Recently my family and I headed to Austin to celebrate the life of Granny Van Vavra, my maternal grandmother. She was a great lady and I will miss her laugh, practicality and curiosity. Although gathered for a sad reason, it was great to spend so much time with my family...

Me with my paternal grandparents, Oma and Big Daddy.

including all the friends and neighbors that loved Granny too.

The flowers in Austin are beautiful this time of year...


but Sylvia was the star of the show.

Luckily, she's an equal opportunity lap sitter

Not to mention easily entertained....

this basket of paper recycling was an endless source of amusement for Sylvia. For the big girls, we got a kick out of comparing her expressions to the dozens of photos we sorted of Aurelia, Susan and myself.

Sylvia and Susan shared her first washtub bath....

And Aunty Vic put her in the antique trashcan. (Sorry, Miguel)

We also took a trip out to Jarrell, where Sylvia and Big Daddy had a long discussion on the building strategies of Tyeco.....or something.

Here's the whole fam....
I also caught up with my oldest friend, Pam Ziegler (now Brown) and her adorable boys

Pam with Logan

Noah just turned 5! He's quite the young man

And an excellent big brother, here with Logan, about 11 months.

Choo Choo to Chattanoooooga

This past weekend, Andy and I decided to celebrate our last work-free weekend for awhile by taking a short trip to Chattanooga, TN. It's a short (2.5 hours Victoria style) drive up to this town that is so fun to say and we were mighty pleased with all we found to do armed only with a New York Times Article (36 Hours in Chattanooga) .

First we stopped at Bea's, where you sit in a big round table with strangers and eat off plates stacked on a lazy susan in the middle of the table. These plates are PILED with fried chicken, fried okra, potato salad, cole slaw (no, not like yours mom), beans, pickled beets (first for Andy) and cherry pie. Oh, my stomach is aching a little just talking about it, but it was excellent.

Next stop, ART (of course). Actually, Chattanooga has quite the art scene with lots of public sculpture as well as an great American art museum, the Hunter. Although they have the standard collection of early American landscape paintings and boring portrait paintings (apologies to the art snobs among the audience), the museum also has a great collection of contemporary art as well as a fantastic view of the Tennessee river.

Plus, the building is pretty cool.


After all of that, we took in some seafood, wandered the town and had a generally good time observing the many high school proms that were taking place throughout the city, from the art museum to the Creative Discovery Museum to the convention center. Nothing makes you feel quite so glad to not be a teenager anymore; I recommend it!

The next morning, we headed up to Lookout Mountain early in the am to catch the views before the tourist flood.

Of course, Civil War history abounds, but we caught some fantastic views and even got a nice little hike in before too many folks were up the mountain.

(We loved this sign....it didn't seem like it would get your attention until you were falling down the mountain.)

Next stop was the aquarium. Now, I'd like to say, after living in Boston for many years, I've been to one of the nicest aquariums in the world. BUT, but....wow. Chattanooga's aquarium (the Tennessee Aquarium) is the largest fresh water aquarium in the world as well as having a great salt water collection as well. (This is the part where I got really brave and touched a shark and a sting ray.)

(No, that's not the one I touched.)

The fauna is so diverse! Otters, penquins, a ton of turtles, alligators, sturgeon, penquins, macaws, a butterfly exhibit, a sea horse exhibit

...and this odd species that we never really figured out.

It was great fun and I HIGHLY recommend it.

Finally we thought we should head on down the road toward the Magic City but made one final stop at the Chicamauga Battlefield, where we learned more about how hotly the control of Chattanooga was contested in the Civil War. In these battles, 47,000 soldiers died. The battlefield was created in 1890 "to preserve and commemorate these battlefields". Every unit that fought there was invited to create a monument or snippet of information that was placed at the site of action. This battlefield is 5500 acres of protected national park with a wide array of plaques, statues, monuments and information about the men who fought there. And it is also a beautiful piece of land. It was quite sobering and Andy summed it up well by saying "I'm so lucky I was born when I was, where I was, and who I am". Amen.

Not wanting to back track (silly us) we decided to try out some smaller state roads to get back to B'ham. We made a wonderful discovery of Cloudland Canyon State Park in Georgia,


which may be the destination of another short trip before too long!

While in Arizona, I made a stop at the Desert Botanical Gardens, which was having a show of the glass art of Dale Chihuly.

I have seen his work before, usually unbelievable chandeliers but haven't ever been overly impressed with his designs. Well, his work seems to have found it's home in the desert landscape; it was a very impressive show and I had a great time exploring it all. If you are in the Phoenix area any time soon, I definitely recommend checking it out.

Best time to go is a dusk, check it out in the sunshine and then at night with the lights on:

Half full or half empty?

I'm writing this from the far side of 6 months of internship. It seems so crazy that it is half over. It sort of begs the question: am I half-way to the amount of knowledge I am supposed to know at the end of this or am I half-way done with the hazing process called internship. Having spent every about 4th night in the hospital for the last 6 months, I know that some of what I say comes from pure fatigue. The funny thing is the way things change that I don't even notice because I am so focused on work, learning new things and not actively (or passively) killing people. Nine-thirty is my new bed-time, meals are rarely sought for enjoyment but simple necessity, I somehow haven't worked out in months and my weight has certainly ballooned to the largest ever....in my life. My tolerance for alcohol has all but disappeared -- now, I was a pretty cheap date before this adventure began but now one good drink and I'm good for hours....until I fall asleep that is!

Other things have changed too. In the last week, I "ran" two codes, meaning I was the first doc to the dying patient and I ordered 10-15 people around to give drugs, put in lines, get an airway and generally try to save the patient. Now, 6 months ago I didn't even KNOW how to do that and now, I wouldn't say I'm comfortable with it, but other residents have said that I "handled myself well". Procedures don't intimidate me as much; I can often help sick patients before calling for help. There are still moments of terror, but they are less constant.

As for knowledge, that feels different. It is not conceivable that I haven't learned anything in the last six months, but I have become so much more aware of what I don't know. Six months ago it felt like a vast and nondescript abyss. It's still a vast abyss but it has acquired some definition that some days make me hopeful that I'm making progress and some days feels so profoundly overwhelming. The knowledge required to be a good doctor is truly infinite: from how to treat a heart attack, to intubating and putting in a giant IV to the cheapest drugs to prescribe patients with no health insurance. I haven't quite grasp how to lasso in the infinite.

Emotionally challenges have gotten a little easier, although I don't know if its better or worse that I don't cry every time a patient dies. I know it makes it a little smoother to get through my days. No matter what your brain says about someone dying, it's always sad. There is always someone hurting over it and it always makes you face your own mortality, with which I'm not that comfortable with. I haven't really had a pediatric patient die yet, but the time is coming. I think that will be a whole other challenge. (Trust me, as it is you don't want to be in my dreams most nights.) As time passes, I just take these moments to be thankful, thankful for my health, the health of my parents and family, the love of those around me and all the luck I've had in my life. I'm thankful now to be taking off for a week with my loved ones and especially thankful that my significant other, Andy, will be moving to Alabama after the first of the year to share even more of this adventure with me. And I'm thankful for another six months to figure all this other stuff out!

Weirdness and Strangeness

October was the month that I switched over to the Internal Medicine (adults) side of my combined program. It's been quite a culture shock not to mention having to a learn a whole new hospital and 3 new computer programs. To make it even more intense, my first rotation in adult medicine is the MICU (Medical Intensive Care Unit). UAB is a large intensive care center and so the patients we have in the ICU are often described as the sickest in 3 states (Alabama, Mississippi and parts of Georgia), which is great for learning but a little intimidating when you haven't seen an adult patients in 6 months. The month has included learning many scary new skills, such as putting great big IV into large veins of the body (central venous lines) and sticking large needles into other body parts (i.e. the chest, abdomen). When on call, in addition to taking care of new patients coming to the ICU and taking care of the really sick ones already in the ICU, we are also part of the "code team" for the hospital. What does that mean? If anyone in the whole hospital codes (i.e. stops breathing, heart stops, generally trying to die) we have to run to the bedside and be part of the team that does CPR, give drugs, shock fatal heart rhythms, etc. With hospital that is spread over 3 city blocks, you can really get a good work-out in on call! The downside is that most codes don't end well. I've dealt with a lot of death this month. I've helped 3 families come to the incredibly difficult decision to withdraw medical care on their loved one to allow them to die peacefully. Many other families eventually make their loved one DNR (do not resusitate) when their heart stops. While a lot of these patients are elderly, I have had many young adults as well, several of whom I found that my greatest accomplishment was helping them go home on hospice. Thankfully, now I'm on to the next rotation. The one saving grace (and pitfall) of internship is that things change frequently!

Outside of work, Andy came to visit and we took a great trip....to Cullman, Alabama, the home of the Ave Maria Grotto.

The Grotto is located in the St. Bernard Abbey, the only Benedictine abbey in Alabama and is composed of the work of the one of the monks that lived in the Abbey. It's tough to describe this feat of folk art: Brother Joseph made miniaturized replicas of religious landmarks.....

(Andy will you give you a perspective on size of the buildings)

(and here's one to give you perspective the extent of Brother Joseph's work)
including the birthplace of Jesus,

shrines,

and non-religious landmarks....and random things, like Hansel and Gretel visiting the fairy castle with a "scary" dragon guarding the gates....

our personal favorite:
I think that sums it up. Oh! Except for the range of creativity and thriftiness Brother Joseph used in his art. Lacking traditional artist supplies, he used cold cream jars, concrete, broken glass, old flashlights and any number of scraps to create his pieces:

We tried hard to be respectful, but there was a certain amount of uncontrollable laughing...

and a little uncontrollable Beatles impersonation

at the chipmunk crossing, of course.

Stay tuned for the next unique Alabama adventure!

August, September, October...oh my!

I hate to be the one to say it, but time flies when you're working your tail off (what, you've never heard that one before?). Needless to say, I survived August taking care of teeny tiny bitsy babies and then took the Pediatric Emergency Room by storm....well, I worked there for a few weeks anyway. September was spent working wacky hours (those doors never close!), doing more lumbar punctures except on bigger kids who are much harder to hold down, suturing many a facial wound incurred while being a kid and seeing A LOT of kids with vomiting, diarrhea, snotty noses and coughs (including the kid that actually managed to cough directly into my mouth, YUCK). I was continuously surprised how a kid with a raging fever will still be bouncing around like nothing's wrong (because my last experience with fever had me conclude that fever=yucky). Miraculously, I stayed fairly well for the month and was even released for AN ENTIRE WEEK to spend with Andy cruising around New England.

First stop, wedding of one of his oldest friends, Jay:

Now, meeting family of your significant other is always nerve-racking (yep, we did that too) but meeting childhood friends?!?! Yikes. I mean anyone can fake being a nice girl for his mom (just kidding, honey) but winning the approval of friends is much more complex.

But, here's the payoff: Andy in a tux....

and Andy dancing! (Can't tell you how exciting it was when I learned that he liked to dance. I didn't know men like that existed.)

I was similarly relieved to discover that he, like most sane human beings, does refuse to dance the Macarena.


After the wedding, we headed to the best city on earth, NYC! Although our GPS really, really, really wanted us to end up in Brooklyn, we eventually made our way to our hotel room in Manhattan and spent several days walking, eating, visiting museums, going to a Broadway show and enjoying the city life.

The first night we stayed very close to the UN building, so we headed over to check it out. There was an assembly in progress and we even got to see some UN protestors (it was great, their protest area was about 5'X5', or aproximately the size of an NYC apartment).

We also made it through Central Park to the Met, where we saw many cool things and this, one of Jeff Koon's sculptures in the sculpture garden on the roof of the Met.

I don't get it.

And what would a visit to New York be without a Broadway show and a stroll through Times' Square (actually, I hate Times Sq but Andy was mesmerized).

After NYC, we headed back to the Boston area to spend some time with Andy's folks in his home town. This is the house where he grew up:


and this is his favorite spot on the north shore (if you squint, you can see the Boston skyline)....


and we really need to figure out the automatic photo-taking thingy on our cameras....

and Continental airlines needs to figure out how to spell.


On a final note, I am recently saddened by the passage of the bailout package. Didn't we used to pretend that the rich guys didn't ACTUALLY run everything? Anyway, it just makes it more poignant to me the importance of an administration change in this year's election. However, sadly, in Birmingham, I feel intimidated and somewhat reluctant to display my Obama support. A friend of mine had an Obama sign stolen out of his yard and it just make me wonder. But, I have resolved to put that sticker on my card and be damned, maybe it will get someone to the polls.

Firsts

Intern year is full of firsts. Primarily, the first time one is called Dr, asked to make an important decision, called to a patient's bedside when they are ill or simply signing your own orders for the first time (in med school someone has to "co-sign" them for you).

To give you an idea of what this is like, I thought I'd make a lists of my firsts since intern year started (as you might guess, I'm working so much I haven't had any fun trips with exciting pictures, so a work-related post is the only option):

first night on call (usually means I spend the whole night in the hospital taking care of new patients that come in and all the patients in the hospital that night)

first "champagne" tap (this refers to doing a lumbar puncture, where you stick a needle in to the space between the vertebrae and the spinal cord to get spinal fluid to test for meningitis, and get no red blood cells in the fluid)

first patient with typhoid fever (really! she was 4 and had never been outside of Alabama, but mama was from the Philippines...there were a few typhoid mary jokes among the residents)

first night on call in the NICU (neonatal intensive care unit), which involves attending all high risk deliveries in the hospital and "resusitating" the babies, which can involve anything from smacking the feet (not the bum!) to sucking goop out of their airway (suctioning) to putting a tube down the throat to help them breathe. Lots of times it also involves showing the baby to mom for the first time....those are good ones!

first tap (lumbar puncture, see above) on a patient on a ventilator (breathing machine)

first tap on a patient on a ventilator (breathing machine) AND with a chest tube (tube place through the skin into the space between the chest wall and the lung...a little delicate)

first intubation (putting a tube down the throat to help a patient breathe)....on a baby that weighs 500g (0.5 kilograms or ~1 lb)

first fever while working 30 hours straight (not fun, but I'm sure it won't be the last)

Well, that's just a few of 'em, but you get the idea. I promise the next post will be more colorful and less full of medical speak.