TNVT

Mat has this lazy Sunday tradition that I love. He lays on the futon nestled in a cozy arrangement of our fuzzy-futon-blankets, chooses a very very intense movie to watch on Netflix, and...promptly falls into a deep deep sleep. As I tap away on my keyboard, pecking away at ignored emails from the week, he snores from under a quilt his grandma made, freakishly long flat toes peeking out from the bottom of the patchwork. The mountain climbers on the screen attempt to summit the unattainable Meru for the second time. 

I broke down in his arms the other night because I had so abjectly failed to exercise or eat right. Clearly, my weekly goals don’t work.

“It’ll be ok, we’ll make a plan and figure it out”

I am grateful to have a partner like him. I am grateful for days like today and moments like this one. I am grateful for his support though I know the motivation and support needs to come from within.

I set three goals on 1/23/2017 as follows: 

walk 10,000 steps a day

drink 8 glasses of water a day

give up chocolate for the week

GOAL 1: WALK 10,000 STEPS A DAY

I’m on my feet at work for most of the day, so I usually average around 4-6k steps, which isn’t sedentary, but not ideally active (’low active’). There have been a smattering of studies out there commenting on 10k as an ideal target, and I needed something to reach for. Here’s week 1:

That week, I was on the consult service at our largest hospital, our busiest service. This involves daily running around our labyrinthine mishmash of buildings seeing strokes/seizures/headaches/whathaveyou as well as taking every 4th day 28-hour overnight call. Monday night was insanely busy with no sleep at all overnight hence the slump on Tuesday as I slept the day away (actually most of the steps I took that day were between MN and 11am). Friday night call was much nicer with only 4 consults before midnight, and a surprisingly unfragmented 7 hours of sleep, so I managed to reach my goal both Friday and Saturday. Huzzah! I think the main thing that got me to my goal each day was walking to work in the morning. I’m often too tired to walk back home after work, but doing that might catapult me towards a goal of >12.5k steps a day (’highly active’). Here’s week 2: 

This week, I was on an ICU rotation - 12-14 hour days taking care of some of the sickest patients in the hospital on one unit. Not as much walking as the consult service and earlier start times. I rarely got my ass out of bed in time to walk to work, so I often took the trolley or, shamefully for a 1.5 distance, a Lyft #deleteuber. I also often took the bus home as I was too exhausted to walk home in the cold. I only reached my goal one day this week, that day being M’s birthday, when we walked to our favorite local brewery for dinner. Disappointing, but I know why I didn’t reach my goal. I was too fucking tired and didn’t try. I’m going to keep 10k as an aspirational goal for this week as I continue on ICU. 

GOAL 2: DRINK 8 STANDARD GLASSES OF WATER A DAY

Nope. nopenopenope. I tried my first call day on Monday, and managed to down only 20 oz (about 2.5 glasses) over the course of the night ‘cause it was too. dang. busy. I also forgot about this goal for the rest of the two weeks. Plan is to bring a refillable 20oz bottle of water to the ICU this week and see how it goes. I may be limited by my tiny, overactive bladder. I also didn’t have a reliable way of recording how much I drink, so I’m going to use this Fitness App on my phone so maybe there’s a better visual next week. We’ll see. 

GOAL 3: GIVE UP CHOCOLATE

I slipped up early in week 1 with a York Peppermint Patty, and it snowballed from there. Goddamn do I have a dependence on the damn thing -- like, seriously, I have withdrawal cravings in the afternoon. Which I satisfied both weeks because excuses excuses stressed on consults and ICU and birthdays and blahblahblah. How do I get out from under the oppressive thumb of my sweet tooth, y’all? I’m going to try the kibosh again this week because this is silly, and I know I can do without it.

I’m feeling a little bit more hopeful than the last time I wrote thanks to a few well-timed messages from a couple of you dear readers (you are all certainly very dear to me. I appreciate you reaching out. Very much.). This one from A was particularly helpful to revisit: 

“I think trying to make little changes may help a lot...I am definitely intimately familiar with feeling betrayed by my body, and I've found small changes to have an outsized effect...”

I also just finished reading Atul Gawande’s latest masterpiece on incremental care (goddamn is he an incredible writer, and a political one to boot), which got me thinking on my own difficult little chronic problem

There was a place for prevention and maintenance and incremental progress against difficult problems...If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention....Success, therefore, is not about the episodic, momentary victories, though they do play a role. It is about the longer view of incremental steps that produce sustained progress

I don’t need a quick fix, I need a *long* one. I need mile markers on my quest to a healthier self. To that end, I am going to try weekly actions. Three goals that are actionable, attainable, and yet aspirational - meaning I can figure out a way to do them, they can be done, but not that easily. Here are my first 3 for the week of 1/23/2017.

walk 10,000 steps a day 

drink 8 glasses of water a day

give up chocolate for the week

I have a Withings watch, which, funnily enough, I obtained through a weight loss study I enrolled in (more on that at another time) after my horrifying up-sized scrubs moment in Jan of intern year. It tracks steps fairly accurately and gives you a nice weekly summary. I can achieve it by walking back and forth to work everyday or getting off the bus somewhat early. The second goal is as much about hunger as it is hydration. I think I often eat when I’m thirsty. The official recommendation is 9 glasses of water for women, but I’ll stick with the standard rec. The last one is a tough one for me, but I need to put a cold turkey kibosh on this comfort food to do it. 

"Are you with child?"

He tried to backpedal it with something about "a glow". I expected the comment as soon as I saw him eying my belly, and, yet, it still decimated me to my very core. I was a little dazed for the rest of the afternoon. That evening, I was chopping a pepper when M made some comment about how I should hold the knife, and I just broke down and wept.

I am not pregnant. I have developed a gut.

I won't say I've struggled with my weight all my life, but I've certainly thought about it from a very very young age -- since 8 years old I think. My mother has struggled with her weight ever since she came to this country and ballooned up while being a lonely and depressed and stressed immigrant housewife for 7 years. Her own anxieties and insecurities about weight enveloped my sisters and me in explicit and implicit ways. Every pound I gain hurts her somehow. Add to that a general cultural surveillance of weight within my extended family. I love them, but I dread going to any event or reunion because of the onslaught of comments about my appearance.  

I don't think I've ever liked my body and how it looked, which is a really sad statement, but it's a breathing and evolving statement. In middle school, I cared more for books than my looks because I thought the popular girls who cared [read: brushed] their hair were stupid. It became more of a weight thing later.

I go through periods where I'm amazed at what my body can do for me, but things have been steadily declining over the last ten years and have really gone down the shitter lately. I was around an ideal body weight when I graduated high school in 2007. Since then I've gained approximately 50 pounds - 15 over the course of college, 15 over medical school, and a whopping 20 pounds over the last year and a half in residency.

The last time I remember feeling good and healthy in my body is the summer of 2012, after my first year of medical school. I spent that last free summer ever in DC doing a primary care internship. I was so broke on a stipend in an expensive city that I *had to* cook for myself and packed lunches everyday. I made time to run (couch to 5k with Urooj!) and walked everywhere. I lost 10 pounds that summer and really felt good  in my body on top of it. The pounds crept back on during the remaining years of med school, leaving me at a net positive 15 over the course of 4 years.

Then intern year happened. What the fuck happened. This was the first time I have ever gained weight at such an alarming rate. It was exponential yet still surprised me somehow. I remember the exact painful moment I realized it -- December of 2015 during the holiday block I was working on general medicine -- about 6 months into internship,  I noticed that I could no longer comfortably fit into the scrub size I wore at the beginning of the year. I had to request a size higher of both my top and bottom. That had never happened to me before.  I weigh myself on a weekly basis but hadn't really noticed the cumulative effect of the upward swing.  That sounds ridiculous I know. I chalked the upward creep to the stress of some family squabbles, moving to a new city on my own,  being in a long distance relationship, eating shitty, and I mean really shitty, and being an intern in general.

But not all residents gain 20 pounds over their first year - natch, first 6 months. I am now decidedly in the "obese" range in terms of my BMI. It's fucking embarrassing. What the fuck happened to me?

I've been feeling truly terrible since then with some new and horrifying consequence popping up every month. I've had to give a large majority of my clothes away. Things that used to look good now won't zip. In yoga, which I've, by and large - pun sorely intended, stopped going to, my body - my bust, my belly - gets in the way. Simple things make me tired. I can't keep pace with my tall boyfriend when we walk. I was so winded after taking two flights of stairs with the consult team that I had difficulty presenting a patient because of how out of breath I was. The consult attending was in his 70s and was fine...

I have added on that dangerous girdle weight -- the one around your middle, the one we warn you about. And so much of it so fast, that I have stretch marks on my belly. STRETCH MARKS. Like the kind pregnant women have after carrying A WHOLE OTHER HUMAN BEING AT 10 MONTHS. That was a wonderful discovery in an Ann Taylor dressing room last month. I haven't admitted that out loud to anyone yet, not even myself. 

What's worst about the weight gain is how truly alone I feel within all my social circles. I can't go to my family for solace - certainly not my mom with her own incredibly warped weight/cultural issues or my young vulnerable sisters. Most of my friends from college are at healthy weights, beautifully thin, always have been and won't really ever get it.  Definitely not medical school friends either. I told bff M all about the pregnancy comment when it first happened, and she sympathized, but she can't really get it either. And my other M, beautiful hypermetabolic M, tries but can't. None of my coworkers are overweight or obese like I am. They don't seem to have the same embarrassing discipline and willpower issues that I have. For the first time in my life, I feel like I really have absolutely no one to turn to for something that is quite literally my heaviest burden. 

I write about it in my journal every few days or months. This is the first day of the rest of my life. But it never is. It's always more of my same shitty eating habits. More of my lazing around. It's always yesterday. 

"I took more photos of the small red bumps and typed “rash” into Google images for the 10th time. That’s how a hypochondriac says, “I love you."

My gaggle from Swat can tell you how painfully nostalgic I was before it was even appropriate to be nostalgic. We'd be walking the sloping path from Wharton to Sharples on some random October day, and I'd say for the millionth time "eeeeeeeeehhhhhhh you guuuuuuyyyyyys this is one of the last one hundred times we'll be doing this together like this!". And they'd groan and roll their eyes and laugh and change the topic to what beige item from fried shit bar would be the best that night.

 I thought my pained pleads were mental preparation for impending graduation, for saying goodbye. It's melodramatic, but Swarthmore had become a real home for me over those taxing four years. And I was leaving that home and all the trees and friends and professors and books and stress I had grown to love while there. For medical school and whatever mystery that entailed. For some place called Missouri.

No preparing for graduation. Lots of crying come May. Here's a picture the inimitable June took of me as I was walking out of the amphitheater. I had just locked eyes with Logan right before we both burst into tears.

That night, after shedding and returning our overpriced sweaty black gowns to the bookstore. After commencement and all the ensuing hugs and awkward family interactions and Big Chair pictures. Basically after all the hubbub died down, we weepily drank beer and shared shitty Chinese from Cheng Hing in the courtyard as each one of the remaining us peeled away in hatchbacks filled to the brim with flimsy cardboard boxes full of unnecessary shit. I distinctly remember letting go of Vy before she piled into a car stuffed with stuff and siblings. That was somehow the most devastating goodbye of the night.

I had the privilege of being a townie and had put off packing till the 11th hour. I finished around 1am, spent in my too short, too wacky Forever 21 graduation dress and tights. Everyone was gone except for him. He and his tireless mother had been cleaning out the true filth that had accumulated in his dorm room since the early afternoon. I felt reckless and went down the hall to say goodbye. He sat in his stunningly sterile room on his made (!) bed, tapping away on his computer. I gave him a too looooong, too wacky hug, hoping it would convey everything I felt for him. It didn't. But I later did, more explicitly, and he would go on to become the first person to truly break my heart.

Leaving Swat was an event. I knew it would be and it was. It was an event in a way that my likely departure from St. Louis somehow isn't. There's a twinge of it, but not much. I feel like it's time to go. I don't get it. Maybe it's because I won't actually know whether I'm staying or going until Match Day (3/20). But. Regardless of where I end up geographically, it's still leaving. Leaving this totally wonderful stage of a relationship with a man I love dearly for a totally uncertain future. Most of my friends will be leaving for residencies in sunnier pastures. I'm finally leaving the confines of the classroom and becoming a trainee in a new, more real and thus more horrifying capacity (actually being responsible for people?!?). Leaving the lazy days of fourth year for the grueling hours of an intern. I'm nowhere ready to go, in so many senses of that phrase.

FUCKING BATSHIT.  

Winter (Ankle) Break

So, I have the ankles of an osteoporotic matron from the Victorian era. After a fall on ice that I'd rather not talk about, I sustained a complete fracture of my right distal fibula -- the skinnier bone that makes up your ankle joint. The fracture was also displaced, meaning the two edges of the break weren't perfectly opposed, so my orthopedist recommended an ORIF (open reduction, internal fixation) that plates the bone together to stabilize the joint and decrease my risk of arthritis later on. In short, I am now a bionic woman who will have a part-titanium ankle for life**. Ti is stronger than Ca, right? I promise, in between ankle injuries, I carve out time to be a medical student. 

**Yep, for life. No, it typically doesn't/hasn't really set off airport detectors. And, yes, it's MRI safe...because electron pairs?

This was the first time an injury was (and still is) truly disruptive to my life. I was on the ob/gyn rotation when I broke my ankle and quickly came to the sinking conclusion that I wouldn't be able to continue (ugh, that clumsy med student whose face is contorted in pain just fell into the sterile field...again). I would have to make up the time somehow. What's more, I couldn't finish out classes with my improv team in time for our first performance.

I did not take this realization well.

I cried, you guys. a lot. Couldn't stop. Big heaving sobs as soon as the poor unsuspecting guy who came with the X-ray results told me I would need surgery. Tears just streaming down my face as the podiatry resident who was splinting my leg tried to console me. Up to that point, I truly believed I only had a sprain, frantically reciting the Ottawa criteria, reassuring myself that yes I could bear some weight on it....all while I crawled around the house on my hands and knees. I kinda knew it was broken but really didn't want to admit it. Denial is a powerful opiate, even (maybe especially) for people in the medical biz.

I was feeling immensely sorry for myself and ugly-cried for two straight days on the couch, alternately pitying and being inordinately angry with myself.  You see, my parents had finally managed to finagle overlapping vacation time over Christmas, so the family was all set to go to the Bahamas. Even I was excited to go around quoting DFW's cruise piece and filming a version of this with my sisters. Instead, this. The whole thing was cancelled. Because of me. 

I was very upset, crowning the whole thing as "the turd cherry on my poop sundae of a year". It took a long time before I could accept the injury for what it was. An injury, that's it. An accident, a something that happened.

I had had an interesting conversation with two improv friends (around the time the whole thing happened) about their generally philosophy of "ain't nothin anybody's fault". I surrendered myself to that. There are far far more terrible things in life. I wasn't necessarily minimizing my experience but accepting it just for what it was...and what it was not. I don't know, that really helped me work through the pain, both physical and mental. I was lucky in a number of ways, you see: 

I hadn't broken my tibia, which is actually the major weight-bearing bone of the joint. In fact, the tiny avulsion fracture of the tibia has been present since 2011. A tibia break would have been much more disabling

I hadn't hit my head. Seriously thank god. 

this surgery largely fixed the issue

my insurance covered my expenses, including physical therapy

school was flexible and accommodating

experienced the patient side of things (I'll write a post about that later)

I am young and otherwise generally healthy. I heal quickly. And I'm doing really great.

my pain wasn't incapacitating

the people around me

The last bullet point deserves elaboration. If you're lactose intolerant, take your fucking Lactaid right now because shit's about to get real cheesy.

to my dearest Liz, Tiff, and Urooj who are always always there and traveled miles and miles for a beer taster in Friendship Mediocre Suburbs. I don't know if you know how much you all mean to me. seriously. 

to Kim, who drove me and Ma home from the airport, bags and crutches and all, and only minimally laughed at the rolling knee walker. No thanks whatsoever to the rolling knee walker, fuck that thing. 

to Miriam. who drove me to the airport. who called and texted even when I was being a brat. who regularly checked up on me. who always always encourages and supports and boosts me up.  who accepts me at my worst and most negative, which has been quite often over the last year. who drives me to the grocery store and other places and listens to my grossest stories and is just an all-around fucking peachy best friend. I don't know if you know how much you mean to me. seriously. 

and, finally, my family. God, I'm getting teary just fucking writing it. I've had some problems with my family in the past and we still have major disagreements. but goddammit they really do have my back and I have never felt more taken care of in my life. this is not something everyone has, and I am really fucking lucky to have them. 

Oh and shout out Rose from the Animal Hospital who saw me struggle-walking in the snow and offered me a ride to the Skinker stop (which I accepted. because I'm in the Midwest, and she looked safe and friendly. don't tell mom.)

There's a Will Smith song for every situation in my life. SWITCH WEEKEND. 

So.

Here are the titles, you pick the 3 you wanna read the most and leave a lil comment. Some are short, some are long, some are old, some are very old. Some are quotes, some are not. etceteraetcetera. You pick!

Med Firm, Generally Sad

Primary Care - "The Sacred Trust"

Cardiology - For Whom the Telemetry Alarm Bell Tolls

Neurology - The Thinking Man's Specialty -or- Neurology: it's cerebral -or- Neurology: How I learned to stop worrying and love the brain

Psychiatry: "you're definitely not in Kansas anymore"

Does Don Draper Have Alcohol Dependence as per DSM V Criteria?: A Story in Gifs

Snaps

i am determined to not let this happen to me

An asshole’s karma makes fantastic leverage

Chick Chat

Winter (ankle) Break

True Love: Adult Schistosomes

Micro Micro Aggressions

Simon and I look very much the same. We are both tall (five feet seven) and have handsome bump in nose. There are differences, though. For example, his hands are very soft, like woman’s. Also, his arms are weak and small. They remind me of baby I saw once who had the infant paralysis.

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 Sarah used to threaten to kill the potato man whenever his prices went up. She would take out her knife and say, “I will kill you with this knife for robbing me.” He would curse her in Hungarian and then the two of them would wave their fists around. It was good times for everyone. These days, though, nobody has that kind of will. It is all please and thank you and have a nice day.

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