realizing long dormant dreams

HA.  That title is way too solemn for what this actual post is about, which of course is nintendo.  I stumbled upon a picture on the internet a while ago of a person playing Mario Kart 64 out in the beauty of nature, projected against a blank wall.  What more could a girl with a super nerd fiance ask for?!  And, more importantly, what more could a super nerdy fiance give a girl who would ask for such things?!

Well we planned and plotted, and packed up a giant haul of things to bring up the street to Joe's house where it had been decided that the shenanigans would go down.  I brought the meat and cheese, and JP hoofed the heavy suitcase.  It was not lost on us that we both had extremely light weight and powerful wireless machines in our pockets that had far more power then all the heavy stuff we were shleping about, but nostalgia knows no weight my friends, so up that hill we did walk.

After the food had been consumed and the sun was just setting, we slung some extension cords out Joe's bedroom window (brown to match the brick work all sneaky style), and let the magic begin.

After a few rounds we realized a fan would be necessary to blow away all the mosquitoes that we couldn't swat away while in the throws of karting.  I'm sure you understand how these things can be.

And in the end, it was everything I ever thought it could be, I wish you could have been there to experience it for yourself because it was glorious.

house on an island

Is there anything more glorious that staying in a house on an island for a week?  That laid back, serene, salty aired goodness to soak up.  Bicycling to the market in the morning (and afternoon, and evening, it's a Walsh vacation, we need copious nacho supplies, come on!), barbequing on the grill or making fresh lobster, reading in a rocking chair on a screened in porch safe from all those ravenous mosquitoes.  Delighting in the exhaustion of a pup who ran all his energy out in the nearby woods and ocean.  Playing cards by candlelight.  Swimming in the frigid water and skipping rocks on the shore.  It was bliss.  We all came and went between work and friends and other obligations. and it was just the perfect gathering spot for relaxation with some of the loveliest people I know. 

My pops and I on the ferry 

Yin likes to travel in style.

 

 Haircuts were had.

 

Rocks were skipped.

Pups were refreshed.

 

Bicycles were biked.

Lobsters were tastily steamed by one brave Emma.

 

 

Naps were attempted.

Sunsets were enjoyed.

fourth!

This time last year I was cramming a ridiculous amount of immunology into what felt like a pea-sized brain.  In stead of that mess, I got to spend this year's festivities with JP, Joe, Emma and our pups.  Next to a lake!  Grilling foods!  Playing bocce ball!

My favorite part may have been introducing Oliver to fireworks though.  He was terrified and army crawled from me to JP to Joe, and dove head first into Joe's armpit to hide.  Joe wrapped himself around O like a protective straight jacket and together they rolled over to the wall and Joe let Oliver squish between him and the wall, covering his eyes with his arm, and letting him peak out occasionally.  It was the most adorable thing ever.  After the fireworks finished Oliver popped out as if to say, ain't no thing guys, I was just pretending. What a loon. 

onwards to summer

Out side of rotations I have finally managed to find time to enjoy summer in New England for the first time!  Last year was all tour-of-air-conditioned-classrooms, but this year is a different story entirely.  I made a rule for myself this summer, and that rule is that if there is a question of swimming my answer should always be yes, yes please.  While living in land locked Colorado, the thing I missed most was a large body of water.  Now I live by ocean and lakes and rivers and streams!  I don't think I want to live anywhere too far from water again, it's so life giving and magnificent.  In any case, I present to you our water filled summer thus far:

O and I visited Em and Chris at Chris's family cabin on Lake Sunapee in New Hampshire

 

 

Long lost cousin's came to Maine for a week long vacation and we grilled on the Eastern Prom at sunset.

 

JP and I took our bikes on the ferry last weekend and biked around Peak's Island.

 

Here is Emily's favorite swim spot on the Presumpscot River, where Emma, Oliver and I have been coming after work to get a break from the humidity. 

So, summer has been good so far!  It feels like a long time since I have been able to get out and enjoy some sun and nature.  I love living in Portland, it's such a great place and so close to a lot of cool things!  My parents continue their hunt for a second home here, and they are coming out on the train for a whole week to visit.  Hooray life!

in the ICU

My first six week rotation is coming to a close with my final shift tonight.  It seems amazing how quickly the time passed, and I can already see that before i know it I will be out practicing medicine on my own.  I've been slowly, sllloooowwwwllly gaining my footing in the ICU, and even on rare occasions have intelligent thoughts to bring to the table.  Miraculous, eh?  Before I close this chapter and move forward to cardiology, I was thinking about some things I learned in the ICU and I thought I would share them with you:

1.  People are fallible, which means that people who practice medicine are fallible.  Simple concept, right?  Well in principle yes it is, but I haven't actually thought about what that really means until recently.  I hadn't realized how much of a person's care is determined by who is caring for them.  In my head I kind of thought, ok, bedside manner aside, we are all practicing medicine from the same blueprint more or less.  The same general set of guidelines that say give this specific drug to counteract that specific problem, recognize that this particular pattern is pathognomonic of that, the steps for problem A should always follow this certain protocol.  I know I am still in my little student world where I really, really, REALLY want things to be black and white, at least until I can fully grasp their concepts and have a prayer of understanding all the gray, but they never, ever are when it comes to medicine.   But, sometimes I see people doing things that directly contradict what the research says, or I watch someone continue to give a drug that is not working but won't back away from the problem long enough to realize that their original diagnosis might have been wrong.  I don't say that to pass judgement or to make myself look like I know better, those moments have just really made me stop and think about care that I have had in the past, or care that my family and friends have received.  It makes me think that when I am out on my own, even with a supervising physician, it really comes down to what I decide to do for my patients because that's what I think is right, and even if I am wrong, that's what the patient will get.  It's weird to think about, and makes me feel like I will have to study every day for the rest of my life just to keep up.

2.  Holy moly are things sad.  In real life I was thinking about how bizarre some of the behaviors that happen in the ICU would seem out of context or even just to anyone not in the actual experience.  The lead nurse said to me "It might seem strange, but we have to laugh to keep from crying".  I had that realization when I had just completed my second examination of the day to determine if either of my two patients were dead by neurological criteria (which both of them were by the end of the day), and we had just reviewed the most recent head CT and officially declared one of them dead.  At one point right after we realized that this forty year old man was not going to recover, we were all standing in the room and laughing about something trivial, like it was just a jolly ol' day, and at the time it made complete sense.  For me, it was an extremely surreal and disconnected moment to hear myself laughing at a joke, and at the same time looking over into the eyes of my now dead patient, with the ventilator still delivering oxygen into his lungs, maintaining his shell of a body.  And then we went on lunch break.

3.  Holy moly are things miraculous.  At the other side of the spectrum are the incredible, death defying moments where a patient arrives to the unit in a state that just does not seem compatible with living for very much longer, and through the work of the entire team they somehow make it to the operating table, the problem is identified and fixed and they somehow miraculously survive!  It's incredible to see someone who needs 24 back to back blood transfusions to even maintain the slightest glimmer of life, and then five days later talk to them in their hospital bed, off of the ventilator and on the road to living their life again. 

4.  Sometimes in the ICU, if you are me, you will look like a gigantic dumbass.  It is my absolute saving grace that my two best PA student friends share very similar stories to my own at the end of every week, and that we can belly laugh so hard at the incredible things that manage to come spilling out of our mouths at times.  It's really hard to weather those moments all by yourself, but man is it good to know there are 51 other people scattered around New England frantically wishing they could shove those words right back into their own gaped open mouth just like I do at times.  Exercise in humility every day over here!

5.  I've learned that I don't want to be kept alive on a ventilator.  I was thinking about that when I stumbled upon a Radio Lab episode about life saving measures.  They said that when polled, something like 90% of the general public say they would want every measure done to keep them alive (CPR, intubation, ventilator, etc) and something like 90% of medical providers say they wouldn't even want CPR done, that all they would want was pain medicine to keep them comfortable.  It's really interesting how in the ICU I have gained a real insight into the reality of what "do everything possible" actually means, and how tortuous that process can seomtimes be for a body.  You can find the episode here if you're interested. 

5.  Lastly, I have learned that time is short and you never know what is going to happen to you or to the people that you love.  In this entire six weeks of humbling, terrifying,  awe inspiring, and devastatingly sad experiences, I learned and hope that I continue to remember to remind the people in my life how very much I love them. 

So, there are some thoughts, of which there are many many more.  I've got one last shift to learn a few more things and then it's off to the next learning experience.  What a ride!

dial it back

Remember that time I biked across the country? You probably do in different ways, just like I do.  I've got some memories from the posts I blogged, pictures I took and postcards I sent and received.  I sent JP good morning videos to give him a piece of my day, and talked with various friends and family while laying on my thermarest.  Some of you came and visited me, some even biked!  A lot of the memories I have though are intangible, and sometimes there are moments when I least expect it that squeeze my heart fiercely, and remind me of the many tiny little details that I cherished.  I was listening to This American Life on one of my early morning commutes to the ICU and an incredible story came on.  It captured so perfectly many of the overwhelming feelings and emotions that were so very difficult to describe while I was on Bike & Build.  I figured I would share it here, and if you like you can listen in and experience a little sliver of how it felt to be on and complete such an incredible journey.  You can find it here. 

Jamaica, in pictures

Our vacation in Jamaica was so incredibly relaxing and rejuvenating, all the things we desperately needed.  Even though I packed two textbooks, I shoved those guilty feelings of not studying waaaay way deep down and didn't even crack them until the flight home. 

It was absolutely amazing.  We did the type of a vacation my family never did when I was growing up.  Probably due in part to having four kids, and a lot in part due to the fact that in my family vacations mean adventure and exploring and camping and hiking and visiting relatives.  Don't get me wrong, I LOVED our family vacations, some of my favorite memories from my childhood are tied up in road trip to our grandparents farm and hiking in to a cabin in the woods for a few days, or just exploring new cities and towns, and I love going to new places and exploring new cultures, but now I know that I can also love a beach vacation with days full of unstructured time, swimming when you want to, reading a book for fun and taking a nap in the middle of the day just because you feel like it.  We went snorkeling every day!

It didn't matter what time it was, we just woke up when we wanted to, ate what we wanted to and did what we wanted to.  Such a different story then our real lives, and it was fantastic!  We stayed in a condo right across from one of the most beautiful beaches in Jamaica, we had a little grocery store on the bottom floor of the building, a swimming pool on the top floor, a place to play pool across the street, and somehow we managed to arrive just after tourist season ended so the whole place was practically just ours! 

We celebrated JP's 27th birthday, a number that he seems to think sounds incredibly old.  I of course have no pity for him, he always relishes in the fact that even if he is old, I will always be the oldest!  I made him a birthday sign, which has become tradition from last year and the year before and even the year before that! Sheesh!  The balloon was a joke, he hastily updated the balloon I made for his 26th birthday by putting an 8 on it for my most recent birthday...now it also has a 7 pasted on top!

On his actual birthday we went to Negril, which was about an hour down the coast, and checked out the famous seven mile beach. 

We also went to the local hot spot Rick's Cafe and saw clif jumpers and divers.  We even witnessed a couple in their wedding clothes jump off the 30 foot ledge.  It was quite a sight to see her wedding gown flowing up behind her!

And that was our vacation!  Of course I would be remiss if I didn't include the gorgeous sunsets we witnessed, which were so beautiful every single night!

                                    And now  back to reality!