Thursday, December 15, 2011

Well, tonight, thank G*d it's them, instead of you...

Does anyone else think that "Do They Know It's Christmas?" is the most uncharitable "charity" song around? It's downright laughable! So much so that I can't help but wonder if there isn't meant to be some sort of sardonic undercurrent beneath the song's earnestness. I mean, there's the most awful line, the line mentioned above, then, later on, we raise a glass to everyone, including "them, underneath that burning sun." ACK! Mix in some "clanging chimes of doom" and "bitter sting of tears" and, well, I admit it, I laugh my *ss off every time I hear this song. Probably not what "Band Aid" was going for, but I digress...

The true meaning for my title really pertains to how I feel when one of my partners is on call and it isn't me. I thank G*d it is them instead of me; because we have been insanely busy. Last call I delivered 8 babies in a 24 hour shift and admitted 9, 10, and 11 in labor. All of the rooms were full and our overflow was spilling into other rooms in the hospital. I have no idea what was going on nine months ago, people, but holy geez, the babies can stop coming any old time! We are T-minus 10 days from Christmas, and I didn't have enough to do, so I thought I'd sit down and let you know that I am still alive...and mostly well...and still wishing to win the lottery so I can become independently wealthy and play internet games and get buff and be the envy of the botox set (without using botox) and never, ever be on call again. I don't think Santa can deliver that kind of present, unfortunately.

This is going to be a magical Christmas for the Whoo family. Bean is 4 and CindyLou is 7 and both are steeped in the wonder and magic of the season. Their joy and wonder is palpable. I love it. It brings a tear to my eye. We only have so many magical Christmases with them, and I happen to be on call on Christmas-flipping-Eve this year. So my Christmas wish is that none of my patients get a special Christmas delivery in the wee hours of Christmas Day morning, so I don't have to miss out on the magic this year...hopefully Santa can manage that. Merry Christmas to all 2 of you still reading out there, may your holidays be Merry, Bright, and Doom Free! :)

Friday, September 23, 2011

She's Complicated

A commenter from the post below states that I'll not likely elicit sympathy by stating that women can be difficult patients, who require significant amounts of communication. The question is also raised why I would "generalize" 100% of my patient population, as surely, if there were no women to treat, I could no longer be an Ob/Gyn (sic). I find it overall amusing that anyone would believe the post below was written, in any way, to garner sympathy, and I also find it a bit irksome to be told that I "shouldn't generalize." I'm not. I am speaking from my own personal experience. Perhaps I should expound upon this point.

I went into Obstetrics and Gynecology precisely because I enjoy caring for the(complicated, difficult) female patient. I would not do anything else, but I would be absolutely lying if I said it wasn't without its difficulties. For the record, I happen to find male patients, no offense guys, infinitely more simple in many ways, but less likely to follow any directed care of a physician unless there is fear of loss of life or, ahem, other *important* functions. In my interactions with male patients, there was little extraneous conversation, merely exam, diagnosis, suggestion for treatment (which they may or may not decide to take, but they certainly weren't going to ask you any questions about it). Women patients, quite simply, are different. They do require a lot more communication; not just about the reason for certain symptoms that they may be feeling, but also for the rationale behind the treatments to alleviate the symptoms.

Usually, this is not a problem for me, being a woman myself, particularly verbose ("talks too much" was a very popular comment on my report cards sent home from school), and, not to mention, I happen to like explaining physiologic changes in a way that women can understand and to which they can relate. However, sometimes something as relatively facile as communication can cross the line. At times, it can be repetitive and monotonous (likely not so different from other jobs). At other times, I feel as though I am speaking a script, word for word. Sometimes, it can be frustrating (for both the patient and myself), because no matter how I frame the explanation, I cannot communicate my point. Most of all, it can become emotionally draining. Women routinely tell me things that would feasibly make most people's ears burn, make me worried for them, and sometimes bring me to the brink of tears. I have an impeccable poker face, but over time the walls get chipped away and I find myself unable to stop bringing my work home with me.

I suppose it is a good thing to be human, but in medicine it is important to remain detached in order to stay objective and to provide good care. It is a difficult balance between being connecting with the patient without becoming emotionally *involved* with the patient. This is difficult and soul-grinding, especially for those of us who have a tendency to try to "fix" people. It is a burden I more than willingly shoulder every. single. day, but honestly connecting with patients can be good for them and harder for me. I'm not willing to stop doing it, but to say that it shouldn't affect me emotionally is far more presumption than I would have the wherewithal to make from the outside looking in. In summation, saying that women are "difficult and complicated" patients is not meant as an insult or to "generalize" women, it is simply a statement that I find to be true, not only of my patients, but of myself, as well.

Sunday, September 11, 2011

Ten Years

Ten* years ago today, I was a harried and hurried OB/GYN intern, the only intern on the OB floor. Rounds ran long because of a long patient census, and we were late getting over to Labor and Delivery to "run the board" (aka, check on the laboring patients). I had four laboring patients, three patients to see in OB triage, and a 30 week pregnant woman just involved in an MVA on the way into the ER. I was just about to check on my first labor patient when the charge nurse came out of a patient's room. "A plane just crashed into the World Trade center!" The sarcastic comments followed, ranging from jokes about air traffic control to what substance the pilot was smoking. It mildly piqued my interest, but to tell the truth, I hadn't the time to sit and ponder the significance. I was halfway through my triage and labor checks when the second plane hit. Then, we knew, this was no accident, and I, like everyone else that day, was scared about what this meant. Ever in constant motion, I caught what updates I could from the patient's TV screens, as I went about the routine business of histories and physicals on a most unusual and frightening day. My chief resident and I went together to see the MVA patient, it was merely a fender-bender, no real trauma, and we hooked her up to the labor monitor to look for contractions. She gasped, suddenly, eyes wide in disbelief, locked on the television mounted on the wall in the corner of the room. My chief and I turned, to see the mighty towers collapsing into dust and rubble. I don't know how long we sat and stared, silent.

The rest of that day is a true blur. I delivered eight babies between 9 am and 5:30 pm that day, four inductions and four natural labors. I distinctly remember one young patient, just 17, crying after the delivery, not tears of joy or even pain from labor, but of sadness and terror. I couldn't help but think that the baby boom that day was simply a surge to replace the souls so tragically lost. I think the unit had a total of 11 deliveries that day. This year, they are 10 years old, nearly ready for 5th grade. In the days that followed, I was morbidly fixed to the TV and the news. My husband couldn't tear me away. I couldn't stop watching. It lasted for about 3 months, and then the shock was not nearly so fresh, and I could watch non-news programming once again. Five years ago, my husband was attentively watching the commemorative movie on television. I have no desire to see any films about that day. I didn't understand why five years was the magical number for it to be permissible to start turning a profit on such a terrible day in our lives and the lives of the victims. I could barely sit through the previews of United 93 without bawling. I don't need a reminder of the tragedy, as it is indelibly burned into my memory. I was fortunate that I did not lose a loved one or a close friend, and for that I am grateful. But we as a nation suffered the loss of, not only the lives of the victims and the heroes of that day (in itself a staggering loss), but the loss of life as we had so complacently come to know it. We lost innocence and we lost feeling secure, and I'm not sure that we will ever feel the same way as we did ten years and one day ago. Today, I, like so many of you, will ponder in silence and return to the day when we knew things would never be the same. Today I will remember to never forget.

*Originally posted on 9/11/06

Tuesday, August 16, 2011

Ob/gyns are terrible people who deserve to die, and other misconceptions

Tempeh writes: Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty.

I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (god forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.

Saturday, August 13, 2011

The Pregnancy Companion

The Pregnancy Companion is a pregnancy book co-written by physician and patient (and friends) Dr. Heather Rupe and Jessica Wolstenholm . In a market that is flooded with pregnancy advice books, what makes this particular book stand out from the rest? Well, actually, a couple of things! First and foremost, this book is written from a faith-based perspective, and the authors do a great job of weaving their faith, pertinent bible passages, and religious tenets within the chapters along with personal anecdotes and solid medical information. I'm hardly an expert on the pregnancy advice book market, but, I would imagine there is a paucity of advice books which incorporate faith. For Christians, it is comforting to have this additional guidance along the uncertain road that pregnancy (and pregnancy loss) can be. Dr. Rupe's medical information is solid throughout the book and written in such a way that it is easy to understand for people who do not come from a medical background. She writes in a fluent and easy way that flows off the page, and her counterpart, Jessica, draws the reader in much as a trusted confidant or long time girlfriend. Reading the book, you can easily read it cover to cover, or chapter to chapter, based on the stage of pregnancy/information you wish to obtain. In addition, the sections on pregnancy loss and personal anecdotes from both of the authors feel very personal, and create the impression in the reader that they are receiving advice from a trusted physician and a good friend. The Pregnancy Companion stands on its own as a complete pregnancy guide, complete with the requisite "month by month" stats and checklists, but this book goes even further, delving into the spiritual side of pregnancy, how it changes us, those who care for us, and how it can, if we choose to let it, bring us closer to God. Brava, Dr. Rupe and Ms. Wolstenholm, on your book, it is a truly wonderful reference to mothers and mothers-to-be.

Monday, August 08, 2011

Into the Fray

So, I admit it, I've missed you. A lot. I've been trying and trying to stay away, but, blog, I just can't quit you! So, hello to all of those of you who know my name, I hope you'll see that even though I'm human, I am still a d*mn good physician who cares about her patients, even when the day to day grind predisposes to bitterness and sarcasm. I desperately owe my good, bloggy friend Dr. Rupe a book review, and, being just a bit OCD, I didn't feel like I could properly do it until I had the chance to read the entire book (not easy in this crazy life). Good news! I've read it (and loved it) and will post a glowing review worthy of it ASAP. I still have no idea how in the world that she was able to co-write the book, when I've barely had time to read it! Many apologies, Dr. Rupe, I wanted to do your work justice!

You won't be surprised that not much has changed around here. Work is crazy, my children are sweet, lovable, and growing up too fast, my husband is a saint, and OMFG it is blazing hot! I'm working a lot, but just came off what may have been my best weekend call of my whole entire life (got to sleep in my bed all three nights, that will never happen again)! I also dropped 20 lbs since April ( I'm thinking, mostly water weight from sweating my *ss off all day long). Most of all I have missed writing, want this outlet back, and thank you for still being out there to listen to my ramblings. Please know that everything posted about clinical situations on this blog is altered to protect every patient's privacy. More soon...

Monday, April 25, 2011

Like a Hurricane

So, yeah. That, apparently, is my new nickname on Labor and Delivery. Hurricane Whoo. Because it is more than just a "black cloud." Because just about every time that I happen to be on call, it's bound to be a sh*t storm. It has gotten to the point, so I am told, that the entire nursing staff offers up a collective groan when they hear that I am the physician on call. Yikes. They hasten to add that they still love me, though. HA! Apparently babies and pregnant ladies love me, too. A lot. The last weekend that I was on call, I delivered 12 babies admitted 2 more in labor before I was finished. It makes the time fly by too quickly, and I hate to find myself wishing my life away. To say that work has been busy would be an understatement, add to that increasing children activities (soccer! Daisies! tumbling!), the arrival of warmer weather, and the presence of a pool at our ready disposal, and my blogging has languished in the corner for more than two months with hardly a glance in its direction! Sorry about that. It's not you, it's me.

If you have been reading for a while, then you may know that my blog started as a primarily anonymous outlet (and boy, have I used it to vent!), save for a few people (Mr. Whoo and one friend who also happened to have an anonymous blog). Well, it so happens that those few people told a few more people, then I told a couple of people, and made a couple of bloggy friends, who were then my friends and boom! Not so super-anonymous any more. This was not a big deal, as it was still mostly amongst my circle of friends, from whom I lived far, far away, and trusted to know me as the person behind the words. Then I moved, and I was closer to some friends, and those friends knew friends, and friends of friends, who also went to the practice where I am working. This is where I keep running into an ethical dilemma. Some people reading this blog know who I am, where I live, and where I work, but are not my close personal friends (friends of friends of friends). Given the atmosphere surrounding the Internet,, and social media with respect to physicians in general, this makes me a bit edgy. Let's face it, I'm not the type to mince a lot of words on this blog, and this is who I am when I am being me. (Because this is my blog, dammit!) My professional persona is not nearly as raw. In fact, if you asked most of my patients, I do believe the word "sweet" would come up more than once. (STOP LAUGHING!! It's totally true!)

At any rate, now I am unsure of my reading audience, and I find myself trending more and more toward self-censorship, which I hate. I just keep wondering if the patient sitting across from me is wondering if I am filing her experience for a blog post for another day. I don't want this to interfere with my relationships with my patients. It was never meant to be a blog that my patients, who knew me as a professional, would read. Maybe that is narcissistic. For all I know, my patients could care less about my ramblings in cyberspace. Patient confidentiality has always been, and will always be protected. Any clinical scenarios that I post are altered from actual occurrences, I imagine I will be posting less of these in the future, as well. So, this blog will be evolving as I try to navigate this slippery slope. Bear with me, readers, and thanks for sticking with me this far...

Friday, February 04, 2011

Office Dos and Don'ts

When I am not on call and juggling office visits and catching babies, I am still working in the office seeing both OB and GYN patients every single day of the week. I realize that most of you spend only a fraction of that time in any physician's office, and frankly, we can tell. Here are some helpful hints to make your day at the GYN go a bit more smoothly:

Ob/Gyn Office *Dos*
1. Do make an early appointment. Whenever possible, make your appointment the first appointment of the morning or the first appointment after lunch. Trust me on this one and see below.
2. Do arrive for your appointment at least 10-15 minutes early. I know, I know, why would you want to show up early when you just *know* you are going to be in the office for *hours* on end. Here's why: The Snowball Effect. Invariably, as is required by the office, your insurance, or pencil pushers from various state and local agencies, you will be asked to fill out some kind of form upon your arrival. These are usually not mind-shatteringly difficult, but they can take time. Then the receptionist has to verify your information, make sure your insurance is still good, find your chart, and send it down the line to the MA/RN who will be bringing you into the office. The MA then fills in any new information, takes your vitals, asks the reason for your visit, and takes you to the room. Imagine what happens when you are "just 15 minutes" late for your appointment, everything that has to be done gets done further and further away from your appointment time. Before you know it, you are in the exam room 30 minutes after your appointment time, and if you think your schedule is thrown off, multiply that by 12-15 patients in a half-day. If all of them are even 5 minutes late for their appointment time, it creates a significant backlog for the physician to overcome. We're good, but we can't reverse time. It's just not feasible.
3. Do know your personal and medical history. Be sure that you have approximate dates of any surgeries or hospitalizations that have occurred in the last few years. Know what body parts you do and do not have. Know what medications (and their doses) you are taking, for the love of all that is holy! I have no idea what birth control pills are in the pink rectangular package, and will not be able to divine it easily. Have a tentative idea of when your last period happened. I also have no idea what is in your medical history unless you bring your records to me to look at or have them sent to the office *before* your appointment, so please don't wave a dismissive hand and mumble something about how "it's all in there somewhere."
4. Do bathe. Applying soap and water to your body sometime in the 24 hours before the appointment is considered common courtesy. I really don't care if your legs or any other areas are shaved, hair maintenance really doesn't concern or bother me in the least, but the courtesy of bathing is much appreciated.
5. Do know what you want to accomplish. Write down the questions that you have or issues that you want to address at your appointment. In the hustle of the office routine, you will probably forget something. Keep a little list on a piece of paper or on your phone to review...and I stress *little.*

Ob/Gyn Office *Don'ts*
1. Don't make a routine appointment for an out of the ordinary problem. This, of all things, is my number one pet peeve when it comes to office visits. If you are feeling depressed, your libido is in the toilet, your uterus is falling out, or you feel like you are bleeding to death every month, even if it *is* just about time for your pap smear, please, please, PLEASE don't call the office to make an "annual exam" appointment. Believe it or not, GYN physicians do more than just pap smears. If you want to see the doctor for a problem, make an appointment for such. Here is something you may not realize: You do *not* have to disclose to the scheduler *what kind* of problem you are having! Simply stating you have a problem you would like to discuss with the physician is totally adequate and spares you any embarrassment you may feel. Annual exam appointments are usually given about 10 minutes, but problem appointments can be scheduled for 15 minutes-30 minutes. This means you get more time with your physician to discuss treatment options and formulate a plan to get you feeling better. In the same vein, don't save up all of your problems for your annual exam; there is only so much we can do in an annual exam. Change your birth control? Yes. Change your birth control, cure your depression, diagnose your infection, and evaluate abnormal bleeding? Not so much. Scheduling the appropriate kind of appointment sets up a "win/win" situation for all involved.
2. Don't expect to get an immediate answer/treatment/cure after one visit. Some problems (like infections) are easy to solve, but some problems are more complex and require data gathering and imaging studies. Your initial appointment may need to be followed by a secondary appointment in order to assimilate information and assess treatment efficacy. You may not have all the answers after seeing your physician one time, but I can assure, you will be headed in a definitive direction for treatment.
3. Don't be rude to the office staff. They are there to do a job, and when you get seen, how you get seen, and certain office policies (like late policies) are totally out of their control. We all work together as a team, and you can bet that if you are a raging b*tch to my MA, I am going to hear about it before I step foot in the room. I can't guarantee a warmed speculum in those cases, either (I KID, NO HATE MAIL, PLEASE!!) On the flip side, if our staff is rude to you we want to know about it, so please share your experience with us.
4. Don't expect your physician to (do even more) work for free. Trust me when I say that much of the "behind the scenes" work that we do goes uncompensated. It is common courtesy to inform you of your lab results over the phone (usually our nurses or clinical staff will do this), however, if you want to discuss the interpretation of your labs or formulate treatment plans based on the lab results? Make an appointment. Physicians' clinical opinions are based upon what we spent years learning; this is our professional service, and we deserve to be compensated for services rendered.
5. Don't attempt to dictate your own treatment. Dr. Google is great for answers in the middle of the night, but printing sheaves of paper dictating how you *think* you should be evaluated/treated is incredibly off-putting. I value an educated patient, and appreciate when my patients "do their homework." This is not the same thing as demanding of a physician a specific test or treatment that you happen to think you may need. We want to collaborate with you about your care, and have spent years of training learning how to do this. Our knowledge is not so easily replaced by We.b.M.D. or W.ik.ipe.d.ia.

Wednesday, January 05, 2011

And two more months slipped away...

Happy Belated New Year, blog and blog friends! I will spare you the "busy, busy" rigmarole because you've heard it all before. Needless to say, it hardly seems real that the last time I logged on to post anything on the blog was back in October! Life and time have continued to move forward at the speed of light. Over the holidays we (or, more precisely, our builder) finished building the house, we closed (i.e. hemorrhaged money), and then, for extra fun, we moved in...the week before Christmas. Why (you ask incredulously)? Because I'm insane (in the, sorry), apparently, and, more accurately, because I already had requested that week off in order to (HA, HA!) relax the week before Christmas. To add to the fun (and this torture was completely self-inflicted, by the way), we just didn't feel *right* about depriving poor little CindyLou and Bean of a Christmas tree and decorations until the week before Christmas (think of the *children!), so we bought a tree for the rental, decorated it and the rental house (including the outside, of course!), undecorated, bought a new tree for the new house, and the decorated the new house once again. I cannot vouch for my mental stability, that bit of madness was unbelievably ill-advised. Regardless, despite several snags, we arrived safely and soundly in the new house before Christmas. Santa even found us and everything! Whew!

So now, I am digging out of boxes, cursing the paper clutter and all of the things that can't be thrown away, but do not yet have a "home." Paper clutter is my true nemesis. We all love the new house. It is so nice to be in a home that is truly "ours" from the very start. Cindy Lou's bedroom is bedecked in lavenders, pinks, and fairies. Bean's is bathed in blues, "Cars" characters, and, let's not forget, monster trucks. We are very happy here, which is good, because (hear this internets) I AM NEVER MOVING AGAIN! (I hope.)

Work is going well, getting back into full swing since the holidays. I find I have so much less to complain about these days. Likely because I am not much on the front lines any more (no more midnight phone calls about cough syrup selection), I am getting more sleep, and more weekends off to play and love on my sweet little family. I still have the occasional fist-clenching moments, like the two sisters, due a week apart. The younger went into labor first, even though the older was *due* first, and the older got so p*ssed off she *refused* to come to the hospital bedside to support her sister. I mean, *dammit* she *always* gets *her* way. (These are grown ass women we are talking about here, you wouldn't believe the adolescent machinations, mostly on the part of the older sister.) Younger sister's baby ended up having an unknown health problem after delivery, which would have made me feel like a criminal that I wasn't there for *my* sister during that time. Older sister's baby was born about a week later and was *perfect,* and I got the vague impression she was feeling quite smug and justified about that. Sad, sad, sad.

There was also the patient whose MIL jumped all over me when, after going to have a "for fun" ultrasound where the US tech said the cord *might* be around or near the baby's neck, I tried to explain that, if indeed the cord was around the neck, there was not a thing in the world I could do about it! I spent 30 minutes with the patient and her MIL, even obtained a (completely normal and beautifully reactive) NST. At the MIL's visit to my partner the next week (for her own medical care) she expressed to them how I just "rushed" them right through the appointment, and how her DIL needed "more TLC" from our practice. GAH! The unmitigated *gall* of that woman! I give up. Haven't seen her or DIL since, and I'm not crying about that one little bit.

So anyway, time marches on...double numbers are luck for me, so I think 2011 is going to be a good one. Maybe, just maybe, I can lose the rest of that weight, organize my life, de-clutter, become a great cook, run a marathon, found a charity organization, and still find the time to be the world's best wife, mother, and doctor. Hmmmmm, probably not! Good to be back, and I hope to write more in the coming year. Hope you are still out there and listening!