FreshMD

Why infectious disease docs are so likeable, Exhibit A

This is the unedited first paragraph of an infectious disease specialist's response to an email inquiry from our clinic regarding screening for schistosomiasis, a parasitic tropical disease that typically presents with abdominal pain and diarrhea:

Schistosomiasis is so COOL.   I love those little fellows.  They get through your skin, go on safari through your tissues, and then settle down to raise a family, letting their eggs cruise out through the intestinal wall or bladder wall to start life anew : )

I'll bet you've never seen an emoticon used in that context.

Every infectious disease physician and microbiologist I've encountered is that enthusiastic. At the ID conference I attended last fall, every presenter spoke with actual affection for his favourite microbe, announcing that he could talk about the subject all day long and sighing when his time was up.

Exhibit B would be their penchant for bow ties.

Obama

A New Mexican medical student shadowed me the other day. He was part of a group of American medical students learning about Canada's health care system.

I always enjoy having students - their youth and enthusiasm is refreshing - and this one was no exception. He had to duck out early to meet up with his group, and as he thanked me for my teaching he rummaged in his backpack and pulled out a pink envelope. It was deliciously bulky, and I set it aside to open after I had finished seeing patients.

At lunch I pulled out the card, and this fell out:

This amused me for the rest of the afternoon.

I am the least likely person to wear a button of any sort, especially a political one. Especially one touting the politics of another country. Did he assume I would be an Obama supporter because I'm Canadian and ergo a liberal? Because I'm a physician? Had the Republicans won, was there any chance that a medical student would have given me a McCain pin? I imagined how my colleague would have responded had a student given him a W pin four years ago. It would have been evaluation suicide.

I showed my gift to the front staff, who all admired it and hinted that they would like to have it. I declined. It was a thoughtful and unexpected gift, and the optimism of the medical student, the gesture and the prevailing mood of post-inauguration USA all came together for me in this small metal square.

So I'll be keeping it. But I'm as likely to wear it as a New Mexican physician would be to wear a Stephen Harper button.

Scars

The patient, an Iraqi man who spent the past four years in Jordan, heaves himself onto the exam table and settles back, head on the papered pillow. I ask to look at his belly and he pulls up his green knit sweater, then loosens his pants, untucks his checked shirt and tugs that upward, too.

I've seen a lot of abdomens, thousands and thousands, but I'm taken aback by this one. It's riddled with six-inch scars. It looks like graffiti, insolent purple strokes made on the sly. It's illegible to me. The marks aren't from trauma or torture; they're surgical scars in a foreign language.

If you lay a Canadian-born patient on my exam table and ask me to tell their medical story from their abdominal scars, I can give a fairly accurate account. The Pfannenstiel incision, a discreet line skimming the pubic area, suggests a Caesarean section. Three short, neat scars scattered over the right upper quadrant point to a laparoscopic cholecystectomy. The one-inch line angled over McBurney's point is almost certainly from an appendectomy.

But examining patients from the world over at the refugee clinic, I've seen many a scar that's baffled me. What surgery could possibly have required an incision running from under the right ribcage, across the belly to the left lower abdomen? What series of procedures would have resulted in a flank criss-crossed with red finger-length scars? Why is the appendectomy scar five times the length I would expect?

The preceding history is often vague. The Iraqi man tells me simply, "The surgery was to stop the pain in my stomach." I order some blood work and arrange an ultrasound to provide some clues.

There is a wildness to these scars. They startle me sometimes, they're so bold and unsophisticated. They make the Canadian medical system in which I am ensconced feel safe, careful, predictable and tame.

Striped

The Morehouse striped vest is off the needles.

This isn't a Sunday-best vest. It's meant to be worn Deep Cove-style, with rolled up sleeves, shirt untucked, ferns and pine needles snagged onto the back. When I knit something for a four-year-old, I fully expect it to be rolled around in.

It does work just as well worn reading Beatrix Potter in front of the fire.

The vest was a beginner-level project, knit with undyed Morehouse merino 2-ply in brown heather and soft white on 3.25 mm needles. The yarn was coarser than what I'm used to (but not itchy), and the needles smaller, and I enjoyed the change.

I've recently joined Ravelry, the online knit (and crochet) community, which allows you to organize your knitting projects, yarn stash and needles, and provides an extensive catalogue of projects shared by others. You have to apply to be invited to join, but I think that's just a manoeuvre to inflate members' sense of accomplishment and belonging. It's not like you have to mail them a swatch.

I'm feeling undecided about what to tackle next. A stuffed turtle? Some Elizabeth Zimmermann?

Or call it a season? I've been back to gardening already, we're planning our annual March-break California road trip and it feels like we're barreling towards spring.

Now that is creative nursing

I asked my sixty-four-year-old Karen diabetic patient if he got the flu shot this year.

"Yes!" he answered. "At church."

Most of the local Karens attend one of two churches in Langley. Turns out the public health nurse showed up at the patient's house of worship one December Sunday morning and vaccinated the eligible congregants, with the help of the interpreter who had relayed that morning's sermon.

A waterbed covered with flannel

I just came across the most accurate description of the postpartum belly I've ever read, and it wasn't in a medical text. Perhaps you should read this only if you've had a child; it's a bit much for the uninitiated.

People kept trying to prepare me for how soft and mushy my stomach would be after I gave birth, but I secretly thought, Not this old buckerina. I think most people undergoing chemo secretly believe they won't lose their hair.

Oh, but my stomach, she is like a waterbed covered with flannel now. When I lie on my side in bed, my stomach lies politely beside me, like a puppy.

- from Anne Lamott's Operating Instructions: A Journal of My Son's First Year

Nordic skiing

We took the kids nordic skiing for the first time on Saturday afternoon.

Realizing that  - especially for kids - the anticipation and memory of an event can be every bit as pleasurable as the activity itself, we began to whip them into a frenzy already as we ate our breakfast fruit souffle. They promptly donned boots, snowsuits and mittens and spent the rest of the morning with their over-padded selves wedged into their chairs at the kitchen table, trying to cut out paper Valentines with puffy mitts on.

Pete and I didn't have any lofty goals for the trip to Cypress Mountain, seeing it as more of a reconnaissance mission. We planned to check out the children's rental options, introduce the kids to locomoting on two extra appendages and perhaps, if we dared to dream, have hot chocolate at the lodge.

And success! Leif glided around like a true Norwegian. He did fall over a hundred times, maybe two, but he laughed every time. At one point I caught him scrambling out of the track, trying to breach a snowbank to ski into the woods in pursuit of bobcats, he explained.

Saskia sailed down hills with her braids flagging behind her, arms outstretched, pink snowsuit-clad legs wobbling.

We were happy that the kids were so game. I think gameness is an undervalued trait, and I hope they maintain it into adulthood.

Ariana was too small for even the tiniest boots, so Pete pulled her in a pulk. Truth be told, I'm not sure we could have handled a third one on skis.

We made it to the lodge. We had hot chocolate and poutine on a scarred wooden table in a dark room that smelled of wet clothes drying.

Happy and tired in the van at the end of the day, we snaked down the mountain with the lights of Vancouver and beyond sparkling orange against a dark blue-gray evening. Mission accomplished, and then some.

 PS The Sony has been hospitalized with a seizure disorder NYD and so I am back to a compact camera (Canon Powershot SD880) for the time being.

More Charley Harper love

I ordered some Charley Harper prints today. Vigilant Vireos for the living room:

Cozy Chipmunk for Leif's room, which is a similarly sloping, brown-sided space:

And The Sierra Range - my favourite - future hanging destination yet undecided. (Thanks to reader Elizabeth for alerting me to the Charley Harper posters available through the US National Park Service for a song.)

Total cost: $85.00 plus shipping. 

Tidying Saskia's room

I just spent an hour cleaning Saskia's room; most of that time was used to organize her desk. I separated beads from stickers, put the ink pads and markers out of her younger siblings' reach and threw out a million snippets of paper collected from previous cutting sprees.

I sort through Saskia's creative messes carefully. I discover drawings I've never seen filed away in drawers, and notebooks with the sweetest things documented: a list of what we had for Thanksgiving dinner; poems about animals; journaling about her day (I got up at 6:38 this morning. I read On the Banks of Plum Creek and did crafts.)

What strikes me is that for the last couple of years, the things she makes hold value for her whether or not her parents see them. Everything Ariana makes is shown to Pete or me so that we can exclaim over it. All of Leif's projects are gifted to us or Scotch-taped to his bedroom wall. Stumbling upon Saskia's projects that she feels no need to show us is bittersweet.

As it is now, Saskia is pleased when she comes home to a freshly organized desk. But I'm acutely aware that the day will come that she doesn't want me to touch her things. We've currently designated one desk drawer as private. (We discovered at Christmas that all those mornings crafting in the wee hours, she was churning out stocking stuffers and stashing them in the drawer. Six for each of us, and seven for Ariana.)

But that pocket of privacy is going to keep on growing.

And so I find nothing tedious about tidying my seven-year-old's room, and leaving the kitchen floor unswept to vacuum glitter off of the bedroom rug seemed a perfectly reasonable choice this stormy Monday morning.