Do not Squander this Precious Life

Said the Reverend in church today. You are a flying fish, leaving the infinite ocean for the atmosphere for this lifetime. Do not forget you are part of the ocean. Life is a gift, not a project.

Not a project.

The five delusory Ps: Power, Prestige, Possessions, Profit, Pleasure. Okay only in small doses and not as a root of meaning.

I don’t feel like I’m good at anything anymore.

We took a leadership survey thing to see what kind of leaders we will be when we team lead this year on wards. I don’t even know what kind of leader I am. If I’m a leader. If I’m effective. Who I am. What I want. Sometimes this career seems at odds with an unknown self.

Love, Serve, Remember.

It doesn’t give me any space to answer questions that I have. Or do I just blame it for that—for the disconnect?

A 16 year old patient of ours died last week. I’d worked with his mom the week before to get his seizure medicine prescription straightened out. We had to change the dosing schedule because his insurance wouldn’t cover the other med he was on. I guess his seizures weren’t very well controlled on either, though. He died in the ocean. Drowned. The medical examiner said his lungs were filled with water. He’d been playing at the ocean with his mom and little brother and sister. She lost sight of him and they found him face down in knee-deep water. He’d probably had a seizure and gone down when no one was looking. It is the most common cause of death in kids with seizure disorders: drowning. They saved his brain, but they won’t be able to tell if he had a seizure in the moments before he died. Only that he had seizures.

Another patient I saw in clinic earlier in the year ended up having Rat Bite Fever. The rash was atypical when she presented. But what if we’d thought about it? What if we’d done blood work? Would we have seen something suspicious before she’d ended up like she was now: in the hospital for weeks, vegetations on her heart valves that went to her brain, causing an aneurysm that burst and had to be repaired with neurosurgery and likely needed a heart valve replacement.

Of course I staffed these two patients with experienced senior pediatricians. And they agreed with our plan. They feel guilty now, too.

What will happen when I’m the experience senior pediatrician/internist and I miss things? How is that responsibility handled?

I feel unbalanced to the point where I can’t take one more jostle of the raft.

I dream about my bikes being stolen now. And my emotional reaction in the dream is the equivalent of, “oh well.”

Do not squander this precious life.

I’m trying. I just don’t know how sometimes. I don’t remember. Or I never truly knew.

ugh

Sometimes I feel like somone had died and it's me.
There are moments when I feel like I don't know myself anymore with this new thing. It's not novel or fun. It's a pain. I live in Southern California and am supposed to not be in the sun too much. Ridiculous.
And how to balance this with my career where I feel stupid all the stinkin' time anyway. I never feel like I know enough. And sometimes I feel like I know nothing.
I guess I have to learn to manage stress better.

Random Peds Clinic Info

• Umbilical cord stumps fall off between 1-3 weeks after birth; keep them dry and not super clean because the bacteria help the cord seperate.
• Little mobile bumps are pretty common on baby heads.
• With crushed fingers worry about infection or compound fractures. Tendons usually okay if can move the finger, but still may have spiral fracture.
• Enteroviruses are polio, echo, coxsackie.
• Herpangina has lesions in the front part of the mouth while coxsackie lesions are more posterior.

Antiphospholipid, too

From my rheumatologist:

"Hi,
I wanted to followup.

"A "sendout" lab slowly returned to your chart. Drawn June 19, 2007
IgA anti- beta 2 glycoprotein I Your result was 55 standard units, with a positive test defined as 21 or greater

"This is considered a potentially pathologic anti-phospholipid antibody. A purist might requie the test to be positive at least twivce, but in light of your other anti-nuclear antibody profile, it is consistent with the anti-phospholipid syndrome diagnosis."


Great.

New Car!

I'm pretty excited about that, too. Just got it on Monday night! 07 Corolla. Still had to go with the Sport Edition. Still red-Impulse Red Pearl or something like that. Got an alarm this time. Plus they have this new thing in Toyotas so that the car won't start unless it is the actual key from the dealer with the little hidden chip in it. It's super cute. I looked at more "grown up" cars, but I'm just not ready for that yet. I'm delaying responsible as long as possible.

Altima Obituary

Three and a half weeks ago my car was stolen. It has not been recovered; and by now there is little chance than it will turn up. Even if it does, it belongs to Geico now. I have to mail them the keys and the title tomorrow (in exchange for the small amount of money that is no where near what the car was worth to me--no payments, reliable, friendly, etc.).

I remember when we first bought the car new. I had just my learners permit, but Dad let me drive it home from the dealership. It was the coolest car on the lot at the time. The one with all the cool features: sunroof, leather steering wheel, cruise control, CD player, automatic everything, spoiler, bright red. In fact, it was the one they used for all the test drives so it has something like 427 miles on it by the time we bought it. My parents never would have chosen that one if I hadn't been about ready to get my liscece the next month. It was more of a me car than a parent car.

That night I called my best friend and talked to her on the portable phone (pre cell phones--though soon to get the giant ones that came in a box bigger than a laptop) for about an hour while walking around my the car over and over telling her all about it. We thought it was pretty much the best thing ever.

Driving around the small town in it, everyone started to recognize it as my car (even though officially my mom and I were still sharing it). You know how that first car you have shapes some of how you come to see yourself? It helped me see myself as fun and sporty and free.

Years later, my resident would see my in it and think it was utterly appropriate that I "had a red car" he would say it in a sing song voice like a mantra. It always made me feel good to see its reflection in the glass windows as I drove down the street. Or zip past somone on the freeway (even at the end, she had great pick up). Or have truckers wave and honk at me on the freeway. Or find her in the parking lot post call and feel glad and proud to drive home. Even when the battery connection went out and I figured out how to fix it, it made me feel calpable and self-reliant.

They say people look like their pets. I think people also grow to take on some of the qualities of their cars. At least in the spaces of their lives which are moldable by that external force. It shapes how you begin to see yourself--espeically that first car.

That first year at college, I didn't have the car, but by the middle of the second year, my parents let me take it up to Washington. It became a sanctuary of sorts. And a liberation. I could go to church and go grocery shopping and drive to the zoo or Seattle. It was freedom.

I took it with me when I moved to Santa Cruz. I even had a cover for it for a while when it was parked down in the remote lot on campus. The cover was stolen, but I always liked to keep it clean and shiney. I waxed it pretty often at first. And the paint was red and shiny up to the end. Fire-engine red. The spoilier part was the hardest to wax and dry.

I broke my foot on the way to sailing class in October of my senior year at college. Good thing it was my left foot and my car was an automatic so I could still drive. I got a handicapped parking pass and drove the car around campus from class to class getting as close as I could then taking the crutches from there. I was pretty depressed about that and would spend hours in the car parked by the ocean staring out there or reading my current Dickens assignment.

It held half of my stuff when I packed it up to move to Davis. My boyfriend at the time took his car with the rest of my stuff. I parked in on the street at the apartment I sublet for a couple months and got three parking tickets in one day. I wrote to the department and pleaded ignorance and they forgave all of them.

Later that year, I decided I was bored with just working and signed up for an evening autoshop class where we worked on our own cars. I changed my tires and my brakes and my oil and checked out my air filter and the electronics. It was all in good shape and I learned where to find things on my car and how to fix it if needed. I learned it inside and out.

When I moved to Cincinnati for med school, my brother drove out with me. And everything I took fit into my little red car. It was quite amazing really. I had bike racks by then with my road bike on top. We drove the 40 hours listening to Harry Potter on CD. The CD player still worked then. It had stopped working by the time it was stolen. But the tape deck still worked. I think the CD player didn't like the cold weather in Ohio. Nor did the car. Nor did I.

It snowed there. I'd never lived in the snow. My red car looked funny buried under snow. We slipped halfway down the hill into my apartment complex before I nudged it into a curb and left it there til the streets were in better shape. I got it washed as much as I could to keep the salt and sand from building up on the paint and undercarriage. It always looked so pretty when it was clean. I would get the vanilla scented things to go inside.

When I'd fly home for holidays, I left her in the school garage for weeks sometimes. And she would start up right away when I returned. No hesitation. I was always glad and relieved.

I matched in San Diego for residency and drove her back out here for another 40 hour drive. This time my dad came with me. She was packed to the gills again. But this time I had to ship some boxes also. Mostly because I'd kept up my obsession with pottery and had been a prolific artist again.

During intern year there were times when I was so tired I couldn't make it home and I'd just put the driver's seat back and sleep there for a couple hours until I could make it home safely. Or until the drool got too annoying. I'd spent hours just sitting in that car--not always driving. Sometimes waiting for someone. Sometimes just watching the world go by. Sometimes listening to music. Sometimes just enjoying that I was surrounded by something that could hold and carry my whole world of things that were important to me. It was my car.

My relationship with my car has been the longest of my life, save perhaps that with my horse. But it's close. Relationships with things that can't talk back are easier I suppose.

I loved my car. I did.

It was perhaps best that she was stolen because it would have been hard for me to sell her or trade her in...and I know it was likely to need some maintenance done soon. Although I had always kept her in good running order.

The exterior went from pristine, so much so that I had them repair a dent on the hood where a walnut hit her, to kinda mangled after an emotional run-in with a brick wall and a slippery rear-ending incident. It was time to move on.

But I do miss her. I don't like to think of her in a chop shop or being revved around the streets of Mexico.

I'll remember our good times together. And there were many.

Perhaps the last lesson that she'll impress upon me is the lesson of letting go (which, by the very fact that I'm writing this, is one that I need).

She was a good little car.