Thursday, July 29, 2010

The "In" Books

Last month, B's overwhelming favorite was Sara Pinto's excellent "The Alphabet Room."

B is old enough to pick out some of the letters, and to realize that the illustrations are really funny—her favorite is when the cat is wearing the moustache.

But yesterday, a new hit book arrived from Deen:

Yes, ladies and gentlemen, we've entered the truck zone. Particularly backhoes. Brynna is deeply, deeply into backhoes. There's enough road construction going on in New Hampshire these days that she can often catch a glimpse of one on her way to or from daycare, but one is not enough: she immediately yells "more back-hoe!" Apparently this is a genetic trait, as Deen says that backhoes were my favorite kind of truck when I was Brynna's age.

(Actually, the Tonka book has excavators. Which are maybe front-hoes? Luckily, Brynna can't actually read yet—next week, probably—so for now we can just substitute "backhoe" and she is none the wiser.)

I've got to say, after reading Tonka Power Lifting three times today, I kind of miss The Alphabet Room. I pulled it out for bedtime, and we got all the way to "D" before she made me go back to Power Lifting.

Wednesday, July 28, 2010

At Home!

I came home from the hospital yesterday mid-day.

I must say that it's quite inconvenient to have abdominal surgery, since that's the most logical place to rest a laptop whilst lolling on the couch or bed, waiting to feel better. (And while being waited on hand and foot by my wonderful father and husband, when they aren't Brynna-wrangling.)

In all seriousness, though, I am getting a bit more comfortable and a bit more mobile with every passing hour, and was even able to get out of bed by myself this morning. (Ah, important life skills.) My surgeon and the residency are quite determined that I take the week off and not go back to work until Monday, which is probably wise, as I have that fuzzy post-call feeling in my brain and am told that it is going to take awhile to wear off.

The other fun side effect of being intubated twice in two days, and having an extra scope stuck down there during one of those times, is that I have a fat lip and—I kid you not—a swollen uvula (the hangy-down thing in the back of the mouth), which makes me feel continuously as if I have something caught in my throat. Mom suggested more Italian Ice, which seems like a reasonable treatment plan to me!

Am now trying to figure out if I can continue to ignore my terrifically long to-do list as I have been doing determinedly while caught in the residency whirl over the last several months, or if "I just had surgery and want to lie here and play on the internet!" should be at least partially ignored in favor of "suck it up and fill out the paperwork so you can actually have your own doctor!" We'll see how that one plays out.

Tuesday, July 27, 2010

Get Well Gorilla

My new gorilla has definitely brought me get-well vibes. The ERCP went well yesterday, and I am apparently now gallstone-free. Whew! It didn't add to the soreness from the lap chole on Sunday, so I'm moving much better and am much less sore this morning.

In fact, the gastroenterologist came in earlier and told me that I could "advance to a regular diet". In his opinion, I can go home today, but it's actually up to "the blades," as he kept calling the surgeons. So keep your fingers crossed.

Here's my very exciting first actual food since Friday night:

I started slow with cream of wheat, brown sugar, and soymilk. It disappeared in about nineteen seconds, so I'm gearing up to order another meal.

Dad has come up to New Hampshire to give us a hand, and he and Brynna came by to keep me company for awhile this morning. Brynna engaged in her favorite new hospital sports: riding the elevator ("el-el-el-va-tor"), looking out my window at the beep-beeps coming through the lot below, and washing her hands in the sink:

I was also finally comfortable enough to roll over on my side and nurse, for the first time in a couple of days. Very pleasant for both of us. I showed her the "boo-boos" on my belly, which she counted (four), and then kissed. That's probably really why I'm feeling better.

Sunday, July 25, 2010

Can You Say "Laparoscopic Cholecystectomy"?

That's Brynna's phrase of the day...because that's what I had today.

Yes indeedy, folks, the tables have been turned, and I am writing this entry from my hospital bed. The doctor has become a patient.

With no history of gallbladder trouble whatsoever, I developed two waves of horrible, writhing, screaming pain in my belly late on Friday night. One of my wonderful residency colleagues and her husband came over at midnight to stay with Brynna while she slept, and Alex and I trucked off to the emergency room.

The pain had let up by this point, and I made a very embarrassed shuffle around the ER (where, let's remember, I am currently doing a rotation) to a room about as far from the entrance as possible. I was relieved to see two of my favorite ER docs on duty. One of them came right in, stuck the ultrasound on my right upper quadrant, and told me that I had a big honking gallstone.

I was relieved that there was something causing the pain (versus, say, really bad gas)...but surgery was not exactly high on my list of desires for the weekend.

Once my bloodwork came back, confirming that my liver enzymes were nice and elevated, the ER doc called the surgeon to admit me to the hospital, with a tentative plan for surgery on Saturday morning.

I got some pain meds and some sleep, but my morning lab work suggested that I might have a stone stuck in the duct between the gallbladder and the intestine. Surgery had a talk with the GI specialist, and they sent me off for an ultrasound that showed a nice, clean, calm looking duct. By then (our hospital works slowly on the weekend) it was too late for surgery.

So I spent last night in the hospital, too. My labs this morning suggested things were calming down, so I went to the OR for a laparoscopic cholecystectomy (removal of my gallbladder using small incisions and a camera, rather than a big open surgery). While they were in there, they did something called an "intraoperative cholangiogram" to make sure that that duct was indeed clear.

And damn it all, it WASN'T. There's a stone stuck there. So tomorrow, it's back to the OR, back under general anesthesia for an ERCP to remove that stone. That procedure carries a 5% risk of pancreatitis, so I have to stay tomorrow night too, just in case.

And I must say, these little tiny incisions from my lap chole hurt a lot. And I'm experiencing first hand a lovely phenomenon that previously has only popped up in my life as a board question— insufflating the abdomen for the surgery irritates the phrenic nerve in the diaphragm, which causes referred pain to the right shoulder.

So, here I am, enjoying my clear liquid diet, watching trashy TV (NCIS marathon!), and trying not to move.

Brynna, of course, is totally unfazed—Mama is "at hospital," just like always.

Saturday, July 24, 2010


Hilary and I haven't been exactly tearing up the international travel scene the last two years or so. There doesn't seem much chance of it in the near future, either. So, I took advantage of this window to renew my passport.

It is no small thing to take that little booklet that has been your companion on many adventures and send it off to god-knows-where in the State Department. The stamps from a number of countries, the memories of travels alone and with friends. Oh, and let's not forget the lovely passport photo:

Blimey! In nine years of use, I'm still surprised that I never received extra scrutiny as some sort of IRA terrorist with that picture. I suppose those nine years have seen a lot of changes in travel security and terrorism.

Thankfully, the State Department was kind enough to send that wonderful passport back to me this past week, with plenty of holes punched in it to indicate that it was no longer valid. The new passport, according to the helpful insert added to the mailing, will come in a different shipment.

The story of that particular passport, and how I ended up with that charming mugshot, is worth a little telling. My original passport was issued in late 1998, in preparation for a trip to Chile to attend the Scouting World Jamboree. I used it again in the winter of 2001 to travel to Germany for several months to study abroad - improving my German, learning history and culture, enjoying copious drinking while under 21. I was not as seasoned a traveler then as I am now, and the transatlantic flight followed by rail trip from Frankfurt to Berlin addled my brain. Surely I had the passport to get into the country, but by the time I reached Berlin it was gone. Nicely done: my first day in-country, and I lose my passport. Bravo.

Well, seeking out the American embassy was a fine way to practice my German and explore the city. The place to handle such things, I soon learned, was not at the embassy proper, but in a smaller consulate office attached to the air base in SW Berlin. Thankfully I did have Xerox copies of the passport to present to them, and the renewal process wasn't all that difficult. They had a photo booth there for just such a purpose, and I guess my irritation at my own carelessness, or the price, showed in my expression. (Incidentally, my new passport photo isn't nearly as interesting, it's just bad.)

It was, however, just a temporary replacement passport that would allow me to travel. On the front cover, under the lamination and next to that lovely picture, it clearly stated an expiration date of one year hence, with a note to look at the last page. That page had an type-written note stating that this was a replacement for a lost passport, reiterating the expiration date, and embossed with the consulate's seal.

A few weeks later, however, my original passport showed up. Someone I suppose had turned it in and it had made its slow way back to the consulate. They now offered me a choice: give me back the original passport, or extend the expiration on the replacement passport to the full ten years. Feeling that the original passport was now tainted from its long time out in the wild (today we'd call it identity theft), I opted for the latter. That led to another page getting a typed and embossed note clarifying the expiration date. This situation has, over the years, resulted in many double-takes, awkward questions, and lengthy explanations in not-English. This all adds charm to the thing: rather like the old beat up automobile whose quirks you know intimately, and would never dream of replacing short of catastrophic breakdown.

So, by my second week in country, I had a new passport. Good thing, too, because during that term abroad I hopscotched around Europe a bit: a few days each in Hungary, Poland, Czech, Austria, Switzerland, Italy. In the nine years since then I've used that passport to travel back to Germany (and internship during summer 2002), Spain (with Hilary and her folks, after we'd been dating all of five months!), Spain again (a robotics conference in Barcelona), Greenland (field research, if you believe me), and Italy. To say that I've been blessed with travel opportunities in my life would be putting it mildly. Notably, aside from that original trip to Chile, or those few weeks on the Greenland icecap, I haven't had the chance to travel farther abroad than Europe: no Asia, no more South America, no Africa. I've got lots of plans, but they'll all have to wait another few years, methinks.

But, hey, I'll need my new passport if I ever want to hop the border to Canada.

Friday, July 23, 2010

Puppy Big Mess

Jasper, being a dog, is capable of doing some really gross things. This isn’t a dig against dogs – people do some pretty gross things, too. However, I had to deal with some particular foulness last weekend, and thought I’d share. Aren’t you lucky?

Last Sunday Hilary went off with her parents and Brynna for two days in Burlington for some obstetrics training her residency class was doing. Jasper and I were looking forward to at least two nights of being bachelors. I spend Sunday evening planning, purchasing for, and starting construction on some shelving for my workshop area in the basement.

Monday, as I was coming home from work, I was looking forward to another evening spent building stuff, without distractions or other conflicts. That ended about two seconds after I walked through the door, and caught the unmistakable odor that Jasper had had an accident. Our house is nearly all tile and hardwood-floored, save for an area rug in the living room, carpeting that remains in the guest room, and the foam tiles that line Brynna's floor. Guess where Jasper most enjoys making a mess? If it is vomiting, it'll be the area rug in the living room, bypassing the adjacent tiled kitchen and hardwood dining room. If it is the other end, it is almost certain to be Brynna's room. There must be something about those foam tiles that he really likes (or dislikes, who can say?).

So, fearing the worst, I went up to Brynna's room, and must have let out a tremendous Wilhelm scream when I saw what had happened. In multiple places, in multiple streaks and splatters, all but two tiles' worth of the floor was covered to some extend in excrement.

Let us just say that the next three hours were not pleasant. It involved the tub, and lots of scrubbing, and lots of bleach, which my hands a week later still smell of. It resulted in this fine pile of tiles set up to dry. I did pat myself on the back a little for my cleverness in the arrangement.

So, Monday evening was shot. Twice in the night, when I heard Jasper padding about with some rapidity, I let him out into the yard. I had the presence of mind Tuesday morning to close the doors to all the bedrooms before I left for work. Unfortunately, when I walked through the door Tuesday evening, my nose told me that his troubles (and my troubles) were not over yet. He had made another substantial mess, but at least this time it was along the second floor corridor. The hardwood floor was a lot easier to clean up. And just in time, too, because Hilary and the crew pulled in not long after I finished.

I heard Jasper wandering around with a quick step around 3 wednesday morning, and so went downstairs to let him out - just in case. Well, it didn't seem to work, because when I woke up at 5 he had managed yet another mess in the hallway I had scrubbed not twelve hours earlier. Poor puppy, poor me!

We did have a phone consult with the vet that morning, and some labs done to check for parasites, etc. It all came back clear, leaving us to guess what might have happened to him. Thankfully, Wednesday morning's mess appears to have been the parting shot, and we've been in the clear since then. We still keep him shut out of our rooms during the day, though.

[the title of this post comes to us courtesy of B. She got freaked out a few weeks back when she witnessed Jasper vomiting in the driveway. To this day, when I bring her home from daycare, she will invariably comment, with some trepidation, on “puppy big mess.” We scrupulously avoided explaining Jasper’s recent difficulties to her, particularly the part about him shitting all over her floor, or we’d never hear the end of it]

Thursday, July 22, 2010

Late Night Brynna

B's schedule has shifted a bit toward the night owl over the last month, as I have been working a lot of afternoon and nighttime shifts in the Emergency Department, and a later bedtime means that she sleeps in with me in the morning and then we have a couple of hours together before I take her off to daycare. But she is still in bed most nights loooong before I get home from work.

Last night, I got home around 11:30 and went up to get ready for bed, creeping into Brynna's room first to check on her. She was stirring as I opened the door, and then she sat up once she saw me.

"Mama room!" she whispered through her pacifier.

"You want to come to Mama's room?"

"Yah," she answered, standing up and extending her arms to me.

"Oh, sweetie, I have to wash my face and brush my teeth and change my clothes first. Can you wait while I do that?"


"OK, well, then you sit down and wait, and I'll go do those things and come back."

She plopped down in her crib and picked up Puppy, her Jasper-look-alike puppet companion.

I headed off to the bathroom, sure that by the time I returned, she would be fast asleep again in her crib, but hoping that she might somehow stay awake, since it really is nice to see her twice a day rather than just once.

But when I came back into her room ten minutes later, she was sitting there with Puppy, waiting for me.

"You want to come to Mama's room now?"

"Yah. Milch!"

So I took her to our room and she had some milk and we both fell asleep. She ended up back in her crib a few hours later after she started kicking Alex. (Note to those of you contemplating children in the future: that double bed that is sized just fine for is not big enough for three!) But then she came back to bed with me around 6:45 and slept snuggled in next to me until 8:30.

When she woke up, she started saying "Mama ummy! Ummy!" Dazed from sleep, I started trying to figure out what she was going on about.

"You're hungry?"

"Ummy, Mama, ummy!" she insisted, gesturing emphatically at the mattress.

I finally figured out that she was saying "Mama tummy," and she wanted me to roll over so that she could rub my back. Perhaps she has a future as a massage therapist.

Today was our last nice mellow morning together. Starting next week, I go back onto the inpatient adult medicine service for a month, though as a senior, supervising resident this time. My schedule regularizes to 7 AM to 6 or 6:30 PM most at least I'll be home for bedtime.

Sunday, July 11, 2010

Black Fly Tri

I competed in another area triathlon today - the Black Fly Tri. This was no small feat, considering that Hilary and I have managed to put in all of about 5 training sessions in the 4 weeks since King Pine. Sadly, Hilary herself could not make it. By cruel quirks of scheduling, she was tied to the ED overnight Saturday. However, she was able to pull herself away (after suturing a man's arm for three hours after its unfortunate encounter with a plate glass window) to take over the Brynna watch at 5:30 this morning. That gave me just enough time to drive up north to the Waterville Valley ski community in time to compete.

The course has some interesting idiosyncrasies. For one, the water venue is tiny: a dammed up pond measuring maybe 100 x 200 meters. Fitting a 1/4-mile swim course into this is tricky, and requires more or less making a full circuit of the perimeter. However, because it lacks a large area for waves of swimmers to start from, and because the swim course is the water equivalent of single-track, the Black Fly is an individual start. That means that the whole field lines up by bib number and gets sent off, one at a time, at 5-10 second intervals.

I hadn't done an individual start race before. The immediate consequence is that the pack gets stretched way out, and there is no good way of knowing where you are in terms of others' net time. There is no opportunity, as with group starts, to mark the person in front of you and pass them with the knowledge that you've moved up in the standings (moving up from a 10th place finish to 9th!). You aren't really racing against people - just against the clock. On the course, passing is still passing - it gives you a sense that you are moving faster than at least some people, but it still doesn't mean much.

Having a relatively high bib number, I got to stand in line for nearly a half hour, while the other 9/10 of the field started, before crossing the timing pad and tiptoeing into the rocky culvert that was the swim start. Ah well, the wait gave me enough time to down a bottle of water - I was feeling a little dry at the start. It is also good because although I thought I'd left myself enough time when I left the house, I was scrambling during the national anthem to finish putting my stuff together in transition.

On the other hand, standing around in a wetsuit, even stripped to the waist, in the increasing sun of a summer's day is no fun. I was a little ambivalent about the wetsuit - an email from the race director earlier this week indicated the water temperature was 72 - a full 20 degrees warmer than this event last year!. But 72 is warm enough that I could reasonably swim without the wetsuit, thus saving some time in transition. But the wetsuit ensured that I wouldn't experience the first shock of the water, and a good wetsuit will make you more buoyant in the water, and generally faster.

So I opted to wear the suit. As I have already mentioned, the water course was tight, and as I'm a reasonably swift swimmer, I passed a lot of people. But it was difficult with the close confines. Plus, because the course wasn't just a straight shot, it required a lot more interruption to my stroke to sight my way to the next buoy. I had a pretty good swim, more or less my usual speed. Not bad for four weeks of slacking!

Onto the bike! In my haste to get my transition area put together this morning, I managed to not fill my water bottle for the bike leg. Thankfully, I don't think this cost me, but it did make me nervous. This bike course is a bit long for a sprint distance - 15 miles. It was chosen largely because there aren't any good long loops from the Waterville ski area, and the best turn around spot for an out-and-back was 7.5 miles away. This course is definitely not flat: more or less all downhill on the out, uphill on the back. So while I was feeling great cruising at 26 mph going out, I struggled to manage 14 on the way back, for an average of just 17.7 mph. Once again, owing largely to my late start, I ended up passing a whole lot of folks.

In order to speed up my second transition time, I attempted a trick that many of the more experienced triathletes do. With a few hundred yards to go, you unstrap your bike shoes, which are clipped to your pedals, and pull your feet out, pedaling the rest of the way on top of your shoes. The time you lose during this maneuver by not pedaling full out is more than made up for by the fact that you are in motion when the shoes come off, rather than standing still in transition taking them off. Many experienced triathletes do the opposite maneuver, too: starting the bike leg barefoot, with the shoes already clipped into the pedals, and strapping yourself in once you have some momentum.

Probably I should have practiced it a bit more. When I lifted my foot off my right shoe, it flopped back, got caught on the pavement, and popped right off the pedal! I didn't want to stop to retrieve it, so I kept going the last 50 yards, hoping I could find it after the race. When I pulled my left foot off while dismounting, the same thing happened! This time I was already stopped, so I did pick up the shoe and keep going. In the meantime, a race volunteer was kind enough to catch up to me and toss me the lost shoe. This crazy dismount maneuver probably did save me some time, maybe 30 seconds, but it could well have been a disaster.

The run goes along various streets through this ski condo community. I can't really say much about it. I do not really enjoy running - I find it a lot more grueling than swimming or biking, especially when you're already an hour into a race. Nevertheless, I seem to be getting more comfortable with it. I did not have the leaden- and jelly-legged feeling today that I usually feel when coming off the bike. I still managed to pass some people on the course, and ultimately managed a 7:30-pace across the 3.5-mile course. I'd call that a decent day for me.

And, once again, I had the support of some familiar faces from Capital Multisport. It was a small crew for the sprint today - a larger crowd competed in the international distance yesterday during heavy rain. There was also a bicycle time trial event on Friday evening. Do all three - as 100 competitors this weekend did - and you get to compete for the Lord of the Flies trophy. Considering my respectable-but-far-from-the-rankings finish today, I'd say I'm a long way off from that kind of punishment.

Friday, July 9, 2010

Five Years!

Smartest decision of my life. (Marrying Alex, I mean...not just the dip part. Though dancing with him is pretty terrific too.)

Thursday, July 8, 2010

Boom OK

We spent the 4th weekend in Lake Placid. The parents of a college friend of ours own a place up there, just a few miles outside of the town proper. We haven't seen this friend, and his wife, for a couple of years. My recollection is a bit shaky, but it may well be that the last time we saw them was at our wedding some five years ago. Some of our other college friends came up from Boston with their ~1 y.o. son, who made a very fine playmate for the B.

A few highlights of the weekend:

Between Friday night and Saturday afternoon, Brynna ate four bananas.

On Saturday Hilary took a little side trip to see our good friend Sara down in Saratoga Springs. The rest of us in Lake Placid took a late hike up a minor bump called Mt Jo, then took a dip in the large pond at its base. It was not a particularly long hike, but there were plenty of steep sections. Plus, it was hot. Not quite as hot as it has been this week, but still pretty hot. Jasper was quite happy to be out and about, though, and just loved coming down off the trail and jumping into the water.

On Sunday, while Brynna had her nap, Hilary and I got out for a decent bike ride. It's only a few weeks from the Lake Placid Ironman, so there were a lot of folks out on the road on bike and on foot. Hilary and I still can't quite see ourselves training up for a full Ironman distance (2.4 mi swim, 112 mile bike, 26.2 mi run, anywhere from 10 to 20 hours). For one, we'd have to really put in the training time: 2-3 hours a day, at least, which is patently absurd in our current lifestyle. Still, it was pretty neat to see so many fellow triathletes out and about.

While we were out, Brynna was avoiding having her nap. After a little while she started crying, and one of our friends went to see her. Jasper was diligently sitting in front of the pack-n-play, and Brynna was standing right up. They brought her out into the living room for a bit, and she (rather humorously) scanned the room from face to face. Mama? No. Dada? No. Mama? No… After determining that we were nowhere around, she crept back against the wall and started looking sad. Fearing an explosion of anguish, our friends asked if she wanted to go back to bed. Brynna said, glumly and on the verge of tears, "yeees," and proceeded to sleep for the next three hours without a peep.

Sunday night was, of course, the 4th of July fireworks. Hilary and I had some misgivings about bringing Brynna. She could either love it or run away screaming in abject terror. Brynna has seen fireworks before, such as last year's 4th on Long Island Sound. But those fireworks were far off, and the booms quite muted. This time we were on a little slope on the water's edge, and the booms were going off about 200 feet over out heads. The first three minutes of the show seemed to confirm our worst fears. Maybe she objected to the weird techno music they were playing as accompaniment (what, no Sousa?). But, through the careful encouragement of Hilary and our friend's mother, Brynna managed to take a more positive view of things. After another few minutes, she was lying back on Mama, enraptured. B thoroughly enjoyed herself by the end, clapping enthusiastically with everyone else. Here's Brynna's take on it.

Boom! Air!
Raaad, ye-whoa, booo, geeen!
Lay down Mama.
Hode Dada hayaaand.
Boom OK!

Monday, alas, we needed to make the rather long trek back to Concord.