January

From January 07

January was busy.

Starting off we had vacation the first week of January, where my dad and Maria came out for two weeks and were a tremendous asset to us with a new baby and three other children. God knew we needed them here, because one of the first days back to work, my dad came and told me at about 6am that the basement was flooded. Seems the roots are growing into our sewer and with the extra rain we had, our drain couldn't keep up and we backed up. Had to tear out half of the carpet, rip up the pad and then my dad bleached everything and we set it out to dry.
Insurance had a carpet guy come out and he sprayed some cleaner into everything and then re-laid the carpet. Next, a cleaner service comes to actually clean the stuff, and then I have to figure out what to do in the office as we threw that carpet out and are not sure what to replace it with...

So, I have no office to work from or be inspired to blog from, which is fine because we have been busy this month with work (I have been on Urology) and sickness. All of the kids have been sick this month, Kristi included. Mary Beth is now out here with us for two weeks and she is sick too. She was well on her way to recovering from a nasty bug when she arrived and I think that we have succeded in giving her a little too much to do. More than we intended, anyway. Last weekend we were in the Children's Hospital for Friday night through Sunday afternoon with Pati, who had RSV bronchiolitis and was having a very difficult time managing secretions. Mary Beth held down the fort with the three sick bigger kids for the whole weekend while we parents were at the hospital. We don't know what we would have done without her.

All is now well, and we even have our recycling trash bin here. The city just distributed new trash cans to us, well, about 4 months ago, and we finally have the special one for recycling so we can save the planet. Phew! sure feels better now.

Urology has been pretty fun. If you like genitals and their pathology. Actually, I like the bladder scopes, and after the second week I was doing scoping people's bladders and shooting dye in their ureters and laser blasting kidney stones with a vengence. Pretty fun, and they make a killing and have a good life, to boot, but there is something that tells me I would grow to hate it, and being so focused on a single organ system would drive me nuts and make me wonder why in the world I got into medicine, anyway. Nice to know that.

Actually, one of the residents a year ahead of me just switched to Urology, so next year he will be an intern again and start all over. Good for him, but bad for us because he is such a good surgeon and guy. Oh well, I hope they find a good replacement, since he and I were supposed to be senior and chief residents together. I am just trusting God for the replacement.

No new pictures at the moment, since my hard drive is tucked away out of water's reach and all of my pictures are on that drive... .Also because I just finished taking my annual American Board of Surgery In Training Examination today. This is a yearly exam we take which is sort of like a "see where you compare with all of the other surgery residents in the country" as well as a "better study more or else we won't let you pass on to the next level" whip.

I will see if I get a chance to throw some pictures up for you all. Since it has been colder and snowy lately, we have not been taking that many pictures, but we will see what we can do.

Hope all is well with you and the new year brings closeness with Him.

David

When you were born...

From Patagonia Ele...

When you were born...



Starting on December 21, I was on call every other day through the 25th, which means I was at home from about Noon until 5am the following morning on the 22nd, 24th, and 26th. I had it all worked out: work straight until the 28th and then I would have five days off, followed by 7 more days of vacation. During these 12 days I was hoping would bring the fourth child of ours. If her respect of my schedule is any indication, Pati will be a most compliant and obliging daughter. There was a crossover date where I had coverage at the hospital, but was expected to be there. Kristi started having contractions starting somewhere around 7pm on the 26th, a day where I got off around noon from a 30-hour shift of being on call at the hospital. I was able to nap some from 11 or so until about 3am when the groaning next to me became a bit more intense and closer together.



The plan was to take the three kids next door to our wonderful neighbor's place (Dana and Nancy Ewing) as soon as we needed to, but we had some backup just in case. On around 6:00 on the morning of the 27th I realized that I needed to get in gear and make sure the kids were breakfasted, clothed, pottied and had a change of clothing in preparation for a quick trip next door to the neighbor's place. Somewhere after the oatmeal was ready (yes, I can cook when I have to, but the trick is to make it edible but not too close to savory that you are asked upon to perform the culinary art during non-emergent states) and the bags were nearly packed our lovely midwife Heather Judson decided to see how things were progressing. Feel, rather, is more like it, I guess. Anyhow, I didn't hear any words of the conversation that was going on in the "exam" room except for the word "COMPLETE."



Now, maybe to the lay person that doesn't mean anything, but I suppose it would be like telling a cook that their oatmeal was either about to boil over or had run out of water. In the next few minutes the children were up, dressed, hastily fed, and packaged and delivered next door after a call to the neighbor at 7am. Fortunately for us, our midwife is no lay person either, and the word "COMPLETE" meant that in the time I had packaged and delivered the bewildered children next door, our bedroom had been transformed into a birthing suite, and before long we were full into it, with pushing, a bag of water that broke and showed us the GI tract was working in the new one as there was some meconium staining in the fluid (this can indicate fetal distress and is a problem if the little tot inhales some with the first breath of cool, fresh air). She was pretty efficient after that and before more than 10 minutes had passed, maybe only 5 since the water broke, a crowning head was clearly visible. One push after that we were trying to find the orifices to suction before the rest of the monster was delivered (the baby, of course is the one I mean is being delivered, although I know it is mutual deliverance). It was difficult to suction because she was facing behind mommy, so suctioning was a bit like attempting to find a hole with a screw on the end of a bit on the back side of an ottoman that you are seated in front of. In no way is my lovely wife similar to an ottoman, but that seems the best description I could think up.



Anyhow, there she was and next thing I know we were sitting there wrapping the little sausage in a blanket and working the clamps on a cord after a minute or two. Pati was discovered to be a Pati and not a Mark, or James, or John, or whatever we would have named her if she was a boy at this point, and was noticed to be incredibly quiet, blue, and nealy inactive except for large blinking eyes. We finally rubbed her down and got a little hoarse cry out of her before we clamped and cut the cord. Then we worked on getting Pati pinked up and suctioned out and dried off and wrapped up while waiting for the twin to be born (the placenta that is). This took a bit of time, and I was a bit too close because this placenta was sort of it's own plug, holding back about a quart of blood and fluid that came out all at once and hit me right in the leg and foot. That being over, we had an issue with mom bleeding for about 45 or more minutes after the placenta was delivered, which involved massaging the fundus, giving some shepherd's purse (some herbal thingy), metherjin (that is how you pronounce it anyway), and pitocin that was intermixed with prayer of course.



The bleeding stopped, the baby nursed, we all felt a bit better and then got a nap or two before our first night together as 6. Pati seemed to be quite pleasant, and has continued to seem so. I don't know if this will continue, but we are sure grateful for her quiet voice and calm demeanor. Takes most everything either asleep or quietly gazing into the still winter air as if she is waiting for spring to come before she really wakes up and becomes who she is going to be.



Heather, the aforementioned midwife and long-time family friend, was escorted by 4 of us this morning to the airport, so it is just dad and the three older kids doing their best to stay out of mom's hair and keep everyone fed, in clean clothes, and the house in good walking order (paths clearly marked). I have no idea how my wife does it. I think I would go insane after a week or two dealing with this crew. Not that they are bad kids at all, just that so much is going on and nobody really is that much of a help, yet. I was able to get some help organizing the lincoln logs and such today, and I can warm up a mean frozen pizza and make some pretty sweet hot chocolate. Really, the older kids and I went to the towpath this afternoon while mom and baby and Anne were napping. We made it a good four miles before the girl had to go potty, and it was right next to a latrine, so I consider it a pretty good day, in all. I still am figuring out how I am going to go to the store and get some necessities. Duct tape seems like it would sure come in handy if it weren't for those bothersome CSD people and their spies. I guess it will be discrete pinches in sensitive locations for now.



Well, this was meant to be both a blog entry for you all, as well as an accounting for Patagonia when she gets older and asks about what her birth was like. Actually, it will be for me because by then I will most likely have some form of dementia or memory loss or something, and will need a crutch like this to help me out.



Thanks for the prayers and for not making fun of Pati's name. We figured she could always go by Pati or Elena or Elen or something if she really doesn't like it. If you don't like it, well that's just too bad.



David

Pictures of December

From December 2006

You don't hear from me (Kristi) much because every time I sit down to write a new posting I get distracted with trying to put a picture in it. I usually just give up after I have used up my 30 minutes of kids nap time trying to get a picture to configure and post it on the site (it must be done before anything can be written). I thought that I must be very inept since I know others who fill their blogs with multiple pictures and it never seems to give them a problem. I feel a bit better to know that the pictures give David trouble too, in fact, posting pictures gives trouble to most everyone who uses beta blogger instead of just plain blogger. Unfortunately we didn't know that there was difference between the two and to change from one to the other now would be a royal pain - so I guess I will keep trying to post pictures with minimal success, althuogh I do hear that beta blogger is working on fixing the problem since no one is happy about it!. [I added the above picture after the fact, DC]

If I could have put pictures in I would have put in Kaytra Copper and Sarah Coder playing with my kids. They came out to Ohio for a week and made cookies and bread and freezer meals, took care of my children, cleaned bathrooms, mopped floors, folded laundry, wrapped Christmas presents, and took about 500 pictures on our digital camera. We sure miss them. They were also here for 3 of the days this month that David worked 30 hour shifts and were great company for me.

The one picture that we almost took but didn't was of Jan, early this last Sunday morning. She had gotten up before anyone else because she needed to use the bathroom. While sitting on the toilet, in the dark with no one to talk to she noticed that there was no toilet paper on the roll. The most natural thing to do was to take off the rod that usually holds toilet paper, take it apart and pretend that it was jewelry. When she finally hollered for me to come and help her one of the ends of the toilet paper roll was good and stuck on her pinky. Of course, David had left several hours earlier and would not be home until the next afternoon. I tried greasing it up with several things, then cutting with tin snips and wire cutters. Nothing worked. It was off to the emergency room. I was so grateful that I didn't have to haul the other two kids out of bed and take them with us too. Kaytra and Sarah stayed with them while Jan and I headed to Akron Children's Hospital. The doctors and nurses down there couldn't figure out how to get it off either. They finally called up a big brawny janitor from maitenance to bring a large pair of tin/wire cutters. About an hour and fifteen minutes after she first put it on it finally came off. Her finger was swollen, cut and gray but she could feel it. (And they gave her a pretty white bear for being so good...she was so pleased with it that I worried a little about a repeat performance.)

It has been snowing for most of this week and it is beautiful outside. We have a few pictures of kids with red cheeks making snowangels. Anne Pilar is so bundled that she can hardly walk, looking like a cross between a boy and a girl in Alec's hand-me-down blue snowsuit and a powder pink hat. Pretty cold, but we make it out a couple of times a day to pull the sled around and try to make snowballs. The first day Jan rolled snowballs around for twenty minutes trying to make a snowman. She kept saying "I think it is getting bigger Mom!" But it wasn't and she finally gave up. I guess wet Oregon snow is just better for snowpeople. David even made it out to pull kids around the house in the sled a few times before he had to go to bed. (His overall schelule this month is pretty awful and he goes alot of nights with no sleep at all..I guess that it will make having a newborn look easy!)

The house is half decorated for Christmas - we hope to make it out to get a tree next week (along with some new PLASTIC toilet paper holders). We don't have pictures of doing advent, but it would be fun to post a few since it really is the best time of day. It is most fun when David gets to be home for it. The kids are relearning some of Luke 2 and are starting to be able to sing the real words to "O Come O Come Emmanuel" (which is good since David and I can't help getting the giggles when they are singing along earnestly, but don't really know the tune or the words.).

I started this month fretting about the upcoming birth, about David's schedule, about lack of childcare options during the birth. Several people have mentioned that they are praying for for all of that. This week I have had peace about God's control over all of those things. I am interested to see how He works it all out...and I can't help wishing that it were over!

Maybe our next post will have real pictures - of a new baby!

Hope you all have a good December.
Kristi for the Carnes

Neurosurgeon Thanksgiving

Giving Thanks is such a good thing. Anything that gets your focus off of yourself is a good thing, and I am hard pressed to think of anything to thank myself for. Being in the line of work that I am gives me much more to be thankful for than most, I think. During my month of Neurosurgery I have been able to meet many grateful and many devastated people.

Two weeks ago a woman in her mid 50's came in to us because we operate on the brain and she had a problem where the remedy matched our job description. It sure is nice to not need an advertising budget as all of your work comes to you. She had been complaining of worsening headaches and some mood changes. She went into the emergency department at her local hospital, fortunately for her because everyone who follows her example gets a CT of their head, and they immediately sent her to us.

I examined her and noticed she had a very flat affect. This is doctor speak for lack of emotion or expression. Her husband added that she had lost nearly all motivation for doing much of anything over the past bit, and was concerned her scan was related. The nurse and I looked at the scan and decided she needed surgery. She got an MRI because the surgeons need the MRI to better show the limits of the tumor that had entirely replaced her Right Frontal lobe... In essence she had a golf ball sized tumor in the front of her brain that was squeezing the living daylights out of it. Fortunately for her, there is not too much that goes on there that will let you know something is wrong. There is no motor or sensation control there, or even speech or anything, so you won't have much more than headaches and problems thinking and feeling (sort of like a functional lobotomy, really)emotion.

When we opened up her scalp and drilled out a wallet-sized chunk of skull so we could access the tumor we were impressed again with the size of the lesion. It was a dark grey mushy mass of tissue inside the ivory white brain tissue, and it took us quite some time to dissect it carefully away from the healthy normal brain tissue, especially since these tumors are so vascular (which means they bleed whenever you touch them). We did finally get her tumor out and filled up the hole with saline so her brain wouldn't collapse back into the hole. We carefully sewed back the layers covering the brain and then I got to screw the flap of skull back on and we closed her scalp.

To my amazement she was only a little nauseated when she woke up. Then when I saw her in the ICU the next morning, she actually smiled! Wow, she hadn't done that for some time. By the third day after her operation she was joking, planning out her holiday preparations and was trying to make up for lost time in the energy department. I am not sure if her husband will be thanking us or not since she lost her energy gradually so he could get used to it, but now she had it all back over the space of 3 days, which has to be quite the shock.

Makes me especially grateful for what I have and how blessed I am. Also makes me feel very safe and secure to know that I have a personal relationship with God, and that He is so steadfast and dependable. Living is so unpredictable in itself, with seemingly random tragedy and elation waiting for each of us around the corner. I sure do not depend on my body for satisfaction or function tomorrow. I can either be cynical and sour about not being able to know that I too won't end up under the lights with my brain exposed, or else I can just accept that uncertainty and take solace in the odds and put my confidence and trust and life in the hands of the Creator and see what it is He would like my body to be doing during the time it is here.

Another guy we took some brain tumor from won't be so blessed. He is pretty devastated and upset given the fact that his tumors, unlike the lady above, are not primary brain tumors but they are metastases from lung cancer that has not yet been located. He has a 10 or less percent 5-year survival and he is very much into his body. He did smoke for years and years until he had a heart attack. He then started working out with the same enthusiasm he used to smoke with, ate all natural stuff and paid close attention to his body. What he gets from that is metastatic brain cancer that will buy him radiation and chemotherapy and a very low chance of making it more than 2 or 3 years from now. Unfortunately he worshiped his body, so he is devastated about it.

I have been thinking about him some lately, and hope I get to see him again sometime as the time he spent in the hospital was very busy for us... I never got a chance to talk with him about God more than just passing one-line comments to ascertain his openness to the subject, which seemed to indicate he was as he has no family and only a few friends around here. I will keep praying he will come to know God in a way that allows him to place his life in His hands (as if it is not already, you know?).

Well, that is what I have been dealing with the past week or so, along with many other patients as well. My stretch of being on call has come to a close so I get to enjoy Thanksgiving at home with the family and even get this weekend off, except I have to go in tomorrow because we are opening up a few more brains and spines.

We hope you all have a good Thanksgiving and have ability to be thankful for the blessings you have undeservedly been given.

David