The decision is made. Babies it is.

Wow, I suck at blogging. I'm not just bad at it, mine is the blog that ends up at the very end of the sidebar list with links to people's "friends & family" blogs because I haven't updated in 2 months. Meanwhile, I don't even have links to the blogs I follow because I'm that lame at blogging in general. Yet I love reading other people's, and I get sad when they don't update. Hypocrite. I think that's the name for that. And now, outfitted with my brand new iphone 4 (because I have medical things to look up...of course), it just makes the excuses all the more lame.

Also, I suck at blogging because I suck at taking pictures. And who wants to read a blog without pictures? It's like reading a novel; and we all know that what people really want to read is one of those board books with quipy, rhyming one-liners that are outnumbered by adorable illustrations all in a "safe-to-chew" package for easing toting to church...

So. Anyways. Here I am. Still no baby pictures. Still no life-altering news. And really in no mood to rant or gush or make a scrapbook out of my life. Sorry if that's what you wanted to read.

Right now I'm doing my family medicine rotation in Safford. It's amazing and puzzling and foreign all at the same time. I've decided that family medicine is for the healthy that are paranoid because really what family docs specialize in is preventitive care. That must be why I love my family doc.

So family medicine is definitely interesting, but not quite my style. Which is actually a welcome relief since up to this point I’ve been having a really hard time deciding what I want to specialize in. But not anymore! I’ve decided that I’m going to specialize in (drumroll, please….) OB-GYN! The one truly unique thing about Safford family medicine is that they still do their own OB-GYN because the town is so small, and although I’ve been seriously considering OB-GYN for awhile now, these past few weeks have cemented it. I’m keeping track of how many deliveries I do in my life. My current total is 6. Not bad for a 3rd year who hasn’t yet done her official OB-GYN rotation! Now, before you start to groan and wonder how any sane person could actually choose this specialty, let me say that this feels right for me. Somehow, I know this is what I’m supposed to do. Ironically, when I started medical school I immediately eliminated two major specialties because I thought they would equal a death sentence for ever having a normal family life: Surgery and OB-GYN. Clearly I was extraordinarily ignorant at that point since OB-GYN is actually a surgical specialty. And it wasn’t until a few months ago when my dad kept asking me if I had yet considered surgery that I realized I didn’t want to consider it. Because I knew that if I did, that’s what I’d end up doing. It took a lot of soul-searching to realize that I needed to put those options on the table…that Heavenly Father is driving this ship, and I have to let go now. I have to trust.

So I’ve realized that OB-GYN is perfect for me. I honestly had no idea what an OB-GYN did until just recently. You’re just a glorified midwife, right? WRONG. OB-GYNs do basic primary care for women over the lifespan (menarche to menopause and beyond), delivery babies of course, manage high-risk pregnancies, perform surgery on women with cancer of the cervix, uterus, ovaries, or any pelvic organ, perform incontinence surgery, diagnose and manage infertility, perform perinatal surgery in utero for fetuses with problems requiring surgical intervention, advocate for women in situations of domestic violence or with psychiatric issues, are experts in contraception, take care of any woman with a complex medical problem who gets pregnant and much, much more. So there you go. I'm thrilled.

Next up...where to move for residency?

Timeline

You know when your whole 10-year plan gets thwarted? I was re-reading my journal the other day and actually that has happened so many times I should just be expecting it at this point, but I never do. I always lay everything out perfectly...so I know exactly what year I'll be doing what in my career, how old I'll be, when I'm going to get married (or now, when we're going to have a baby in all that ridiculousness) etc...etc...

Have any of you ever seen the movie Lucky 7? It's with the girl from Father of the Bride and Dr. McDreamy (can't think of his name either right now) from Grey's Anatomy. Anyways, the girl's mom dies when she is 7 years old but before she does she writes out a whole timeline for her little girl that includes when she'll go to summer camp, when she'll run for class president, what she'll major in during college and study in grad school, and how many boyfriends she'll have over the years, including when she'll get married. The movie fasts forward to the girl's life with boyfriend #6. So far, the timeline has been right--predicting all of these wonderful things she'll do in her life, including going to law school, and touring Europe. But then she falls hard for boyfriend #6, when she was supposed to fall hard for boyfriend #7, and suddenly her life plan is wrong and she starts second guessing herself and her timeline.

When I was in seminary at age 15 I remember our teacher asking us to think hard about what we would be doing in 5 years. So I was thinking, okay, 20 years old...I better be sleeping at this hour! And I'll probably be in college, hopefully at the airforce academy doing an engineering degree. Clearly I was deranged about my career plans at that point, because what person in their right mind would want to do an engineering degree at the air force academy? Thankfully my dad talked me out of that one (or at least, that's how I remember it). Then she asked us to imagine where we'd be in 10 years and I was thinking, hmmm. 25 years old. That's tough. Maybe I'll be getting married then. Hopefully I'll be working for NASA as an astronaut. I guess my childhood astronaut dream hadn't quite fizzled at age 15. Fast forward a few years and I thought I was going to marry my high school boyfriend when he got home from his mission and major in math education. By age 18 I decided to go to medical school and basically not date at BYU at all because I didn't want to get married young. One more year under my belt and I was reluctantly saying yes to the most persistent (not to mention attractive) boy in our apartment complex--in the infamous Peaches. I thought I was going to marry him too and when he died in a climbing accident I about died from heartbreak. Fast forward to junior year and Peaches' best friend, Boyd, becomes my best friend, and I realize that this was how it was supposed to be all along. It was fast...a year and half later we were married, but he was leaving for grad school and I knew this was my chance, take it or leave it. For once in my life I followed my gut and threw my 10 year plan out the window and got married at 21 when everyone thought I was crazy and way too young. But that turned out to be the best decision I ever made.

So now I am 25 and maybe I'm done with 10 year plans. I try to figure out how we're going to fit in 4 kids in the next 10 child-bearing years of my life along with my residency and Boyd's plans that probably include more school down the line. I think I've decided that I don't know who buys nice homes anymore because I cannot ever imagine a time when we'll be able to afford such a luxury and maybe our kids will have to be okay with apartment living. If we can even have kids! You know how those things haunt you? Things like infertility and never getting out of school and never having a real job? Sometimes I just want to be a real adult. I mean, there are physicians that I work with who are still asking me what I want to be when I grow up, and patients wanting to know when they're going to see the "real" doctor. And I know what they mean, but it's still depressing when you realize you have 1 1/2 years more school and then 3-5 years of residency where you're still not a "real" doctor. And each year in our ever-changing ward we get younger and younger. Because, we must be 22, right? Maybe 23? Newlyweds obviously, and are we doing our undergrads at the UofA? Flattering as that is...

I'm not sure where my timeline goes now. I've reached 25 and it ends. I often wish that someone could just give me the briefest glimpse of my life in 10 years so I can see that we will have kids, and maybe a house, and that light will stream into in the nursery with a rocking chair just like it always does in my reoccuring dream.

HELP!

I'm having a quarter-life crisis trying to figure out what to specialize in. I have to turn in my elective choices for the end of 3rd year/4th year and that means I need a pretty solid idea of what I want to do for the rest of my life. Yikes! Only 11 months before I have to make my final decision--I didn't think it would come so fast. I feel like I pretty much enjoy everything in medicine (except maybe psychiatry) and so now more than ever I have no idea what I want to go into. I've put up a poll for everyone to put in their two-sense. I won't tell which way I'm leaning until after it closes.

For those not familiar with internal medicine, because I have a lot of people asking me what that is exactly, that includes the following: cardiology, nephrology, infectious disease, pulmonology, gastroenterology, rheumatology, endocrinology, allergy/immunology, and hematology/oncology. So basically everything between the neck and the hips.

To be continued...

Dermatology 101

Yesterday in neurology clinic:

Dr. Torres (the attending): "So what do you want to do with your life?"

Me: "Well, I have a top 5...it pretty much boils down to dermatology, neurology, family medicine, pediatrics, or endocrinology. Pretty broad, I know, but I think derm is definitely up there."

Dr. Torres: "Dermatology? Well, you have to be all posh for that. Wear high heels and have those Louis Vouitton purses."

Me: "huh, yeah. It's pretty competitive I hear."

Dr. Torres: "Yep, really. You have to have perfect skin too. I don't know about that for you. They're all about looking beautiful. So much of their practices are cosmetic, you know, so just keep your options open because you might not cut it."

Me: "well, I'm working really hard, you know, and I think I can do it. I've got good board scores and research so I hope that makes a difference too."

Dr. Torres: "Well, you know, you won't get into a top program or anything, but maybe somewhere in the midwest. Yeah, I bet there are some fat derms in the midwest. Gotta be."

I'm not even making this stuff up. Seriously? I know I'm pretty nerdy, and not exactly the most beautiful person you'll ever meet, and I struggle with Rosacea/acne, and I also know you can't take this stuff seriously, but you tell me, how would you feel if your superior talked to you like this? And she has to evaluate me! Um, I'm pretty sure I won't be applying for neurology in Tucson is all I have to say.

Scared of psychiatry? I was too.

Seriously, where does the time go? Today I just finished my very last day on my psych rotation. The shelf exam is Friday and then I get to start neurology! By no means am I planning on going into psychiatry, but I loved learning about it because it is:

a) so controversial
b) so prevalent
c) so gosh darn interesting
d) so heartbreaking
e) so challenging
f) so cushy (meaning, the work days are short and sweet)

I've never met more people scared of using psychiatric medications. I think it's natural to be scared of drugs that act primarily in the brain. Heck, I think it's natural to be scared of prescription drugs, period. And to be sure, a lot of the old drugs could kill you in overdose (although, most drugs can do that if you mix them right). Plus there is plenty of pop culture about "anti-psychotics" and "tranquilizers" and other things that will "fry your brain." The multi-billion dollar drug industry is also not really helping things with its pretty advertising followed by ads parading as "public service announcements" for lawyers who can get you compensation for drugs with "evil" side effects. Bottom line: it's confusing.

But if I learned anything on this rotation, and in med school in general, it's that prescription drugs are necessary--life-saving even--for many, many people. Even the psychiatric drugs. Especially the psychiatric drugs. If you've ever seen a child with severe ADHD, you realize that this disorder could literally sabotage his whole education and development if the proper treatment isn't started. For those who think medicating their kids is for the birds, "treatment" is not just drugs. Treatment for these kids is holisitc, or should be if the parents are on board. It includes not only a psychiatrist, but therapists, parenting classes, behavioral planning and changes in the home structure, dietary changes, and teachers. I'm all for alternate therapies including diet, exercise, and behavioral therapy, but sometimes it isn't enough, and the best thing a parent can do for their child is accept a diagnosis and work with the entire team to implement care on all levels--including drug therapy. I can't tell you how frustrating it is to work with parents and patients who put ultimatums on their treatment. For example, they'll say they'll do "anything" but try a stimulant for their child. Or, they'll allow an anti-depressant, but "no more than 10mg." Honestly, why do we even go to medical school if parents and patients are just going to tell us exactly how they want their child or themselves treated? And I'm not talking about advocacy. I think every patient and parent has a right to advocate for their child and for their own healthcare. Truly, studies show that when patients are in charge of their health, they are more compliant and heal faster. But advocating for yourself crosses a line at the point where the recommendation/opinion of the health care professional no longer matters.

I'll get off my soapbox. I just want people to really think before they judge about things like whether diagnoses such as ADHD even exist, or whether psych meds are a bunch of hooey. It's so easy to jump to conclusions and so hard to actually dig through the reserach. Guess what? Most good doctors have dug through the research.

So what have I learned? ADHD is real. So is depression, and anxiety, and psychosis, for that matter. When people suffer from psychiatric illness it is not their fault. People with depression can't just, "snap out of it." Drugs help--help a lot of people actually--and it isn't a sign of weakness if someone needs and anti-depressant or almost any other kind of psych drug. Also, psychotherapy works and it's also not a sign of weakness if you need to see a therapist. Or if you need to be hospitalized. Psych diseases are just like other medical problems, our culture has just bent them out of shape in weird ways so that we get scared when a family member or loved one has a diagnosable psych illness. So get the facts. Advocate. And don't be scared. Psychiatristis are some of the nicest people I have ever met.

San Diego

This is by far more pictures taken in one week than have been taken in the past 4 years of our relationship--so I hope you enjoy seeing, well, a lot of us. On the first night we ate at this quaint little restaurant called Prep Kitchen in La Jolla, which is what the fuzzy sign is attempting to say above...

Continuing our culinary tour we had brunch at the Hash House in downtown San Diego the next day. The line was about 1 1/2 hours long but sooooo worth it! Demonstrating my beautiful watermelon kiwi lemonade below:

Sunday we went to the Spreckel's organ concert at Balboa park. Here we are documenting the largest outdoor organ in the world. They even let us borrow big beach umbrellas for the concert. Only in San Diego...

We also did some cooking and made good use of the grill, outdoor jacuzzi, and gorgeous, beachfront, wrap-around porch. Here is our nod to California for Sunday dinner. Obviously there were avocados.

Boyd showing his extraordinary beach cruiser skills. All free with our rental! So Lily Allen...

Children's pool in La Jolla.

I actually had a dream that involved steps almost identical to these with Boyd on them about a month before our vacation. Creepy!

Somehow only Boyd was captured in a swimsuit appropriate to post here...!

Boyd showing off our sweet digs.

We won't brag too much about the just as sweet deal we got with it.

Clearly, the food itinerary must have been set by me. Oh man, this place was up there with finale in Boston. And if you havn't been there we pity you.

Boyd's first peek at Disneyland to round out the California experience. This is at California adventure.

Obligatory picture by the "L"

Proof that we actually went to the real thing too. And ate dole whips. Who's jealous now?

So even though we celebrated in full before I got my board scores, it turned out it was well deserved in the end. Since no one from med school reads our blog, I can proudly announce to my family (and the few friends that read our blog who I know won't spread it to the wrong people) that I scored a 245! Plenty high enough to be really competitive for any residency I could possibly dream up. Plastic surgery anyone? Just kidding.
Thanks everyone so much for all of your support and help during my studying. I couldn't have done it without you!

Mini Memoir: The Girl in the Mirror

When I was little I would watch my mother get ready for the day. I often perched on the cold marble of the bathroom sink and, although I swear I was better seen than heard, I’m sure my mom would describe me in perfect chatterbox form. I was really such a chatty Kathy growing up—everything from know-it-all status to a delinquent fondness for talking back--for which I was rewarded with many mouthfuls of Dial soap. To this day I can’t use Dial for that reason. But even if my mom may not remember these mornings in quite such an optimistic light, I really liked them. The steam would billow through the shower and create those condensation droplets on the marble and the mirror. Sometimes I would drag my finger through it and write her messages. I like to think they were clever little Haikus or limericks but I think the standard “I love you Mom” might have been the best I ever conjured up.

She always showered in the dark for some reason I’ll never quite understand—still does in fact—and then when she stepped out of the shower she used this Crabtree and Evelyn body powder called Summertime. It was in a granny shaker—really it was—all floral looking with loopy cursive. When I was a teenager I crinkled my nose at such a fluffy and functionless powder all wrapped up in old person’s wrapping. Now I think it’s beautiful. Isn’t that the way it always goes? Now I cherish things like the vintage rocking chair that I acquired a few years ago and that Boyd has been working on sanding for my birthday which was, wait, in February? That’s okay, I still love him. And part of me kind of loves the fact that it still isn’t finished. I can’t really say why. Now I’m debating whether we should really be re-staining it at all.

After the body powder came the round woven basket of makeup. Whenever she’d put on her blush I would get some too—that was probably my favorite part. She had that blush for I think about a decade. But seriously, do you ever run out of blush? I know I haven’t yet. Well the end of that blush was when I went in her bathroom around the age of 16 to try on all of her makeup before she came home from work. I think prom was about 2 weeks away and my cover girl just wasn’t cutting it. Her Clinique “Breathless Berry” was guaranteed to make me more beautiful than my cover girl cheekers, “pink.” Seriously? Don’t they pay someone to come up with names for make-up? Clearly not enough. Anyways, I fumbled with the breathless berry, and it came crashing down onto the whiter than white tile my mom swore was practical. And, of course, being more than 10 years old, the blush cake shattered into about a hundred pieces. Which I put back into the little snap case and quietly stowed away. I didn’t even have the guts to admit I had broken it when she came asking the next day.

Just the other day I noticed that whenever I look in a mirror I put my tongue just up to the insides of my lips to make them look fuller (I guess us Dahl girls weren’t exactly blessed with the Angelina Jolie lip pout) and I realized just how much I look like my mom. She actually does this little lip-plumping exercise too, although she'll probably deny it. People always said we were twin growing up, but I never saw it because, well, I have blond hair and she has dark brown hair. We obviously couldn't have looked alike. But we do, it’s undeniable. Now that I have just the finest of lines around the corners of my eyes and my baby fat is all but gone off my face I see it. I see the skin so white it’s almost translucent and the occasional tiny capillary running through it. I see the dark sun spots that so easily mark how old we are. I see the hazel eyes I used to think were an ugly pea green, all speckled and frog-like, now deep and earthy and prettily freckled. I see the lashes so long it looks like I’m wearing fake ones every time I put on mascara and know that mom blessed me with those beauties. And now when I get ready for the day, and fog up the mirror, and powder up, and put on a blush that’s actually my color, I see that I am beautiful, just like my mother is beautiful. And I thank my lucky stars that it was never on the outside that counted anyways.