Call Me Dr. Lisa

Love and Light

2011-11-04T15:52:00.000-07:00

Unexpectedly, and oh so unfairly, Lisa has died.

This is her friend Kim posting on her behalf.

She was doing great physically and spiritually, and yet she went to bed on Wednesday night and did not wake up again. We don't know exactly why or how.

Word has spread throughout her vast community and many people are making donations to her Team In Training effort to raise money for leukemia research. She had been training for a half marathon in January. That information can be found here, and you can donate in lieu of flowers if you wish.

Lisa is now love and light. She is all around us.

Taking my Training to the Pool

2011-10-26T15:47:00.000-07:00

I’m 11 weeks into my journey with Team in Training and I’m taking to the water for good reasons. I have commented several times over the last few weeks about how much pain I’m in. It didn’t always seem like running aggravated it, but any time on my foot definitely did. So, I listened to my body and took my running to wetter pastures. It is helping even if I miss running.

Still, I’ve questioned is this pain the inevitable result of running on a largely de-innervated foot or will it get better? As a Type A personality, I can withstand anything when I have an endpoint or a goal, so again what is the recovery potential? No one knows for sure, but I’m seeking several opinions…

My foot and ankle surgeon remains less than optimistic, and recommended some new palliation treatments that were sadly not helpful. So then we assessed the rate of nerve regeneration and lo and behold a simple Tinel’s sign says that my nerve has continued to grow right on target and has reached the metarsal heads (AKA the ball of the foot, AKA the site of my excruciating shooting pain. This all makes logical sense, the raw nerve endings are exactly at the point of maximal impact during running. Light Bulb goes off in my head, no wonder it hurts SO MUCH.

So, to decrease the impact on my foot, but continue building my endurance for the Walt Disney World Half Marathon I have turned to aqua-jogging which could be a mind numbingly boring exercise except for the amazing support of my Team in Training Teammates. Last weekend a few of us aqua-jogged for just short of two hours, this weekend will be longer. I’ll be in the pool during the week too. We’ll see how long I have to stick to the pool, but it may be a few weeks. However, as long as there is an endpoint I can do it. I know I can.

I remain as committed as ever to complete my first half marathon just short of the one year anniversary of my surgery. I continue to feel incredibly fortunate to be on this journey with some of the most amazing and inspirational people I’ve ever met. I appreciate everyone’s support more than you know.

GO TEAM!

Pain

2011-10-19T20:49:00.000-07:00

Its been 9 months since they cut cancer out of my ankle. 9 months since my 14 hour surgery. 9 months.... I can't believe it. Sometimes I stop and am awed by this fact, by how much time has gone by, by how little time has gone by. Yet still its been 9 months. Physically, I'm healing. I'm proud of having been able to complete 2/3 of a triathlon. I'm amazed that I am training to run a half marathon less than a year after my surgery. These facts make me smile, but I hurt.

For 9 months I have been in pain all day every day, and I'm tired. My surgeon yesterday said this is the harder part of my recooperation. Geez, I figured out months ago. I can power through the physical part, sheer will and determination is getting me back into shape, but this pain is something else. There are mornings that I realize I'm awake when the pain kicks in, nights it wakes me up, evenings that I sit on the couch and won't move because I don't want to take a step. Yet...

My foot hurting means that I have a foot. The shooting pain in my foot and ankle means that the nerve graft took, and the nerve is regrowing. The aching pain in my arch may mean that some of my foot intrinsic muscles are coming back. My foot hurting means there is a chance that it'll recover completely, a chance that this will all become just a memory.

Still I can run again on this foot. I can ride my bike. I can do most of what I want to do. I can make this be OK. I just have to keep reminding myself.

Blessed

2011-10-09T19:37:00.000-07:00

Today I ran the furthest I’ve ever run. I ran 9 miles less than 9 months after my radical ankle resection and nerve graft. My ankle is still healing, my nerve is still regrowing, I still have no muscles in the sole of my foot, yet I run. Every step I take hurts, yet I run. Then I pause and remember how blessed I am to be running.

I am blessed to be on the road to recovery. I am blessed to have dear friends who have picked me up when I’ve fallen over the last 9 months. I am blessed to have parents who dropped everything to spend a month with me in New York while I had my surgery. I am blessed to have remembered that I love my profession. I am blessed to have a friend who’d help me finish a triathlon less than 8 months after my surgery. I am blessed to still have this leg. I am so blessed!

Today, while I was running, I mostly felt blessed to have joined Team in Training, to have met these incredible people who are helping me run further than I ever thought I could. Who are helping me to achieve this goal I have set for myself to run the Walt Disney World Half Marathon a few weeks shy of one year after my surgery. Along the way, I have pledged to raise money for the Leukemia and Lymphoma Society. Along the way I’ve met a group of amazing people, for that I am blessed.

Every Sunday before our runs, someone shares their story of what Team in Training or LLS has done for them, a few weeks ago one of our coaches described joining Team after his mom was diagnosed with an untreatable form of chronic leukemia. He described Team as “saving his life.” I get this, I feel the same way, or maybe just similarly, I get it nonetheless.

I am blessed. I ran further today than I ever have. I was supported every step, every painful step, by my teammates. I feel strengthened by these people who all have amazing stories. I run because I want fewer lives affected by cancer. I run because I need to.

I am so grateful to so many for your generous support. Yes, I am blessed!

Its D- Day...

2011-10-04T13:42:00.000-07:00

..As in D for Doctor!

I last assumed responsibility for the care and lives of critically ill babies on January 10, 2011, nearly 9 months ago. Since that time, I have had a 14 hour surgery, spent weeks in the hospital, months in a wheelchair, months at rehab, and spent 8 months on pain meds due to the constant, constant pain in my foot. I have also completed 2/3 of the Malibu Tri and completed my first 10K run, committed to Team in Training to train for a half marathon.

Some may not understand how i could return to athletic endeavors before work, to those I ask "would you want your baby's doctor on pain meds?" The answer is easy, no way! I committed early on this process this time to not rush my return to work, to not renege on my Promise. I have tried to stay true to these promises.

So, today, I'll put my green scrubs back on and assume care at our smaller hospital to ease me back in. I'd be lying if I tried to deny that I am deeply nervous about this. What if I'm rusty? What if I'm in too much pain? What if my foot doesn't hold up? I could make myself crazy with the "What If's." The truth is I think I'm ready, my partners have given me the support I need in case I need an extra hand. It is time. Even if I feel a little like I am graduating from medical school all over again, except for the fact that I actually know what I'm doing. Still....

Wish me luck, please!

Malibu Triathlon- This is Why I'm Doing This

2011-09-11T16:58:00.000-07:00

The Nautica Malibu Triathlon is in a week. The Fundraising efforts are closing in on raising a million dollars to support Childrens Hospital Los Angeles's Pediatric Cancer Program. Those who read me here or on Twitter or on facebook know why I'm doing this even if I can't do the whole thing quite yet. I'm so thankful to my friend Jason who will compete in the run for me.

Yesterday, I completed my last real training with slightly over a mile ovean swim practicing entry and exit through the surf, tehn simulated start and race distance swim. Then I rode the course between cloud bursts. I fel tgreat. I love that I am back able to do these things 8 months post my surgery, I am awed by the support of my friends and family. However, when I need more inspiration I will just reread this email..

XXXX:

The event is coming up fast, wish I had trained more in June and July. But the event is on my mind in a different and perhaps more meaningful way as I write this note. Just yesterday morning as I was driving into work one of our cancer docs called me to say that our personal family friend’s child who he has been treating at CHLA lost their her battle with cancer. Although the news was devastating, it energized me even more to want to work even harder for making the 25^thAnniversary of the Nautica Malibu Triathlon that much more meaningful.

In just days as we gather on the shore at Zuma Beach in Malibu to test our skills against Mother Nature and our own athletic abilities, I will be thinking about doing my race in honor of our family’s young child. I know she will be looking down upon all the participating athletes and giving them the inspiration to achieve their utmost.

I hate cancer, but I love the feeling of knowing that thousands of athletes and supporters of the triathlon will come together and make a huge difference in our battle to end cancer.

Thank you XXXX…

Remember thsi is why we are completing a triathlon to support Peds Cancer Research at CHLA.

Thank you to all who have already donated. If you still want to donate you may do so by following this link. Thank you

lap by lap, pedal by pedal, mile by mile, mm by mm

2011-09-08T15:50:00.000-07:00

Lap by lap, pedal by pedal, mile by mile I slowly begin to feel more like myself. Slowly that confidence that used to exude from my being but then got replaced by fear, doubt, anxiety has begun to return to me. I am far from being the shape that I was in last year, but as evidenced by the miles I rode my bike and the miles that I ran this past weekend I am even further from the wheelchair bound version of myself of this past winter.

My vanity wants to wear my cute shoes again. My pride wants to be able to be back at work full time taking care of critically ill babies, but not yet. I still must wait. However, with each lap I swam this morning (and there were 80 of them) I could feel my strength coming back. Each mile I run reminds me that I can do anything I set my mind to. I remind myself that great strides and accomplishments are not met by sitting on the sideline by staying with that which is safe. You must risk to achieve. So, I risk. I choose not to sit on the sideline.

Still my real recovery is not measured by the miles I cover in my athletic pursuits. My real road to actual recovery to finding out what will be my new normal is measured in millimeters. As millimete by millimeter the nerve regrows in my foot, the sensation has slowly begun to return to the bottom of my foot. Will I ever recover any strength in my foot, no one knows, but there is reason to hope. So while the rest of my body powers through miles, the nerves continue their millimeter a day progress. And I wait and to build the new version of me whatever it will be.

Pause

2011-09-07T11:23:00.000-07:00

Talking to my physical therapist the other day, we realized that I will be doing my 2/3 of the Malibu Triathlon a few days short of 8 months after my surgery. 8 months, wow! My PT says most people would be barely getting around 8 months after the type of surgery I had. However, I never strive to be most people. Still 8 months...

Thinking back to where I was 8 months ago, a lump rises in my throat, my chest tightens and I remember the fear the anxiety that filled me in that time. I didn't know what they were going to have to do to remove the recurrence of that silly cancer in my ankle. I knew there would be no radiation this time, no other treatment, just cut it all out.

Fast forward, a month or two, I'm sititng on my parents porch still in a wheelchair, deciding that signing up for a portion of the Malibu Triathlon to raise money for cancer research is a good idea. I recruit my friend to run for me and Team Lisa is born. Crazy, maybe, a little, probably, yes, more than a little crazy. However, I needed a goal. My psyche, my health, my sanity needed a goal. Thus, I started to swim as soon as they said I could, I started to ride my bike as soon as possible. I found freedom, peace when I could be on my bike or in the pool. Therefore, less than 8 months after my surgery I will swim and ride in the Malibu Triathlon and my friend Jason will run. He has supported me through out this whole adventure, kept me positive, kept me within my limits. I am honored to have such a friend and blessed to be able to be on this road. I may not be able to feel the bottom of my foot, I may have no muscles left in my foot, I may not be able to stand for more than a few moments at a time, but swim and ride, I can do that!

Still 8 months? Wow, there is a lot about the last 8 months that I'd like to forget, there's a lot I don't remember, but this, as I said in my post about joining Team In Training, feels right to me. It has given me strength and purpose. I'm still shocked when others tell me they find my journey inspiring, because to me it was just about staying sane over these last 8 months. About not letting cancer take anything else from me. I would be honored if you would help me support for Pediatric Cancer Research or any words of encouragement as race day approaches.

Thank you for joining me on this journey.

To donate to the Nautica Malibu Triathlon follow this link.

Ode to my Bike!

2011-08-31T22:33:00.000-07:00

Yesterday evening I ran downstairs, as quick as I could, to get napkins from the garage and suddenly I noticed something missing. Something was out of place. My bike!!! Where the "ef" was my bike? I screamed just as my best friend and her family arrived for dinner another friend upstairs ran down. My bike! My bike, it is gone! Comprehension dawned slowly, somehow, someone had stolen my bike from my garage! I couldn't fathom it! How? Why? When?

I'm not a very materialistic person. I mean sure, I like nice shoes (even though I can't wear them anymore). I like my home, love some things in my home, but if you would've asked me about my most dear material possession, I might have said my bike. We have history. We've traveled miles and miles together. We've fallen in and out of love together. It taught me how to ride better... Gone!!

Today, the police report, the insurance claim, the fear, the anxt- I mean I am doing 2/3 the Malibu Tri in 2 weeks. I need my bike! All of this made me feel superficial. My bike was a possession, I can replace it. Yes, an expensive possession along with all the assorted gear that was stolen too. However, my bike was more than a possession...

I bought it in the run up to my first triathlon. I hadn't been on a bike in 10 years when I signed up for that race. I didn't own a bike, but hey, I thought it should be fun. After months of riding on a loaned bike, I decided I needed one of my own. Enter my bike!

I knew next to nothing about road bikes when I bought it, but it fit my price range and was comfortable and available, so it become mine. That race lead to more tri's, which lead to more half centuries, which lead to centuries. My bike and I became friends. It wasn't a material possession, but it was freedom! It was also peace.

I run for the endorphin rush, I ride for clarity of mind. As I've gotten back to cycling post my surgery I've realized that my bike brings me peace and calmness. I love my bike, that which it represents not the material, bike, I guess.

My insurance will pay for a new one (minus the deductible). I'll have two weeks to become friends with it before the Malibu Tri. I can do that I hope.

Still ByeBye my bike! I miss you!! I can't believe that someone took you from me!

First few steps towards a Half Marathon

2011-08-25T12:50:00.000-07:00

My alarm goes off at 550 am. I groan, Sadie snorts and buries her head in the pillow. I hit snooze and briefly debate staying in my bed. However, when the alarm goes off the second time, I open my eyes and begin my stretching routine that will let me get out of bed. Sadie retreats under the comforter declaring it too early with a loud huff. My puppy may be smarter than me, but it is time to get up to head to my Team-in-Training practice.

More stretching, eating and wiping of cobwebs off my brain, and I'm ready to head off to SantaMonic for a planned 4 mile run. It's a great group of people with a great energy all joining together to run either a full or marathon and raise money for the Leukemia and Lymphoma Society. I'm not sure if I find the fund raising task more daunting or the running, but I'm committed to do both.

Cancer has changed my life, changed my life permanently. I'd rather not have had to face it. I'd rather not be in pain all day, every day, whatever I do. I'd rather not have known it, but I still know that all of the changes aren't bad they are just there. Before I started down this road, I'd let myself get out of shape. I'd put my own health on the back burner in lieu of my medical training, work, other things that seemed more interesting. Since my first series of surgeries health and fitness have been staples in my life. I've complete several traithlons, and am now training for another.

However, its not just about the races, the athleticism, I want to give back to the cancer community that has supported me. I want fewer people to know this pain and fear. I want cancer in all its forms to become treatable, for fewer poeple to die. Raising money for Pediatric Cancer Research as a part of the Malibu Tri, raising money for the Leukemia and Lymphoma society as a part of training for the WaltDisney World half marathon, somehow this makes sense to me. It feels right. I chose to give back rather than kick, scream and cry. (Though, I've done that to).

I'd be incredibly honored if you'd help me support the Leukemia and Lymphoma Society and Team in Training by clicking here.

Before each Sunday morning run we have a moment where someone shares what Team-In-Training has done for them, invariably I cry. But I feel so blessed to have been able to have met these people and to run again on my foot I can't feel. Cancer sucks, but my life is blessed. So while you all are snuggled up in your beds on Sunday mornings and my dog is hiding under my comforter know that I will be running and doing my little part to give back to the cancer community.

Thank you

Back to work, but I miss being a Doctor

2011-08-18T15:49:00.000-07:00

I've been back to work part time since August 1. The nagging pain in my foot, my inability to stand, or move quickly on a moments notice, and the difficulty focusing caused by my pain meds have conspired to keep me from returning to clinical work, but I'm at least back doing something doctorish.

This past week, I've attended several teaching conferences, yesterday during an interesting conversation of complication cardiopulmonary physiology, I remembered that I love being a Neonatologist. That my chosen field remains fascinating and intellectually stimulating to me (even though it is not always easy). That I enjoy teaching young physicians. That my job is far from just a job, it is a career that is a huge part of who I am, and I miss it. I have been blessed to be with families through some of their darkest hours and hopefully watch their babies improve.

I'm probably still months from being able to return to clinical work. The size of our new unit overwhelms me. We are going to have get creative to get me back there, but I will get back. Just as I am starting to run, I will find a way to get back to taking care of critically ill babies. However, I will not return until I know I keep my Promise.

Accepting Limitations is so hard!

I believe in hope

2011-08-11T18:17:00.000-07:00

Two weeks ago, my surgeon in LA told me "I've never seen the intrinsic muscles in the foot come back after being atrophied for so long. You may need to prepare yourself that this is your new normal." What? I can't stand, I am severely limited in the shoes I can wear, I hurt all the time (I mean all the time, ALL day, every day). How can this be as good as it will get. I cried, I called my dear friends and family for support. I grieved this loss. I tried to process it.

After a few hours/ days, I came to the conclusion that if this is as good as it will get for me, that's OK. I have my foot, I can swim, I can ride, I'm starting to run, I can live my life. Yes, the pain sucks. I hate the pain, but I'm still glad my foot is my own. Sensation or no. Someone wanted to cut my leg off, but my tenacity said no there must be another way. So, I had to found that other way, and I'll find a way to make this work too.

Still I held onto hope. No one was saying it was impossible, just that they hadn't seen it. Maybe my doctors in NewYork would have a different theory, different info. I prayed silently in the night for that to be so. My dear friends propped me up supported me, said those prayers with me. I knew I'd make it OK, I just wanted to be told, I wasnt' in this pain for no reason.

Fast forward a few weeks and I'm in New York in my ortho oncs office, she says yes its possible I'll get the muscles back, never as robust, never as strong, but back yes. She says the pain should improve over the next 6 months to 1 year, the muscles may take up to 2 years, but she believes. I believe too, I choose to believe in hope. I choose optimisim.

Malibu Triathlon Again

2011-08-04T21:11:00.000-07:00

Last year I signed up to complete the Malbu triathlon as a way of giving back to the cancer community, a way to raise money for our most innocent cancer patients, children. I felt I was at the pinnacle of health, at least for me. Sure my foot went numb sometimes, and I had other odd symptoms, but I was 4 years out from my cancer diagnosis and certain that it was behind me...

However, a month before last years race, I received the cruel news that no, it wasn't behind me. My tumor had likely returned. I told very few people, I was too scared to admit that my nightmare might be recurring. I trained hard. The race day dawned and I loved every second of it even though the hideous numbness kept telling me there probably was something wrong.

The rest of the story is now well known to those of you who follow my blatherings here or on twitter or facebook, I lived in denial for awhile, then finally got it biopsied only to learn that, yes, my cancer had returned. Yes, I was once again facing possble amputation. Yes, this was a nightmare! I cried, I screamed, but ultimately did what I do best, face it.

Surgery was more extensive than anyone hoped and I woke up begging to be told why it had lasted 6-8 hours longer than it should have. Slowly the reality of what was done to remove the cancer from my foot and give me the best chance at a functional recovery dawned on me. I vowed to fight. Two weeks in the hospital, weeks never out of a chair (wheeled or otherwise), and the deadline for the Malibu tri approached. I had planned to do the olympic distance this year, but now I was in a wheelchair unsure of whether I'd walk again from my own cancer journey.

Still somewhere in my self absorbed brain I knew it was better to face this as a functional adult than a child and that I'd find a way to swim, bike and run again. I didn't know how, I just knew I would. The deadline to sign up was days away. Initially, I said "no way, I can't. I don't know even when or how I'll walk again." I was fairly certain I could swim by then, bike maybe, but to run? that sounded preposterous. I asked a few friends what they thought. "Could I walk the run?" consensus, my ego wouldn't allow it.

Should I sign up to do the race?- My friend Jason replied

"After much thought I would say not this year.

I admire your desire to move forward and not let anything hold you back. I think more than anyone else I know, you COULD do this. Your enthusiasm and sacrifice far exceed most.

I always proceed on the side of caution with these things though. You should take the rest of this year and let your body heal, rejuvenate and get back to where you want to be. There are plenty of tri's to do and I'm sure you're going to kick ass in all of them but for this year just regroup.

This is not to say you CAN'T do this .. you totally could.

I would rather see you fully recover over the next 6 - 10 months and then start training hard for the next season."

His thoughts stuck with me, should I focus on recovery? Or give myself a goal? I knew that he was right, if I set the goal I'd make it, but would that hurt my ultimate goal of health?

My solution, sign up for the race as a team. I asked him if he'd run for me. The next day he told me how inspired he was by my determination. I don't know about that, I was just a girl in a wheelchair with an irrepressable spirit. I asked my friend who'd turned me into the cyclist I was prior to surgery if he'd ride, and thus Team Lisa was born, a mixed relay triathlon team. It hurt to not do the whole thing, but over time I knew it was right. Then a month or so ago, I realized I wanted to swim and ride the race and Jason would run. It felt right. My training has been fun and inspired this year. Everything I do, and have done, for the past 8 months hurts, but training for this race has felt easier, smarter than last year. I've been safe, stayed in my limits and enjoyed it.

So, in 5 weeks time, I will complete 2/3 of the Malibu Triathlon with my friend Jason running to support me in every way as he has done over the last 4 years of our friendship. We do this because cancer won't get me down, but more importantly it shouldn't get any children down. We'll race for me, for health and fitness, but also to raise money for my hospital, Children's Hospital Los Angles's pediatric cancer center.

I am beyond proud to do this and beyond proud to have a friend who will help.

Will you also help us?

To donate in my name click here

To donate in Jason's name click here

Next stop Alaska

2011-06-28T13:31:00.000-07:00

Sitting in an airport lounge awaiting my flight to Vancouver, I think back to that night 4 months ago when my dear friend asked me if I wanted to go to Alaska with her for her birthday. I was at my parents house at the time, high on narcotics, in a wheelchair, all around miserable. June seemed a million years and a lifetime away. A vacation in Alaska with dear friends a reason to get out bed the next morning. Yes, I said immediately. I'd love to. I've always wanted to go to Alaska, the only place I've ever wanted to go on a cruise. It sounded perfect

Now months later, I can't believe that it is reality. In a few hours I'll be in Canada, tomorrow we board that ship to cruise up to Anchorage. I have no idea how it is that it is June already, but I can't wait. I may post pictures of glaciers calving into the ocean, of the wildlife we see, or I may not. Just know that I am so happy to be Alaska bound with dear friends.

An S&M relationship for good!

2011-06-16T15:17:00.000-07:00

I’m in a Sadistic/ Masochistic relationship, and I like it. Now don’t get any crazy ideas, but really I let this guy strap electrodes to my leg, put me in a 40 pound flack jacket and then do exercises, and that is just the beginning. Yep, I’m talking about my physical therapist. Still I go back twice a week because he knows what he’s doing and I’m getting better.

Physical therapy is a funny thing. Recovering from a surgery, especially one as extensive as mine, PT is essential. However, physical therapy can do so much more. I have friends in PT now for dog bites, bad backs, sore knees etc. Sometimes we take how we move and how we exercise for granted. We focus on the big muscle groups or how far or hard we ride/ run/swim as we train. Rarely, does anyone take a break and think about the muscles in your foot, hand, spine etc that makes all that possible. Yet, in part that is the job of a PT. Here’s a few snippets of my journey…

I have a deinnervated foot, half an ankle, a quad that had a section of it removed, and then significant muscular atrophy from months of sitting around doing nothing. The first thing that my PT started working on was regaining my flexibility. Then we progressed to work on my foot and ankle. You can’t stand if you have no strength in your ankle. Think about it. First exercise assigned: Pick up marbles with your toes! Yep, I spent 15 minutes trying to make my little toes that can’t feel and can barely control to pick up marbles and drop them in a pitcher. Good fun, 3 months later, I rock this exercise!

Then we progressed on to other fun ankle strengthening things like, put your foot on a BAPS (solid surface on a ball) and rotate it around. It sounds silly, but week by week my ankle got less wobbly as I slowly learned to walk again. There were all kinds of crazy core exercises to strengthen my back and get my abs back. My BoSu ball and I became best friends.

Soon, I started to be able to upright and the sadist focused on strengthening my ankle and balancing. Thus, I became friends with a lovely pair of shoes I coined “Birkenstocks on balls.” First I just tried to walk on them, then I had to do various odd walks on them with resistance bands ties around my leg. Thus, the S&M relationship began, because really that is crazy.

Then the crazy lunges and core exercises really began. Slowly, my body started to look like what it used to, but still my quad didn’t seem to activate normally through the surgical scar. So, the sadist attached electrodes to my leg and sent electrical stimuli through my quad at as strong of a frequency as I could handle all the while doing leg lifts. I felt like a prisoner at Guantanamo Bay, yet I didn’t reveal any secrets.

Week after week the exercises intensified as did what I was allowed to do outside of the PT gym. Yes, you can swim. Yes, you can spin. Yes, you can ride a bike. Yes, you can get on the elliptical. Aqua-jogging? yes. The yeses began to grow, my strength, confidence and optimism slowly started to return.

Still the sadist always pushed me with a smile on his face, if I started to get good at an exercise he made it harder, up the resistance, up the weight, do it standing on a foam pad. He pushed, I laughed and set out to meet the new harder version. Thus the masochist in me is fueled.

He started having me do lunges wearing a 40 pound weight vest. Then other exercises in the flack jacket. He wanted to load my Achilles so that I could prepare to run. I now spend an hour at PT wearing this 40 pound vest. Craziness I swear, yet I do it. Sometimes, we jest about the combo exercises. One day as a lark he said- stand on one leg on a foam pad, wearing a laser target, vibrate a body blade and throw a ball against the trampoline. My prize for this stupidity, no BAPS board that day which is the true Guantanamo Bay exercise.

I go, I go twice a week. I spend 3 +/- hours there and I do whatever he says. My reward, today he had me run on a treadmill. 5 months after my surgery and I’m starting to run again. I’m well on the road back. It feels great. I’m good with this S&M thing we have going on!
I'm also incredibly thankful to my PT Jonathan for travelling this long journey with me!

Are Physicians really Bad Patients??

2011-06-01T23:41:00.000-07:00

Are doctors really worse patients than non-MD trained people? I have given this question a lot of thought and have yet to reach a conclusion. However, I’m going to start sharing some of my thoughts…

I thought about this the other day as I headed to my dental cleaning, a dental cleaning I was 4 months late for mind you. Also, this was my 3^rd medical appointment of the day, plus an hour with my personal trainer. Yep, it was a day of Lisa. Funny thing is most days these days are “days of Lisa.” MY medical appointments fill the functional hours of most days, and I hate it, and maybe that is my point.

Why do doctors have a rep as being bad patients? Often, that rep stems from being non-compliant with their treating physician’s orders, their medications or their follow-up. OK, maybe just being non-compliant in general. I have tried really hard to be a good patient, but it is hard (oh so hard), and this is my full time job right now.

So, as I drive from appointment to appointment, I question why is it hard for doctors to be compliant? At first I thought maybe it was the years and years of training where your schedule is not your own. I personally spent 6 years in post medical school training, and I can’t even tell you how many appointments were missed because of unexpected emergencies, how many teeth cleanings were cancelled. I won’t mention how long I went without certain standard screenings. We were taught in medical school, and in our training, to put our duty, our patients, above our own health. Even as our mentors would espouse that in order to be good physicians we have to take care of ourselves they would make it difficult for us to be released from duty to take care of our own needs.

Henceforth, for years we are taught to put off our needs. Whether they be simple needs like eating, using the facilities, or making our own appointments there was always a patient that had to be seen. It is a part of the profession, but does it subliminally train physicians to put off their own care in order to focus on their patients?

As I examine my own life, I have realized that I have often rushed my recovery from injuries. Four days after breakng my foot still non-weight-bearing on crutches, I was on service in the hospital responsible for 30-40 patients and new interns trying to crutch around ahospital larger than 2-3 average city blocks. My attendings would laugh at me seated at the central nursing station with my foot up so I could be available, most days my colleagues would take the code beeper since I couldn’t get anywhere very fast. Yet, I was there bright and early every morning even though I had to pack to move across the country to start my fellowship through it all. I never considered calling in sick, how would that have worked that then? Nothing bad happened, but I shudder to think of the possibilities if I couldn't have responded to an emergency on time.

After my first go-around with cancer surgery I returned to work a few weeks after being cleared to walk again post radiation. I was far from being ACTUALLY able to handle the rigors of my job and returned to work in a non-clinical status, but returned all the same. I fell asleep on the floor playing with Sadie that first day back. The first time I took call my foot was still so stiff upon waking that when I was called to a code in the middle of the night, I had to hop down the hall to respond. I could hop pretty fast, but…

So, this time, I vowed to myself that I would take the time needed to heal myself before returning to work. I have refused to feel guilty about that. Every morning when it takes me 5 minutes of stretching to get out of bed, I know that I am far from being willing to be responsible for a baby’s life when I can’t respond quickly enough. I am making great progress, but I am far from being ready to do my job, to accept responsibility for a child’s life. I’m giving myself this time, and I can only hope that when I return to my profession I’ll be ready for it, because I do love my little charges!

I am learning to accept my limitations and take care of myself. I know that when I return to caring for babies this will make me a better physician.

Believe in Hope

2011-05-13T15:38:00.000-07:00

My worst fear heading into my surgery was that they would have to sacrifice the posterior tibial nerve. That nerve provides sensation to the bottom of the foot and to the muscles in the foot. Without that nerve, you can't feel the bottom of my foot or really grip your toes. That fear was realized when they discovered that my tumor had infiltrated the nerve. My surgeons almost stopped the surgery to talk to me when they discovered this, but after meeting with my parents and best friend they proceeded to do what needed to be done.

When I was in medical school, we were taught that once a nerve was removed it didn't grow back or grew back so slowly and in a disorganized fashion, and thus once such a large chunk of nerve was removed it was gone forever. However, in the intervening decade plus medicine has advanced such that we know it is possible for a nerve to regenerate, but it needs a roadmap. Thus my surgeons did a nerve graft to provide the posterior tibial nerve a route to travel. I was told to watch for a slowly progressing Tinel's Sign. Tinel's Sign is a shooting pain along a nerve that is irritated, which a growing nerve would be.

I have been afraid to believe that this is working and this current state of a numb, non-functional foot developing hammer toes, wouldn't be my life forever. I have tried to convince myself that I can learn to get used to this, that it is OK that my toes will never grip a shoe again. I mean who needs to wear slides, who needs flip flops. Sadly, I haven't been doing too well at convincing myself. I still pray every day that there is another option. But I have been afraid to hope, afraid to believe it, almost afraid to even pray.

Today, as I walked up my stairs, I was getting shooting pains into my foot, so I stopped and carefully tapped up the route of the nerve, consistently I could reproduce the sign. I looked at my roommate and asked for a tape measure. We measured how far from the edge of the scar the growth was, converted it to millimeters and came up with 112. I could consistently reproduce the Tinel's sign 112 mm from the edge of my scar, a nerve grows at the rate of 1 mm per day. So, I pulled up the callendar and counted the days since surgery, 112 days. I had the surgery 112 days ago. The reality slowly sunk in. I couldn't believe it. I could believe in hope again. The emotion overtook me, I started to sob.

I've been so afraid to believe, to hope, that the nerve would regenerate; that I'd convinced myself it wasn't. However, there were the numbers staring me in the face. It's right on target! I can believe in hope again!!! I like hope!

Roses

2011-05-09T15:13:00.000-07:00

Last night, I walked up the stairs to my house and looked at my rosebushes. They needed desparately to be deadheaded, but still there were some beautiful roses. I decided to pick a few to bring their fresh smell into my house and to bring me some of the joy that I always feel in my garden.

Of course, I couldn't help but to do a little trimming of the dead blooms, but still I managed to pick myself a small bouquet of roses to bring in. These included the best smelling roses ever. A simple action, but it makes me smile.

I was once told to find something that makes you smile and make it a part of your daily life. Or to stop and smell the roses. My roses make me smile, so I brought a few into my house!

Hope you all have soemthing to smile about every day!

Spin me Right Round Baby Right Round

2011-04-12T22:17:00.000-07:00

Two months and a few days ago my OT in the hospital shocked me by saying I could take a shower. It had been almost two weeks since my surgery and I'd barely been out of bed since my surgery. I had had nothing but sponge baths for two weeks and thus the water, the emotions of something so simple, so amazing. I sat in that shower and I cried. I mean, I, me, actually sobbed. (if you know me you know that is rare)

Fast forward 10 weeks, my shower chair is in my garage, my crutches stand in the corner of my room like soldiers, my house is slowly returning to order, these markers that I am getting back to myself each give me pause to think about, yet I want more. Always, I want more. Every time I pull into my garage I see my bike sitting there waiting for me, taunting me. I can't quite describe how much I want to go for a ride or a run. It is funny how much a part of my life that has become in the last few years...

Two weeks ago, my PT said I could ride an exercise bike, I looked at him in dismay, really? 15 minutes in I was exhausted, my cardio, my stamina were all lost. However, persistance is my middle named, so I pushed. In a little over a week, I could do 45 minutes on the bike with hills. Yesterday I sheepishly asked my PT when he thought I could start to spin again. He said, why not now? Give your days a few days of rest and by the end of the week you're good to go. What? Really?

It felt like getting something back that I had lost, a skilll, a hobby I used to take for granted. It felt a little like getting to shower for that first time, something so fundamental. It felt like a return to me. I declared it on twitter and on facebook with glee in my heart, then I sat in my car and cried. It has been a long few months, but I have come so far. Sometimes I need to remember that. Sometimes I just need to cry

Shoes

2011-04-08T07:17:00.001-07:00

Yesterday, I went shoe shopping…. I've written about shoes before. Who knew shoes could be so important? Alas, I am a well shorn woman.

Two months after my surgery which removed all sensation to the bottom of my foot and left me with thigh fat where my skinny ankle used to live, I’m walking. I’m riding a stationery bike. I’m exercising 1-2 hours/day. I’m doing lunges wearing Birkenstocks with balls (more on that later). I’m on or ahead of schedule, but I miss my shoes.

No outfit is complete without the proper foot adornment. My shoes were a reflection of me. I love shoes. Yet lately, I’ve been wearing only a limited number of orthotically correct shoes. Cute, sexy, they are not… Except maybe what my friend Jen calls my sassy boots. Still these are functional foot adornments.

They are a far cry from the last 3 pairs of shoes I bought. Le Sigh, the life of the well shorn professional is not to be mine for awhile.

So, shoe shopping yesterday...

The goal find shoes that I’m not embaressed to have on my feet and are comfortable for my poor abused Lefty. This is not an easy task I tell you. Enter my dismay that Ugg now makes sandals. They are comfortable and they are not ugly. Actually they are kind of cute and there are some that I might be able to get to adorn my foot for an upcoming wedding.

Alas Shoes.

Outsourcing for Good or for Bad??

2011-03-25T14:08:00.000-07:00

I'm a do-it-yourself kinda girl. It's in my genes, my parents and my brother all do the same thing. I can't help it, or maybe I can. Who kows I'm working on it.

Case in point: I fired my garden a few years ago, because I knew I could do a better job. Before I moved back home a few weeks ago, my garden was full of weeds, sad and neglected. Between being away, not being able to walk, life etc. there just had been no time for gardening. I love to putter in my garden but pulling weeds isn't fun. A friend has taken to sending me a gardener to deal with my yard. A precious gift. Outsourcing a gardener is a good call, now i just need to find a new one to do my yard on a regular basis. See, I'm learning.

Further, case in point: I like to sew, I have recovered most of the furniture in my house so that it matches my color scheme and my style. It is a laborious project, but one I enjoy. I've recovered couches, made chair cushions, recovered more chairs than I can remember. I bought fabric a year in a half ago for curtains for my dining room, that fabric is still folded up in my closet. Sigh, one more project for me to do in my new found spare time. I'll get it done I swear and no I won't outsource this one. (yes, I fully realize I could buy curtains in a fraction of teh time and energy required to make them, but that is not the point, sillies.) Outsourcing curtain, good idea, but not going to happen.

Lately, I have had to outsource something else, walking my beloved dog and constant companion Sadie. I love my nightly walks with Sadie. Really all she wants from me is some attention and a couple of walks a day. That is what being a dog is all about. However, I can't really walk right now, so someone else has to take Sadie. Therefore, I hired the dog walker that my friend who kept Sadie while i was in New York uses. He knows her, she likes him, it seemed like a great idea. However, when I am home and he comes to get her, she doesn't want to go. Hello, my dog doesn't want to go OUT? He says if I'm home as soon as the business end of the walk is done she just wants to get back home to me. Talk about a bonded puppy. It makes me sad to be outsourcing the one thing she wants from me a day, but what am I to do. I've taken her for a couple of walks with my crutches and the poor dog is afraid of the crutches, but desparate to go out. talk about doggy PTSD. So, I persist, I'm not outsourcing my dog, I'm taking care of her right?

I could go on, but you get the idea I like to do these things, but there are only so many hours in the day and one of me. So, some things get pushed off. It is the way of things. I'm getting stuff done that needs to be done. Some things must be outsourced, some things can wait. Maybe next year, I'll even hire an accountant to do my taxes, maybe? Outourcing is good. Learning to ask for help is a big step forward.

Such is the ying and yang of life.

Two Months

2011-03-21T19:01:00.001-07:00

Two months ago, I was wheeled into an operating room after kissing my mom and best friend good-bye. I had signed a consent for what felt like everything short of amputation, and a separate consent for all types of reconstructive options. The truth is I didn’t know what they were going to do, my surgeons didn’t exactly know what they would do until they saw how big the tumor was. We had agreed that if possible without significant long term risk, they would spare my posterior tibial nerve, but it looked like the tumor was surrounding it. Therefore, I knew there was a real risk.

Thirteen hours later I woke up and looked at my parents and said “what happened to me?” They wouldn’t tell me. I cried. I knew the surgery had been bigger than planned, and I knew I was in horrible pain, but I didn’t know what they had done to me. All night long the nurse wouldn’t give me details. I slept no more than a few minutes at a time due to the pain, and them dopplering my ankle to make sure there was still blood supply to the graft. As morning dawned, I asked everyone what happened to me. Finally, my surgeon explained to me that the tumor was bigger than expected, that she had to remove all the soft tissue in my ankle including the nerve, veins and the artery. However, they had done a nerve graft in hopes that the nerve might grow back. In hopes that someday I’d feel my foot again.

Processing that news was hard. My drug addled mind couldn’t compute it. I got through each of the next days with the help of my family and my friends near and far. Now two months later, I’m still having trouble processing that I can’t feel my foot and that that may be my new norm.

Still I make strides everyday. I’ve been swimming again for a week. I work out as I can preparing the rest of my body to help Lefty out. I’ve taken several steps without my crutches, but I hate the feeling. Today, I walked my dog around the block alone for the first time in 2 months. We both loved it. These strides forward should be written on a calendar.

In 2 short months I’ve learned a lot about living with a numb foot even while I test for nerve growth once a week. When I look back on the last two months I know that what I will remember is not the pain, not the hard times, but the support and love of my friends and family. Looking back is always colored by how you choose to look at the past. Recently I’ve had a reminder of how precious life is, and the fact that I have a numb foot suddenly seems like just one more thing to get through. Time does give us perspective. Time does heal wounds. Time will even make me think its OK to walk on a numb foot.

Lap by Lap, yard by yard, I feel more like myself!

2011-03-17T22:13:00.000-07:00

Last year at this time I started training in earnest for the Malibu triathlon, and I had to force myself to swim. By that time I was riding and running regularly, so I was pretty confident there. However, it had been a couple of months since I'd gotten in the pool. So, I declared it time to swim. First time in the water I easily swam 2000 yeards, so I was fairly sure the distance wouldn't be a problem, but open water swimming is totally different. So, I prepped to train for the ocean. I started in a protected bay and slowly moved to the Pacific. Open water was hard, but I pushed through it.

Whatever the venue swimming has always provided me a place of comfort, of escape. I used to joke that it was the only time in my overly connected world where I was truly unreachable. I joked about this, but it is profoundly true. I run with my phone on my waist, ditto on my bike. When I swim the phone is safely locked away from that corroding water. I am unreachable. Sometimes I relish in that.

I happily proclaimed on twitter and facebook the other day after I was finally allowed back in the pool, "lap by lap, yard by yard, I start to feel more like my old self." I thought about why I felt this way. Was it the return to some form of real-ish cardio for the first time in 2 months, maybe. Or just the return to the order of exercising, training for something, maybe. Or was it the simple stillness that swimming in a pool is, possibly. Whatever it is, being back in the pool feels fantastic. I can only imagine how great it will feel to get back on my bike, or to run (if I'm ever allowed to do that again).

Still there is something about swimming, especially in a pool. To me, it is rote muscle memory. Lap after lap, stroke after stroke, same thing over and over again, your arms propel you from one end of the pool to the next. You can hear nothing but your breath and the occassional splash. You focus on your breathing and your forward progress, you see only the black line beneath you. To me, it is made for meditation, or for a clairty of thought which is a form of meditation itself. According to yoga philosophy during mediation you are both observer and observed. Iyengar says, "Meditation does not make the dull. Rather, in meditation the mind is still razor sharp, silent but vibrant with energy." Further, according to yoga philosophy, when in mediation time should have no meaning. I'm not sure I can reach that level of clairity while counting my laps and swimming away, but I know that I see things more clearly when swimming and that time has no meaning. I lose myself in the water.

All this begs the question, is my missing of my exercise routine, missing the exercise or the clarity of mind? Missing the place of protected isolation that allows for me to see my life clearly? Maybe I should meditate on that? In the meantime, i'll keep swimming!

The Promised Land

2011-03-12T16:11:00.000-08:00

Sometimes I feel so weak I just want to explode

Explode and tear this town apart

Take a knife and cut this pain from my heart

Find somebody itching for something to start

Bruce Springsteen, “The Promised Land”

When I originally returned home from New York, I wanted to go to my house. I needed to pick up some items, but mostly I just wanted to be in my house. I stood at the bottom of the stairs and looked up. Could I make it? How could I be so weak? This recovery road is long, but bullheaded I was I determined I had to try. I made it up the stairs exhausted, and then I needed help to get back down. Clearly, I wasn’t ready to move home.

Fast forward a month later and through the benefits of physical therapy and exercise the stairs while still daunting are able to be scaled without too much thought. The time to move home has arrived. While being fortunate enough to have been given the time and place to heal, I am ready to move back to my house.

So say goodbye it's Independence Day

It's Independence Day

All down the line

Just say goodbye it's Independence Day

Bruce Springsteen, “Independence Day”

Thank you so much to my parents for providing me a place of respite and care to allow me to heal and get back to this place. I can only hope that my progress will continue at the same pace.

Driving

2011-03-04T17:41:00.000-08:00

I remember turning 16. I don't remember if I had a party, though i assume I did. I don't remember what I wore or where we went. I don't remember any of the adolescent drama that I'm sure seemed tres important at the time, but I do remember...

Rushing home from school to get in our family's old Chrysler LeBaron station wagon to go get my drivers license. I remember waiting in anxiously in the car to Take my behind the wheel test afraid of parallel parking between cones. I remember making sure I knew how to do a 3 point turn. I remember these things across the expanse of time. A car meant freedom or a little of it. It meant, going to the movies with friends, the mall, swim team practice, etc. It meant my mom no longer had to shuttle me everywhere.

This past Tuesday I awoke with that sense of anxiety, anticipation, joy at what the day held. I was off my pain meds and thus could drive again. We'd agreed we'd pick up my car after PT. My mom worried and fretted probably not unlike when I was 16. Still I drove us to PT, just to check. All good we proceeded to pick ip my car. That little bit of freedom, independence returned to me. I was so happy, I couldn't stop smiling. My car, the ability to drive, I will never take it for granted again.

Afternoons with Mom and Dad

2011-03-03T12:43:00.000-08:00

I've been on this recovery journey for almost a month and a half now. I got released from the hospital just over a month ago. I have had long hours to fill while I am able to do very little. I've had visits from friends, gone on outings for tea, burger/ beer /and sports, dinner, etc. However, I still spend most of my time with my parents who are graciously caring for me. Along this journey, I've spent a couple of afternoons with mom and dad getting otu of the house and into nature in whatever way possible. These days have both come at good times and boosted my spirits.

An afternoon in Central Park with my Dad:
Shortly before we left NYC, the mercury finally topped freezing and so my dad loaded me in my wheelchair and we headed off to Central Park.

Thus, prepared for the cold, with Lefty wrapped in cashmere and me covered in a blanket. We headed out to take in what the last few snow storms had done.

We even bought the roasted nuts from the street vendor. Dad and I both relished time outside. I insisted on helping to roll me up the hills. He managed to not roll me over his toes on that day!

An afternoon with Mom at The Huntington Gardens:
Back in SoCal, we arrived at my parents house just as the camelias were in full bloom. I asked if we could spend an afternoon at the Huntington Gardens to explore their camelia gardens. The Huntington is just a few short blocks from their house. Yet somehow we didn't make it for this outing til yesterday. Mom and I headed out. I swallowed my pride and agreed that the only way I could explore properly would be in my wheelchair.

The camelias didn't disappoint.

The Clivia were amazing.

The Chinese Garden beckoned me, but the hills were daunting, so we'll save that for another trip when I have two legs for locomotion.

Mom enjoyed it too.

These days are special memories in a world of pain and frustration. Thank you will never be enough, Mom and Dad.

Two shoes!

2011-02-28T19:00:00.000-08:00

When you stop and listen, you hear amazing things. When you stop and smell the roses, you might just be greeted by a treat. When your glass is half full, you realize how far you've come. No situation is all good or all bad, nor is life. I choose to embrace my life, or at least fight like hell to get it back.

I may exercise much, much, less than I did 6 weeks ago, but what could you expect. At least I'm working out. My stamina, my endurance are slowly returning, I mark these things by how many blocks I can go on my crutches before gasping for air. My strength (upper body that is) slowly returns as I gauge my weight work outs. But more than any of that....

I haven't been in my wheelchair in 4 days!!! Yes, 4 days! I get around on crutches. Yes, for the next few weeks there may be events that will require the chair, but the bathroom door is back on, and the chair is out of my bedroom. Another piece of medical equipment has left too. I exalt in those changes, but even more...

I've put on two shoes for a few hours every day for the last three days. It's part of a desensitization plan. The foot feels less foreign through a shoe, or something. All I know is that the sight of my fat ankle in a shoe overwhelmed me. It is a milestone at 5 weeks post surgery. I'm amazed by it, even if simultaneously a little disturbed by my fat ankle. But I digress, two shoes!

Two shoes, one yardstick! I get better, stronger, closer to my goal everyday! Onward and upward they say!

Prisoner of my Own Foot:

2011-02-19T18:37:00.001-08:00

I looked in the mirror this morning as I did my hair and the reflection is the same. Maybe a little gaunter, definitely paler, but still the same bright blue eyes reflect back at me. Straighten my hair, a touch of makeup and I look like me, the old me. Everyone comments that I look so healthy. I feel stronger every day, my brain becomes clearer as I wean off of the drugs. But I am not the same. I get around via wheelchair and for a precious small time each day, crutches. Every action, every movement has to be planned ahead, I feel like I am a Prisoner of My Own Foot.

This morning I awoke to bright sunshine and the crystal clear mountains, and every fiber of my very being longed to jump on my bike and go for a long ride, or strap on my running shoes and run; but I can’t. Not yet at least! This foot holds me prisoner still. That thought caused me to throw the covers over my head and burrow into my bed. Still self-pity isn’t my style, so I settled to sit on the porch in the sun and enjoy my coffee.

Last week, I didn’t leave the house for 4 days, for 4 days! (The only exception being my daily 20-30 minutes wheels around the block with Sadie) This is me, homebound, no! I reject that with my very soul. I am learning patience, I am doing a puzzle, reading a book, filling my time, but still…. My foot controls my day!

I watch my ankle heal and with each day it looks less like an alien and more connected to reality, to a foot that I mostly can’t feel, yet one that controls my every move every day. I want to hate it. I want to scream at it, or scream at the universe, but I can’t. Every night after I give myself my nightly shot and take my meds, I lay in the darkness and mutter a silent prayer that the nerve graft will work, that I will feel my foot again. Then I pray that if that doesn’t happen, if a half dead foot is to be my life, I will learn to run on it. I will learn to ride my bike again. It is a prayer so desperate, that I will only whisper it in the night.

I meditate on these thoughts as I fall asleep, and as each new day dawns, I fill my time and work on preparing the rest of my body to help in this battle. My strength physical and mental will free me from my jailer in time. Whatever the outcome is to be I will only give this jailer, This Thief, a limited time, and then I will free myself.

I will not be a Prisoner to My Foot for long, forever! To this promise I will be true!

Back in SoCal and Thanks to Great Friends Near and Far

2011-02-17T11:43:00.000-08:00

So, my time in New York City has drawn to a close. I don’t think any of us were sad to leave that frozen island this trip. New York City was not really made for wheelchairs, especially in the cold. Plus, I felt too awful most of the time to be up for much anyway. Although the last week was actually filled with visits from college friends and a dinner with one of my cousins to add fun and laughter to our time and make us feel connected to the world.

Still we all wanted to come home, though I dredded the flight. The flight was less horrible than I feared and once we were off the plane we were greeted by the beautiful mountains around Burbank, sun and warmth. I quickly shed my jacket, my sweater, my scarves and soaked up the sun. Loaded in the car we journied to Casa de los Padres, where I will be in residence until I can handle the stairs at my home.

Within moments of arrival as CdlP, we were greeted by the most beautiful of sites; one friend returning Sadie to me while other friends arrived with dinner. They were all shocked when we suggested a bottle of champagne to celebrate our safe return and the beauty of friendship. We then feasted on the amazing meal they provided, a gift so great all you can say is thank you. Then you can only hope that when a friend needs that kind of gift you’ll remember to pay it forward.

By the next day, I needed to see my house. (OK, I needed a few items from there too, but I really want to be home, so we went by my house). I’m allotted 4- 30 min periods upright, so I saved one to tackle my stairs. I stood at the bottom and contemplated the flight and a half of stairs. Daunted, I began the task slowly and step by step, I made it to my first floor.

I enjoyed visiting with my new roommate while my mom gathered my things and I ached to be back in my home, but not yet as evidenced by my mild difficulty getting back down the stairs. So, I will continue to enjoy the hospitality here at CdlP, and work on my strength and healing under my parents careful eyes.

This regimen of working on my strength has gained a new component, daily wheels around the block in opposite directions with Sadie. I’m here to tell you that this activity is no joke, wheeling a wheelchair up hill by yourself . Anyway, I put Sadie on her leash, attach the leash to the wheelchair and off we go. When we really get going at times, Sadie helps. She gives me an indignant look when she realizes her duty as a sled dog, but I’m training her.

Thus life will continue here at CdlP, I slowly get stronger, sleep long hours and watch my ankle heal. Please come visit, Pasadena isn’t Siberia! Today it is absolutely beautiful!

When you can't hold yourself up!

2011-02-11T08:51:00.000-08:00

Yesterday, I stood up for the first time in 3 weeks. Stood upright, just like us Homo Sapiens are supposed to. Enough of this upside down, backwards crab crawling from bed to chair, to wheelchair. Enough, of this sideways slide from chair to chair. Those manuevers may have been had a benefit in ensuring that my triceps didn't dissolve the way my gastroch have, but I am humankind and we are meant to travel the world upright. That is how we evolved to be superior to monkeys, also how our homes, streets, sidewalks and vehicles are designed but alas I get ahead of myself....

My plastic surgeon has been very strict about keeping my foot elevated at all times. As I have no more veins, lymphatics or functional nerves on the inside of my ankle to deal with the pressure of gravity. Thus, I have been relegated to the seated or reclined position since my surgery. Yesterday, in his office, he tested my foot in the dependent position. I sat upright like a normal person with my foot dangling for 15 minutes, and my back rejoiced at not having my hip tilted at some odd angle to keep my foot up. As long as the foot didn't turn purple, I'd pass the test. If I passed, I'd get to begin brief periods of having my foot dependdent.

I passed the test! My prize, crutches! Oh crutches, I have had a love hate relationship with you in the past, shall we begin the dance again? At this moment, you feel like freedom, but I know shortly you will be a jailer again. Thus the ying and yang of healing! Still today, you are freedom and thus crutches in hand, I stood up. I got a little dizzy and realized I hadn't been completely upright in 3 weeks. Woa, folks this is going to take awhile. Still, there is progress. I may still primarily depend on my wheelchair to get around, but this am during my allotted upright time I was able to brush my teeth and wash my face over a sink! Progress, my friends progress!

The world may be built for us to travel it upright, but I have learned that people are very nice to you in a wheelchair, even on the Manhattan's Upper East Side

The Sacrament I Never Wanted

2011-02-10T13:21:00.000-08:00

On Sunday, I received a sacrament. It wasn’t planned, arranged,or organized. It just happened. I remember my First Communion. I had to buy a dress, there was a party. A big deal was made! In CCD, we spent a year or two preparing for our Confirmation. I had to pas a test with our monsignor to prove readiness, my dad sitting next to me. I remember being nervous. I had to pick a sponsor, there were practices. These milestones, in my life as a young Catholic, they were big deals, signs of maturing in the church.

Through the preparation of those milestones as a child, I’d learned about Annointing of the Sick (Last Rites, as it used to be colloquial called). The image in my brain was of a death bed with your family gathered around you before you peacefully died. "Call the priest, there is nothing left to do." Isn’t that the idea? So, even though I’ve been living my life as a cancer patient for four years (however, much I may want to deny this fact), I’ve never considered seeking out this sacrament.

So, I innocently went to church Sunday and lo and behold, it was a special mass for the sick and they were offering the Annointing during the mass. My dad pointed it out to me. I considered the situation, sitting in my wheelchair in the aisle. According to Doctrine:

The anointing of the sick conveys several graces and imparts gifts of strengthening in the Holy Spirit against anxiety, discouragement, and temptation, and conveys peace and fortitude (CCC 1520). These graces flow from the atoning death of Jesus Christ, for "this was to fulfill what was spoken by the prophet Isaiah, ‘He took our infirmities and bore our diseases’" (Matt. 8:17).

Well, I can use all of that. I mean who can’t when dealing with something serious. Right? However, this sacrament used to be called “Last Rites,” and I’m far from needing that! I may be knocked down a little, I may not be running for awhile, but I’m far, far from needing “Last Rites.” So, again back to doctrine:

Does a person have to be dying to receive this sacrament? No. The Catechism says, "The anointing of the sick is not a sacrament for those only who are at the point of death. Hence, as soon as anyone of the faithful begins to be in danger of death from sickness or old age, the fitting time for him to receive this sacrament has certainly already arrived" (CCC 1514).

“In danger of death,” not sure I can accept that. That sounds a little like being sick. I’m not sick, I don’t feel sick. I don’t act sick. Yet, I cannot deny that I have an illness. I do not, nor have I ever felt in danger of dying from my tumor. My fear, my reality has always been a loss of function, the looming potentional of a loss of limb. That may not be “danger of death,” but it is big and horrible to me. Therefore, if receiving the sacrament can give or help me to find any “peace and fortitude” against that reality or even my current wheelchair ridden one. If I can have help avoiding “anxiety, discouragement, and temptation,” as I face my current struggle. Can my faith help me with these things?

So, I received the sacrament. The priest anointed my forehead and my hands, he prayed over me. My parents and a dear friend witnessed. It felt real even if it was without pomp and circumstance. I may never have wanted this sacrament, but I’m glad my dad decided we go to that church on that Sunday.

Formula for Crazy

2011-02-05T15:40:00.001-08:00

I sit at the kitchen table, listening to the sounds of NYC, looking out at my limited view, wishing I could lace up my running shoes and head to Central Park. Oh how I wish for that. Actually at this point I’d settle to just be able to walk to Central Park. Wait, I might even settle to be able to go there on crutches. (Hmmm, given the ice on the street that might be dangerous). OK, so let’s be honest, I’d settle for any form of locomotion that would allow me, ME, to control my destiny, ANYTHING that would allow me to regain some independence.

It’s been two weeks since I woke up in the PACU at Memorial Sloan Kettering and asked “what happened to me.” In that time I have been getting better and stronger every day. I have tried to be a good patient, even if I have the most conservative of plastic surgeons. He ordered 7 days of complete bed rest with my foot elevated at all times, and there was no wavering. At the end of that, he says 2 more weeks of chair privileges, as long as the foot stays elevated. He won’t let me have crutches to prevent any cheating. OK, OK, I’ll listen.

All of this leads me to the following formula….

How To Make a Highly Independent Somewhat Type A Person Completely Insane:

Step 1- Take away their ability to do anything for themselves- Seriously, for awhile, it was ANYTHING.

Step 2- Take away the ability to do any real form of cardiovascular exercise

Step 3- Have them in constant, severe pain

Step 4- Throw in pain drugs that limit their ability to multi-task and fog their brain's functioning

Step 5- slowly and progressively deny them their personal dignity

Step 6: Assign them a loud, whiny, intrusive, anxiety riddled roommate who leaves their TV on all night to deprive said person of a good night’s sleep for days on end

Step 7- Have their cell phone die so that they can’t even contact the outside world

Step 8- do all of the above while it is freezing outside and the sidewalks are partially covered in ice

The antidote to the above insanity inducing actions:

Step 1: Laugh a lot, laugh often, laugh at nothing, just keep said person laughing because while laughing the insanity can’t possibly build

Step 2: Lots of visitors, visitors are essential to step 1, but also to break the monotony

Step 3: Messages from friends and family so as to not feel completely disconnected and forgotten in their own world

Step 4: Activities to pass the time, puzzles, card games, good books, etc.

Step 5: Allow uninterrupted sleep once finally out of the hospital

Step 6: Exposure to sunlight and fresh air at least once a day even if such air is freezing

Step 7: Good friends to take care of their dog and home so as to not have to worry about those things

Step 8: Continued support, prayers and well wishes from dear friends and family whether near or far.

Step 9: After getting a new replacement phone in record time at the Apple store, run into a guy who holds the elevator for you saying “I spent 5 years like that,” and admits he also used the shark attack tale.

Step 10: Get back to sunny SoCal (and my Sadie) as soon as possible!

A special thanks to all of you who have helped with the antidote over the last two weeks, you are all very dear to me and have helped in ways small and large. It has been a long rough road so far and so much left to go, but I make progress every day and I know that I couldn’t forge my way along this road alone.

The simplest of things, the most profound of emotions

2011-02-01T09:29:00.000-08:00

11 days ago at 5am, I stood in the shower taking my prescribed preoperative, disinfective shower. As I stood under the stream of water, I thought of what was to come. I worried about the possibility of losing sensation to my foot. I worried about the loss of active lifestyle. However, I set my mind to be positive, stay positive, fear would not rule my emotions nor my recovery. I set my mind for this journey, for this fight whatever was to follow.

We all know the story now they opened my ankle, and it was obvious that the conservative option wouldn't work. She talked to my parents, got consent, and proceeded to do a wide excision. Pathology later confirmed that this was the right choice. The tumor had invaded the nerve and my old skin graft. This explains the numbness and nerve symptoms that have plagued me for months. A good decision was made, the chance I may not have to do this again. I only cried once when my best friend came in to see me the next day. I've been determined to stay positive, stay the course, to confront this and deal. To make my new reality fabulous, maybe even better than the old one.

So I spent 7 days in bed, my leg has not been below my hip in 11 days. Discharge prep began... My parents have been analyzing the bathroom in the apt to see how I could get in and out of it adn the shower from my wheelchair. We've discussed this with my OT, Mary. Then this morning, when Mary came to check on me, I asked again. She went and looked at the shower and said, let's see if you can shower here.... OMG, i said really? I called my dad, "can you bring shampoo over like now, I'm gonna shower.". My dear dad got dressed in 5 seconds flat and hightailed it to the hospital.

With Mary's help I made it into the shower, we high fived, and I smiled a true genuine happy smile. Since I made it there, she went to get the stuff for the next step, and I sat on the shower chair in my hospital gown, and all of a sudden it was too much. I started to sob, the tears just fell from my eyes, I couldn't stop. Something, so simple, something we all take for granted, a shower reduced me, ME, to tears. But it was so much more than that, so many emotions, they just flowed. I finally released myself to let it out. For a minute or two, that was all I'd give it.

Done with that I proceeded to take the most amazing shower of my life even though Lefty was propped up on the armrest of my wheelchair. It didn't matter. It was a simple unexpected luxury that I vow to never take for granted again.

Now, on to getting the heck out of this hospital!

I survived!

2011-01-29T21:05:00.000-08:00

I survived 7 days of bed rest. I'm still not sure how, but I'm sure that being run over by a Mack truck, lots of pain meds, my parents and some good friends have had something to do with it. Still when friday morning dawned, I was like a kid on Christmas morning. Every delay seemed forever. I just wanted out of bed! Even if I couldn't lower my ankle at all, even if I couldn't put any pressure of lefty. I just wanted out of bed!

Mission accomplished! I worked with my PT and OT to sort out how to do this safely, effectively, alone when need be. Skills mastered! It wasn't much, but getting to a wheelchair meant i could leave this room.

For the last week, my parents and i have played near daily games of gin rummy. Today I wanted out, we put me in the wheelchair and left the room!!! I wouldn't let them wheel the chair, i wanted to move of my own accord. We went up to the family rec room and played our game.

Away from the other side of the curtain, and its new inhabitant, we were able to joke, jab, roast each other as only families can. No one else was up there so we didn't have to be quiet. After about a half an hour the rec room volunteer came over and said. "This is a table filled with love and some really FUNNY people.". Yep, that sounds right!

It felt great to have new surroundings, to get to laugh like that. To see the NYC skyline and the snow filling the terrace. Today was a good day! Tomorrow maybe might even be better!

This time IS Different!

2011-01-26T10:19:00.000-08:00

Before I left for New York last weekend, i complained of feeling the worst kind of deja vous. I was packing to return to New York 4 years and about a week after i made this journey last time. I know that i am not the same woman who started this road 4 years ago, yet still there was a fear. A fear that was real, even if I barely spoke it, of going backwards..

The lasting legacy of my first journey with ankle liposarcoma, is my health revolution. Making working out, triathlons, healthy eating and lifestyle an active choice for me everyday. Would prolonged bed rest undo that? Would I develop a fatalistic attitude that said that it didn't really matter? The few times i spoke these fears aloud, my friends pushed them aside, saying "Lisa, that's not you anymore." "you won't let that happen." still the fear was extant.

I talked my way into to getting to use the gym in NYC. I worked out right up until the night before surgery. I believed, but i worried.

A few days ago i asked the plastic surgeon if i could do some seated exercises while on bed rest. He said, no! Defeated, I didn't ask again until today. My OT said she'd work on it for me. Two hours later she returned with resistance bands. I was cleared! I exclaimed it on twitter, texted a friend, and did a quick 40 minute resistance band work out. It was easy, cause she didn't bring me the strongest bands, but it felt so good. To feel my muscles respond. to know that this fear could be relegated away from the forefront.

Thus, any lingering doubt about whether the new Dr.Lisa is here to stay is gone. I may be weakened, i may have sustained a blow, but I'll better it and be better for it. Somehow!

The Other Side of the Curtain

2011-01-25T11:38:00.000-08:00

When I checked in for my surgery on Friday, the financial lady asked me if I'd like a private room. I had memories of my hospital roommates being up all night gibbering away with loud accents, of them snoring all night despte their sleep apnea/biPAP machine, and memory of mysteriously getting moved to a private room post my skin graft and actually getting some sleep. So, I said yes I'd be interested. Then she said, I'll need your credit card as it's $500 extra a night. *Cough, sputter, gag, um no thanks!*. The happy thoughts of a blissful recovery dissolved.

Therefore, i have a hospital roommate again. When I got wheeled into my room after the long night in the PACU, she introduced herself through the curtain. "Hi, my name is S. I have brain cancer how about you?". I replied "Nice to meet you, my name is L. I just had survey for cancer in my ankle.". Thus, the odd relationship through the curtain began.

It is an extraordinary thing. You take two people, two families, two social networks and throw in a mountain of stress, a flimsy curtain, some drugs, and a lot of pain and see what comes out. That there aren't frequent brawls might be amazing. But most people just live and let live. Most just accept the parallel life going on on the other side of the curtain.

We are privy to intimate details that no stranger should know about another person becuase there is simply nowhere to go to maintain true privacy,. I'm on complete bed rest, so i really can't go anywhere. She had a consultation that by all rights should be private, but I couldn't leave the other half if the room. My dad went and got coffee out of respect. I put on my noise cancelling headphones. It seemed only fair.

Although, at points yesterday while she prepared for brain surgery today, I didn't think I'd survive her visitors, all in all general courtesy still wins out. Her husband helped with some of the banal tasks of daily living i cant handle (closing curtains, or turning on a light, etc.) They really are very nice people, extraordinarily scared at what today holds. I understand this. I know this fear that can be palpable, it can be paralyzing. She went to the OR this morning for brain surgery. I wished her luck, told her I'd pray for her. She may come back here, she may not. I may begin the dance with someone new you never know.

I wish good luck to the Lady in the Other Side of the Curtain!

Update!!!

2011-01-23T17:36:00.000-08:00

*Please note not for the squeamish*

So, my surgery on Friday was to remove the recurrence of my round cell myxoid liposarcoma in my ankle. The plan heading into the surgery was to be somewhat conservative and try to spare the nerves and vessels in my ankle. Thus, giving me the best chance for the best function, accepting a small increased risk for recurremce.

However, when they started operating it was obvious that that plan wouldn't be possible. So, they moved onto plan B, sacrificing the nerve and artery. The plastic surgeon performed a nerve graft and then transferred a free skin flap from my thigh.

Although this isn't what I had hoped for, everyone is positive that I will have a reasonable functonal reponse in time. Plus, there is a higher likelihood that all the tumor will be gone this way. Therefore, I'm growing to be OK with it.

While yesterday I said it felt like I was hit by a Mack truck, today I have some of spunk back! Intakes a lot more than this to hold me down!

Leap of Faith, a reprisal

2011-01-20T08:28:00.000-08:00

I went skiing for my birthday last month. As I stood on the top of the Cornice, I looked out into the distance, and as I often do, I was amazed at the beauty of the mountain ranges before me. The wind wasn't howling, so I paused and soaked in the beauty of what I was looking at. The distance so clear, so sharp, so magnificent.

Then I turned my attention to the lip of the Cornice. Skiing off that edge is a leap of faith I've written about before. To make that first turn requires complete focus and trust in your own skills and strength. To go forward into that which you can't see is always a little scary. You must be in the moment, completely in the moment, so that you can deal with whatever the mountain throws at you. The first time you ski into the abyss, the conditions are unknown, you may have to make slight adjustments. What if someone falls before you, what if you hit ice, what if?? You could go crazy if you play the what if game. Therefore, I take a deep breath, and I go. I know I can handle whatever is thrown at me because I have before. I believe in my strength. I love the ride.

Yet, last month I had a slightly different thought. the distance was so clear and sunny. The immediate slope was in the shade, and was unseen. It felt a little like my life. I look at a year from now and I know, I'll be OK. I don't know exactly what my reality will be, but I know I'll make it OK. Yet, my immediate present is scary and unseen. Still I can't stand on the ledge and not move. Therefore, I must take a deep breath and go forward. There is no choice.

Tomorrow I will have surgery, I don't know exactly what that surgery will entail, but I trust my surgeons. I have been down this mountain before, but the conditions are always a little different. I know I may hit ice patches in my journey, but I have faith in myself and my amazing support network. So, I will turn off the ledge and find my down the mountain so that I can make it to the distance. That distance that is so bright and sunshiny. I will get there somehow!

The worst kind of Deja Vous

2011-01-15T15:28:00.000-08:00

A little over 4 years ago, I was prepping to go to New York for surgery at MSKCC on my ankle. Now a few days over 4 years later I'm doing the same thing. Preparing to go to New York, I am reminded of how I came to this decision, I am reminded of how this nightmare began.

I described my original decision to have treatment at MSKCC, where they were willing to given me an Option 4. This is not a question I have the emotional capacity to question right, it is what it is. I trust my doctor there, I trust the staff. Also, in a weird way it has kept my life as a cancer patient there, away from the rest of my life.

This morning as I cehcked more things off of my To Do List and then headed out ot the gym for a quick 1.5 hour workout, I was reminded that while yes, so many things are frieghteningly similar as the last time I did this, still I am not the same person I was 4 years. I am stronger, physically and mentally. I am 70 lbs lighter. I have found a faith in myself. I know that I will get through this even when I have my days that I just want to curl up in a ball. Can you blame me?

Alright, back to work young lady- cracks the whip!

Escapism!!

2011-01-07T13:50:00.000-08:00

The #SunBowlRoadTrip represented a journey to watch our college football teams play each other for the first time in 20 years, but also it was an escape from some of the serious issues going on in my life.

As we drove away from Los Angeles I felt myself lighten, some of the burden I was carrying seemed a little less. I didn’t care that we were to drive until 4 am through the desert. For 4 days I didn’t have to think about what January held and I embraced that. We laughed, we laughed at stupid stuff, we made fun of each other. We taunted each other about our teams. Occasionally we’d touch on the serious but we’d back away. Port-a-potties on the border were funnier.

Sunday morning as we had breakfast, we both wanted to stay longer. To linger in the lovely Phoenix sun (that was actually not hot) and drink mimosas and pretend that reality didn’t exist. Alas, our pragmatism kicked in, and we began the last leg of our journey home.

With every mile closer to our home, I felt a little of the weight return to my shoulders. After we crossed the border into California, it seemed real. A few hundred more miles and I couldn’t pretend like my reality didn’t exist anymore. I couldn’t take it any longer. So, we got off the highway and followed a dirt road to its end, and had a picnic.

We enjoyed a few last moments in the great expanse of the Southwestern desert. Nothing around us but tumbleweeds, cacti, the mountains in the distance, the blue ski above and the distant sound of the freeway. It seemed idyllic. We lingered longer than we intended. I fought the urge to say screw it, I’m staying. Still, I’m too pragmatic, too realistic about the importance of what I need to deal with. On my days off since, I’ve fought the urge to drive back to the desert, but there is no more time for me to bury my head in the sand. Reality is here now…

What’s so scary? Several months ago, I learned that the cancer in my ankle that I dealt with 4 years ago had come back. Initially, there was fear I’d have to undergo amputation, but after more tests, we’ve agreed to give me one more chance at conservative therapy. One more chance to keep a functional foot. My surgery is scheduled for 2 weeks from now. That reality is what it is.

My recovery will be long, but hopefully cleaner than last time. I started blogging because of this, so it hasn’t seemed right to not blog about it, but I wasn’t sure if I should write here or go back to The Tale of My Left Foot. For good or for bad, I’ve decided that I want to stay here. So, I’m finally ready to start admitting to my reality. Its time to face it. Thanks so much to all of you who have supported me.

Still, I really want to return to the desert. Can you blame me?

The Lure of the Open Road

2011-01-03T21:39:00.000-08:00

I have loved road trips since I drove to college with my old roommate. Those trips from LA to South Bend and back are great memories. Memories of camping in the Bad Lands, visiting Mt Rushmore, camping in Arches, visiting friends along the way, and laughter always, always lots of laughter. Those trips were part necessity (we had to get from here to there, and we wanted a car when we got there) and part fun.

In real road trips the journey is as important as the destination and the company trumps all. I've done my fair share of roadtrips in my life. I have driven round trip from South Bend to South Padre Island, Los Angeles to Vancouver, Canada, LA to New Orleans, hwy 1 to the wine country and then back via Vegas, and most recently LA to El Paso. I've done one way road trips LA to DC, and Chicago to LA. All of these trips are special memories to me. All of the friends who joined me on them dear. There are only certain people that you can sit in a car with for days and days on end. If you survive the trip with your relationship in tack, then it is golden and hold on for dear life.

What is the lure of the open road? Why does it draw me so. It is a unique way to see the country that we usually bypass. I remember driving through South Dakota fascinated by the rolls of hay in the varying angles of the sun. As that was pre-digital cameras, I have about 30 pictures of rolls of hay or grass or whatever. Is it getting to decide that since you're here you just must see Devil's Tower (which mind you is near absolutely nothing), or Mesa Verde (which was how I was paid back for the Devil's Tower sojourn). Or is it deciding that you should visit the meteor crater in the Arizona desert because its there and so are you. It is all of these things, and I'd almost forgotten how much I love it.

I got home yesterday from my well documented road trip to the SunBowl in El Paso, TX to watch my Notre Dame Fighting Irish beat, my friend, Jennifer's Miami Hurricanes. Sure we went because we love college football and our teams, former rivals were playing each other for the first time in 20 years. Yes, the football game was the reason, but in part the roadtrip was a draw. The game, while I'm happy with the result wasn't really a good football game, and it was COLD, even for the ND girl. The roadtrip didn't disappoint.

Driving through the night to get to ElPaso in time for a few hours of sleep was a feat of hilarity, well documented on twitter and posterous. The trip home included a trip to the border, just because Jen was fascinated with the border and border patrol. We marvelled at the beauty of the southern NewMexico we had driven through in the dark of night, we enjoyed sunsets and stars. We gained a new appreciation of tumbleweeds, and we laughed. We pretty much laughed for two straight days. Some worried whether we'd make it home friends, no need to worry there.

The Lure of the Open Road, I don't know what it is, but I know I feel it and I can't wait for my next road trip with a funny friend.

Why I love College Football- Or how a friendship began!

2010-12-29T21:59:00.000-08:00

So, unless you've been living under a rock or don't know me at all, you know that I'm a sports fan. I love my Lakers. I'm a Kings fan. I kind of like soccer, especially the World Cup. But I love college football and my Fighting Irish!

I've loved college football since I was a kid and grew up going to USC games because my family had season tickets (mom's an alum). Those 6 or 7 Saturdays every fall are great childhood memories. Mom would make us my favorite sandwiches, ham, provolone, and pepperoni- no mayo for me thank you very much. We'd picnic on the lawn in front of the Natural History Museum on SC's campus. My brother and I'd throw the football around. We'd go to the games. Cheering for SC with everyone else. Even as a little girl though I refused the whole "Fight On" thing.

Still when I started thinking about choosing a college, I felt no affection towards USC. Those days were separate. Starting in high school, I used to always think that the other fans were classier, their cheerleaders better, more collegiate somehow. My senior year in high school, Rocket scorched the SC defense as the Irish destroyed the Trojans en route to their last national championship. I'd already decided to apply to Notre Dame by then, but I remember observing the crowed watching the game. I cheered for ND for the first time that day.

Then my college years started and a fall football season at Notre Dame is like no other experience. Sure I love the game, but its about the loyalty and rivalries that people feel for their schools. That is what I loved, still love. I was hooked.

As an adult, I still love college football, it reminds me of my days in college, good memories of those football Saturdays bakc int he day. A few years ago, I took care of the son of a guy who played for one of ND's rivals. He told me about playing against Montana. As our game approached we placed a friendsly wager of $5. His son, now 5 is thankfully healthy, and every year the bet is renewed. This is why I love college football. Sure our schools are rivals, but there is a respect for the traditions.

When I joined twitter, on those days that I'd watch ND games on my own. I'd live-tweet them. I noticed others doing the same. One woman stood out. She clearly loved her team, but she appreciated others who loved their teams. Thus, a "friendship" was born. Initially I didn't even know that Jen lived in Los Angeles. She was just a football fan I twittered away with on Saturdays. I have many sports fans like that. Mostly Lakers fans, but I appreciate them nonetheless.

Then last New Years Day, I met Jen for the first time at my friend Kim's New Years party. A friendship grew. We respect each others love of college football and our teams. So when the god of bowl games decided to have our teams play each other for the first time since we were in college. The idea of a roadtrip took oh about 20 seconds to blossom.

Therefore, I am going to drive to El Paso with Canes fan Jennifer Vides and we're going to love every moment. If you wanna follow these two crazy football fans from rival schools travel together, check out Football-Loving-Women!

Go Irish Beat the Canes!!!

Waiting....

2010-12-02T14:59:00.000-08:00

I walked around the unit the other nigth and paid attention to the look of anxiety on some of the parents faces. I'd stop and chat with them and listen to their concerns. More than one parent was anxiously awaiting some sort of test result on their baby. Being the end of Thanksgiving weekend the wait was slightly longer than average as routine tests and procedures don't usually happen over the holidays.

I feel for these parents waiting anxiously. One dad in particular was so frustrated. I know that the info he is waiting for isn't going to change anything in our treatment of his baby, but I still understand the anxt. I made one of the only promises I ever make to parents to him. "As soon as I know, you'll know." There are only 3 promises I ever make to the parents of my patients and that is one of them.

It has always been something that has been important to me. This sharing of information, or results as soon as I know them. I strongly believe that as physicians we must be in partnership with our patients and their families. It is their baby who's care is entrusted to us; thererfore, they must be given information as soon as possible after it becomes available. We must help them to make informed decisions when those decisions come up.

As a patient, I understand that waiting game. I am waiting right now. I should hear soon about what the plan is for my surgeries. A few weeks ago, I was waiting for the phone to ring to give me my results. I hate waiting. Still, I feel a combination of wanting to know and a little fear at the answer. Somehow it has been easier to deal with since I knew for sure that I have a recurrence. Reality is so much easier than fantasy or fear.

So, I wait.... I hope that my time on this side of the doctor-patient relationship will continue to make me a better physician in the future, that I will conitnue to grow through my experience. That would be a good thing!

My Promise

2010-11-02T17:06:00.000-07:00

You grasp my finger with your tiny hand. My finger that is bigger than your arm. You who are impossibly small, but perfect and feisty. You sometimes kick and cry. Your little arms and legs stretching out into the world around you. I examine you every day and promise you that I will do the best that I can to help you grow.

Your mom looks at me with fear in her eyes. I promise her that we will do everything we can. That we'll be with her every step of the way. We say having a preemie is a roller coaster ride. I hope that she knows we'll support her on this trip.

This is why I do my job. My goal every day is to do my best for you and all the other babies in my care. You who are the size of my hand, may I be up to the task. This is my wish!

Magic- Lessons from Plants

2010-10-07T12:43:00.000-07:00

I have this plant on my porch. Its a desert succulent called a Night Blooming Cereus. I've written about it before, but typically this plant has one bloom a year. Each flower lasts for only one night. It opens after darkness falls, and the bloom is dead with the rising sun.

For those few hours while the bloom is open it sends the sweetest aroma wafting through the air. You can't stick your nose in the bloom and drink in the smell like a rose, you have to sit 5-20 feet away and slowly breathe. The rewards amazing! This smell is not to be bottled, not to be sold, but savored and enjoyed as you take a few moments break.

In the summers of my youth, my dad would sometimes wake my brother and I late at night so that we could experience a moment of this flower's brief life. He told us that the night that the plant blooms is an auspicious one and given its fleeting nature, we should make a wish. Some kids wished upon a shooting star or a fallen penny, but I wished upon a flower who would only grace the world for a precious short time.

Therefore, I always feel a special sense of something: nostalgia, hope, dreams on the night that the plant blooms. I've been known to cancel plans to just sit on the porch and drink in the aroma. I feel cheated when I miss the flower.

Some years, crazy weather patterns will allow the plant to bloom twice. Then it is that much more special, that much rarer. When I came home from work this morning after an exhausting, trying night, I immediately smelled it. The plant had bloomed!

I poured my coffee and sat on my porch and took in aroma and felt that sense of hope and peace. I pray that the second bloom of the Night Blooming Cereus grant us all good luck and fortune!

Malibu Triathlon

2010-09-15T22:27:00.000-07:00

Last Sunday was race day! The Nautica Malibu Triathlon to benefit Childrens Hospital Los Angeles.

I've been training for a few months, I did my best to taper the week leading up to the race. Saturday night found me with pent up nervous energy from tapering, ready to do this thing, but feeling anxious about my prep. Nonetheles, my calmer side prevailed. I knew that I was as ready as i was goign to be. So, I managed an early evening to bed and a blissful sleep until 3:45 when my alarm went off.

The first thought as my alarm blurted out Indigo Girls music was I need a new hobby! Still it was race day, so I got up. Stretched, made breakfast changed and drove to the beach as what still an hour before Oh Dark 30, the freeways were empty.

I made it to Zuma dealt with the parking mess, got my stuff to the transition area and got my stuff arranged for the feat to be done. I got myself into my wetsuit and headed out to the beach to wait for my wave to start.

As we all gathered on the beach the prerace meeting, the energy in the crowd was palpable. They announced that we had raised over a million dollars for cancer research at CHLA, amazing!

Then began the long wait to start my race. I was in one of the last waves to race, so I was standing on the cold beach for over an hour. My foot, never a fan of the cold with its poor radiated nerves, was so cold and numb. I started to worry, once my foot goes numb it usually stays that way. This could go poorly. However, I couldn't focus on that I had the ocean to contend with.

Finally it was time for my group to enter the water. We ran into the surf that was blissfully not too violent this year. I did my best to just focus on my swim, but I really don't like getting kicked and hit while in the water. There is just no way to make me feel comfortable wtih that. Each time someone ran into me, I'd lose my rhythm. Oh well, I was able to keep going. I rounded the last bouey and was able to catch a wave partially into the shore. 0.5 mile ocean swim 20 minutes. I'll take it.

Into the transition area I ran, now painfully aware that my foot was completely numb. I managed to get out of my wetsuit, into my bike stuff and out of the transition area in just over 6 minutes. Oh well, I haven't really practiced fast transitions.

The 18 mile ride along PCH was beautiful. There was one scary moment when the woman in front of my crashed getting onto the little ganglplank to go over the flooded underpass, but other than that the bike was a nice recovery. My numb foot didn't hinder me too much. I was able to eat some food and drink some water. Kept to my rhythm, I kept to my pace. It was good. 18 mile ride along PCH 1:05. My goal was to do the ride in about 1 hour. OK, i was a few minutes over.

Back into the transition area, this foot thing was a problem. I could barely manage to get completely numb foot into my shoe. I tried stretching briefly, no improvement. Undaunted, i headed out. Each step felt like little needles coming up through my leg, but I carried on. I was encouraged by all the people lining the rae course cheering on the CHLA team. The few peopel I knew cheering me on. It helped to keep me going. I made a quick pitstop and kept running. There was no way my will would allow me to stop.

My timing chip thing didn't work on my exit from T2, so I don't have an official fun time, but it was about 40 min for a 4 mile run. Slower than my usual pace, but considering my pitstop and the pain from my numb foot I'm good with that.

Total time 2:17. I called two hours and 15 minutes Friday night and was pretty close to that.

It was a great event, great energy, great comaraderie. So fun to have gotten to know some of my work colleagues in a different way. I'm so proud of the community support for CHLA. It was funning seeing all the other teams out there racing away. An amazing day!

NICCU Reunion 2010

2010-09-13T15:59:00.000-07:00

Every two years, we have a reunion for the graduates from our NICCU. It is always an amazing event lovingly put together by our nursing staff, and an event that highlights why we all do what we do. I try to never miss a reunion. I wrote this after the last reunion in 2008.

Therefore, this Saturday afternoon found me at Live Steamers in Griffith Park. Immediately upon arrival I was treated to the sight of a miraculous set of twins who are now 5. They are beautiful and although still small, they were running around playing together and with some of the other children. They played like 5 year olds should. Their mom instructed the little boy to hug and thank me, and I choked back the tears.

Then I saw another family whose now 5 year old daughter is also one of our graduates. She was off playing with her older sibling. Happy smiling, talking away, beautiful, precious, as all children are. Her mom said to me, “We’ve never forgotten the first time you came to her bedside and didn’t hide your smile. It was the day, we believed our daughter would survive, would come home. Now look at her.” Now look at her indeed, they photographed us together. More tears threatened to make their presence knows.

However, I got sidetracked by a 3 year old who ran past me sporting a shirt that declared “Chicks dig scars!” We all laughed at his parent’s sense of humor. However, knowing that boys story to see him thriving in this way was amazing. He arrived at our hospital months into his hospitalization for extreme prematurity barely hanging on. He stayed with us for many more months. That he is running, talking, playing is amazing.

One family, walked the grounds wearing t-shirts emblazoned with the image of their baby who was in our unit, but didn’t survive. That they would still come to thank us for the time they had with her speaks volume to what happens in our unit. Speaks volumes to some of the amazing people whose children we’ve been honored to care for.

Other families, came up to me showing off their children. Many still bore the signs of their rough beginnings; however, several I had to ask which of their beautiful children spent time with us. The entire day was an overwhelming blur of emotions. Working in this field can be exhausting and trying and takes an emotional toll. However, seeing these children play and the gratitude in their parent’s eyes, is all the thanks I need!

I left the reunion so proud to be a part of this amazing group to get to play an integral role in some of these families lives. I’m humbled and proud!

Final Triathlon Prep! (AKA: Why they call them Bricks!)

2010-09-10T15:29:00.000-07:00

My last weekend of real training for my triathlon on Sunday was a week and a half ago. I had the weekend scheduled to do back to back bricks. Saturday- Bike, run! Sunday- swim, bike!
They call them bricks because when you get off of the bike or out of the ocean your legs fill like bricks when moving to the new discipline. Therefore, training back to back is essential to prepare for race day without injury.

Saturday's plan was to ride near the race distance and focus on speed since lately I've mostly been doing distance rides. My goal is to finish the 18 mile ride portion of the race in an hour, totally doable, but it will mean pushing myself. Therefore, I headed out on a ride I've done routinely to meet that goal. I rode from my house through Griffith Park, past Forest Lawn cemetary, through Burbank and then back along the LA River ride, 20 miles according to my cat eye. It took me just over an hour. Therefore, feeling confident I headed out for a 3 mile run. There is no such thing as a flat run near my house, and that run was agony. My legs complained every step. I was soar and tired and could barely make it. That is why they call them bricks!

Ack, defeated! I tried to console myself by the fact that I had worked out once or twice a day for the preseedng 3 days. I did a killer spin class two days early and lots of weight training. So, I told myself, I'd be OK. I rested Saturday afternoon, visited my friend with a hottub, stretched, tried to eat right, so that I'd do better on Sunday.

Early Sunday morning found me sitting on Zuma beach ready to practice entry and exit through wves that were towering over my head. We went in and out to a starter's siren three times swimming almost the distance of the race, but the hardest part. Then my friend and I headed off to ride 20 miles along the race route. We made it in an hour! Quickly we changed our shoes, locked up our bikes, and then headed to run 3 miles or so down the beach. Therein I realized the saving grace, the race course is flat! That run was easy! We made it right on target around 9 min miles! We finished feeling confident that we were ready!

Race weekend has come upon us. I've done what I can to prepare and I'm overwhelmed by the generosity of my colleagues, friends and family who have supported me. I'm buoyed by their faith in me.

I'm ready! Bring it!

Denial

2010-08-23T19:15:00.000-07:00

Denial aint just a river in Egypt!

I read through my tweets from last weekend, and I had to laugh at myself. I transitioned from complaining about the denial of the parents of one of my former patients to happily entering into my own state of denial. Denial can be an important coping mechanism, but it can also be dangereous, so very very dangerous.

In the case of my patient, her parent's denial lead directly to harm being done to her. Lead to them puposely not bringing her medical history when they brought her to a different ER hoping against all hope that they would be told something different. That they could be told she was fine.

It makes me sad. She is a beautiful little girl. Of course they want something different than to accept that her time is limited. Because that is awful, unbelievably awful. Still the fact that painful, unnecessary things were done to her is also awful.

Yet still I laugh at myself because, not 12 hours after I tweeted about the strength of their denial and how sad it made me. I sat in my doctor's office and heard that I might have a recurrence of my cancer. I was numb, I couldn't think, I couldn't believe what I was hearing. How can that be?? I'm the picture of health.

My own denial kept me from asking the questions I needed to ask. My own denial kept me from demanding to find a way to get an answer. My own denial was every bit as strong. Every bit as potentially harmful to me, to my health.

Fortunately, within 24 hours, I was out of my state of denial and ready to deal in facts. I talked to my doctor today. I'm having more tests done. We're working on a plan. I'm out of denial but still oh so scared!

Swimming in the Ocean isn't Just a Walk in the Park!

2010-08-11T13:03:00.000-07:00

I’ve been swimming since I was a small child. I swam competively in high school. I’ve swum more laps in various pools than I count. Sighting along the black line at the bottom of the pool, flipping off the walls. I am comfortable in the water, I always have been. It is rote muscle memory for me to swim a few thousand yards. I’ve written papers, blog posts, and even had arguments in my head while automatically gliding through the water. However, these days, I typically just count the laps and relish in the fact that it is one of the few times in my overly connected life that I am completely unreachable.

Suffice it to say that when I decided to do my first tri last year, the 500 yd swim didn’t even give me pause. I had no concern over that part of the race. I hadn’t been on a bike in 10 years, and I hadn’t run over 2 miles in about 5. So, I had other things to focus on. Sure I swam during my training, but it was the easy part.

Then along came race day….

The swim was horrible! I was completely unprepared for open water swimming. I had no idea how to sight in the open water. People kicked me, clawed at me, and I couldn’t see my hands in the water. Afterwards, I didn’t get back in the pool for 5 months. I felt anxiety about swimming for the first time ever.

So, when I started training for my upcoming race, I had a mind block against the swim, but I knew I had to get in the ocean and prepare. I’ve worked my way up to it by doing open water swims in LongBeach Bay and Lake Arrowhead, but that isn’t an ocean.

So, last Saturday, found me sitting on the sand at Zuma Beach in Malibu waiting for an ocean swim training class…

It was good, being with others who have similar issues. We practiced entry and exit from the ocean. We practiced swimming while sighting. We swam only about 500 yards or so in total, but it was enough.

Afterwards, I went for a 50 or so mile ride along PCH with some colleagues from work. It was a beautiful day to ride PCH.

I’ll be back this Saturday, and am practicing the swimming with a head up stroke every 10 strokes in the pool. I’m going to rock this thing!

I’m doing this to support Pediatric Cancer Research at my hospital.

If you want to support me, follow the link here!

Thanks, all!

Reality Check on Foreign Aid

2010-08-10T10:38:00.000-07:00

I heard the news today of the medical aid workers who were killed in Afghanistan over the weekend and my heart fell. As a physician who has spent a fair amount of time in devloping countries providing healthcare, I have always been aware of the inherent risk involved.

In one of my many trips to the Atlantic Coast of Nicaragua we were on the road between Bilwas Karma along the Rio Coco and Puerto Cabezas, which was our home base, when we were passing through a small town and were held at gun point until our Miskito translator could convince the drug runners to take money and let us go safely. Looking back on that incident 10 years later, I am aware of how easily it could have gone the other way. At the time, I trusted that they wouldn't really hurt us. Naivete can be so dangerous.

While in Haiti, our compound was under lockdown several nights due to civil unrest. Several of the people there complained about that, but I figured they knew more than I did, and I was perfectly happy to be kept safe. Plus, from the perspective of Project Medishare an entirely volunteer run organization that was requiring 150-200 volunteers a week to function. Any perceived increased threat to the workers could cripple the organization, and, despite the difficulties, I believe that organization is doing good work.

The night before I arrived in Haiti, there was a bus accident involving a group of college relief workers. Several of whom were critically injured. They were all taken to the Project Medishare hospital because even though it was "hospital" in tents on the airport, it is one of the best staffed trauma centers on the island. Many of them had to medivacced to Miami after stabilization. I shudder to think what might have happened to those teenagers without that group.

So, back to what happened in Afghanistan. Apparently it was a small group with a Christian affiliation that was conducting eye clinics in a small province and they were killed on a mountain pass near where this picture was taken. The Taliban has claimed credit for the killings of the 8 medical aid workers and their Afghani translators for "trying to convert the Afghan people to Christianity."

It is horrible, my heart aches for their families and the loved ones left behind. I miss my 20 something year old self who was certain that even with a gun pointed at me I'd be fine. I pray for all relief workers, and especially for those who were involved in this tragedy. May it not prevent others from being willing to give.

My dad made me write out a will and file durable power of attorney paperwork before I went to Mongolia. Maybe he had a point even though I didn't want to think about it. Will this deter me from doing this kind of work in the future, probably not. I don't want to think that my idealistic side is dead.

To Vaccinate or not to Vaccinate!!

2010-07-29T13:03:00.000-07:00

I wrote this post last year. I decided to repost today...

I read this article in the LA Times yesterday about vaccines and recent outbreaks of Measles in certain communities and it made me mad. I well realize that parents on both sides of this argument feel very strongly. So, this could get me in trouble, but I'm willing to take the risk. The gist of the article is that in California there is a rising number of kindergartners who are getting vaccine exemptions (essentially the parents saying we don't believe in vaccinating our kid). They just have to sign a form and the kid can enter school unvaccinated. This isn't such a problem if the majority of the other kids are vaccinated, but with as few as 5-10% unvaccinated kids you can get mini epidemics of diseases that are otherwise quite rare these days, ie measles, mumps, diptheria etc. According to the LA times there have been several such measles outbreaks in the San Diego and the rate of unvaccinated kids is especially worrisome in several charter schools and non-catholic private schools.

OK, here is my take on this vaccine thing. When I was a pediatric resident at the beginning of every year in clinic we reviewed the vaccine schedule, risks and benefits of all the vaccines and why we vaccinate against them. As you can imagine, by the time we were third years my friend and I would joke that the reason to vaccinate against these diseases is because they can KILL. Most of the diseases vaccinated against are things that kill people. (OK recently we've added a few not so deadly disease to vaccinate against and I used to use this same argument to question if that was right). But I digress the main issue at hand seems to largely be the Measles/Mumps/Rubella vaccine (MMR). This one started to fall out of favor after an article linked it to autism. The fallacy of that study is that autism typically becomes apparent around 15-18 months and almost every child gets the MMR at 12-15 months. The two were temporally linked, nothing more. The only study that really looked at vaccines and autism rates showed no difference. So, my argument and what I used to advise people to do if they were really worried was just delay the shot until their child was already talking. OK, so there is the mercury thing, but manufacturers have gotten into that and combined more shots and made more of the vaccines without the mercury contained preservative so that is pretty much a nonissue. Of course, again, you can delay, space them out and make it even less of an issue if really worried.

So back to the diseases behind the vaccines, why care. Let's start with measles since that was what the article was about. Measles still exists in the US and is especially prevalent in certain European countries, not to mention less developed nations. Measles isn't so bad for the average school age kid, but it is DEADLY for infants, and not good for the elderly or immunocompromised. I took care of a 9 month old infant who had measles encephalitis as a resident. The child spent two weeks essentially comatose. She ultimately went home, but the long term effects are likely significant. Hello this baby almost died, her parents were rightly infuriated and scared.

How did she get it? Her older sibling's friend wasn't vaccinated. She came home from vacation with measles and before she got sick played at the vaccinated friends house. Thereby exposing the unprotected child. The child who was too young to get vaccinated even though her parents would have. You see there is the problem. It isn't just one kid. It effects the community. The LA times article had several similar vignettes of infants under 1 year of age being exposed to measles by unvaccinated friends of their older siblings. The year before the measles vaccine was released- ~500 people died from the measles and ~4500 kids had measles encephalitis. Do I really need to say more?

OK, so now mumps. Mumps doesn't seem so bad, right? It used to be the biggest cause of male infertility. That's right mumps infections in prepubescent or adolescent boys can leave them infertile. How about Polio? Now eradicated from the Western Hemisphere, but its long term effects were devastating.

I could go on, but I think I have said enough. I guess my bias is obvious. Please people vaccinate your kids. If you're really worried, it isn't terrible to slow down the vaccinations, but please. These are bad diseases.

So, I have a stalker...

2010-07-14T23:48:00.000-07:00

So, I have a stalker..
Or there is a very bad spy?
Or there's a time traveller in my neighborhood?
Or just a very creepy guy?

I run from my house around the Silver Lake Reservoir and back, a lovely almost 5 mile run with a nice amount of hills v. flat, few stop lights, on packed dirt. I run the route 2-3 times per week most weeks. Sometimes in the morning, sometimes in the evening, whenever I have time.

Still some large percentage of the time, I see the same guy on the same corner in the same clothes. He's older, with a big pot belly and wispy grey hair that always looks the same. Lately he even acknowledges me. Who is he? Why is he always in the same spot? I thought about this while i ran the other day.

Having read the Time Travellers Wife, I wondered if he is a stalker travelling throug time to alway sbe there when I run. Maybe that explains why he always looks the same.

Maybe he is jsut a sad, lonely old man who stands on the corner all day, but nah that story is sad. I prefer it to be something fantastical.

Mr. Stalker guy will I see you tomorrow?

Triathlon for a Cause

2010-07-07T22:49:00.000-07:00

Last year I completed my first triathlon as a testament to my own health and recovery from cancer. In my mind it was the conclusion of my journey as a cancer patient. It was my way of stating that I had prioritized my own health and fitness.

Initially I never thought that I would do more than one triathlon, but as soon as it was done, I knew that I would do another. However, I wanted to find a way to both pursue my personal athletic and fitness goals, while also benefiting this community of cancer patients of which I had unwillingly become a member. The perfect solution is the CHLA/ Nautica Malibu Triathlon, which takes place on Sept 12. In which I will do a 1/2 mile ocean swim, ride 18 miles, and run 4.

I am proud to work at Childrens Hospital Los Angeles (CHLA), and to be a member of their team for this event. Even better, the official beneficiary of the nautical Malibu Triathlon is Pediatric Cancer Research at CHLA.

I remember all too well receiving my diagnosis, the first weeks of figuring out what to do, and that feeling of terror and confusion. I was an adult, a physician no less; therefore, I had loads of resources and support. Further, my diagnosis wasn’t life threatening exactly, more threatening to my lifestyle. I can’t imagine having to deal with that as a child, or worse as the parent of a child diagnosed with cancer. The money raised by this event will help to give more of those children a chance to learn that through trials you can not only survive but achieve things you never thought possible. I hope that more children will be given that chance.

Thank you for your support of me while I train for my first International Distance Triathlon and thank you for your support of the outstanding research being done at Childrens Hospital Los Angeles to help pediatric cancer patients.

In order to donate please click on the link below or you can mail me a check (email me for the address and details.)

Again thank you!

To donate click here!!

Chanting in Haiti..

2010-06-21T20:08:00.000-07:00

The week I was in Haiti, I was the pediatric and newborn intensivist. I ran the combined NICU and PICU servicing upwards of 20 patients, the first and only such unit in Haiti. I worked with an amazing team and had lots of help and support. Still it was hard. We had lots and lots of really, really sick infants and toddlers brought into us. Sadly, often near death from dehydration or infection.

The first few days it seemed like there was some direct line from what I was doing behind the curtain that divided the ICU from the peds ward that would let them know when I child was fighting for its life. Without fail they'd start into a religious chant. The entire peds ward would fill with the sounds of the chanting, while the parents, patients, and the workers would clap, dance, and sing. The sound was sometimes deafening but spine-tingling at the same time. Reminding me that I wasn't alone in what I was doing.

On and on the dancing and chanting would go. We would sometimes wish for silence so we could do our jobs, but never really. The experience was too amazing if not otherworldly surreal.

A video that includes the chanting...

Transition

2010-06-02T21:45:00.001-07:00

I’ve wanted to write about Haiti, but right now I’m feeling the transition back to my real life… So, sorry that’s what’s on my mind…

While I was in Haiti, I constantly was forced to make decisions based on allocation of limited resources, decisions based on the needs of group, it is not something I am used to. Alas, it is a reality there, if you have two functioning ventilators and three babies who might benefit from being ventilated a choice must be made. Those aren’t easy choices, and they tug at my soul, but I don’t question any of the choices I made. I had to trust in myself, in my training, in my skills.

Yet here we don’t have to make those choices, at least not so acutely. The other night, I was at work and confronted by the futility of so many of our patients. The dichotomy of my limitations in Haiti where I know with a few more resources, I could have saved some of those kids v, the reality of US medicine where we often go beyond what is reasonable tore at my heart.

After the night was over, I sat outside, I ate my breakfast, and I thought. U2’s lyrics played through my head. “Its not where we live that should determine if we live or die.” The problem is, I was equally torn by the kids I couldn’t save in Haiti as those I can here but for whom there is no life, no real independent life. I cried for all of them. I never cry, but alas the emotions overtook me. So, I just sat there and I cried in my coffee. I let emotion have 10 minutes then I collected myself and I went back to work. I had no choice.

I know in time I’ll sort this out. But for now, I’m going to feel this and maybe it’ll help me be a better doctor or maybe just a better person

Tweets from Haiti

2010-05-25T17:04:00.000-07:00

So, although I wasn't really able to blog from Haiti, I tweeted my way through my adventure. Here is a summary of my tweets from Haiti for waht they're worth. Real blogging to commence soon. So much to write about.

Interesting crowd heading to Haiti! The adventure is about to begin! #Haiti   

Sitting next to me on this airport is a native Haitian returning for the first time with a disaster relief group. Amazing! #Haiti

   And so it begins..... #Haiti

   My first glimpses of Haiti reveal a beautiful lush tropical island, but even at the airport the damage is visible. #Haiti

Day 1 of Haiti is winding down, I'm finding my groove, amazing people, united for a goal! #Haiti

Camp is under lockdown tonight, but it's great sitting around chatting with all the other great people here in #Haiti

Happy Haitian Flag Day!!!! (ie. Haitian independence day) #Haiti

My friends were worried I'd come home w a Haitian baby. Holding a beautiful abandonned baby, they had reason for concern. #Haiti

This compound looks like it was taken straight from a scene in Mash! #Haiti http://twitpic.com/1oz1al

   I'm melting.........

Finally venturing into the streets. Piles of rubble still line the road, although rebuilding is obvious too! #Haiti

As I watched this mom walk away with her twins the look of fear in her eyes tore through my heart. Www.callmedrlisa.blogspot.com

I just resuscitated a 2 month old while all the Haitians moms in the Peds unit were chanting some prayer. Surreal!! #Haiti

   I'm eating a backpackers meal, cause I need the protein. Just realized it has more salt than I eat in a day.

The dedication and compassion of the volunteers here amazes me! #Haiti http://twitpic.com/1pes6m

   Last night was a lesson in practicing medicine with limited resources. We do the best that we can. #Haiti

OMG! My ankles are so swollen from being on my feet for almost 33 hours straight. #Haiti

  Liquid malaria prophylaxis once again! I deserve it after the last two days! #Haiti

   Tonight's malaria prophylaxis was brought to you by these people. http://twitpic.com/1pk3gs

   Leaving the Medishare compound today to run a clinic in Port au Prince! #Haiti

The view from the top of the police station in Port au Prince 4 months post earthquake! #Haiti http://twitpic.com/1ps96p

Driving through downtown PaP, there are tents everywhere, sometimes completing filling small streets. #Haiti

   The countdown to flush toilets and handwashing has begun... #Haiti

Oh, and a LONG shower!!!!

I just consumed what is hopefully my last backpacker meal for awhile! #Haiti

   As my time in Haiti nears it's end, I am finally beginning to process some of the amazing things that have happened this week.

   I just took a cold shower outside in the rain, and it was AWESOME!!! #Haiti 4:43 PM May 21st via Twitter for iPhone

Student’s Ear Reattached by Miami Docs in Haiti – NBC Miami http://bit.ly/dduK8q #haiti (via @Haitifeed) So, I was a part of this....

Project medishare had 160 volunteers (doctors, nurses, SW, support) this week. Amazing the capacity of people to give! #Haiti

I've itched ever since clinic yesterday. Scabies is rampant in the tent cities! Gonna bath in permethrin ASAP. #Haiti

As much as I want a shower, debating if I'm really ready to go home! #Haiti

Post #Haiti the throngs of people in the Miami airport are overwhelming to me.

You know you've been somewhere crazy when the restroom on the airplane feels like luxury!! #Haiti

First Haiti Thoughts

2010-05-18T15:39:00.000-07:00

Landing in Port Au Prince, my first glimpses of Haiti revealed a lush Carribean island like so many others. The large central mountains, relics of the islands volcanic origin, the rocky coastline, the lush vegetation, then we landed and we were shuttled to the boarding terminal. Damage from the earthquake was still visible in the buildings at the airport. Then we left the airport grounds, and on our short drive, the disarray of the city was obvious. Although despite the extant destruction there were many signs of regrowth.

The hospital at Project medishare is actually on the airport grounds and is one of the larger functioning hospitals in Port Au Prince even though it is basically a Mash unit. I have been amazed at the dedication of the staff, and at what we both can and can’t do. I have primarily stayed in the combined pediatric/ neonatal ICU area, but even there some of these stories are so tragic. For example, tomorrow we will discharge a set of twins, the children were born 3 months early just weeks after the earthquake that claimed their father’s life like so many other Haitians. They have suffered no major complications of their prematurity, but what is the world they are being sent into. Their mom has a spot at a UNICEF tent for Mothers and Babies.

So many more stories, so little time. Each one has its own portion that tugs at your heart.

This experience is incredible and reminds me of the good that still exists in humanity, and the challenges as well.

More yet to come.

T minus 2 days to Haiti

2010-05-14T21:34:00.001-07:00

I leave for Haiti in 2 days. I planned on writing all about the build up to this trip, but I seem to have spent my time working instead, sorry.

I am going to Haiti to provide medical relief with a program coordinated out of the University of Miami (blasphemy to us Domers, but still..) called Project Medishare. They are running a Mash style hospital that is on the airport grounds. We will all be staying in a large tent in the compound. We will work at least 12 hour shifts caring for whoever is comes. I’ll be functioning as a neonatal/ pediatric intensivist. I’m a little afraid of the pediatric part, since I haven’t done that in awhile, but it will be fine and there are some resources.

I’m so proud of the number of people from my hospital who are working with this endeavor. The team from my hospital includes a pediatric surgeon, anesthesiologist, peds resident, several nurses and myself. We will be joined by groups from other hospitals. I have no good idea of what I’m getting myself into, but I’ll do my best. That is all I can do.

Mother's Day in the NICU

2010-05-09T18:55:00.003-07:00

Working in a Neonatal intensive care unit on Mother’s Day, I watch the mom’s of my patients coming in to spend time with their precious babies who can’t be home with them yet. It is poignant and heartbreaking. One woman, said to me the other day that she just wants to feel like her baby’s mom, and to take care of her. She acts as her mom in everything she does even if it wasn't what she imagined.

Still, I did get to discharge two babies today. Two mom’s got to take their children home for the first time weeks or months after their babies were born. One of these babies is extra special to me, cause I know the family in my real life. She looked at me and said, "I finally feel like I'm his mom." "Oh no," I replied, "you've been his mom and advocated for the best for him all along, but now its time for him to go home." I wish them all the best!

I wish a Happy Mother’s Day to all of you mom’s out there. And a special Mother's Day wish to mom's of sick babies, you often amaze me with your kindness and your patience!

Tri again, this time for a cause!

2010-04-30T12:29:00.000-07:00

Last year I did the Hansen Dam triathlon as a testament to myself and my own recovery. This September, I'm going to do the Malibu tri with the team from CHLA and this time it is all about raising money for Childrens Hospital Los Angeles.

Here is a brief video about the race.

Leap of Faith

2010-03-30T09:21:00.000-07:00

Standing on the edge of the Cornice at Mammoth, I look at the precipice of the run I’m about to undertake. I watch skier after skier complete their first turn off of the edge and disappear below. The sun beats down on me. It is a perfect day for skiing. For the first time in recorded memory the wind is not howling on this ridge so I can take a few moments to look around, to appreciate the beauty of where I am.

Then I turn my mind back to the run in front of me. A big group has just gone. It is my turn. I feel my heart beat faster, those few familiar moments of fear as I prepare to drop into the bowl I can’t see. I trust in my skill on skis, my experience, my strength. Yet still there is something awesome about having to take this kind of a leap of faith into that which you cannot see.

I take a deep breath, and I drop from the cornice. The first few turns are so steep, but the snow is perfect. I gather speed. I can only hear the sound of my skis speeding over the snow as faster and faster I carve my turns. My legs, my body respond on muscle memory alone. I am 100% in the moment, nothing else on the mind. Just this. At the bottom, I feel the exhiliration the rush of doing something that seems a little crazy. There is no lift line. I go again and again, different runs off the top, the same moment of fear, the same exhilaration at the bottom, until my legs scream that they can take no more.

There are days I walk into situations at work that seem so terrible, terrible beyond anything most can imagine. I feel a similar moment of questioning, of anxiety. Am I equal to the task placed on me? I allow myself to question it, but only for a moment that is all that fear gets. Then I’m calm and collected as I direct the team. I trust in my training, my skill, my knowledge, my colleagues. In those moments, my focus is similar, I am 100% in that moment, yet the two experiences couldn't be more different. It is a leap of faith of a different kind.

Objectivity

2010-03-03T20:08:00.000-08:00

I am a neonatologist, most of you know this. My specialty isn't all about happy endings and everything coming up roses. We deal with critically ill babies, babies so sick or with such rare diseases that they are transferred to us when they cannot be cared for in the community anymore. We have many wonderful success stories. I celebrate those because they keep me going through rough days. However, we also have many sad, sad stories and unfortunately some of the babies who come to us cannot be saved.

In my professional life, I am equally dedicated to saving the babies in my care who have a chance at survival and doing so with the highest level of skill and integrity that I can, as I am dedicated to not inflicting unnecessary suffering when it is clear that there is no possibility of survival. These dual goals of mine are not at all at odds with each other, but they do require extreme clarity and certainty of your knowledge. You must have the facts and when they are unclear fight for life. When the information is there you must be able to tell the family so they can understand and work towards acceptance. If you are not objective, this is not possible. This is why as physicians we do not care for family members, or those who are like family. Because try as you might, you cannot be objective. I have on more than one occassion wound up having to care for the children of people that I know in real life whether close friends or acquaintences. We have had family members of our staff in the unit etc. and try as you might that objectivity is affected. Which doesn't always translate to better care for the patient which is after all the whole point.

However, this is not in anyway to say that you should be withdrawn. As a neonatal intensivist, my humanity, my care, my concern is my center, my driving force. I must care, so that I can do my job to the best of my ability. As I have said the day that I do not shed a tear when a baby dies will be the day I quit. No questions asked, no second thoughts.

I struggle with these issues when life forces me to cross those lines and the black and white that I can normally see all becomes shades of grey. I try to avoid it, but sometimes I can't. I just try to do the best that I can and admit my weaknesses. Wish me luck.

What does it mean if you die in your dream?

2010-02-23T09:22:00.000-08:00

I occassionally remember my dreams, most of the time I do not. In the last few months, I've had several particularly vivid dreams. Some a little disturbing on different levels. I tend to dream more vividly at work, probably because I don't sleep deeply.

However, last night after spending a lovely relaxing evening at home. An evening that included a great run, yummy dinner, long bath, productivity, watching of the olympics etc. I settled down for a good nights sleep after a busy wedding weekend. I promptly entered dream land....

In my dream, I was a passenger in a car (not mine) driving down the Rim of the World highway. We were singing off key to the music, laughing. Not sure who I was with though. When all of a sudden we hit a patch of ice. The car spun out of control, I screamed. We hit the guard rail, tumbled over and then hit a tree on my side of the car. All went dark, and I woke up a hair bit mad at my subconscious for doing such a thing to me.

So, if this means something bad is about to happen, its been awesome knowing you all. I'm still going skiing on Monday, though. I can't put too much stock in this dream stuff.

Conversations with my 13 year old self

2010-02-01T20:26:00.000-08:00

Last October I found myself at my 20 yr high school reunion. An event I almost didn’t attend because I wasn’t sure if I wanted to go back there. Surprisingly, I had a really nice time, and I have reconnected with some old friends, and for that alone it is well worth it. However, it was also fun to see how people have changed, grown, matured. At the reunion itself many of the old cliques were still present, but mostly everyone was friendly.

So, a few weeks ago when I got an invitation for a girls reunion with some of my old classmates, I decided to give it a try. So, there gathered at a bar/ restaurant in Pasadena was a group of 8 women. Several of whom I had known since age 5 when we started San Marino schools, most I’d known since Jr High. Some I was friends with, some not so much. It was a gathering of people that would never of happened in high school, that much I am sure of, but it was fun.

As I sat around the table and listened to everyone talk about the reunion, their lives and some of our experiences. Over half of those gathered had reasons why they had almost not gone to the reunion, or gone out that night. Yet there we all were laughing together. I thought of Pink’s song, "Conversations with my 13 year old self.” I questioned, what I would tell my 13 year old self, if I could go back in time. Pink says “You’re laughing, but you’re hiding. I know the trick too well…Don’t worry, everything will work out fine.” That’s a nice message, but I’m sure that 13 year old me would have said “yeah, yeah what do you know.” Adolescents always think they know everything. Still it is true, we do all grow up.

So, I am grateful that I have reconnected with some of the people I grew up with. I hope that we stay reconnected and can call each other friends.

Why I'm proud of my hospital

2010-01-19T20:46:00.003-08:00

When leaving work on Friday, I ran into our chief of surgery. He and I have a jovial relationship, but he was somber. He is Haitian. I asked if he’d heard from his family. He said he’d had contact with half of them, and was leaving for Haiti the next day to do what he could to help and hopefully hear about the rest of his loved ones.

Here is a man at a zenith in his career who came from humble beginnings. He has never forgotten this, I have always respected that about him. However, to see a man of his power so scared was humbling, because in this kind of situation it does not matter. Money isn’t going to get you anything in Haiti if there is no water, when there are no roads, when the situation is that bad. Yet, we hope. He is traveling to Haiti with a medical team. They will treat whoever is brought to them. He hopes to find his family.

My heart bled talking to him. I told him I couldn’t go this weekend, but if there would be future trips, I’d go. He said he’d be returning in a few weeks. I’ll try to go, if they need me, and my boss will let me. When I entered the medical field, I always believed that I’d spend a fair portion of my time working in developing nations, but I chose a technology dependent specialty and travel is limited. However, if my skills could help in Haiti, I’d go in an instant. Because it is the right thing to do.

I’m proud that our head of surgery understands this and supports it with his own time and skill.

The World According to Dr. Lisa

2009-12-22T14:50:00.000-08:00

Several of my friends are shocked that I'd post my age on the internet, but age is really a figment of time and place, right? Not a question of yourself. I mean if I lived on Mars, I'd be younger as defined by the number of times my home planet orbitted the sun, but still the same time would have elapsed. Or is that a little existential. Seriously, though, I have now been 39 for a week, and I'm good with it. I know who I am. I have been on the journey that is my life with all of its ups and downs and I am the sum total of that journey. Of course there are things I wished would have happened by now, but I can only worry about what I can control. My grandpa, who was a wise man, had a motto "never begrudge getting older, it is a privilege denied to many." There is a lot of truth to that. So, while yes, I'd love to have fewer lines on my face and not be fighting gravity. (At least people no longer ask if I am old enough to be their child's doctor.) I see no point in lying and saying that I'm younger or trying to hide my age. I can't imagine being 30 again, that wasn't such a great year. So far life at 39 seems pretty great, and 38 was out of this park. So, if things keep getting better, no clue what could happen next.. I might just run the world by the time I'm 40, and let me tell you, the world according to Lisa would be pretty cool. So, I embrace my age and I'm going with it.

Birthday Soiree

2009-12-16T15:23:00.000-08:00

Being born in December, I have grown accustomed to having my birthday passed over. What with all the holdiay craziness etc. The past year has been so amazing, and I fully expect the amazingness to continue so I decided that that would just not do. I organized myself a little birthday soiree. I invited a bunch of my favorite people, people I know in a variety of different ways. I made food, cocktails and set my house up for a party. My friend, Kim, made me a cake. I laughed, I smiled, I entered the last year of my 30s on a good note.

Thanks to all who came and helped me celebrate my birthday. This has the beginnings of a pretty good year..

Guest Starring... Me

2009-12-04T20:13:00.000-08:00

Last night I was on BlogTalkRadio as a guest on the Dr. Anonymous show. We talked about how I got into the blogosphere the impact that blogging has had on my life. Why I did a triathlon, and issues related to protecting our privacy as physicians in the blogosphere and our patient's privacy as well. I had fun, I hope that those of you who listened did too.

Below is a link to the archive of the show. Sadly no video due to some trouble with the video feed last night. Oh well, I guess Dr. Anonymous will have to have me back...

Where you'll find me tomorrow night!!

2009-12-02T15:38:00.000-08:00

I have made some friends in the blogosphere and am followed on twitter by a bunch of very interesting doctor types who are also in the blogosphere. Somehow through one of these connections I have been invited to be a guest on the Doctor Anonymous Show on BlogTalkRadio tomorrow night, December 3, at 6pmPT/ 9pm ET. We're going to be talking about stuff--- Neonatology, my trip to Mongolia, my life as a doctor, my experience as a patient and whatever else anyone finds intersting. Join us, won't you.

My Happy Place

2009-11-29T19:08:00.000-08:00

I joke frequently about finding my happy place. Most of the time I am referring to a state of mind. A state where my mind is clear, quieted, calmed; thereby, allowing me to focus on whatever requires my attention, or at least not be distracted by the stuff that surrounds me. Putting it in other words, getting my mind where it was in Bali, but Bali is very, very far away. So going there to sort stuff out would be impractical to say the least. Therefore, alternatives must exist and fortunately they do. My happy place can be many different places, but it always involves fresh air, typically water in some form (snow, lake, river, ocean, fountain- I'm not so picky), some nice pine trees and maybe a sunset. Sold!

Really though when I speak of My Happy Place as a real place it is Lake Arrowhead. Or more specifically that little corner of Lake Arrowhead where I have spent so much time in over the past 35 years. It meets all of my criteria-
Water- check, there's the lake, a stream running by our place, and sometimes snow
Fresh air- check, it's the mountains, silly
Pine trees- done, it's the middle of the forest after all, we even have 2 Sequoias and if those aren't grand trees I don't know what is
Sunset- sure the sun sets there and you can watch it from the dock or our porch

So yeah, that is my happy place. Most of you who pay even the slightest bit of attention to this site know the last few weeks were a little rough. So I made plans to escape for the little free time I had this holiday weekend to Lake Arrowhead. I arrived up there and felt the mountain air begin to do it's work that was then aided along by waking up to a world blanketed by the first snow of the season.

I am thankful to know where my happy place is and to be able to go there. Happy Thanksgiving all!

Diction

2009-11-16T14:26:00.000-08:00

A few months ago I wrote about how difficult it is for me to speak truths to the family of my patients some times, about my realization of the power of words, and my pursuit of speaking clearly. I am still a work in process in this regards as in so many others.

Today as I prepare for a family meeting, I am thinking about some of the words/phrases that I use on an almost daily basis that are thankfully foreign to most. Things like "limits of viability," "incompatible with life," "allow natural death"... These phrases have very specific meanings in my world, but they sound cold, harsh, unfeeling. Yet sometimes that is reality and there is no sugar coating it. I wish there was.

20 yrs- Really??

2009-11-03T20:41:00.000-08:00

A few weeks ago, I found myself heading to my 20 yr high school reunion with a big sense of trepidation brewing in my belly. To say high school wasn't exactly my time might be an understatement, but when I'd looked through my photo albums and yearbooks with my BFF on the phone prior to the reunion I remembered that there were some really good times. Some good friends, many memories and although I have only really kept in touch with only said BFF since high school. I was curious. Yet, still when I didn't feel so good that day, I almost gave in figuring I had an excuse. Somehow or another I convinced myself to go.

I arrived at the San Gabriel Country Club and was greated by many familiar faces and many not so familiar. I found some old friends and found easy conversation, interesting people. Yes, we have all grown up in the last 20 years. The people who were friendly and interesting, still are! For the most part, the people who were tools, still are! Even with that said. I had a really nice time. I am glad that I went. I was really glad to reconnect with many of the people whom I had known since I was 5 years old, when we all started kindergarten. I have made plans to see some of them since.

Maybe you can't go back. I am sure that I don't want to go back to high school, yet still it was a really fun evening.

Best wishes SMHS class of '89 it was good to see you again.

Bye Summer '09- you've been good to me.

2009-10-13T19:42:00.000-07:00

Today is a rainy SoCal day, it feels like fall has actually arrived here in Los Angeles, and I am ready to embrace a new season. However, this transition of seasons has me looking back over the past season and shaking my head a little because the Summer 2009 might be one for the LK record book. Really all of 2009 has been pretty good to me. Certainly there were rough times, but as I begin to think about all of the year ending festivities that approach I am awed at what a summer (year) it has been.

Summer 2009 dawned with me in a minor state of flux, focussed on training for my triathlon, but worried about things I couldn't control. I gave up controlling the uncontrollable and just went with things. The results have pretty much been good. A few bumps on the way, but forward progress nonetheless. Then there was the tri... As July waned, my exercise complusion grew. I approached the triathlon with excitement and trepidation. When the day finally came, I was well trained and met almost all of my goals. Afterwards, I surrounded myself with friends and basked in the glow of completing the race and finishing in the top 1/3 of my age group. People said I glowed, maybe I did, but I was certainly on a post race high for at least a week. Then the reality that my Asia trip was fast approaching set in and my focus switched to planning for that. A few short weeks later I hurtled through time and space, and I found myself in the admazing adventure that was my trip to Mongolia. After an amazing week of trying to help the people of Mongolia I set off to relax in Bali. Bali was unlike any place I have ever been. It was beautiful, it was relaxing, it was centering. And then I came home, and life picked up where I left it. Again I find myself trying to just go with it, enjoying the journey as it passes.

Whew what a summer it has been, as I think about moving into fall, I fear that this sort of post crazy multi event high might be leading to an emotional crash. That wouldn't shock me. What goes up usually comes down, but I feel like my life is on a forward trajectory and my outlook is amazing. Thanks Summer 2009, I'll remember you!

Dear Owner of the dog who attacked Sadie

2009-10-09T15:10:00.000-07:00

Thank you so much for your kind note and apology for this weeks incident between our dogs. It was very kind of you to replace my shirt that your dog ripped even though it was a very old t-shirt. While it was cute of you to sign it from your pit bull, I truly feel that it is you the irresponsible owner that owed me and Sadie the apology, not your dog. I have absolutely nothing against pit bulls, some friends of mine have a pit bull who is one of the sweetest dogs ever. When I am at their house tomorrow, her head while likely be in my lap while I scratch her tummy. However, her owners know she is dog aggressive and have her well trained and don't let her run around the street off leash. That is the difference

Your dog did what pit bulls were bread to do, attack a dog that crosses their home territory and to desist when the humans get involved. The fact that I literally yanked Sadie by her leash away from your dog and then hoisted her to my shoulders is why she is unharmed. The fact that the incident happened at all is because your dog was off leash in public. That is on you, an irresponsible dog owner.

I take exception to you signing the note from your dog because it really isn't your dog's fault, you just need to realize that you have a dog aggressive dog and not let him run around loose in front of your house. Bad things can follow...

Thank you very much,

Lisa

This incident occurred during Sadie's and my regular evening walk along our regular path on Monday evening. I haven't walked back by the house yet, but I know that neighbor and have seen her dog running the streets off leash when he has gotten out before. We just happened to be in the street in front of their house when he got out this time. However, aside from us both being upset we are fine. Sadie is back to normal. Me not quite, but we're fine.

Wash your hands, please!

2009-10-07T16:07:00.000-07:00

In 1845, Dr Semmelweiss in Austria investigated why women were dying of postpartum infections at an alarming rate, ~15%. He instituted a policy of handwashing after discovering that interns and residents were sometimes proceeding straight from performing autopsies to delivering babies. After instituting the hand washing policy the rate of infection fell to the baseline for the era. Slowly his discovery that hand washing was an important tool to prevent spread of infections gained support. It is now accepted as gospel truth that dirty hands can spread infection and that hand washing, as simple as it may sound, is one of (if not the) most important weapon against preventing the spread of nosocomial infections.

When I was in Mongolia, I was aghast at the lack of facilities for appropriate hand hygeine. The staff restrooms often doubled as storage closets. There was no way to dry your hands. They did have alcohol gel avialable to use before touching patients, but not at every bedside to be sure. When the neonatologist there broached the subject of their infection rate, Monica and I immediately launched into a discussion of careful attention to hand hygeine and appropriate patient skin prep and care of central lines. At first they were resistent, but with gentle support they could appreciate the impact something so simple could have. Of course, the barriers to hand hygeine in an emerging country are huge.

However, it would be very narcissistic and first world-centric of me to say that the barriers only exist in such circumstances as those I saw in Mongolia, when everyday in my unit we are still working to achieve 100% compliance of all health care practitioners to hand hygeine. For something so fundamental, I do not think that 100% compliance is an unrealistic goal and fortunately, I have the support of my hospital to try to get there.

Thanks Dr. Semmelweis. I hope your contributions to medicine will no longer have to be talked about soon.

Book Club

2009-09-30T23:26:00.000-07:00

Sunday night in the midst of a severe case of jet lag, I found myself at my friends house for book club surrounded by some of my favorite people. As always after book club, I am buoyed by the support and fellowship of my friends.

One of the beauties of the group is in our very diversity. We range in age from the late 30s to 50. Our careers span the spectrum from producer, special effects production, music management, running a non-profit, real estate to medicine. Some of our group have children, most do not. We have burgeoning relationships, dying ones. We are married, divorced, single. But all these things are just some of the labels that are so often applied to us as women and used to define our role in the world. The truth of the matter is for those hours once a month none of those labels are important. What matters is that we are all friends, and we are all free of judgement of each other. Oh and yes, we do actually talk about the book in addition to eating fabulous food and drinking wine.

Last month we read "The Little Stranger" by Sarah Waters a subtle tale of haunting set in the dying era of the old manor homes in England. Next month "The Help" by Katherine Stockett a fantastic book looking at the struggles of race relationships in the South at the beginning of the civil rights movement.

Stillness

2009-09-26T06:35:00.000-07:00

“When you learn to quiet your mind, you will hear them too” (Name that movie and the character who said that and to whom, and you will get, um, nothing, but I’ll know you know too- you can even correct the errors in the quote that I think might be there.)

That quote entered my mind the other day while sitting looking out at a bunch of rice fields in Bali, watching a couple of men chase birds out of the rice that was about ready to be harvested.

My life generally proceeds at a relatively frenetic pace. I work long hours, then I try to carve out time to have a social life, to take care of me, to sleep, whatever. I seem to be always rushing from one place to the next and detesting being late anywhere. A few years ago, I committed to “scheduling” one night off a week. Literally, when I have weeks that are becoming too full, I’ll make sure that one night stays blocked off for me to not have plans. I actually calendar my night off. The whole idea of scheduled free time seems hypocritical, but it has made a big difference for me and my state of mental exhaustion.

Yet still, I have been in Bali for 12 days and have rarely found a place so relaxing. I have literally sat and looked at nothing for hours, and I usually don’t sit. I have actually succeeded in stopping my mind from playing the perpetual what if games. I can’t ever shut it off, but I’ve turned the volume down at least. I have found tremendous pleasure in such simple things. At the beach, I walked along the water every morning and then sat in a pagoda things and looked out at the ocean and felt the cool breeze blow over me. I’d think about things important to me, but mostly I’d just be there and look. When I moved inland, initially I found the same morning ritual in along the edge of rice fields and then when the sun shone again by going for long morning walks (sometimes with people, sometimes alone). I have rarely felt so calm in my adult life. This new state of calmness prevented me from being able to tolerate shopping in Ubud the other day. It was too loud, too bustling, too much going on, I had to escape. (So, if you thought I might bring you home something from Bali- sorry I just couldn’t do it.) Shopping has always been utilitatrian for me, and I have never been a fan of the whole bargaining game, and well they was nature and sunlight to explore.

Just a few photos from Bali- so many more..

Last night as I started to think about getting ready to begin my 24 hour journey home, some of the trappings of my LA life started to seep back in. I balked. I know it is inevitable, but it would be nice to live life as we know it with this type of serenity. An impossibility I fear, but a noble goal. Let's see how long I can keep that goal in the midst of a 24 hour journey home.

Just so you know!

2009-09-23T19:14:00.000-07:00

I'm still here, still in Bali, still having a great time. I'm just too busy exploring this beautiful country to write about it. Plus, my camera cable is being mailed to me at home, so no pictures anyway. So, when I'm stuck in some airport again or when I get home, I'll tell you all about wandering through rice fields, the Balinese festival I watched, the sacred monkey forest, the elephant cave and just sitting at peace. Etc., etc. So many stories so little time.

It is amazing here. Ciao!!

The news I dreaded

2009-09-20T01:39:00.000-07:00

When we had dinner with the High Lama of Mongolia, he gave each of us a small baggy of what he said was precious earth. He told us to use small amounts of it to put into bodies of water and pray. He said he hoped that this little bit of Mongolia would help some of the suffering in the US. It was a beautiful sentiment especially when you consider that we were there to try to help some of the suffering in Mongolia. Still I couldn't help thinking of Johnny Depp in Pirates of the Carribean saying I have this jar of dirt. I know, I'm going someplace bad. I digress.

This morning when I logged onto the computer, I received the message I'd dreaded the whole trip- my beloved grandfather had died yesterday. He is one of the strongest men I've ever met, and I loved him deeply. Yet still I left home with instructions that I was to be notified if he died, and that I wouldn't fly home. Johnny wouldn't have wanted me to do that. Plus, I feel like I have said good-bye to him. I even told my mom that yes, she could use my post as his eulogy as she'd asked.

Yet, this morning the news brought tears to my eyes. After breakfast, I walked to the spot I have walked to every morning since I arrived here...

I sat on that table that feels like some sort of a shrine, and I thought about Johnny. I cried (something I never do), and I tried to honor the man who he was. The man I am fortunate to have grown up knowing. I am travelling a new continent. In the last few weeks, I have dined with a Lama, I have visited a Buddhist temple, I have worked to help healthcare in Mongolia, I have slept in a Gher, I have walked the Mongolian national parks and the Balinese beaches. Tomorrow I will visit temples here in Bali and visit a Balinese park. I am honoring him, by honoring things he loved. Yet, still I know that my world is a little smaller a little less without him in it.

I stood by the Indian Ocean today and I took a little of the High Lama's dirt and I put it in the ocean, and I prayed that Johnny is now holding hands with Frankie again, and that they are travelling the universe together.

RIP Lloyd Johnson 9-1-1914 to 9-18-2009... I love you!

Mother Earth as an alarm clock.

2009-09-18T16:56:00.000-07:00

At 7:06 this morning I was literally shaken awake by the Earth. Yes, there was a magnitude 5.8 Earthquake off the coast of Bali this morning. Other info says it was 6.4 magnitude Earthquake, I don't know, which is true. Still, aside from waking me up earlier than I wanted I am fine. The hotel says there is no potential for a tsunami since it was too close to land. Good. Now I can return to my morning coffee drinking pursuits.

Thanks again to those who checked on me! And wow, my twitter friends heard about it almost immediately. Crazy social media.

Learning to Relax!

2009-09-18T04:48:00.000-07:00

A million years ago when we used to go on family vacations my dad would always take a couple of days to relax. He'd be antsy and grumbly the first few days and then get into the vacation thing. As a kid, I didn't understand it. To me arriving in Hawaii, or whereever, would flip a switch and I'd pull up a beach chair slather myself with suncreen and read all day without a care in the world. When I went to Hawaii for my friend Calista's wedding a few years ago, I finally understood the phenomenon. After the hectic pace we kept in Mongolia, this trip has exemplified the need to ease into relaxation mode.

I have now been in Bali for four days, and I'm finally relaxed. I have met some tres fun 30 something Aussie's to hang out with and have finally quieted my brain. Let the vacation begin..

Cultural Whiplash!

2009-09-15T17:07:00.000-07:00

I sit on my balcony drinking Balinese coffee made in a coffee press writing this post, looking at this scene.

Thinking about the cultural extremes of the last week, might give me whiplash..

11 days ago, I left LA in the middle of the night and 30 hours later arrived in UlaanBataar, Mongolia in the middle of the night. For the next 5 days I awoke each morning to the sounds of the crazy Mongolian traffic and looked out at a likeness of Ghengis Khan on the hillside rimming UB.

Then we went to a Mongolian National Park, Terilj (sp) stayed in a Gher kept warm by a fire and listened to crickets and the horses grazing outside our Gher.

Me and my Gher!

The view outside of the Gher.

After that drove back to UB for one more night. Left for the aiport so early in the morning it felt like the middle of the night to fly to Bali, where arrived after midnight. (BTW- what is up with these middle of the night Asian flights) Woke up to palm trees, the sound of the Indian Ocean, walked the beach, rested, looked at these kind of scenes.

See what I mean, cultural whiplash in an Oh My This is Amazing sort of way.

Gotta go meditate on that. Ciao

More Mongolian Thoughts... Still Just Me

2009-09-13T23:34:00.000-07:00

Still bored in Seoul.. Still blogging about my trip..

In Mongolia, I gave several talks to the neonatal division, sort of small informal teaching sessions on very specific talks. These talks pretty much took up the majority of my last 3 mornings at the hospital. We covered basic neonatal topics like infection control, fluids and electrolytes, feedings, basic management of patients with gastroschisis. It was remarkable to have dialogue with the Mongolian team to learn what they do well, to add insight where I had it. It was those exchanges where I felt I had the most opportunity to make an impact. In the afternoon, we did big lectures for the whole hospital. I gave two with the help of Monica, the neonatal nurse who was with us. None of this teaching would have been posisble without the help of our Mongolian translators. My main translator was a neonatology resident who studied English for only 6 months. Her English was great and she seemed to really enjoy the experience. I am in awe at how well many of the Mongolians speak English.

Monica and I, and the Mongolian neonatal physicians.

The last day we were there I was giving a talk on "The Transition and Disorders of the Transition." I was making my case to my colleagues that the transition from fetal to neonatal life is the most important transition in life. Not sure I convinced them, but alas I digress again. After my talk I was introduced to a neonatologist from the Mongolian countryside who had travelled 6 hours by train to hear my talks. Humbled, I shook her hand and listened to her stories of medicine in the countryside of Mongolia. I couldn't believe that she had gone to such efforts to hear me, me. I am no one, just a doctor in LA trying my best. Yet she travelled for hours to hear me. Wow!! With a double dose of wow.

A guy I used to have thing with delights in commenting about how I remind him of how trivial his job is, (Maybe why things would have never worked out there) but more to the point, I have never considered myself as extra ordinary. I'm just me, the same girl I was 20 years ago just with more grey hairs and wrinkles in my skin. As I have progressed in my career, I have always seemed the same, from the inside looking out. I still have my idealistic side even if it does become ever more jaded and is now balanced by some skill in my profession. I was awed by this women's desire to go to such exremes to meet me, me. I hope I didn't disappoint.

Traffic Mongolian Style...

2009-09-13T22:37:00.000-07:00

After I upload my pictures from the country, I will finish my travelogue from Mongolia. For now, there have been little vignettes of observation that have captured my attention.

Mongolia like many emerging countries with ever increasing access to newer technologies and ways of doing things has changed rapidly. According to those in our group who have been coming to Mongolia for over 14 years, 10-14 years ago, there were few cars in UB and people still got around on horses, even in city. There were few apartment buildings. Even in the city people still lived a fairly traditional life. As modernization has snuck in with ever increasing strength, the city has multiplied without benefit of city planning. Buildings have popped up everywhere. Cars have multiplied in a manor that would make rabbits seem impotent. The streets have few lights, few rules, no cross walks. In general it is mass chaos.

Getting in a car is an act of great faith, crossing the street even worse. We had cab rides to go 2-3 miles that took 45 minutes. On one fateful cab trip the 4 women of the group each told each other our wishes in case we died, and we weren't exaggerating although we were laughing. (Maybe my parents had a point with the whole will, power of attorney thing.) When the Lama was driving us to the infamous dinner, he declared that traffic rules were beneath him and proceeded straight. Prompting us to declare "breaking the law with the Lama." We hopped his karma would extend to us and keep us safe.

Walking across the street took guts and courage, we got better over the week, but still. One day leaving the hospital, there were two small children (4-6 year olds, I'd guess) crossing the street completely alone. There were cars whizzing towards them and they just took off into the street. Feeling protective and horrified, Monica and I tried to cross the street with them, figuring we at least were taller than the hoods of the cars. The children looked at us like we were insane. That we didn't see traffic accidents every moment was shocking to me.

The head of our group had a meeting with the minister of health one day while we were there who said the number one thing he'd do to improve health and safety in Mongolia would be to install traffic lights and enforce seat belt and car seat laws. From what I saw that would be a good thing.

Mongolia strooling acoss the street with his hand up, to say "hey don't kill me"

Our group walking purposefully across the street trying to not get killed.

A brief nonrepresentative snapshot of what traffic was like.

Mongolian Ingenuity

2009-09-13T21:57:00.000-07:00

The other day Monica and I were doing some teaching with the Mongolian doctors and nurses about hand hygeine and central line care. We were trying to make the point that careful attention to infection control could make a huge difference for them. An interesting conversation to have in a hospital that doesn't have toilet paper and in which it takes an act of congress to wash your hands. They did at least have alcohol gel readily available throughout. But I digress,

A baby returned from the operating room after getting a colostomy for imperferate anus. We were busily documenting the way they transported the baby with a pillow filled with oxgen that they squeezed to fill the mask they were using to bag the baby. Crazy..

Amira, my translator, hooking the oxygen pillow up for transport.

Then they got the baby in his isolette and began to set up his ostomy. They were attaching a latex looking thing with a dam of sort that they tied to the skin. I looked at Monica and said "is that a.." She replied "female condom, yep!" There you go they had attached ties to a female condom and were using it as a colostomy bag. Brilliant really..

Ingenious really! Who uses them for barrier protection? They are cheap and readily available. We were amazed.

Day2-3 Mongolia

2009-09-10T07:17:00.000-07:00

Day 1 in Mongolia was amazing..

Day 2 even better..

Day 2 dawned with another beautiful sunrise. Another early morning breakfast with the team and then Monica and I headed to the hospital where they had asked me to round with them and to give a couple of talks before our afternoon lecture series. They presented some fascinating cases to me, I helped as I could, I gave my lectures. For 3 hours, I spent time with the doctors in the NICU in UB, answering their questions, awed by the combination of what they could do and what they couldn't. We discussed the plans for the next day and we headed to a late lunch with our team.

My jet lag demanded an easy afternoon, so we went back to the hotel. I helped Monica fine tune her talk for the next day, finished mine, caught up on some things and headed downstairs to meet up with our group for our evening. On tap that night...

A visit to the High Lama of Mongolia who had granted us a private audience and then agreed to dine with us afterwards. After a cab drive in which my new friends and I all told each other our wishes for our funerals and where our wills were, we arrived at the Buddhist temple that is the Lama's home. We spent about an hour with him discussing the ways to integrate Eastern and Western medicine. He presented each of us with Buddhist prayer shawls and an envelope of sacred earth that we were to put in a water way at home when we make a wish.

A portion of the group with the Lama!

Then we headed out to dinner with the Lama as our culinary gruide. We went to a "hot pot" restaurant. Much hilarity ensued. I have never laughed so hard or been so entertained by my company. We all ate bull penis and you know what, it isn't bad.

Thoroughly content we headed home. Day 2 in Mongolia= undescribably amazing!!

Day 3 was tame by the prior days standards, but more of the same. We awoke early, dined with the team headed to the hospital. Spent the morning teaching on the NICU floor. Gave my talks in the afternoon. Dinner with the other women on the trip. Day 3 may have been tame by the standards set by the prior days, but filled with laughter and hopefully, good experiences for both us and the Mongolian physicians we are trying to support...

Mongolia: Day 1

2009-09-09T01:05:00.000-07:00

So, after my millions of hours of travel and a few inflight naps and a little uncertainty, I arrived in Mongolia. I was actually met at the gate by the lovely woman coordinating our trip and two Mongolians who would take me on my first heart stopping drives through the Mongolian streets. Given my state of exhaustion, I begged off dinner ate the remainder of the baked chicken and settled in to get some desparately needed shut eye.

Actually managing to sleep, I was awoken the next morning at 6 am by a gnawing emptiness in my stomach. I then rolled over and saw some light poking in through the curtains I hadn't fully shut the night before. I got up open the curtains and saw the beginnings of sunrise over UlannBataar (UB- to its friends).

Appreciating what looked like an amazing city, I prepared myself for the day ahead. I had few expectations, no real knowledge of what I was heading into. However, I trusted the people who invited me here, and so fueled by my thirst for adventure, and my headache that needed coffee, I headed down to breakfast with the team, and to figure out where the day would lead.

Team over breakfast my first day (their third) in Mongolia

We discussed our plans for the day and then divided as per our duties with the majority of us heading off to the hospital. My first impression was the the hospital looked like a Russian jail. It was a big industrial building in the middle of what appeared to be a construction site with random gates and random roads and cars parked everywhere and kids running through the parking lot. That there was order in this chaos was amazing. There standing at the doors was one of our translating physicians, who guided us through this maze and brought myself and the ebullient neonatal nurse, Monica, who is my partner in crime this week to the NICU. Our lead physician came with us as he had never been to the Mongolian NICU before and wanted to see what was the deal. (He probably wanted to check on me too.)

Anyway, we met our lovely translator, who is a neonatal resident with amazing English skills. We toured the NICU talked about several babies, met some of the families. We were able to learn what their needs were so we could tailor our teaching for the rest of the week. We rounded on a couple of the babies with them.

The woman on my right is the translator, on my left is the head neonatologist and then the other residents. In the back is Dr. Ross.

The baby they wanted help with the first day.

A preterm baby in the isolette in a room with her mom.

Our day continued on with lunch with the head of the hospital and the secretary to the minister of health where we discussed on going educational needs of the Mongolian physicians and then we did two hours of our formal lectures.

After that I was about to die from jet lag, so Monica and I and Kate, the adolescent fellow, went for a walk to a Buddhist monastery. Where I saw the third tallest gold Buddha in the world.

Waking out of my jet lag stupor after my brief emersion in the culture, we headed off on a walk with a bunch of the Mongolian expats. We were put on a bus and taken out into the countryside outside of Mongolia to climb the hill and watch the sunset over the river and the planes. A 45 minute walk with some fascinating people. There was the woman whose kids were finally grown up so she had joined the peace corp and just moved to Mongolia with her husband to be the Peace Corps chief medical officer, a couple of teachers at the Mongolian interntational school, embassy workers, and the guy who introduced himself by saying he driven from Detroit to UB (going with his car by boat from New York to London- he admitted). Such amazing people, fascinating conversations, lovely views- what an end to my first Mongolian day.

Made it to the Asian Continent!

2009-09-06T19:20:00.000-07:00

Deciding to go to Mongolia and Bali in the same trip is sort of like deciding to go to LA and New York because you’re going to be in the US. They aren’t exactly close to each other. However, I have never been known to do things the easy way. Plus, I had enough miles to get me round trip to Asia in business class which made my route of travel even more suspect. Therefore, here I sit in the Hong Kong airport, wishing I had enough time to explore the city becuase the little that I see out the window is really pretty. I actually managed to get some sleep on the plane so I am feeling somewhat rested and ready to continue on to Seoul and then finally tonight I will arrive in UlaanBataar, Mongolia where I will be met at the airport by the Mongolian physician who is to serve as my translator for the week. Apparently, we are then going out to dinner. All said and done I am hopeful that I will be able to sleep once I finally get there despite the 15 hour time change that has my days and nights swapped and threatens to send my body into a severe state of confusion.

Am I fully formed?

2009-09-06T00:11:00.000-07:00

Leaving the US for the first time in a couple of years, I am reflective about my prior trips. The things that have had the biggest impact on me- my time in school in Spain, my trips to Nicaragua, being in Greece over 9/11, realizing that residency wasn’t the cure to jet lag, but that our lives were conducted in a constant state of jet lag. These events, disparate as they are were all so formative in developing who I am now. Lessons that I learned from each of those trips come up all the time. When people are getting to know me it rarely takes more than a few conversations for one of those trips to come up. They are fundamental to my view of the world and to my persona, such as it is. Will this trip be formative? Or am I already formed? There is so much to be told.. Stay tuned this is only the beginning…

Is medicine going backwards?

2009-09-05T11:58:00.000-07:00

One of the talks I am giving to the OBs, Pediatricians and Midwifes in Mongolia is reviewing neonatal resusciation and the reasons for using room air v. 100% oxygen. This is a relatively hot topic in the neonatal community as there an ever growing body of evidence that 100% oxygen in the first minutes of life isn't a good thing. There have also been several studies recently that have demonstrated that babies resuscitated with room air do just as well if not better. The problem is that several of these studies were not approved to be done in the US because they couldn't get IRB approval due to the strong belief that oxygen was needed, that they would be "doing harm." Further, at least one of the early trials had the Oxygen arm in developed countries while the room air arm in the developing nations. Again a way to bypass IRBs, but also potentially treating those in developing nations with less respect. An interesting issue to deal with when giving the talk in a developing nation. I'm trying to be sensitive to these concerns without ignoring them. It is a fine line.

Further, in tangentially talking about this the other night over dinner, we wound up discussing how medicine might be about to start going backwards, or at least stop forward progress, given the need to have everything so tightly monitored and watched over. So many of the great advances in medicine occured through happinstance and use of questionable techniques. If Alexander Fleming complied with current standards of cleanliness and research protocols, we might not have penicillin. If Jonas Salk wasn't willing to consider injecting people with cow pox, small pox might not be erradicated, and the concept of vaccines might never have been born. These are major steps forward that occurred in ways that would be considered unethical now. There are more recent examples too, a study completed in England in the 90s was considered unethical in the US because it was potentially witholding life saving therapy even though that therapy had never been proven effective, nor rigorously studied. I'm currently trying to get a research protocol through my institutions IRB and the amount of red tape for something simple is mind boggling.

Is it possible for medicine to continue to move forward in this era?

How do we continue to move our therapies forward and respect all people equally? because just taking the studies out of the US is not the answer...

Gap Born To Fit!

2009-09-03T15:09:00.000-07:00

A couple of weeks ago I got invited to this party by my friend the Slackmistress where I was told I'd get a new pair of jeans, but I'd have to take off my pants. Interesting catch phrase to get me to a party of a bunch of fabulous blogging women.

I arrived at the party in the Gap Pop-UP store, where I was greeted to free parking, free sangria, free appetizers and a shopping consultant to help me pick out jeans that would complement my figure. Seriously, these people know how to throw a party! I tried on the "Sexy Boot" jeans, went down a size and had the following photo taken of me.

Modeling the Gap "Sexy Boot" Jeans

Photo by Janet Barnett

Although, I may not like my smile, this photo was labelled by Nina as Dr. McDreamy. Um thanks for the confidence boost and prompted the following tweet from my friend Kim "HOT pic of you, dear @lkkelly http://bit.ly/eMOqg". So needless to say I am now a huge fan of these "sexy boot" jeans. With my friends supporting my ego like this, I want more....

The Slackmistress is now giving away a coupon for a free pair of Gap jeans from her blog, details here. In order to win you have to tell a story about your favorite jeans, your old fav jeans and/ or tweet about the contest. Got it.

I am a Spring, so I always get to wear jeans and have always loved jeans. In college, I had these old gap skinny jeans that were my favorites. I had worn them for years and as I was gaining the freshman 15 that ballooned into more like 20-30 they grew tighter and tighter on me, but I loved them still. They were worn in just right, the fabric was soft. They were like a security blanket, but by the time that snow had been on the ground of South Bend for 4 months they were TIGHT. One day walking to the dining hall in the bitter cold over the snow and ice, this Soutern California girl bit it on a patch of ice. Seriously, I fell over like a comic book character, feet flying into the air, landing with a carumph on my now padded derriere. Rip went those jeans below each butt cheek. NICE! I refused to take off my jacket for the rest of the day (which was fine as it was subzero in March), and then borrowed my roommates sewing machine and sewed patches on the backside of the jeans that made them even funkier (not to mention roomier). My favorite jeans were saved to last several more years. I was in college after all.

Can't I focus on the Awesome?

2009-09-02T19:08:00.000-07:00

I have travelled a lot in my life. I've been to some exotic places. I've been to the third world before, I've been in the jungle along the Rio Coco, I've done Central America, the Carribean, Europe, Australia, etc. Like I said, I'm not a novice international traveller. I was stuck in Greece after 9/11 and found my way home with some ingenuity and help. I was once stranded in Nicaragua, and found a way out of that one too. OK, I've never been to Asia before, and it is half a world away, but it is just a really long flight and some serious jet lag, culture shock and language difference away, right? Or so I keep telling myself.

Aside from this being a remarkably amazing opportunity and a trip I am so seriously looking forward to, there are those around me who are a little concerned about my safety. My parents, in particular. I take it to mean that they love me, but... really? For the last few weeks they have been on my case about setting a power of attorney, a medical power of attorney, making a will, etc. I know that these are all good things to do and once they are done you can forget about it. It is supposed to give you peace of mind. It is supposed to be a good idea. However, it is making me feel vulnerable, mortal, and alone. I don't like it, not one bit!

I'm not sure why they have chosen this trip to freak out about, but I want to just focus on the pure awesomeness of my upcoming adventure. Please... thanks!

I have an addiction

2009-08-31T13:00:00.000-07:00

In medical school, we learned the CAGE questions to judge if someone had an addiction problem.
CAGE is an acronym to prompt you to ask these questions
Have you ever felt..
the need to Cut down?
Annoyed when people ask you about your...?
Guilty about the behavior or something you did under its influece?
the need for an Eyeopener?

If you answer yes to more than 2 questions, the teaching is, the patient has a problem.

After an irrational response to the caferteria lady, I asked myself the questions related to my addiction problem behavior...

C- cut down, yep.
A-annoyed, clearly- I'm writing this post aren't I
G- guilty, yep I often try to hid the evidence
E- eyeopener..hmmm- Well, if defined by once you start, you can't stop. Yes, undeniably!
Henceforth, why I set rules to control my indulgence (Sounds like that should be the 5th one- do you set rules?)

What is the offending substance- Garden Salsa flavored SunChips - you got it!

I only indulge at work, and I only indulge when I get them for free from the neighbor hospital. I can't let such things in my house, because I have no will power. Still when the check out lady comments on it a few days a week when I give in, I have to fight the urge to scream. Hello, I have like 21% body fat, let me have my chips without comments from the peanut gallery. That isn't rational, right?

So for I just smile and chuckle. Then spew here. Thanks

Thanks and I haven't even done anything... Yet

2009-08-31T10:46:00.000-07:00

Just got this email and I have even done anything yet.

Dear doctors, nurses, and medical professionals, from CHLA and Southern
California.

I want personally to think you for volunteering your valuable time, energy, skill and wisdom in furtherance of our unique effort to help the women and children of Mongolia.

When we began this program circa 1995 little did we know that so many of you from CHLA would be attracted by our program. Some of you are now returning for the second time.

I am wishing you a safe trip and a seamless transit to Ulaanbaatar, Mongolia.

And, I am wishing you as well a successful medical experience and MEEP program. I hope you make some good new friends, and I know you will make a lot of Mongolian people happy and grateful.

Again, Thank you very much. Good journey and good program.

I can't believe that I leave in less than a week, and with all the travel time will be arriving in Ulaanbaatar in about 7 days. So much to do before I go, but I can't wait for the adventure....

Destination: The Far East- revisited

2009-08-26T11:25:00.000-07:00

This post originally appeared here a few months ago, but since I couldn't figure out how to just transfer a few posts from my old blog I am revisiting....

I've done my share of travelling. I've done my share of medical volunteer work, locally and abroad. I've been to Nicaragua several times and had to cancel a trip when I got sick. Ever since then, I've been searching for opportunitites to get back in touch with that side of me that is fueled by being involved in something so much bigger than yourself. I have had many opportunities presented to me over the last year, but for one reason or another none worked out. However, a few weeks ago I was contacted to join CHLA's trip to Mongolia as they wanted to focus on some more maternal- fetal- neonatal health issues this trip. The trip works with my schedule, works with my plans and so I'm in. Plane tickets are reserved and will be paid for by the end of the day. I've never been to Asia, I'm a little nervous, but I'm really excited.

One of the big issues with this kind of work is to find a way to make sustainable differences in the healthcare in developing nations. This is a huge topic and used to be a source of much dialogue amongst the Nicaraguan group. Certainly they need supplies, but also standards and education. The thing I really like about the approach of the CHLA Mongolia mission is their appreciation of those issues and the dedication to going there in order to provide not only education and support during the time that we are there, but also working with the health ministry to establish some standards for continuing education for physicians in Mongolia. Also, there is some effort being spent on extablishing internet based education and support materials for the doctors and nurses there. I had lunch with the organizers yesterday, and got quite excited about what they're doing. So now I'm trying to convince a few others to join me. Either way it is a great opportunity.

After spending a little over a week in Mongolia, I am going to continue on to Bali for some vacation while I am on the other side of the world. I can't wait. More to follow...

I leave on this journey in less than two weeks. For now, my days are occupied with writing talks for this trip and my evenings largely planning for the journey. I am beyond excited even though there is so much to do.