Showing posts with label feeling grateful. Show all posts
Showing posts with label feeling grateful. Show all posts

Wednesday, September 14, 2016

Goodbye hormonal birth control

It’s kind of hard to say goodbye to hormonal birth control when it’s been so good to you for so long. I started taking the pill as a teenager. My father is a teen parent and my mother instilled in me such a huge fear of early pregnancy that I stayed prepared, mostly to avoid her wrath! Talk about the teen brain in action; birth control was a very concrete option. Avoid pregnancy or be beaten, possibly at school in front of all of your classmates. YouTube videos of parents beating teens wasn’t around then, but if it had been, I’m sure this nightmare would have included my Aunt videotaping and putting it on the Internet. (note: I am totally over-dramatizing this and my mother and Aunt are two of my dearest friends now. They loved me fiercely and kept me from all types of danger including a few college boyfriends who were up to no good.)

I still remember sneaking to Planned Parenthood (it was across the street from a busy metro station) in order to get my first pack of pills. I was sweating, I was scared. But larger than my fear of being seen was my fear of getting pregnant and having to tell my parents. I knew getting pregnant before college would make my dreams of becoming a doctor even more of difficult to achieve, if not impossible. I had my share of providers over the years. I remember one male doctor that tried to shame me by drawing horribly graphic pictures; I wanted to yell at him but was too scared. I remember some outstanding older nurse providers (one super cute grey-haired lady in particular) who were very sex-positive and helped me try various methods.

Methods I have tried to date (in semi-order): combined oral contraceptive pill for years, the patch for less than a month,  Depo-provera for a few months, abstinence, emergency contraception, pills again, the ring for a few cycles, the Mirena IUD for 3 years, a healthy planned pregnancy 3 weeks after discontinuing the IUD, breastfeeding and the mini progesterone-only pill for a few years, and finally my second IUD.

Somewhere around age 30 and my pregnancy, I began to have hormonal headaches each month around ovulation and changes in birth control. Now that Zo is well out of diapers, we are ready for baby number 2. So I said goodbye to my second IUD. Hubby and I decided this would be the end of hormonal birth control for us until we decide to have someone’s tubes tied. I am still holding out hope he’ll see me waddling around pregnant and will decide to get a vasectomy.

I know this country tends to shame sexually active teens, but I was one of them, and I turned out alright in my opinion. I’m a pretty successful Pediatrician, married, with a child. I have friends who used various methods and ended up teen parents and now as an adult I have countless friends dealing with infertility. I wasn’t promiscuous (though I won’t shame those who are), but I always knew that avoiding pregnancy and infection were top priorities for me (referring back to my mother who wanted no parts of being a young grandmother). Now that infection is virtually impossible (if anything goes down hubby will have some ‘splaining to do) and we actually want to expand our family, I say goodbye to my old friend hormonal birth control. Thank you for keeping me safe and allowing me to follow my dreams.

Saturday, August 6, 2016

In praise of skin

Another work post from the burn unit, Kamuzu Central Hospital, Lilongwe, Malawi. I want to tell you about dressing change days, and interject a little ode to skin. I wrote a version of this for my private blog, but wanted to share with you all as well. As always, thanks for reading these ramblings!

Mondays, Wednesdays and Fridays bring dressing changes in the burn unit. This means that every patient—as many as 42, plus the many others who come in from home just to get their dressings changed--line up at the end of the hallway and wait their turn, while 3-4 intrepid nurses unwind and wind miles of bandages, slather ointments, and squirt morphine into their mouths. Except when there is no morphine. Then it’s diclofenac, which is, I imagine, the equivalent of getting a swig of ibuprofen right before you get scalped alive.

Walk with me. From the outside, down a dark hallway filled with people, toward the light at the back and up the stairs, three flights. The staircase is open to the outside and on each flight there's a big window with a view of the city--today it's hazy and hot, so the buildings are distant under a screen of red dirt and smog--but it's not airy or breezy. The stairs are worn from countless people walking up and down it for years, and on the second flight a woman wearing yellow wellington boots is mopping, with a broom that's seen better days and concrete-colored water. On the third floor we briefly bump along behind two policemen, big guns swinging freely, talking exuberantly and walking oh-so-slooooooowly—and finally we arrive on the third floor, and walk down the hallway to 3B, the burn unit.

Before you open the door, take a little deeper of a breath, for you're about to experience that smell. On a good day you manage to take 3 steps inside before it hits--the odor of maize meal cooked into grits-like porridge, or a paste, or a hard cake (nsima); of bodies, urine and boiled cabbage, dirty wounds, feet, doughnuts, and fear--and then you see the mother carrying her five year old daughter wrapped up like a mummy with an IV tube sticking out of her neck--and you feel ashamed for even noticing the smell.

There are six rooms, 4 beds each, lining the hallway to your right. Linking them is the open breezeway down which you’re walking, which opens onto a shared courtyard where people dry their laundry and family members cook their meals. On the other side of the rooms is another hallway, the khonde, or “outside,” which becomes another long communal room during the months when there are more patients in the unit than there are beds. During the cold season—June, July, August—the khonde is full.

Two boys, aged four and six, one with a bulky bandage around his leg and the other with a belly dressing, are playing with a glove balloon, and you toss it back and forth with them for a little while, their smiles lighting up the day.


Are you procrastinating? We have to keep walking down the hallway, to the room at the end, where all those people are queued up, since that’s where all the action takes place. Each mother dons a protective plastic gown and gloves and takes the child—the median age here is 3—on her lap. The mothers hold the children down. The first trial begins, that of forcing the morphine into the children's mouths. Most take it willingly, especially ones who have been here a while, but sometimes they purse their lips, or cry, or swat with their arms. It doesn't matter if the morphine trickles inside or outside of their mouths--there is no refill and the dressing change happens with or without it.

Next, the nurses soak the bandages in saline to help with removal. Since there are 42 patients and 3 nurses, waiting for a complete soak would take way too long. Some of the kids start screaming in the hallway; some when the mothers take them on their laps; some with the morphine; but all of them are screaming by this point. These kids are burned over 10-40% of their bodies, on average; over all possible body parts; in two main ways: they scald themselves or catch themselves on fire. It's the cold season in Malawi, no one has heat at home, and very few people have stoves; cooking happens over open fires, outdoors, and accidents happen frequently. Malawi is burnin', y'all:




Skin gets so much criticism. We stare at our pimples as teenagers and wish them away; at our wrinkling faces as adults, and hate their testament of the passage of time. We scrutinize moles and massage cellulite; we want elasticity and spend millions on creams and lotions that promise to keep us looking young. Even as we enjoy skin's gift of touch, in embraces, caresses, and kisses, we resent and focus on its fragility, its ability to hurt, and too often, its color. We don't appreciate scars. Skin should be blemish-less and baby-soft. Not at all like the skin I see in front of me--discolored, twisted, partially healed, in some cases with the tell-tale cheesecloth appearance of a healed skin graft. This is beautiful skin because it works in its intended way: not as pretty packaging but as a barrier to infection and pain, as the selectively permeable wrapper that allows the rest of the body’s functions to proceed uninterrupted and unthreatened, with just enough openings to allow a regulated exchange with our environment.

It's the absence of skin that exposes its absolute necessity. This six year old girl being unwrapped now has full thickness burns (what we used to call third degree) over 55% of her body: anterior and posterior thorax, both legs, both arms, a bit of face and neck, buttocks. Her big, deep brown eyes look at me with tears trickling down her cheeks as her mother’s helper raises the IV bag above her head and arranges it so the tubing is not kinked. This is a bad burn: flame generally causes deeper burns than hot water, and in this case, it looks like her clothes were on for some time, and the contact did a lot of damage. Like countless others, she was playing with her friends and tripped into a fire, where her clothes caught the flame. She cries, but not much: a bad sign. Although we teach that full thickness burns are insensate, since by definition the heat has destroyed the skin's sensory apparatus, not everything burns to the same depth, and partial thickness areas surround most full thickness burns—and those do feel pain. Her name is Chisomo, meaning Grace. She will die in 3 days.

I think about the ones we can’t save, back home, and here. I hold on to them for motivation to keep studying, keep waking up, keep leaving my family, and keep trying—and to honor their memory, although I see them usually only in a dehumanized form, although I know them usually only as bodies wrapped in dressings and not as children chasing goats, eating mangoes or diving into the lake. Knowing what makes a patient human makes me a better doctor but it also hurts more—and many times I don’t want to admit they are people because doing so makes me transiently incapable of returning to work. It’s like this in the States and it’s definitely like this here. The constant blur of activity insulates you from processing both the good and the bad, but both stay with you, and sometimes when you get a breather it all comes out, and it’s very hard to figure out what to do with all of it—so I try to just notice it and not cry, and carry on, because in the end, there are more of the ones who get to be human again than the ones who don’t, and so you keep going. As shown by the parents and patients in this burn unit, every day, with their smiles, their high fives, and their endurance, despair is a luxury. Ain’t nobody got time for that.

Wednesday, July 6, 2016

My Target Guardian Angel

     I like to think of myself as someone who generally has her sh*t together. Someone who is skilled at multitasking, who keeps her cool when things get stressful. Which is how I found myself at Target last week staring at one cart full of children squirting poop and tears and another piled high with cartons of diapers and wipes. Oh, and three huge containers of animal crackers mixed in there for good measure.
     My plan had seemed foolproof. (Okay, at the very least, doable.) Feeling too guilty to have a huge order of mega-packs of diapers shipped when there was a store nearby and I had a day off from work, I had placed my order online and selected in-store pickup. The next day, I loaded up my sons, two-year-old Bean and three-month-old Teeny, both freshly fed and changed, and headed out. Bean’s naptime still loomed a good two hours away and Teeny usually snoozes happily on and off throughout the day, so conditions seemed ripe for success.
     All went smoothly as we circled the store to grab a few small items and made our way through the checkout line. We headed over to customer service and the guy behind the counter pulled up our record then wheeled out a shopping cart filled with large boxes. He eyed the cart I was pushing, the main section of which held Teeny in his infant carrier and the front section of which held Bean. “Do you need help?” he asked halfheartedly, as I started loading the boxes underneath. I waved him back toward the counter where other customers had begun to line up because, I figured, I’ve got this.
     The tipping point was when I tried to snug two of the containers of animal crackers in the front with Bean. He didn’t want to share his space – in fact, he suddenly wanted out of the cart right now - and began to whine, which escalated quickly to a wail. Teeny, who had woken up a few aisles back but until now had remained quiet, decided that he, too, was done with this expedition and would prefer to be held and fed. It was around this time that he also let out a poop explosion that not only blasted out of his onesie but, as I would later discover, puddled into the carrier, soaking the seat cushion and dripping through the cracks to the coat the plastic base.
     I tried firmness and then bribery with Bean, trying to coax him into letting me stuff several items in the seat beside him as I simultaneously tried to shove another carton of diapers onto the shelf below. I’ll just squish everything together, I thought, as the boys’ cries continued to escalate. It will be fine, I reasoned, with less and less conviction.
     “Can I help you?” a new voice asked. I looked up to see a petite woman eyeing our situation with concern.
     “Oh no, it’s all right,” I said, waving a hand at the general chaos before me. “We’ll be fine.”
     She frowned. “There’s no way you’re going to fit all of that. Here, I’ll wheel the other cart out to your car.”
     “Are you sure?” I asked. “I mean, only if there’s nothing else that you need to do.”
     “Only return a pair of shoes,” she said, “and I can do that after I help you.”
     I sighed. The boys’ chorus continued. I acquiesced.
     “I remember having young kids,” she said as we headed out to the parking lot.
   I wanted to explain that it’s not usually like this. That during residency I resuscitated babies while swollen from belly to ankles as I carried my own; that I managed the ICU with no in-house fellow or attending. That I pride myself in working full time, raising my kids, and keeping our house and lives in order. That complications and multitasking are kind of my thing. And yet as we wheeled our way down one row of cars, stopping so that I could survey the lot in search of my vehicle, realizing only after I spotted it that I driven my husband’s car and not my own (and moments after that that while I was now searching for the correct model of car, the one I was currently steering us towards wasn’t actually ours), I felt like my sh*t couldn’t be less together. I hurried along, willing this interaction to end so I could return to at least pretending to be a competent parent and adult.
     We parked the carts once we reached the right car, and I hustled the boys into their seats, promising Bean that he could have some animal crackers if he would just wait a moment longer. I began loading boxes into the trunk, praying that the woman wouldn’t notice that we were also barely going to be able to fit everything in the car around the clutter already there and wondering from which of my sons the scent of stool was now wafting.
     As I thanked her, perhaps too hurriedly, the woman paused and held my gaze. “This was my random act of kindness.”
     I must have given her my best What, now? look because she quickly pressed on. “One of my friends just lost a baby. Her other friends and I are doing random acts of kindness this week as a tribute.”
     I don’t know what I said next. I’m not even sure what I felt. I know that the woman wished us well and that, sitting in the parking lot with the air conditioning blasting, no longer in a hurry, I ate animal crackers with Bean. I stripped Teeny down, sopping up the poop as well as I could but also knowing that whatever I missed could be washed out later. I nursed him until he calmed and then buckled him back into his seat. I drove my boys home. And I hugged them hard.
             

*Cross-posting with The Growth Curve

A quick intro since this is my first post:
Hi there! I'm Beckster, mom of two little boys, wife of my high school sweetie, and pediatrician in Providence, RI. I love to write and luckily I realized early on that it just might be the thing that keeps me sane through my medical training and practice. I'm currently a fellow is Hospice and Palliative Medicine (and one-year position) and after that will begin a fellowship in Pediatric Hematology/Oncology.