20 weeks, and snake...surprise

20 weeks! And I'm not even wearing scrubs!

When I knew I was giving that talk at Wellesley, I took three vacation days this week--Monday and Tuesday to get there and back (if at all possible I like to limit all business-like travel to 24 hours, that way, it's not any different for the kids than me being on call) and Wednesday to decompress in case travel was awful. GOOD PLANNING, ME. Having the extra day off also allowed me to squeak in my 20 week OB appointment without too much logistical hassle, which was nice. I like making doctor's appointments for the morning if I can, because I figure it's less time for the practitioners to accumulate serial delays over the whole day of seeing people (they are inevitable, and really not their fault, especially if they are trying to do a good job with each patient), but because of my work schedule, usually I have to make appointments for the afternoon.

Also, I would like to point out (see above) that you can find plenty of maternity-ish tops in non-maternity sections, see that Old Navy tank up above. It probably won't work in another month or two, but generally (and this I found with my first two pregnancies as well) Old Navy and some other stores tend to cut their clothing overlarge and somewhat billowy, so what may be a really unflattering shape for a non-pregola (I would never have bought this shirt under other circumstances) works out great for the parturient, at least up through the second trimester. Also, non-maternity clothing tends to be cheaper, because it's not considered "specialty." More choices in cut and color too. I got a whole scad of these T-shirts when they were super on sale after Christmas (I ordered my usual size but in "Tall" so I could have a longer shirt-tail to cover the unfortunate elastic waisting of my pants) and they look much better than regular maternity T-shirts, which can tend to have more of a tent-like cut. Anyway! Girl talk! Clothes! Shopping!  (These links are not sponsored, by the way, I just thought I'd share what I've learned from clothing myself these past three pregnancies. Especially since, not knowing what I know now, I gave ALL my maternity clothes to Goodwill this past Spring after we moved--like, SMOOTH MOVES, EX-LAX.)

Wait, what?  You want to know about what?  The...oh!  Right.  The ultrasound.

Let me say first that I really like this OB practice we're with.  I was a little less than crazy about the group that we used for Mack (and obviously I'm not going to say who they were), but given that we've moved since then and would probably be delivering at a different hospital anyway, it was as good a time as any to switch practices.  Anyway, this group is a bit smaller, more personal, and they spend quite a bit of time talking to their patients, which, even as a third-time-arounder, I really appreciate.  Also, for all of the routine ultrasounds, an OB is actually doing the scan himself, which is very nice, especially since he really explains what he's looking at and isn't bound, like a tech, to not make diagnostic calls or say certain things for medicolegal reasons.  Anyway, we like both doctors with this group a lot, and I think they are excellent clinicians.

And we got some really nice pictures.  (Ignore the "Wondershare" watermark, it's just because I had to download some software to do the video file conversion blah blah blah nerd talk. CARRY ON.)







"Hey little guy!  Look at him go!" said Joe, when he saw Thing 3 moving around.  (I'd forgotten that he's only seen still images thus far.)

"Yeah, he's moving around a lot now," I confirmed.  We walked through the head, the heart, the abdomen, the cord, looked at his little face, his arms, his legs, everything.  "He looks great!"

"Yeah, he does," the OB, measuring this that or the other thing.  "Although, if we keep calling him 'he,' I guess we should actually look at that part too, to confirm."

"Oh yeah.  Sure, take another look."

"What did I say last time?" the OB asked, flipping through my chart.  "We said boy?"

"You said you were 99% sure he was a boy, but you also said couldn't get a super-fantastic view."

"OK then, so let's see here..."  He looked.  Then he looked.  Then he looked again.

Joe and I also looked.  "Uh..."

"I said boy?" The OB froze the frame. "I was wrong there.  Nope, totally wrong.  It's obvious now.  Huh, funny, usually when I made a wrong call, it's the other way around."

"Well, it was only 16 weeks..."

"Yeah, more difficult to say on a 4 oz. 16 week fetus...though, usually, I have to say, it's pretty obvious even at that stage.  Regardless, I think it's pretty clear now."

"Wait, so..."

"It's a girl.  100% certain this time.  You guys are having a girl."







WE'RE HAVING A GIRL.

Well, hell.  I hope she doesn't mind wearing a whole lot of blue clothing for the first 3 months.

Obviously we're thrilled to bits and aren't fussy about the clothing--and whatever, babies can't read anyway.

HOLY SHIT, WE'RE HAVING A GIRL.

up in the air

I think it's generally good to accept fault where fault is due (or is most probably due), but--and I don't use this phrase very often--this wasn't my fault.

On Monday I flew into Boston to give a talk at the Wellesley College Hippocratic Society's Annual "Women in Medicine" lecture. The talk went wonderfully, and thank you so much to those lovely ladies (and all those departments!) for hosting, it was truly such a humbling honor to be back giving a talk in the same tiered lecture hall where, once upon a time, long ago, I sat there pretending to understand Organic Chemistry. I would have liked to have spent more time on campus--and my original intent was, indeed, to get to campus well before noon, so I would have the afternoon to walk around, visit old haunts, take pictures, and visit the bookstore for loot (I have my fair share of Wellesley outfitting, but I wanted to get some sweatshirts or whatnot for the kids, because I think there is probably nothing as cute as seeing little boys dressed in Wellesley gear), but as it was I didn't arrive on campus until less than an hour before the event began, and here's why: I missed my plane.

OK, so that sounds bad, like I overslept or something, but listen! Here's what actually happened! Let me say first that I am a historically neurotic traveller. When they say get to the airport two hours before your domestic flight, I get to the damn airport two hours beforehand--I like to think of it as leaving enough buffer time for two disasters. (I'm very "worst case scenario" in that way. Typical anesthesiologist.) It was a little busy at Hartsfield Intergalactic Monday morning (lots of business travelers, I guess) but I got my boarding pass at the kiosk and the security line moved through quickly enough so that I still arrived at my gate more than an hour before departure.

When they started boarding the plane, I moved to the front near the desk and waited for them to call my zone. First they boarded First Class. Then Zone 1. Then Zone 2. Then (wait for it) Zone 3. There were still a lot of people standing around--I assumed for Zone 4 (my zone) and a boatload of people waiting to fly standby. This flight, as well as every other flight to Boston out of Atlanta that day, was significantly overbooked, to the point that they were offering $400 vouchers to people willing to volunteer off the flight. I waited for them to call Zone 4. I also looked at the screen overhead to see if they were calling Zone 4. It only listed Zones 1 through 3. Then--this is the part that I thought was weird--the lady who was calling the boarding zones left her desk, walked through the boarding gate and closed the door. Guh? Maybe something was happening on the plane, I figured, and she didn't want to leave the door open in case non-ticketed passengers tried to rush the walkway.

But then she didn't come back.

I walked closer up to the desk, waited for the be-dreadlocked guy standing there to look up from whatever he was doing, and politely (I thought) asked him when they were going to board Zone 4.

He looked at me blankly. "The plane is gone."

I blinked. "Gone? Like...gone?" Maybe I was misunderstanding.

"Yeah, the plane just left. Where were you?" he asked me accusingly.

I looked at him in disbelief. "I've been standing here right next to you for the past 20 minutes! I was waiting for you to call Zone 4!" I pointed to my ticket, where "Zone 4" was clearly labeled. "You called Zones 1, 2, and 3, but I never heard you call Zone 4!" I gestured to the screen overhead, which was, indeed, also only displaying "Boarding Zones 1, 2 and 3." You never called me! You never called my zone to board!"

"Plane's gone. Don't know what to tell you." He shrugged, looking away, bored of the conversation already.

I had not been distracted. I was not on my phone. I was not wearing earbuds. I was standing right next to the gate. I also would like to note (and these are just things that I observed from the OTHER THREE FLIGHTS that I tried, in vain, to get on on standby) that during this particular boarding process no one ever said anything like:

"Boarding all zones."

"Final boarding call for flight XXXX."

"Paging passenger Au, final call for passenger Au." (I saw this on other flight where passengers didn't board on time but were checked into the airport--I, too, had checked in at the kiosk earlier that morning so in theory they should have known at least that I was there)

Could I maybe have not heard them call Zone 4 because I was, I don't know, daydreaming? Possibly. Could that have unfortunately have coincided with them also not displaying that same information on the screen overhead? Again, possible. Could I have missed ALL of those announcements, the boarding all zones, final boarding, them CALLING MY NAME if I was literally standing right next to the person making the announcement? Possible, I suppose, but I have to say, highly improbable.

People who know airline stuff (Blue, I know you work on an airline, though a different carrier than the one I was on)--what do you think happened? Did I do something wrong? I think the most likely scenario is that they were way overbooked and they just gave away my seat. How they could have done that when I had already booked, paid for, and claimed my seat, I cannot say. But I spent all day at the airport yesterday. It was, uh, a subpar experience. Luckily (and thank goodness for the wonderfully efficient people at the Hachette Speaker's Bureau) they got me onto an early afternoon plane to Philly, with a 40 minute connection to Boston. And I made it in on time and then everything was Swellesley. But that's why I have no pictures of the campus to show you. Well, except for this one picture of my accommodations at the Wellesley College Club, which were cozy and charming and overlooking Lake Waban.

Thank you, Wellesley, I miss you already.  Again.

And screw you, Delta.


* * *


I'm 20 weeks this week, and getting Ye Big Olde Anatomy Scan tomorrow. This is the first time that Joe will actually be able to come with me--it was hard enough even scheduling one of us (me) for an appointment during the first two pregnancies; working both of our schedules into the mix would have been a pipe dream. (To be fair, we were both in residency when I was pregnant with Cal, and with Mack, Joe was in fellowship--generally two stages of life not conducive to ducking out midday. I think the only reason I was able to make my own appointment for Cal's anatomy scan was because I was on a NICU rotation at the time and everyone there was super-paranoid about congenital malformations and therefore more than happy to cover me for the half an hour that the ultrasound took.)

(Don't let this be a call for you guys to tell me stories about congenital malformations, by the way. I've seen them too, and am paranoid enough on my own, thanks.)

Anyway, here's to hoping that everything looks sweet, and that we get some nice pictures out of the deal. We'll post some of the better ones up here, of course. It helps that Joe got the scanner back up and running again. He gave me some long explanation of how he did it, but I stopped listening after he said, "So all I did was..."

Hope everyone out there is doing well.

hauling ass

One thing that did not totally occur to me until Joe pointed it out was that crossing the threshold into the three-kid arena meant that we would need to get a bigger car. Serendipitously, the lease on Joe's current car (a Honda Fit--which is a fine, and more importantly inexpensive car, though likely one of the smallest four-door cars on the market) runs out in July, so we should be all set to trade up for some sort of three-rowed conveyance device, likely a minivan.

Having grown up in Manhattan well away from car culture, I have no particular prejudice against getting a minivan--I have heard the arguments before about how uncool minivans are, but in my mind, ALL cars are uncool, so really for us it purely comes down to a functionality issue. Also, let's remember that I'm already uncool, so it's not like the car I drive is going to change that. (Obnoxious penis-substitute car drivers, take note!) Anyway, the most likely finalists are the Toyota Sienna versus the Honda Odyssey--we're leaning towards the Toyota because it's somewhat cheaper--but if anyone has any particular recommendations on a seven-to-eight-seater car, please feel free to recommend or dissuade. Whatever the brand, we will likely get one of the lowest trim packages (meaning no DVD players, no navigation, no leather seats, no flux capacitor), so fancy features are not a concern. The only add-on that Joe thinks we should likely get is some sort of "backing up" camera, mostly because I am, uh, not a good driver,  and he wants to make sure I don't run over anything vital, like our mailbox, or a mailbox-shaped human.

(Of course I have been reading online car reviews and consumer report guides, but I have noticed one thing in the minivan guides in that after you read many of them in a row, you realize how many of them are jarringly anti-kid. One example from Motor Trend magazine: "...since children and their Cheetos-encrusted boogers are the target audience, perhaps a really nice interior doesn't mean a whole lot in this segment." In minivan reviews, apparently, there are lots of "jokes" like that, mostly related to how disgusting and annoying multiple children are. You could well make a drinking game out of it. Drink every time a review mentions crushed Cheerios messing up the backseat. Drink every time a review talks about the DVD players quieting your squalling hellions. Drink every time a review talks about how multiple kids are the death of cool, and how the utilitarian suburban drudge cart is now your cross to bear. I GET IT, CAR MAGAZINE, YOU HATE KIDS.)


* * *


19 weeks. Look, a different shirt!

I know that externally, it seems like kind of a gradual progression, but let me assure you that it sure doesn't feel that way. Look, just think of this week-by-week photo project (granted, more for personal archival purposes than anything else) as the most boring flip-book ever. Anyway, the fundus is just below the umbilicus that this point, and I can tell we're moving along because the umbilical port scar from my old med school lap appy is actually visible now. THINGS ARE EVERTING. Sorry, was that gross?  Well, take it from a doctor, that's how the human body is, kids.  Gross.  Gross but functional.  Like a minivan.

(And that's what we call "coming full-circle.")

rooty tooty fresh and fruity

Joe had to go to the annual meeting of the Georgia Society of Ophthalmologists all day today (which I'm sure was exactly as exciting as it sounds), so I took advantage of my relative high energy level this morning and took the kids to IHOP for breakfast, and then to the playground.

I'm not sure that Cal's ever had a Belgian waffle before, having only eaten their toaster-ready brethren. He was very impressed by its goliath proportions.

Mack and I shared a pancake combination plate, which means that he stole all my bacon and refused to eat anything else, even though I poured three kinds of syrup on the pancakes. THREE KINDS OF SYRUP!

Syrup application, in case you were wondering, is a serious business.

Hide-and-seek at the playground. You'd think from Mack's covering his face that he'd be the one counting and then seeking, but actually, he's the one hiding. Because if you cover your face, no one can see you.  Think of all the research money the armed forces could have saved if only they understood this principle!  (Cal also noted that the fact that I was standing there taking pictures of him made Mack particularly easy to find.)

My penchant for striped shirts, exposed.

I know this was just a pile of pictures, but that's basically all I got. Oh, that, and this: one more Whitney Houston tribute courtesy of Randy Watson and Sexual Chocolate.





I suppose I could write more now, but I just downloaded Season 2 of "The Walking Dead" from iTunes (which includes all this "Behind the Scenes" cast commentary) and it's pretty much blowing my mind that Andrew Lincoln not only doesn't have a Southern accent in real life, but, in fact, has a British accent. It's Downton Abbey with zombies!

winter melon soup

One of the somewhat annoying things about this pregnancy (and this has by far been the most symptom-laden of my three pregnancies to date--about which more later, if I feel like whining) is the fact that I really haven't felt hungry for, oh, the past four and a half months. Not that I'm not eating, of course--I am, pretty much as usual. But I just feel kind of generally blergh about the idea of food, and I haven't been really hungry in the classic sense since about the middle of November. I just kind of eat when it's eatin' time, because I know I should, and because my stomach is making noises. These days I'm usually indifferent at best about food before I eat, and then after, I feel kind of bloat-y and nauseous.

Eighteen weeks and counting. This had better be a mighty cute baby is all I'm saying.

I have been craving certain types of foods (this, again, is no different from before I was pregnant, only that I'm paying more attention to foods that don't fill me with a sense of mortal loathing), but these foods are not so difficult to locate in Atlanta. Mostly I've been craving Chinese soups. Real Chinese soups. Not the messes you find in your Chinese takeout restaurants--your MSG-laden wonton soups, your cornstarch-thickened hot sour soups or what have you.  And it's really not that I have anything in particular against takeout Chinese food--it has its place, and I enjoy a mess of greasy pan-fried noodles with beef as much as the next person. It's just a different cuisine entirely.  Authentic Chinese soups--what they in Chinatown call "slow fire soups" (I believe this is the more literal translation--anyone who speaks Chinese better than I please correct if necessary), are a different beast; soups that have been slowly simmering over the stove for hours, if not all day.

Chinese "slow fire" soups are different than Western-style soups in that they are much more broth-oriented. Many Western-style soups (consommé excluded) do kind of straddle that line between soup and stew--the solid ingredients are the focus rather than the broth itself. Chinese soups tend to focus more on the liquid component. You could filter our all the solids and still have an exquisite bowl of soup--clear yet full-bodied. Not to get all medical on you (nor to get you to focus on the common end-point of all ingested foodstuffs) but Chinese soups could well be included in a clears-only diet, whereas most Western soups would be excluded until one's diet was advanced to full regular.

What I decided I wanted to make was a winter melon soup.

(Thankfully, my go-to Asian mart sells winter melon pre-hacked into usable-sized chunks, because I seem to have left my machete in the car.)

Now let's not let the fact that I have never in my life made a winter melon soup, nor the need for a few specialty ingredients deter you. That's what the Internet is for. I skimmed this recipe from Epicurious (which I used more as inspiration rather than explicit instruction, because--stuff a whole chicken's hollowed out organ cavities with matchsticked scallions ham and ginger to make my own chicken broth? How much time do you think I have?) and kind of cobbled together my own recipe out of what schedule constraints and ingredients I could readily get my hands on. And now here it is for you.

I don't really have the amounts precisely because I'm a little slapdash as a cook, but here's what I used generally:

• Winter melon (Dur. May be hard to find in a regular supermarket, but an Asian grocery store should have it)
• One big carrot (to give the soup some easy sweetness)
• Smoked ham hocks (for adding porky fattiness to the broth--the kind I got were frozen but no matter--I used half of the package depicted)
• Chicken broth (I used one carton's worth)
• Water (About 1.5x as much as the chicken broth)
• Ginger (peeled carefully!) -- about two inches worth
• Scallions (one bunch)
• Dried shrimp (about a handful)
• Dried shitake mushrooms (about a handful too)
• Salt

Except for the winter melon, put everything into a pot and then simmer the shit out of it for three hours.

(Seriously, that's most of my "recipe."  LOOK, I DON'T COOK, OK?)

Fine: I peeled the carrot, cut the ginger into discs and cut the scallions into four sections, but seriously--that's about it.  Oh, but look at this cool thing I got at the Asian mart (it's not an Asian implement per se, but they happened to sell it there for super cheap):

Maybe you can't see it too well from the shadow of the pot lid, but it's this little permeable metal basket for broth-making ingredients. I wanted to flavor the broth with the scallions and the dried shrimp*, but I didn't want to go fishing them all out at the end either, because my goal was a nice, clean soup without a lot of bits floating around in it. So this basket seemed like a good option, almost like a giant version of those things that people use when they want to use loose tea instead of teabags.

Anyway, simmer the shit out of it. Salt the broth to taste, but don't get too crazy with the salt unless you want to RUIN EVERYTHING. After three hours, take out all your ham hocks and your little basket of scallions and dried shrimp--they've done their job, now they can go, because they are ugly.  I guess a purist might filter the broth through a fine mesh to get it really nice and clear, but what am I, Martha Stewart?  Just leave it, it's fine.

Cut up your winter melon (not including the peel, also get rid of the seeds and stringy stuff) and cut it into nice spoonable sized chunks. Add to the broth and simmer for another half an hour or so, or until the melon gets translucent and velvety.  I also added a little bit of Napa cabbage at the end because it seemed contextually similar and something else to soak up those nice soupy flavors, but you don't have to--it's not really a classic interpretation.

(I have seen some other recipe variations which included cilantro, which while I admit might improve the presentation--the palette runs somewhat monochromatic--also kind of defeats what to me is the essential appeal of winter melon soup.  I think of this soup the way that Ruth Reichl once described mushroom soup, which is that it is smooth and easy and comforting with no sharp edges to jar the palate.  I like cilantro, but it doesn't belong in every damn thing, people.)

Dish it out.  Serve with white rice.  Or put the rice and the soup right in the same bowl, like I do.

It's eatin' time.

How about you all? What easy ethnic comfort foods have you guys have been able to recreate reliably at home without too much fuss?

* I substituted dried shrimp for dried scallops, because even at the Asian food mart, there were no dried scallops to be found. Perhaps at a different market, or in Chinatown--a urban neighborhood which, so far as I am aware, Atlanta lacks. I do recall there being a jar of dried scallops in the fridge at my house during most of my childhood, and though they looked like ugly little dessicated eraser nubs, I can attest that the flavor is quite good--very salty and savory and jammed with flavor, like fishy Milk Duds.  Dried shrimp is a decent substitution though, or at least so says Ming Tsai, noted Chinese person who cooks stuff on the teevee.

17 and 18 weeks

So I kind of feel like I should stop posting these pictures until something interesting is happening, but now that I decided to do this week-by-week thing, I am unable to half-ass it. I WANT TO USE MY WHOLE ASS. And if you're wondering, "Michelle, do you really wear the same clothes every day?" The answer is clearly: yes, yes I do.  Right down to the T-shirt.  (I swear these pictures were taken a week apart--I do launder my clothes occasionally.)  Also see evidence of the index finger I shaved off.

17 weeks:

18 weeks:

If also you were wondering: "Michelle, you use ultrasound regularly in your anesthesia practice. Are you ever tempted, maybe late at night, on call, when nothing else is going on and all the patients are tucked up in their little beds, to take a quick peek and see what weird contortions your fetus is doing? Because you think you feel it moving around in there, but at this point it could just as well be gas or the remnants of this afternoon's beef stroganoff?"  Well, the answer to that is also: yes--yes I am, and yes I have. I don't have the right kind of ultrasound probe of course (different probes have different degrees of penetration--we as anesthesiologists usually use a linear ultrasound for line placement or nerve blocks and as such usually don't need to see much deeper than two or three inches; while obstetrical ultrasound obviously goes deeper and through more tissue) but at this point, even at three inches it's enough to see a select body part or two.

(That's the feets.)

Hope your week is starting off right.

help me help you

Off the top of my head: five tips for people who might need to undergo anesthesia.


1.) Know what medications you're taking, and know what you're taking them for.

I guess this must seem easier for us, because by and large if you're reading this you are on the younger end of the spectrum, statistically more likely to be healthier and on fewer medications, and demographically at least somewhat medically inclined, but--you'd be surprised how many people have no idea what medications they're taking or for what condition they were prescribed.

Patients--please know what medications you're taking! It really makes a difference, and can affect how your body might respond to anesthesia or the various insults of surgery. And it's often not quite enough information to tell me that you take "a blood pressure medication," because there are many different types and they all work through different means. Is it a beta-blocker? An ACE inhibitor? A diuretic? An alpha-2 agonist? And guess what--even if you don't know half of what I just said, it doesn't matter. Just know the names of meds you're on, tell me, and I'll figure it out, because it's my job. If it's hard for you to remember, write your med list down or have a family member help you. Carry the list with you in your wallet if necessary.


2.) Know your own medical history.

Equally important, see above. Do you have a scar over your sternum? Do you have a device implanted under your left pectoral muscle? Sure as hell I'm going to ask you about it. I'm not being nosy, I need to know these things to make sure I can take care of you in the safest way possible. If you can't remember, or have a hard time because you have a long medical history, write it all down (list of diagnoses, surgeries, doctors with contact info) and carry it with you, maybe along with your med list. Better yet, keep it as a file on your computer, so you can update and print it out as necessary.

I know it's annoying to have to answer the same questions again and again, but it's a matter of safety as well. So bring your information. And don't just trust that, "it's in the chart," because sometimes it's not. Anyway, a good medical practitioner doesn't just trust someone else's History and Physical, they do their own.


3.) Do yourself a favor and think long and hard about your allergy list.

As an anesthesiologist (or even as a doctor in general), when I ask you about drug allergies, what I'm really asking you is, "will the benefit of me giving your a certain medication as indicated be outweighed by an adverse reaction of giving you that medication, and do I have good alternatives?" Putting lots and lots and lots of drugs on your allergy list to which you're not actually allergic does nothing but tie my hands to treat you in the safest and most efficacious way possible. Feel free to tell me if you tolerate some meds worse or better than others--if Flagyl makes you queasy or that historically you respond better to morphine than Dilaudid. I do want to know these things, so yes, tell me. But when you tell someone that you're allergic to every antibiotic on the planet because sometimes antibiotics give you the runs, it can really hamper our ability to treat you in a safe, effective, evidence-based way, because the word "allergy" means something very specific in medicine, and we take that word very seriously.

(Also: no one is allergic to epinephrine. Your adrenal glands make epinephrine. If you were allergic to epinephrine we wouldn't be standing here having this conversation right now. Sorry, pet peeve. I don't blame patients for saying it, by the way--I blame the boneheads who, knowing better, write it down anyway and thus immortalize it in the medical record.)


4.) Don't eat or drink after midnight the day of surgery, but it's OK to take most medications.

The surgical team may ask you to hold certain medications prior to surgery, and most of these medications make sense to stop. Since you're not going to be eating for a good couple of hours the day of surgery, it makes sense, for example not to take medications that will further lower your blood sugar (meaning oral medications for diabetes, or your full dose of injected insulin--brittle diabetics, consult your endocrinologist for specific instructions). Also, as surgeons try to keep bleeding to a minimum when they're cutting on you, so with some exceptions in specific cases (like if you've recently had a stent placed in your heart for example, of if you risk for clotting outweighs your risk for bleeding), it's usually advisable to stop taking any blood thinners or certain anti-inflammatory medications for a period of time prior to the surgery date.

But for the most part, other medications are fine to take the morning of surgery, if that's when you usually take them. In fact, I prefer it if you take most of those morning medications, particularly including any medications for your heart, your blood pressure, any breathing issues you might have, or medications for chronic pain. When you think about it, it makes sense: you want to be medically optimized for surgery, not with your blood pressure through the roof, wheezing, and with your pain out of control even before incision.

 Have questions about taking or stopping a specific medication before you get to the OR? Ask to speak to an anesthesiologist prior to your surgery date. Don't just call the surgeon's office and ask--often the person fielding the call (not always a medical professional) will not have the first clue, and will instead say, just because he or she thinks it's the safest answer, "don't take any medications the day of surgery." I had a myasthenic patient come in for an afternoon surgery having skipped several doses of Mestinon because the secretary she talked to told her not to take her meds. Like I said, if you have medical questions about day of surgery medications, ask to talk to an anesthesiologist beforehand. Again: it's our job.


5.) If you have any specific fears or concerns about the anesthesia itself, let us know beforehand.

Help us help you! Are you claustrophobic and hate the idea of having a mask over your face? Do you have a needle phobia? Did you have a family member with a very bad reaction to anesthesia, or have you yourself have a traumatic anesthetic experience in the past? Do you have questions about "The Michael Jackson Drug" and want to know exactly how the same fate will not befall you? Let us know! We can help you! There are things we can do to make things easier! Better! Smoother! Less scary! We have all sorts of tricks in our bag, is all I'm saying. We just need to know when and for whom to pull them out.


Medical professionals in this or other fields: another other tips?


* * *


For people of a certain age, Whitney Houston runs throughout the soundtrack of our childhood and adolescence. So if you want to pretend that you've never been alone in the bathroom hoping that the tile acoustics would help you better belt out the chorus of "One Moment in Time," I'd think I'd have to call you a damn liar.





Thank you, Whitney. You were transcendent.

more on hand wounds

Thanks for the input, guys, though I wish now that I had solicited your advice on how to more easily peel ginger (with a spoon?  Really?  And it doesn't just turn it into a mush?) BEFORE slicing a sliver of my damn finger off, not from the arguably more bloody world of the retrospective.  This is why I can't have nice things.  Like, you know,  fingernails.

Also, one commenter noted: "Wasn't there some big debate over bagel slicers at one point and now this? Is that irony I smell?"  (Click on the link to read the debate itself, but for the lazies, briefly: Joe had this bad habit of holding his bagels in his palm while cutting them in lengthwise directly into his hand, and I had a problem with that, especially given that he's in a profession where hand tendon injury could be catastrophic.  For instance, a minor to moderate hand injury would not necessarily end my career as I know it, but it could almost certainly end his.  However, you will be gratified to know that after that last discussion more than a year ago, Joe doesn't cut his bagels employing the "hand taco" method anymore--or at least he doesn't do it in front of me.)

Well, here's the difference as I see it.  I slice a lot of vegetables with a vegetable peeler.  This most recent event I would classify as an accident.  Accidents happen.  For example, I try to be cautious at work, but sometimes accidents still happen, like, say, needle sticks in the OR.  But accidents happening despite best precautions is different than habitually unsafe practice--like recapping non-blunt needles by hand, or sloppy sterile technique. (This is no one in specific, by the way, just a few easy everyday examples I can think of).  Or, to bring it out of the hospital setting and back into the kitchen where it started, let's say slicing bagels using your palm as the cutting board, or rubbing raw chicken all over your countertops.  My point being, I would say it's the difference between cutting yourself in the kitchen (it happens to everyone) versus setting up a situation where cutting yourself is much, much more likely to happen.

So no, that's not irony you smell.  Just the smell of human flesh and ginger cooking in a delectable mélange.

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Oh, and by the way, not that I wish you pain, but if you happen to have cut your hand and if you also happen to work in some kind of germ zone (or at least in a job where you have to wash your hands a lot), here's a great and truly occlusive bandage that will hold up for, I kid you not, a good couple of days.  

I got a six pack of these for the winter season (A.K.A. the "I'm washing my hands so much and the weather is so dry that my hands be cracking everywhere" season) and between me and Mack (Mack is a great believer in the curative power of Band-Aids, even without any actual visible injury--he prefers to prophylactically laminate himself) we are putting them to good use.  They're a little more expensive but seriously, they are worth it for high-mobility areas--as mentioned before, they are truly occlusive, they really stick well, and don't tend to get all sodden and ooze off like the more traditional model.  

Now everyone go get injured!

the view from below

What I didn't tell you before because it seemed premature (poor word choice) was that during my 12 week ultrasound to measure nuchal lucency, my OB told me that he was "90% sure" that the fetus was a boy.

"Can you really tell that early?" I asked, trying to see the screen better.  I saw what he was looking at, but from my (admittedly imperfect) memory of embryology from medial school, I thought that at 12 weeks gestation the unmentionables were simply classified generically as a "genital tubercle," with no real differentiation between male and female, blah blah blah something Wolffian and Mullerian ducts, blah blah.  (I never said I didn't remember the words, I just don't remember what they mean or are.)  Anyway, the OB said that was basically right, but sometimes one can get an indication one way or the other from the angle of the genital tubercle, uh, protuberance--and in his own, anecdotal, completely not scientifically rigid experience, he has a track record of being able to call the gender from the 12 week ultrasound about 90% of the time.

At the 16 week ultrasound this last week, he looked around a bit, looked at my chart, and asked, "What did I say it was going to be the last time?"

"You said it looked like a boy."

"Huh."  He angled the probe this way, then that.  (Thing 3 was angled weirdly, legs all criss-cross applesauce).  "Well, I think I may have...hmmm.  It looks like...huh.  I think I was wrong.  I think it looks like a girl.  See that mound here?"

(I did not see the mound.)

"Usually this mound here means...oh wait.  Here's a better picture.  I think...I think I was right the first time.  I think it's a boy.  Usually I can get a better picture than this, though, at 16 weeks...Usually it's like, KABOOM, you know?"

"Kaboom," I echoed, obligingly.

"Huh.  I wish I could see better.  But I think it's a boy.  Let's say 99% sure it's a boy.  But I'll save that last 1% for next time, when we do the anatomy scan."  And then I forced him to look at the head and heart and the diaphragm and the guts to make sure they were all properly septated and in their proper areas (it's a little early to do the full anatomy scan, but major anatomical badness we could probably see, though thankfully nothing ominous presented itself at this point).

So, we are left with several possibilities.

1.) It's a boy, a fact that will become KABOOM, in your face (ew) obvious once the testes actually descend from their Spring Training Camp in the peritoneum.  (Yes, now is an appropriate time to scream the word "GUBERNACULUM,"--I for one have been waiting for years to use that word in its correct context, as opposed to just, you know, saying it randomly just because it sounds awesome.)

2.) It's a girl (unlikely, I think, which is probably good, because we were already expecting a boy and when Target had a huge sale a few weeks ago I got a bunch of boy-flavored onesies, for like, a dollar.  When Cal was first born I was determined to find only gender neutral clothing, because, like, gender role stereotyping is bad!  See also: votes for women, step in time!  But soon I realized that outside of a very limited selection of green-or-yellow newborn items, no one makes gender neutral kids clothing; everything is either, like, a screaming pink onesie with scalloped neckline and rhinestones spelling out "DADDY'S LITTLE PRINCESS" or a hyper-blue onesie reading "MOMMY'S FAVORITE QUARTERBACK," embroidered with, like, a football and a rifle or something.  Anyway, my point being, it's probably not a girl--a fact that might disappoint some but for me and Joe, at least, was admittedly something of a relief.)

3.) The final option, which crossed my mind, and which I will sum up with the following story.  Back when I was a Peds resident, we used to write notes or call consults in this little glass-walled closet known  as the Resident Work Room (the term "room" was generous--for those who similarly trained at Babies Hospital, as we were known at the time, this was back when we were still working primarily out of the old hospital building, which looked like a sanatorium and still reeked faintly of cholera and The Black Humours).  Anyway, sometimes we would stick things on the walls of the resident work room--mostly they were boring things, like schedules and reminders, but sometimes there were funny things, like notes or dictations gone awry.  One such dictation was from an abdominal and pelvic CT of an infant (maybe it was a plain film), and either the radiologist had a very heavy accent or the transcriptionist was tired that day.  The final line of the dictation was highlighted in yellow, and read, "DIAGNOSIS: UMBIGUNOUS GENITARIA."

Anyway, Thing 3 looks good.  And it's looking with increasing certainty like we're going to be living in a live-action version of Alvin and the Chipmunks.  (To be clear: Cal is Simon, Mack is Alvin.  Joe and I, of course, play the role of Dave Seville on alternating nights, please check your programs for last-minute substitutions.)

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Usually it wouldn't have taken me that long to write the above entry, but this morning I was peeling some ginger (I am attempting an experimental new recipe for Asian-esque short ribs--if it turns out well I will post the recipe here, otherwise let's never speak of it again) when the vegetable peeler slipped and instead of taking the skin off the ginger, took the skin and 1/4th of the nail off my left index finger.  Look, usually I'm more careful in the kitchen, but ginger!  It's so bumpy!

Anyway, the good news is that it didn't ever hurt that much (strange how little it hurt, actually, juxtaposed against how disgusting it looked) and it's on my non-dominant hand.  However, the bad news is that my left hand is also my laryngoscopy hand, so I guess I'll be intubating next week with one finger sticking out, like I'm a dainty madame or something.