Favorite Photographs: December

1 Mom bakes bread

2 Taussig Cancer Care Clinic

3 Rain

4 Christmas picture-taking gone awry

5 bus stop

6 gingerbread!

7 phone call to Grandma

8 Thanksgiving meal with Moyer Grandparents

Lately I have become highly interested in knowing who and how many are browsing my blog - so the time has come to reveal your identity. Some of you have left comments but many of you yet remain anonymous. If you read this blog regularly, abate my curiousity by shooting me an e-mail at whenelephantsmuse@juno.com While you're at it, vote for your favorite picture of December and I'll tally the results.

A House-Trained Yak

Hair has become a way of life

I’ve been contemplating hair today. I spent a good chunk of the morning trying to clean it out of our vacuum and it’s been quite the challenge. As one who tries to maintain cleanliness and order in the house, I usually look at hair as a threat, an imposter, something that needs to be tolerated. It clogs up the drains in the bathroom, it litters the floor, it sticks on my clothes, it wraps itself tightly around Maggie’s wet fingers, it settles like dust on the couch.

Growing up at home, my brother insisted that I clean all the hair off the bar of soap in the shower. I laugh at this now – how sensitive we were to a few strands of hair! – how pristine our awareness! Getting married was the first step to changing all that – my hair tolerance has been pushed far beyond what I ever imagined.

I view my relationship with hair in four levels of intensity (so far. I don’t know how many more stages there will be.) Growing up with my brother was stage 1. We both had close-cropped hair and my mother cleaned our house regularly and well. Since he and I were the only ones to share the same bathroom, we lived a relatively hair-free lifestyle. (our older sisters had their own bathroom.)

Stage 2: living with a long-haired wife. This is the stage where you accustom yourself to finding clumps of hair lying on the floor. You also familiarize yourself with drain-unclogging procedures and become increasingly comfortable while “living with hair”. It is not uncommon to occasionally pull long strands of hair off your sweater or coat.

Stage 3: childcare with a long-haired daughter. At this stage you learn that long hair care is labor intensive. As your daughter’s locks grow, you spend more and more time washing, grooming and braiding. Long hair takes a long time to dry. If the hair is fine and wispy, it needs to be combed out twice daily to prevent irreconcilable knots. There are a host of infiltrating agents that thwart hair care efforts: honey, gum, milk, candy – virtually any food. A good game of “let’s play monster by thrusting our heads under a blanket” can completely eradicate 20 minutes of careful grooming. This is the stage where picking hair off things becomes second nature, and third, and fourth. Hair becomes a routine, a lifestyle, a mode of being.

Stage 4: raising a long-haired dog. This is the stage that puts you over the top. You have climbed the hair-care summit valiantly up to this point. You have conceded your obsessive-compulsive cleanliness as much as you possibly can – you have acclimated and adjusted to life with hair – now this! . . . this dog . . . this . . . hairy . . . thing! I will not go into a lot of details here – I feel like I’ve written enough about Dylan. (Let me not discourage any would-be dog lovers.) Suffice it to say that he has placed me in stage four of my hair awareness.

Suddenly, as my oldest sister begins to lose her hair because of chemo – I begin to view hair as less of an imposter. It’s been easy to take it for granted, but hair is a really big part of our identity – it makes us who we are to others and plays a role large enough that when it’s gone, there’s a big emotional impact.

I don’t know what stage 5 will be – raising a house-trained yak? I’m not sure I want to know. But until then I’ll work on enjoying stage 4 and being more thankful for hair, hair, HAIR!

Ordinary Love

if it wasn’t for the years
we had passed along the way
I would have forgotten
your name-
into the idyllic stream we slipped
immersed in our togetherness like nothing
over fetching under
into arms weak with want
into days
into moments
now this-
these years of a lifetime together
of wanting and holding and walking and waiting
of willingness and letting go
walking through you, through me
each of us into ourselves forgotten
we forget how
we forget us
we fight for us
we want-
we yearn for the placeless things
the untouchable, faceless things
the outcast and misshapen-
sidestepping quickly
we are run down in the street
by necessities and eclipses
of other times
their yearning for us
for our seeds
like sprouts on the doorstep-
their consuming
and relentless becoming
out of our failing
our incompletion
our rejoicing among laughter
inside our weakest parts
and out of our love

Confessions of a Young Doctor Post-Call

Olivia reoccupies her childhood landscape

-written by Olivia in January-

Bill Cosby once said, “Give me one hundred two year olds, and I could conquer the world.” They are tenacious and indomitable creatures.

Over last weekend, I was the doc on call. The siren of fear in my head started several days before, and grew to an all-out wail by Saturday morning, when I was up at 5:30 AM to start morning rounds in the well newborn nursery. After finishing rounds, I worked the rest of the morning at the office, seeing sick visits. I had a few hours at home in the afternoon, waiting for the siren to subside. It didn’t.

In fact, it got louder all weekend. The only thing that made it stop was when my beeper went off. My heart would jolt, and the siren would quiet long enough for me to punch in the phone number requesting my reply. I got all kinds of calls, everything from a baby who didn’t want to poop at 11:00 PM, to another baby with a “fever” (temp of 100.2) who was cooing and laughing at 1:00 AM. His Mom wanted to know if she could give Tylenol. I felt like I was turning stones over in the woods, desperately, at breakneck speed, searching for a *real* concern, listening for that tone of voice that might mandate further action.

One six year old’s father called Saturday afternoon. I had seen the little guy a few days earlier, with high fevers and a sore throat. “He is still having high fevers. He is looking tired,” his father said in a pleasant PA farmer tone. I remembered the little Mennonite boy who smelled like dairy cattle. I offered to see him that afternoon before evening rounds. He came into the office, still smelling like a dairy farm, and looking awful. His liver and spleen were huge. “Oh man,” I thought to myself, “my first leukemia diagnosis so early in my career.” The parents were self pay, with no medical insurance. I told the mother we needed to admit him. I sent them to the local hospital with orders for tests that would either raise or confirm suspicions for leukemia. I spent the evening waiting about in the ER for his test results. Somehow it was more comfortable there than at home. At least no one in ER was hoping I’d play a game or make a craft with them.

Sunday morning, the little boy’s test results were negative for mono, but they certainly didn’t support leukemia, either. I was puzzled. I called a specialist and welcomed his input.

Sunday afternoon, I transferred a baby to Geisinger for further eval of some dusky episodes she was having. Her color changes were scaring the nurses. I didn’t have a good explanation for them. I wish I had been a little less hurried when I spoke with her parents.

On Monday, still on call, I went in to the office for evening hours. I was slamming through the rooms (overturning stones), when I entered a room with a Mom and a 2 year old girl. The little girl was pale, greenish pale, but she still wondered curiously about the room, exploring. “Her belly is big,” her mother said. “We didn’t want to come earlier because we didn’t want people to think the bruising was from us.” Bruising? The little tyke climbed up onto the table. Her liver and spleen were huge. She had bruising over her belly and legs. I sent her mother to the local hospital with orders to start some testing.

A few rooms later, I entered the room of a little 2 yr old boy with vomiting and diarrhea for 24 hrs. His siblings were sick too, with the same thing. Sounds like viral gastroenteritis, I explained to his grandma, who trusted me fully as we joked about the amount of laundry she’d been doing that day. His pulse was elevated, but the rest of him looked good to me. He climbed perkily up onto the table. His eyes were bright. His grandma said he had been starting to keep fluids down a few hours before. I sent them home with instructions to follow up with any changes.

After wrapping up the office work at 9:30, I headed to the hospital to check on the little girl and her Mom. Her lab results: very suspicious for leukemia. I called the local specialist, and we transferred her out around 1:30 AM.

I went home, trying to calm myself down for a few hours of sleep. When I walked in the door, Matthew was cleaning Lyric and Maggie’s vomit out of the bedroom. They had caught the same bug as half of my patients. We spent awhile getting the girls back into bed. I think it was 3:00 AM when the siren finally silenced enough to let me drift to sleep. At 4:30 AM, my beeper went off. This time it was the ER. The two year old boy with vomiting and diarrhea had arrived hardly responsive. His labs? Very suspicious for new onset diabetes! He perked up quickly with the help of the ER doc and some IV fluids.

I had diagnosed a new leukemic and missed a new onset diabetic all in one night.

The hardest thing was getting out of bed a few hours later to shower and go back into the office for evening hours on Tuesday. Matthew was manning the fort at home, running load after load of laundry. I vented to my empathetic office staff, poured over the chart of the 2 year old diabetic, and started overturning stones for yet another night.

Yesterday, I got some results for the little 6 year old boy with a big liver and spleen. Looks like he has mono after all. The specialist taking care of the two year old girl with a big liver and spleen says it looks like low risk leukemia. Jokes on me, I guess, but who’s laughing?

I am eternally grateful for the resilience of two year olds everywhere. I respect their ability to take on life and all of its foibles with unbridled curiosity, despite huge livers and spleens, and no platelets. I am thankful that their bodies have enough life left in them to be forgiving of missed diagnoses. Two year olds don’t seem to be bothered by what their doctors do and don’t know. In fact, most of the time, they give me a royal fight before they give me what I want when I’m trying to examine them. I suppose I shouldn’t sulk over my own limitations, but should learn a lesson from my patients and get up and face the day, exploring and throwing temper tantrums at Life. A cream filled donut never hurts, either.

P.S. Who says Gen Peds is boring? The six year old with suspected mono is still having fevers. This is his fourth week of fevers. His labwork is looking suspicious for hemophagocytic lymphohistiocytosis, a very rare complication of mono with a poor outcome. The problem with Gen Peds is not that it is boring, but that it appears to be. I am on call again next week and my neck muscles are tensing just thinking about it.

A Roller-Coaster of Blah

So it’s single digits again outside. On days like today, I feel guilty and relieved that I live in the modern era – after things like insulation and furnaces were invented. I secretly fear the stories I’ve read or heard about – of polar expeditions, of mountain climbing adventures gone awry, of prisoners in Siberia – and what it would feel like to be out in the elements without shelter on a day like this. How long would I last? Would I go insane?

In truth, I’ve never been good at being cold. Whether ice skating, skiing or even just swimming in a lake – my body has never held up well to cold environments. I’ve thought of myself as having poor circulation, although I don’t really know what that means medically. Are my blood vessels too thin or too few? Is my blood pressure too low?

Regardless of how much one likes the winter season, this kind of cold can be wearing. Lyric and I bundle up and stand at the bus stop waiting for that big yellow caterpillar that is always late – sometimes I have to take Maggie out too. (she loves it!) Lyric informed me that Punxatawny Phil, or whatever that pudgy rodent is called, saw his shadow again this year – she even made a cutout puppet of the rascal.

Yes, those of us who live without a garage are tired of scraping snow off our windshields. In town we are tired of trying to park on piles of ice and slush. My dedication to layer up and go out and exercise despite treacherous footing is wearing thin. Dylan is tired of trying to drink water that has turned to ice. I’m tired of paying for heating oil that my dinosaur furnace sucks like nectar to heat this tired, old house.

While my daughter was watching the antics of Curious George, I overheard the narrator refer to the winter doldrums George was experiencing as a “roller-coaster of blah.” I chuckled as this reference struck home. What better way to express these post-January cloud-weary blues?

Maybe if I envision this mid-west version of winter (with its endless freeze & thaw, rain and ice, cloud and gray) as a roller-coaster ride, it will be more fun. At least I know that every ride has an ending – the car pulls to a stop and we get off, albeit dizzy and with our heads spinning.

I’m looking forward to running in 70 degrees again, with sweat dripping down my back. I’m achin’ for spring, Phil, but I might be able to hold out for 6 more weeks.