In case you can't get enough, here's chapter two:

http://momd-thesecond.blogspot.com

See you there!

THE END!

Today I was in the resident lounge, and it dawned on me - this year is O-V-E-R. There was a fresh batch of interns trying to put on their calm face when inside you know the anxiety was nauseating. They sat at the computers frantically scribbling notes trying to learn the patients they would be responsible for in a few short hours. Several were still trying to figure out how to log into the computers and asking where to find charts. It wasn't long ago that it was me in those shoes. And as much fun as it was to watch the incoming class, it was even more exciting to watch my fellow soon-to-be-former interns. Confident. Knowledgable. Relaxed. What a striking parallel to the nervous, naive, and stressed interns that started the year twelve months ago. Truly remarkable. Change is awesome.

Clearly, I've grown as a doctor in the past twelve months. It would be impossible not to. But it has also been a complete transformation at home. I went back and read my first few blog posts and remembered what it was like it to hold 6-month-old Owen. I didn't think it could get any better. I was wrong. It is so much better. To see that smile and those little feet chugging as fast as they can go to the door when you get home has brought me to tears more than once. My heart melts when he lifts his arms in the air to be held (which doesn't happen very often), and who could resist his sloppy kisses. He is such a little man now. And just think, there is another little one ready to come and melt my heart any day now - maybe any hour. Being a mom has been more than amazing, and more than I could ever express in words. Talk about changing you. It doesn't get any more transformational.

So I guess this is it. This blog is a wrap. "MOM.D. - Intern year" is completed. Intern year is completed. Never will I go back. Never again will I be that low on the totem pole. No more 30-hour call shifts. No more crunchy hospital pillows. No more single stroller jogs. No more family photos of three. No more. Good-Bye. The End.

... at least until I come up with a name for another blog

What a Day

Have you ever gone to bed at night and thought, "Wow, if I had only known what this day would hold when I woke up this morning..."? It was one of those days today for me. Yesterday at this time our lives were different. More uncertain. So much hanging over us.

As I finished up work on a presentation this morning I heard Jason in the other room on the phone. Anytime he's on the phone, I play this game with myself and try to guess who he's talking to and what they are talking about. Not to brag, but I'm pretty good at it, too. So even though I had it all figured out by the time he hung up, it was still a relief to hear Jason confirm my suspicion. He was indeed talking to our real estate agent, and we indeed had a negotiated contract on our house. Yes! This is what we've been waiting for. Of course there are a lot of hoops yet to jump through, but we are one huge step closer. If everything falls into place we will close on July 27. God's timing is perfect! We'll get to bring Baby Newman #2 home to our home (not to a temporary apartment or hotel), and yet we won't have to pay a single extra month of our mortgage. What's even more, our yearly flood insurance premium is (or would be) due on... you guessed it: July 28. Perfect.

If that isn't enough exciting news for one day, I had an Ob appointment this afternoon. Everything is moving along smoothly, and they started my "checks" today. 2-cm and 50%. Whoohoo. The doctor in me says to chill out because a single check doesn't mean a single thing (I could go into labor tonight or in a month); however, the expectant mom in me is excited that this body of mine is actually doing something, and we'll be having a baby soon. Although my due date would say I still have 4 weeks, I just got a little more hope that it won't be nearly that long.

Wow, what a day.

Just A Theory

I have a theory. It seems the less I "have" to work the less I "expect" to work.

On months where I slave away for hours and days on end, I seem to be relatively productive with my time. And, I seem to gripe and complain less when I have to go in for a few hours on the weekends. I'm grateful to get off at 5:30 instead of 7:00. However, on months like this one, where I'm working 9-5 or less, I dread going in and count the minutes until I'm on my way home. I hate to admit it, but sometimes I even whine when I have to stay the full time until 5:00. Why is that? Maybe it's just me.

For example, today 9:00am was the start of my work day. On previous rotations I've been there for at least three of four hours by then. Our staff on this rotation is usually late so I even rolled in 5 minutes late today myself. (I was the first one there.) I had a meeting at 11:30 across town, so my "work day" ended at 11:00 and I was home after the meeting around 1:00. I really worked for less than two hours and yet instead of being thankful, I wished instead that I didn't have to go at all.

Then, since I wasn't expecting to have the afternoon off, I concocted all of these brilliant plans for the afternoon. Study for boards. Finish a presentation. Clean. Do laundry. Make some phone calls. Two and half hours in and guess what I've done... check email and facebook (a few times, might I add), and now clearly I'm procrastinating even more by blogging. Pretty pathetic, huh?

I should probably make a mid-year resolution to change my attitude. So for now, I'm going to close my internet and get to work on my presentation... After I check Facebook one more time.

Alzheimer

I've seen a lot of sick people. I've had to tell a lot of people bad news. I thought telling people they had cancer was going to be the worst part of the job, but I'm quickly learning that people take hearing they have, or their family member has, Alzheimer dementia just as poorly. Who could blame them?

Nearly half of the elderly population have AD, so if you haven't dealt with it yet, just wait. It is also not a very forgiving disease. It slowly steals your life and your dignity. Trust me, it doesn't just steal your memory. First you lose the ability to do things you learned as a young adult. Managing finances. Cleaning and cooking. Then those teenage lessons are gone. Driving. Shopping. Time keeps rolling backward and you loose your childhood. Dressing and hygiene. Finally, you're stripped of all independence. Toileting. Feeding. All gone.

Terrible. Frustrating. Aggravating. I know. To shed a little light on such a gloomy topic, there are a few things out there to slow it down. Aricept. Razadyne. Exelon. Namenda. Take your pick. We might not have a cure, but it's usually better than nothing. And at this point, it's all we've got. People have tried estrogen, testosterone, NSAIDs, and ginkgo, but nothing else has really panned out. Hopefully, there are some smart people somewhere hiding in a lab working on the next "latest-and-greatest".

Maybe we shouldn't just sit around and wait for the robber to come in the middle of the night and take this from us, why don't we try locking the doors and windows first and prevent this relentless beast from taking hold in the first place. Sounds like a great idea, and we've been looking. Unfortunately, NOTHING has been shown to be effective in preventing AD. Few people say that taking omega-3, controlling blood pressure, and staying physically and cognitively active can help, but unfortunately the data just isn't there. Yet. In my opinion though, it can't hurt. So keep playing Rumikub, Grandma!

In One Month

In one month, our world is going to be rocked! Literally. We'll be rocking Baby boy Newman #2 in a few short weeks. (Although I'm sure it's going to drag on as I not-so-patiently and anxiously wait.) This pregnancy has flown by to say the least. At times it actually makes me sad because I want to savor every big pregnant belly moment and time for those moments is getting less and less as each hour passes. As hard as it is to remember all the details and feelings of carrying Owen almost two years ago, I know that these new feelings of kicks and anticipation will fade with time as well. Thankfully, they will be replaced with memories and emotions of holding a precious perfect little life, and smelling that new baby smell. That's a pretty fair trade if you ask me.

If you think having a baby is a big family change, in one month we will also be packing up and moving to Grand Island. In my opinion each of those events is enough excitement for a year, but don't call us exciting for cramming it all into a few weeks - call us crazy! Just like with this baby's birthday, the date for the big move is yet to be established. Hopefully, they won't pick the same day. This baby will come when he's ready. And our house will sell when it's ready. While that definitely raises the blood pressure of this left-brained planner, I know that it will all work out in the end. The baby may not have a cute nursery to sleep in his first night at home, but I did get him a cute little outfit (including shoes) to leave the hospital with. And, as Jason says, he'll never know, or care. He has two parents, a big brother, and lots of family who love him. God doesn't make mistakes, so it is no mistake that these two events are colliding now. Thankfully, it won't be more than we can handle. We will all just have to wait and see where we are and who we have in just one month.

In a Groove

Maybe it's the fact that I'm a few weeks away from being done with this year. Maybe it's that I'm burned out from my last few months. Or maybe it is being 8 months pregnant, miserable, and exhausted. Whatever it is, I cannot find my groove this month. Usually by the first week, I've settled into the new routine and its expectations, but this month on geriatrics I am still struggling to be efficient and to take ownership of patients. Nursing homes are not my favorite places to be or to practice medicine, but neither was the cancer floor or the ICU. Hopefully, I'll either find my groove soon or just pray that this month will go by quickly.

Vacay

What a way to start a month. After just a couple of days of work, I am out. Vacation here we come.

With a 17 month old, a tight budget, and being 8 months pregnant our idea of a vacation is a little limited. Even though he was an angel at 4 or 5 months old when we flew to Texas, there is no way a plane trip would be a pleasant experience now. At least I'm not going to try and find out. And, after several trips to Grand Island, we're learning our driving time is getting shorter and shorter. Owen pulls out his special, shreeking scream just for car trips. It gets under my skin in about 1 minute and under Jason's in 1 second. Add to that Jason's bladder (which, for the record, is much more of an issue than this pregnant lady's), and we are lucky if we can make it out of Omaha. Kansas City seemed like a decent enough challenge - tolerable driving time yet far enough to feel "away."

Even with my type A personality, we haven't planned a lot for this trip. Of course we are going to a baseball game. Jason wouldn't have it any other way. And if you know my husband, we've already had a few detours to random historical sites "on the way." (By that he means 30 minutes out of the way for a 30 second photo op.) Makes me laugh - usually. We are also planning another detour to see some friends who moved to Kansas on our way home. And other than that, our plans include sleeping (except after one night we've discovered that's not one on Owen's agenda), eating lots and lots of the hotel's free breakfast and maybe some barbeque, swimming, visiting some parks, and mostly just relaxing.

Relaxing! That's what I'm looking forward to the most.

Cancer Sucks

Some days I really can't believe that I survived the last two months. It is the end of a long, long journey. I've grown and learned a lot, but there is one realization I knew going into this that has only been solidified: Cancer Sucks! And, at times, it does Big Time.

Sure there are plenty of other diseases that can give a person a shorter life expectancy, and sure there are more and more treatments and possibilities for cure than every before, but still there are no other more earth-shaking, life-altering, gut-wrenching three words that I, as your doctor, could say than: "You have cancer." And if it's earth-shaking, life-altering, and gut-wrenching for me, there is no possible way to begin to understand what it is like for you, my patient. The faces of the people with whom I've had that conversation are burned in my brain. Over my short career, it hasn't gotten any easier - actually, maybe it's getting more difficult. The other day, I was surprised, and a little relieved, to hear one of our staff oncologists, who does this everyday, say that it hasn't gotten any easier for her either.

To those parents who are, or have, watched their children (grown or not) battle this disease, I'm sorry. So sorry. There are few things that could be more painful or more unfair. I understand that you're angry. When I was frustrated with you for being frustrated with us for not doing things fast enough or good enough even though we were doing things as fast and as good as possible, I imagined Owen laying in that bed. Wow, does that sting. I snap out of it in less than a second because it hurts too much and come back to the reality that I have a healthy boy running around at home. I can't bring myself to even imagine him crying out in pain, full of fear, and leaving me helpless to change it. Me, running back down the hall after I stepped out of his room just to get a drink when I hear a beep echo and think that it is something terrible coming from his room. Thank God, He has a plan.

It has been one thing to take care of patients with cancer this month, but even when it has been my turn to go home and set the pager aside I haven't been able to escape. A few months ago, our sweet Uncle Loyd was diagnosed with cancer. Metastatic. Painful. Incurable. The stubborn man with the great stories and a huge soft spot for Owen is slipping away. And fast. In November he was working two jobs. December, he made his famous Christmas breakfast. January, on a train to California to see his family. February, fighting. March, losing. April, realizing it. Now in May, he's laying in a hospice bed with no chance of balancing relief from the pain with sedation from the medication. Do you mind if I say it one more time? Cancer sucks.

I think I've cried more these past two months than the ten before. I've said prayers, but not enough. To our family facing the reality of cancer, to my patients' families, and to yours if you find yourself stuck in this too, God does have a plan. A wonderful plan. But if it helps, it's okay to admit, to say, to yell: Cancer Sucks!

Other Side of the Coin

After my rant about being tired and overworked yesterday, I did feel better. However, it also made me reflect on the past few weeks. In the midst of that reflection came a realization that there have been some pretty awesome moments, too. I'd feel like a used car salesman if I only told half of the story and didn't "rant" about the good stuff, too.

On my only night that I didn't get called in for a new admission, I came in for a different reason. One of our patients had a sudden change status. It was so unexpected that I didn't even check my bed hair in the mirror before heading out the door at 2am. His blood pressure and heart rate were off the charts. He had a fever literally radiating off his skin. And when we were able to wake him up we almost wished we hadn't with his swinging arms and kicking legs. Immediately, we started testing and treating for all of the bad things this could be. (After all, there aren't too many good things this could have been.) Within a few long hours and a few wrong hypotheses, we had our answer. Thankfully, we hadn't waited those few long hours to begin treatments, because otherwise, as my boss put it later that week, "we would have diagnosed it on autopsy." He also told me, "The decisions you made that night saved his life." Catch that - Saved His Life. Awesome.

Recently, I've been seeing a patient who is in complete denial about the terminal part of his diagnosis. (And maybe that's not an all bad way to live the short life you have left. After all, no one really can say I have any more days than he does and sometimes I live in denial of that.) I've decided to just let it be. I'm learning that it's not my job to beat it into his head until he cries. He knows. Now I'm just trying to make him feel a little better each day. Today was a good day. "You're the best, Doc" he called out as I left the room this morning. Rewarding.

A hug from a patient or a family member is always lovely. The hug I got a little while ago was even more so. She hugged me out of genuine thanks and gratitude for making the long phone calls that made it able for her to get on a plane from Afghanistan to Omaha in order to be with her dad in his last few days. The pride, peace, and joy in his eyes brought tears to mine. Unforgettable.

Lastly, a patient was sitting in her chair as we came in for morning rounds. A tube was coming out of her nose, IV's connected her arms to poles, and the few hairs left on her head were laying every which way. She scanned the crowd of seven-or-so of us as if trying to figure out who we were. Then her eyes landed on me. They brightened. "Dr. Newman. You're the faithful one." Turning to my boss she said, "She's here everyday." Ahhh... appreciated.

14 Days and a Few Hours

If this month is any longer than 14 more days and a few hours, it may be the end of me. I'm dying. I knew Oncology would be a difficult month, but it has far exceeded expectations. My patients are awesome... for the most part, and the actual work itself isn't bad. However, there are only two residents on the service (for some ungodly, political reason) to split the call. I'm not that great at mental math, but there aren't too many creative ways to split a month of being on call between two people and end up ahead. What it has boiled down to is what we call "q2" (in layman's terms - I'm on call every other freakin' night). And the way my luck would have it, even though it's calls we can take at home, I'm at 100% for having to go back into the hospital during the night for a new patient or something going on with a current patient. My body is exhausted, sick and dehydrated, and my emotions are fried. When I'm finally able to break away and come home I'm torn between my need to sleep, eat, cry, go to the bathroom, or spend desperately valuable time with Owen and Jason. That doesn't even touch the things I "want" to do: cook, buy groceries, watch the news, buy something for this neglected baby I'm carrying, clean the house we're trying to sell, do laundry, buy my husband a birthday present (especially because his birthday was May 14th), call my parents, hang out with friends who are moving away, go on a date with my husband, take Owen to the zoo, go to church, get a haircut, buy a few more maternity clothes that actually fit this ever-expanding belly, etc... Not that I'm frustrated or bitter or anything. Ahh, the life of an intern. Honestly though, I couldn't make it a second more than 14 days and a few hours. The count down has begun.

whew... that felt good to get off my chest. sorry for being such a debbie-downer. i hate being so negative, so here's a little something that will make anyone smile...

Oncology

Once again it is a new month. It's a little bit warmer outside, the sun is still up when Owen goes to bed, the grass is greener, the heater is off, and I find myself yet again on another new rotation. This month: Oncology.

The general chatter in the resident lounge on the first day of the month is figuring out what everyone else is doing. Most of the comments thrown my way were: "Susan, glad to be done with ICU?", "Susan, haven't see you in a while, when are you due?", "Oncology this month, huh? Sorry about that", but my favorite - and what says it all: "Oncology right after ICU. Who hates you? [pause] and your baby?!" If you can't tell, Oncology is not going to be a restful month. Today we got the talk by our supervisor (also known as our "fellow" in case I use that term later) that this rotation can be draining, not only physically and on our time, but also on our emotions. If ICU wasn't enough, here comes more bad-news-talks and more dying patients. Oddly enough, that isn't what I dread. (And actually, in some strange way I find that part satisfying. That is, helping people die gracefully - how and where they want. Honestly, my entire job, from PAP smears to doing CPR, is just delaying the inevitable and asking people to choose between quantity and quality of life. Anyway...) What I am dreading more than anything is another month filled with sleepless nights away from my family.

Thankfully, this should be the last worst month of residency. Next month, in June, I'll be doing Geriatrics and basically just taking care of nursing home patients. Honestly, it will probably be more dying patients, but it should be a lot less busy and lot less stressful. I hope. Then, after June, I'll be finished with internship. Can you believe it?! Woohoo! I think I can get through this month because I can see the light at the end of the tunnel.

It's Hard to Believe...

... that Easter was already nearly a week ago. Although we didn't have spectacular plans, it was a fun weekend. (Really, any weekend I have off is fun.) It was also the first Easter Owen has been old enough to do anything "Easter-y". And it didn't take him long to figure out that finding eggs in the backyard was more than a chore when he realized they were filled with his favorite treats: mini-M&Ms. What can I say the boy loves chocolate... just like his mama! He also looked handsome in his Easter outfit for church. But, as much fun as it is to dress up and eat candy, I hope that he grows up appreciating Easter for its true meaning.

... that my ICU month is down to one more weekend, and one last call. For nearly a year I stressed about this month, but looking back I am so thankful. I still feel like I have so much more to learn, but taking care of some of the sickest patients around has been an awesome experience. I have more respect for my patients. I have more appreciation for their families. I have more awe for unexplained outcomes. I have more confidence in my own instincts. And I have more love for what I do.

... my belly is this big already! In a little over 11 weeks (plus or minus a couple), we'll be meeting little Newman #2. Talk about "it's hard to believe!" We still don't have anything for his nursery, or a baby book, or an outfit to bring him home from the hospital. The one thing we do have is a name... But, no, we aren't sharing. Something has to be a surprise.

... our house is on the market and we are getting ever closer to the big move. Now that the sign is standing tall in our front yard, we just need that special buyer to walk in the front door and sign on the dotted line. Any day now, I hope.

... that I got sucked into the "Royal Wedding." For as little t.v. as I've watched lately, I spent way too much time this evening watching every carefully choreographed move of a couple I have absolutely no attachment to. As useless as my gawking was, I must say that she looked amazing and they way they looked at each other was terribly romantic. Okay, now I'm really getting pathetic.

... that I'm 27. I don't why I thought of that, but I'm getting old.

Post-call Treat for Me

Sleep deprivation can do a number on a person's ability to make good decisions. At work, we've been told that when we drive home after a 30-hour shift our abilities are equivalent to someone driving legally drunk. Makes you feel pretty safe, huh? They have even contemplated making us take mandatory naps before we leave the hospital. Can you imagine? Back to preschool we go.

In addition to our driving abilities, they have done studies about spending habits when residents are sleep deprived. Sure people buy junk food, clothes, shoes, etc... But, I've even known a resident who bought a car post-call.

Well, after a long, very long, call night (which included me breaking into hormonal tears at one point) I had my own impulse purchase. I finally bought a nice camera! Some impulse purchases people regret, but I'm not regretting this one yet. Although I still have a lot to learn, it has been a lot of fun so far.

Here are a few shots of my favorite subject from my post-call purchase:

Experience

As I settle into the ICU, I am amazed how much you can learn in twelve days. It is incredible what medicine and technology can do, and yet, what I am learning has less to do with medicine and technology and more to do with personal experience. I see people who are easily in the midst of the worst time of their life.

Obviously, the patient's experience is difficult, but it is surprising how different and unexpected their reactions can be. There are people who have gone 50 years without seeing a doctor who are suddenly dependent on us for their every breath. Some cling to the support with every ounce of strength they have left in an effort to fight the terrible illness that got them there. Others choose a different, yet equally difficult, path and leave our unit peacefully to a quieter room, their home, or their eternity. It truly has been my privilege to be allowed into these personal decisions and private moments. An honor.

What has also been fascinating is the experience of the people who aren't laying in the bed but who are going through an equal amount of pain. Family and friends diligently sit at the bedside. At 2:00AM, the waiting rooms are filled with plastic hospital pillows and cheap white blankets that cover exhausted spouses, parents, children, and friends. When I get the page that someone has taken a turn, it is not unusual to be beaten to the room by their loved ones. The bags under their eyes are darker than mine. Just like the patients themselves, the families reactions are as varied as the colors of the rainbow. Most, to my surprise, are calm, collected, and reasonable. I think my natural reaction would be hysteria and panic, but that is the minority. How do you watch your mom go through painful treatments? How do you come to terms that life will never be the life you and your husband had planned? How do you allow your son decide he wants to go home and rest while the cancer takes over? How do you respect your grandma's wishes when it means the end? How?

I don't have the answer to that question, but I've see it done. There is so much to learn about human experience, and so much more than cannot be understood. And that is endlessly more interesting than the wealth of information I've been learning about ventilators and shock.

Intensive

My anxiety level has never been higher for starting a monthly rotation than it was on March 31st. I have had a healthy fear of the intensive care unit forever, and an even greater fear for taking care of it's patients. When I volunteered at a hospital in college I would even get a little nervous if I was asked to help in the ICU waiting room just making coffee and cleaning up. Can you imagine how much more intense it is to be thinking about ventilator setting, pressors, and sedation? And while working on the general medicine hospital floors, the ICU seemed like a magical place where you send people you don't know how to, or can't, take care of anymore. Now, I'm it. My team is the one that gets called when doctors don't know how to, or can't, take care of the patients anymore. We're the end of the road. If we can't fix it, it's over. Talk about pressure!

Well, April first came around just like I knew it would. There was no avoiding it now. With lots of prayers for clarity I scanned my badge and entered "the unit". To my surprise, amidst the anxiety and nerves was a sense of calm and confidence. A God thing because I can think of a million reasons why not to feel calm or confident. Without too much trouble I made it through my first morning rounds. We all survived - me and my patients. Success! Normally, that is all that has been asked of my on my first day, but not only was this my first day, but I was also on call. I survived the normal day with my staff and my team to help me out, but what in the heck was I going to do when they all went home to their warm beds and left me alone with the pager all night long?

When the last resident said good-bye, my heart raced a little faster. It picked up tempo every time the pager went off. I was tachycardic when the page came from the ER letting me know they had an admission. Here we go. It's just me, my sweaty palms, and a patient that has just been intubated and put on a ventilator. As soon as I walked into the room the Respiratory Therapist looked at me, read off the most recent labs, and asked what I wanted to do with the ventilator settings. (What I really wanted to do, was run out of the room and let someone else make a decision so I don't kill this guy, but I don't think that was what she was hoping for.) Needless to say, I didn't run, and it all worked out fine. And, it was also good to get my first admission out of the way. Then came the second. Then a third. We all made it through the night - and it was a long night!

Now it's April 4th, and I'm a pro. Okay, not really, but definitely feeling better. Less overwhelmed. Less anxious. More confident. More knowledgeable.

What Kids Do

Currently, I am working in a Pediatric clinic. As cute and adorable as kids are (and mine in particular - *wink, wink*), Pediatrics was not one of my favorite parts of medicine. However, after a few weeks of seeing them day in and day out, all day long, I've actually grown to love it.

One of the best things is that you never know what you are going to get when you walk into the room. Oh, the stories Pediatricians can tell. The innocence of a child is priceless, and can be stinking funny, too. Kids will do, and say, the funniest things.

Well, I have a pretty stinking funny, priceless, cute Pediatric patient of my very own - Owen! Although we have some good stories from his visits to Dr. Mogenson, he may have topped them all this morning at our house.

As you know, we are getting ready to sell our house, so in the spare moments of the week I've been doing some touch up painting. Today was no different, and I decided to take full advantage of a day off. There had been a small painting incident earlier in the month with Owen, so I decided today I would be wiser and only paint things higher than the door knobs because that it precisely how high his little fingers can reach. My plan was working, and I covered a lot of ground while Owen was running from one room to the next. Of course, painting gets boring so I decided to take a break and do some laundry. (Yeah, I know, some kind of break.) I washed out my brush, put the lid on the paint can, and pushed it against the wall on our nightstand near where I had just finished.

Shortly into my laundry pile, my ears realized the familiar toddler chatter was missing. That is never a good sign. Quickly, I headed off in search of Owen's next great adventure. Sure enough I found him in the bedroom. On the floor was laying an empty water glass that previously had been filled with water on our nightstand, soaking wet slippers "strategically" placed, and...

the white paint can! Can you imagine what was sitting next to this now opened can? Yep, a sweet, innocent, adorable little boy with gooey white hands in his Husker pajamas changed from red to white. Paint was in his hair, and there was a big gob on his face next to a big grin. AAHHHH! Do I scream, laugh, or cry first?!

I swooped him up off the ground and held him out in front in a futile effort to save my clothes. (Trust me, nothing could have saved my clothes in that mess.) We rushed to the only place I could think... the bathtub. This has been our place of refuse for many a mess, but I wasn't sure if even it was ready for this. Thankfully, I tossed the brand new shower curtain out of the way and the matching rug into a heap as far away in the corner as it could get, because it took all of 5 seconds for him to grab the his bath toy with his paint covered hands and pitch it out of the tub. Bounce, bounce it went across the room leaving a wet, white trail in its path. By this point I was laughing uncontrollably.

Thankfully, he cleans up well, as did every surface in the bathroom and, thanks to our Spot Bot, the carpet at the scene of the crime, too. What a way to start the day! I've heard many stories like this from my patients, but to live it was really something else.

Yum!

Living in the biggest city in Nebraska definitely has its advantages. One of the best is that there are lots of great places to eat! (It also is nice to be pregnant and have an excuse to not care about calories.) As our time here is winding down we have set three ground rules for when we go out to eat: #1) No restaurants that are in Grand Island; #2) No restaurants we have been to before; & #3) No chains. With those in mind, we have been accumulating a list of places to taste before we leave. It's a good thing that Omaha won't be too far away, because we are finding so many great places. Here it is (and of course we are always open to more suggestions):

• Twisted fork
• Caniglias
• Mahogany Prime
• Big Mama's Kitchen
• Jazz
• Mother India
• Pitch
• Johnny's Cafe
• Espana
• Anthony's Steakhouse
  

Here are the places we've already tried: ...Yum!

• Stella's - Known for the best hamburger in Omaha, we agree!
  
• O - This is a swanky Chinese place downtown with awesome Pad Thai.
  
• Pudgy's Pizzeria - Funny Story. Several months ago, when this list was being created, I asked Jason where he wanted to eat before we move. He responded quickly, and I busted up laughing. I was expecting him to say some fancy steak place, not Pudgy's! I had never heard of this place, and it literally is a pizza place in a strip mall. Regardless, we went, and it was actually really good.
  
• M's pub - Love the atmosphere, but don't expect to walk in and get a table the day before Valentine's day. Who would have thought?
  
• Vivace - Again, another great restaurant with cool atmosphere in the Old Market.
  
• Zio's - We actually tried this pizza place a long time ago, but it is such an Omaha legend it had to make the list so we don't forget to go again.
  
• Upstream - Yummy martini's (pre-pregnancy, of course).
  
• Petrows - The place to go when you're craving a milkshake and cafe foods. And, I love the cute sayings on their sign.
  
• Lo sole mio - Roasted garlic to die for! Seriously, I'm drooling right now thinking about it.
  
• Kona Grill - We went here while I was pregnant so we didn't try the sushi they are known for, but the California Roll was super yummy.
  
• La Casa - Aunt Jan's favorite pizza.
• Piccolo Pete's - Not my favorite, and honestly kind of weird.
  
• Katie's - The med center get's gyros from here pretty frequently, and I'm always happy when I walk into a lunch meeting and smell it.
  
• Bonefish Grill - Even for someone that's not usually a seafood person, this place was impressive.
  
• Brother Sebastian's - Probably one of the standouts for atmosphere - e.g., the waiter's are dressed like monks.
• Rick's Cafe Boatyard - We ate here for our anniversary and spent a lot of time chatting and looking out over the river.
  

Okay, now I'm just hungry. Time to go find a little snack.

D

A little more free medical advice:

(I feel like I should insert some medical-legal disclaimer in here, but I wouldn't know what to say and that's just not my style. Seriously, though, if you have questions ask your doctor. Okay, moving on...)

A, B, C, D. D. Vitamin D. One of the best kept secrets out there, but we're working to make it a less well hidden secret. At my clinic, we have been checking Vitamin D levels on just about everyone who comes in for their annual exams or is getting lab drawn, and I've been shocked how many people are Vitamin D deficient. It is so prevalent that some doctors in our clinic have stopped checking and just tell everyone to start taking it.

Why does it matter? The benefits in bone health has been known for years and years. Our grandmas have been told to take calcium and vitamin D forever, right? Now, however, there are studies out there showing even more benefits, and it's not just for Grandma anymore.

Here are a few of the benefits:

• increased muscle strength
• treats psoriasis, a skin condition (obviously not the only treatment, but can't hurt)
• better immune system
• decreased risk of lymphoma and colon, prostate, & breast cancer; also, if you have one of these cancers it improves your chance of survival.
• if taken during pregnancy, it may be able reduce the risk of juvenile (type I) diabetes as well as asthma in the baby
• reduces risk for multiple sclerosis, Crohn's disease, rheumatoid arthritis and osteoarthritis
• helps to improve high blood pressure and prevent heart failure
• decreased risk of depression and other psychiatric diseases

It sounds like the cure all, right?! While all of those things have been documented, it is important to understand that the risk reduction isn't always very dramatic. We're talking about a difference in the range of fractions of a percent. While, unfortunately, it isn't the cure for cancer, depression, or heart disease; it sure can't hurt.

So, check the label of your multivitamin and make sure "D" is in there. Or, you could hang outside in your swim suit for 30 minutes a day in this lovely 30-degree March weather and soak in some sun to get it the "natural" way.

Home

Several days of my week of vacation (which is a treasured occasion to say the least!) and the weekends that followed have been spent painting, packing, and preparing to sell our house and move the big G.I. Each week as things slowly get packed up and taken to storage, I'm already starting to miss our house. It isn't even for sale yet, and I'm already missing this place we've called home.

Who are those people who move into this house five years ago? No Herbie. No Lambeau. No Owen! I hadn't started med school, and Jason hadn't even finished college. We were a few pounds lighter, and thankfully, Jason didn't have much more hair to lose. The '96 red neon was parked in the driveway, and the third bedroom was just used for storage. I was excited to have a laundry room that didn't take quarters, and Jason was excited to have a lawn of his own to mow.

Now, Herbie has worn a path around the backyard, and the neighbor cats still come around looking for Lambeau. Owen has spit up, crawled, and is now running on our "new" carpet. Med school feels like forever ago, and Jason is well on his way to his Master's. Jason blames Owen for his pant size, and I'm blaming Owen's brother for mine. The neon is long gone, and our driveway has since been graced by the little red Ranger, our Mitsubishi, and now the Rendezvous. The third bedroom has been through multiple make-overs: from a closet, to a dining room, to a nursery, and now to a little boy's favorite place to hang out. I'm a little less excited about doing laundry, but Jason still has the same smile on his face mowing the lawn as he did the first day. (By the way, he still mows it twice every time in different directions to "get the mulch.")

Sometime this summer we'll be pulling all of those boxes back out of storage and unpacking into a new place in Grand Island. Memories will be made there just as they have been in every other place we've called home. That's the best part about home, isn't it: it has a way of finding you where ever, and whenever, you go.

It's a BOY

Oh my! What am I going to do? Testosterone is going to be flowing through my house. My imagination is filled with wrestling matches, broken windows, black eyes, and T-ball games. Yet, it all brings a smile to my face. Today, Jason and I found out the little life inside me is going to be a little boy. Even though less than twelve hours ago I would have told you I wanted a little girl, at this moment I couldn't be happier. Being able to see his little face and his hands and feet as he squirmed and dodged away from photos sealed the deal. That's my baby - Owen's little brother. I can't wait to meet him and hold him. And I can't wait for all of those wrestling matches, broken windows, black eyes, and T-ball games. He is going to look so cute in little white baseball pants.

What You've Missed

* Happy Birthday, O!

* Chomp. Chomp. Owen finally has teeth. (Even if they were late bloomers, I still swear that he has been teething since he was 6-months old.)
* Christmas. Done. That's about what I remember considering I was on call Christmas Eve and New Year's Day.

* One long long long month of Cardiology.

* Started and completed my first and last Family Medicine in-patient hospital month.

* Happy Birthday to me. One year closer to...??

* Slow month of Februrary with lots of time off. Yes! How will I ever go back?

* And some other stuff, too. I'm sure.

** Oh Yeah... in case you didn't hear, we're pregnant! Again.

I Am Alive

No I didn't fall of the face of the Earth. I didn't change careers either. And, believe it or not, I didn't want to stop writing either. So... here's a little explanation:

Around my last post a master email went out to all of the residents warning us about tweets, blogs, facebook, and myspace posts. While it wasn't targeted at me, I felt warned. Like a good girl, I didn't want to disobey and most of all I want to respect my patients. For the last few weeks I've been trying to decide where to go from here. My decision: keep going! I love writing so much, and it has been such a release. I promise to keep my commitment to my colleagues, patients, and myself; but I also intend to keep it fun and exciting. Can't wait!