Adrenaline rush

Yesterday I took the test to become certified in neonatal resuscitation protocol (NRP). Today I found out that I passed (actually made a 100% on the written half). Ha ... turns out that I didn't need a test to tell me that!

Like I mentioned in a previous entry, this month I'm on call every 4th day to deliveries where something is expected to go wrong in a small way that one person can handle. I always have the full resuscitation team to call with the push of a button (which I did twice yesterday), but it's still just me in charge til they get there, and it's up to me to keep these 90-seconds old babies alive. When I arrived to work yesterday morning, I'd never had to intubate a baby before; when the babies are born with meconium (aka "baby's first poop") in their amniotic fluid and are either not breathing or are giving a very poor respiratory effort, we stick breathing tubes down their tracheas to suction out their meconium. Yes, that is very gross, and I'll even admit it as a doctor that I hate seeing babies covered with mec. Some of these kids are just NASTY at birth! In all of the deliveries that I'd gone to for the last 2 calls, the OB team had called me with enough time to get to the room, set up all my equipment, and grab a warm blanket to whisk the baby off to the warmer as soon as the OB cut the cord. All of my babies had done fine with simple suctioning, and I started to joke again about my white cloud that follows me around on call.

Yesterday I didn't have the same luck. Early in the day I arrived to one of the rooms as the baby's head was being delivered, and I didn't even have time to set up my full equipment. The OB brought the baby to the warmer where I was still hooking up the suctioning, and the baby looked horrible! Limp, blue, no cry ... I paused for 1 second, and then my training kicked in.

I quickly suctioned what I could out of the mouth and grabbed my laryngoscope. Where were the vocal cords? (Despite what TV shows like ER may depict, intubation is not always easy -- especially when your baby has a mouth full of nasty.) I thought to myself, "Ok, pull out and try again ... hurry, hurry ... steady ... there they are! Go! I'm in ... no mec below the cords. Okay, laryngoscope out and reassess. Baby not breathing ... let's bag him. Squeeze-two-three, squeeze-two-three, squeeze-two-three ... Keep it up. C'mon, baby, gimme a cry ... still bagging with no response. Okay, let's do it -- hit the Resus button and call the team. Where are they?? Has it really only been 30 seconds? Wait, what is this? A cry? C'mon, baby ... YES!! Good cry!!! You're pinking up!!"

By the time the team made it upstairs, the baby looked great. I felt a little silly to have them there for a pink, screaming baby, but it was better to have them there and have fixed the problem before their arrival than to have waited too long to call them. My heart was pounding the entire time especially since I was the only one in the room who was in charge of this baby. God really brought everything I studied into my mind at this point!

Later in the night (or actually early this morning), I got called to one of the delivery rooms for what must have been at least the 15th delivery I attended in 24 hours. I announced "Pedi!" as I always do when I entered the room and asked for the story. Initially I was told that mom just had an infection ... no other problems. Okay, that's cool; I'm trained to do that alone. I asked if there was mec(onium) and answered that there was not. As I rushed to set up my equipment, I heard someone at the mom's bedside call out, "She's moderate mec." Oh really now? Hmm, I can handle 2 things alone, but I better check and make sure the 3rd element of the so-called "triple threat" wasn't there. "How is the baby's heartrate?" "Actually, since you asked, he's been decelling with every contraction." CRAP. Infection + meconium (a sign of potential fetal distress) + abnormal fetal heart tones = triple threat = resus team = why the heck did they call just the intern??? They should have known better. I radioed my senior resident on call on the walkie we carry to confirm that I shouldn't be there alone, and I was instructed to push the Resus button NOW.

In the meantime (of course), the baby was delivered. It was COVERED in grossness and not breathing. Being the only pediatric provider in the room at this time, I grabbed my equipment and prepped for intubation. This one was harder; I was scared and had a hard time visualizing what I was supposed to see, but I KNEW it had to be done. Praise God, I got the intubation on the first try. Unfortunately this baby did have meconium below the cords and didn't respond at all at first to my efforts. By this time, the team had arrived and took over resuscitation. It was a good thing they were there because this kid needed way more support than I could provide or even than the senior could have provided alone. He ended up doing fine, but it was SCARY!

My whole point is that my life feels like one big test sometimes. I don't study anymore to make a good grade. I study because my patients depend on my knowledge; sometimes they even stake their lives on it. I'm glad I passed when it counts.

I'm not sure what it is ...

Earlier this week I saw snow in Texas for the first time since 1989. I was not in Houston a couple of Christmases ago when it snowed, so I hadn't seen snow since it snowed in December 1989 in Houston. I'm now leaving for work at the fabulous hour of 6:30 (no more 4:45 trips to the hospital for me til I'm a 2nd year!), but it's still dark when I get to work. As I pulled out of the garage one morning earlier this week, some weird white stuff started hitting my car. I called my husband at home (yes, at home!) and warned him to be careful since the roads were iced over and this weird sleet/snow was coming down pretty hard. As I drove for a few more minutes, it lightened up a bit and began to swirl around, and I realized that we had honest-to-goodness snow in Dallas. It was amazing!! I'm such a nerd for getting so excited about snow.

I'm in the Newborn Nursery this month, so I'm taking care of relatively healthy babies by day and then going to deliveries with problems every 4th day and night. It's kind of scary -- some of these babies aren't breathing when they are born, and I'm the only pediatrician in the room! I can call for back-up if I need it, but it will still take the senior resident on call at least 60 seconds to get there, so I really need to know what I'm doing.

In other exciting news, my beloved is home!!!! I didn't believe it until he finally didn't get on a plane Monday morning. It is so weird to come home and know he'll get home several hours after me. It's really hard being on call every 4th night now that he's here and knowing that I'm the one away, but it's so great to see him the following night and not have to wait several days after a rough call night to get a hug from him. He has to go to training on the East Coast for 4 nights next week and will have to go back to California for 2 nights this Spring, but he'll be in Dallas for the majority of the next 3 months. I can't wait to see what marriage is truly supposed to be like!!

I miss ...

I miss my girlfriends. I must admit that I have often been called a loner; I don't "need" people. I like people a lot, but I'm one of those people who tends to forge a few very deep, meaningful relationships instead of many surface ones. Most of the people who truly know the real me are people with whom I rarely speak, but when we do speak, it's like no time has elapsed since we were last together. There are many days when I feel like Colonel Brandon from Sense and Sensibility ..."the sort of [wo]man every speaks well of but nobody remembers to talk to." I get along very well with 99% of the people with whom I come into contact, but there are very few times that I actually bond with someone on a very deep level. Part of that comes from my extreme dislike of the telephone. There are two people in the world with whom I can carry on a telephone conversation lasting more than 3-5 minutes: Scott and my mom. Even my sister, who is one of my very best friends, and I rarely speak on the phone for more than just a few minutes at a time; it's just not my thing unless I know you well and am super comfortable. I don't think to "call up" friends; I'm much more of the "let's go grab dinner and catch up" type. I need the face-to-face contact! The problem is that my close friends are now scattered across the country: Houston, San Antonio, North Carolina, Wichita Falls ... the list is short but important.

I miss these girls. I miss coming to them and laughing, crying, or just gabbing for hours. I miss knowing they'd accept me as I am without judgement but would still nudge me towards the right direction. I miss laughing at old jokes. I miss talking about how we had no idea where our lives were headed but couldn't wait to find out. I miss not discussing politics with one of my best friends whose political views are totally opposite mine because we'd agreed to disagree and then moved on and stayed so close. I got an email from one of my bridesmaids this week, and I welled up with tears when I read it because I felt the ache again of not having that female companionship that I took for granted back in Houston. I know that God provides all we need and will provide me with women of quality in His timing, but in the middle of intern year when I don't have the time to forge friendships since I practically live at the hospital, I just miss that. I miss having girlfriends to grab coffee with after work. I miss coming to the hospital and seeing people I'd had dinner with two nights earlier. I miss going to church on Sundays and seeing women where I knew details of what was going on in their lives; I am so rarely able to make it to church (once a month if I'm lucky) that it's difficult to feel authentically involved with the women there to the same degree which I am used to. The girls at work are great, but I haven't bonded with any of them to the same degree that I did with my med school friends.

I know there is a purpose for all of this, and I know that it is making me a stronger person. I just don't want to forget what it's like to have close relationships with women who live in the same town I do.

A new year

I could bore everyone with a reflective post on all the changes that happened in my life in 2006, but instead I'll leave yall with a list of interesting events from my life over the last two weeks:

• I chopped off 8 inches of hair.
• I was told I can finally get a puppy whenever we move into our house!
• We had our build meeting for our house cancelled for the second time in a month -- twenty minutes before the meeting was scheduled to begin. We then had one of the head builders find out what happened and personally reschedule our meeting to be with him that afternoon. Our house should break ground sometime within the next couple of weeks!
• I stayed up 34 hours straight thanks to my inability to sleep on a hard plastic mattress and my evil pager that went off every 20-30 minutes for the little time I had to lie down.
• I crossed the halfway point of internship. Baby, it's all downhill from here. I also realized that I've learned more in the last 6 months than I ever knew possible.
• I fell in love with my job all over again. I may hate the long hours, I may get frustrated by inane rules and paperwork, I may be driven slowly crazy by parents, but I sure love these kids.
• I discovered that chocolate chip waffles made at home with someone you love can be one of the best dinners ever.

I had a great 2006. 2007 is only looking up.

What goes around

Yesterday sucked. After starting the morning in the NICU at 6 AM, I got "tricked" into a situation that forced me to stay in my weekly continuity clinic until 6:30 PM last night (oh the sheer agony of it all). I was extremely frustrated by the entire situation and wasn't as eager as usual to get to work today.

In stark contrast, today's day at work was fabulous. I arrived in the NICU and checked the patient board out of habit. For about 1.5 seconds, my heart stopped; one of my very favorite patients was no longer on the board. I thought to myself, "Oh no ... it couldn't have happened ... she was doing so well ... wait a second, there's her name -- she moved rooms! She's ACN!!!" For the uninitiated, we divide our babies into 3 main categories: 1) intensive care nursery (ICN) -- the sickest ones who aren't doing so well and need high levels of attention, 2) acute care nursery (ACN) -- babies who still require monitoring but are on the mend, and 3) continued care nursery (CCN) -- little guys and gals who are usually just learning how to eat all their meals by mouth and not a tube so that they can go home. My little one had done so well that after 2 months in ICN, she finally moved down right before I'm about to hand her off to another resident on Monday. It was a great thing to see her doing better. Another one of my very favorite patients also officially made the move to CCN today and is preparing to go home early next week after over 3 months in the NICU; today was just a great day for my babies! Since I didn't have any ICNs to check out at our 3 PM ICN rounds, I got to leave work 2 hours early today -- another FABULOUS thing after my long day last night. Only 7 hours at the hospital today instead of 12.5!!

After that, my day took a momentary dip. I discovered my husband has unfortunately been requested to be out in California for at least an additional two weeks of the new year. Secret translation of his company = ha ha, we got you now; see your wife in June! I know it's not really like that, but I was so upset and so disappointed that I called my mom and just started to cry. I can't even enjoy my marriage most of the time because we're hours and miles apart, and I ache to my very soul without him. As I cried to my mom (who was a medicine widow herself for several years as my dad did his residency), I drove down the road to Target. Then I spotted him ... about 5 seconds too late. The motorcycle cop on the side of the road walked out in front of me as I was going 10 miles over the speed limit and motioned me on to the side street. Oh no! I hung up the phone and rolled down the window. He asked me for my license and insurance, and I asked if I could get out of the car to get my wallet from the back seat. I didn't offer excuses, and I tried my best to dry my tears. I knew I was speeding, and I knew I was wrong; there was no point in trying to argue my way out of the ticket because I knew I deserved it. I was still wearing my scrubs and pager as I stepped out of the car, and when I handed him my license, he asked me where I worked. I told him, and he asked me what exactly I did. I told him I was a first year resident, and the conversation proceeded like this:

Officer: Yeah, you probably really don't need a ticket right now, do you?
Me: Well, no ... (my voice starts to crack and tears start to roll) and I just found out my husband's job in California got extended two more weeks, so he won't be home when we planned.
Officer: (as he hands me my license) Ma'am, please just try to pay more attention next time. Have a nice day.

I thanked him profusely and climbed back into my car. Before I could turn around and drive off, he already had another car pulled over. I couldn't believe it! I was totally prepared to accept the ticket, and the kind officer showed me mercy and didn't punish me for speeding. This incident helped me to put things into perspective and remember what a great and merciful God we have. I can do all things through Christ who gives me strength ... all things.

Head above water

Okay, Todd, okay ... I apologize for the lack of blog material, but everything in my life lately has seemed too serious for an entry or too stupid to waste time writing about it. Add to that my complete lack of time on the computer, and you get no new blog material. Todd, Laurie and Jeanine (whom I would love to meet one day), my faithful readers, here is an entry just for you.

Life is moving too quickly before my eyes. I'm two weeks into my four week neonatal intensive care unit (NICU) rotation, and the things I've seen have blown my mind. It's crazy how little these babies are; it's even crazier the abilities we have to help them. 37-40 weeks gestation is considered full term, and our hospital will make the effort to save babies as young as 23 weeks and as small as a pound at birth (although there is frequently a certain amount of ethical dilemma involved in treating those that little versus letting nature take its course since the prognosis is so poor). I don't think I could do this forever, but now that I've learned the rules of neonatology (totally different from the general rules of pediatrics -- go figure), it's getting to be more fun. I just love the babies; I make it a point to do at least one feeding per call night. Holding the little ones is so relaxing, and some of these babies are just so cuddly! Taking care of some of the extremely sick babies is so hard; you get very emotionally attached to them, and when things don't work out perfectly, it hurts.

At least I'm back on a more human(e) schedule. The first week in the NICU, I was getting up at 4:15 every morning to make it to work by 5 or a little earlier; now that I'm getting the system down, I'm only getting up at 5. It is still weird to leave for work when it's dark and occasionally not leave for home until it's dark again; at least I'm not fighting my circadian rhythm anymore. My husband has been home for a large part of the last two weeks (only gone for four out of fourteen days!), and since tomorrow is his birthday, he gets to stay in town for an extra day. Having him home has been amazing; this is the most time we've spent together since July. I've had the chance to make dinner several nights, and even though it was nothing fancy, it was still great to cook for two. I've already had 3 out of my 4 days off this month, and he's been in town for all of them. We have almost finished the Christmas shopping (thank goodness for amazon.com) and have even put up our Christmas tree. Life has been pretty decent lately, and I'm very thankful for everything that's going on. I have never had a year harder than this one, but in spite of everything, I am still joyful.

Untitled

Ever have those moments when you're so tired, confused, and hurting that you don't know what to say to God but are just glad that He's there?

I'm there now.

Ironic

My husband is going to flip when he reads this. It's totally amazing that I know how to save children's lives and treat their medical conditions (although admittedly I still have years of learning ahead of me), yet I'm forgetful enough to leave my keys in the front door. Some nice lady just knocked on my door to let me know they were there. Yikes.

In other news, I only have three more nights of sleeping at home in my comfortable bed for a while. I'm starting night float on Sunday, meaning I'll be at the hospital from 1 PM Sunday to 7 AM Monday and then from 7 PM Monday to 7 AM Tuesday and so on through Friday morning. I'll be covering the subspecialty services for the next 4 weeks, so I'll be a little vampire! :)

I'm trying to decide what to be for Halloween. Since I'll be spending the night at the hospital, all the residents who are on that day are planning on dressing up. I need a practical costume, but I don't want to spend much (if any) money on it. I was thinking about going as a redneck; I have a camouflage shirt that has my name embroidered on it, but I don't know if that would be politically incorrect to wear that with some pigtails and a John Deere hat. No, I did not pay any money for this shirt; it's a long story, but an ex-boyfriend's mom bought me the shirt and had my name embroidered in tan lettering on the shirt. I've yet to wear it, but it's so hilarious that I couldn't bear to throw it away.

Any other ideas or suggestions? And please don't say "be a doctor" ... I already wear scrubs all the time!

Nine more months!!!!

Ha ha ... no, not THAT. Over the next seven to nine months, we're going to be building our new house!! We put down earnest money last Sunday after church to build a new house in Irving, and we are both so excited. While we were signing the papers, our salesperson was explaining the whole building process to us and going over some of the details such as all the meetings we'll have to attend. She made the statement, "I can promise that there will be at least one point (and probably more) where you are so frustrated with things that you are going to want to walk away. Sarah, you might even come in here crying," [and I probably will] "but I will be here to take care of things and make them right." I thought she was crazy, but just two days after we signed the papers, I was already getting really frustrated with things.

It turns out that the power company (or maybe the cable company) had placed a slab on the lot next to ours that was going to interfere with our driveway, and they hadn't bothered to tell the salesperson about it. We drove by our lot after we'd signed the papers (probably at least the 10th time we'd driven by it) and said, "Huh?? What is that? That wasn't there before!" Praise God that we have a great salesperson; she is in the process of getting us switched to a different lot so that we can be completely happy with our new place. Unfortunately, it's looking like this glitch is going to prevent us from going to the design gallery to pick out all the fun stuff for the inside of the house since this Friday will be the only time in October that my husband will be home on a weekday. :( It's now looking like November before we can pick anything out, and even when we do get to go, it'll be after I'm up all night on my night float rotation. Sadness! I'm sure it will all work out, and this is just another example of God teaching me to be patient (seeing as impatience remains as one of my biggest shortcomings).

I am SO excited though. I can't wait to start creating my little home instead of living in this apartment. I have been woken up in the middle of the night for the last three nights by my loud upstairs neighbor who has a bladder problem and stomps on his way to the bathroom at least twice per night, and last Saturday night we were, um, exposed to the sounds of our next door neighbors, um, becoming, uh, "well-acquainted" with each other. Ick!

All joking aside, we've been praying about this almost since we moved to Dallas. It seemed at first as though God had closed the door on this option to build our house; in August we'd been told there were no more lots on which to build the house we had selected. There were few places within a decent driving distance to my hospital where we could build a new home, and all the ones we'd been able to find were out of our price range. We had almost resigned ourselves either to buying an older home or to having to live in our apartment for four to six extra months while we waited on our house to be built at this location. At the end of September, we decided to take a little trip back out to this development and looked at some different floor plans. We ended up finding one we liked even better, the house could be built on any of the remaining lots, and it was a little less expensive than the house we'd originally considered. Praise God!!

In seven to nine months, we will get to move into a place of our own, and my sweet husband says we can FINALLY consider getting a dog!! I am so excited and so thankful for this. It's still hard having my sweetie gone all the time, but at least I feel like there is a goal in sight now. God is so faithful and answers prayers even in dark times!

Meet me where I am

God bless Bebo Norman. That fella's music has stuck with me through the years! I (along with a large percentage of other young Christian females) used to crank up his music and sing my little heart out in college and in med school as I was searching for the one God had created for me, finding comfort in knowing others were sharing similar experiences and emotions. I cried tears of happiness as an excited engaged woman when I would try on my veil and tiara in my apartment and listen to "A Page Is Turned" and other mushy songs.

Now my situation is different. I'm a Song of Songs 3:1 kind of girl lately. I'm lonely. I'm hurting. I'm having a hard time understanding many things lately. I'm having an extremely hard time effectively living in another city from my new husband (we just had our five month-iversary last week). For some reason, I haven't felt that it's okay to show this side of me to many people including my beloved. I've felt like I'm supposed to show only the happy sides of me and that anytime anyone asks how I'm doing, my response should not contain any words other than "happy" and "blessed." I have a husband who loves me (even if he isn't in the same time zone), a good job, decent health (although it's been questionable at times lately!) ... what should I have to complain about? A while back, I received some well-meaning but really bad advice that I should put on a smile and "support" my husband's job which included not telling him how hard of a time I was having with his absence.

I've since realized that it has done us no good at all for me to put on a brave front if I'm really torn up inside. I need to be real. I can be supportive and understanding without lying by omission. Praise God for His mercy and the healing He is bringing to both of our hearts as we work through all of this. By God's grace and some good timing on the part of my attending, I was able to finish my work early and attend church last Sunday for the first time in a month. In Sunday school, our teacher spoke of "leading prognostic indicators" for marriage. He told us that one is going to bed at the same time every night; I started to cry right there in Sunday school because I miss that SO MUCH. We shared that every night for the first eight weeks of our marriage, and now with his work schedule and my call schedule, we might get to do that four times a month if that much. I stopped the tears and held up through AM service, but when we started to sing one of my favorite Chris Tomlin songs, all I could was whisper the words as my voice cracked and the faucets ran. "You see the depths of my heart, and You love me the same ... You are amazing God."

So back to Bebo ... I picked up his new CD yesterday afternoon and have been completely floored by his lyrics. I've only made it through the first six songs so far because I keep hitting "repeat" so many times. Yet again, God is using the Beeb's lyrics to meet me in my place of need.

"I Will Lift My Eyes"

God, my God, I cry out
Your beloved needs You now
God, be near, calm my fear
And take my doubt

Your kindness is what pulls me up
Your love is all that draws me in
I will lift my eyes to the Maker
Of the mountains I can't climb
I will lift my eyes to the Calmer
Of the oceans raging wild
I will lift my eyes to the Healer
Of the hurt I hold inside
I will lift my eyes, lift my eyes to You

God, my God, let Mercy sing
Her melody over me
God, right here all I bring
Is all of me

'Cause You are and You were and You will be forever
The Lover I need to save me
'Cause You fashioned the earth and You hold it together, God
So hold me now



I'm stuck. I can't fast forward. Yet again he has captured my feelings exactly as I'm feeling in this moment of confusion, pain, beautiful desperate faith, and growth. I can be hurting and still be His beloved child. I'm not cheating Him out of glory by admitting to others than I am living through a rough period in my life. May I find my rest and find my peace in God's arms, not only now in this time of turmoil but also in the easy happy days that I know will one day come.