Life in Cleveland

Another week of Comp Care (comprehensive special needs care - it wouldn't be medicine if we didn't shorten it to something almost unrecognizable) has flown by. In fact, now we are down to only one and a half days left. It's been a whilrwind, even just from a work perspective. I am not sure which was more dizzying - navigating the commute through the center of Case Western's University Circle or navigating the electronic medical record system. But after 3 weeks, I've got the knack... until I make a wrong turn (either system, just as lost). I am quite sure I know why I didn't take computer classes in college - definitely not my thing. But I'm not sure why I STILL don't have a map of Cleveland. I wonder about this everytime I get lost.

Thanks to Mapquest, though, I've managed to find the friends who've migrated into Cleveland over the past few years. Earlier last week I dropped by Marie (formerly Murray) and her husband Jeff's place to meet the family and have dinner. I got immediate smiles from Moira, a perplexed frown from the one-year old Ella and after a dinner's worth of furtive, side-long evaluations (- Mom, I LOOKED at her!!) Kasha gave in and gave me a green light to come again: I found myself being recruited heavily by both twins to read the bedtime story. Marie intervened, and I got invited back to Sunday Mass & brunch instead. They live pretty close to the Ruics, so that was perfect and I got to spend most of the day with them. Conversation ranges from FBI agents to making your own Christmas beer and maple syrup and crazy ER stories. We had all lines represented: EMS, nursing and physician!

Marie, Kasha & Moira - a mellow post nap moment

Saturday, even out of town, has a way of making itself classic: you can't escape Saturday chores, and you might as well enjoy coffee, bagels, the morning air and good company while you're at it. So Brueggers (not found in Illinois) got paid a call, then all the errands, AND the wash got done - all before company started dropping by around 11:30 for football. Marie is all Michigan, Ed all Ohio. Hannah wore an Ohio shirt and Michigan bib, depending on the parent was closest to her. I went back to my birthroots to side with Marie - and the losing team - since nothing but red and gray... or rather scarlet and gray as I got repeatedly corrected - followed the guests in.

Somewhere in the middle of the last quarter I slid out to attend the one and only Porkulous - the one event in Cleveland where you can witness sausage, bacon and ham being made in the average kitchen. Well, the garage, actually. Enter Ildi & Scott (last sighted by me in 2003 at their wedding!) - their kitchen temporarily became a miniature Penzey's Spices and the garage had enough meat in it to rival a butcher, not to mention send the neighborhood dogs wacky. It was a very fun afternoon and evening. I can't claim any work, but it was a sight.

Also a delightful suprise was walking in and finding not only Ildi but another college classmate and music ministry-mate, Ericka. I met all the husbands, kids and good friends-who-like-making-sausage. It's definitely a community oriented task: don't try turning 60 lbs of meat into breakfast edibles on your own.

Ericka with her Gabriella, Ildi & I with Ildi's boys Xander and Liam respectively.

Now it's back to work for a few more days... I spent part of today at a unique group home / skilled nursing facility for very advanced cases of cerebral palsy. It's an interesting story of how one orphan special needs baby got dropped off at home of a woman named Hattie Larlham, and eventually it became a farm, then an orphanage, now a high-tech rehab - school - nursing home. It's sad to see how bad the cases can be, but encouraging to see the creativity and commitment of the staff. There are even two artists - a painter and a sculpter - who showed us some impressive creations by some of the kids.

So in few days, it's off to NY for Thanksgiving....

Now Cleveland's more than skyline. :)

More great stops on the next Autumn Circuit!

November 23, 2009

~~~~~~~~

Where in the World?

MetroHealth Hospital, Cleveland, IL

I realize that some months keeping up with my location can be like the old game of Where in the World is Carmen Sandiago? You have to piece together names, destinations, county routes and addresses - until I finally pull my bloggership together and get everyone up date. :)

So here I am - mostly in Cleveland this month. I'm working at the hospital above at a clinic for special needs children and adults. It's a busy rotation and I'm seeing a lot of diagnosis that I usually only see in books. The hours are long, but the company is good and weekends are free! That of course means I'm not staying in one place....

When at my current home base, I'm in Cleveland Heights with a lovely family Marie & Ed Ruic, and their 2-year old, Hannah. Jeanette knew Marie from Franciscan. I'm sort of a late evening arrival every night, but Hannah gets used to checking in on me before she goes to bed. Marie generously prepares hot dinner nightly - what a treat!

Fall has been beautiful here, barring a few truly "November Gray" days. The perk of some parking garages is that they give you nice views... the taller one where I usually end up parking on the top floor has a great view of the city. I tried for a nighttime skyline shot, but my camera couldn't quite capture the city lights (given the background lights!). Still, I enjoy the view!

So last weekend I went down to Franciscan and we fortunately had the same great sunshine - it actually was warm. Walks were definitely in order! Donna hosted me (far L), incidentally in the same house in which Justyna had first hosted our Honors' dinner senior year. (They were roommates then.) Justyna and I enjoyed a relaxing Saturday afternoon and her mom served us some lovely meals! As usual, I always learn something new... like pomegranates & feta cheese with balsalmic vinegar makes an outstanding salad and cocoa powder is a fantastic topping for vanilla bean ice cream. (We did talk about more than food!)



Of course, the Blackburn family is the other main attraction! Lydia is the newest addition, so we made acquaintance. Hannah (R) and Cecilia (L) are very happy in their shared role as older sisters. We endeavored to be adventurous and check out local cusuine... Fortunately pizza is really hard to do badly so we had a fun lunch if a little squished in our old-fashioned wooden booth.

We had a lot of fun at the park before I took off north on Sunday afternoon!


Little Cecilia - very ticklish!

That's all for now, folks!

November 11, 2009

Cathedral of Our Lady's Assumption from the Peoria River

Peoria, IL - July 2009

So imagine going through college and your only exam was once a year - one exam for everyone in your major, which you all take at the same time. It occurs on a random day in the middle of the week.

There's no prep or cramming - you're supposed to be studying all year, of course, because this covers every subspecialty imagineable whether or not you have actually trained in it yet. (There IS a study guide based on last year's exam, which the truly test-oriented students actually use.)

Your grade is a mysterious number comparing you not with your whole major but year-for-year with your peers across the nation. Your goal is to hit a general range, improving gradually over your course of studies -sounds almost reasonable, but slightly crazy - because wait - did I mention this exam is 8 hours long?

Yes, internal medicine Intraining Exams are at hand.

Mine is tomorrow - all 8 hours of it. :)

Say a prayer that double vision, spinal cord compression, comatose-like sleep, insanity or other asundry conditions do not set in while surviving the Ordeal.

By tomorrow night, I suspect I'll be doing the classic Kemba-thing (above)!

Jer. 29:11

~~~~~~~~~~~~~~~~~~~~~~

On the Road Again... Omaha!

I-74 over the Illinois River, Peoria

It does not seem like a year ago that I took a cross country trip east in October.. This year I have taken the opposite direction, with a little different purpose. Then, it was reconnecting with family and friends. This year, I hopped into a Suburban with Caron Easley and three little Easleys and made a brisk 6 hr trek to Omaha Nebraska. That was Friday afternoon. It was filled with funny conversations from the 2 & 4 yr olds, Henry and Violet, minor dramas from the same department, entertaining commentary from 6 yr old Annabelle, and great conversation with Caron. The scenery was somewhat obscured by pouring rain, but that didn't really dampen the enthusiasm for the journey. I really am looking forward to the trip back for an encore of such good company - it far exceeded making the drive solo in my tired post-nightfloat state of being.

Currently, I've settled into the Comfort Inn in Omaha for a 9-day course on the natural regulation and management of fertility, woman's health and the psychosocial, medical and ethical issues that all play into this. It's challenging and fascinating. There are a group of Ob/Gynes with a special clinic devoted to this - associated with Creighton University - leading this research.
I come with a healthy mix of curiousity and lots of questions. I think I've had such a broad exposure to so many women's experience that I come in with a lot of ideas about ths particular system's benefits and limits. It's a great opportunity to delve into the medical aspect of things for myself and to meet lots of other (young!) residents, nurses, moms & dads, some older doctors too, becoming practitioners - trained experts who will help teach patients how to use this. Tapping their wide experience - from converts to previous patients (with and without underlying problems) - has shed a lot of light on my questions. I think i'll be putting a lot more work into this in the future, partly because I see so many ways it can be applied and how it needs to grow as well.

In the meantime, I mostly here to learn - not dream - unless that's in bed, where I should be, as we actually have an exam on Tuesday so tomorrow night is study night. :)

~ ~~~~~

All About Watermelons

A brief note to all my fellow gardeners - or semi-gardeners - whom I pestered with the question about when to harvest a watermelon... This is what I found. Of note, the famed sound of a ripe watermelon is NOT hollow, but dull (which makes more sense, given its increased water content).

Thanks to the Univ of New Mexico and their agricultural program:

Picking ripe watermelonsQuestion: How can I tell when my watermelons are ready to harvest? Every year I waste several, picking them before they are ready or waiting so long they are overripe. Thumping them doesn't work for me.
Answer: Choosing a ripe watermelon is a challenge. In the field or garden it is much easier than in the store because you will have more clues. The indications to look for in the garden are the drying of the "pigtail" or tendril closest to the melon on the vine. If it dries while the leaves and rest of the vine looks good, the melon should be ripe. The tendril is not available to melon hunters at the grocery store. A second clue, which is available at the grocery, is the color of the "ground spot," the place where the melon rested on the soil. If this ground spot is yellow or a cream-yellow color, the melon is ripe. If it is green or white, it probably is not ripe. The rind at the soil spot should toughen and resist denting with a fingernail when the melon is ripe. Finally, for those with an ear for music or who can easily distinguish sounds, the ripe melon will have a dull thud when thumped, while the unripe melon will have a tighter, ringing or hollow sound.
New Mexico State University Extension Guide H-216, "When to Harvest Vegetables" is available at your local county Extension office. This publication gives guidelines for determining when to harvest 40 common garden vegetables, including watermelons, cantaloupes, and pumpkins.

Basic Owl Time...

Everyone knows I am apt to go MIA for months at a time. This summer proved to be no different despite hopes to the contrary! Most recently I have been working the nightfloat shift, 7pm-9am for 5 days a week, aka "Basic Owl Time." (So-dubbed by Julie.) I thought perhaps there would be quiet nights where I could caught up on important things, like medical records and blogs, but these proved to be rare and elusive. In fact, when the quiet hour hit I was just happy to catch up on the work from earlier in the night or catch a catnap. The latter happened a grand total of 3 times.

My team had a lot of fun together, though. Entertainment ranged from talking the midnight chef into making fresh French fries (my intern Maxine's specialty) or making coffee & chocolate cake runs, calculating how to correct low sodium levels or run fluids for DKA (diabetic ketoacidosis), or laughing at how our sleepy dictations turn out when the hardworking transcriptionists attempt to guess at what we were mumbling. There have been some choice mistakes - have you ever tried "teething" the details of a situation out of a patient? (I meant teasing out the details.)

As proof that Basic Owl Time is amenable to cross-country travel, disregarding time constraints and zones, I did manage to get out to Maryland to see Julie, Stephen & the boys...

(Speaking of entertainment!!)

And I made it to Chicago for Amy & Clif's wedding, complete with many friends.

In retrospect, perhaps one trip would have been plenty as I have now contracted one of our malignant, nosocomial, highly contagious and persistent hospital viruses. But life does not wait on residency schedules and the trips were well worth it....

So, on we go.... Heading of to Omaha, Nebraska next! I'll keep you all posted.

Today I admitted a 55y-o type 1 diabetic and went suddenly into diabetic mode. ... Then I got wistful about the great outdoor time at camp and all crazy insulin calculations I can now do in my head. (no calculator! My gradeschool teachers would be amazed and proud.) General adult medicine is complex and thoroughly brain-fatigueing in the hospital, but it's almost fun for the same reason. If only we named our teams after Wild West characters. :)

Half-Way Through!

This July 1 marked the official half-way point for the med-peds residents in my year! Of course, it's a momentous day by all accounts since all the new interns start, the previous interns are catapulted from a junior position to senior responsibilities, and the 3rd year "categorical" pediatric or medicine residents have a momentary pause as everyone now greets them with "12 months left!" - likewise the fourth year med/peds residents like my roommate Kate.

Before we hit that day, the pediatric and med/peds residents had a retreat day off to themselves to catch our breath. It started with some standard, but pretty funny, team-building exercises. We learned some interesting things, such as that our quietest resident Marte (middle above) was a rugby player in college (!) and Jane (below left) who wants to do clinic medicine because she's not a crises sort of person started out in emergency medicine.


You may also be encouraged to know that if you happen to get stranded with Lena, Marte and myself (above) in Northern Canada in the winter, when your plane crashes and leaves you with a very limited number of supplies - you're very likely to survive according to the special forces Army whiz that put this together. You'll have to build a fire, wear Crisco as face protection and maybe even eat it.... but you'll have good company. (It helps to have lived in Minnesota and met -40 degree weather.)





On the other hand, if you get stuck with this team of Jane, Chris and Zain, your chances are somewhat slimmer. You'll either have to hike 20 miles by compass with a map that is of questionable value since you have no idea from where you started, or you'll die in rapidly after chocolate-whiskey fondue has given you a temporary high, followed by alcohol-induced vasodilation, causing you to rapidly lose all your body heat. Nonetheless, you'll STILL be in good company... :) (They took this defeat with good humor.)



On to more serious things, Drs Javed and Edwards discuss the merits and demerits of private practice vs pediatric hospitalist work.... Dr Javed is our newest neonatologist and the assistant residency director for pediatrics. Dr Edwards heads up the pediatrics hospitalist service.

Dr Schultz - head of the pediatric ambulatory clinic and newborn nursery service - taking in all the banter and commentary on how times have changed!

The Drs Nulty -

the truly delightful husband & wife team that head up our combined internal medicine / pediatric program. They fall into the category of relatively few people who qualify as being both admirable and imitable!

After a session on legal topics (really nice ones like depositions and being called to court), lunch with the attending panel discussion on Life After Residency (closer for some than others!), we headed out bowling.

Only three of our 7 med-peds residence made it this far in the day, but we scored quite well, Randy and Zain (behind me) making up the bulk of the points! I think I came in not-exactly last.

That rounded out June, my month on the floors. It was a tough but interesting month. I directed a team of two juniors and 2-3 medical students. For the medically or encyclopedic minded, our cases ranged from central line sepsis in a baby with congenital nephrotic syndrome (of the FINNISH type, mind you), failure-to-thrive in a baby with caudal agenesis / sacral regression syndrome who wieghed 1kg above her birthweight at 9 months age, to respiratory failure in a little girl with only one patent nostril ("choanal atresia"), a floppy airway and Freeman-Sheldon Syndrome (one of 15-20 described cases world-wide of this musculoskeletal disorder). At one point every child on our team of 12-16 patients had a complication of a syndrome or cancer - no "average" asthma or diarrhea cases! (Those came later.) We also had some great cardiac cases (all repaired with little post-surgical idiosyncracies)- such as transposition of the great vessels, Tetrology of Fallot and hypoplastic left heart. It was like a board review up close & personal all in four weeks... if I'd just gotten to read about everything instead of working madly to keep up with the lab results!

I was pretty tired by the time July 1 rolled around, but it's a great feeling to come through a hard month pretty well. Like a well-run marathon.

At the end of the month, my friend Rebecca (and her baby Sarah) and I hosted a baby-shower for one of our pediatric interns, Morgan...

It was a fun afternoon to indulge the craft & girlish side of the doctors involved!

So lest you worry when I lapse into long silence, there's always two sides to life in residency. :)

July 12, 2009

Rain & Shine

After all the late winter and spring rains that kept the Peoria River well above the flood level for three months straight, we have finally settled into a gorgeous cyle of showers and sunshine. It's been a lush time for the yard, and work has forced some early risings, so I get to enjoy it at its best! My favorite morning start has been sitting on the front stoop to soak in the sun and a little quiet time...

One morning last month a huge storm had just rushed through. There was such a rosy glow outside that I stepped out to catch some of the post-downpour freshness... and saw this vibrant rainbow!

Immediately, everything running around my mind went quiet. I was in the midst of an especially crazy week on the pediatric wards, somewhat understaffed for the time of year, causing some of the residents to wear multiple hats at once. (Multitasking is not my favorite passtime.) The image of the rainbow cutting through the tangle of powerlines struck me - and all day stayed with me, reminding me of how faithful the Lord is in the midst of the most mundane or self-contrived chaos.

To save my sanity I've put in alot of time in the garden, often before work. There's a great deal of entertainment some mornings, depending on who is up. This particular morning, Kemba came out with me and calmly watched all I did. Being one of the most gregarious cats I know, Kemba's main fault is getting under foot and hand while I'm trying to weed. Occasionally he things sitting ON the plants is the best way to hold my attention. It is, briefly - while he is ousted.

With Kemba's antics comes an audience of blackbirds and - this morning - squirrels. They hover on the power lines and comment on every move he makes. The squirrel, well out of reach of anybody, proceeded to give me a half-hour earful on what he thought of Kemba - loudly, with all sorts of pitches and possibly expletives, punctuating certian points with a bounce and emphatic gesture of The Tail. I had to capture it (though poorly) on film because of his singular perch and opinion, all alone in the expanse of sun and blue.

As of yesterday, the garden is voluminous and very happy. Quite by accident, I located a large zucchini as I was doing a last survey before dinner. We already had the grill going for chicken and veggies, so on went fresh zuchini - with onions and peppers! The results were excellent.

Today has been a pleasantly rainy day. I went into clinic (where I'm supervising the interns this month, teaching them the basics of the clinic routine), only to find there was no work to be done, no interns so teach. It's a new schedule that I'm still trying to learn.... So I wrapped up some paperwork and headed back to my attic retreat for a few hours. That's why your getting this blog update today! :)

With the exception the a few interruptions by the airforce jets, it's been deliciously quiet.

I love raindrops.... on windows, on umbrella's, and especially on flowers, so I went on a browse in the garden...

Then the sun returns...

It's a great month in Illinois.

July 8, 2009

Just Right

There's nothing like a little time in the garden after a long overnight call at the hospital! This evening I went out after my afternoon catch-up nap and completed weeding around my beans and peas. It's just been long enough that there was extensive invasion by the clover, creeping Charlie and other low trailers. The neighborhood was cheerfully noisy, but my yard was pretty quiet. My coffee cup and I were very pleased to have some solitary quiet time with the plants!

Actually, I've made a habit of getting out there pretty frequently. Somewhat like studying, 20 minutes here & there does wonders... I wonder if the same thing would work with blogging? :) Last week Kemba and I were outside one evening (above) and cleared out the creepers around the tomotoes... Then a couple of early mornings - before 6am when I have to leave for work! - I've taken my morning coffee out there to soak in the birds, fresh cool air and early sunlight. Since I am on floors (wards) in pediatrics and the shifts are 12-14hrs, sometimes that's the only sunshine I get all day. I've discovered it's good to be a morning person if your core rotations require 5am rising to get the most out of the day!

Last Saturday I was out there not quite so early, as a day off really does beg for the indulgence of sleeping in. Nonetheless, I beat the humidity and transplanted all of my lettuce and itty-bitty peppers to the main garden, interplanting with the tomatoes and the huge zuchini that has taken off in the center. Having cleared that out, I was left with clearing around the legumes this evening. Next in line: a trellis-ish contraption to get the peas growing upwards instead of other questionable directions!

June 15, 2009

WestCoast Weekend

The past weekend I spent in California with my grandmother. It was really delightful. Slow paced, a little rainy, but warm... Lots of time to enjoy conversation, many cups of tea and pictures, golf tournements and ballroom dancing.

Outside of her window was a wall of roses that filled every sense with color and fragrance as soon as you drove up! I've never been to visit in the spring, so this was a new and vibrant sight.

In between raindrops I ran to San Ramon one evening to visit with an old friend, Jenny. She was conveniently 5hrs south of her home at a conference, which enabled us to catch up over coffee after a 4-year lapse! Thanks to the Soroptomists for that fun little evening. Ironically, although Jenny is a great photographer and we both had cameras, we of course for got to have anyone catch a shot of us together!

We also got in a little run to the nursery and added sunny Mexican daisies to the back porch mix. The last evening if finally got warm enough to sit outdoors and take in the flowers.

It's a great thing to slow down life... Maybe we think you deserve a more leisurely pace at 96 years, but I wonder if more of us would make it that age if we took our usual frenetic pace down a notch.

We'll see how long this wisdom lasts as I return to the hospital routine tomorrow! :)

May 6, 2009

Roses & Texas

Hello from DFW, Dallas, Texas! A four-month lapse in updates is somewhat deplorable but thank goodness for long lay-overs in which to finally mellow out with a mocha latte and play with pictures. :) The humorous part of it is that I'm already two weeks out from my weekend with the ladies in the Roses, my college household. In fact, I'm heading out to California just now, but apparently it takes crossing state lines and official vacation time to allow mental and scheduling space for blogging!

But two weeks ago I actually spent the weekend Texas with my college household sisters...

April is Texas' loveliest time of year, I suspect. It was also much milder and more in-bloom than Illinois was that week! It felt like a true vaction, if only for 48 hours. :)

There is nothing like friendships that have taken root over years (college + 7!) to bring out the best and the most relaxed side of one's personality. It has been a long time since I spent two full days just soaking up friendship... Good coffee, slow mornings, botanical gardens, and superb fajitas and margherita's never hurt! And there's good reason for that. My reading time on the plane today was spent on some essays by Jean Vanier, founder of L'Arche communities. There I found a beautiful comment capturing this:

"Autonomy can be good to a certain extent, but in our community a number of people who wanted to live alone fell into loneliness and alcoholism. It always comes back to belonging....

"... We have to discover more fully that the Church is a place of compassion and fecundity, a place of welcome and friendship.... There are three activities that are absolutely vital in the creation of community. The first is eating together around the same table. The second is praying together. And the third is celebrating together. ...

"... By celebrating together, I mean to laugh, fool around...

to have fun, to give thanks together for life..."

Thanks to Amanda (and Michael!) we indulged in a whole lot of time and laughter together...

And spring beauty!

The Fort Worth Botanical Gardens' Conservatory is really a sight.

Waterfalls... there are always two views!

Botanists have a good sense of humor sometimes.

This tree's name had something to do with fish scales... based on it's leaf pattern.

I think coral-pink was the theme color this year....

Amanda & Baby Johnson #3-on-the-way!

Giant, seriously giant, ferns!

Sunshine would have been a great touch, but the lushness made for a beautiful walk!

The cascading rose garden... (a bit of a hike!)

~~~~~~~

At the opposite end of the spectrum, there's the Fort Hood Stock Exchange!

Get out the magnifying glass...

You'll learn some good details on the Texas Rodeos at the Coliseum.

We also arrived in time to see the traditional evening cattle drive. The way the officers zealously cleared the street you would have thought there would be a hundred fast-stepping long-horns coming down the road.

Not exactly.

Not that I want to get in the way of horns that long, but my general impression was that these may be the retired and geriatric Long Horns.

Makes a great picture though. :)

After that we were off for some excellent margheritas!

(And a more authentic touch of Texas. )

Back to the ranch.

In Texas everything gets bigger. Some Roses get as big as the Long Horns... if they stretch.

Evening run...

And beautiful sunset...

I realized while looking at this beautiful mound of clouds that you can't see much of the sky in most areas in Peoria, so the sunset was a welcome change.

Gwen and the dogs before taking off for Colorado...

"I will not get left behind!" (Not that this has ever happened!)

Lenny and company got the outdoor fire primed for the evening...

(Kelly - it's just me, not a Texas bobcat!)

Sunday we enjoyed Mass, brunch, then a trip to downtown Dallas...

For the history buffs among us, the Sixth Floor Museum detailing Kennedy's presidency and assassination was really interesting. I was also intrigued by the fact that most of the photographic footage was taken by amateurs and snapshot cameras, which were just becoming every-day items. There's only one professional in the whole lot of photography of the event.

6th floor of the textbook warehouse where the shots were fired from... most people think.

After two walls worth of debate documenation, I'm not qualified to make general statements.

On to brighter things... Liz & Kelly en route to ice cream before the airport stops. :)

General consensus: we should do this more often!!

Sunset over Texas

April 17-19, 2009