“Everything in life is only for now”

May 3, 2011 § Leave a comment

Everything in life is only for now – quote from Avenue Q imprinted on a pin that one of my patients wore on her hospital gown everyday
Residency

This post will focus on what I’ve gained, both with respect to my medical knowledge and my fitness.  It’s been an emotional and physical test of my ability to cope with loss, gains, and learning what is most important in medicine.  It’s been painfully humbling to say the very least.

This month has been a particularly challenging one, not in terms of the medicine, but in terms of the emotional connectedness and empathy I felt on a daily basis.  I spent four weeks on the Hematology/Oncology ward.  This means I was taking care of patients with blood disorders such as obscure anemias, bleeding disorders, leukemia, lymphoma, and specific cancers such as lung and melanoma.  There is no other service that teaches you how to connect with your patient or fosters an environment where bedside manner can make or break your relationship with the ill patient.  This was, in all respects, my favorite rotation of intern year.

Human connectedness

Those two words describe the essence of the service.  I have never developed connections with my patients as I did this month.  Yes, of course I care for all of my patients and am generally interested in their well being, but let me assure you then when you have a patient who is experiencing end of life, the relationship beckons deeper love.  I think this was, by and large, a month where I learned more from my patients and was “helped” by them more than I could ever have done for them.  I found myself going the extra mile, staying many hours beyond my duty hours just to spend time with the families, ensure that crashing patients were safe, all loose ends were neatly tied, and, foremost discuss end-of-life decisions- the latter being the most emotionally moving aspect of my training to date.   It become my job to initiate a natural path to death with my beloved, terminally ill patients.  No other profession is honored with the rights to discuss DEATH with another being, to tell a true fighter that it’s ok to let go. I would do absolutely ANYTHING to allow them the most comfortable and peaceful path towards death. I grew intensely attached to my patients, regardless of age, stage of disease, or stage of grief.  I found myself calling the nurses long after I left to make sure the dying had enough pain meds, were comfortable, and that their families could call my cell if they needed. Humbling, terrifying, mystifying.  While the families we cared for were losing a loved one to sinister disease process, I was gaining insight into the depths of family values, the human experience, family dynamic and the meaning of love.

Losing patients to disease hit me so much harder and signing a patient’s DNR/DNI form would bring me to tears at times.  One patient’s decision to become DNR/DNI (meaning that they did  not wish to have CPR or any life support) led me to the closest bathroom where I spent a solid 30 minutes sobbing.  Of course I didn’t do this in front of the family during decisions of that magnitude, but I can assure you that I broke down into tears while holding the hand of several of several patients while  listening to their life story.  Beautiful.

Also, something that I saw on this service that I didn’t see an ounce of on my other rotations was POSITIVITY.  I was astounded at the positive attitude and zest for life that my patients had.  Considering the grave prognoses I wrote in charts daily, I was inspired that each patient was living for THIS day.  They focused only on THAT days’ total blood count, THAT days’ pain control, THAT days’ time with family, and some days even shared the travel plans they had for their last days.  There was only one time where I saw a patient cry over their disease, otherwise these patients were the embodiment of stoicism.  Again, they taught me lessons that a medical text book or attending could never teach me.  The quote in this post’s title was on a pin adorned by one of my myelodysplastic patients everyday.  She was preparing herself for a bone marrow transplant but was developing complicating infections because her immune system was being ravaged by the disease process.  Every morning I walked into her room she was playing vivaldi on her iPad, had her hair and make-up done, and would smile at me and say, “Good morning Miss Thing, I’ve missed you! How are we gonna start this day?”…and all the while all I could see was her rouge smile, while in the back of my mind knowing how ill she was, yet she saw past the disease and chose to live her life.  Her’s, as well as the experience from others, made me re-think those little things that I get worked up about, that we all stress about, and that we allow to ruin our day.  I thanked all of my patients at the end of the month, wished them well, sat in my car and and just cried, not wanting the month to end and not wanting to lose these patients.

Who would have thought that dying patients would teach me how to live. One day at a time.

Weight

Two weeks ago I reviewed my previous work-outs and saw that P90x (lean) made me put weight on and it was by no means only muscle weight. I went up a dress size and felt uncomfortable.   This gain did not make me happy but, like I said above, I have chosen to focus only on my activities and wise food choices I make THAT day.   I have several goal dates in mind (long term) but refocused on the short term goals by staying in the now.  With this mindset, a change in my exercise routine, a new exercise partner (mini-me, baby sis), discontinuing P90x (because there is not nearly enough cardio), I have lost two pounds this week.  This loss occurred despite going out to dinner and enjoying a few fantabulous vanilla bean cupcakes with Nutella frosting that I made for  my heme/onc nurses & attendings.

Recipe

I’ve chosen my French Onion soup because, like the experiences I’ve had this month, it’s simple, full of flavor, and the simplicity gives it it’s divine savory flavor. How fab does this look!?


French Onion Soup
As adapted from Gourmet, 2006

Ingredients

  • 2 lb medium onions, halved lengthwise, then thinly sliced lengthwise – **I actually used sweet onions**
  • 3 sprigs fresh thyme
  • 2 Turkish bay leaves
  • 3/4 teaspoon salt
  • 1/2 stick (1/4 cup) unsalted butter
  • 2 teaspoons all-purpose flour
  • 3/4 cup dry white wine – **I used equal amounts of Gewurtztraminer for the sweetness and acidity to offset the savory croutons and broth**
  • 4 cups reduced-sodium beef broth (32 fl oz) – **I used fat free, reduced sodium, minimal loss in flavor**
  • 1 1/2 cups water
  • 1/2 teaspoon black pepper
  • 6 (1/2-inch-thick) diagonal slices of baguette **I used freshly made, large cut Butter- garlic croutons** from the Fresh Market
  • 1 (1/2-lb) piece Gruyère
  • 2 tablespoons finely grated Parmigiano-Reggiano to sprinkle atop just before broiling
Prep

Cook onions, thyme, bay leaves, and salt in butter in a 4- to 5-quart heavy pot over moderate heat, uncovered, stirring frequently, until onions are very soft and deep golden brown, about 45 minutes. Add flour and cook, stirring, 1 minute. Stir in wine and cook, stirring, 2 minutes. Stir in broth, water, and pepper and simmer, uncovered, stirring occasionally, 30 minutes.

While soup simmers, put oven rack in middle position and preheat oven to 350°F.

Arrange bread in 1 layer on a large baking sheet and toast, turning over once, until completely dry, about 15 minutes.

Remove croûtes from oven and preheat broiler. Put crocks in a shallow baking pan.

Discard bay leaves and thyme from soup and divide soup among crocks, then float a croûte in each. Slice enough Gruyère (about 6 ounces total) with cheese plane to cover tops of crocks, allowing ends of cheese to hang over rims of crocks, then sprinkle with Parmigiano-Reggiano.

Broil 4 to 5 inches from heat until cheese is melted and bubbly, 1 to 2 minutes.

What experiences have reshaped you recently?

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How do you do it?

September 23, 2010 § 4 Comments

This post will be sort of a hodge-podge but the meat and potatoes are in the middle…it’s my deconstructed Shepherd’s Pie, if you will.

Luckily I’ve had plenty of time to blog over the past few days.  It’s given me an alternative way to unwind in ways that exercise and my daily prancing around the stove have been (unusually) unable to.  Somewhat of a side note – I had initially planned a flight to Sacramento which would allow me about 3 days in Lake Tahoe and 3 days of wine tasting in Napa.  The plan was set but man, I had a VERY difficult time parting with money that I had saved.  So much time, sweat and sleep deprivation had gone into making that money that I couldn’t part with it.  I know, I know. This seems foolish because I know I’ll burn out before my next vaca, but I’ve developed a little bug in me that already wants to start saving for my childrens’ education (mind you, I have ZERO children/pets/nieces/nephews/godchildren/not even a pet cockroach and no potential to have any in the next few years). So I’ve spent some time doing a little local travel and mainly spent my time put-sing around the kitchen, trying out new recipes and taking in as much of the local fare I can.  Festivals and farmer’s markets galore!  With all of this free time and writing also came time to read some blogs that I had never read…

On to the meat

Being a sort of successful weight watcher’s gal, I tend to stick close to home and read the blogs of fellow WW girls.  I can commiserate with their struggle, get ideas on snacks and healthy lunch or dinner items, and get some fab work out ideas.  Overall I find this soothing in a way; knowing that I’m not totally alone in this battle of the bulge.

This time off from work has made me curious  and I’ve been able to read through the blogs that I’ve never visited…I won’t name names – they’re excellent blogs), but what I’m finding is….they’re pretty impressive!  There’s an astounding number of people who can challenge weight loss on their own.  How do they do this?  How/where do they find the motivation?  How do they figure out what’s right for their body and what limitations to set?  In other words, how do they do this on their own?  Many of these “independent” fitbloggers don’t point this out.  I’ve tried elucidating this from the “about me” sections but they seem to be similar to mine – meaning that they basically felt some sign or urge to make a general change and just moved forward.  What made one turn to weight watchers and the other turn to him/her self?

now the potatoes

Eating healthy and exercising seem incredibly simple if you have a little motivation and time but in reality, it’s really not.  Not at all.  I’m sure you’re reading this thinking “Good job, little doctor.  Your 1/4 million dollar education seems to have really paid off (giant eye roll).”, but here’s the thing, medical school doesn’t teach us HOW to be healthy, it actually does quite the opposite.  I will rant about this in a later post.  In all of my years of schooling I of course knew that calories burned must exceed calories consumed, but I could not practice this for a multitude of reasons.

  1. No motivation,
  2. Literally never took the time to take care of myself because I’m disgustingly competitive and felt the need to study for 10-16 hrs/day (and FYI I was no where near as successful as most students who were just as intense and obnoxious as I was…probably because I never took care of myself – didn’t sleep more than 4 hours, didn’t eat well at all, ever, and was just miserable…you get the ugly picture).
  3. I didn’t have a supportive network by any stretch of the imagination,
  4. I wasn’t willing to take the time to prepare healthy meals.  **Message to pathetic old Me, how much time does it REALLY take to make and pack a sandwich, as opposed to the daily nonsense of stopping at Panera/subway/Moe’s, etc  for almost every meal?  Hello – waste of $$$$ that you don’t have!**

Back to my original thought….

If I didn’t pay someone to basically teach me what I already knew about health and wellness, to weigh me weekly, or  to set limits for me in terms of exactly how much I was allowed to eat daily, I would not have lost 35 lbs. I know it.  Not on my own.  I just don’t know if I have that determination in me.

How do you self-propelled people do this?  What triggered your mind to become structured and to stick with it? How did you determine (aside from the clear calculations of kcal/kg/day along with carb/fat/protein breakdowns) how much and what to eat daily? How do you not just give up when you don’t have a monthly WW bill hanging over your head? (Mind, I know WW has helped me to this point and it’s not only about paying to lose weight..some days it is, but 90% is wanting to be healthy and to look/feel like $4 x my tuition).  I really give you all a lot of credit for being so successful on your own.  I wish I could harness an ounce of that determination to succeed on my own.

Another thought. I wonder if long term success rates differ between self-propelled and weightwatchers people.  I wonder if I would have stuck to a plan this long if I hadn’t been shelling out $40/month to get my self in gear.

Any feedback or thoughts? (about that pesky topic of medical school and nutrition, more on that in another post)

Now for something fun and random

Also, I thought if I had time I’d start posting new recipes in the body as opposed to a separate recipe page.   I love my new camera and have been making great use of it (in the kitchen) so why not share the photos and the food?

I had some left over potatoes from a previous meal along with some carrots and a new BAG (hangs head in shame) of butternut squash.  I had been craving butternut squash soup as it’s healthy and nicely accents the new seasonal changes underway.  I typically only use squash and potatoes but having the carrots on hand was a great change.

Spiced Butternut – Carrot Soup


  • 1 cup yellow onion, chopped
  • 3 tbsp light olive oil
  • 2 cups frozen (preferably fresh) butternut squash, cubed
  • 2 cups carrots (or parsnips), chopped
  • 1 cup peeled boiled potatoes
  • 1 cup LIGHT cream
  • 1 and 1/2 cup fat free, reduced sodium chicken broth
  • 1 tsp curry powder
  • 1 tsp ground ginger root
  • 2 tsp cinnamon
  • 1 tsp marjoram
  • 1 tsp sage
  • 1 tsp dried thyme
  • 2 Tbsp dark brown sugar
  • s/p to taste

*hand held mixer or food processor

My Method

In a 5 quart pot, heat oil and add onions and carrots.  Once onions develop translucency, add squash and potatoes and heat until squash becomes soft.  Add cream, stir to incorporate, and add broth.  Allow to simmer for approximately 15 min.  Carrots should become soft at this point.  Now either remove mixture and add to food processor or blend with hand held.  Consistency should be that of farina o…or to your liking.  At this point add herbs and sugar. Allow to simmer for another 15 min.

I garnished with toasted Thomas’ Bagel Thin (cinnamon raisin- with a light spray of light olivio and sprinkle of cinnamon/sugar) crostini, a dallop of light cream cheese and chives.  It definitely hit the spot.

I also found a great deal on some organic figs and figured the best way to celebrate the season was so preserve them to enjoy all week month long.I ended up making a cinnamon fig/apple/walnut jam as well as a raspberry/nectarine jam infused with orange.

Such beautiful figs

decorating a piece of Manchego

Imaginary Obstacles

August 28, 2010 § Leave a comment

A few months ago I was told that it would be impossible for me to be an interventional cardiologist AND a wife/mother.  What I was really hearing was that it’s impossible to be a woman and live my personal dreams.  Unfortunately I admired the neurologist who told me this far too much otherwise I would have printed this article and stapled it to his forehead….or somewhere else.

NEJM article-

Women in Medicine Force Change in Workforce Dynamics

April 2005

By Bonnie Darves, a Seattle-based freelance health care writer.

Career Resources Editor’s Note: Women are finally gaining equality with their male colleagues in terms of admission to medical school and representation in non-surgical sub-specialties. However, significant disparities remain in surgical sub-specialties, senior academic and leadership positions, as well as in salary. Crucial to the advancement of women in medicine is positive role modeling and mentoring from those who have overcome obstacles and achieved success. The outlook remains bright for women entering medicine and choosing a career path that will bring personal and professional satisfaction.

John A. Fromson, M.D., Vice President for Medical Affairs, Massachusetts Medical Society

In July 2003, when Nancy Nielsen, M.D., Ph.D., was elected speaker of the House of Delegates at the American Medical Association, the Buffalo, New York internist was presented with a box containing glass shards. With becoming the AMA’s first female HOD speaker, Dr. Neilsen had truly broken the glass ceiling.

That story contrasts sharply with what happened 70 years earlier in Dallas, Texas. A year after the country’s first female orthopedic surgeon, Ruth Jackson, M.D., started her practice, the newly founded American Academy of Orthopedic Surgeons (AAOS) opened its membership to all practicing orthopedic surgeons — except Dr. Jackson. It wasn’t until four years later, when Dr. Jackson passed the American Board of Orthopedic Surgery’s newly instituted exam, that she was admitted to the AAOS.

Dr. Jackson’s struggle paled in comparison to the discrimination and ostracism the country’s first female physician, Elizabeth Blackwell, M.D., faced en route to receiving her medical degree in 1849 from Geneva Medical College. Yet it illustrates how little the acceptance environment had changed by the early 20th century.

Perhaps the most telling story about how things have changed in the intervening years for women in medicine — and what the future holds — lies in two statistics that made headlines last November. The Association of American Medical Colleges (AAMC) reported that for the first time in history, women made up the majority of medical school applicants, and that the number of black women applicants exceeded 1,900 — a 10 percent increase over the previous year. And in 2002, 40 percent of all residents were women, a statistic that clearly supports the prediction that by 2010, approximately 40 percent of U.S. physicians will be women.

In certain specialties, especially primary care, women have made large strides. Women comprised only 20 percent of pediatricians in 1970, for example, but accounted for 49 percent in 2002. In obstetrics and gynecology, the growth of women in the field is even more dramatic: from 5 percent in 1970 to more than 70 percent three decades later.

Despite how the overall numbers picture is changing, women in specialties such as orthopedics are still relative rarities — in 2001, less than 9 percent of orthopedic surgery residents were female. Yet times are changing, if slowly, even in this traditionally male-dominated specialty. Sybil Biermann, M.D., associate professor of orthopedics at the University of Michigan in Ann Arbor, who has conducted research on orthopedics work force trends, is buoyed by the changes she has witnessed in the field since she completed her residency in the early 1990s. She is also well aware that much work is needed to increase recruitment in orthopedics and other surgical specialties.

“In my field there is tremendous opportunity for women, and there really are no obstacles in terms of gender bias when you are at the level of being considered for a residency program,” says Dr. Biermann. “The issue is that we’re not recruiting women into the field early enough.”

Dr. Biermann, who joined the University of Michigan faculty 11 years ago, credits the tremendous support she received from the department chair at the University of Iowa as one of the chief factors in her decision to pursue orthopedics. “I was fortunate to be in a program that had trained more women than perhaps any other program at the time, and that really helped to create a supportive environment,” Dr. Biermann recalls.

Orthopedics has been considered one of the last “holdouts” in the surgical specialties, as regards the presence of women in the field. In general surgery, for example, nearly one-fourth of residents are women; and even in neurosurgery, another traditionally male-dominated field, women account for approximately 10 percent of residents, according to the most recent data from the American Medical Association and research conducted by Dr. Biermann for her article published in the December 2003 issue of the Journal of Bone and Joint Surgery. Changes are also occurring in thoracic surgery, where women residents made up nearly 7 percent of the total in 2001, compared to only 0.61 percent in 1970; and in urology, which saw the percentage of female residents increase from 0.27 percent to 12.6 percent over that three-decade period. The most dramatic increase is seen in ophthalmology, in which there has been a tenfold increase — from 3.6 percent in 1970 to 32.4 percent in 2001 — in women in training programs.

The career path of Ellen Raney, M.D., a pediatric orthopedic surgeon in Honolulu, exemplifies the changes that are occurring in the surgical field as a whole and orthopedics in particular. Now chief of staff at Shriners Hospital for Children in Honolulu, Dr. Raney might not have imagined that eventuality when she was the sole woman in her training program 12 years ago. “I was fairly naive to the obstacles in the beginning, and it was hard to be in a program where I had no role model,” Dr. Raney says. “But I loved orthopedics — and I found I had an aptitude for and special love of pediatric orthopedics, so I was determined not to lose sight of my goals. Today, I like to think that my success is making it easier for the next woman.”

Illinois neurosurgeon Gail Rousseau, M.D., a past president of the organization Women in Neurosurgery, was also a “solo act” as a woman in her training program at George Washington University, which she completed in 1992. “I think the environment was fair. I got no breaks for being a woman, but encountered no special difficulties because I was a woman, either,” says Dr. Rousseau. “Neurosurgery is an exacting science and a rigorous residency for anyone who undertakes it — as it should be.” She notes that then department chair, Edward R. Laws Jr., M.D., was supportive during that time, as were her male counterparts in training and the attending physicians. “They were all very supportive and I’ve felt that way, almost without exception, throughout my career,” says Dr. Rousseau, who has held leadership positions for both the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

Despite the increasing numbers of women in the field — only eight women composed the founding membership of Women in Neurosurgery in 1989, but there are approximately 250 practicing women neurosurgeons in the United States today and 550 internationally — women remain a small minority in the field.

In traditionally male-dominated non-surgical specialties, relative representation of men and women is changing far more rapidly. According to the most recent data published by the AMA, in the September 3, 2003 issue of JAMA, women physicians, in growing numbers, are choosing to go into a broad range of non-primary care specialties. For example, 27 percent of anesthesiology residents are female, 25.7 percent of radiology residents are women, and 49.4 percent of pathologists in training are women.

The successes of pioneers such as Drs. Raney, Biermann, Rousseau, and others who have ventured into surgical specialties are, in fact, figuring in the career decisions medical students are making these days. Catherine Mohr, a California medical student who is in her fourth year of Stanford University’s five-year program, credits several mentors — both men and women — with her decision to go into general surgery. A female friend who is a surgeon has given Mohr an honest picture, she says, of “the pluses and minuses of the field, so I’ve been able to watch her career develop. But one of my strongest supporters is a male surgeon,” says Mohr, referring to Stanford’s chair of surgery, Thomas Krummel, M.D., with whom Mohr consulted even before she decided to go to medical school.

At the time, Mohr already had an established career in engineering, but was wrestling with the growing personal recognition that she had shied away from her true calling. “I shared my interests with him, and he simply said, ‘what will it take to get you to come to Stanford?’ ” she says.

Women figure prominently in medicine’s wave of the future, but challenges remain

Although women physicians are far more common in the OR and the ER than they once were, they are still a minority — if a visible one — in the boardroom, the executive suite, and the upper echelons of academia. Diane Magrane, M.D., associate vice president for faculty development and leadership programs at the American Association of Medical Colleges, notes that there has been a stagnation of sorts in academia, in particular. “Women have been about 30 percent of [medical school] faculty since the 1970s, but what we know is that women are less likely to advance past assistant professor than men are,” Dr. Magrane says.

Further, women physicians continue to earn less than their male counterparts — an estimated 25 percent to 35 percent less, depending on the field. While part-time employment status and the predominance of women in primary care surely contribute to the earning disparity, those likely aren’t the only factors, according to the AMA office of Women and Minorities Services.

Dr. Magrane agrees. “There is still a disparity that can only be attributed to gender. How much that is, we don’t know, but it has been consistent,” she says.

In 2002, for example, only 12 percent of full professors were women, compared to approximately 1 percent 30 years ago, and women comprised only 14 percent of tenured professors, according to the AAMC report “Advancing Women’s Leadership.” “That’s not that much of a shift, considering the number of women in the [academic] field now,” Dr. Magrane says. And while there are now 11 female medical school deans, women clearly remain a small minority given the fact that there are 126 teaching institutions, Dr. Magrane adds.

Responses to a survey regularly conducted by AMA’s Women Physicians Congress support Dr. Magrane’s contention, but indicate that advancement opportunities are improving for female physicians. In 1998, respondents cited “leadership development, education, and training” opportunities as their No. 1 priority, but by the 2003 survey that issue had dropped down the scale considerably. And when asked whether the professional climate, as regards disparities or discrimination, had improved for women since they entered medical school, 44 percent of respondents said “somewhat” and 27 percent said “very much” — and only 6 percent said “not at all.”

Despite the statistics on women in leadership positions, which may be attributable more to women physicians’ lifestyle choices than to actual obstacles in academia or the business side of medicine, the environment is far more “women-welcoming” than it once was, recalls one pioneer, Barbara LeTourneau, M.D., M.B.A., vice president for medical affairs at Regions Hospital in St. Paul, Minnesota. “When I received my MBA in 1987, there weren’t very many women in medicine — and there definitely weren’t any women in management positions,” says Dr. LeTourneau, an emergency medicine physician. “When I was 35, I almost never saw a woman in the role of an elected medical staff position, but that’s changed now.”

For Dr. LeTourneau, the move into management was gradual and, as was the case with many of her female colleagues at the time, the first leadership position came about almost by way of default. After she had been in practice for a few years, the physician group with which she was affiliated discovered that although the number of women in the group was increasing, the board of directors was composed entirely of men.

“I think I was recruited because I was the only female full-time ER physician. But then I discovered that I liked management and had a flair for it,” she says. Even though she experienced occasional roadblocks in the management side of her career, mostly because she was a rare sight at the time, Dr. LeTourneau thinks that opportunities for female physician executives are abundant now, for those who are willing to deal with the minority factor that persists in the business arena.

“Women who are entering the physician executive field now will find the playing field level at the entry level. But I still think that where women have to work harder and outperform men is at the upper levels — because even though you’re not excluded, you have to overcome the difficulty of not being part of the male ‘club,’ ” Dr. LeTourneau says.

SLUG

August 16, 2010 § 1 Comment

FAT

It’s been days since I’ve worked out. I’ve gone on a run but I haven’t been able to keep up with my C25K.  I thought it was hard to exercise while working nights but this….THIS nonsense is just insane.  Working upwards of 80 hours/WEEK…yes, WEEK makes it damn near impossible to get a decent work out in. I typically wake up at 4:15 am, get my self all gussied up, grab my coffee, head to work to round before 7am. The fatigue. I’m perpetually exhausted, but not in the miserable  way that I was at the VA last month.  This month has been awesome because I can actually use what minimal brain cells I have, but I digress.

SLUGGGG

I’m feeling super sluggish because of my zero booty shaking.  I haven’t done any yoga recently, I was going to start P90X but my lady-friend still hasn’t mailed it to me yet(we’re over a month late on that ), I have barely seen the gym doors, no pilates, no weights, no walks, just a few random jogs. My legs feel like giant 1000 lb LOGS.  I do my best to shake my ass when i can, luckily my sister is in shape and loves to run so she’s a great buddy to have.

Luckily eating has not been as much of an issue. I’ve lost some weight but my gut is becoming a bit more protuberant. Bluuurp.  I really hope my double chin doesn’t make a comeback. yuck.

All for now. Feeling gross. Also haven’t been to a WW weigh in for 3 weeks. nice, right?  Whenever I’m able to make it their doors are locked. Boo.

For the Birds

July 30, 2010 § 2 Comments

This month of night float is almost over…THANK GOD!

That lifestyle is for the birds

The things that this schedule has done to my metabolism, mood, waistline, circadian rhythm, personal relationships, work ethic are catastrophic.  I have never felt more out of touch with the world, even while I made my monthly cross country treks during my last two years of school.

It’s such a struggle for me to look on the bright side of things right now.  I hate seeing these changes in my life.  I have been venting non stop to one of my favorite people how my life feels so out of whack right now and how I’m not sure how much more of it I can take – having second thoughts on a daily basis and wishing I had chosen surgery or ER over internal medicine.  Dammit, I had the scores (I think).  Why did I choose internal medicine out of the fear that I wasn’t cut throat enough to survive a surgical residency or fear that I wouldn’t get interviews? Why didn’t I tell the program director at my ER rotation that I would do anything to switch to his program because it was so strong in both didactic and clinical areas? I’m so damn sensitive.  Why the hell did I settle? Maybe these ridiculous questions are just part of this treacherous territory. It’ll most likely all work out in the end…only if I get that cardio fellowship (fingers crossed).

The main goal of this post was to highlight how my body and mind have changed drastically this month.  I have to look on the bright side and congratulate myself for the strides I know I’ve made.  I started spin class when I knew my stress level was a bit high, fell in love with it and now I can’t get enough.  I  spin about 3 times a week and I’ve continued my C25K on days opposite spinning, almost right on schedule. That’s pretty stinking good, right?  I typically only leave one day out of the week to rest my muscles one weekly.  I’m so f^&*ng proud of myself for the determination that takes.

There’s a but….

Despite how much more exercise Im getting and how the scale reassures me that things are going well overall, I still look at my gut and overly large chest in the mirror and wonder why they won’t budge.  Aggravation!  I have attributed it to a few things, all related to night float (for the most part). I’m not doing nearly as much yoga/pilates as I was during my slightly flatter belly days, not eating on a normal diurnal cycle, and not eating the most of the healthy foods I used to crave – simply because night shift is such an abusive schedule on the body.  I used to eat once every three hours and barely ate carbs simply because I didn’t crave them.  I would have one of the major meals of the day and creaking it up with a Kind bar, fruit, little yogurt shakes, SOMETHING of substance.  I can’t eat on my normal schedule when I’m sleeping at odd times and eating when I can.  These days all I crave are bagles, Dunkin’ donuts grilled cheese flatbreads, chocolate, sweet breads, chips and salsa, chinese food, salty, and more chocolate.  What the F*** is that about?  I suppose my body is just in freak out mode because of the change in cycle – I think that’s why the carbs are being over desired.  This is no bueno.

so….

I’m going to attempt to take these changes in stride.  It’s OK that I put on pound on this week – after all, the nurses loved working with my co-intern and I so much that both the ICU and the ER had little parties for us. That meant pizza, wings, ice cream cake, garden fresh veggies, homemade brownies/choc chip cookies, and my favorite – cheese and crackers.  This, by the way, is an extremely rare thing for nurses to do for interns (so I’ve heard) so I’ll give myself (and my co-intern) a huge pat on the back for keeping the RNs happy. (Plus of the month) It’s OK that I ate that way.

I’ll also have to learn to forget the scale for the time being.  I didn’t go for my weigh in this week because I knew what the situation was and I didn’t want to be too much harder on myself.  I know what this night-style is doing to me so I’m letting it go. Along those lines, I’ll have to let go the negative feelings I have about my job right now.  I think the mental and emotional hardship is part of the game at this point and I have to remember that I’m still learning.  I think it’ll all be OK at the end.

My main goal of the week will be to add more of my Yoga or Pilates as my schedule changes to day team, finally.  I’ll see how that schedule works out and if I have time for the yoga, I’ll do it; if not, then so be it.

Happy Reading 🙂

I am what I eat

July 11, 2010 § 5 Comments

Gross

I feel so gross.  Residency finally started and I’m working night float so that means I’m not really eating much because I’ve never been a night eater, right? I thought that when I shifted my sleep schedule that I’d also eat much less  and I’d be busy enough to stave off cravings.  I couldn’t have been further off.  The only accurate part is that I’m not, or at least I didn’t think I was, a nighttime snacker.   Working nights has made me soft, literally.  Some how I’m hungry every hour. I have been trying to stick within my WW points and pack little 4-point almond butter and banana sandwiches, apple, greek yogurt with granola and fruit, and by sticking to my all bran in the AM.  I have even stuck with my eating every three hours rule and have an eating schedule planned out in my head.  None of this is helping.  For some reason I’ve re-developed my love handles and my abdomen looks like something I’ve only come across on maternity units.  My measured weight is actually continuing to decrease while my image in the mirror is NOT what is was when I graduated last month.

I’ve been eating so much more…and not just when I’m at work, it’s mainly when I wake up in the afternoon. I’ve completely let myself go to the point I had TacoBell two times last week while hanging out with the little bad influence Runt-my sister.  I hadn’t touched bad-for-you-nutrient-deplete fast food in months. MONTHS.  Then she introduced me to the crunch wrap supreme. 12 fucking points.  12!!!!! Mind you, this was at 1 a.m. It’s been downhill from there.  I had tiramisu, went to a wedding and had cake and a cannoli, multiple sweet mixed drinks, I’ve even gone back for more TacoBell.

I miss my last few months of people making fun of me for eating so healthfully and for my self-control around desserts/junk at work.  I’ve never had control like that before.  As much as I say I want to get back where I was with my self control i feel like it won’t be as easy this time because i don’t have a particular goal.  Last time it was that I didn’t want my classmates seeing me as a fatty at graduation.  I haven’t been able to find a new short term fitness goal.  I know this is what works best for me.

The only thing I’ve go going for me lately is that I’ve been exercising A LOT lately.  I’ve been doubling up on spin and running; a little speed-junkie I guess.  The only thing I really miss is my hot yoga… and I guess pilates.  I’m pretty sure those were the two things that really helped me tighten up and tone…the only issue is that I can’t afford the Bikram anymore and I have no patience for pilates.  It’s just not what I need these days.  I’ve got to get back into it.

I need some tips and encouragement/motivation ASAP.

happy Eating…. 🙂

My Independence Day

July 4, 2010 § Leave a comment

A fore note:

The lighter side of this post

To all the SOB mosquitoes out there who may come across my blog.  It is not OK to mess with me and my skin during my run. It’s hard enough to get my fat ass out of bed at 5AM to exercise let alone get swarmed by you and your disease ridden cousins. Think of me when you meet this in my backyard.

Independence Run

I started this Independence Day off right; with a sweet run.  Just finished my C25K intervals for the day and while I wasn’t too thrilled about starting at 5:30 AM, I got ‘er done.  As warm and fuzzy as this sounds (mind you, I am not a warm and fuzzy kind of person) it was such a welcome release.  I hate being a sap but I found it invigorating – ugh, too cheesy calming to run in my quiet neighborhood with the summer time baby rabbits hopping around and the little drops of dew across my neighborhood’s landscape.  It was sort of celebration of my independence as I ran step after step.  Loved it.

The somber part of this post

My internship year has started with a month at the VA.  I love my patients.  I hate seeing them sick, but I have such respect for them and what they’ve done that it makes work that much more interesting.  That being said, while I was on my run I started thinking about the above paragraph,  my thoughts took a sad turn and I remembered reading this article last night about the tragedies and triumphs that befell a young vet.  After I dwelled on that for a bit, it then hit me hard to realize that I had requested today off to attend my dear friend’s wedding.  That sort of crushed me a bit and I almost felt myself dumping a guilt bucket over myself.  I wasn’t going to work today. I wasn’t going to be able to take 4 am pages about blood pressures or put my stethoscope on the chest of the men and women who took their time to do so much for us.  Yuck.  I didn’t feel all warm and fuzzy anymore. I felt like shit. This is was what dawned on my while I was out celebrating that independence I talked about.  This didn’t sit well with me.  I’m not sure how I’ll get over the guilt but I know they’ll be well taken care of by the residents that are working tonight and I’ll be sure to think of them throughout the day, honoring them the best I can in light of the selfish decision I made.

How are you all celebrating your independence and honoring the vets?

Happy Independence Day 🙂

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