Obstetrical Spanglish, Birth Plans, and Salad Bars

No One Is Going To Read This On A Friday Night…but these little posts each night are becoming sort of a habit. So, I’ll write it anyways.

Today, I reached what might have been the pinnacle of my obstetrical Spanglish.

I was trying to explain to the patient that she needed to push very hard because the baby’s heart rate was dropping after each contraction (recurrent late decelerations, if you want to know the specific term) and that baby would not tolerate labor much longer (and, hence, the C-section she had shortly thereafter).

I think I said something along the lines of “Señora! Es muy importante to empuha with todo su fuerza! Todo su fuerza!”

(Translation: Señora! It is very important to push with all of your force! All of your force!)

I mean, I think that’s what I said.

It was super elegant and rolled off the tongue very nicely.

Along the lines of birth plans, let me say this: there is no crystal ball in obstetrics. As part of the “induction of labor” bedside chat I had many, many times when I did L&D nights as a second year, I emphasized this fact. There is no way to predict exactly what will happen between the onset of your labor (natural or medicinal) and the exit of the fetus from your corpus (either vaginal or abdominal).  You can have a terrible tracing. You can get chorio. Or maybe you’ll get lucky and the baby will fly out (usually with the 2nd or 3rd kid unless you’re really lucky like my former co-resident who thought she was 2 cm with her first baby and was actually 10 cm).

Then again, going against what I said, I do have a very specific birth plan for when I am pregnant. Epidural on arrival. AROM. Pitocin. Delivery of baby over an intact perineum OR ELSE. I also want to go into labor at, let’s just say, 38 0/7. I hope my fetus gets the memo. I would also like it to be approximately 6# 10 oz and in direct OA position (I’ll take LOA or ROA….fine) or else it cannot have Pirate’s Booty until the age of 5. DO YOU UNDERSTAND FUTURE FETUS?!

I’m not asking for too much right?

On a separate note, I had a super exciting Friday night. I went nuts at the Whole Food ssalad bar and bought full fat Greek yogurt (variety in fat percentages in your yogurt really is the spice of life, no?). I have no idea why I am not married.

I also bought a new flavor of La Croix seltzer. For my 30th birthday, I would really like a mini-fridge full of La Croix seltzer that I can solely dedicate for this purpose. I just need to find space in my 425 sq foot apartment for it.

Again, no idea why I’m not married.

Final thoughts: how can a person (such as myself) like olive oil but not olives?

Is this a mystery to anyone else?

Night Night

Until next time…

Until next time…

Senior Resident

I just prepared a presentation for tomorrow. The concept in the article (cerebroplacental ration predicting adverse perinatal outcomes) at first involved some diagrams to understand the metric (see yesterday’s post), but once I understood what CPR meant it was actually a good article to read. More words than numbers. And nice tables.

I remember when I was an intern and I listened to the third years (my current year) give their article presentations, I thought they knew so. much. I couldn’t fathom how I could ever know as much as they did because I was still trying to get a cervical exam right (i.e. that thing people measure with their hands in labor to tell you when its time to have the baby or not have the baby).

I’m still sort of grasping this whole “I’m a senior resident” thing. I still feel like I was an intern yesterday and realized I have learned a lot, but that there is still so much more to know. You can quote me on that. Stitch it on a sampler. Realizing you don’t know everything? Deep thoughts, I know.

Speaking of deep thoughts, today was National Hot Dog Day. I did not partake. Again, the timing and spacing of these food holiday celebrations needs to be addressed. Who do I take this up with? Obama?

I found out that Donald Trump is doing some really ridiculous things – like giving cell phone numbers out on national television. Jon Stewart is really retiring at the wrong time.

Daily Thought: Don’t underestimate the comfort of a workout onesie.

Night Night

Until next time…

Daily Coffee Tally: 2

Animals

7/22/15:

Do all working people feel like caged animals sometimes?

Today, when my co-resident pressed herself against the window and we all longed to go outside for 2 min (mostly do defrost since Bellevue’s AC is blasting in clinic), I thought to myself “we really are like caged animals.” Tied down by pagers and a strong urgency to get. things. done. Preferably, 5 minutes ago .

The benefit of this is not knowing anything that is going on in the world. If we get blown up by Iran, then it will be a surprise to me. And, apparently, Donald Trump said something derogatory (again) about something (are we surprised?). I’m fine not knowing.

What I do know is that math is confusing. And math is everywhere.

I was reading a paper today (two, actually, as I have to prep two articles to present this week). You know what will make you head spin really fast? Reading the statistics in a paper.

For example:  

“In the intention-to-treat group, vaccination also statistically significantly reduced the risk of any high-grade cervical lesions (19.0% reduction; rate vaccine = 1.43, rate placebo = 1.76, difference = 0.33, 95% confidence interval [CI] = 0.13 to 0.54), vulvar and vaginal lesions (50.7% reduction; rate vaccine = 0.10, rate placebo = 0.20, difference = 0.10, 95% CI = 0.04 to 0.16), genital warts (62.0% reduction; rate vaccine = 0.44, rate placebo = 1.17, difference = 0.72, 95% CI = 0.58 to 0.87), Pap abnormalities (11.3% reduction; rate vaccine = 10.36, rate placebo = 11.68, difference = 1.32, 95% CI = 0.74 to 1.90), and cervical definitive therapy (23.0% reduction; rate vaccine = 1.97, rate placebo = 2.56, difference = 0.59, 95% CI = 0.35 to 0.83), irrespective of causal HPV type.

Really cool information but my eyes are very overwhelmed!

Reading papers also makes me still realize that I can’t grasp some concepts without writing them down. Paper to pen is powerful, guys. side note: I still want to buy this weekly schedule notepad. Its graph paper!

Currently..

IMG_6475

Question of the day: How many salted cashews a day is one too many?

Gave up dessert. Replaced that vice with almonds, pistachios, and cashews.

Night night.

Until next time…

Daily coffee tally: 2 (one was even “high elevation grown coffee” which is apparently a fancy coffee thing now)

16 Patients

7/21/15:

Booking clinic was not as bad as expected. I think we saw 8-10 patients (me and my chief resident). We were able to finish by 1 pm, which was good (since the next clinic panels start at 1. I hope my preparation helped. Next week, there are 16 patients scheduled for booking. That seems absurd.

For those not in medicine, booking a patient for surgery can be a long visit. You have to make sure the patient is worked up properly, talk with and examine the patient, determine the surgery they are to have and the mode of such (i.e. minimally invasive, open, etc etc) and then discuss all the risks/benefits/alternatives of that surgery. Then, you have to find a date for them and make sure they get the appropriate pre-op appointments, labs, etc.

It is a lot of check boxes. It is simultaneously type A’s dream and nightmare.

So, 16 patients next week in 3 hours seems like a really…overwhelming and slightly impossible task for one booking panel. My shoulders are creeping up to me ears with tension just as I think about it.

An interesting post about waiting for the doctor: http://raphafamilywellness.com/blog/2013/9/18/why-in-thedoes-a-doctor-schedule-an-appointment-for-240-and-keep-my-ass-in-the-waiting-room-for-at-least-30-minutes

Your thoughts?

Apparently, today was National Junk Food Day. A few days ago it was National Ice Cream. I think we should really space out the scheduling of these “holidays.”

In fact, with the state of obesity in the nation, we probably shouldn’t encourage celebration of sugar.

Speaking of sugar, watch Katie Couric’s documentary, “Fed Up.”

Finally, in my quest for the perfect notebook, I found this cool furniture site: School House Electric and Supply company. I love the industrial desk. And, you know, iPhones are cool and all, but I’m still into pen and paper. If you want to buy my love, you can buy me this weekly schedule notepad.

I’m going to go read about HPV now.

Night night.

Coffee tally for the day: 1.5 (WHO AM I ?)

A New Idea…

…of “micro-blogging.”

I used to love writing all of my thinks on this blog. Then, residency happened and I barely have time to pee anymore, much less keep up a blog.

However, I thought about trying to write a few sentences each day (or, let’s be real, every couple of days…ok, maybe once a week) about my day so I can document this extremely busy, but significant time in my life: residency. It would mostly be my internal dialogue, which I guess is what people do when they keep diaries. I’m a extrovert, so I’m just putting it on the internet.

For instance, today would read as below. Let me know what you think. I’ll keep it up if people (HI MOM!!! HI ALLY!!! GOOD LUCK ON THE BOARDS!) actually like it. Otherwise, I’ll continue telling my all thoughts and neuroses to my friends (HI JOCELYN!!! HI JAWS!!!).

7/20/15:

First day as booking resident. Finished high risk clinic early so I went through and made really detailed notes on all the patients coming to booking tomorrow and prepping the consents. I hope this makes clinic go more smoothly. I made a copy of all of my notes for my chief, too. My hand is really tired of writing “bleeding, pain, infection, damage to surrounding structures” under the “risks” portion of the consent. PSA: the risks of any surgery are bleeding, pain, infection, and damage to surrounding structures. Now that I have done this, I’m sure it will be a whole different panel of patients. I also wrote the consents in blue because the black ink on my four color pen (this is the lifeblood of a resident) wasn’t working. If I have to rewrite them all in black, I might cry.

I booked my chief a really awesome LAVH (laparoscopic assisted vaginal hysterectomy), maybe VH (vaginal hysterectomy- my favorite surgery) and I am really proud of myself.

I like to plan ahead. It decreases my anxiety. For this reason, I have no idea why I went into or love obstetrics, which is the most unpredictable thing in the world (besides the fact that, that eventually, the baby must come out one way or another). I think its because I really love getting people to deliver vaginally if possible mostly because I hate arrest of descent C-sections. I love screaming babies out of people (if they need the screaming). Its like being a fitness instructor, but I think my result is a little cooler.

Boxing and blueberries are having a really big moment in my life right now. Boxing is a hard work out. I love it.

I feel like that girl in Willy Wonka with the blueberries.

I am breaking out in rashes everywhere. The powder on the gloves. The scrubs. I have some KP-ish look thing on some parts of my body and contact dermatitis on my feet. I am becoming so atopic I swear I’m going to have asthma soon.

I am not as tired as I thought I would be after my reverse 24 hr call Sat-Sun. I only had 1.5 coffees today (usually 3-4). This surely means I will be exhausted tomorrow.

That being said, night night.

Until next time…

On Trying New Things…

In the academic medicine world, every two weeks we have a lecture called “Grand Rounds,” which is usually when an expert on something comes to lecture the department on that…something.

One of our speakers last year specialized in surgical education.

Learning to operate is a rather humbling experience. After eight years spent in college and med school, you still go into a surgical residency being an absolute beginner, which can be very unsettling when you have a fancy degree behind your name and feel like a fool and a fake.

Bright-eyed, matched, newly minted MD with no idea how to even sew two towels together...

Bright-eyed, matched, newly minted MD with no idea how to even sew two towels together…

After some time and a few hundred C-sections (if you’re in OB/GYN), certain things start to become second nature and you forgot how you never knew how to load a needle, call for an instrument at a certain step, or throw a stitch.

To be a better teacher, the speaker said she tried one new activity every year that she was a complete beginner at so she could remember how humbling and scary it could be. Waterskiing, improv class, stand up comedy, dance… her list went on and on.

Even though I’m still very much a beginner at many things surgically related, I thought this was a great idea.

Fortunately, there are 500 new things  you could try in NYC on any given day, especially if you’re into exercise. So, I’ve given a few new things “a go,” some of which were rather scary for me, and some of which weren’t.

Trying new things has been pleasantly uncomfortable and empowering at the same time.

Here’s what the were and why you should try something new, too!

YOGA: 

I’ve written previously on my experiences with yoga and how I’m sort of turning a corner with the whole yoga “thing.”

I don’t go regularly so I’d still consider yoga “new” to me. I’ve hit the mat maybe 5 times this year, besting last year’s record of one class.

Yoga was scary for me for two specific reasons.

First, it has become very apparent that I am not good at relaxing or sitting still. I either like to be in a constant state of motion/doing or asleep. Call it adult onset ADHD, fear of complacency or my own thoughts, or just a case of the typical New Yorker mentality, but it makes me uncomfortable to not be doing something.

One reason why I didn’t like yoga in the past was that it might force me to stop for a second and NOT do something. And, what if I didn’t like what I was thinking or feeling while I was NOT doing? THE HORROR. And, then I’d be trapped in a class of other people who enjoyed not doing and just being with no escape.

Second, I have a hard time at letting go of the “I’m good at this, bad at that” mentality. And, truthfully, I’m not good at yoga. I can’t do side crow or go into a handstand without kicking like a gymnast.  I know that every yogi reading this is thinking, “its a practice- no good and bad!” I’m too results oriented and focused on getting “X” right. It is going to take a lot of yoga and maybe a small exorcism to release my inner competitive, self judging self into a yoga mindset. Maybe a trip to the South of France, too, if someone out there would conveniently like to pay for that…

Standing on one's head…doctor approved! Don't ask to see anything else…its not pretty.

Standing on one’s head…doctor approved! Don’t ask to see anything else…its not pretty.

Fortunately, I’ve found yoga that is a bit more playful and fun (thanks to Bethany, Lyon’s Den, and Jessica), and I actually like it and, even more shocking, look forward to it. I know, its weird for me, too, to say that.

The best part about giving yoga a try (again) was actually learning the above things about myself and that it is ok to not be good at something as long as you’re still enthusiastic and working toward that certain something.

Moving on…

BOXING: 

To be fair, “boxing” for me did not mean actually boxing someone. I will not be entering a fight anytime soon. That is, truly, terrifying.

Boxing – meaning that not directed at another person but rather shadowboxing or on a bag – is quite the fitness trend lately. Being the fitness class enthusiast that I am, I wanted to give it a try.

I’ve tried Overthrow, Mendez Boxing, and Shadowbox, my favorites being Mendez (for the legit boxing gym experience) and Shadowbox (for the group fitness class experience).

Boom boom…pow!

Boom boom…pow!

My general take on any fitness class that I haven’t tried is that nothing bad can actually happen to you in a group fitness class. So, why not give it a go?

I'm going to Shadowbox tmw at 8pm -- who wants to join?!

I’m going to Shadowbox tmw at 8pm — who wants to join?!

Boxing is, actually, really fun. Like any fitness class, it can be as hard or as easy as you want it to be and my entire body has never felt as sore as it did after boxing the first few times. But, there’s something very cathartic about hitting a 140 lb bag no matter how technically correct your jabs or crosses are.

Just kidding…I've been boxing since 1990.

Just kidding…I’ve been boxing since 1990.

Boxing is empowering; it helps you realize your own strength and toughness. Its helped me walk a little taller and feel more confident.

If you’re tired of spin or bootcamp, give this one a go.

It’s a damn good workout, too. Giselle is on to something. I will what I want, too!

[PS: My all-time favorite boxing workout is with Jaws at Shadowbox — check it out! She even has a FREE event at Athleta this Sunday. I’ll be working. Go for me!]

BURLESQUE DANCING:

This one I could’ve used an Ativan for prior to going.

Going to a dance class for me is somewhat intimidating because I haven’t danced since I was eight. That’s a 21 year leave of absence if anyone is counting.

But, I always liked dance (and gymnastics, natch). I bug Jaws to teach me dance all the time (sorry, dude). I love learning choreography because its a bit like a game to me (i.e. the “How fast can you pick it up and memorize it?” game.) I will not divulge the number of times I’ve spent trying to learn different dances on YouTube.

Screen Shot 2015-07-05 at 6.38.01 PM

Toddlers and Tiaras? Nope, just a dance recital in Alabama. #grandsupreme

Toddlers and Tiaras? Nope, just a dance recital in Alabama. #grandsupreme

Burlesque dancing, however….

Well, let’s just say the nuns in the Sister Act can shake it more than I can.

It appears even at 29 years old, I have not yet rid myself of the “omg, is everyone looking at me” adolescent mentality.

This was the most uncomfortable and, therefore, probably most important thing I did of the three. I had to pretend a little bit to be something that I’m not (I’d be a terrible actress). I had to push myself out of my comfort zone. I had to, again, be ok with not being so good at what I was doing, but trying my best anyways.

In the end, I actually had a lot of fun and gave the left shark a really good run for his or her money. I’d 100% do this again. (And, a big thanks to Mallory for being so patient and encouraging.) No matter reserved or uncoordinated you are, try dance.

Giving the left shark a run for his money. @mmmallory #fishoutofwater

A video posted by Meggie (@mbsthinks) on Jun 26, 2015 at 6:40pm PDT

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The best part about all of this has been learning how adaptable I can be (if I want to), how you can teach an old dog new tricks (with some limitations), and pushing my the limits of my comfort zone to realize that, truly, there are no limits unless you set them.

Pleasantly uncomfortable and empowering.

Go try something new!

TELL ME: SOMETHING NEW YOU’VE TRIED IN THE LAST 6 MONTHS – WHY YOU DID IT AND HOW YOU LIKED IT. 

[And, if you’re really digging around for something new — come box tomorrow – 8 pm at Shadowbox. I’ll be there!]

Until next time…

The X Factor

An alternate title for this post could be “…and other ways to lie to yourself.”

Lying to yourself can be a very powerful thing.

I remember a sports psychologist telling me when I was 17 that our minds (or, rather active imaginations) make up a lot of stories that we end up telling ourself. As it was pertaining to tennis, “my opponent is mean – I don’t like her” or “I’m terrible, I can’t do anything right!” when I was losing. The more you repeat these things to yourself – true or false – the more they become true because your have now made them your truth, your belief, made it into a real story that you believe (even if no one else does).

I’ve always remembered this and kept it in my back pocket when I realize my mind is working against itself.

[See Exhibit A – mental breakdown over laparoscopy every single day — “I’ll NEVER BE ABLE TO DO THIS! THEY’RE GOING TO REMEDIATE ME IN THIS RESIDENCY! LIFE IS OVER! I SHOULD GET A JOB A STARBUCKS OR FOLDING JEANS AT THE GAP!]

Anyways, training for the NYC Half marathon started off with a bang – 10 miles on New Year’s Day!

And, then, winter happened (and continues to do so, it seems).

It was cold. There was snow. Lots of it. And there were indoor activities, too – like SoulCycle, Barry’s, and Pilates.

Each time I chose something other than running, I knew exactly what I was getting myself into it. I always had some intention of doing a long run. But, it just never happened. Two spin classes in a row is like a long run, right? I told myself that and I believed it.

The week of the NYC Half Marathon I did realize that I had put myself in a tad hole having not run more than 6 miles since 1/1/15.

And, this is where lying to yourself comes in handy. I really like to think of it as spinning the truth, enhancing the positives, but it’s probably a bit more delusional than anything.

Despite not running so much, I told myself I was still in pretty good shape. I [quite literally] run around all day as part of my work description and do exercise 5-6 days a week on top of that. I do a lot of “doubles” on my days off — spin + pilates, double spin, run + pilates, run + spin — so I knew my body could take the amount of time it takes to run a half marathon. The only question would be whether my legs could hold up to that pounding.

And, this is where I came up with this ridiculous idea that I had “the X factor.”

The “X factor” is as follows: working 24 hours straight on a busy labor floor as the lone resident.

If I could do that, 2 hours or so of running was nothing.

I convinced myself that I was this warrior, hardened by the rigors of residency, with the endurance of an….energizer bunny? Someone on steroids? I’m tired and running out of good metaphors.

Somehow (likely a little bit of luck) things worked out and I finished! In 1:50 and change and I couldn’t be happier.

The take home point of all of this can be summed up by one of my favorite quotes of all time:

“The mind is the athlete; the body is simply the means it uses to run faster or longer, jump higher, shoot straighter, kick better, swim harder, hit further, or box better. Hoppie’s dictum to me, ‘First with the head and then with the heart,”‘ was more than simply mixing brains with guts. It meant thinking well beyond the powers of normal concentration and then daring your courage to follow your thoughts.” – Bryce Courtenay, “The Power of One”

Now, if I could just translate this mental toughness into residency and operating we’d be golden (reference back to above daily breakdown over laparoscopy).

In the mean time, there’s ice cream.

Until next time….

PS – Special shout out to JMK for running with me!