1 year.

Today marks the one year anniversary the death – the murder – of my classmate and friend. She was a victim of intimate partner violence. I’m wearing the purple pin today, the same one I wore at her funeral.

There hasn’t been a single day in the past 365 days that I have not thought of her. Her death was a shattering blow to my little world.  I have been lucky, I suppose, not to have yet experienced a sudden, unexpected death in my circle, let alone, a murder.  The world has since felt cruel and unfair and unjust.  When my youngest son smiles, giggles or cries, I think of her youngest. My heart breaks into a million little pieces thinking about that little boy who is the same age as mine and is now growing up without his mother.  When I look at my 9 year old daughter and how she is growing and changing, I think of her two girls, aged 13 and 9 and my heart breaks a little more.

I’ve attended the preliminary hearing of the man accused of killing her and seeing him makes my skin crawl, my blood boil and the rage I feel is unlike anything I have felt before.  Her immediate family cannot attend as they are witnesses, so I try to go when I can.  It is a painfully slow process and I wish it would go faster.  We all need some closure.  Sadly with the state of our justice system, that closure will not (has not) come quickly.

I have read accounts of the families of victims of murder eventually being able to forgive the killers. They are stronger than I can ever be.  I will never forgive that man for what he did to my friend, to his children.   But I know that anger and rage is unhealthy and can eat away at me so I try to keep it buried and I run it off when I can.

She enjoyed running.  She would find the time to comment on my posts about running on social media and every now and then a memory will pop up and I’ll see a comment from her. I can’t lie, it helps ease the pain in one sense, but re-ignites the rage in another. I honestly don’t know how her family is coping, I know they have to push forward for the children, but I wish they didn’t have to. No one deserves this kind of living hell.  No one.

I don’t think I’ll ever quite get over this loss.  I wish I understood why it has affected me so much.  We hadn’t physically seen each other since graduation but with social media, I knew enough about her and “followed her” that I felt we were still connected.  She reached out to me a few times when she moved back to the city and we were pregnant at the same time, but we never found the time to reconnect in person. I think I will always, always regret that. I do know that I need to forgive myself for that.  There was nothing I could have done or said, had I known about her situation, that her closest, trusted friends and family, hadn’t done or said already.

I’m mad at her too.  God, it feels awful to say it, but it’s true.  Why did you stay with him? Why didn’t you run away when he hit you the first time?  Why didn’t you listen to your friends and family then? It could have been all so different.  You might still be alive today.

Fuck.

 

To treat… or not.

My dad was diagnosed with prostate cancer on his 82nd birthday. I expected it when his PSA test started increasing. He had a biopsy.  I couldn’t attend the appointment for the results but asked my mom to make sure she found out his Gleason score. When she called me on his birthday, I heard it in her voice before she said the words.
Cancer.
It’s considered an intermediate- risk tumor.  There is no metastasis. But given his advanced age and other co-morbidities, namely the Alzheimer’s, surgery is not recommended.
At his age, hormone therapy and radiation is recommended. Without treatment, he has perhaps 10 years.  But that means the tumor will get larger, he’ll have more lower urinary tract symptoms of obstruction and likely bone pain from metastasis.   Radiation is not easy.  It involves daily trips to the hospital for weeks;  20-39 radiation visits. That’s 20-39 days that my mother has to drive him to and from hospital and pay exhorbitant fees in parking. My mom went through  radiation treatment for her own breast cancer 15 years ago. She still remembers how hard that was on her. How difficult now will this be on my dad? He asks her several times a day what the next doctor’s appointment is for. Because he forgets. How difficult will this be for my mom to take him to the hospital day in and day out,  in his already semi-frail and de-conditioned state?  Is it cruel to put him through treatment? Is it cruel not to?
After meeting with his radiation oncologist and learning about a new treatment protocol involving only 5 weekly visits for radiation therapy, it looks like we will be embarking on treatment for my dad.  He seems to understand the side effects of treatment and that it means weekly visits to the hospital.  Of course, he’ll ask many times why he’s going but that is okay for now.  Five weekly visits is going to be much easier for my mom.  If and when it gets to be too much, we’ll make a decision to stop.  But for now, he/we are going to fight this.

2017 – with a vengeance.

2017 came in with a vengeance, for me at least. New Years Eve day started out with my three-year-old up chucking his applesauce then spiking a fever for most of the afternoon. While the older two kids were on their way to my in-laws, it was touch and go whether the baby would be staying home and changing our NYE plans or going to my mom’s for the night. Thankfully with some Advil and Gravol, he perked up enough to be sent there for the night.

As my husband and I prepared to go to our friend’s place for the evening, I had a fleeting thought of “What if I’m the next one to get hit with the stomach flu?”  I forgot to mention that my eldest got hit with the stomach bug two days before.

The evening started out great. We brought all the fixings for a cheese fondue and it turned out great but shortly after starting to eat I felt the distinct uncomfortable rumblings in my lower stomach that signaled something wasn’t right.  Sure enough, an hour before midnight I was hugging the porcelain god and wishing I were dead.  The stomach virus that gently hit my children assaulted me with a vengeance.  Minutes after midnight I was lying in an upstairs spare bedroom shivering with chills. So much for my new year’s eve plans.

Why is it that the holidays bring on such horrible illnesses? This is the second year in a row that my family has been plagued with a stomach virus over the holidays. I myself have had more of these bouts of illness in the last 5 years than I can remember for most of my life. Is it the kids?  Are they the germ factories?

It’s downright awful.

Even after spending almost the entire day in bed yesterday and sleeping close to 14 hours I am still not 100% today and feel like I could be on the verge of intimacy with the porcelain gods again.  As I write this I’m lying in bed with three children arguing for my attention.

Time to sign off …

What if?

What does a wife and mother to 3 children do when her husband (who stays home to look after the kids) is suddenly offered the opportunity of a lifetime but it means 2 years away from home while he tours Canada, the U.S., and Japan?

Gah!

So many scenarios run through my head…

Of course we could make it work.

I can parent three children on my own and still work 30 hours a week.

My job is relatively flexbile, I could change my hours to accommodate school pick up and drop offs.

I can’t let him pass up this amazing opportunity.

What if he resents me in 10 years because he didn’t go?  What if he resents me in 10 years because he did go?

I used to watch this television show called Fringe.  The main premise of the show was parallel universes.  I often wonder if there were a parallel universe or ten, what would it show me?  How would my husband leaving to go on tour for 2 years affect my children’s development? How would it affect them if he didn’t go?  Would it make me a more capable mother or would it make me worse?

I don’t think he’s going to go, but the exercise of thinking about it and wondering if I could handle running a household on my own really makes me realize how much I depend on him and need him. Sometimes I think I might take that for granted.

This also reminds me of my favorite poem:

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.
Robert Frost, “The Road Not Taken”

 

From Scratch

I couldn’t let the day pass without writing.

It’s February 29!

Happy Leap Day/Year everyone!

There has been so much I wanted to write about but getting my thoughts down has been hard.  It’s been very busy at work and by the time I get home and see my kids, eat dinner and relax, it is time for bed.  I’ve been running about once a week which isn’t nearly enough and that has been hard to deal with as well. I just haven’t been motivated to run lately and it hasn’t helped that I’ve been on-again off-again having issues with my calf.  Coming home late from work also means there’s no time to run.  The kids barely see me during the week as it is, so it’s not like I can arrive home and immediately turn around and leave for a run. Needless to say, mommy guilt is at an all-time high. 

I have also been preoccupied lately with being an assessor for medical school admissions.  After doing a file review of 30 applicants, I also took part in the in-person interview. I’m not sure who was more nervous, me or the applicant!  Thinking back to my own medical school interview, it was an hour long while I sat across from four very important looking people. Daunting indeed. It was interesting being on the other side of the table. It was more a privilege than anything else. I felt like I was a member of a very important club and it felt good to be able to play a small role in choosing our future physicians. 

Husband and I have been watching a lot of Netflix recently.  We just watched a documentary called “Cooked” and it was a fascinating look at how we as humans approach food.  One of the episodes was called “Air” and it was a look at the art (and science) behind bread.  Did you know that if you mixed water and flour and left it to the air that something magical would happen?  You can make your own yeast sourdough starter!  You don’t need anything else but time and patience.  There are yeast spores in the flour and in the air, all ready to start doing their thing.  Ever the scientist, I decided to give it a try.

Day 1. A boring paste of flour and water. IMG_1336
Day 2. Something is happening. Those bubbles are CO2 being formed by yeast. After adding more flour and water to feed the fledgling yeast 

Day 3.  More feeding of flour and water. More magic. Now it’s starting to smell a bit funky, which I hear is a good thing.

  

Day 4 – today. Sour and pungent smell. It is almost ready. 

 
When I got home tonight I decided it was time to try out some bread making. Now the dough is rising for the next 12 hours (sourdough) and for the record had I known this would take this long to make one loaf of bread I would have just gone out to the bakery and bought one. 

😉

Habit and Breaking It. 

I’m writing this as I sit in a taxi on my way to a conference. My driver is a woman. This is a first for me! I can honestly say I have never had a female cab driver before. My initial instinct after telling her my destination is to take out my phone and snap a photo of her. Why? To post on Instagram of course. 

I stopped myself. 

“You aren’t on Instagram anymore.” 

“Who are you posting that for?”

“Why does anyone care!?”

I admit I got caught up in the desire to photograph my life for others to see, that is, to photograph those things that I wanted people to see. Again I have to ask myself why? What does it prove? Why does anyone care that I’m awake this early on a Saturday attending a conference about the Eye?  The better question is why I feel the need to tell people about it? 

Deep thoughts for a Saturday morning. 

Thursday Thirty.

Thirty things I love.

1. Myself.
2. My husband
3. My children
4. My parents and brother
5. My friends
6. My cat
7. Running
8. Chocolate
9. Cross stitching
10. Coffee
11. Wine
12. Bailey’s
13. Martinis – preferably chocolate-y and sweet
14. Steak
15. Being a doctor
16. Being respected
17. Being someone to count on
18. Being my own boss
19. My bed.
20. Chips and dip
21. Ice cold water
22. The sun
23. Baklava
24. The smell of my kids right out of the bath
25. The scale 😉
26. My Guess jeans
27. My boots
28. My nails (they are the longest now they have ever been … ever!)
29. My house
30. My life

Life Imitates Art.

I have always been a sucker for disaster movies.  If I’m laid up on the couch sick with the flu, or just need a go-to movie to watch, my husband always knows which film to put on.  Hollywood doesn’t disappoint – there are many to choose from, be it in the form of natural disasters like comets and asteroids threatening the Earth, or solar flares, or climate change causing another ice age – I have my pick of movies that I can watch over and over and over again.

There’s a certain suspension of reality from the movies I’ve listed below – how likely is it that we will see another ice age? I mean, really.  How likely is it that a comet or asteroid is suddenly going to be discovered that will hit us in just the right way to cause an extinction level event?  I always joked that if such a thing were to ever happen, I would want a front seat to watch it.  A giant asteroid hurtles towards the Earth and will destroy the planet?  Yes! Sign me up for a front row seat to watch it enter the atmosphere!

 

 

 

 

 

 

 

 

 

 

 

But then there’s the other kind of disaster movie.  The movie about a virus, spreading throughout a population.  There’s only been a few that I can think of, probably because it hits a little too close to home for most people.  You know the movies.  You’ve seen them.

These movies are a little harder to watch, especially Contagion.  Why?  I think that’s pretty much self-explanatory.  The likelihood of a virus causing illness and spreading quickly, infecting and potentially killing people, is well documented in human history.

The Black Death (aka the Second Plague) killed an estimated 75-200 million people in the 14th century.  It was caused by a bacterium called Yersinia pestis and was carried by rats.  Also known as the Plague, it ravaged most of Europe, and took almost 150 years for Europe’s population to recover.  The Plague recurred on and off for the next 500 years, causing smaller outbreaks in Spain, France, Sweden and Russia.

 

Smaller pandemics of cholera, typhus, measles and smallpox have been reported throughout the past 1,000 years:

  • The Italian Plague killed 280,000 people in the 1600s
  • In Southern New England, 30-90% of the population of the Wampanoag people died of leptospirosis
  • In the 17th century, the Great Plague of London killed an estimated 100,000 people
  • In Asia/Europe, in the early 1800s – the first cholera pandemic killed over 100,000 people
  • The second cholera pandemic, in the mid 1800s, killed another 100,000+ people in Asia, North America and Europe
  • In 1838, over 100,000 people died in the smallpox epidemic of the Great Plains
  • The third cholera pandemic affected Russia killed 1,000,000 people in the span of 8 years, between 1852-1860
  • 20,000+ people died of a typhus epidemic in Canada, in 1 year in 1848
  • In 1875, 40,000 people died of measles in Fiji
  • Worldwide, in 1889, 1,000,000 people died of a flu pandemic

The 20th century alone saw some of the world’s worst pandemics.

  • The Spanish flu decimated the world’s population after WWI, killing an estimated 75,000,000 (75 millon) people, in 2 years!
  • In 1957, the Asian flu killed  2,000,000 people worldwide.
  • 1 million people died in 1968 of the Hong Kong flu.
  • 15,000 people died in India, in 1974, of cholera
  • More than 30,000,000 people have died of HIV/AIDS since 1981

The 21st century is almost a decade and a half old.  We have seen our fair share of outbreaks. Nothing as devastating as in the past, thanks mostly to sanitation, vaccination, antibiotic and antiviral medication, but outbreaks nonetheless.  One might argue that the world is due for one.

  • In 2003, SARS killed 775 people, mostly from China, Hong Kong and Canada; it spread to 37 countries from China
  • The 2009 flu pandemic (H1N1) killed about 15,000 people worldwide.

And this brings me to the real reason for this post.

For months now, news of the Ebola epidemic in West Africa has filtered through my Twitter and Facebook feeds.  The numbers of infected are astounding. I’ve seen estimates that by January 2015, over 1 million people will be infected, half of whom will die.  Ebola, historically, has had 90% death rate.  During this recent epidemic, about half of people infected are dying.  But that is still 50% case fatality rate.

So, what is Ebola? And why is it so deadly? Well, Ebola is a virus.  It’s actually quite pretty, I think.

My knowledge of virology is limited to a few hours of lectures on viruses from medical school.  It has an RNA-genome and it is kind of long for a virus.  Like most viruses, Ebola enters a cell by attached to that cell’s protein coat and fusing with it.  Once fusion of the two occurs, the virus empties it’s contents in the cell and the RNA attaches to the host cell’s RNA and takes over. Instead of the cell making its own proteins, it now has instructions from the viral RNA and starts making copies of the virus.  Once those copies are made the virus attaches to the cell’s outer coat, buds with it and leaves the cell.  By this time, the cell usually cannot function anymore, and so it dies.  The new virus copies get into the bloodstream where they are free to infect other cells and the cycle starts again.  The host immune system cannot keep up with this invader.  The virus makes special proteins that interfere with the hosts’ defenses and leaves the host vulnerable.

The Ebola virus especially likes the cells that line the blood vessels, as well as certain cells of the immune system and the liver.   After infecting these cells, it damages the integrity of the vessels, leaves the immune system’s defenders weakened, and damages the liver’s ability to form clotting factors.  The host then starts to bleed internally, hence the reason Ebola virus infection is also known as hemorrhagic fever.  The host bleeds internally, eventually causing death.

By the grace of God, if you so believe, Ebola virus is not airborne.  This means that it’s not present in the air and cannot be transmitted from being coughed on, sneezed on, or breathed upon.  Infection with Ebola occurs when bodily fluids (blood, feces, urine, emesis) from an infected host are mixed with a healthy host.  Most of the people who have gotten sick in Africa were family members and health care workers caring for the sick, and sadly, the dead.  The WHO recommends avoiding contact with the sick whenever possible, regular hand washing with soap and hot water, and discourages traditional funeral rites of washing and embalming the bodies of the dead.  The virus can be killed with heat (heating for 30 to 60 minutes at 60°C or boiling for 5 minutes).  Quarantine remains an effective method of controlling the disease.

I’ve often joked with friends and family that the world is due for a pandemic.  It’s been almost a hundred years since the Spanish flu pandemic.  The seasonal flu is nothing to joke about – the very young and the very old, still die every year from regular, joe-schmoe influenza.  There is a vaccine developed every year against the strains that most likely will be in circulation.  Since 2009, the vaccine now protects again H1N1 as well. Our office is getting ready for our annual fall classic – the Flu shots are arriving tomorrow and we are starting “flu shot” clinics next week.

But something in the news recently has me a bit worried. Earlier this week, it was reported that a traveller from West Africa boarded a plane in Liberia and landed in Dallas, Texas.  Asymptomatic at the time, he passed through whatever checkpoints were in place and entered U.S. soil.  A few days later, he started getting sick and presented himself to the local ER.  He told the triage desk his travel history, was seen by a doctor, given a script for antibiotics and was sent home.  He returned to the hospital 4 days later, very ill, and was diagnosed with Ebola virus.

Yes, folks. Ebola virus is now in North America.

I have one question.

How the FUCK did this happen?!?!?

Why are planes from West Africa being allowed to land?  If such a plane does land, why aren’t those travellers being immediately quarantined and monitored for symptoms?  Have we learned nothing from SARS and H1N1?

I wouldn’t want to be that triage nurse in Texas who took the travel history information from the Ebola patient and failed to forward it along to the attending physician.  I’d like to think that physician, had he known his patient had recently been in Liberia where there is an Ebola outbreak occurring, would have immediately notified the Centers for Disease Control and Prevention (CDC), and locked down his hospital. But no, that physician apparently didn’t know of the travel history, the patient didn’t bother to mention it again, and he was sent along his merry way to infect his family and God-knows who else.

Apparently, the man went back to the apartment complex where his family lived, started getting progressively more sick, was actually seen vomiting outside the building before being taken back to the ER where he was eventually diagnosed.  Does this not alarm anyone?  When I read the news report to my husband, he made an interesting observation. One that actually is a bit frightening.

Who cleaned up the vomit which likely was teeming with Ebola virus?

Did a dog come by and lick the vomit? Did that dog go back to his owners?  Is the dog sick? What will Ebola do in a new host species? Has the virus mutated? Can it become airborne?

According to that report yesterday, 18 people have been identified as being in contact with this individual.

Today? The Texas health departmentt said there were 100 potential contacts.  “Dallas County officials said more than 80 had direct or indirect contact with the patient.”

Well, which is it?  Indirect contact shouldn’t be a concern with Ebola, right?  Only direct contact, like family members cleaning up vomit or feces, or wiping the face of their sickened family member; or the maintenance worker of the apartment complex told by his bosses to clean up the vomit outside the building?

Today it’s 100.  Tomorrow it could be 1000.

Is this the beginning of next pandemic I joked earlier I thought we are due for?

In those two movies I love to watch, Outbreak and Contagion, the CDC takes control of local health departments and gets the epidemic under control.  Is life about to imitate art?

For all of our sakes, I certainly hope not.

 

 

 

 

 

 

 

 

 

Bread and Butter.

I’m not talking about food, though is there anything better than warm bread slathered in salted butter?

Yum! 

What I am actually referring to is the “bread and butter” of family medicine.  The day-to-day stuff that brings home the bacon.  Hmm…. bacon.  (Never mind me, I’m just hungry).

Colds, flu, back pain, anxiety, depression, high blood pressure, anxiety, work stress, anxiety, depression and well baby visits.

Repeat.

This is the bread and butter of family medicine.

Did I mention anxiety?

I’m not even half-way through my work day and I’ve already seen 3 patients with anxiety.  (You may wonder how I have time to blog?  Lunch baby.  Lunch!)  I do NOT work through my lunch.  I eat. I blog. I digress.

The bread and butter often comes in lumps — some days there is nothing but back pain, other days everyone’s got a sinus infection.  It’s very strange.  After 7+ years in practice, I still haven’t figured out why that is.  Perhaps I never will.  It’s one of the mysteries of life.