Mayo Flashback

We had a wonderful weekend back in my old stomping grounds of Rochester, MN, where K and I got to stay with Lesley and David and meet their two adorable boys, Caleb and Josiah (and they all got to meet Kelvin for the first time)!  We figured out that the last time I was here was in April 2010, two years after graduating medical school and when Les was still pregnant with Caleb. Time really flies, but with Lesley and David, who are very low-key, relaxed people and parents, it seems just like old times :)

me and "JoJo" (8 mo)

 

with both boys

Daddy David and Josiah

Kelvin shows Caleb (who is very into animals!) (iPhone) pictures of Pepper

(love their matching sweaters:))

We had a nice dinner last night with the Yuans (med school buds) and Ebby & Ronnie, who lived below me in a split-house for about a year and a half amidst my four years here (sorry-- no pics taken!). We missed Rachel and Hans (& fam) who are in Boston this year :(. Today, we went to church, watched football, and I took Kelvin around downtown and the WFMC ("World Famous Mayo Clinic," as we affectionately call it).

It is really strange being here.  I don't know that there is ever a place as unique as Rochester, with its small-town feel but dominant medical clinic. While, for many reasons, I did NOT want to stay here after medical school, being back here, a place which was so formative to me as both a person and doctor and which holds so many memories (some wonderful, some heartbreaking), really does make me nostalgic. Here is an article about Mayo's history.

Kelvin was really impressed with the school, the Gonda and Mayo buildings, and the "subway" system (underground walkways built so you can avoid the usually-brutal winter weather [although it was in the 50s here today!])

 "not many, but good" - motto of the Medical School (the smallest in the country)

 

 

 

Gonda Atrium

The Plummer Building

We drove around town a bit-- this is Soldiers' Field, where we used to play ultimate frisbee on Saturdays, a tradition that Kelvin and I actually started up among our residency friends in Sacramento!

While I am wearing a new, warm puffy coat (my Mall of America purchase!), it was lovely, weather -wise this weekend-- 50s and sunny (warmer than Arcata, I think!).

More family time after a takeout dinner of pho ("not bad," said K!)

Love this girl!

Caleb is a real ham, and Josiah has the best eyes...

..."cartoon eyes," I call them :)

I wish we lived closer to these dear friends, but I'm sure we will find reasons to see them again soon, wherever they are located.  For now, goodbye, Rochester!

Winterizing

We are headed (after seeing our dear Lee friends in Oakland!) to Minne-SNOW-ta in two days and we have been busy digging around for all of our cold-weather clothes this week. While Humboldt County (where it is 40-60 degrees, year round!) is no Orange County in terms of weather, it was definitely still weird (shocking) to see temps in the 20s (for which we're lucky!) when previewing next week's weather in Crookston, MN.

Kelvin actually has never been to Minnesota ever, much less in the winter, and prior to this year hasn't even owned a winter coat (living in Vietnam followed by [mostly southern] California doesn't call for acquiring much winter wear [Good luck, honey! Welcome to the family!]). To have a heads-up on what we're getting into, I really think he should read my great friend Wendi's past awesome and memorable blog posts, Surviving a -29 degree day and Returning to the Polar North, which chronicle better than I did (could) some of the weather novelities/challenges of our years in Rochester, which is actually located in the "warmer" part of the state :). A cold hater and overall wimp, I still can't believe that I survived four years of medical school in the Minnesota tundra.

Some snippets of conversations we had this week:
K: "I need a hat that covers my ears."
T: "Okay, but it CAN'T look like the hat pictured above. That is just ridiculous. Although you are generally the more fashionable person, you have to take my word on this. That hat is awful. I'd rather your ears be cold." [although I am usually all about comfort over fashion]

K: "I'm going to wear my snow boots (new BOGS he bought) all the time there, ok?"
T:  "Uh... ok. You do realize, though, that although it might snow and is quite cold, the Polar North is not just heaped in snow all the time. People do wear normal shoes there, you know."

K: "I'm going to pack this hydrocortisone cream, ok? Just in case we get bitten."
T: "Bitten by what? You know that nothing can live at those temperatures, right? Do you mean frost-bitten?" :)

K: (anticipating we'll be kinda bored in MN, which is not the case!) "Can we take a day-trip to Mt. Rushmore? I've always wanted to see it!"
T:   "Seriously?! Do you have any idea how big those midwest states are? That's like driving from San Francisco to Mexico!" (We are only in MN for 6 days).


I can't wait to hear what comes out of his mouth when his nose hairs freeze up there (as we used to say, "you don't know cold until your nose hairs freeze!"). Polar North, here we come.

Mind of a Midwife

 

Last weekend, Kelvin and I (along with some of the prenatal clinic staff) attended a showing of "Birth Story: Ina May Gaskin and the Farm Midwives" at the Arcata Playhouse, featuring one of the most important people in the modern field of midwifery, and the The Farm (commune) she helped found in 1971 which was one of the first out-of-hospital birth centers in the U.S. You can read more about Ina May's mission here and here (when we entered the theater full of women, K remarked, "This is just like when we went to see "The Help"(a wonderful book and movie)! But he agreed later that it was an interesting film).

Now, I am a family doctor doing obstetrics who can and will perform cesarean sections; however, I like to believe that I think more like a "midwife." Some days, I actually think that midwifery may be more my calling than is being a "jack-of-all-trades" in medicine with the added stress and patient demands (but I do love the variety of family med:)).

I have pushed with a woman for six hours to get her a vaginal delivery. I have watched labor curves moving slower than molasses in January and not intervened because I felt that the woman could "do it." I have tolerated some ugly, ugly fetal strips because I knew a vaginal delivery was still the safest option for mom and baby. I am a huge proponent of VBACs (vaginal births after cesarean) and recently rewrote our hospital policy to allow our women with prior c-sections (even >1) more choices and say in their delivery plans and their acceptance of levels of risk.  I delivered a vaginal breech baby this year and would probably do it again ([with extensive consent] [Ina May does!] if a patient felt very strongly that they wanted to try it (although a c-section is generally accepted as the safest delivery route of a breech term singleton). I do c-sections very reluctantly and am often times more devastated than the patient that an operative delivery is the outcome of their birth (as it was yesterday with a woman and twins who just wouldn't come out from below) because the bonding and experience of a vaginal birth is so rewarding. In medical school, I used to cry at most deliveries I attended, and while I have been able to put a plug in most of my own tears (except when I am emotionally and physically exhausted), I love, love, love delivering babies.

I am a bit torn about "home births." Many of the audience members of the show last weekend were actual home birth midwives, women who delivered their kids at home, or children born at home.  This area of the country is very big on home births (and even home VBACs). Because I see and have seen lots of obstetric emergencies and do a lot of the care for "home birth transfers" (home births gone bad), I generally feel that a hospital birth is safest, particularly for the "baby resuscitation" aspect of things, but the midwife in me still sees labor as inherently natural and (hopefully) free from interventions.  I would love to have the opportunity to be a part of/witness some home births to see that side of things. I think that if I were in labor, I'd probably try to check my own cervix and stay at home as long as possible before I committed to the hospital for electronic monitoring, an IV, etc. (I'd love to roll in and be 10 cm and have an unmedicated birth) but would still plan a hospital or birth center birth. I would love to have a midwife do my delivery but have nothing against doctors (if they're of a like mind! :)). How many of you had your baby delivered by a midwife?

While Ina May clearly feels that doctors/hospitals "create" problems for births (sometimes making women feel unsafe, nervous, and unempowered) and that insurance companies/malpractice can really make OBs (and FPs doing OB) more likely to intervene prematurely, I didn't feel while watching the movie that she was attacking doctors as a group (sometimes I get sensitive about midwives hating doctors who do deliveries). As a result of my training, I am a doctor and will be throughout my career (unless I undergo formal midwifery training, that is :)). However, what she communicates well is that doctors and midwives can learn a lot from eachother and should really work together. The Gaskin Maneuver (one maneuver to try during a shoulder dystocia, where the baby's shoulder gets stuck behind the maternal pubic bone) is named after this famous midwife (although the idea was taken from a Belizean midwife who learned it from Guatemala) and, while I've not had a dystocia bad enough to need to use it, I will certainly have it in my toolbox.

Gaskin Maneuver

        from: Obstetrics and Gynecology Clinics, Volume 34, Issue 3 (September 2007)

One of the best books I have read is Midwives, by Chris Bohjalian, a fiction thriller about the scope of practice of a midwife. Many people have suggested I check out the PBS show "Call the Midwife," about midwives and nuns in 1950s East London. Have any of you seen this?

I am excited to delve into some of the books that Ina May has written, including:
-  Spiritual Midwifery
-  Birth Matters: A Midwife's Manifesta

(and, if/when the time comes:)
-  Ina May's Guide to Childbirth
-  Ina May's Guide to Breastfeeding

Any other midwife media suggestions for me?

election thoughts

 

I know that politics is a touchy subject in this year, as it is in most other election years. I also know that many people who read my blog completely disagree with me. If you are unhappy with the above image, you may want to stop reading this post now. However, this will likely be my one and only political post of this next term.

While it is definitely not a secret that I was very pleased with the outcome of this election, I think the election of four years ago in 2008 was perhaps the most excited I have ever been after a political race and it was interesting for me to flash back to the blog entry I posted then (I believe I was on night float). My friend Michelle wrote these words which captured my sentiments exactly,

    "i chose a winner. after years of feeling disenfranchised, and in fact never getting the president of my choice for as long as i've been able to vote... years of feeling disgusted, discouraged, and actively considering a move to another country...finally. yes we can."

There will be many more races in which I will vote in this lifetime, perhaps even some more historic than those in the past four years. I'm sure I'll be disappointed in some outcomes as I was for several elections before 2008 but for now, I am happy about four more years of liberty, choices, tolerance, and, well, democracy in general.

While I, too, got inundated with the facebook posts either (overwhelmingly) praising this victory or being bummed that this nation is "going to hell" (doubtful, and a bit too dramatic, I think), I had to share this one FB post, from a friend (K.W.) of a friend and which describes a parent's point of view (which I, obviously, don't yet have but feel I would if I had kids).

"This afternoon, I’ve seen quite a few posts in my news feed about friends who are worried for their children’s future. From my perspective, I am hopeful for my sons’ future. Because of media coverage showcasing other nations celebrating our election, I am hopeful that my sons will grow up, as global citizens, in a stronger, more unified world. I am hopeful that they will receive a quality education in a public school with classmates who don’t need to worry about missing lunch and whose families have access to affordable healthcare. I am hopeful that more of my sons’ classmates will be able to attend college and enjoy the benefits that accompany higher education. I am hopeful that my sons will work with women who will earn the same pay and that they will date women who will have the ultimate power to make their own decisions regarding their own bodies. Or, if is the case, I am hopeful that my sons will have the choice to propose to and marry their boyfriends, whenever they want, wherever they want. I am hopeful that my sons will be compassionate and root for the underdog – and that they will learn to make decisions based on fairness and goodness, rather than money. I am proud to be a parent in America, and I am hopeful that my sons, too, will grow up proud of what will be accomplished in their lifetimes."

Amen.

A Day at the Zoo

  

(fake goat, don't worry)

On Saturday, we had glorious weather (for Humboldt County-- it was in the 60s and sunny!) and we spent a bit of town outdoors. One of my patients works for the Sequoia Zoo in Eureka and recommended that we check it out. The zoo is very quaint--- established in 1907, it is both the oldest zoo in California and one of the smallest accredited zoos in the U.S.  I was quite pleasantly surprised by the quality/rarity of the zoo residents!

These "cavies," which appear like large jackrabbits, are native to Argentina. Here is a mom nursing her babies. I'm not sure I've ever seen a "cavy" before!

 

(sorry for the glare)

Some birds... (I'm more into mammals)

(K is very proud he caught this bird, "in action," stretching)

 

 

Llamas!

 

... and other grazers

 

We loved watching this red panda climb around!  What a cool animal!

"The Barnyard"

Yay for compost!

(I almost invested in worm bins for our home compost but found the thought a bit icky)

 Can you spot the gray foxes in this photo?

Gibbon!

We enjoyed our little town zoo-- traversing it took about an hour, but it was well worth it! How does your town zoo compare?

A Gem of a Gem Show

After a busy 10 days straight of call and a million meetings, I was thankful to have a day off on a lovely fall Saturday. Kelvin and I checked out the annual Gem and Mineral Show at the Eureka Fairgrounds.  I definitely was a rock nerd in my younger years. I remember that I loved collecting fools' gold and rose quartz nuggets from national parks (not sure where those are now), and one year I even got my own "rock tumbler" as a Christmas gift.

The fair was great! The (Christmas) shopping opportunities abounded.

  

Agate wind chimes... 

There were a number of displays- including petrified wood, dinosaur eggs, and an amazing "Dinner of Rocks."

 

 Check out this "dinner table"

Wish you could see all the plates close up!

Yay for gems, rocks, and other minerals :) Check it out if you live locally (or come visit us next year-- I'd love to go back!)!