Sunday, November 27, 2005

happiness is....

- new, freshly laundered flannel sheets and a new pillow
- homemade pepper and chicken quiche, with plenty of leftovers for breakfast/dinner this week
- my immediate family all together this week (all of our feet under the table, as my mom puts it)
- a year of this blogging thing down (another one to go?)

- a garage and a driveway that I do not have to shovel or plow (both things are a step up from my parkingban'ish place (with on street parking) last year)

- 8 finished hats to be sent off to warm little (and big) one's heads. (all are at least double thick or are made with two strands tightly knit yarn due to Norma's friendly request from the last time snow flew)

(tonight the ends will be secured)
- being on call this weekend and getting a call to be present at two births this weekend
- my youngest brother asking me to knit him a scarf to match his jacket

I knocked a few potential knitted gifts off of my "to do" list after evaluating who was going to receive what this year; my lists aren't long, and 98% of my holiday season shopping was done before Thanksgiving. Our family discussions have concluded that no one needs any more "stuff" and because it's as much of a birthday season as it is other holidays season we've vowed to enjoy our time together as much as anything tangible.

Two years ago I knit everyone a scarf and my youngest brother got one made out of a yarn with as much plastic as wool because his ski trips mean that whatever he wears needs to be washable and it seemed like a good idea to make it in his loud school colors. This year he surprised me by requesting one in more mature colors, similar to the one I made our other brother. I've got my eye out for some navy and burgandy cascade 220 and then the "what stripe pattern is best for him?" debate can begin.

My leftover/barginbin/why did I buy this again? yarn pile is sloooowly shrinking as I finish the donation hats. I've aways to go before it's finally gone but it is nice to the yarn finally being used up! It's also helped me to justify a few online purchases that may or may not be used for some birthday gifts...

This rotation is really squishing my knitting time and I've been trading it for sleep. I am looking forward to being able to think about complicated cables and fair-isle projects again....

What I learned this week:

I wasn't scheduled to be at the hospital Thursday through today but I left several well-placed notes with my pager number urging them to please call me if someone in labor came in. It was a very quiet (QUIET QUIET QUIET (if me chanting it doens't work then perhaps "shouting" it across the internet will work)) week and I knew as soon as I wasn't in there'd be some action. I was called in on Friday and two new little ones entered the world! The docs I'm working with let me in on the "schedule" of due dates in the next three weeks and at some point there will be A LOT of action. My fingers are crossed I'll be there.

Those with a birthplan will have everything they planned for happen opposite to the way they want(ed) it to. (for instance, several nurses shared that their experiences have shown that a birthplan = c-section, for a variety of reasons.) I'm still figuring out my own reasons but I've seen it happen.

Some women, even first time laborers, will smile until they are 5-7cms dialated. Their sense of humor is is an important guage in the scheme of things (the smiles do, in general, decrease as time passes) but it is not an absolute measurement of progress.

It is also important to note that most women are exceptionally polite throughout their entire labor, even with lots of encouragement to drop the niceties. (it's hilarious to me that someone who has been pushing a baby through the birth canal for 45 minutes (that's normal - nothing to be alarmed by dear pregnant readers) and is using lots of colorful language, will still stop and appologize if/when she hears she could push another way. Then she'll say "thank you" when I get ice chips and a cool cloth and in the next sentence spew half-formed words to everyone else in the room.)

I love obstetrics, but I do not really want to be an obstetrican. The family doctors that I'm working with get to follow the moms and the babies, whereas the OBs just follow the moms. One doctor told me that she thinks I'm a closet pediatrican and I had to agree with her - but even if I went that route I wouldn't get to help directly welcome a babe to the world. Another reason for me to stick with family practice....

Sunday, November 20, 2005

happiness is....

-a cat, in my (scrub clad) lap, inspecting my (for charity) knit cap.

it met her approval - she settled in for a nap. (I was spread out on a futon, and with her on my lap I put everything I thought I'd need for the next 30-45 minutes right next to me so as not to interupt her sleep...) I spent the night with the three of them before returning back to student housing.

-setting up a "tuck in call" with a Sheep for Thursday night (I've never done this before, we don't have that particular store in this area and no, I don't plan on shopping the next day; I just couldn't pass up a sheep putting me to sleep...)
- knowing that there is a scheduled c-section tomorrow, so at least one new babe will enter the world
- strong, hot tea with lemon and a smidge of honey
- finally remembering to take my vitamins
- dogsitting for a few days/nights later this week

I'm tired. OB has an interesting schedule and though I don't mind the late nights, the early mornings are killing me. I'm not a morning person - even with copious amounts of coffee and tea I am just not happy (or awake) until 9am. The 6:30am rounds are wearing me out....

I've been doing a lot of charity knitting with the hope that when I'm done I'll have turned 12 balls of (bargin, traded or leftover) yarn into warm, thick hats for kids and adults. It's mindless, instantly gratifiying and for a good cause. I'll return to things that require thinking (sock heels, sweater planning, mitten figuring) when I feel like I can think about something non-medical. I hear it'll be soon - I do have Thursday off.....

(What you've said about white coats is interesting and all of the "views" I was hoping to see represented are there. I'm going to wait until I feel more "on my game" to write about it. Right now I'm up waaaay past my scheduled 11pm bedtime, and 5:45am is going to come tooo soon...)

Thursday, November 17, 2005

an answer for you (for the price of a question.....)

I realized last night that the well thought out section on how the undyed yarn was chosen for being extremely madeover (a passage that involved a letter, interviews with the friends and lots of desperation) was left out of the post. Oops. Posting pictures (the way that I have been) is an exercise in patience and sometimes it publishes itself before I'm done.

Many asked about which dyes were used for the last batch; the answer is dyes from prochem. (I have two sets of kits (for cotton/wool) that were reasonably priced; my only gripe is the relatively expensive shipping but it was sent out fast.) I experimented with drink mixes last winter and as much as I liked how good and fruity my kitchen smelled, the colors were too pastel-ly and they seemed to fade as I used objects knitted from them. The dye day at Julia's this summer was just what I need to see that using chemicals isn't that complicated, and the colors are far superior to grocery store buys.

The process I use is a combination of what I saw that day and the result of a few emails with Claudia. It's really rather simple and pretty failproof, as long as I keep an open mind!

Step one: acquire "blank" yarn. It doesn't have to be white! I've enjoyed knitpicks free shipping on the "color your own" line more then once... Figure out how much you want to dye and then fill the kitchen sink with water and a splosh of vinegar. Drop the yarn in and make sure it's completely underwater (or at least all wet). I've found that up to three hanks of yarn is a good fit in one side of the sink.

at the same time, or after the yarn is all set, put together the crockpot (used from a second hand store or one that won't be used for food again) with a vegetable steamer (ditto). The plastic wrapped yarn rolls will eventually "steam" in this and it's not a good idea for th e yarn to come in contact with the water. (I solved this problem by elevating my steamer with an old ceramic mug. I like to use an inch or two of water so that I get a good bit of steam.) Turn in on high and let it sit. (It's a good idea to put the crockpot near where the yarn coloring is going on; trying to transfer yarn across the kitchen when it's dripping with dye isn't a good idea - trust me on this one.)

Step two: while the yarn is soaking, get the dyes together. It's important to note that any coloring agent is non-discriminatory: I wear clothes that I don't care about and limit my work area to a small section of the kitchen counter so if I notice a spill I can clean it up asap. The dyes from prochem include directions but I don't always follow them. Empty water bottles (think 20 oz'ish with spout lids (or not - I don't have them and it works out okay) are what I use to mix up the colors. I wish I had a scale to precisely measure out the powders, but that isn't practical for me right now so I simply sprinkle the powder into the bottles. I've thought about dedicating small measuring spoons to my coloring process, but haven't gotten around to picking up a set yet. (I do this part of the process with warm-ish water. Add water to the bottles and then mix in the powder - and remember that (with chemical dyes) a little goes a long way!) The bottles are good for storing the colors if they aren't all used up. (I either do this in the other sink or I switch this step with the next one so I can set up the colors on the plastic wrap. This is more fun then setting plastic though, so I usually do it first!)

Step three: Lay out sheets of plastic wrap. There are many variations on this, but this works best for me. I start out by overlapping to long "strips" of plastic wrap and then add a third over the seam that has been created. I am living in a house that is considered "student housing" and so I'm a bit paranoid about dripping onto the countertops. My initial biggest mistake was not making the strips long enough; look at how long the hanks are and then go bigger. Plastic wrap that doesn't wrap all the way around the yarn is nothing but a BIG mess. Get together as many long "sheets" as you'll need and set them aside; once the dyeing starts it's hard to stop and arrange plastic wrap!

Step four: Rescue the yarn from the sink, one hank at a time. (ideally it's been in there for 20-30 minutes) Gently squeeze it to get most of the water out of it - I've no advice on how to do this, or how much water to get out of it. I leave it so that it's damp, but not dripping. Place the hank out on the plastic wrap and add the colors. I have done it a few different ways - and haven't been disappointed because I've kept an open mind. The colors will spread out and eek into the other colors if they aren't totally soaked into the yarn. To try and avoid this I add one color at a time, slowly, and in between colors I pseudo-wrap the yarn up to try and mush the color into all of the yarn. (I worried about the middle sections of the yarn not getting enough color - mushing helps with this.)

Add color as you want! I started out with two colors in various patterns and intentially blended some. The yarn directly laying on the plastic wrap will be the most mottled because that's where the extra yarn will settle.

Step five: when you're set with adding dyes, wrap up the yarn. I wrap the ends in first, then roll it up, as best I can. (too little plastic wrap makes this hard!) If it's dripping (at this point) I hold it over the sink and gently squeeze while letting the water run to dilute the colors. I can't afford to color the sink! (it hasn't been a problem but I don't trust it to sit and then come off without a fight.) Then it's into the steamer - I liked to spread it out a bit, but keep it wrapped upon itself. I do the dark colors first, then set the lighter dyed colors on top so that if it drips or bleeds it won't discolor the bottom roll.

Step six: repeat the process for as many hanks as you've soaked, adding them to the "sauna" as they are finished. My crockpot and vegetable steamer comfortably holds three rolls - the same as the sink.

Step seven: the hardest part - wait. The yarn needs to steam and get good and hot to set the dye, so I let it be for an hour or two. Then I turn it off and take the lid off to start the cooling down process. It's wool, and one of my fears is felting it - so I don't rush this part! After it's cool to touch (it will be HOT! when the crockpot is turned off - if it's not, then it's not done yet) I pull it out and let it sit in the sink for another stretch of time so I'm sure it's room temperature. Then I run the water so that it's lukewarm (in the other sink) and run it over the yarn rolls. The plastic wrap is sometimes mangled and fussy - just get the yarn out and throw the plastic away. Rinse out the yarn - the water should run clear - then hang them up somewhere to dry. Step back and admire often. Once it's dry it can be reskiened/balled and used!

I hope that makes sense - on a students budget, after the intial investment, it's cheaper and more satisfying to dye my own sock yarn then it is to buy it. I've been somewhat intially disappointed in how it knits up, but a pattern change or a needle size change has often made all the difference in pooling!

Now, a question for you:

What are your thoughts on white coats and doctors/med students? Do you think doctors should wear them, do you expect doctors to wear them and do you even think about it? Please share your thoughts on this matter - I'll hold back sharing my opinions and most recent ramblings until I know what people think and/or where you're coming from.

Tuesday, November 15, 2005

Yarn Gone Wild, or "Extremely Madeover: Yarn Edition"

once upon a time there were three very colorless hanks of yarn. They always felt very underdressed when spending time with their more vibrant friends.

Their friends were required to wait in the, er, waiting room/chair.

here they are - just after going "under." They risked being in the hands of a med student because, as they put it, being a dyepot mistake is better then being like all of the other undyed hanks of yarn out there.

the sock yarn was up first; it had requested lots of colors, in no real pattern.

mission accomplished!

hank #1 of the worsted weight (they both dreamed of someday being a part of a mitten) was doused with warm colors; the goal of "peaches, reds, yellows and lots of blending" appears to be achieved.

Hank #2 was covered in cooler colors, and just after this picture the plastic wrap aided in lots of color blending.

then it was off to the sauna for a long, hot steam.

after the steam they cooled, and hung to drip dry and recover for a day or two. Then it was time to show off their new look!

old friends are reunited and everyone seems pleased with the makeover. (Yes, they might seem to look similar, but the yarn weights are different. Yarn liposuction to reduce worsted to fingering weight is still being perfected...)

everyone, busy at work. The blue/purple/green sock yarn is seen here modelling a cabled sock in progress; this is pattern attempt #3 and appears to be working. It's stalled right now because the needle size, stitch count and pattern are making the heel difficult. (notice the white medical tape holding needles together - a sure sign it was worked on in the hospital.) The worsted weight yarn is realizing it's dream - a mitten in progress!

the other side of the mitten; I got wild and crazy and reversed the motif colors, just to see if I could. I can, but I'm not sure it's the best idea for the mitten. (I really should have waited for proper mitten ratios but it fits okay and will be warm...)

(not shown are a pair of socks started in trekking xxl and another sock made with hand dyed yarn. The yarn that looks black is really the navy blue cotton liner for the Kristen fair isle hat.)

Monday, November 14, 2005



- the last few sips of apple cider, heated up with spices
- five knitting projects, all fighting for my attention
- the smile on a new mom's face after seeing her baby enter the world (after a day of labor pains and colorful words and lots of "I am NEVER doing this again" 's)
- not having to be at the clinic until 8:30 tomorrow morning.

- the significant other who decides to yell at the doctor next to me and I because he thinks the medical care his "girlfriend" is getting is second rate and a load of (fill in colorful words here). (the internet has taught him to be a doctor and therefore she needs an ultrasound now, damnit.) (I am still unsettled by the whole encounter and will try and process it all before I fall asleep tonight)

- five knitting projects who are all at forced stopping points because I haven't yet learned that I should follow a pattern. (mittens that I'm making up as I go along because I had the yarn and needles and no pattern so I'll just swatch and oh no it looks like I'm going ahead and making mittens I'm too attatched and committed to rip it all out now), two pairs of socks - one that is stalled at a heel that I'm not sure is working and another that I'm trying to decide if the stitch count and needle sizes are compatible (and if the finished sock will fit...)) and the fair isle hat that I feel I can't really work on until I master two hand knitting (see mittens, above).

- starting the diet named after a particular beach during PMS. I should have known better. Really.

- a pictureless blog entry; I'm working on it. OB is keeping me busy, and out waaaay past my bedtime.....

Saturday, November 12, 2005

thank you and med student ramblings (with no knitting content)

Thank you for all of the thoughts, prayers, and comments left when I shared the news of the death of my “aunt.” It means the world to know that others are thinking about her family and I thank you for the support. I’ve spent lots of “quality” time with my family over the past few days and my brothers and I have talked about what would happen if either or both of our parents died, and we’ve had a lot of heart-to-heart time. It’s been a silver lining.

I’ve been knitting, but have nothing to show pictures of right now. It seems that a lot of little things in progress makes for not-so-great knit blogging fodder. However, I have much to say about being a med student and medicine…

What I learned this week:
- the trend of labors this week was long first stages (the dilation of the cervix from 0-10 cm) and very, very short second stages (the pushing of the baby out of the birth canal). (Any predictions for next week’s trends?)
- a woman who just a mere minute ago who was in Immense Pain will look at me as soon as her baby is born and say “I feel SO MUCH better now.”
- Most of the time, babies enter the world when they are ready. Sometimes though, they need some help, and that is not anyone’s fault when this happens. Some mothers will need some reassurance that it is not their fault, and the more they hear that all is well, the better.
- some nurses will drive me crazy. I’m learning how to work with people that I cannot stand being around.
- Being on call with obstetrics is much more fun then being on call with other sorts of medicine.

I was excited to start my ob/gyn rotation because I (not-so-secretly) love obstetrics. The first three days were quiet; there were a few non-stress tests that I helped set up and interpret, and a saw a few interesting gyn surgeries. (I had the option to scrub in and assist but thought it best to watch from afar the first day in the OR; given my past experience with surgery I thought I should check and make sure I could keep my legs under me.)

The doctors I’m working with all remarked that it was slower then normal but assured me that it’d pick up. “When it rains, it pours” was repeated over and over again and I was reminded not to use the “Q” word. (regardless of what I was told not to do I’ll admit that I sat alone at one of the nurses stations and chanted “it sure is quiet” over and over again.) There was one early, early morning delivery, but things moved too fast for them to page me and I was “new” enough that they didn’t think to call me as soon as she came into labor and delivery.

Thursday I had made arrangements to be excused from the rotation for the funeral services. Knowing that things would probably happen the second I wasn’t there, I told them that I’d probably be home again by 3pm and they were welcome to page me if there was some action. When it rains, it pours indeed as two babes arrived that morning and when I answered my pager that afternoon three more babes were on the way. I arrived just in time to watch a baby girl emerge into the world before I befriended one of the other patients and helped her change position, walk, get into the hot tub, re-hook up the monitors and then (eventually) helped welcome her son to the world. As soon as he was set I ran downstairs to join up with the couple who were going to meet their first child via a c-section. I didn’t get home again till after 11pm but it was well worth it!

I’d been waiting for a baby to arrive so that I could complete my own greeting-card’esque-afterschoolspecial’ish-lionking “circle’o’life” thinking in that life and death cycle together. It took the first few days for me to remember that I’m not really one to subscribe to such ideas and the irony of me waiting and waiting wasn’t lost. (I suppose it helps to know me personally for the irony to be clear; I buck trends and am more used to taking things as they come. I was simply impatient waiting for some action!) Turns out I don’t need to witness a little one entering the world and breathing and crying for the first time for me to appreciate life; it’s a lesson I won’t forget anytime soon and was better learned without a pending birth.

The language of medicine is very different from social language and literature and my rotations are serving as an education for what I am supposed to say and chart. For instance, in my medicine rotation I learned that when patients answer “no” to a question that I ask them (such as: “do you have any chest pain or shortness of breath?”) I have to chart it as “patient denies chest pain.” (actually it looks more like this: pt denies (insert a circle with a line through it here) CP/SOB.) Usually the word “denies” is seen as a bad thing – insurance claims are “denied” and it’s an awful thing; it can conjure up a tv drama courtroom scene where a lawyer questioning someone throws the word around with undertones of negativity. Pts deny illegal drug use, wt gain/losses and all symptoms. It’s all considered subjective data and though I can take them at their word I can’t say for sure if what they say is “true” or not because I have not seen the activity with my own eyes. (as opposed to more objective information that I can gather: lab and test results, physical exam findings and appearances.)

Maria made a point that a mom delivers a baby, the doctors (and in my case, the med student) simply assists. This is true, but in talking with doctors and reading through charts and other forms of patient literature, it is common to see that the doctor delivers the baby. I could argue with them until I’m out of breath, but I’m one person with a lot less training and experience then many of the folks I’m working with, and in these cases I simply have to adopt phrases that are used. I don’t like saying that a person (who is a patient or pt) “denies” anything, but it’s what is said/written. I’m learning all of the abbreviations that once looked like Greek and may sometimes look like obscene derogatory words.

The other aspect of medicine that is becoming blatantly clear to me is the financial end of the process. A hospital is a form of a business, and they have people to market the benefits of picking that hospital over other ones. When a person enters the hospital they are assigned an account number and everything that they are there for (a short stay, or a test, or an operation, etc) is recorded and “charged” to their account. Things as simple as a meal to a short stay in a hospital room (for an observation for an hour or so) are all charged, and it’s an important aspect of the nursing care for the patient. I’ve also heard comments from doctors (throughout the last 3+ months that I’ve been in offices/clinics/hospitals) that they are not being reimbursed enough from some insurance programs, therefore they’ve closed their practices to people with some types of insurance. It’s hard for me to hear because the folks enrolled in those programs are the same people who are not making enough money to afford a trip to the doctor’s office, and they are often the ones who need the most care. If they were able to get into a doctor when they first got sick (a relatively inexpensive visit in the scheme of medical things) then they might not get sicker and require more interventions (a hospital stay for instance) if the disease/illness progresses. (I am going to refrain from diving into the political commentary on how little an increase in funding it would take for some federal programs to allow for more people to have access to preventative care and medications to keep them healthy, especially when some programs are being cut while we’re spending billions on a war that I do no support…)

At this point in my training, the idea of being in a solo practice is nothing short of a potential nightmare. I don’t want to worry about how many patients I’m seeing each day so that I can afford to pay back my loans and office overhead (let’s not even begin the discussion of malpractice insurance and how someday, regardless of what I do, I will probably (statistically) be sued), let alone be in a call pool that eat up my evenings/nights and weekends. I have much more to learn about the financial and business end of medicine and I’m uncomfortable both with what I know and what I will need to learn. I just want to apply my years of classes and hands-on experience to help people feel better, die with dignity and enter the world with joy.

Sunday, November 06, 2005

the news that I have not been wanting to hear.

My mom just called to let me know that my dear pseudo-aunt, godmother figure and once upon a time my future "guardian if anything should happen to my parents" died of lung cancer today. We knew the news was inevitable, but it's still hard to hear, and I am currently in a state of disbelief. All of the cliches are true for her (too young, too healthy, too full of spirit) and her kids (the ones that are younger but stairstep my brothers and I) have lost a parent. I can't even imagine, and my heart aches for them as much as it does my mom, who viewed her as a sister. The world has lost a kind and generous soul and I can only hope that the heavens are ready for a contageous smile and big heart.

Life is hard, life is short and I am doing my best to remember that life is meant to be lived.

happiness is....

- standing in front of the dishwasher during the "heat dry" cycle
- knowing I can still pull and an nighter to write a paper and still function the next day

(The Friday morning sunrise as seen across our front yard; I was up tweaking the paper I had to hand in that morning.)

- my extra car key; something I needed when my key broke in the lock yesterday
- putting on a pair of clean jeans and finding a freshly laundered $20
- finding another 4 skeins of a yarn (in the same dyelot and during a random two day sale) that I needed to match the 6 I bought (on sale) last January
- knitted fairisle catnip toys

(catnip-less catnip cat toys; they'll be stuffed before heading out to their new homes. (The yarns I posted last week were hand dyed in the crockpot and all of them were used here.))

the toys willed be heading off to cats I've taken care of this fall. They were a great excuse for me to work on my fair isling and have given me a heads-up for what I need to work on as I get started on the colorwork part of the fair isle hat. I finally feel comfortable working with yarn in both of my hands though my "picking" still isn't as second nature as my throwing is. I knit these on dpn's because I hope to knit the hat up on dpn's; 16 inch circulars just aren't as practical as double pointeds and it I get into and it looks too tight I can always take it out and start over.

I've been working on a few things but there isn't a whole lot to write home about. My "so called scarf" is still growing and a trekking sock I started on size 2's lasted only as long as the day I carried it around. It looks like I'm finally going to need to drop down to the popular-in-blogland size 1's in order to get a more "sock-like" fabric. I'm not sure why it changed but my knitting on the 2s was too loose! (It was knit during a stressful-ish day in a busy doctors office so I was surprised it was too loose....)

My $1 crockpot has been busy with dyed yarn and I hope to share pictures of my latest attempts after what is in there now cools down and the sun comes out. Trying to get "true" pictures on drab days is tough. (that and some other swatching for a potential sweater are keeping me busy...)

My obstetrics rotation starts tomorrow and I'm excited to spend some time on labor and delivery. (I may stalk Kristin and Mia for advice!) My manipulation rotation is over - it ended on a good note and my presentation went well. Overall I had a good three weeks and I saw several examples of how different doctors offices work; all in all I still see myself in the type of practice I was drawn to before, and hope to remain in academic medicine.

I've been musing over the language of medicine and will elaborate on that in the near future; I'm hoping to gain some more experience with the words of birth and how the field of medicine (and coding and billing) turns logic on it's head.

Those who are here in this state - please remember to vote on Tuesday! Let's not let the fear that some have stand in the way of equal rights for everyone. (Pocketfarm Liz has some additional info on this issue)