On Feeling Safe at Home (in Your Own Country)

I haven’t written in eleven days.  It isn’t for lack of topics and events.  My mind and body have been moving at warp speed, busy, busy, busy.  (Of course, I mean that as what amounts to warp speed for me.)  It is both my reason and my excuse for avoiding writing.  Not only do I feel too busy (no time, no energy for the blog), but I also feel that so much is happening that I can’t adequately describe the events or express my feelings about them. 

That was yesterday.  Today I can see that President Obama’s criticism of the Cambridge police force and his subsequent conciliatory action toward them is still raising discussion, and I have two cents worth to add. 

In 1977 I was a married student living in a campus apartment in a building owned by Vanderbilt University.  There were businesses on the ground floor – a bank branch, a record store (the one I visited daily while I awaited the release of Stevie Wonder’s Songs in the Key of Life), and others.  One day there was a bank robbery.  Soon after, my husband heard a knock at the door.  He opened it to find a group of Nashville policemen, their assault rifles drawn and pointed at him.  They entered, questioned him, looked around our apartment, and left without apology.  When we discussed the incident with neighbors who were home, we discovered that no one else had been similarly invaded.  My husband, the only dark-skinned tenant, was a target. 

There is a special vulnerability that comes from being threatened in your own home.  When the threat comes from those who are sworn to protect and serve, it leaves you with a horrible, gaping wound – an affirmation that you are not of value in your own country.  Dr. Gates should have been permitted to retreat into his home without further harrassment, surely already humiliated and embarrassed by the assumption that he was breaking into his own house.  Instead, he was handcuffed (- handcuffed!!!) and taken to the police station.

As for the African-American member of the Cambridge police, who says he completely supports the actions of his colleague – I imagine his family needs to eat.  He can’t afford to not be a team player.   

Dredging this up makes my stomach hurt.  If you know me personally, you know that my gut is made of iron.  My college days were punctuated by incidents like these.  All the feelings come back.  I’m a naive 17 year-old freshman, in a non-violent protest against some discriminatory practice at the office of the administration.  I am a 20 year-old married student, walking down the street with my dark-skinned husband, hearing some misguided citizen yell at me “Nigger lover!”  I am in a premed counseling session, with the program director assuming that I want to go to an all-black medical school-no, assuming that I cannot be admitted to a majority school. 

One person’s teachable moments are another one’s life.

Peace.

Everything I Know About IVs

Every so often, I remember that I am reporting on this journey with systemic lupus.  It has been sixteen years, and lately I am experiencing a rapid, unprecedented improvement in all symptoms.  I credit everything:  my B-cell killing therapy, years of mostly vegetarian eating, changes in my state of mind, prayer (mostly from other people)…I’m always supportive of multifactorial responsibility.  These are things I can do now that I couldn’t do six months ago:

1.  Get ready from start to finish and leave my house in 30 minutes.

2.  Stay up until 4 a.m.

3.  Ride my exercise bike at 8 mph speeds for 10 minutes or more.

4.  Take a bath, brush my teeth, and not need to rest afterward.

5.  Hurry from one end of the house to the other.

6.  Go to the mall and other places that require reliable, long distances of walking.

7.  Plan for more than one big activity per day.

8.  Wake up without oral ulcers. 

9.  Schedule appointments in advance and be pretty sure I won’t have to cancel at the last minute.

10. Pick up things that have fallen on the floor immediately, rather than waiting for extra energy.

11. Carry many pounds of groceries up the stairs from my garage into the house.

12. Sit for three hours and not get huge leg swelling.

13.  Taper my prednisone below 10 milligrams daily.  (I am currently at 7 with no symptoms.)

That’s progress!!

A ways back I mentioned that I wanted to do some “Everything I Know” posts.  One aspect of being chronically ill prompts me to start with this one.  When you have an illness that requires frequent blood-drawing (venipuncture) and occasional intravenous  (IV) therapy, the quality of those procedures can drastically improve or negatively impact those experiences.  I knew this from an early age, having started with serious medical problems at age 19.  I was determined to be adept at procedures so that they would not be additional torture for patients who already had to cope with illness or trauma.

 

Everything I Know About IVs I Learned From…

…two incredibly talented, African-American students in the class ahead of me at Jefferson Medical College.  The two guys were friends, and not only were they some of the smartest people I ever met, they were willing to mentor anyone who asked for help.  They were masters of preparation for every medical encounter, from exams to patient care to the competitive, universal, sometimes antagonistic Socratic  teaching in clinical sessions.  These are some of the things I learned:

1.  Read first.  There is something written on every topic you can imagine, and it’s your duty to find good sources and learn from them.  Don’t just rely on what the instructor or professor says or the books they recommend.  Figure out how you learn and find a source that teaches it that way.

2.  Practice, practice, practice, practice, practice…you get the idea.  We used foam pads to stick our needles into at first.  We practiced pushing IV catheters into them and having the catheter end up centered under a single ink line.  We used suture kits and practiced surgical knots until they could be performed without thinking.  It was inexcusable to have your first practice be on a patient. 

3.  Lay out your supplies in advance.  You should have everything within easy reach, keeping sterile things untouched.  You should not require the precious time of a nurse to hand you your supplies. 

4.  You don’t have to make a patient scream with an inhumanely tight tourniquet.  Tourniquets only need to be tight enough to obstruct venous blood flow.  Arterial blood still needs to flow into the limb.

5.  Leave the tourniquet on adequate time for veins to fill.  Unless your patient is a healthy athlete, you can’t get a good idea of possible puncture sites in 30 seconds. 

6.  Look first.  Examine the limb that you’ve tied off, top, bottom, sides, from end to end, so that you don’t miss any visible possibilities.

7.  Feel, feel, feel.  Full veins are palpable under the skin if you use a gentle touch.  This is crucial in darker skinned patients where you may not see the blue of a vein through the skin.  You should develop such sensitivity that you can “feel the red blood cells slipping past your fingertip”.  You can also feel the tough, hardened cord of a vein that is sclerosed and which doesn’t have enough of an opening to thread with an IV. 

8.  Determine the course of your selected vein, and mark it with a pen if necessary.  Your IV will only thread if you hit the vein and push the catheter in the right direction.  Pushing directly against the wall of the vein, instead of into the lumen, results in a punctured vein and big bruise.

9.  Make your puncture swift and sure.  Draaaaaging your needle slowly through the skin is undeserved torture for your patient.  Keep one finger on the vein while you are sticking, so you don’t lose track of your target.

10. Tape neatly but securely.  Your patient should be able to use the limb while the IV is flowing. 

11.  Clean up after yourself.  Anything else is unfair to the nurses. 

All of this sounds very straightforward, but there was one additional element.  My guys insisted that you treat every patient with respect and compassion.  They never entered a room without knocking, introducing themselves, and announcing what they were doing.  When they sat down to start the IV, they would be in conversation with the patient.  Not only were they describing what they were doing and preparing the patient for it, they were chatting and engaging the patient in an experience outside the procedure.

 

Great teachers.  Great friends.  Thanks, guys.

Peace.

Watching “Hopkins” on Independence Day

Soooo, Happy Independence Day.  It is almost 11 p.m. and my neighbors have kept up their artillery barrage of fireworks for more than two hours.  My brain is exhausted.  It works slowly at best during a flare of lupus, and the constant noise has exaggerated this.  My reluctance to approach them and request a cease fire reminds me of my daughter’s difficulty confronting her peers when they are doing something outrageous or hurtful.  We all want to keep the peace, don’t we?

 

Tonight, after another person asked me if I was watching the ABC series “Hopkins”,  I went to their website and watched the first two episodes.  I knew that folks would ask me because of my residency training at “the John”, and I did have some curiosity about the lives of the young people training there 30 years later.  A few things struck me.  First, it doesn’t seem that the 80 hour per week limits on clinical training time is actually being practiced.  There was no limit when I was training, and our weeks averaged 120 hours “at the bedside”, as Victor McKusick called it, pointing out our good fortune to be immersed in that service (read “servitude”).  The second thing that struck me was the obnoxious music, complete with lyrics that were meant to reflect whatever emotions went with the situation.  It was cheesy and frequently inappropriate-too light a treatment for the gravity of the subject matter.  I don’t know if the regularly scheduled broadcasts were heavily laced with invitations to hear more of the music, as the webcast was.  Third, as many medical shows tend to do, “House” being a notable exception, this series is heavily weighted toward showing surgical specialties.  It is grossly misleading, as the majority of physicians are not surgeons.  It falls into the trap of presenting medicine as a “let’s go in and fix it” kind of profession, something like plumbing with more delicate pipes.  The real meat of medicine is prevention and diagnosis.  Most physicians are involved in trying to keep people healthy, assessing patients’ level of health, and figuring out what’s wrong and what can be done about it when someone has a problem.  The vast majority of medical problems that plague people (diabetes, high blood pressure, liver and kidney and heart disease, asthma, infections, addictions, allergies, arthritis and joint problems) are treated with lifestyle changes and medication, not surgery.  When a patient does arrive in the surgeon’s office, she/he usually already has a diagnosis, with tests to prove it, and the surgeon is the technician who spends ten minutes in the office and some number of hours in the operating room to “fix” it.  The more unusual case is for the surgeon to be the one who has to operate in order to find or diagnose the problem.  I do not say this to suggest that surgeons are any less smart, but to note that the role of the diagnosticians and physicians who use an arsenal of medications and other nonsurgical techniques is vastly underplayed in the television world.  And of course, I say this from the point of view of a Board-certified Internal Medicine specialist who loved the realm of diagnostic medicine and the long-term relationships we kept with our patients as we tried to improve their lives.  No prejudice-some of my best friends are in surgical specialties.  Oh wait, no they’re not. 

 

I heard three male physicians ask patients for reassurance instead of asking how they felt:  “are you alright?”, “are we still friends?” (to an older woman whom he just met in the emergency room), “are you happy?”.  Ugh.  Thoughtless words meant to forestall a patient’s revelation of how s/he really feels; it’s easy to put words in someone’s mouth, time-consuming to actually listen to them.  I also heard some overly-optimistic words about the effects of some surgery.  Um, no doc, when you cover up that piece of brain by replacing the lost section of skull, you aren’t going to heal the brain.  It’s still damaged, and will have to heal itself-or not.  On the up-side, a capable young woman who is the first female urologist at Johns Hopkins.  Her thoroughness and attitude with her patients was refreshing. 

 

There was also a lot of talk from the surgeons about how they held patients’ lives in their hands, yada yada yada.  Not so much information about what they actually did.  Lots of angst, but nothing to show the humor and irony that always accompanies it when you’re taking care of patients.  I was sort of grossed out by an attending neurosurgeon telling his preschoolers about his work and looking for affirmation that he was a surgical superhero.  Come on, guys.

 

Ooh.  I had more to say about “Hopkins” than I thought.  Frankly, it wasn’t typical of my years there or the people I trained with.  Thank goodness.  (sung to the tune of Death and All His Friends)

 

Peace.

The Pressure Cooker

My training prepared me for a lot of things.  Some of them were not so good.  When you train in medicine, you learn to be under pressure much of the time.  I was in medical school from 1978-82, and in my internal medicine residency from 1982-85.  That era in the medical education field is not known for its attention to the stress levels of the trainees.  It predates the movement to limit the number of hours students and house staff can work, something that has since become a mainstream position, resulting in binding rules to that effect.  It also predated the idea that stress was something to be avoided, or at least managed.  No one was sitting around looking at the amount of stress we were under and calculating how to minimize it.  There was little attention to the fact that the stresses we talked about with our patients might be affecting us ten-fold, and causing the same diseases and life reactions that we cautioned our patients about preventing.  

 

When I view that time period in retrospect, I can pick out a number of instances when  those attitudes prevailed.  An example is when a fellow intern developed a heart arrhythmia.  She was examined in the office that the residents used on our hospital floor.  As word spread that she wouldn’t be able to take call that night, several other interns came to see her and look at her electrocardiogram, checking for themselves to see if their own increased workload was justified.  Instead of being sent to an appropriate treatment area and given rest and sympathy, she was treated with a chorus of “Are you sure the atrial fibrillation is still there?” and “You’re not working tonight?!” 

 

Another episode:  I was a fairly capable and efficient intern, having come from a medical school that valued clinical work and gave us plenty of experience as junior and senior medical students.  I could take in patients from the emergency room, push them through the subterranean tunnels of the hospital, and load them into the elevator to come upstairs to a hospital room, and simultaneously take a history from the poor soul on the stretcher.  Once we arrived at a room, I had to perform a thorough physical and then collect blood and urine specimens which I examined in the lab myself.  If there were other procedures needed for the patient, such as IVs or joint fluid extractions, those were also done by me.  This went on over and over again on a call night, admitting one patient after another and performing the evaluation to determine what was wrong and what needed to be done.  I recall a night when I reached ten admissions, an astronomical number of patients to admit and work up.  My conversation with the resident in charge included his verbal pat on the head for me, acknowledging that I “could handle it.”  I was proud.  I did not question the fact that I was being asked to perform back-breaking work on no sleep, and that it might not be good for my health or the well-being of the patient. 

 

It was rumored that one of the women who began internship with me that year tried to commit suicide within a month of our July orientation.  She quietly disappeared from the program.  There was no discussion of the event, no evaluation of the rest of us to see if perhaps it was the program and not the intern that needed fixing.  I think the general concensus among the housestaff was that she was wimpy, inadequate, poorly prepared.  God help us, we were ignorant.

 

I say all of this because I have experienced a recurrent problem since that time of rigorous, crazy training.  I see large, monstrous tasks of questionable worth and herculean work requirements and run towards them.  I feel pressured to have a challenge in my life.  I fight to make things harder, longer, more painful.  Even though I recognize this now, and can forcefully change my reaction, my knee-jerk response is to embrace stress.  This doesn’t go well with a diagnosis of lupus, or with a healthy emotional life. 

 

Tonight I clicked on a new blog and the word “contest” leapt out at me.  It was a store blog, and they were seeking to sell large amounts of a gorgeous, expensive (and notably quite fine) yarn by sponsoring a design contest.  The entry requirement was to purchase their yarn ($46 a hank) and design a beautiful piece of lacework with it.  Now I love design, and I have learned much from entering contests, but I’ve never done any knitted lacework.  I actually paused for thirteen minutes to consider whether I could teach myself enough about lace and practice hard enough to produce a professional appearing garment by mid-May.  Now that I have backed away from it, the word “insane” comes to mind.  I don’t need an excuse to buy that yarn.  I can have it if I want it.  I can learn to knit lace – I was talking to a fellow knitter about that today, as a matter of fact.  But why would I want to jump into a situation where there is time pressure and judgment riding on it? 

 

The answer is in my training.  While I learned a lot, and became a good doc in the process, I also learned some bad things, and I have to continue to fight against them.  At least I recognize it.  At least I said “No” to this challenge.  Deep breaths…

 

Peace.

New Line-up

I am crocheting turtles.  These little critters, done in elann.com’s Peruvian Highland Wool, are going to be lapel pins for my sister’s sorority convention.  She discussed them with me last year, but only yesterday confirmed that they (the organizing powers that be) indeed want them, and that at least 100 are needed.  Also, and perhaps the most important, she confirmed that I will be paid for them.  Never start a custom project without knowing you’ll get paid.  For anyone but my sister, I require half up front, a deposit that will at least cover the yarn cost in case they back out part-way through and leave me with dozens of little oddly-colored, awkward sea critters.  My prototypes are swimming across my night table, waiting for mass felting.  Crocheting them gives the turtle shell it’s uneven, patterned look, even with moderate felting.  I don’t have a pattern for these turtles, I’m winging it. When my prototypes are completely satisfactory, I will share some photos and instructions. 

I have another custom item on my plate.  A yarn seller who is reviving a line of patterns from Vogue has asked me to knit a sample.  I did one a few months ago for the same company, and as it was a great experience, I have agreed and chosen my piece.  The previous one was my first time accepting a job like that, and I was terrified.  I chose to knit a garment that had cables, and I had never knit a cable before.  The pattern was also very cleverly but obscurely constructed, as Vogue patterns are wont to be (sewing and knitting ones).  I began it with faith in my ability to read and follow directions and completed the garment without a hitch.  It is beautiful, and I absolutely love the yarn it is made from, and I will show it off once the photographs of it are released next month. 

I know this sounds rather crazy, accepting a job doing something that is quite new to me.  I figured that the company that hired me knew what they were doing; they had seem samples of my work in items submitted for contests.  I was even a finalist in one of them.  My confidence in the ability to learn something new has a bigger foundation than that, however.  In medical training, we often speak of “see one, do one, teach one” as being the method of learning manual tasks, things like putting in an IV or draining fluid from a swollen joint.  We are expected to observe carefully when someone more experienced performs a task, perhaps backing that up with reading about it and being able to describe the procedure.  Then we should be able to do  it ourselves, usually under supervision.  Finally, we must be capable of teaching that same procedure to the less-experienced students or interns on our teams.  The teaching arena has limited numbers of cases and there is a lot to learn, so there’s no place for someone who requires repeated demonstrations or who lacks the confidence to make the needle stick or scalpel cut.   

There is another principle that was expressed about some of us.  It was a compliment when someone said you could “drop a lung and still sleep soundly”.  You see, “dropping” a lung was a known complication of sticking a needle into the chest wall to drain fluid.  It could happen despite doing everything right, and if one performed enough chest sticks, it was inevitable.  The first key was to not let that small possibility prevent you from doing the required task, because the patient was likely to have dire consequences if you did not perform the chest stick.  The second key was to always know how to handle the possible complications, as they could be easily remedied.  The third key was not to obsess and lie awake feeling guilty if the complication occurred.  You had to know you had done your best, and handled the worst case scenario with grace, and that your rest was essential if you were to repeat that performance the next day.   

Anyway, I am grateful that I can see how one profession and way of working has prepared me for another.  Medicine and knitting may appear disparate on the surface, but they do require some similar skills and benefit from similar mindsets.  In general, confidence and courage are good for one’s performance in most areas of living.

Peace. 

I Want to Write This Morning!

I am sitting up in my bed doing a little dance because I am excited about writing this morning.  I don’t know why, exactly.  I never have trouble finding things to write about because this is a conversation, and if you know me you know that I can talk forever.  I will talk with anyone.  I have conversations in the grocery line, my doctor’s waiting room, across the street to neighbors.  I am very much like my mother in this instance.  When I was a kid I used to wonder why she would strike up conversations so easily.  Now I know that there’s something to connect me to every human being in the world and most of them want to be acknowledged and engaged. 

I can actually remember the point at which I began to feel comfortable talking to “just anyone”.  I was in junior high school, my father had retired from the military and we had moved to Chattanooga (Mama’s home).  We were attending a traditional Baptist church with older people who noticed the children and took an interest in our well-being and progress.  I found that I could answer their questions and then ask them about themselves without too much blushing or stammering, and soon I found myself seeking out certain ones to connect with regularly.  In retrospect, I realize that we were being trained in a number of ways.  The children were encouraged (sometimes forced, never bribed) to speak publicly by performing in plays and talent shows, reading aloud in Sunday School classes, and taking part in special church services that were well-rehearsed “Boys Day” and “Girls Day” celebrations.  By the time I finished high school, I had written presentations, spoken, played piano both for performance and accompaniment, sung in two choirs, planned lessons…First Baptist Church East Eighth Street had thoroughly groomed me. 

When I graduated from high school I had no appreciation for what Chattanooga had given me.  I left for college and planned to never look back.  Due to the foresight and persistance of a relatively small group of citizens, in the next eleven years the city pursued a progressive, inclusive course that helped to draw me back after I finished my medical training.  That progressive nature wasn’t an isolated or new feature here.  When my mother’s matenal grandmother, a white woman married to a black man, boarded buses with her three brown grandchildren in the 1920s, no one persecuted them.  In the 1960s when other southern cities were torn apart by battles over forced integration, Mayor Ralph Kelley took Chattanooga in hand:

  • “In a sweeping change in Chattanooga’s history, Mayor Kelley declared all city facilities “open to all.”  This action on September 24, 1963, opened all public buildings, parks, playgrounds, swimming pools, golf courses and community centers began Chattanooga’s desegregation.  As the south worked through desegregation, Mayor Kelley worked with representatives of all communities in Chattanooga to try to ease citizens’ concerns.” http://www.chattanooga.gov/Mayors_Office/9_1963-1969RalphHKelley.htm

Three years after the death of former Mayor Kelley, his widow, Barbara Kelley, an energetic woman with her own formidable history of public and private service to the city, is running for City Council.  Her webpage shows more of that ability to articulate current issues and willingness to attack them head-on, as well as a love for this community that I share completely.  (http://www.kelleyforcouncil.com/)

I must continue the theme of praising and encouraging Chattanooga because it comes naturally to me to discuss things that I love, and because I am fighting against some powerful self-righteousness and arrogance.  In 1985 I made the decision to return here, and shared that with my fellow residents at Johns Hopkins Hospital.  To my surprise, their comments were steeped in ignorance.  They wanted to know where I would work, if there was a hospital in Chattanooga.  They asked how I would survive in such a “backward” place.  The worst was they suggested that perhaps my excellent training would be “wasted” practicing internal medicine here, as if the perceived population of hicks and foundry workers didn’t deserve the finest medical care.  The fact is, this city was well on the way to becoming the half-million metro area with the beautiful riverfront, active arts community, vibrant downtown and diverse population that I so love now. 

Don’t get me wrong-I’m just as likely to fuss about people who’ve never set foot out of Chattanooga as people who malign it.  I am a proponent of learning about this world, ALL of this world, and feeling our responsibilities and connections as global citizens.  I loved my daddy’s Army career and the way it moved us every few years, sometimes on pretty short notice.  You know that the world is small and accessible when you live in Missouri today and Germany tomorrow, or when you realize that you were born in Germany (yes!) but are an American citizen, or when you look around your classroom and see kids of Japanese, Hawaiian, African, Swiss, and Native American heritage.  That was life as a military kid.

The one huge failing of that life was that I was very late learning continuity of relationships.  Every few years my family was uprooted, and my friendships all ended.  There was no internet and long distance phone calls were prohibitively expensive,  so we’d write letters, frequently at first, but quickly diminishing to  a Christmas “hello” and update, and then we’d lose touch completely.  We quickly made new friends and adjusted to new places, filing the old ones away. 

Lorraine Palos, my best friend from medical school, was my first continuous, long-term friend.  We met late in our freshman year of med school, striking up a conversation on an escalator and knowing by the end of the ride that we would be friends.  At the end of school we separated to residencies two hours apart and kept talking and visiting.  At the end of residency, she stayed on the east coast and I moved back to Tennessee.  We married and kept visiting.  We planned common vacations, hiking in Gatlinburg the year that we both had baby girls in Snugglies.  Our daughters, thus introduced, remain friends.  Lorri taught me everything I know about continuity because she just kept planning for us to be together, even through treatment for a brain tumor that eventually took her away.  I still close my eyes and talk to her. 

It is Sunday, and I am not in church.  Not unusual.  I just realized that one throwback to my childhood is that I change churches every few years.  No guilty feelings here.  In a minute I’m going to pick up the light plum block I’m knitting for my daughter’s afghan, and I’m going to feel reverent and blessed with that beautiful cotton yarn sliding through my fingers. 

Peace!  

Two-Mood Morning

daynasblanketseconddraft-001.jpgI told you I wake up happy and optimistic.  That includes looking forward to my breakfast, which is something I never skip (and you shouldn’t either–don’t get me started!).  This morning I thought a lot about what to fix for breakfast.  Because the prednisone makes me wake up hungry, I had a banana and a cup of coffee while I was thinking, and I read my email and let the dog out and then went back to the kitchen.  I was craving protein, specifically meat, and I compromised with some Better Than Eggs microwaved with shiitake mushrooms.  No big prep-I keep packages of shiitakes in the freezer.  Waved some Mrs. Dash Tomato-Basil-Garlic over it.  It was delicious, but a total nutritional compromise.

You see, when you have an autoimmune disorder like lupus, eating recommendations are for a low-protein diet with the majority of your proteins coming from non-animal sources.  Dr. Weil explains this and gives very specific recommendations in this article:  “The Wellness Diet:  Anti-inflammatory Diet Basics and Diet Tips” at http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet.  If you search on his website you can find it in a briefer form, but I love you dearly and would like you to have the more complete information.  Ordinarily this wouldn’t be a problem for me.  At heart and in practice I am usually a vegetarian/vegan.  But my ability to comply with that is sorely compromised by the evil prednisone.  I shouldn’t say “evil” because it is a powerful anti-inflammatory agent and the cornerstone of most treatment for auto-immune, allergic, or severe inflammatory conditions.  It is a life saver, given properly.  But every treatment is a compromise, and the side effects are what you pay for that life-saving ability.

One of the most vicious side effects of prednisone is that it increases appetite.  It doesn’t just increase appetite, it causes you to feel pressured to eat.  For many people, that pressure takes the form of wanting specific foods, things they don’t necessarily eat when their dose is lower or they are off the prednisone.  It seems that most people are pushed toward high-fat foods like cheese and meat, and toward foods that are high in sugar and simple carbs like pastries and cookies.  I Googled “prednisone and eating” this morning to see what other’s experiences have been, and was propelled into the second part of my two-mood morning.

One of the huge list of references I found really caught my eye.  Midwife with a Knife   at mwwak.blogspot.com/ is the two-year blog of a young woman who is completing a fellowship (extra training in a medical specialty) in maternal and fetal medicine and also dealing with newly-diagnosed ulcerative colitis.  That particular colon disease is an inflammatory, auto-immune disorder like lupus, and the first line of therapy is controlling the disease with prednisone.  The entry that came up on Google dealt with how prednisone was affecting her eating, but the parallels to my own life and memories dredged up and feelings evoked by it all kept me reading for more than an hour. 

I have been close to tears since I began reading about her situation.  Don’t get me wrong-she details her hectic, pressured training, the trials of her own illness, the interactions with her family (good and bad) all in a very matter of fact way, with no quest for sympathy.  Her tone is generally upbeat, and there is no hint of surrender to the pressures that she is under.  Indeed, there may even be some failure to realize how far from reasonable her situation is.  When you choose a life in medicine, you are choosing to make such extreme sacrifices that somewhere in your mind you have to readjust your perceptions of what is normal and human.  There is a good bit of cognitive dissonance involved in this readjustment.  If you have an illness that is best served by decreasing stress and living a healthier lifestyle, the validity of your career decision is tested daily. 

I left a kind comment for this young obstetrician .  What I wanted to say was “Pack up your forceps and stethoscope and run like hell!!!!”  I didn’t do that.  I pulled myself out of medicine one inch at a time, going from full-time private practice alone to full-time with a partner, then part-time, then part-time in a clinic setting, then part-time in an easier specialty, finally to retiring completely.  And though I say “completely” I still treat a few friends and family, still do more than the required continuing ed every year, maintain my license and DEA registration and pay my minimal malpractice insurance fees and state professional privilege tax (damn you, Tennessee!). 

This is what the cognitive dissonance is saying:  Essie my girl, you trained so hard, and worked so long, and invested so much of yourself in medicine that even though the lifestyle clearly was detrimental to your health, you must hang onto whatever piece of it you can manage.  What crap! 

Thank God for knitting.  Thank God for the chance to have a supremely creative existence.  That includes the drawing, painting, poetry-writing, mosaicing, cross-stitching, sewing, crocheting and everything else that is so active in my life now.  Did I skip piano-playing?  and bad singing?  and the two-minute dance with Ellen every morning?  My life is a breath of fresh air.  My life is no longer killing me.

So, wiping away the tears for that young woman and hoping the best for her, I am looking at today.  As promised, I finished the first strip in Dayna’s afghan.  I have to stop calling it a blanket, as it is intended to be about 36 inches x 52 inches.  To achieve this, I am casting on 48 stitches with size 4 US (3.5 mm) needles.  I am a fairly loose knitter, and I certainly am not going to sear my fingers by trying to tightly knit a substantial size cotton, but if you are a tighter knitter you will want a slightly larger needle, probably a 5 US.   The photo that I opened with shows one end of the first completed strip of the afghan.  The whole strip has four colour blocks, rose quartz, oatmeal, rose quartz, and persimmon.   Last night I laid out the strip with the remainder of my skeins of Cozy Cotton and figured out how I wanted the other two strips arranged.  You’ll see what I chose as we continue to work on this baby. 

daynasblanketseconddraft-002.jpgThis is the other end of that strip.  Don’t you love the bright punch of colour that the persimmon brings in?  daynasblanketseconddraft-003.jpgI think you can see now in this enlargement of the oat block that it has strips of seedstitch (knit 1 purl 1 through the entire row, knitting on the purls and purling on the knits) alternating with bands of double seed stitch (also called double moss stitch).  About.com has a lovely knitting stitch glossary for detailed explanations of how to achieve many of the common stitches at http://knitting.about.com/od/stitchglossary/Learn_to_Knit_Knitting_Stitch_Pattern_Glossary.htm

and I try to be consistent about using the names that they use there when I’m refering to them.   

daynasblanketseconddraft-004.jpgThis enlargement shows one end of the blanket strip.  You can see that I’ve chosen to put a few rows of garter stitch at the end-I just like the finished look it gives the piece.  In addition, there is a garter stitch border around this block consisting of four stitches at the beginning and end of each row.  Since I cast on 48 stitches, this leaves me 40 stitches to do the pattern I’ve chosen.  For this particular block I’ve chosen to make squares in two sizes.  The larger squares are 8 stitches x 10 rows, and the smaller squares are 4 stitches x 5 rows.  Remember that a stitch is wider than it is long, so you get a truer square by making the number of rows slightly more than the number of stitches. 

Whew!  Enough!  Gotta get an order ready to mail and contemplate dropping in at Yarn Works Inc for their open house.  Knit happy, people!