Mommy tip

I guess it would be a tip for anyone caring for children. I discovered it in a time of desperation and it is forever burned into my memory as one of my most brilliant moments. The only audience was my four children and only one of them noticed; not Pati grinning in the stroller or Alec worrying about getting to push the elevator button once we got back to the elevator or Anne touching everything in the bathroom she shouldn't - just Jan, sick as a dog.
If you are ever in a public place and need something portable and disposable to catch any kind of mess, just look under the garbage bag in the rest room. They keep whole rolls of extra garbage bags. Tear one off the roll and you have a portable throw up bowl or whatever. I had to do it twice from two different bathrooms as we were caught in a large office building with an appointment to keep and Jan was suddenly very nauseated. And I knew exactly what she had had for breakfast. Alot.

Summertime

From July 2007

Some time now has passed by since I last put anything down here for people to peruse. I always have liked the sound of that word, just been a while since I have been able to do it or use it.
Since I last wrote something down, Kristi, Alec, and Anne have all celebrated birthdays. We have four new fangs in Pati's mouth, the northwest has been blessed with our presence as we returned for a family reunion and wedding anniversary, and because some of our wonderful family paid the way for us to go. We had a great time out there and it felt like a real summer to be able to spend time with family, play frisbee and eat watermelon.

On the work front, I have been doing the upgraded duties and schedule of a second-year resident, which includes lots more work when I am on call, and I am on call much more, or so it seems. Now a days, I am quite proficient at putting in central venous catheters, thoracostomy tubes, and just last week I removed my first gallbladder as the operator (not the assistant), which means from start to finish I did the entire case myself. Most likely doesn't mean all that much to you, because you can't appreciate the difference, and in a year or so I suppose it won't mean much to me either, as I will be doing that more than assisting, but for now it is a pretty big milestone in my mind.
We have also enjoyed relative good health this summer, with only some fevers and minor illnesses to account for. Jan is getting quite old it seems, and is more of a help to mom than ever. She is much more interested in school things, and even writes "cursive," and I think by the looks of her "writing" she may have some medical potential there.
Alec is now without training wheels, is still working on his "R's," and "L'S" because they both come out "W" still. He is getting to be a help to mom as well, and is pretty interested in "boy" stuff.
Anne is the life of the party, and alternates from being the most entertaining and sweet child to a real challenge if she is crossed or corrected and doesn't appreciate it. She has quite the wit and vocabulary, and uses both prolifically. Her eczema is much more controlled now that she is on the strict and rotating diet, and I think it just might work for Anne's health, but not for Kristi's mental health. I am not sure how she manages to keep a home, raise a family, and see to the needs of a husband like she does. She is amazing and I know she has the hard end of this deal for sure. She has stuck with me though, and still says she loves me, so I guess it is worth it. I am so grateful to have her, and could not do this residency thing without her.

At work we have been dealing with all of the greatest members of society, who seem to save up their tricks and fancy moves for when they are drunk and tired. I think working on the trauma service is sort of like a box of chocolates, "cause you never know what you will get next." Usually one common denominator is alcohol, and a very low I.Q., which may be redundant as I am not really sure which one comes first.
Some of the more interesting cases lately have been those that I had a "strange feeling about." It is the not very scientific part of medicine, and I seem to recall a book I had started reading with Kristi called "Blink." There are these cases I get where I get one story, and then things just don't feel right, so I start following my sense of what isn't right and have ended up with some bad stuff. The first one was a couple of weeks ago, when I was called to go evaluate a patient who had just completed open heart surgery 4 days prior to my seeing him. His abdomen was distended and he was breathing sort of fast and shallow, and just didn't look right, but he refused to acknowledge anything going on, or any real pain.
I didn't believe him and went to look at the CT scan he just had that the radiologist read as "negative." I stared at it and something just didn't seem right, so I played around with it for a while and then started to see some air that wasn't in his bowels. This means you have ruptured a hole in the bowel somewhere between stem and stern, so I showed it to my attending, and told him my concerns. He agreed with my analysis that something was up, and so we went down to radiology to have them explain to us how this gas was read initially as not outside of the bowel... Anyhow to make a long story short, he had ruptured his colon and we had caught it early enough to hopefully catch him before he got really sick.
The next case was a lady who came into the emergency room looking like she was going to die, pale, sweaty, heart rate fast, and writhing in pain. The emergency room told me they thought she had a ruptured aneurysm, or at least a dissecting one, and when they sent her to the CT scanner, told me they were going to call me about her. I was curious, so I went down and watched her CT scan, and her Aorta was fine, but her bowel looked goofy to me. The radiologist told me that she was just breathing too much and the CT was too poor quality to make any diagnosis, but he didn't think anything was wrong. I disagreed, and went and showed it to my attending who was in surgery at the time. He went on my intuition and scheduled her for the OR. I was starting to feel like maybe I would look really stupid if he opened her up and didn't find anything, so I started second-guessing myself, especially since she was much more comfortable with the pain medication on board. To shorten it up again, we decided to go to surgery anyway, based on my bad vibes, and the attending called me into the OR 45 minutes later. I was thinking, "here it comes, I am going to get reemed out for making him operate on a perfectly normal and healthy lady." As I walked in the door, I could smell this unmistakeable smell of death, and looked on the table and he says, "you think we should have operated?" "I guess so," as I look at 3 feet of dead small bowel sticking out of her belly. Normal small bowel is pink. Dead small bowel is very dark red/black color. She had an internal hernia of her small bowel and it strangulated the blood supply, killing off a loop of her bowel.

Well, enough of the stories for now. I have to run study for my board exam next week, see Alec's new bike kickstand and bell, and put the kids to bed.

Take care and write if you get a chance to tell me how you are doing.

David

Summer's end

July flew by and August is almost gone too. I hate to see it go, I have always loved the summertime. Tonight the kids thought that I had let them stay up REALLY late since it was actually dark when they got into bed.
David was able to take a week of vacation time in July and we flew to Oregon for a trip that was just too short. Wow we saw alot of relatives! It was a good time of reconnecting with people and letting the kids reconnect with cousins. We sure miss everyone out there. Going "home" was like a breath of fresh air for me, I loved it. It was good to come to our real home, though, and swing back into real life here.
For over a month we owned our very first family pets. Goldfish. It was fun while it lasted. Several wading pools in town release 400 goldfish into their pool one day midsummer(it is when they are refilling the pool, before chemicals go in) and let kids try to catch them in a container and take them home. It was FUN and we came home with four fish. Every morning we would make our way to the breakfast table, wondering if the fish would be swimming around or floating upside down. Each one was carried outside on a slotted spoon and buried in the flowerbed. Two of them have crosses. Alec dug his up several days later and reburied it...just curious I guess.
The kids have been "building stuff" out in the yard. We brought home a carload of free lumber scraps from Home Depot and Jan and Alec built a bike jump (with some help), some boats to float in their plastic pool and some other stuff. Most of their spare moments have been spent outside hammering this last week (Anne too).
The kids and I have been driving out to Wadsworth every weekday for the last two weeks for swimming lessons. (It is just a twenty-five minute drive, but somehow, here, the way people think of it is "driving ALL the way out to Wadsworth".) Jan is really swimming, and Alec is just starting to paddle around too. The first week we went out we missed three days because of thunderstorms (Humidity! That whole week I felt as though we were living in a bathroom while someone was taking a shower). We have two make up lessons this week for the days the pool was out of commission because it was directly hit by lightning. Now, when the kids are out playing in the plastic pool in the backyard Jan hustles everybody out at the least hint of thunderstorm. She takes such good care of everybody.
That was the week we had our first tornado warning, too.
All of the sudden everyone is talking about school starting and fall coming. For some reason I just am not ready for summer to be over yet. All of that canning that I didn't get done, the planning for school that I have yet to do. I work really hard and never seem to get it all done...but I do take lots of breaks to race kids around the house (they make a mark for every trip around the house...Jan is winning right now) laugh over their funny books from the library and set the chipmunk traps, and get out junk so they can do projects and do all of the things that never make it onto my to do list but they are the only things that we remember when the day is over.
On the other hand, it is good to see time passing since that means progressing through residency. Right now just checking off one more day of it is good! No matter how hard David works he never gets it all done either.

"For we are His workmanship, created in Christ Jesus for good works which God prepared beforehand that we should walk in them." Ephesians 2

Chipmunks

This spring we were overrun with chipmunks. They were everywhere all of the time. Squirrels too, but the chipmunks caused trouble. Digging holes in the grass, eating things in the flower beds, getting into the garage and just generally messing with things. After trying several "humane" things our neighbors bought rat traps.
Grandpa and Grandma Copper came out to visit (and Uncle Titus and Aunt Kaytra, along with cousins Elise and Triana Engen). My Dad bought the kids a chipmunk trap. They were in heaven. They learned that you have to put the bait on a scoop of peanut butter so that the chipmunks can't just take the bait and escape before the doors close. For days that was the most exciting thing happening here. Usually when Jan and Alec or Anne wakes up in the morning they come to see me (makes me feel important). Not when the traps were set. I would hear noise from their bedroom and stumbling out in the hallway, and they would run right by my room and out the front door to see if they had caught anything. I think that the final count was 18. Some days they caught 4 or 5. Alec and Grandpa Copper would load them into the car and give them their freedom at the golf course a little way down the road. They caught a few squirrels when the chipmunk trapping slowed down. One of the last nights they set the traps we watched a skunk with a long flowing tail prance through our backyard. We all hoped that skunks didn't like peanut butter.
At the beginning of June we got the results back for a blood test that Anne had taken. We have been careful with diet but unable to pin down all of her food sensitivities without a blood test. She had been tested for IgE reactions last fall and showed an allergy to rice. I had removed rice and milk and eggs and oats and chocolate and citrus and tomatoes and I don't know what else. She improved but still wasn't doing well. She flared up badly this spring, awful eczema, 7-8 poopy diapers a day, some in the middle of the night, nearly always woke up poopy or so wet her bed was wet too. Her bottom was orange (like a burn) and often raw. She was crabby and cried alot, her nose was usually runny. She was up nearly every night, usually 2 and 3 times crying and itching or crying and pooping. God provided the money to take a different blood test, a test for IgG reactions to 115 different foods. It came back positive for 26 more things. She is on a very limited 4 day rotational diet and has slept through the night for two weeks now. Her orange bottom is gone and she has a much better disposition. The only gluten containing food that she didn't react to was rye but when I gave it to her on her "rye day" she had an awful reaction to it and although she had not been tested for gluten sensitivity, at this point I think that it is a likely possibility. I am trying to be diligent to really rotate her foods and am grateful for the improvement in the last two weeks. (Enjoying the break in the diaper department as well, since she is down to 2 or 3 times a day.)That may be a boring update for some but it is something that has been a "big deal" for us and it continues to be. She is a good sport, eating steamed cold cauliflower when other kids are eating goldfish crackers. She has learned to say "I don't like it!", but she will eat it anyway.
After a comparatively good two weeks as far as schedule goes David is back on yucky schedule. I guess there is a reason that they call them "residents". We won't see him much for the next three weeks but then we do get him for a week of vacation which we are all excited about. He has to take another nasty test in July or August which means that he will spend most all of his "free" time between now and then studying for it. All I can say is that David is a diligent man who works hard and does what he can to keep a good perspective about where the Lord has him. "They" say that all surgical residents seriously consider quitting during years two and three. I am beginning to understand why and I don't even go to the hospital. I just see the demands put on him in terms of time and energy and am proud of all that he does. He took the kids to the ball field last night and pitched so that we all could bat and run the bases (Alec had bought a pair of baseball cleats at a garage sale and really needed to try them out).
Looking forward to seeing some family and friends in the few days that we will be in Oregon.
Kristi