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1st January 2021

Happy New Year

Happy New Year

I have been looking forward to days of more sun for a while now. I’m a night owl in general and I find comfort in the night usually. I work so much at night and I love my drives home, especially when it’s a little foggy and the street lamps make halos in the haze. But this year. This year has been one of sleepless nights and bleak days, where I’ve struggled to connect or do anything important. It’s been hard to be positive about anything in a world of lies and conspiracy theories, when I’ve come to despise people that used to be family (it’s true that the falling out happened years ago, but it felt more “in my face” this year seeing how little they cared on posted on social media).

So this year, I lit a candle and watched the solstice dawn over Stonehenge and listened to Loreena McKennitt and the world has felt a little brighter since then.

A foggy morning at Stonehenge. Appropriate for this year, as things slowly become brighter.

Karin and I made a “Christmas tree” out of the yarn swift. I thought it was quite festive.

I’m quite aware that the marking of a year is an arbitrary thing, that the earth rotates around the sun, which rotates around the galaxy, which rotate around more galaxies, regardless of whether we humans acknowledge it or not. And yet, there’s is something hopeful about turning a page and starting afresh.

Happy new year, my dear friends. So glad to still be here, with you, on another rotation.

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18th December 2020

a tiny morsel of hope

#notthrowingawaymyshot

Today may be the happiest day of this entire year.

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29th November 2020

Fiber arts and crafts

Fiber arts and crafts

About a year and a half ago, I took up knitting. I had try to teach myself how to knit several years ago and had started to make a scarf and hated it, so I stopped. But at my grandmother’s funeral, my cousin was knitting a hat and I was utterly mesmerized as she swiftly moved yarn across needles and created magic. And my therapist had suggested that I look into some creative outlets as she thought that creating something beautiful and keeping my mind engaged with the project might help me with my anxiety swirls (she was right). So I invested in some good circular needles and visited a local yarn shop and found some pretty soft yarn and a pretty pattern and taught myself how to do cables, which made knitting so much more interesting that my previous scarf. And I made myself mittens. And then a matching hat.

My first mitten. I’m still darn proud of those cables!
The hat is a little tight for my head and the gloves are a little big and floppy and I utterly love them. (it’s not very visible here, but the hat has the same cables as the gloves.
Me modeling my hat at Arches National Park – it does not go well with my scarf at all, but I love the cables.

I made my mom a hat and matching mittens last year for Christmas:

My second hat for my mom. It’s called a “honeycomb” pattern and was super easy to knit up.
Same yarn as the hat – lighting makes such a difference (it’s closer to accurate here).
Look Ma, they’re glittens!
My mom with her hat and glittens.

I started the year trying to make socks. My friends recommended that I start with baby socks. I had a co-worker who was having a baby, so I thought it would make a great present. My first sock would have fit a toddler. I ripped it out. The second who fit a 30 week old premie. I hated the cast on (always my least favorite of any project). I hated the knitting. The pandemic happened and I lost interest in knitting with all of the other stresses in my life as these socks were not bringing me joy. So I’ve put down the socks. Maybe I’ll come back to them because the yarns are so pretty.

So instead, this fall, I started knitting up this scarf with a variegated cotton yarn that I thought was going to be a lot more blue/brown than what it ended up being (it was a lot of brown/blue – but I had a lot of Qualms when I say that massive bit of yellow in the middle. I’m still a little uncertain about the colors but oh well). I’ve really loved this project, despite multiple times of messing up on my counting and having to rip out a row or two.

It’s called “Changing Staircases” as has alternating sections of stockinette and lacework.

My next projects are hopefully a matching scarf for my mom for Christmas (still deciding on a pattern), a cardigan for me with really really soft alpaca/silk yarn that was on clearance (also looking for a pattern), and an Anne Shirley like doll that I found on ravelry. I’m nervous about the doll, as it will require small stitches and a precise gauge and I tend to wing it. More techniques to learn. If it goes well, I’ll make a matching doll for my niece.

A recent pic of me. Who knew that. I would still be dealing with zits at 42?

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22nd November 2020

On Beings Friends

“A bosom friend–an intimate friend–a really kindred spirit to whom I can confide my inmost soul.” ~Anne of Green Gables

I know, I know, yet another banner proclaiming that “herein lie tantalizing secrets that you don’t know about.” I’ve been hesitant to “friend only” this journal, because I love wandering around the journals and reading about people’s interests and lives. It astonishes me how honest we can be in this forum – and with people that we have never met in real life. I love that, it’s probably why I am so addicted to lj.

However, I am also aware of how … perilous the internet can be; how that same honesty could have serious repercussions if I reveal too much about my personal life. And from the beginning, I’ve screened certain entries that I didn’t want the random stranger to see, or even the real life person who might take it in the wrong context. In the next (several weeks, probably), I’ll be going through and making more entries friends only.

So, please comment here, if we have shared interests and just tell me a little about yourself. I’m sure we are kindred spirits just waiting to discover each other!

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22nd July 2019

summertime sum-up

Hi friends!

Just popping in to let you know that I’m alive and around and still chugging along. My plans to catch up and stay caught up never comes to fruition. Someday, maybe?

My summer is busy. I’m going to try to go up for Associate Professor this year, if I get everything together, but honestly, everything has been falling apart and it’s really stressing me out and I’m not sure I’m going to go through it. Maybe. We’ll see.

I just completed my 6th year working at OHSU. My neurosurgery interns that I taught my first year are now the chiefs and it’s just so satisfying seeing them become competent and thoughtful and compassionate physicians. Granted, I’ve had several years of residents graduate, but these two were my little nestlings. I keep holding onto that, rather than thinking about the next decade + of fighting about sodium levels.

I also got a new work title that comes with money (that doesn’t go directly to me – academics, man) and supposed protected time. I’m now with Epic Physician Informaticist for the critical care units, which means that I’m doing more training to understand the workings of our electronic medical record and to be the liaison between the computer analysts and the physicians. So far, it’s translated to a lot more meetings. But it’s really making me think more seriously about getting a graduation certificate or master’s degree in medical informatics, which I’ve been toying with for the last couple of years.

No real travel plans (see above about promotion), but I did get to go home and play with my niblings for a few days. We went camping and walked the creek and played Exploding Kittens over and over and over and over. Love them.

I recently recorded a podcast with A Thoughtful Faith about being a critical care physician and witnessing death and how it’s influenced my beliefs and faith that some of you might be interested in. It was a really lovely conversation with Gina Colvin (the host of the podcast) and I thoroughly enjoyed it. I unfortunately, am completely unable to ever listen to myself on audio so I don’t know how it all sounds, but the feedback on facebook has been encouraging.

Here’s the blurb:

What is death when you are on the other side of Mormon orthodoxy when the belief system you might have inherited might not serve you well any longer?

When our former stories of death and dying tire, what frames of meaning-making take their place?

In this reconstructing death series, I talk with a range of LDS spiritual, palliative and health care professionals whose work is with those at the threshold of death. Each of them explores their evolving understandings of dying and death as a result of both their professional work and their personal faith development.

My guests reflect on their refreshed understandings of death which we hope helps furnish us with new and enriched perspectives and stories about death that support our ‘falling upward’ (as Fr Richard Rohr calls it) into our second half of life spirituality.

You can listen to it here: Reconstructing Death. I really could have talked for another hour. I’d love to know what you think.

And that’s the sum up? How are you doing?

 

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22nd November 2018

2 score years ago

Today is my 40th birthday. I just completed that 40th turn around the sun. I celebrated it with my parents and my sister with good food – a Thanksbirthgiving Day is one of my favorite ways to celebrate my birthday. I won’t have another Turkey and Pie Birth Day until 2029 – over 10 years from now.

I honestly can’t quite wrap my head around it. I can’t say that I “feel 40” – if I were to put a guess on it, I’d put my mental or emotional age around 33 or so. But my body feels older – it doesn’t bend or recover like it used to, I have severe back pain that limits my ability to walk much, my fingers will never bend like they’re supposed to, etc, etc. There are lines in my forehead and around my eyes – my patients don’t ask me if I’m old enough to be their doctor anymore (I don’t exactly miss that). I’m surprised looking in the mirror at the weight that covers my cheekbones and my jawline and stretches out my abdomen – it’s been there for years, but I’m still not used to it being me.

Overall, it’s been a good life so far and I’d rather do this living thing for many years to come.  I have a career and a job that I overall love (which I need to remind myself right now, as I fight yet again with our billers, and spend too much time writing endless notes, and rounds that last forever). I have a family that I still enjoy, despite these 40 years together. They irritate me at times, but overall, they are wonderful people. I adore my niblings to bits and I’m so happy to continue to watch them grow and develop into unique humans. I have friends, close friends, who I think generally like me and love me.

Goals for my next decade of life:

  • Get promoted to Associate Professor (ugh)
  • Master’s degree?? (ethics, medical informatics, as well as additional courses in research, have been serious considerations
  • Take those voice lessons you’ve been talking about
  • Photography class
  • See all 60 US National Parks (Alaska’s dozen, US Virgin Islands and American Samoa may be difficult to get)
  • Visit all of the provinces of Canada
  • Travel to Greece, Japan, New Zealand/Australia, and Thailand. I’d also like to go back to South Africa, particularly to Cape Town.
  • Reconnect with friends. I feel like I’ve lost so many threads and connections over the years because of life and busyness, and I want to try to get that back.
  • Date? *shudder*

Me – Great Smokey Mountains National Park

 

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10th November 2018

Day #4 – Savannah to Jacksonsville

Day #4 involved a lot of driving. I have a couple of friends from residency who have set up shop in Jacksonville and when I reached out to them, we made plans for lunch. Unfortunately, this was still several hours away from where we stayed, so we made a beeline down.

Nitin and Rajul met us for lunch at a local Indian restaurant and we got to catch up for an hour. Hard to believe that it’s been 7 years since we finished residency (although the picture of us definitely shows the passing of time).

After we said goodbye, as they had to get back to work, Dad and I drove down the coast a bit to walk around St. Augustine and Castillo de San Marcos, one of the oldest forts in the Americas. We ended the day by driving another long slog across the panhandle to just outside Tallahassee for the night.

 

 

 

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8th November 2018

It would be ridiculous

It would be ridiculous to take a class or go back to school, just to learn how to break apart a chrome extension app and figure out why it removes the bold and italic formatting when you select to Print to PDF so that I could more efficiently download fanfiction, right?

(The app is EasyReader and it’s such a neat little extension but this bug drives me nuts and nobody’s responding on the review page and I don’t know enough to even try to figure out where the problem is. Argh).

(I am half thinking about going to get a masters degree in bioinformatics so I could be more involved in the utilization of our EMRs. But I also contemplate a masters in ethics. And I haven’t made any moves with either of them. So, who knows.)

(I would also love to take apart this crosspost plugin that I use for wordpress that adds in an extra < p > when I crosspost to DW. That is also something that I can’t figure out.)

 

 

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7th November 2018

day #3 – Savannah GA

My blog titles make no sense, but I’m just going to let me them go.

On the third day of the southern road trip, Dad and I drove around Port Royal and Beautfort and enjoyed the water and beaches (I took no photos) an then made our way towards Savannah. We stopped for several hours at the Savannah National Wildlife Refuge for a mini “safari” and hiked among the wet-lands, making caution friends with some reptiles. This is land that once upon a time had rice fields, but has since been allow to return to nature where birds and small animals and alligators reside. However, only miles away, oil refineries stain the horizon.

 

Afterwards, we made our way across to Savannah and walked along River Street (my word, the stairs down to the street are treacherous) and had a late lunch at Tubby’s. Alas, we did not actually take a ride on a river boat.

A memorial to the 12 million slaves that were brought to the US (around 1.5 million died in the transport)

We were stolen, sold and bought together from the African continent. We got on the slave ships together. We lay back to belly in the holds of the slave ships in each others excrement and urine together, sometimes died together, and our lifeless bodies thrown overboard together. Today, we are standing up together, with faith and even some joy. – Maya Angelou

Afterwards, we drove down to Tybee Island, where we braved the very chilly, brisk winds to walk up and down the beach. Such gorgeous sand. The place was virtually deserted.

 

 

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6th November 2018

Day #2: State 38

The next day, we drove from Augusta, GA through the back roads of South Carolina to visit Congaree National Park. Another one of my bucket lists is to see all 60 US National Parks (which is going to be my goal for the next ten years), so when I was making plans, I detoured slightly to incorporate Congaree and what a great decision that was!

Y’all, Congaree is lovely, just absolutely beautiful. It’s an old, dense forest, with ponds and pools of water and so much luscious greenery. We went for a 3 mile hike from the visitor center and I was just enchanted. About a half mile back to the visitor center, it started to downpour and we got soaked. We stayed at the center for another hour or so to allow it to let up and then took off again. I had initially planned on staying in Charleston that night, but my dad isn’t a big city person, and I worried about the time crunch, so we bypassed Charleston and drove on to Beaufort/Port Royal, SC for the night.

I’d love to go back and go canoeing in these drifting streams.

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5th November 2018

Road Trip #1, Day 1 – State #37

I started out the year with 14 states left to visit: Maine on one end, Alaska on the other, with the majority of the southern states in between: Kansas, Oklahoma, Arkansas, Kentucky, Tennessee, West Virginia (I was across the river once when I drove with friends from Pittsburg to Washington DC), South Carolina, Georgia (I’ve been to the Atlanta airport  at least 6 times, but had never set foot outside, which is my criteria), Louisana, Mississippi, Alabama, and South Carolina. I briefly contemplated doing one long road trip starting in Kansas and getting all of the southern states, but since I wanted to do a little more than just drive on freeways, and I have limited chunks of time available, I ended up with “smaller” road trips.

I decided early on that I didn’t want to do any of the trips in the south during the summer because I did not want to face humidity and mosquitos (I’ve been spoiled since moving to Portland). So the first road trip took place in April and it really was the perfect time.

The trip: Georgia -> South Carolina -> Florida -> Alabama -> Mississippi -> Louisana

I had gone to Florida last June for a conference, so Florida wasn’t one of the states that I needed to see, but I love the ocean and the beach, and there may have been a small part of me that has wanted to see Pensacola, Florida since I watched Contact so many years ago. Plus, when I was making my plans, the southern states were being particularly icky with their support of confederacy monuments, and I’ve been disturbed by my country’s embrace of populism since November 2015 and I didn’t want to get into the heart of Mississippi and Alabama. Hence the somewhat circuitous route.

My dad came on the trip with me, which, given that it was an 8 day trip, I was glad for the company.

Day 1: Atlanta, GA. We flew into Georgia late the night before and stayed in a hotel near the airport. Early the next morning, we drove to downtown Atlanta to see Centennial Park, as well as the Center of Civil and Human Rights museum. They have this one exhibit, where they’re recreated the lunch tables of Woolsworth, where you sit on the stools, and listen to voices shouting insults into your ears as everything shakes. Completely changes your perspective on what a “peaceful” protest entails – so powerful.

Centennial Park – Home to the 1996 Olympics

Enjoying a warm spring day in the Olympic ring sprinklers

Center for Civil and Human Rights

“Protesting white supremacists (below) line the streets to harass civil rights demonstrators in 1966. These images shocked a nation accustomed to telling itself that racism was mainly a southern problem.”

Nitrogen-frozen ice cream

I met up with a fandom friend for lunch and then we went to the Martin Luther King, Jr Memorial, which encompasses his birthplace and the church where he and his father preached. It’s the 50 year commemoration since his murder; it was sobering realizing how far we’ve come and how far we have still to go – and how easy it could be to slip back.

Martin Luther King, Jr’s birthplace

At the King Center (now one of my favorite quotes)

Principles of Nonviolent Resistance

The tomb of MLK, Jr and his wife Coretta Scott King

Pianos for Peace were scattered throughout the center.

Ebenezer Baptist Church

Inside the church – MLK preached here only a few days before his murder.

We stayed there until closing and then left the city (after a detour to REI since my shoes were rubbing blisters in my feet) and stayed in Augusta that night, before setting off on our next stop: Congaree National Park.

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2nd November 2018

NaBloPoMo – Day 2

I feel much better today – the pressure from my sinuses and ears is less and I don’t quite feel like death. I unfortunately have all of my notes from yesterday AND today to write, so this is going to be short again.

I’ve had a few things that have been weighing on me this year. One has been the fact that I’m turning 40 in 3 weeks and I am struggling to process that – this feeling like i’m facing a deadline and haven’t accomplished nearly what I’ve wanted to, this feeling of confronting mortality and aging (which has not been made easier by my hand injury that I’ve been dealing with for two years now).

And then in March, one of my residents died by suicide. I had no idea that she was struggling. This is the second suicide in our small group in less than a year and it devastated me. I have wrestled with guilt and grief all year – guilt that I didn’t do more to stop some of the toxic behaviors and environments that I had witnessed but had felt powerless to stop. And so much grief – there’s just a hurt in my heart at this needless loss of such a smart, charming, faulty human.

So I’ve been grieving this year and floundering. Which set up my year of traveling and reflection and “finding myself” again.

I have had a goal for years to see all 50 states, which was a goal set during medical school when I started visiting different places during interviews. When I turned 39, I realized that I still had 12 states to go – and a year to complete that goal.

 

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1st November 2018

1st of November

It’s been over a year since I posted here – and what a year it has been! It’s my 40th year of life, so I have tried to make it My Year.

Unfortunately, I am sick with a cold and I’m on service this week, so you’re not going to get the big update. Maybe daily morsels?

Here’s the sum up: Road Trips (Southeast, Maine + Nova Scotia and Prince Edwards Island, Kentucky/Tennessee, with Oklahoma/Kansas/Arkansas in two weeks). Cruise to Alaska. Hamilton. Visits with my niblings. Harry Potter and the Curse Child. Darren Criss/Lea Michele concert.

Stay tuned. 🙂

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17th October 2017

progress

progress

Today marks 5 weeks since my surgery.

(Me pre-op just as they were wheeling me away and at my first therapy appointment)

It’s been a long 5 weeks, full of pain and swelling, and lots of physical therapy and manipulation and stretching and disappointments and hurdles. The surgery went well – I had conscious sedation and a modified peripheral nerve block, which made for so much easier of a recovery. I was groggy for a couple of hours, slept in recovery for a bit, and then went home almost feeling like normal. The surgeon reported that he got full range of motion of my fingers in the OR after making incisions and cutting across the joint capsules, but he warned that it was going to be a constant fight against scar tissue formation and I was instructed to start moving my fingers pretty much instantly, which stressed me out so much in the recovery phase, as I had so much pain but was panicky that I wasn’t doing enough. I saw the physical therapist two days later, and was given a list of exercises to do, which felt so discouraging, but I persevered and little by little, I could move my fingers again.

The first week was painful and swollen; the second week was a dream. My fingers felt like butter. Nearly all of the stiffness was gone and with the range of motion activities, things felt so good, with the exception of swelling and tenderness. And then the scar tissue started to build up, and by the end of that week, I had lost 10+ degrees of motion. It’s been challenging since then.

I’m so much better than I was before the surgery. Before surgery, this was the best passive range of motion that I could do, without heat:

With some heat, I could get nearly a fist, but I could never get my ring finger to touch my palm. I went through my physical therapy records and compared my range of motion, because I like numbers and data:

AROM 10/24/16 11/4/16 11/18/16 11/18/16 s/p paraffin tape 12/5/16 12/21/16 1/3/17 1/18/17
Ring MCP 40 45 50 50 50 55 55 60
PIP 40 55 60 65 55 60 60 60
DIP 30 35 45 55 60 65 65 65
Total flexion 110 135 155 170 165 180 180 185
Small MCP 40 50 45 50 50 55 55 50
PIP 25 50 55 65 75 75 70 75
DIP 35 40 60 60 65 65 75 75
Total flexion 100 140 160 175 190 195 200 200
(MCP=metacarpophalangeal joint (aka the finger to the palm joint), PIP=proximal interphalangeal joint, DIP= distal interphalangeal joint (the tip of the finger)) (Numbers are degrees of flexion – 90 is roughly normal)

The first date is the first time I was able to see physical therapy, nearly 6 weeks after my injury. The last is the best measurements I ever got (I continued to see the therapist for another month, but we didn’t take measurements), which took extensive heat therapy – and I couldn’t maintain it for more than ~ 15 minutes. And after my second injury, when I broke my finger and didn’t know it, my range of motion became even more limited. By the time I saw the surgeon, I could only get 20 degrees of flexion at the small MCP, even worse than when I was first injured.

Here’s the numbers post-op, including today!

AROM 9/14/2017  9/20/2017  9/29/2017  10/3/2017 10/10/2017 10/17/2017
Ring    MCP 40 60 53 55 55 60
           PIP 45 70 71 80 75 80
           DIP 60 56 65 60 70 80
Total flexion 145 185 190 195 200 220
Small  MCP 25 66 55 50 50 60
           PIP 50 60 70 85 85 80
           DIP 65 78 80 70 85 85
Total flexion 140 205 205 205 220 225

And this is what my hand looks like tonight:

I can just barely touch my ring finger to my palm (there’s a small bone growth there that I’m pretty sure is impeding a little – I tried to get my surgeon to take it out at the time of surgery to no avail) and I have difficulty completely extending my ring finger too, but that is a damn fine fist, if I do say so myself. There’s still stiffness, especially in the morning or if I haven’t used it in an hour or so, but I can break through it easier. My hand no longer feels like I’m trying to bend a steel rod like it did before. I still have pain, especially in the bases, and the incisions are starting to tighten up. I saw my surgeon yesterday, who was overall satisfied with how things are going, but suspects that I will always have some stiffness and will probably not get full range of motion, but we won’t know until about the 6 month mark.

My incisions won’t be tiny – they spread a little because of all of the active movements that I had to do (and there were a couple of spots that I noticed that should have had a stitch in between), but they shouldn’t be too noticeable either.

I do several hours of therapy a day – wrapping it in heat, stretching and mobilization, finger bends and taping a fist, massaging the scars. It’s been such a joy working in the ICU while trying to find time to do the exercises. It’s still painful to put on gloves and I haven’t dared let any one shake my hand yet. I have several braces that I wear now; every time I see the therapists, she gives me a new toy. This is my current collection:

When I injured my hand, I realized that I had never consciously taken a picture of my hand before – I’ve lived my entire life embarrassed about my bone condition, trying to minimize it as much as possible, not draw attention to it, and in so many ways, I minimized its impact to my life as well. I remember in college, being so shocked when my doctor wrote in my medical chart that I had severe MHE – severe? Me? It’s only been in this last year, that I’ve been able to acknowledge that I have a disability, one that I compensated for until I no longer could. But trying to ignore it, not documenting how my body worked meant that when I was injured, nobody really believed me of the severity when I tried to explain.

My hand has felt like a stranger’s for the past year – all of those things that I used to be without second thought were gone. Now, now, there’s signs of real recovery and it is such a relief. I can almost hold a pen like I used to do. I can wash my hair with all of my fingers – not as smoothly, no, but the movement is there.

I am not optimistic that things will ever be as they were before, but I think that there’s a good chance for function and I’ll take that.

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5th September 2017

health update

I’m schedule for surgery for “capsulotomies” on Tuesday. Tuesday September 12th. Because I called today to ask why I hadn’t heard back (*SIGH*) and the availabilities was either December 5th or a week from today.

I hadn’t even had a chance to reach out to the tumor orthopedic here because my weekend was so so busy. I emailed him tonight (I hate these kinds of emails, ugh). I don’t know if he’ll have time to see me or if he’ll have any recommendations. I worry that I’m doing the surgery too fast without considering options. I’m worried that I’ve taken too long already.

My sister has been with my parents for most of the summer – she and my mom are going to drive back this weekend so they can be there for my recovery. If they can make it because the entire state is on fire.

I’m teaching the med students this week – I taught the neuro exam today, I’m teaching stroke subgroups tomorrow, and a lecture on coma on Friday. I’m taking stroke call Thursday night. I’m working nights on Friday, Saturday, and Sunday. I’m hosting this neurocritical care course in 3 weeks and I’m not sure we are going to have enough attendance. I’m trying to find a replacement for the week that I won’t be working because I’m going to be recovering from surgery.

I’m so stressed you guys. My anxiety is out of control and I am so sad and despondent about the state of the world and the destruction of the prettiest oasis in the country, that I feel like I’m barely holding on.

I’d really like a hug. Just a nice long, “things are going to be okay” hug while I cry and then carry on. Good wishes, thoughts, prayers and words of encouragement are desperately needed right now.

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31st August 2017

update

My previous ortho doctor emailed me back.

In his words: “the Venn diagram for MHE [my disease, multiple hereditary exostoses] and hand is quite limited”. He has a suggestion of a tumor ortho to see at OHSU, but more as a reestablishment, in case I need to any other surgeries and for followups (my bone growths have a small chance of transforming into cancer, whee!) but probably won’t be helpful with this situation. I’m going to be emailing him just in case. The only hand tumor specialist that he knows is a doctor in New York City, so who knows when I’d ever get an appointment to see him.

I’m still waiting to hear whether my (ridiculous, worthless) insurance company to approve the capsule surgery, 10 days later.

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30th August 2017

Testing…

My previous post didn’t go to my RSS feed. Hmm. Anybody know how to troubleshot that?

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29th August 2017

broken wings

Nearly a year ago, I fell. Missed a step and went down hard on my hand and instantly couldn’t bend my fingers (I wrote about that here). The ED sutured my bleeding eyebrow, took an xray of my fingers, gave me a split to wear which I wore for a couple of days and then stopped because it hurt and wrote me a pain subscription (which I took for a couple of days but then decided that the nausea was worse than the pain, so stopped and just bore the pain). By 10 days, I knew that something was really, really wrong. I saw my primary care doctor, got an x-ray, which showed again that it wasn’t broken, and a referral to an hard orthopedic and hand physical therapy – both which were booked up and I couldn’t get an appointment to see them for a month (I’ll save my rant about people believing that it’s an issue only for socialized medicine. It’s not).

So, six weeks after I fell, I saw the ortho PA, who wasn’t sure what was going on, but thought she saw a hairline fracture (there wasn’t), and that it should get better with time, and agreed that hand therapy sounded like a good thing. I started seeing the therapist that day. I used braces to stretch my fingers and when that didn’t work, I switched to a TENS unit where I sent shocks of electricity into my skin for hours a day. I dipped my hand in wax to mold my fingers. I saw some improvement, mere 5 degrees at a time, which would last a matter of minutes and then disappear, leaving my fingers stiff and painful.

After a month, I made an appointment with hand ortho again, this time with an attending that I’ve interacted with on rare occasions. Who basically implied that it was all in my head and I wasn’t trying hard enough. It was devastating. Never mind that I have a genetic bone condition, with a legitimate reason to have pain that could be contributing. Based on his non-diagnosis, my (utterly ridiculous and waste of money, again I’ll save you the rant about socialized medicine) insurance company denied the MRI, which I didn’t find out about until after I got it (I may have written a strong email to my doctor informing him that he would be calling and get it approved that day – which his staff did). The MRI showed possible reasons for the finger stiffness but nothing clearly conclusive. My doctor never contacted me about the results, and by this point, I had so little trust in him that I wanted him nowhere near my fingers.

So I did more therapy. I met with my therapist nearly every week. I underwent “iontophoresis with dexamethasone” which is a fancy term to say that my therapist used an electric current to try to get a steroid into the soft tissues of my fingers. Pain got a little better – I could put on gloves, I could (mostly) shake hands, but movement and stiffness didn’t. And then my therapist stated that she didn’t think more sessions would help. So I continued to do it on my own. I wasn’t perfect, but I tried to do the wax treatments once or twice a day. There was one week when I wasn’t working, so I dipped it 4-5 times a day. Nothing I did really made a difference.

I knew I needed to see a new doctor, but honestly, I was really burned with the experience. I felt completely dismissed. And I just didn’t have anybody else I trusted to evaluate and likely operate on my dominant hand. And trying to navigate the system – getting referrals, collecting my medical records, getting copies of the imaging – exhausting.

So I dallied and delayed.

And then I fell again. I went to San Diego to vacation with my college girlfriends and on our first night, walking back from dinner, I stepped off the sidewalk and (I think because it happened so fast) tripped on a water sprinkler that was jutting out of the ground, and went down. It swelled up and bruised pretty much within minutes.

IMG_1274 IMG_1276

Beautiful, right? I lost every bit of progress because the pain was unbearable to even attempt to bend, and once again, it was agony shaking hands and putting on gloves.

Finally, after the swelling went down, and I started crying to a colleague, because this has been utterly depressing and devastating and I am not dealing well with it, he recommended one of the hand plastic surgeons at OHSU, so I emailed him, and managed to get set up with an appointment last week. It was a better experience – he at least took me seriously and did a full physical exam, but he was also somewhat, I don’t know, a little victim-blaming? Basically, he thinks that my joints have stiffened, because of the initial immobility (which mind you I was instructed to do, and again I couldn’t get an appointment sooner and my therapist was terrified to work with me for days), and that I should have sought him out months ago.

He proposed taking me into the OR, putting me to sleep, and then forcing my fingers to bend – and then if that doesn’t work, he’ll open me up and lyse the joint capsules. Which may or may not work but we won’t know for months afterwords. So I agreed, and have been waiting for insurance clearance to schedule it – which probably won’t happen until late October or November.

He wanted repeat xrays though. Sure, fine, whatever. I got the xrays and then went back to work (it’s awfully fun trying to break away for a doctor’s appointment when you’re on service and your entire morning was interrupted for the eclipse).

I didn’t even look at them until the next day, when I was reviewing my patients’ images right before I went to bed. I actually read the report first, because I’ve already stared at my fingers a year ago looking for something wrong and didn’t think that it was going to show something new.

Screen Shot 2017-08-22 at 10.20.22 PM Screen Shot 2017-08-22 at 10.21.10 PM

Can you see it? The fracture at the base of my little finger, slightly displaced and extending into the joint. And at this point is over two months old and likely healed out of place. The fracture that I didn’t even know I had because why would this fall be any different than the last one?

(You can also see my shortened ring finger due to the short bone in my palm, and then many little bumps which are all of the bone growths that I have from my bone disease).

I broke down at work four times the next day, to colleagues that had known about my appointment and had asked how it had gone. I was a mess – honestly, I still am.

I emailed my new doctor, who felt that the treatment for the fracture (which would involve rebreaking it and putting pins in it) would be the exact opposite of what I needed to treat the joints and the stiffness, but again, he won’t know until after I’ve undergone the surgery of whether or not the fracture will interfere with my joint being able to bend.

So I’ve screwed myself over in so many ways and I may never have function of my fingers again.

I think one of the most frustrating aspects of this all, well, besides just the overall awfulness of having a hand not function properly, has been that I have been utterly without resources. In Utah, I had trusted doctors, who when they said I needed surgery or didn’t, I could take them at their word. They knew me, they knew my disease and how it manifested. And here, I’m seeing surgeons who have a passing familiarity with my disease. They aren’t even considering it as being a factor.

I emailed my old surgeon in Utah today, poured out my story in as few words as possible and asked him for a referral, either here or back in Utah (he’s not a hand surgeon. Hands are tricky and small and delicate). I don’t know if he’ll respond. I don’t know if it’ll make a difference.

I’m nervous about the surgery. I’m nervous that the surgeon will put me to sleep and my fingers will just move when they are relaxed and under a neuromuscular blocker and he’ll think that we’ve fixed the problem. I’m nervous that he’ll do the surgery and the fracture really will impact movement and I’ve just caused myself a whole lot of pain for nothing. I’m nervous that the little bone growths really are at the heart of all of this and nobody knows enough to fully evaluate it. I’m nervous that I’ll do all of this and it won’t do anything. I’m angry with myself, for not getting that xray after the second fall (it felt just like the first), for getting myself into this situation. I’m scared that I’m going to have a minimally functioning hand for the next 40 years of my life and what that is going to mean.

posted in Uncategorized | 4 Comments

4th May 2017

dig the grave

Well.

It passed.

The amoral, atrocious, vindictive, abomination of a bill passed the house today. The more I read about it, the more I am horrified. Truly horrified. The media has been focusing on the pre-existing conditions clause, but what has made my soul ache is the complete destruction of Medicaid and the loss of $880 billion in funding. $880 billion. The fact that every single medical society, every single healthcare advocacy group decried it should have meant that they considered the ramifications and had a thoughtful, careful approach to it. But I overestimated their moral conscience.

I’m enflamed and outraged. I am also terribly depressed and worried. I’m not comforted by knowing that it has to go through the Senate, as everybody keeps saying. All this revealed is how much our voices are ignored. I hope that this really does bring change at the midterm elections – but it didn’t when the republicans shut down the government for weeks so I don’t know why this would be different.

A few years ago, I was really into politics – I read about how the Supreme Court worked, I followed different bills and lawsuits, etc. A colleague of mine suggested getting involved in the AAN (American Academy of Neurology), as they have some political leadership courses and I could get involved in advocacy. And 4 months into this presidency and all of those kinds of thoughts have vanished. I’m tired and the thought of getting involved more… I hear that this has encouraged many people of the democratic party to seek office, and boy do I wish them well, and sort of wish it was me, mixed with gratitude that it’s not.

posted in On doctoring, Politics | 0 Comments

3rd May 2017

in the red

I met with my department’s financial administrator today. A year or so ago, my division suddenly had a shortage in our budget, which has meant a year of trying to figure out why. So, in response, I took over in understanding our numbers and working as a liaison with the financial administrator. I’ve spent hours trying to figure out why, met with the billing department, changed our documentation, etc. etc. And found out today that it hasn’t made much of a difference.

Working in the health care business (and not just as a health care provider), has been filled with these frustrations. I work in a academic hospital and there is still so much pressure for better billing and collections. I spend so much time writing notes, putting in accurate diagnoses, making sure that the wording is clear and detailed and it still doesn’t feel like enough.

And it’s only going to get worse with the likely repeal of the ACA, in so many ways. Patients losing insurance again and not getting the care that they need, not being able to go to the rehab centers that they need afterwards, not getting their medications – being a resident in Milwaukee when so many of my patients didn’t have insurance was a nightmare, and I can’t believe we’re going back to that. Our hospital, as pretty much every hospital in the country, has been dependent on funds from medicaid for funding, which impacts the care we can deliver and so on.

The health care debate and debacle has been so stressful that I haven’t been sleeping well again. Having absolute ignorant, greedy politicians refusing to listen to how this impact their constituents, refusing to take their time and make improvements to the system. I hate them. I utterly loath them. I am having a very heard time thinking charitable thoughts about them – and I don’t like that. Even though I’m a fairly hard left leaning person in my politics, I’m also someone who believes pretty firmly in compromise and that there could be value in some conservative values, but this is truly trying.

It’s been months since the election and I’ve had this constant pit of anxiety that never really goes away. I started seeing my therapist again because I wasn’t sleeping and was cycling into a really dark place – that’s improved, with a couple of relaxation apps. My grandfather died when my mom was 15, from a bleeding ulcer and complications related to that, but my mom will say that he worried himself to death. While I know that the two are unrelated, I wonder how much of that worrying nature I’ve inherited.

posted in Uncategorized | 3 Comments

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    • Happy New Year January 2, 2021
      I have been looking forward to days of more sun for a while now. I’m a night owl in general and I find comfort in the night usually. I work so much at night and I love my drives home, especially when it’s a little foggy and the street lamps make halos in the haze. […]