Boards, boards, bored

I have officially moved my test back to July 11th, and it's truly as late as I feel I can take it without going into labor during one of the blocks. Though it might make for a great story, probably won't make for a great score... I took a practice test on the weekend and I'm still not quite where I want to be for this test. The problem is, I have other rather pressing things on my mind that make studying more than a little difficult. Why would I want to stare at practice questions when I could be refinishing the baby dresser, buying those last minute things that I haven't gotten around to yet, putting shelves into the closet, packing the hospital bag, reading the mounds of books I've accumulated on labor and infant care, making frozen dinners that can be easily reheated after we have her, etc.

I would be less freaked out if I felt like this kid was going to term. But somehow I just know that is not the case. I've been having some seriously painful contractions, disturbingly often recently, and not only does it make it hard to concentrate (or sleep or anything productive..) but it makes me worry about getting this test done before we have a kiddo. Yikes.

Not to mention that she's definitely "dropped" and now I truly understand the uncomfortable pregnant woman. Blah. I'm just a little stress ball right now, and hopefully I'll get it together this week so I can relax a little. Anyone have any tips?

PS. The application for residency opens this week. Not that it's stressful or anything....

33 weeks

I don't talk about my pregnancy too terribly often on public forums. It's just kind of a private thing, and frankly, not my favorite experience ever. But I thought I would update folks about the little peanut. She's doing great! Had an appointment this morning and she's wiggling around as usual. As of right now she's about 4.2 pounds (seems shockingly big to me!). My doc thinks she'll probably get to about 7-7.5 pounds by the time we have her. He also thinks we won't make it all the way to the due date, but of course doesn't have a crystal ball and can't really predict when she'll make the grand entrance! I'm ready to start a pool soon, so let me know if your interested! J thinks she'll come on July 26th since that's the date I was assigned to for my meeting with the dean to go over my dean's letter for residency. I think my doc thought there was some dramatic irony in that, would be about par for the course in the past 7 months! I'm just hoping for the end of July so I have all of August to spend at home with her. But, she'll come when she wants to. One can dream though!

As for me, I'm getting to the point where I can't really sleep. I fall asleep no problem but I'm uncomfortable and wake up often. She's super low now and it makes my hips pull apart which is not super comfy. I feel bad for J since I wake him up as well. But I have lots of time to rest today. So it's good. I'm really more rested than I have been in the past year, and a lot less stressed out. Overall, things are good. Now I just need someone to walk one of the pups so I can just handle one of them. It's so beautiful outside and I want to enjoy it. I feel really lucky that as of now, I really feel happy in the heat. Everyone has been telling me how miserable summer will be, but I've always been the type of person who is more comfortable in the heat than in the cold, so I'm just happy I can wear nice loose clothes and enjoy the Colorado sunshine. So far so good!

Happy

Things that make me happy this June:

-I actually took a bubble bath in the middle of the day yesterday, just because I could!
-It poured down rain yesterday with the sun shining. Summer is wonderful!
-Studying for this set of boards is infinitely better than the last time around, and I feel good about learning a lot in the past year
-My dogs are great company! They love me even when I waddle.
-I am already finding time to meet up with old friends. So great! One of these days I will get my big belly to Golden and revisit my favorite places. Then it will really be a perfect June!
-The house is starting to look like a 3rd person is at least on the way. Scary, but exciting!
-I baked cookies on Monday, and they didn't turn out like big puffy pillows for a change!
-I have made and eaten my weight in pasta salad in the past week. I do not feel bad about this. It is delicious.
-It's farmers market season, and the big guy is great company. He's such a ham when we go to all the stalls, everyone has to pet him. He's great, and never pulls me around. I don't think I could so much stop him anymore so at least he's good on the leash!

June makes me happy. It's gonna be a great month!

Heart failure....and summer!

I think I promised a while back to have some less depressing stories from my 3rd year of medical school. I've been saving this one. Now, don't judge. Although I find this absolutely hilarious on some level, it's still sad that there are people who really let things get this bad.



Last week of my medicine rotation we get a consult on a patient who is in kidney failure (yes, I know the title is heart failure). She has no history of previous kidney failure. She has pitting edema in both her legs. Pitting edema is just what it sounds like, you push your fingers into her legs and the imprint of your fingers stays there like a pit. Hers was particularly bad. I was sent in to get her history. You know it's bad when...

"Well, I last went to the doctor about 3 months ago and I was so surprised because I had lost about 20 pounds, and all I had been eating was cheesy puffs. So I figured, if I could lose 20 pounds eating cheesy puffs, it must be because of the cheesy puffs. So that's all I've eaten for the past 3 months."

Me: "When you say that's all you've eaten, do you mean that's mostly what you've eaten?"

"Nope. I am on the cheesy puffs diet. Sometimes I have water, because they make me thirsty."

Far as we can tell, she was on such a low protein, high salt diet that several things happened. The decrease in protein in her circulation allowed her blood vessels to get really leaky and her blood volume got squished out into her interstitium (area in tissues that is not in blood vessels). This made her functionally dehydrated, even though she was full of fluid weight that was making her all puffy (the pitting edema). Her heart was trying hard to keep up with the decreased fluid by pumping faster than it was used to. Over time, this put her into heart failure causing fluid to back up further and contribute even more to her edema. This also made less blood available to the kidneys, which are very sensitive to changes in blood flow. The kidneys were also seeing all this extra salt that made them think the body was very dehydrated, holding on to as much fluid as possible and making her more fluid overloaded, which also ended up in her interstitium. Also over time, this led to renal failure, which was then picked up on routine labs and ended her up in the hospital.

Lesson: though cheetos are delicious and a fun bright orange snack, they are in no way enough to maintain a human being for any sustained length of time. Sorry Cartman.

The good thing, for this woman it's a reversible condition treated readily by protein replacement and fluids. And likely lots and lots of nutrition counseling.

More good news: she'll likely lose even more weight after all the fluid is diuresed from her legs.

The best news: this was actually the day before I was done at this particular hospital, so I didn't have to be responsible for the care of this misguided patient.

Ah memories.

I'm happy to say that my subinternship ended well and that I had a wonderful time. I learned so much and I feel like there's no doubt in my mind that this is what I want to do and that I found "my calling." I find that folks in medicine are always on about where their passion lies and what they are called to do. Considering all the training that goes into medicine, it doesn't completely surprise me that people want to end up doing something that really speaks to them and will make all that work worth it. I'm glad that I've decided to bite the bullet and do that. When I started med school I was pretty focused on "lifestyle" specialties which could afford me a lot of free time and good pay. But, ultimately what I do for a living will have to make me happy while I do it, since so much of my time will be spent working, regardless of the field I enter.

And for now, I'm even happier to say that summer is here and I'm home to enjoy it! Today starts the first time off I've had in some time and I am looking forward to it. So are my feet. They get tired standing for 14 hours at a time. I am taking my Step 2 board exams this month, so it's not a complete vacation, but I think it will probably seem like it! And the way fresh air feels in the morning in the summer is something I'm excited to experience again! I love summer!!!! Shoot me an email or text or let me know when you all have some free time! I'm looking forward to catching up again!