Birthing Stool

Since working at the local community hospital in my hippie county, I have been a part of lots of interesting birthing experiences. I have done waterbirths (see my thoughts/initiation to that on my post here). I have done lotus births (where the placenta comes out still attached to the baby). I have delivered from hands-and-knees, and from women in the squatting position using a squat bar above the bed. I have pushed directly with women for up to 6 hours (with successful vaginal deliveries). I have watched women chug down their blended placenta from the delivery room when I am still completing the perineal repair. However, a couple of weekends ago, I did my first birth involving a "birthing stool."

Birthing stools are awesome! In contrast to the position ("dorsal lithotomy") of pushing of most women with an epidural (who can't move/walk/squat, etc.), there are lots of more effective positions for pushing for un-blocked women.

The birthing stool my patient used (which was provided by her midwife doula; our hospital doesn't have any and I'd never seen one!) looked something like this:

www.ghananewsagency.org

Seated with her knees slightly open, a woman can, using gravity to her advantage, push more effectively with an open pelvis, and the delivering provider can sit/crouch in front and, literally, "catch" the baby (I still haven't dropped a newborn, although this was a bit tricky with the ground being so close!). The birth was fabulous!!!

Being excited about birthing stools, I did some research online and they come in a variety of styles.

Cushioned one

www.betterbirth.com

Antique model

www.turningtidesmidwifery.com 

Seat with back

www.birthrite.com.au 

You can check out another site for more ideas here: http://www.kayabirth.com/ .

If you are pregnant and considering having a delivery outside the "bed," I'd really recommend having a stool like this as an option!
 

Ups and (lack of First) Downs: Niños and Niners

We headed down to Oakland this weekend to hang out with the Lees and attend our first (and probably only) Niners game! Our time was filled with ups and some downs (lamentably, not the type of downs you'd want watching *your* team play football).

UP:  Seeing several old friends!
On Saturday evening, we had a homemade sushi dinner with fresh fish from the Tokyo Fish Market (with fixings including seaweed salad, edamame, miso soup, avocado, rice, spicy tuna, crab, hamachi/salmon/albacore/tuna, sea urchin, salmon skin and unagi.... MMM!).

We enjoyed seeing Amy and Jenny, some friends of K's from his UCLA days (who drove up from Fremont and San Jose, respectively), as well as Alvin (FP/psych friend from residency) and Brad & Serena who now live in the East Bay, too (Serena took a nice break from Psych boards-studying to join us!).

The spread

Mason (now almost four!) wanted to roll his own rolls (Sophia, 18 months, looks on).

We had delicious mini-cheesecakes and cupcakes for dessert.

(We celebrated K's birthday a week early)

DOWN: On Saturday, Kelvin and I decided to set out on a 8-mile hike at nearby Redwood Regional Park in Oakland. Unfortunately, it POURED rain for the entire (which ended up being 6 miles due to trail closure) hike. All three of us (K, Pep, and me) were completely drenched from head to toe at the end of the hike. We didn't even take out the camera once. Let's hope our weather in Tanzania next month is a bit better.  Interestingly, about an hour after we returned, the weather switched back to beautiful. Bad luck.

Sunday:
UP: we got all festive to head to all of our first 49ers game. Despite the Niners suffering a pitiful loss last weekend to Seattle, we were all very hopeful to see a better game this week, at home, and were excited to visit Candlestick Park in its last, "Farewell" season before the move to Santa Clara.

Sophia and Mason fed Pepper her breakfast

Aren't these jerseys the cutest?!

All ready in red!

We drove over the (new, now earthquake-proof) Bay Bridge into San Francisco

We parked well outside the park and then followed the other early fans to the stadium, passing lots of tailgaters :)

Since we arrived early, we had time to check out the 49ers Museum.

(I remember watching, on TV, last year's Espy-worthy game between the Niners and the Saints)

with Frank Gore's jersey :)

We miss Joe Montana...

... and Steve Young!

We need some more Superbowl Rings!

We need Kaepernick to step up! 

UP: We had a lovely, bright sunny day!

Mason and Sophia got pins for attending their first Niners game!

The kids were also incredibly well-behaved during the whole game. How many three year-olds do you know who would sit calmly for 3+ hours? They only knocked over a wee bit of kettlecorn onto the guy in front of us but he was a good sport.  Sophia somehow took a little nap in the second half amidst the raucous cheering.

 Kaepernick and Harbaugh, getting warmed up

The pregame show included a lap around the field and some words by Jerry Rice, and the halftime show featured a reunion for the "Gold Rush" cheerleaders, but those really were the highlights of the game.

  

DOWN: This guy:

(Andrew Luck)

 

Unfortunately, the game was pretty awful. The Niners got a ton of (undeserved, in my opinion) penalties, only scored 7 points (all in the first quarter), and didn't have much in the way of defense, either. They lost, 7-27 to Luck and the Colts.  In fact, the Oakland As, who played a baseball game the same afternoon at the nearby Oakland Coliseum, actually scored more points (11) in their win vs. the Twins than the Niners have scored in their last two games (10). If I liked baseball, we may have had a better time there.

Oh well. 
We then had to collect the doggie from Serena's and drive the 5+ hours "home" to Arcata, which made for a long day!

Kelvin asked me last week, "Do you want to try to go to a Redskins game in D.C.?" (when we're there over Thanksgiving). "No,"I replied. "I can watch them lose for free from my own living room!"  Disappointed in the Niners, I can also watch them lose for free from home. I may wear my (free) VISA Signature cap we got at the park, though!

Doctors' Sacrifices

With myself often feeling stressed, overworked, overwhelmed, exhausted, emotionally drained, and underappreciated, I found it interesting to read some good recent articles which do explain what it takes and what we give up to be (particularly family) doctors.  I can definitely tell you that most of us are most definitely NOT overpaid for all that we "put into" and sacrifice for our jobs.

10 Things You Need to Give Up to Become a Doctor - By Leo

Following a recent article elsewhere which generated an interesting discussion, I started thinking about the things one must give up on the road to becoming a doctor.  It’s a long road, beginning with an initial decision, some early voluntary experiences, an application to university and some hard work trying to achieve the barely possible. 

But it doesn’t even end there. The hard work really only begins at medical school where long hours and repeated exams are considered normal and where you need your patients more than they need you.

There are plenty of things you have to give up along the way, here are my top 10:
1. Your desire to be wealthy
Very few people in medicine ever become hugely wealthy, at least not in Europe. If riches are what you desire there are many many easier ways of getting that involve alot less heartache, money and stress. If you want to be a millionnaire before you’re 30, my advice would be to avoid university altogether. Most doctors are in the profession for genuinely altruistic reasons as well as the satisfaction that comes from knowing that you have the skills and knowledge to save lives and apply these every single day as a routine part of your work. [Most doctors start their careers in a lot of debt and in a high tax bracket which is unfortunate].

2. Your desire to change the world
Equally you must, eventually, give up on the idea of becoming some sort of medical superhero who can solve the worlds medical problems one by one. Yes doctors can do some impressive things when applying their skills to the right situation. But remember that however good your intentions, you will not be able to overcome the problems caused by poverty, war, government neglect or abuse, or coorporate profiteering at the expense of the sick. That doesn’t mean you can’t try to help people afflicted by any of these, you’ll just find that you are usually too small to make any real systemic difference.

3. Your free weekends
It starts at medical school when the work starts to pile up, and weekends are sacrificed to meet deadlines and for exam revision. Once you start working as a junior doctor, you’ll find yourself scanning each new doctors rota to work out where your on-call weekends have landed and who can swop with you so that you can still go on that holiday or get married or whatever. There will be sunny weekends when your non-medic friends will be having a barbecue whilst you sweat it out on a ward seeing yet another gastrointestinal bleed wondering why you chose this path.
[Man how I would LOVE some more weekends off to do things like "normal people."] 

4. A good nights sleep
Gone are the days where doctors would be on call for 48 or 72 hours and then do a clinic for the boss before retiring to bed [not gone in my world! I still do this on a weekly basis!]. However, modern working arrangements have brought into existence the 'week of nights'  where you work 4 or 5 and sometimes 7 night shifts in a row.
As someone who has done these I can confirm that doing nights is pretty inhumane. The talk amongst doctors doing nights together often centres around changing specialty or leaving the profession. Don’t worry, it all gets forgotten once normal daytime duties are restored.
[OH, how I miss my sleep. Why do babies always seem to come between 1 and 6 am?!]

5. Your desire to avoid feeling like a fool
You will make mistakes from time to time in this job and your mistakes will all be potentially serious ones, simply because everything you do affects your patients’ lives directly.
Furthermore, there will be times when you have to withstand an onslaught from senior doctors who feel that teaching by humiliation is the only way forward. You will feel like an idiot at times and if the thought of that frightens you you should promptly pick a different profession.
[I wish I knew everything and I didn't have to look stuff up so much! I definitely worry about the consequences of my medical decisions every day.] 

6. Your desire to always put friends and family first
As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him.
Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.
[This is certainly one of the hardest things about this profession. It's hard to be a great physician and a great family member.]

 

7. Your desire to please everyone.
Whether it’s your friends or family, as above, or your future patients you’d better get used to upsetting people from time to time. Telling your wife you need to postpone an evening engagement because you are still operating on a difficult case, or telling a patient you won’t be operating on them as they only have three months to live, are both likely to be met with upset. Each situation has it’s unique challenges and needs some communication skills, but the bottom line is that you will have times when you will have to make someone want to either hit you or cry in despair.

[This is, perhaps for me, what makes this job so very hard and what I struggle with the most. I am a people-pleaser. I want to make people both happy, and well, which can't always happen.]

8. Your creativity
Not many people admit this but medicine takes people who are often very creative and turns them into workaholic, automatons who have little room left in their lives for creativity. If you want evidence for this, go to any dinner party that includes more than one doctor. Chief discussion topic will be work and medicine. That’s partly because anecdotes from doctoring are entertaining, but also because if the medics stray from this conversation topic, they will rapidly expose their banality and limited insights in other areas particularly all things creative.
Much of medicine does not allow much creativity in it’s day to day practice and the intensity of the work beats any desire for creative thinking right out of you before you even realise it’s happening.* Of course whilst accepting this fact you must fight this tendency and attempt to keep up your other interests, otherwise, I can guarantee medicine will invade everything you do.
*There are a few notable exceptions to this!
[I miss being "well rounded"-- haven't played my flute or been involved in music in years.]

9. Your desire to stay in one place / live close to friends and family.
Want to do something competitive, like medicine? You have to realise that choosing your location is a luxury and you may have to follow your dream in a less than ideal location. Even after you graduate, having your heart set on one specialty is a sure way to geographical instability. Some people don’t mind this, but some with strong family ties or a mortgage, the need to move frequently is a pain.
I began to come to terms with this when I found that even the most obscure places have hospitals. Working in these places you’re just as likely to meet doctors who have also had to move from here from the other side of the country. It’s a great way to meet people but easy to lose touch once you move on.
[I really miss being around family and friends and it does get old to move so much.]

10. Good health
You may not know it, but you’re joining a profession that has high rates of physical and mental illness as well as drug and alcohol misuse. Doctors are also less likely to seek help than other professions which all adds to a rather worrying picture.
Although ill health isn’t guaranteed in a medical profession you should realise the future risk now and take steps to formulate good lifestyle habits to minimise your risk factors. A good network of non-medical friends should also protect you from neglecting your own needs while you’re treating your patients.
[Doctors don't really take sick days. Our health always comes second to that of our patients]

That’s plenty to sacrifice just for a job isn’t it? However, I guess the reason you’re in medicine (or trying to get in) is that you’ve realised that medicine is not just a job, it’s a whole way of life, that’s difficult to let go of once you’ve decided to enter it, and these sacrifices are simply part of the deal.


And here's another article, From Medentzz - We Care, Not Just Cure

"SUBJECT: HOW MUCH DO DOCTORS MAKE??

Somebody asked:
"You're a Doctor? How much do you make?"
I replied: "HOW MUCH DO I MAKE?" ...

I can make holding your hand seem like the most  important thing in the world when you're scared...

I can make your child breathe when they stop...

I can help your father survive a heart attack...
I can make myself get up at 4 AM to make sure your mother has the medicine she needs to live...
and I will work straight through until 4 AM to keep her alive and start the day all over again!
I work all day to save the lives of strangers...

I will drop everything and run a code blue for hours trying to keep you alive!!!

I make my family wait for dinner until
I know your family member is taken care of...

I make myself skip lunch so that
I can make sure that everything I did for your wife today was
correct...
I work weekends and holidays and all through the
night because people don't just get sick Monday
though Saturday and during normal working
hours.

Today, I might save your life.

How much do I make?

All I know is, I make a difference."

Out on top? (A Sports Dilemma)

I have now temporarily recovered from my intense tennis-watching addiction and have had much more free time now that the U.S. Open (which ended on 9/9) is over.

It was a bit of a sad tournament in my opinion and I'm only now able to write about it :)

Roger Federer, who I adore, and who leads all men of all time with number of Major Championships, just doesn't have the game to hang with the top seeds anymore (and was seeded 7th at the Open). I was unfortunately too sucked into the demands of med school and residency to watch him when he was most dominant, and now, to my great disappointment, he's definitely on the downward slide. After an early Wimbledon exit in the second round, his U.S. Open tournament also ended unfortunately prematurely in the 4th round just before he would have faced Rafa Nadal (the eventual champion [boo]) in a much-hyped potential quarterfinal matchup.

I wonder how long he'll stick around. The debate exists: should he retire now?  Does he have it in him to win another major tournament? When is it the right time to retire from sports?

I am more into watching tennis than I am into other professional sports, so I'll use it for most of these examples.

Last year, we saw Andy Roddick (while a Major Champion, not an overachiever by any means) announce his planned retirement from tennis at the U.S. Open. This year, James Blake, another American (and wonderful, resilient human being although not a dominant sportsman) announced his planned retirement but exited after losing a heartbreaker five-setter.

In contrast, several athletes have gone out "on top," after the high of winning. Pete Sampras retired from tennis in 2002 after beating Andre Agassi to win his fifth U.S. Open title. Marion Bartoli, the dark-horse Women's Wimbledon Champion of this year also announced her retirement this fall, just after winning what is arguably the most desired trophy in all of tennis.  In football, Ray Lewis was able to end his career on a high note after the (unlikely) Baltimore Ravens won the Superbowl (sadly, beating our Niners) last year. 

For mediocre players, the issue of "when to retire" is probably not as critical or difficult a decision. However, for a former #1, which option makes more sense-- to go out/retire on top with the possibility of forsaking a few more years of *pretty* good play and money, or to continue to collect a good (but not top) salary while playing a "B" or "C" game?

Personally and as a perfectionist, I feel that if I were a pro athlete and (former) #1 player, once I felt or started to see that I couldn't compete at the same, top level, I'd probably retire (/quit). It's sad to me when I see former standouts- i.e. Grant Hill (one of the top players in NCAA basketball history at Duke, a former Pistons star, and gold medalist) or Juwan Howard (one of Michigan's Fab Five) warm the bench of teams like the L.A. Clippers or Miami Heat (the latter which won back-to-back NBA Championships including last year).  This also brings up another question-- would you like to be a benchwarmer on a championship team (a small fish in a big pond) or a starter star on a mediocre team (big fish in a small pond)?

                                                                     www.ocregister.com


In any case, I found out that between July 2012- July 2013, Roger Federer's salary (including endorsements as well as prize money) was something like 70 million dollars.  I guess I could handle being a #7 seed if I made that much. But, retired, he'd probably still make 500x or more what I'd make in a year.

What do you think? What would you do?

My Civic Duty

Last Monday, I had to report for jury duty.

I'm not sure how often other people get summoned for jury duty. 
Number of times I've been summoned in my life prior to moving to Humboldt County: 0
Number of times I've been summoned in the last two years since moving to Humboldt County: 3

Perhaps the frequency of my being summoned has to do with our (small) population pool in this rural area. Perhaps I have gotten summoned more because I have signed so many "medical deferrals" for jury duty for my patients that they have even a more limited pool of county residents!

I'm not sure what most people think when they get a jury summons. I worry about inconveniencing patients from either cancelling/blocking clinic (and reopening it last-minute) or having to rearrange call. It's really quite hard on my staff and colleagues and feels like a hassle.

When I have been summoned in the past, I accepted once (then called the requisite phone recording the night before and was not needed), and deferred once due to being out of town. I was summoned again in August, and this time actually had to report last Monday!

It was an interesting process. "BRING A BOOK," I was told (which was fine by me!). At 815 on Monday, I reported to the County Court House in Eureka and sat with a bunch of prospective jurors as the (volunteer) staff told us to fill out our jury cards and hang tight. They offered us water and coffee. We watched a short video on jury service in which many citizens attested to the fact that being on a jury was a great experience, making them feel of good service to their country and giving them more faith in our judicial system.  About an hour later or so, the staff let us know that we were being considered for a trial which was expected to last up to 4-5 days, after which we were asked to complete a "hardship" form if this length was to present problems for us (um... yes! I can't just take a week off work!).

Then, another hour later (about three hours after reporting and being prepared and even a bit intrigued to serve as a juror!), we were informed that the "case was resolved" and all of us were immediately dismissed!

It was a bit of a wasted morning from my clinic's perspective. I rather enjoyed a relaxing morning, reading my novel instead of being stressed out by back-to-back-to-back patients, inbox management and charting, but I didn't actually get on a jury which I do think (if a short case) would be a good experience. Apparently for reporting in person, I do get "credit," though.... so it's supposed to be at least 12 months until I can get summoned again. We'll see if the government sticks to that!

Below is the text of an amusing article by Joel Stein that I read last week in Time magazine that was very timely given my experience above!

Adventures in Jury Selection - Joel Stein

I'd be so good at judging my peers. Yet I can't seem to get myself picked for a jury.

Far too little is asked of me in return for being an American. Sure, I could join the military, work for the government or stop using complicated accounting tricks to avoid taxes, but I'm the kind of guy who prefers to be forced. So I get excited whenever I get a jury-duty letter. Not only is it an opportunity to do my part for a legal system I believe in, but also, after a career of writing columns, it would be nice to finally have my opinion matter. 

Yet I've never even gotten close to making it onto a jury. A few weeks ago, I once again sat in an L.A. criminal-court building all day, hoping to be assigned to a trial. Then, just an hour away from being once again sent home, I heard my name called. I ran down the hall like it was The Price Is Right.
The first thing the Honorable Craig Richman told me and my hundred competitors was that our trial was going to take a little longer than average, since he likes to make it fun. Judge Richman, I could tell, really knew how to read a room. He asked Deputy Velasco, who is short, to stand up even though he already was standing; he told us not to leave our belongings behind since this was a criminal court, which meant there were criminals around. It was the material of a man who had a legally captive audience.

The next day, I was randomly labeled juror No. 5 and proudly took my seat in the jury box. Then Judge Richman asked if anyone had a reason they could not serve on this jury. People had incredibly elaborate excuses about how busy they were with their jobs or their kids, and for some reason, Judge Richman never said, "Oh, you're right, that does sound far more important than figuring out if someone tried to kill another person."

Judge Richman then asked us each if we were able to avoid making assumptions about the defendant, who was also in the room, based on the enormous tattoo covering his face. I told him I certainly could. But by the 20th time he asked a potential juror, I started to wonder if, compared with the non--face tattooed, the face tattooed are more likely to make poor decisions. After all, these are people who walked into a tattoo parlor and said, "I think this design will go well with my face."

Next, we were asked our occupation, our family members' occupations, if we were tight with any cops and if anyone close to us had ever perpetrated or suffered from a violent crime. I was shocked to find out that a quarter of my fellow potential jurors had experienced horrifying violence: a husband murdered, an ex-husband in prison for murder, a sister killed by a gang member, a woman whose suburban home was broken into and had knives left on her bed as a warning. One guy had so much drama in his life that an hour after he was asked, he raised his hand to tell the judge he'd forgotten to mention that his brother got arrested for having marijuana in his car, did three years in a Texas jail and got deported on the day of his release. When a man stepped on my sunglasses as we left for lunch break, I didn't get angry at him, not because his brother and two cousins had been murdered but because he knew that I knew that.

I made it to Day Three without a single question being fired at me by either attorney. With only half the room remaining, I was feeling great about my chances, when, out of nowhere, I was sent home by the prosecutor. Which verified all my fears: I am too soft, too weak and too liberal to convict even a potential murderer. I stood up and yelled, "What did I do? I was well behaved!" I left the courtroom and mimed "I'll call you" to the prosecutor.

The prosecutor wouldn't talk to me, possibly because my miming was more suggestive than I intended. So I called Philip K. Anthony, CEO of DecisionQuest, a national trial-consulting firm. He told me that because I live in Holly-wood and work in the media, I am indeed too soft, weak and liberal to ever get picked for a criminal case, though he thought I might be good for other cases. "If you got called on an intellectual-property case, both sides could potentially say, 'We need people who can analyze data and be precise. This guy is perfect,'" Anthony said. In other words, I'm such a nerd that I can judge only other nerds.

Tossing me didn't help just the prosecution but also justice itself. Because while a jury that included a few educated English speakers might sound great, Anthony told me, it's more important to have a homogeneous jury that will debate instead of being led by one person's opinion. That's why I got thrown out at the same time as four other potential jurors with white collar jobs. Who, I must admit, were not a jury of peers for the face tattooed. Or people who don't watch Mad Men.

I don't know what the jury decided, but I'm sure they made a better decision than I would have. Because I'm not jury material. Or Army material. Or government material. They really should raise my taxes.

Gluttony down south

When we go down to Southern California, one of the things we really look forward to is eating! Kelvin has his "requests" for Asian food. We tried some new delicious desserts and some old favorites on this past trip.

After our Secret Stairs hike on Saturday, Vanda joined us for hotdogs at Pink's, a famous L.A. establishment from (I think) the 1930s. The good thing about going at 930 in the morning after a crack-of-dawn hike? No lines!!! (While this was only my second trip there, the last time, we waited about 1-1.5 hours for food. None of the others, had seen it line-free either!)

Me and Tina

Danny and Vanda

Here is Hac Cao (Vanda's 10-year old shih-tzu) and Pepper sharing the floor

We then headed to nearby MILK, a nearby dessert place.

They make ice-cream sandwich cookies with pressed ice cream and macarons that are to DIE for!!!

 

I wish I had room to try more flavors, but we just had the salty caramel, which was heavenly on the hot day.

We had a family dinner of Shik Do Rak (Korean barbeque) and then finished the day with (Taiwanese) shaved snow, which Theresa informed us was THE FAD from last summer, and has continued to stay popular.

Finer than shaved ice, the "snow," which appears in soft sheets, really melts in your mouth. You can add "drizzle" (like condensed milk) and toppings like fruit, mochi, candy, etc. much like with yogurt bars.
These are pics off the internet and not our own creation, but our treat was delicious!

This week will be a bit heavy on the exercising to make up for our gluttonous weekend!