are reserved and will be paid for by the end of the day. I've never been to Asia, I'm a little nervous, but I'm really excited.

One of the big issues with this kind of work is to find a way to make sustainable differences in the healthcare in developing nations. This is a huge topic and used to be a source of much dialogue amongst the Nicaraguan group. Certainly they need supplies, but also standards and education. The thing I really like about the approach of the CHLA Mongolia mission is their appreciation of those issues and the dedication to going there in order to provide not only education and support during the time that we are there, but also working with the health ministry to establish some standards for continuing education for physicians in Mongolia. Also, there is some effort being spent on extablishing internet based education and support materials for the doctors and nurses there. I had lunch with the organizers yesterday, and got quite excited about what they're doing. So now I'm trying to convince a few others to join me. Either way it is a great opportunity.

After spending a little over a week in Mongolia, I am going to continue on to Bali for some vacation while I am on the other side of the world. I can't wait. More to follow...

Something Good from Swine Flu

2009-05-26T20:27:00.000-07:00

I happened to enter my hospital through the main entrance for the first time in weeks and walked straight into several signs warning everyone about extra precautions due to swine flu. Signs remarkably like this one.

Reading, don't visit if you have fevers, aches, chills, cough etc. Further, as staff of the hospital we have gotten multiple emails saying that if you have any of the above symptoms, you are to go to employee health and get swabbed to see if you have swine flu before you can work. The staying away from work if you have a cough, cold, chills etc., I get. The idea that we are to get screened and if it isn't swine flu you can work. That I don't get. But alas, baby steps right. baby steps.

I have made it clear that I find all of this swine flu hysteria a litte rediculous, but there may be some good messages coming out of it. I work at a Children's Hospital taking care of critically ill babies. Viruses that cause the common cold in adults and healthy, older children can be deadly to my patients. It seems like almost every year, we have some parent visit their child with a runny nose and wind up spreading their virus to their child and others. These same viruses that can cause severe respiratory issues and can be deadly to former preterm babies, babies with congenital heart disease, etc. and not even to mention all of the patients in this hospital getting chemotherapy. There are a hundred reasons to screen visitors before allowing them to come into the hospital and if swine flu is what has finally gotten this done. I'm OK with that. I just hope that people will continue to be vigilant when this hysteria has passed and realize how much broader the threat is to medically fragile babies and children.

Please think about these things before visiting the medically fragile, whether in the hospital or not. Thanks

Incarcerated?

2009-05-18T19:47:00.000-07:00

I have recently posted several times- things like I'm incarcerated again, have I been bad. I'm incarcerated again, I've worked so many nights I feel like a vampire etc. People who know me now, know that means I am at work, but still they don't get the analogy. Truthfully, the nurses and respiratory therapists I work with don't get it either, as they will often reply "will then I'm incarcerated too." To which, I invariable respond, oh no you're not. You get bathroom breaks, lunch breaks, whatever breaks.. See there is a difference.

When I am at work overnight, there is only one of me, and I am in charge. Yes, I have my team, residents, nurse practitioners (during the day), fellows (sometimes) etc., but only one of me and ultimately everything that happens in my unit on my watch is my responsibility. That is the nature of the job. If I have done the teaching portion of my job well, than my team can handle 90% of what happens and so I hang in my office doing whatever it is that I do. However, we aren't allowed to leave, just in case. Invariably if I have a slow day and spend two hours getting work done in my office and then go to get food,or go to the restroom, or go outside- I'll get paged- invariably. Leading to my comment that we are really denied our civil liberties. There is no freedom for those hours, none.

Don't take this to mean I don't like my job, I do. I know that I am good at what I do. Take my recent 24 hour Saturday call, one of my friends on twitter made fun of me for not working too hard since I was tweeting. My response was "no one wants to know the truth of what I do." I believe that and trust me THAT wasn't a fun day, but I know that I left the babies better off than when I got there even the one who died peacefully in his parents arms. I know this, but still sometimes, it would be nice to be able to have a few moments to relax, at least to not be responsible while in the restroom. I'm just saying. So yes, it does feel like I'm incarcerated, held at the mercy of my little charges illnesses for the sentence imposed on me (tonight, only 14 hours). I hope that I do right by them. That is my overarching wish in my job to do right by the babies.

On Notre Dame and Obama

2009-05-18T10:19:00.000-07:00

I started this post as a comment in response to a post that my friend from college wrote after reading the LA Times this morning, but it got long so I decided to put it here. Of course, Kim is much more eloquent than I will ever be, but this is how I see the swirling controversy surrounding our President giving the commencement address at my alma mater.

I consider myself extremely lucky to be a graduate of the University of Notre Dame, a school often labeled as one of the nation's premiere catholic institutions. A label it justly deserves as the very air of Notre Dame is infused with a spirtuality that is palpable. Some of the memories that I hold dear from my college years are the walks around the lakes, the visits to the grotto, dorm masses, walking across the parking lot at sunset hearing the band practice the alma mater, long nights hanging with my friends. The school makes no amends and offers no pretense of being anything other than a catholic institution, but it is also an institution of higher education and a welcoming place. People aren't turned away because they aren't catholic, differences of opinions are inevitably voiced and debated as occurs at any university. Albeit with a larger voice to more traditional. conservative values.

Barack Obama was invited to give the commencement address at this most conservative catholic university and he accepted. A dubious selection by the university, maybe. A PR opportunity for the president, maybe. People have protested this choice because he is pro choice, pro stem cell research. However, as ND's president Rev. Jenkins was quoted as saying "Others might have avoided this venue for that reason (knowing of the inevitable protests), but President Obama is not someone who stops talking with those who differ from him." For if you do not discuss things with those who see things differently than you than how can you ever reach compromise. Obama said in his speach "When we open up our hearts and minds to those who may not think precisely like we do or believe precisely what we believe that's when we discover at least the possibility of common ground." He also contended that the two sides of the abortion debate may have "irreconcilable differences", but they can also find a common ground in working to increase accessibility to adoption and in decreasing the rate of unintended pregnancies.

As an institution of higher education if Notre Dame was to shield its students from the political debates of our time because they disagree with the church than in my opinion the university wouldn't be doing its job to educate future members of society. If the clout of the university is such that the President will speak to its graduates as they head off into uncertain times, then I applaud them. Learning to find common ground in life, in jobs, in careers is essential. I am proud that Obama spoke at Notre Dame and that at least the majority of the university community welcomed him.

... just to clarify, no this doesn't mean I agree with all of Obamas politics

Soak up the Sun

2009-05-09T08:07:00.000-07:00

I have recently been in a funk; the reasons are many and varied. Also, it seems like a lot of people around me are in funks too. Now there are lots of really good reasons for such malcontent, but often it seems that they lie in wanting something you don’t have: a career you believe in, enough money, the perfect relationship, health, a child, a healthy child, a change in some circumstance etc, etc. My funk certainly fills some of those bills.

As I’ve said before, Sheryl Crow is one of my favorites. I love her new album. “Soak up the Sun” definately is near the top of my list. I’ve always loved the beat, it makes me run faster, it will keep me on the elliptical. I’ve heard that song enough that I should and do know the lyrics by heart. So, it surprised me the other day, when it came on while I was driving and all of a sudden a single line hit me. “It’s not having what you want, but wanting what you’ve got.” I played it again, and a light bulb burst on over my head. That is the point. This song would be my new mantra. It’s not easy, it is human nature to want to keep up with the Jones’s as it were, but when I really look at things I am inordinately blessed. The funk didn’t get banished immediately, but ultimately it got pushed out of my conscious thought. The motto, not easy, but a work in progress it is. So, I’m off to “Soak up the Sun,” thanks Sheryl.

Good News and Caution

2009-05-05T11:01:00.001-07:00

Back in New York, I have now finished my scans, tests and seen my favorite ortho onc, and I'm still healthy. Yep declared to be in excellent shape. No sign of any recurrent or metastatic disease. She was amazed by how much I can do, how strong my ankle. Everyhting is good. We went through the usual discussion of my recent athletic pursuits and she gave me that look. That look I remember from when I asked if I could get out of the wheelchair because I wanted to exercise by using crutches. Well, not quite the same but still I knew the look. She is happy about what I can do, happy about how strong I am, proud that I have focused on getting healthy and strong, but worried about me starting to run long distances. She is OK with the triathlon, but warned against pushing myself to hard. As she says the constant banging on a post radiation heel and ankle can be hard on the ankle. Further, apparently the radiation weakens the bone and makes stress fractures more likely and post radiation stress fractures might never heel. So, Be Careful is what she said. She wants a picture of me crossing the finish line. She was not so subtle about pursuing any longer distance running- that got a serious negative.

Ok, I can deal with all of this. I'll listen to my body. I'll be careful, I promise. I worked too hard to keep my ankle and to get in shape to let anything derail that.

Train of Tranquility

2009-05-04T15:18:00.000-07:00

For the past two and a half days I have been at the Pediatric Academic Societies meetings in Baltimore, MD. For two and a half days, I have had to be “on” from pretty much the moment I wake up until I go to bed (which has been well after midnight every night). I discussed a paper I’m working on while on the elliptical, connected with old colleagues in line for coffee, etc., etc. My brief respite was dinner at my Aunt and Uncles on Saturday night, a meal of great hilarity as we participated in what my cousin calls “full contact dining- bring your armor and your wit, or you’ll be either torn apart or left behind” I love my family. Anyway, point being- I’m exhauseted. The kind of exhausted where you are on sensory overload and a little amped on caffeine to get through my 7 am breakfast meeting today. The kind of exhausted where you’ve been rushing from point A to point B for so many days, you forget how to stop.

So, when I arrived at the Amtrak station to get on my train to New York for my biannual check up and saw there was a quiet room, I made a beeline. The trip from Baltimore to NYC aboard the express train took slightly less than three hours. For three hours, I sat in blissful silence broken only by the conductor announcing the next city. I napped, I read, I wrote, I stared out the window. Ah, such bliss before the sensory assault that is New York City.

Tales of my Own Stupidity

2009-05-01T19:43:00.000-07:00

Before this morning, I had missed two flights in my life.

The first one was totally my fault. I was in Nicaragua and misread the departure time of my connecting flight as the departure from Managua (this after I’d checked my luggage mind you). When I returned to the airport two hours late for my flight, I learned of my mistake. I made it home 24 hours and fair chunk of change later without my bags in the same clothes I’d worn for 48 hours. I ultimately got my bags back a month and a half later. Not one of my best maneuvers ever, clearly.

The second, I was flying to DC for my cousins wedding. I left my house two hours before the flight, but hit traffic, and delays getting the shuttle from the parking lot found me in line to check in and check my bag 42 minutes before the flight. The two people in front of me were on the same flight, they checked in- then the flight attendant lady said- nope you missed the “40 minute window.” But, but… I stammered, no luck. She rerouted me to a later non-direct flight, I made it through security before they even began boarding my original flight. I tried to sweet talk my way onto that flight, but nope. Defeated, I accepted my fate.

Then there is the flight I tried to get on 24 hours early, but THAT story’s already been told.

So, this morning… I found myself once again heading to DC on a direct flight. (I believe this might be the first time since that last ill-fated journey.) I was ready to leave my house two hours before my flight. My car was loaded, I’d eaten first breakfast, left my dog crying on the stairwell when I realized, I’d forgotten my sweater. I ran upstairs to the chair said sweater had rested on yesterday, but my ever efficient cleaning lady had moved it. Oops, I ran around the house for 10 minutes looking for the stupid sweater, never found, pulled down a replacement. OK, 10 minutes late, but I should still be fine. Checked sigalert.com, bad traffic on the freeway I was headed towards, I took a detour- Bad Idea. Worse traffic there. Oh well, I was still OK. More traffic on the freeway, now I’m beginning to panic. Arrive at the parking garage, 45 minutes before my flight, need to wait for shuttle. Woops, I try to get on line on my phone and check in, but nope- you can’t check in from the internet within 1 hour of your flight. This is looking bad. OK, I don’t have to check my luggage, I’m fine, right? Shuttle guy finally pulls up several minutes later. I arrive at the electronic check-in thingy with 29 minutes to go to departure time. No dice, I can’t check- in. URGG.. Long day at the airport ensues. Cancel plans with my family for tonight, flight rescheduled. I prepare to become passive and just go with it, while internally screaming at myself.

Morals to the story-
1- check-in to your flight from home before you leave it so you don’t have to deal with arbitrary time cut offs
2- If you can’t find your sweater, chose a different one immediately, or just buy one at the airport, anything
3- Or better yet, put stupid sweater away where you know where it is before it is mysteriously moved by said cleaning lady.
4- Maybe for a 9am flight from LAX leaving your house at 7am is really just too late. Maybe

Simple Things That Make Me Happy

2009-04-20T17:27:00.001-07:00

As many of you know, I have been in a little bit of a funk lately. I'm out of it now thankfully, but it got me thinking about the simple things I do almost every day that make me smile. Here is the most recent.

When I first moved into my house, I immediately tore out all of the iceplant on the hillside in front of my house, and replanted it in a Tuscan/ Califonia themed, water conscious garden. I chose every plant myself for its shape, color, smell etc. It occupied me for months. I spent special attention choosing the rosebushes that line my stairs. The one that is on the landing was the hardest. It took me forever to find it, but when I finally did, it was chosen for not only the color of the flowers, but the smell of the roses. (Yep, I can get obsessed that way.) As I walk down those stairs everyday, before my first cup of coffee, I stop and smell the roses and I smile. It is a simple act, but it connects me. It grounds me in a fundamental way.

The best smelling roses ever.

The other roses along the stairwell.

How Safe is Your Home Birth?

2009-04-15T10:38:00.000-07:00

Last night I read my friend Jessica's post on a home birth turned tragedy, and immediately replied that I'd weigh in on it today. The tragedy, the death of a baby born in an unassisted, unmonitored home birth. So, here I am.

As a neonatologist, my profession, my passion is taking care of critically ill babies, most of whom would not survive without medical assistance. I live in the world of the <1% of births that go really wrong. Approximately 10% of babies require some assistance at birth, included in that number is the ever increasing percentage of preterm births. And yet still many argue that we are "medicalizing" a process that is natural and has occurred without medical assistance for thousands of years. True, but for those same thousands of years there was generally a midwife or some trained person who assisted the the delivery. Further, for those same thousands of years childbirth was the number one cause of death for women and babies. Like I said, I live in the world of 1%. I have seen crazy things. There is one case that is burned into my mind of a home birth where the mom refused to listen to the midwife and her husband and go to the hospital when things started to go wrong. After the woman passed out, the midwife drove her to the hospital, the baby was delivered, saved, but left neurologically devastated because of waiting too long. A few hours earlier, they might have had a healthy baby. The list is long and bad things happen even under the best of care, but wouldn't you want a chance to intervene if things start to go wrong, a chance for the baby and the mom.

Reading the article about this woman in Australia it is clear that her labor was not going as planned, that she had to have an emergency c-section for her first child makes it even less safe for her to be completely unmonitored and unassisted. That she labored for 5 days, something no physician or midwife would allow, especially with the risk of uterine rupture after a prior c-section. That the baby is dead is a tragedy. Could medical intervention definitely have changed the outcome, no. However, it would have given this baby a chance.

Just like riding a bike

2009-04-04T10:53:00.001-07:00

I'm one week into having committed to this triathalon thing and the training has begun. As I said before, I'm confident I can handle the swim. The run will be rough because it is last, and 4 miles is pretty much the longest I've run. So I definitely have to work up my running tolerance... However, I haven't been on a bike in years.

So, phase 1 of triathalon training is to get comfortable riding a rode bike. A friend from work lent me a Bianchi rode bike. I had to get new pedals for it last weekend because I'm not quite ready to have my shoes clipped into the bike pedals. Maybe that will come. Then I had to start riding the bike. People always use the phrase "just like riding a bike" to describe something that should be rote muscle memory. Something you haven't done in years, but that comes back to you immediately when you try again. I am here to tell you IT ISN'T QUITE THAT EASY. It is going to take some work for me to get really comfortable on this bike. So, that is phase 1 of triathalon training. Oh yeah, and to continue to build up my cardio toleranace. On that note off to the gym I go.

Are Hospitals promoting Health?

2009-04-02T17:41:00.000-07:00

I put this post up on facebook from work the other night when I discovered that the food that I had brought to be my evening snack was bad. It was simple- "I'm in trouble, I'm at work, I'm hungry and my hummus is bad. What will I eat?". This was after spending 2 hours at the gym earlier in the day which always leaves me somewhat hyperphagic and after recommitting to my healthy eating habits. So, there I sat HUNGRY with just plain celery to eat. As I munched away on my celery I pondered my possibilities to get something solid to eat and got some hilarious comments from my friends. The sad reality is that at 8 pmon a weeknight while stuck in the hospital, my options are limited. There is a McDonalds in the hospital open 24 hours, but I won't eat there. The cafeteria has almost nothing by processed overly salted food I wont' eat and if it were a weekend it wouldn't even be open at all. I found an old banana in my desk drawer and some trail mix.

So there you have it my options were McDonalds v. processed cafeteria food v. old food leftovers in my desk drawer. Fortunately, the food in my drawer wasn't bad so I ate that. However, it really is a sad commentary that at an institution that is supposed to be promoting health there is nothing healthy to eat. In an era when childhood obesity is an evergrowing problem, The only place to buy food from at on certain hours and on the weekends at a large freestanding Childrens Hospital is McDonalds. Is the hospital really promoting health? And it is not unique to this hospital. I have worked at several children's hospitals in the country and most of them have a McDonalds because of the link to Ronald McDonald houses, and most of them primarily serve unhealthy, fried food in the cafeteria. As leaders in pediatric healthcare shouldn't we be promoting healthy lifestyles? I don't get it. As I lay in my bed hungry that night this thought plagued me.

Tonight when I came to work I packed plenty of healthy food and made sure it was all still good.

To vaccinate or not to Vaccinate

2009-03-30T19:25:00.001-07:00

I read this article in the LA Times yesterday about vaccines and recent outbreaks of Measles in certain communities and it made me mad. I well realize that parents on both sides of this argument feel very strongly. So, this could get me in trouble, but only about 10-20 people visit my blog daily so I think I'm safe. The gist of the article is that in California there is a rising number of kindergartners who are getting vaccine exemptions (essentially the parents saying we don't believe in vaccinating our kid). They just have to sign a form and the kid can enter school unvaccinated. This isn't such a problem if the majority of the other kids are vaccinated, but with as few as 5-10% unvaccinated kids you can get mini epidemics of diseases that are otherwise quite rare these days, ie measles, mumps, diptheria etc. According to the LA times there have been several such measles outbreaks in the San Diego and the rate of unvaccinated kids is especially worrisome in several charter schools and non-catholic private schools.

OK, here is my take on this vaccine thing. When I was a pediatric resident at the beginning of every year in clinic we reviewed the vaccine schedule, risks and benefits of all the vaccines and why we vaccinate against them. As you can imagine being me, by the time we were third years my friend and I would joke that the reason to vaccinate against these diseases is because they can KILL. Yep, most of the diseases vaccinated against are things that kill people. (OK recently we've added a few not so deadly disease to vaccinate against and I used to use this same argument to question if that was right). But I digress the main issue at hand seems to largely be the Measles/Mumps/Rubella vaccine (MMR). This one started to fall out of favor after an article linked it to autism. The fallacy of that study is that autism typically becomes apparent around 15-18 months and almost every child gets the MMR at 12-15 months. The two were temporally linked, nothing more. The only study that really looked at vaccines and autism rates showed no difference. So, my argument and what I used to advise people to do if they were really worried was just delay the shot until their child was already talking. OK, so there is the mercury thing, but manufacturers have gotten into that and combined more shots and made more of the vaccines without the mercury contained preservative so that is pretty much a nonissue. Of course, again, you can delay, space them out and make it even less of an issue if really worried.

So back to the diseases behind the vaccines, why care. Let's start with measles since that was what the article was about. Measles still exists in the US and is especially prevalent in certain European countries, not to mention less developed nations. Measles isn't so bad for the average school age kid, but it is DEADLY for infants, and not good for the elderly or immunocompromised. I took care of a 9 month old infant who had measles encephalitis as a resident. The child spent two weeks essentially comatose. She ultimately went home, but the long term effects are likely significant. Hello this baby almost died, her parents were rightly infuriated and scared.

How did she get it? Her older siblings friend wasn't vaccinated. She came home from vacation with measles and before she got sick played at the vaccinated friends house. Thereby exposing the unprotected child. The child who was too young to get vaccinated even though her parents would have. You see there is the problem. It isn't just one kid. It effects the community. The LA times article had several similar vignettes of infants under 1 year of age being exposed to measles by unvaccinated friends of their older siblings. The year before the measles vaccine was released- ~500 people died from the measles and ~4500 kids had measles encephalitis. Do I really need to say more?

OK, so now mumps. Mumps doesn't seem so bad, right? It used to be the biggest cause of male infertility. That's right mumps infections in prepubescent or adolescent boys can leave them infertile. How about Polio? Now eradicated from the Western Hemisphere, but its long term effects were devastating.

I could go on, but you can see my point. I think I have said enough. I guess my bias is obvious. Please people vaccinate your kids. If you're really worried, it isn't terrible to slow down the vaccinations, but please. These are bad diseases.

Let the Insanity Begin

2009-03-23T16:42:00.000-07:00

So, all of you who have read this know that I used to be a competitive swimmer. Serious emphasis on the used to be part, but as of late I have been swimming again. I have even tried to train to swim the 100 fly once again. My time is not so far off from what it used to be. I count that as one of my many blessings. Further, in my new found pursuit of health and fitness I have started to run. Nothing crazy, but I routinely run 2-4 miles, 3-4 days a week. I have never considered myself a runner, but nonetheless it isn't that hard. When I lived in DC, I used to bike. I would bike the 25 miles or so down the Potomac to Mt. Vernon and then take the subway back, at them time it was my escape. I loved it. So naturally lately many friends have been asking when as a swimmer and now a runner, who used to bike, when would I do my first triathalon. My response, had been umm- never, but it got me thinking. Why not. I'm in good enough shape, a half mile swim is still a warm up to me, a 4 mile run something I do when I don't have time to work out. I can do this. So, I have officially agreed to do my first triathalon- 0.5 mile swim, 19 mile bike, 4 mile run. It is in August. I'm doing it with my trainer and friend, Jason.

Let the insanity begin. God knows where this one could lead.

Lost Hour

2009-03-09T12:59:00.000-07:00

I love daylight savings time. That magical change in the clock that all of a sudden gives me sunlight when I get home from work. Really I do. However, yesterday I never quite seemed to recover form having lost an hour. I spent the whole day feeling behind schedule and wound up not getting everything in, then this morning 5:45 came terribly early. I know I'll be happy about this in a few days, but today I'm tired.

Words

2009-03-06T10:38:00.000-08:00

I am reading a beautifully written book now, Edgar Sawtelle. The author has the sort of mastery of language that I love and can't read fast enough, but don't want to end. The protagonist of the story is a child born without the ability to speak and the dog who decides his purpose is to be the boys protector. I'm half way through it and it is the kind of book that I know I'll be sad to finish, but it has me thinking about the power of words. The ability of language spoken and unspoken to provide support or cause pain, to share emotions, to transcend time, to inspire or to belittle.

As a physician I have worked to become aware of the ambiguity of language and have trained myself to speak as precisely as possible. I work towards perfecting the skills of delivering bad news with compassion but strength, but still there are times when I know that the words that are about to come out of my mouth are going to change a families life forever and cause them nightmares and inordinate suffering. Yesterday was such a day. I fight my own personality which is to spread cheer and not cause pain by trying to not say such things, but sometimes you must, and I firmly believe that it is worse to withhold the information. However, the aftereffects of delivering such news are rough to bear witness to. I only hope that we (my coworkers and team) can also use our language spoken and unspoken to support.

Business Trip?

2009-02-27T15:42:00.000-08:00

How many people in corporate America take a day off to play golf and then claim that they get good work done on the golf course, forge contacts, build teamword, etc. right? That is the excuse that thousands across the US use for their corporate expensed golf games, country club memborships etc. I just got back from using similar logic on the ski slope although I actually did attend a conference and even had to present some of my data and had two former mentors show some of my slides. I had lunch and skied Tuesday afternoon for awhile iwth my former boss and mentor and discussed plans for some future papers. So, really I was working, I swear.

That being said the Rockies are beautiful. I spent the weekend in Denver, truly working then 4 of us rented a car and drove up to Keystone in the midst of a major snow storm that dropped at least a foot of fresh powder on the hill. On Tuesday morning the sun was out, fresh powder was all around and as soon as I could escape the meeting, I suited up and hit the slopes. I demo'd an amazing pair of skis. Volkl's made for women. They were so great to ski on, too bad I could never afford to buy them. The conditions rocked and Wednesday was even better. On wednesday, I skied by myself and kicked my tail as I spent about 6 hours with nary a break charging down the slopes. Lefty held up although she was seriously sore after Wednesday. The mountains awesome. Sometimes I love my job.

A little of the Colorado Rockies

Inspirational?

2009-02-11T19:46:00.001-08:00

One of my friends has currently gone back to school to get a masters in medical ethics. Her most recent assignment was to write a paper on someone who had gone through a significant illness and how their background impacted their coping and adjustment to that illness. She chose to interview me. In preparing to for the interview, she sent me a list of questions and answered many of them with links to posts I have written over the last two years. I reread parts of this narrative that I haven't looked at in a long time, and I laughed and cried with myself again. I just read her paper. I know it's about me, but sometimes I forget.

This was her summary:

"In summation, Lisa’s illness narrative is an amazing one, and one that I wish I could tell more of. Her illness experience spans the range of human emotions, triumphs and defeats. Lisa shared her humanity, her strength and her fortitude to take on a frightening, painful and long illness and turn it into a life learning experience. She used her illness to emerge a stronger, more compassionate, more health conscious individual. She used her illness experience to emerge a more understanding physician of the demands that illness places on effected patients and their families. She has used her illness experience to grow in cherishing her family and friendships. She seems to have genuinely learned the value of herself, her self-worth and really used the experience to better herself and enrich her life. Her story is compelling and one that serves to only inspire anyone who has the fortune of hearing it. "

Aw, shucks, who knew I was inspiring- thanks BB

Collections

2009-02-05T19:42:00.000-08:00

I quick look around my house will reveal several collections, things that I have collected or kept over long periods of time. These collections tell little stories about my life, who I am, who I used to be, and what my hobbies are. They are a little like an archeological expedition into my life. There is the fact that I have 5 bookshelves all full to the brim with books I've read, want to read or am reading. The styles and genre vary, but there is no way you could spend more than 5 minutes in my house and not know that I read, a lot. There is my Lladro those beautiful porcelain figurines that are sweet reminders of my time in Spain. My shot glass collection that reflects my college years and life in my 20s. My Zaworski (sp) crystal collection, my collection of puzzles, etc. You get the idea.

Then there is my other collection that is not so visible, but apparent to most people who know me and was brought to my attention when I sent a simple email today. I was explaining to a friend that I had to change my plans for Friday because I had to go pick up my friend Lisa's car. I got back a two work email "Which Lisa." Valid question, you see, I collect friends who share my first name. How this started I'll never know, but by now it is rediculous. In college, I lived with two other girls named Lisa, they are still two of my closest friends. When I went to school in Boston, I immediately became friends with a Lisa. In residency, one of my closest friends- you guessed it Lisa (but then I had two other really good friends both named Kathy). Then I moved to Chicago and my lab had 5 women in it and 3 of us were name Lisa. Those two Lisa's are still friends, and one of them is another of my dearest friends and the person in question whose car I have to drive to Long Beach in the rain tomorrow to get. Does it say something about me that I have so many friends with my same name? Or does it just mean that Lisa was a seriously popular name round about the late 60s early 70s? and it wasn't a local phenomenon. No two of these assorted women were born in the same state as another (except two who are from Phili), and one was born abroad. Nope just random that I count upwards of 10 Lisas as friends. No idea if this says something about me, but it is curious.

Nonetheless I love my Lisa's. They rock

A Day at the Races

2009-02-04T17:42:00.001-08:00

I grew up a few short miles from Santa Anita Race Track. I learned how to drive in the race track parking lot. i have been to mulitple random events at the Race Track, but I had never seen the horses race there until Saturday when some friends from work invited me to join them. I immediately accepted, because I had been wanting to go for awhile. We got comped tickets to a box on the clubhouse level. We were a little too high up to fully get to see the view, but the day was beautiful. A perfect setting for a fun Southern California day. We studied the program and in the first race was a horse who caught my attention "Devil Cat MD." That so was going to be my horse. My friend, Sandy explained the details of horse betting to us and I placed an expecta box bet on Devil Cat MD and horse #3(whose name currently escapes me). Essentially I was betting that these two horses would come in 1,2. We watched the race and Devil Cat MD won and horse #3 came in 2nd. My first bet on a horse race ever and I won an expect box. I was thrilled. Not so much success would follow, but alas it was still a great day at the Race Track.

I forgot my camera, so these were taken with my phone. They at least give an idea.

Leslie and Sandy in our box

The horses racing to a photo finish on the turf

Horses being lead out to race

Oh and if you go to the races, and are hungry- my advice, skip the regular concessions and go for the hand carved sandwiches. I had turkey on sourdough. I couldn't quite eat the bread, but the turkey was awesome. My friend got roast beef on rye which looked super good too.

Out with the OldIn with the new

2009-01-21T10:38:00.001-08:00

In honor of the peaceful and historic change of the presidency yesterday, I have begun a purging of my own. I walked into my office yesterday and started searching for a random but very important piece of paper and threw up my hands at the chaos of my desk. So, project declutter began. I have completely cleaned off my desk (Of course, my office floor is now littered with papers and folders, but they are slowly getting filed away). It feels good to restore order. So good, that I carried the project home with me, where I commenced in a similar clean out phase in my home office and next in line my closet. My closet is full of clothes that are too big for me. I have given some away, I am getting some altered, but then the perenial question remains. Do i stick to optimism and say that I will never ever be a size 12-16 again and get rid of those clothes, or alter them all. Or do I store some in case I back slide. I want to go for optimism, but buying and paying for altering for a whole new wardrobe is causing me financial pain right now. But then, I am vowing to never go back, right? But the little devil in my head says yeah but look at Oprah (although, all who know me, know i hate Oprah) So, I write, non-eloquently at that, about my internal debate so that I don't feel like I belong in the United States of Tara.

Alas, for now- project out with the old, in with new- will be organization and moving to a different closet I think.

Can California Really Do That??

2009-01-19T10:20:00.000-08:00

So, as pretty much everyone knows California is broke. I mean really broke. I argued this point when the elections came around and the stupid people of California voted for more spending, but alas people aren't always so smart. So, now not only is the state broke with bond issues that are barely above junk bond status, but the yahoos the are running the state seem to be incapable of coming up with a budget. So according to various news agencies the state will apparently be out of money Feb 1. Therefore, they are now reporting that their current money saving strategy is going to issue IOUs for income tax refunds. Did you hear that IOUs, from a state with no money. Seriously, folks they are threatening to not honor the tax refunds owed to the people. Can they do that? Apparently, they can.

Now I know that overpaying taxes and then getting refunds is giving the government an interest free loan, and I know it isn't smart. However, the couple of years i had to pay taxes were really rough and every year I have a couple of really big bills that always come in around the time that I get my tax refund and the beginning of the year is always a little tighter financially for me, so getting a nice check from the government has been working for me. But... If they are going to start not honoring what they owe then this policy needs some serious rethinking. I had a long chat with my dad, my ever present financial advisor and he gave me some good advice. I'm going to do some homework and see what I can make work. In the meantime I curse those elected state officials for throwing my money away and not honoring their debt. Curse you