Monday, December 26, 2005

I missed it!

I missed the birth I was waiting for. Missed it! I've had my pager with me for the past week or so and was really looking forward to meeting the little one I had gotten to know over the previous six or so weeks. Tonight I ran out to the grocery store and didn't have it with me - when I returned to the house I'm catsitting at it was beeping. I called the hospital, thinking I had a long night ahead of me, only to hear that she'd delivered the babe!

(I suppose I should add that the OB shouted to the nurse that I shouldn't feel bad because *he* missed it too...)

I missed it. I'd only missed one other birth on my rotation - at the time I was dog-sitting and left to let the dog out. The woman, who asked me if I could stick around with her, who had been dialating 1cm every two hours then went from 6-10cm and pushed the little one out in less then half an hour. Why? because I left to walk the dog.

the lesson? When I am cat or dog-sitting the pregnant women that have asked me to be present at their delieries will progress so fast that I will miss it.

(edited to add: my mom reminded me that I predicted the babe would arrive today and it did. Yet I'm not nearly as happy about that as I should be. I missed it!)

(I am knitting socks while I swatch for Rogue; there are many reasons why it's the sweater I chose and now my decision is about which yarn to use....(and dare I say that I might need to include a few other colors of yarn that mysteriously bought themselves in my pile of "sweater possibilities" yarn?)

Saturday, December 24, 2005


today I am officially 26 years old.

I say "officially" because I've been trying it on and answering the "how old are you" question with "26" for the past few weeks. I like the way it sounds, and so far I've had good luck with it. I look younger then my age and though people questioned 25, no one has said anything about 26.
I'm finally on this side of my twenties, headed on to 30. I welcome the new year and if the trend of each year being better then the last continues then this is bound to be a good one.

I arrived to the world a few weeks early (I make no promises that the early thing will ever happen again) and didn't tip the scales much beyond 4lbs, but was healthy enough to get away with only a few extra days in the hospital. The cold winter didn't scare my parents and I grew to love layers and being wrapped in several blankets.

(the original polaroid says: Kristen and Linwood, Jan 11th 1980)

Today is bittersweet for me though, as the gentleman in this picture died on my sixth birthday. He was a phenominal honorary uncle who loved my family as his own and the smell of a pipe still takes me back to sitting in his kitchen with a homemade cookie straight from one of his vintage collectable cookie jars. The irony of his death on my birthday is something I take the time to think about today and our family has a grand time retelling his stories.

The holidays are a wonderful time for my immediate family as we have waaaay too much fun together. I wish you all a wonderful weekend and the happiest of holidays!

Friday, December 23, 2005

what I learned on my OB rotation....

before I delve into the wonders of a med student's experience on the labor and delivery floor I want to thank you for the sweater suggestions. I think I know what's next, but I need to do some swatching before I make any final decisions. My mom pointed out that, for the past 20 years (give or take), I've never followed directions as written. Recipes always wind up with my own twists and additions, fabric patterns were altered and if I thought I could do it on my own without any references, I did. I don't believe in making sweaters out of "pictured" yarns, and still wing some of the things I've knitted. This sweater, the one that I will make for me, will have to be made by the book. I need a sweater success before I go back to flying by the seat of my pants. (it might be a challenge - on lots of levels!)

This week has flown by and I don't have a whole lot to show for it, but I finally feel like I've caught up on my sleep. I've had time to process the past six weeks and feel like it was, overall, a good rotation. There were several frustrating undercurrents that I made a point not to mention (no need to spread negativity) and now that I'm not immersed in the daily routines of being in the hospital I feel like I'm back to myself. One of my classmates taught me the med students creed and if it's the secret to happiness then I'll use it on my next rotation (it's used no matter what the situation): It's all my fault. I'm sorry. It won't happen again.

I've been known to say to people (nurses, doctors, assistants, etc) "I don't know, I'm just the med student and I'm new. " The ones who reply with something that reminds me to remove the "just" from that statement are often the ones who are the most helpful. Others are grateful that I've acknowledged I have no idea (where something is, for example) and exploit it. I tried to remain positive and remember that I'm at the bottom of the pile (nurses are high above me because they can chart, accept orders and administer drugs - this was made known to me over and over again) and my position in the scheme of things isn't permanent, but it's hard to remember when I'm over-tired and frustrated and often the reason for whatever the problem is/was. I never said or did anything that was inappropriate and often remained quiet when I probably should have said something, but it got me through. The doctors were great teachers and one birth in particular really did make the whole time worth it....

I often left notes with my pager number up at the laboring nurses station before weekends - most said that if a woman in labor came in they could page me and I'd love to come in. Saturday Dec 10th my pager went off at 11pm. I was getting ready to head to bed and paused to think about if I really wanted to go in before I called to see what was going on. A resident answered the phone and filled me in on what was going on, and hinted that if I came in I'd be able to "do" the delivery. That was all it took - a quick shower later (I've learned the hard way that when I leave for the hospital I never know when I'll be back again) I was on my way in.

The doctor who was "on" for the birth was a family physician, and he's seen me around and worked with me (and other med students) before. After we talked about the possibilities for this delivery he took the resident off the case and said that we could do it together; this later evolved into me handling the birth with him assisting.

The laboring mom and her husband welcomed me to her process and was comfortable with how things were going. It was their third child and she had a history of quick labors. This labor took a turn and wasn't quite as fast as we'd predicted, but after an hour or two of sleep it was time to be everpresent in the labor room.

The doctor I was working with had spent some time training with midwives and he taught me a technique to minimize tearing; when it came time for her to push, my hands were the ones on the baby and with the help of the doctor, a bright-eyed babe entered the world without any tears or cuts. I was hesitant to apply as much force as I needed to for the shoulder delivery, but he was there to help out and now I have a (first hand) idea of what it takes to deliver shoulders. (doctors do this part of the delivery differently and this was just one technique) It might have taken an extra contraction or two (of her pushing vs. just a quick cut and the baby being out) but as soon as the placenta was delivered we were able to put the bed back together and leave the room without needing to spend more time repairing things. (we went out and greeted the two bleary-eyed-just-woken-up (in the middle of the night) older kids and gave them the news - that was priceless.)

The difference between this delivery and the others I was at are many, but the one that stands out in my mind was the confidence the doctor had in me. This wasn't' t his first time working with a med student, and it wasn't the mom's first delivery. He was right there to help and had enough experience sitting "back" that he was relaxed through the whole thing. His relaxed (but ever aware - he wasn't lackadaisical about it at all) attitude helped everyone in the room to relax - and that, I think, was key to the success. His experiences aren't something I can count on every doctor having. The whole delivery was calm (in retrospect - there was some yelling and some pain but it was short lived and they said well worth it) and the beauty of the birth process was crystal clear to me. It's the delivery I hope to have with my own kids. (and showed me that it's possible to have a med student there...)

other things I learned....

- new, just born babies sometimes look like old men. A few have coneheads. People who have never seen a new baby can be surprised and might need reassurance that the babe is really okay.

- the placenta is still amazing to me, but it's not always amazing to everyone else in the room. Some women don't realize that it will still have to be "pushed" out a few minutes after the baby. We always said that it didn't have any bones and shouldn't hurt. That said, however, women who have birthed more then one baby will probably notice that the afterbirth cramps are stronger and can be more painful. This tiny little tidbit isn't well known and second time moms often remarked that they didn't remember that aspect of the process.

- While on OB I will have at least one pregnancy and/or delivery dream a night. Giving "birth" nightly is exhausting and not good for quality sleep. (I have no idea if I had boys or girls but it was probably a nice mix of both.)

- guessing the correct weight of a baby once will always be remembered. (it was 9lbs 2oz and I will probably never forget it)

- walking, a birth ball, the hottub, rice socks and hot blankets can all be used for pain relief, and what works for a few minutes during one contraction might not work during the next one.

- Pregnant women are not "ill" because pregnancy isn't a disease. Sometimes, though, pregnant women do get sick or hurt.

- sometimes med students feel like crap and need to go to the doctor too. A trigger point injection and some manipulation can leave me feeling 100% better.

there are many other things I'm sure I've learned, but a week away from the floor (no call on the other babe we're all waiting for) has cleared out that part of my mind. (I can't wait til I get a chance to do it again though...)

Tuesday, December 20, 2005

it all started when someone told me about a beautiful sweater.....

top left to right:
greenish cascade 220 (initially bought for a Rouge cardigan)
a green tweedy Jo Sharp Silkroad Aran Tweed
green/blue/purple cascade 220 quatro (read this yarns potential fate below)
Bottom left to right:
Jo Sharp wool in an icy purple-gray color (an after-test yarn splurge because it was on sale)
Bartlett wool in blueberry (bought after my mom's sweater in this yarn was finished)
Rowan Big Wool in Berry (this yarn screams "warm!")

another view of the yarns - somewhere between these two pictures is where the "true" colors exist. (the Aran Tweed looks better when it's not sitting next to the cascade...)

At the most recent Harlot Sighting at Willow's bookstore (last October?) I had a chance to meet up with a group of knitters who were all at Rhinebeck this fall. Kellee and I discussed the merits of cascade 220 (it started with a "perfect sweater" discussion) and she mentioned that she had seen a beautiful rendition of St. Brigid done in 220 and it was as soft as it looked. A helpful link pointed me in the right direction and after I'd poured over Vicki's page on her St. Brigid I was convinced I needed to make one of my own.

I'd emailed with Katy about the knit-a-long, but I tend to shy away from group things and didn't think a knit-a-long was the best idea for me. In the emails I learned where the pattern was (in a very much out of print book - Alice Starmore's "Aran Knitting") and learned that I could probably use InterLibrary Loan to get ahold of the book. After a little paperwork and a few weeks wait I had it in my own hands, and know that I can get it again if I decide to go ahead and knit this one up.

St. Brigid is one of the sweaters that catapulted me into reading knitting blogs - the pattern was simple enough that the cables really stood out and it wasn't too fussy looking and had a true feminine edge to it. (that could have been the models wearing it, I know, I know.) I like cables, and after hearing it was possible to knit it up in cascade 220 the wheels in my head started turning....

I had six skeins of the purple/blue/green quatro in my stash that were a result of a special order during a local store's winter yarn sale last year (12/04). I called them a month or two ago to see if they had more of it in the same lot and they did (!) so I picked up another 4 hanks. I love the colors of this yarn and bought the 10 hanks after I fell in love with the way it knit up into a warm winter scarf. Now I have enough to go ahead with the sweater, but do I have the time?

A sweater for me is the ultimate project but so far my attempts at them haven't been too successful. My noro sweater needs to be taken apart and re-knitted with some waist shaping and additional length, the sonnet sweater needed a trip through the washing (felting) machine to be wearable and my striped brown sheep cotton sweater is still in time out for sleeves that aren't quite right. I did finish a warm (and simple top down raglan) sweater for my mom last year and I've had great luck with kid's sweaters, but my confidence in another sweater for me is shaken.

Part of the problem is that I have no idea what looks good on me. Margene and Claudia are great examples of people who know what styles look good and what sizes are best for their body types - I don't think I've figured that out yet. I do know that cardigans look better then pullovers (and are more practical) and that some negative or less ease (or a more fitted style) is more flattering. But putting those things together into a sweater that I'll wear? that's the trouble....

I have enough yarn for several sweaters but only a (relatively) short time amount of quality time to spend with my knitting before the craziness of my rotations starts up again. Do I make a simple top down cardigan in the blueberry Bartlett because I know it's simple enough to work on? Do I knit something up with the big wool because it'll be a fast knit and warm enough to wear this winter? Is a Rogue finally in my future? Or I do start swatching the quatro for a St. Brigid and do the best I can with it before I start in the hospital again?

I don't know. I do know that until some of the above it knitted up, I do not need any more sweater yarns.....

while I'm regrouping....

here are some links to one of my favorite things about this season.......

You've seen this - but have you seen all of them? (these bring a smile to this sister of an engineer)

my favorite television commercial - who doesn't love a headlamp?

and a short (free!) film staring a Santa Tree Ornament who is on a mission

I'm officially done with my ob/gyn rotation and have two weeks off* before starting a six week stint in heme/oncology (the study of blood and cancer). The last week of ob ran me ragged (the combination of a storm and a full moon!) but I had a good time and had a great delivery that made the entire thing worth it. A final "what I learned on this rotation" is in progress and will appear sometime this week. (The belated happiness is.... post may show up at some point too.)

(* though I am free of any hospital duties these two weeks I asked to be paged when a patient that I've been following comes to the hospital in labor. I met her during my first week on the labor and delivery floor and saw her 1-2x week for 6 weeks. She asked if I would be there for the delivery and I can't wait until I get the call! She will deliver in the next two weeks so now it's just a matter of waiting for the page...)

knitting: it's great to have time to think about what is next up on my "to do" list and after a few small holiday projects are completed, I think it's time to dive into a sweater. Today I went through my set-aside-for-a-sweater yarn stash and have a few contenders - more on that to come when I can get daylight pictures. I sent a handful of hats off to Kaleidoscope Yarns today and my fingers are crossed that they'll arrive before the deadline for getting them to the shelters. (I'm not worried about entering the contest - I just want to make sure they get to people who need them!)

All in all I'm glad that I have some time for myself right now but I do feel more disoriented now that I don't have a place to be every morning. My car looks like it's been lived in and the library of books in the backseat all need to come in and be reshelved. The pile of clean laundry waiting to be ironed could take over a small country and I'm afraid of what is possible if it ganged on up on me with the waiting-to-be-washed loads - all I know is that I'd loose. The piles of yarn all over the house need to be gathered and sorted and put away (somewhere?) and I need to figure out if everything in the fridge is still good. Life seemed easier when I just didn't care about these sorts of things....

(I think I'd like a helper elf for Christmas. Is that possible, or am I too late to order one?)

Thursday, December 08, 2005

another thing (or two) to be happy about....

it's not Sunday but there has been enough going on for me to recite what happiness is midweek:

- hot hot tea with fresh lemon and honey
- today is my friend Katie's birthday
- I was able to take a looong nap this afternoon (and woke up feeling 100% better)
- my board scores arrived today, and I passed. :)

I'm excited that this aspect of my third year is over and I can stop thinking about "what if" and relax. Thanks for the good thoughts sent during the exam - I owe you all.

Sunday, December 04, 2005

happiness is....

- a sock-in-progress knit with trekking xxl and size US 1's (tiny for me)
- koigu, waiting for it's turn on the needles (or to be shoved into the stash; it's fate is still up in the air)
- a pager that did not go off this weekend
- a "my so called" scarf that is thisclose to being done
- fresh purple juice
- being able to sleep in, two days in a row

I'm working on some holiday knitting, but it's a collection of simple things that I can pick up and put down. Chances are good that they'll be done by the 25th, but if not it won't be the first time I've gifted balls of yarn and needles with the promise of a finished product. I'm itching to get going on a pair of socks on US2s, but I'm trying to limit how many socks I have going. (I have a cabled pair of "homemade dyed yarn socks currently stalled just before the heel" currently on the 2s. Working on them again will require thinking. I'm not there yet.)

I didn't realize how tired I was until I had time to sleep this weekend. When I am at the hospital or in the clinics I am "ON" and go and go and go because I love what I'm doing and I'm excited to be there. (especially when women are in active labor and babes are being born left and right) It's not until I "stop" that my exhaustion catches up to me, and I enjoy being able to sit around the house in my jammies with cups of tea, junk tv and my knitting. I love to shop but hate the crowds of people and traffic that is out this time of year, so I stay out of the way and get what I need to (groceries and gas) in the late evening hours. It's cut down on my yarn buying because by the time I get out, the yarn shops are closed!

I'm 4 weeks into my 6 week ob/gyn rotation and I can now see the benefit of a 4 week rotation. At this point I know my way around the floors, know the nurses (and which ones are good and which ones are excellent), and have seen some patients more then once so they now know who I am and ask if I'm around to help with their monitoring... but I feel like I've been doing this a long, long time. Next year I'll have the freedom to create my own schedule and 4 weeks is the standard length for a rotation. (even in my internship year of residency the rotations are 4 weeks long) This isn't to say that I won't put 100% into the next two weeks (and perhaps the few births I'm hoping to see in the two week "winter break" I have after that) but hearing about how my classmates are sick of what they are doing is dragging me down. I do love OB, but the days without any action sure are loooong.

(this means that my ob/gyn ramblings will only persist for another two weeks; then knitting and dyeing and even drop spindling return to center stage)

Theresa, a knitting 4th year med student, is someone I met at the first Willows-YarnHarlot book signing I attended. She just started a blog - please go and say hi!

And Elinor, a former lurker here, just started her own blog too - check out Exercise before Knitting and welcome her to the knitting blog world.

Saturday, December 03, 2005

what I learned this week

Knitting is happening, there just isn't anything interesting to post pictures of...yet. This will become a knitting blog again soon, as my ob/gyn rotation is 2/3 over and I've only got another 2 weeks to go.

- women come in all sizes, shapes, heights, weights and ages, and with various previous birthing experiences, but everyone dilates to the same 10 cms.

-Epidurals don't always work. There is no way to tell, before an epidural is placed, if it's going to work. Most of them do work. If it doesn't work, there are other alternatives. The anesthesiologist can be a laboring woman's best friend.

-There are things that lamaze (and other forms of childbirth education) doesn't teach: pushing will hurt, but it might feel good to be doing something. The action of pushing uses the same muscles that are involved in episodes of consitpation. If you think about and feel like you're taking the biggest dump of your entire life, you're pushing correctly. (chin to the chest and curling around the baby might not feel great at first, but it's much more effective then arching the back and throwing the head back. I say that with absolute certainty because I've seen the difference and women "move" the baby down further when they're curled.)

-there are many ways to describe the stages of labor (aside from the well documented and classic "Three Stages of Labor") and one way is by looking at who comes into the room and what they are wearing. For instance: the nurse sees you for a labor eval. The doctor is called. The doctor arrives in nice clothes to check in with you. The nurse checks in (again and again). The doctor checks in and you're almost completely dialated. The doc appears in the room dressed in scrubs (getting close!). The doc gets dressed in a snazzy sterile blue get-up (even closer!). The room fills up with a baby nurse, a labor nurse, another doctor clad in blue and lots of "stuff" for the babe. This is a sure sign that the arrival of the little one is mere minutes away.

The birth plan = c-section observation is something I've been thinking about and I have a few additional thoughts on how it works *in the hospital system I am in.
(* this is important because I have limited experience outside of this hospital system, and do NOT believe in generalizing because there are always exceptions to the rule.)

- the women I've met who've presented the nursing staff/doctor with a birth plan have been young, and often have sisters, cousins or friends who have encouraged them to write up a plan. This could be because the women's friends/family didn't have the birth they wanted and wish that the laboring woman have a better experience OR because the friends/family did have a plan and feel that the positive experience they had was because of the plan.

- many of the women are not familar with hospital policies. The hospital that I've spent the majority of my time in has standing requirements such as each woman have a heplock or IV and that's often one of the things people wish to avoid. (most wish to hydrate themselves by drinking liquids, which is fine, but there are cases when medications need to be given quickly, and that's what the iv access is for.) Some wish to eat whatever they please during the labor and it's oftne the policy that clear liquids are all that is allowed (for many reasons). Many wish to walk, move around on the birthing ball or use the hot tub for pain relief; that's encouraged, but every 45 mins or so we ask them to stay in one place so we can monitor the baby's heartbeat and contractions for 15-20 minutes. The people who don't realize this feel restricted and it can lead to frustration that could be avoided if the policies were discussed beforehand. (I have more time to spend with patients then the doctors and nurses and try to answer as many questions and explain everything because I think an educated patient feels more comfortable with the situation they are in, and that can make for a better overall experience.)

- some women with birth plans come to the hospital for labor induction. The process starts with an overnight cervical ripening (which requires constant monitoring overnight) and the next day a medication (that is a chemical analog to the body's own natural labor starter and uterine contraction creator) is started. The medication requires an IV and IV fluids and some find that the contractions are stronger then with "natural" labor. This means that the nonmedication-based pain relief isn't as effective and then some feel like failures when they ask for pain medication. To some, this is a surprise because they didn't realize it might be "harder" with the labor induction protocols.

- no one knows how they will handle labor until they are in the middle of it. Even moms who have done labor before might find that the labor they are in is nothing like previous labor experiences. Some who are sure they'll be able to labor without any pain meds are disappointed in themselves when they feel as though they can no longer take the pain, while others who walk through the door asking for an epidural have labors that move too fast for any pain medication.

- sometimes expectations (such as those found in a birth plan) seem to hinder progress. Most of the birth plans I've seen are for "all natural" labors** and they are frustrated with how slow things can move. Women who are tired and in constant pain (sometimes) do not progress as fast as those who are more comfortable and able to "open up" to let their body do what it needs to do. There are a few reasons for a c-section and two of them include "failure to progress" (not dialating or the baby isn't moving down) or a babies inability to handle the labor. In the failure to progress cases (when the baby is doing fine) an epidural can be all it takes for everything to relax and rest and dialate.

(** I now believe that a "natural" labor is one that results in a baby.)

Thursday, December 01, 2005

note to self:

apparently "shouting" the phrase "It sure is QUIET (QUIET QUIET)" to the internet works better then silently chanting it at a nurses station.

Last week? nothing, nada, I didn't get any calls for deliveries.
this week.......
Tuesday: 2 new babies
Wednesday: 3 new little ones
Today? 4 down, 2 are resting and will probably deliver in the next 12 hours.

There were random other deliveries (middle of the night deliveries, ones when I wasn't there because I was out in offices, c-sections) that I haven't been a part of, but overall I am very excited at this turn of events.

I've been working on my trekking sock and though I like the fabric that size US1's are producing, I must say that I miss the speed and "fastness" of the 2's. It's been slow going because I've been busy! (that's not a complaint, simply an excuse for why I haven't been knitting....I miss it, but know I'll have time to pick up the needles again soon.)

I've seen a lot, done a lot, learned a lot and must say that seeing a baby enter the world is nothing short of spectacular. The whole event leads me to be incredibly giddy and I've been known to jump and hop down the hallway. I need to learn to contain myself because the nurses are starting to make fun of me......