The World According to Dr. Lisa

Several of my friends are shocked that I'd post my age on the internet, but age is really a figment of time and place, right?  Not a question of yourself.  I mean if I lived on Mars, I'd be younger as defined by the number of times my home planet orbitted the sun, but still the same time would have elapsed.  Or is that a little existential.  Seriously, though, I have now been 39 for a week, and I'm good with it.  I know who I am.  I have been on the journey that is my life with all of its ups and downs and I am the sum total of that journey. Of course there are things I wished would have happened by now, but I can only worry about what I can control.  My grandpa, who was a wise man, had a motto "never begrudge getting older, it is a privilege denied to many."  There is a lot of truth to that.  So, while yes, I'd love to have fewer lines on my face and not be fighting gravity.  (At least people no longer ask if I am old enough to be their child's doctor.) I see no point in lying and saying that I'm younger or trying to hide my age.   I can't imagine being 30 again, that wasn't such a great year.  So far life at 39 seems pretty great, and 38 was out of this park.  So, if things keep getting better, no clue what could happen next..  I might just run the world by the time I'm 40, and let me tell you, the world according to Lisa would be pretty cool.  So, I embrace my age and I'm going with it.

Birthday Soiree

Being born in December, I have grown accustomed to having my birthday passed over.  What with all the holdiay craziness etc.  The past year has been so amazing, and I fully expect the amazingness to continue so I decided that that would just not do.  I organized myself a little birthday soiree.  I invited a bunch of my favorite people, people I know in a variety of different ways.  I made food, cocktails and set my house up for a party.  My friend, Kim, made me a cake.  I laughed, I smiled, I entered the last year of my 30s on a good note.

Thanks to all who came and helped me celebrate my birthday.  This has the beginnings of a pretty good year..

Guest Starring... Me

Last night I was on BlogTalkRadio as a guest on the Dr. Anonymous show.  We talked about how I got into the blogosphere the impact that blogging has had on my life.  Why I did a triathlon, and issues related to protecting our privacy as physicians in the blogosphere and our patient's privacy as well.  I had fun, I hope that those of you who listened did too.

Below is a link to the archive of the show. Sadly no video due to some trouble with the video feed last night. Oh well, I guess Dr. Anonymous will have to have me back...

Where you'll find me tomorrow night!!

I have made some friends in the blogosphere and am followed on twitter by a bunch of very interesting doctor types who are also in the blogosphere.  Somehow through one of these connections I have been invited to be a guest on the Doctor Anonymous Show on BlogTalkRadio tomorrow night, December 3, at 6pmPT/ 9pm ET.  We're going to be talking about stuff--- Neonatology, my trip to Mongolia, my life as a doctor, my experience as a patient and whatever else anyone finds intersting.  Join us, won't you.

My Happy Place

I joke frequently about finding my happy place. Most of the time I am referring to a state of mind.  A state where my mind is clear, quieted, calmed; thereby, allowing me to focus on whatever requires my attention, or at least not be distracted by the stuff that surrounds me.  Putting it in other words, getting my mind where it was in Bali, but Bali is very, very far away.  So going there to sort stuff out would be impractical to say the least.  Therefore, alternatives must exist and fortunately they do.  My happy place can be many different places, but it always involves fresh air, typically water in some form (snow, lake, river, ocean, fountain- I'm not so picky), some nice pine trees and maybe a sunset. Sold!

Really though when I speak of My Happy Place as a real place it is Lake Arrowhead.  Or more specifically that little corner of Lake Arrowhead where I have spent so much time in over the past 35 years.  It meets all of my criteria-
Water- check, there's the lake, a stream running by our place, and sometimes snow
Fresh air- check, it's the mountains, silly
Pine trees- done, it's the middle of the forest after all, we even have 2 Sequoias and if those aren't grand trees I don't know what is
Sunset- sure the sun sets there and you can watch it from the dock or our porch

So yeah, that is my happy place.  Most of you who pay even the slightest bit of attention to this site know the last few weeks were a little rough.  So I made plans to escape for the little free time I had this holiday weekend to Lake Arrowhead.  I arrived up there and felt the mountain air begin to do it's work that was then aided along by waking up to a world blanketed by the first snow of the season.

I am thankful to know where my happy place is and to be able to go there.  Happy Thanksgiving all!

Diction

A few months ago I wrote about how difficult it is for me to speak truths to the family of my patients some times, about my realization of the power of words, and my pursuit of speaking clearly.  I am still a work in process in this regards as in so many others.

Today as I prepare for a family meeting, I am thinking about some of the words/phrases that I use on an almost daily basis that are thankfully foreign to most.  Things like "limits of viability," "incompatible with life," "allow natural death"...  These phrases have very specific meanings in my world, but they sound cold, harsh, unfeeling.  Yet sometimes that is reality and there is no sugar coating it.  I wish there was.

20 yrs- Really??

A few weeks ago, I found myself heading to my 20 yr high school reunion with a big sense of trepidation brewing in my belly.  To say high school wasn't exactly my time might be an understatement, but when I'd looked through my photo albums and yearbooks with my BFF on the phone prior to the reunion I remembered that there were some really good times.  Some good friends, many memories and although I have only really kept in touch with only said BFF since high school.  I was curious.  Yet, still when I didn't feel so good that day, I almost gave in figuring I had an excuse. Somehow or another I convinced myself to go.

I arrived at the San Gabriel Country Club and was greated by many familiar faces and many not so familiar. I found some old friends and found easy conversation, interesting people.  Yes, we have all grown up in the last 20 years.  The people who were friendly and interesting, still are!  For the most part, the people who were tools, still are!  Even with that said.  I had a really nice time. I am glad that I went. I was really glad to reconnect with many of the people whom I had known since I was 5 years old, when we all started kindergarten.  I have made plans to see some of them since.

Maybe you can't go back. I am sure that I don't want to go back to high school, yet still it was a really fun evening.

Best wishes SMHS class of '89 it was good to see you again.

Bye Summer '09- you've been good to me.

Today is a rainy SoCal day, it feels like fall has actually arrived here in Los Angeles, and I am ready to embrace a new season. However, this transition of seasons has me looking back over the past season and shaking my head a little because the Summer 2009 might be one for the LK record book.  Really all of 2009 has been pretty good to me. Certainly there were rough times, but as I begin to think about all of the year ending festivities that approach I am awed at what a summer (year) it has been.  

 Summer 2009 dawned with me in a minor state of flux, focussed on training for my triathlon, but worried about things I couldn't control.  I gave up controlling the uncontrollable and just went with things.  The results have pretty much been good.  A few bumps on the way, but forward progress nonetheless.  Then there was the tri...  As July waned, my exercise complusion grew.  I approached the triathlon with excitement and trepidation.  When the day finally came, I was well trained and met almost all of my goals.  Afterwards, I surrounded myself with friends and basked in the glow of completing the race and finishing in the top 1/3 of my age group.  People said I glowed, maybe I did, but I was certainly on a post race high for at least a week.  Then the reality that my Asia trip was fast approaching set in and my focus switched to planning for that.  A few short weeks later I hurtled through time and space,  and I found myself in the admazing adventure that was my trip to Mongolia.   After an amazing week of trying to help the people of Mongolia I set off to relax in Bali.  Bali was unlike any place I have ever been. It was beautiful, it was relaxing, it was centering. And then I came home, and life picked up where I left it.  Again I find myself trying to just go with it, enjoying the journey as it passes.

Whew what a summer it has been, as I think about moving into fall, I fear that this sort of post crazy multi event high might be leading to an emotional crash.  That wouldn't shock me.  What goes up usually comes down, but I feel like my life is on a forward trajectory and my outlook is amazing. Thanks Summer 2009, I'll remember you!

Dear Owner of the dog who attacked Sadie

Thank you so much for your kind note and apology for this weeks incident between our dogs.  It was very kind of you to replace my shirt that your dog ripped even though it was a very old t-shirt.  While it was cute of you to sign it from your pit bull, I truly feel that it is you the irresponsible owner that owed me and Sadie the apology, not your dog.  I have absolutely nothing against pit bulls, some friends of mine have a pit bull who is one of the sweetest dogs ever.  When I am at their house tomorrow, her head while likely be in my lap while I scratch her tummy. However, her owners know she is dog aggressive and have her well trained and don't let her run around the street off leash.  That is the difference

Your dog did what pit bulls were bread to do, attack a dog that crosses their home territory and to desist when the humans get involved.  The fact that I literally yanked Sadie by her leash away from your dog and then hoisted her to my shoulders is why she is unharmed.  The fact that the incident happened at all is because your dog was off leash in public.  That is on you, an irresponsible dog owner.

I take exception to you signing the note from your dog because it really isn't your dog's fault, you just need to realize that you have a dog aggressive dog and not let him run around loose in front of your house.  Bad things can follow...

Thank you very much,

Lisa

This incident occurred during Sadie's and my regular evening walk along our regular path on Monday evening.  I haven't walked back by the house yet, but I know that neighbor and have seen her dog running the streets off leash when he has gotten out before.  We just happened to be in the street in front of their house when he got out this time.  However, aside from us both being upset we are fine.  Sadie is back to normal.  Me not quite, but we're fine.

Wash your hands, please!

In 1845, Dr Semmelweiss in Austria investigated why women were dying of postpartum infections at an alarming rate, ~15%.  He instituted a policy of handwashing after discovering that interns and residents were sometimes proceeding straight from performing autopsies to delivering babies. After instituting the hand washing policy the rate of infection fell to the baseline for the era. Slowly his discovery that hand washing was an important tool to prevent spread of infections gained support.  It is now accepted as gospel truth that dirty hands can spread infection and that hand washing, as simple as it may sound, is one of (if not the) most important weapon against preventing the spread of nosocomial infections.

When I was in Mongolia, I was aghast at the lack of facilities for appropriate hand hygeine.  The staff restrooms often doubled as storage closets.  There was no way to dry your hands.  They did have alcohol gel avialable to use before touching patients, but not at every bedside to be sure.  When the neonatologist there broached the subject of their infection rate, Monica and I immediately launched into a discussion of careful attention to hand hygeine and appropriate patient skin prep and care of central lines.  At first they were resistent, but with gentle support they could appreciate the impact something so simple could have.  Of course, the barriers to hand hygeine in an emerging country are huge.

However, it would be very narcissistic and first world-centric of me to say that the barriers only exist in such circumstances as those I saw in Mongolia, when everyday in my unit we are still working to achieve 100% compliance of all health care practitioners to hand hygeine.  For something so fundamental, I do not think that 100% compliance is an unrealistic goal and fortunately, I have the support of my hospital to try to get there.

Thanks Dr. Semmelweis.  I hope your contributions to medicine will no longer have to be talked about soon.

Book Club

Sunday night in the midst of a severe case of jet lag, I found myself at my friends house for book club surrounded by some of my favorite people.  As always after book club, I am buoyed by the support and fellowship of my friends.

One of the beauties of the group is in our very diversity.  We range in age from the late 30s to 50.  Our careers span the spectrum from producer, special effects production, music management, running a non-profit, real estate to medicine.  Some of our group have children, most do not.  We have burgeoning relationships, dying ones.  We are married, divorced, single.  But all these things are just some of the labels that are so often applied to us as women and used to define our role in the world.  The truth of the matter is for those hours once a month none of those labels are important.  What matters is that we are all friends, and we are all free of judgement of each other.  Oh and yes, we do actually talk about the book in addition to eating fabulous food and drinking wine.

Last month we read "The Little Stranger" by Sarah Waters a subtle tale of haunting set in the dying era of the old manor homes in England.  Next month "The Help" by Katherine Stockett a fantastic book looking at the struggles of race relationships in the South at the beginning of the civil rights movement.

Stillness

“When you learn to quiet your mind, you will hear them too”  (Name that movie and the character who said that and to whom, and you will get, um, nothing, but I’ll know you know too- you can even correct the errors in the quote that I think might be there.)

That quote entered my mind the other day while sitting looking out at a bunch of rice fields in Bali, watching a couple of men chase birds out of the rice that was about ready to be harvested.  

My life generally proceeds at a relatively frenetic pace.  I work long hours, then I try to carve out time to have a social life, to take care of me, to sleep, whatever.  I seem to be always rushing from one place to the next and detesting being late anywhere. A few years ago, I committed to “scheduling” one night off a week.  Literally, when I have weeks that are becoming too full, I’ll make sure that one night stays blocked off for me to not have plans.  I actually calendar my night off. The whole idea of scheduled free time seems hypocritical, but it has made a big difference for me and my state of mental exhaustion.

Yet still, I have been in Bali for 12 days and have rarely found a place so relaxing. I have literally sat and looked at nothing for hours, and I usually don’t sit.  I have actually succeeded in stopping my mind from playing the perpetual what if games.  I can’t ever shut it off, but I’ve turned the volume down at least.  I have found tremendous pleasure in such simple things.  At the beach, I walked along the water every morning and then sat in  a pagoda things and looked out at the ocean and felt the cool breeze blow over me.   I’d think about things important to me, but mostly I’d just be there and look.  When I moved inland, initially I found the same morning ritual in along the edge of rice fields and then when the sun shone again by going for long morning walks (sometimes with people, sometimes alone). I have rarely felt so calm in my adult life.  This new state of calmness prevented me from being able to tolerate shopping in Ubud the other day.  It was too loud, too bustling, too much going on, I had to escape.  (So, if you thought I might bring you home something from Bali- sorry I just couldn’t do it.)  Shopping has always been utilitatrian for me, and I have never been a fan of the whole bargaining game, and well they was nature and sunlight to explore.

Just a few photos from Bali- so many more..

Last night as I started to think about getting ready to begin my 24 hour journey home, some of the trappings of my LA life started to seep back in. I balked.  I know it is inevitable, but it would be nice to live life as we know it with this type of serenity.  An impossibility I fear, but a noble goal.  Let's see how long I can keep that goal in the midst of a 24 hour journey home.

Just so you know!

I'm still here, still in Bali, still having a great time.  I'm just too busy exploring this beautiful country to write about it.  Plus, my camera cable is being mailed to me at home, so no pictures anyway.  So, when I'm stuck in some airport again or when I get home, I'll tell you all about wandering through rice fields, the Balinese festival I watched, the sacred monkey forest, the elephant cave and just sitting at peace.  Etc., etc.  So many stories so little time.

It is amazing here.  Ciao!!

The news I dreaded

When we had dinner with the High Lama of Mongolia, he gave each of us a small baggy of what he said was precious earth. He told us to use small amounts of it to put into bodies of water and pray.  He said he hoped that this little bit of Mongolia would help some of the suffering in the US. It was a beautiful sentiment especially when you consider that we were there to try to help some of the suffering in Mongolia.  Still I couldn't help thinking of Johnny Depp in Pirates of the Carribean saying I have this jar of dirt.  I know, I'm going someplace bad.  I digress.

This morning when I logged onto the computer, I received the message I'd dreaded the whole trip- my beloved grandfather had died yesterday.  He is one of the strongest men I've ever met, and I loved him deeply.  Yet still I left home with instructions that I was to be notified if he died, and that I wouldn't fly home. Johnny wouldn't have wanted me to do that. Plus, I feel like I have said good-bye to him. I even told my mom that yes, she could use my post as his eulogy  as she'd asked.

Yet, this morning the news brought tears to my eyes. After breakfast, I walked to the spot I have walked to every morning since I arrived here...

I sat on that table that feels like some sort of a shrine, and I thought about Johnny.  I cried (something I never do), and I tried to honor the man who he was.  The man I am fortunate to have grown up knowing.  I am travelling a new continent.  In the last few weeks, I have dined with a Lama, I have visited a Buddhist temple, I have worked to help healthcare in Mongolia, I have slept in a Gher, I have walked the Mongolian national parks and the Balinese beaches. Tomorrow I will visit temples here in Bali and visit a Balinese park. I am honoring him, by honoring things he loved.  Yet, still I know that my world is a little smaller a little less without him in it.

I stood by the Indian Ocean today and I took a little of the High Lama's dirt and I put it in the ocean, and I prayed that Johnny is now holding hands with Frankie again, and that they are travelling the universe together.

RIP Lloyd Johnson 9-1-1914 to 9-18-2009... I love you!

Mother Earth as an alarm clock.

At 7:06 this morning I was literally shaken awake by the Earth.  Yes, there was a magnitude 5.8 Earthquake off the coast of Bali this morning.  Other info says it was  6.4 magnitude Earthquake, I don't know, which is true.  Still, aside from waking me up earlier than I wanted I am fine. The hotel says there is no potential for a tsunami since it was too close to land.  Good.  Now I can return to my morning coffee drinking pursuits.

Thanks again to those who checked on me! And wow, my twitter friends heard about it almost immediately.  Crazy social media.

Learning to Relax!

A million years ago when we used to go on family vacations my dad would always take a couple of days to relax.  He'd be antsy and grumbly the first few days and then get into the vacation thing.  As a kid, I didn't understand it.  To me arriving in Hawaii, or whereever, would flip a switch and I'd pull up a beach chair slather myself with suncreen and read all day without a care in the world.  When I went to Hawaii for my friend Calista's wedding a few years ago, I finally understood the phenomenon.  After the hectic pace we kept in Mongolia, this trip has exemplified the need to ease into relaxation mode.

I have now been in Bali for four days, and I'm finally relaxed.  I have met some tres fun 30 something Aussie's to hang out with and have finally quieted my brain.  Let the vacation begin..

Cultural Whiplash!

I sit on my balcony drinking Balinese coffee made in a coffee press writing this post, looking at this scene.

Thinking about the cultural extremes of the last week, might give me whiplash..

11 days ago, I left LA in the middle of the night and 30 hours later arrived in UlaanBataar, Mongolia in the middle of the night.  For the next 5 days I awoke each morning to the sounds of the crazy Mongolian traffic and looked out at a likeness of Ghengis Khan on the hillside rimming UB.

Then we went to a Mongolian National Park, Terilj (sp) stayed in a Gher kept warm by a fire and listened to crickets and the horses grazing outside our Gher.

Me and my Gher!

The view outside of the Gher.

After that drove back to UB for one more night. Left for the aiport so early in the morning it felt like the middle of the night to fly to Bali, where arrived after midnight.  (BTW- what is up with these middle of the night Asian flights)  Woke up to palm trees, the sound of the Indian Ocean, walked the beach, rested, looked at these kind of scenes.

See what I mean, cultural whiplash in an Oh My This is Amazing sort of way.

Gotta go meditate on that. Ciao

More Mongolian Thoughts... Still Just Me

Still bored in Seoul.. Still blogging about my trip..

In Mongolia, I gave several talks to the neonatal division, sort of small informal teaching sessions on very specific talks.  These talks pretty much took up the majority of my last 3 mornings at the hospital.  We covered basic neonatal topics like infection control, fluids and electrolytes, feedings, basic management of patients with gastroschisis.  It was remarkable to have dialogue with the Mongolian team to learn what they do well, to add insight where I had it.  It was those exchanges where I felt I had the most opportunity to make an impact.  In the afternoon, we did big lectures for the whole hospital.  I gave two with the help of Monica, the neonatal nurse who was with us. None of this teaching would have been posisble without the help of our Mongolian translators.  My main translator was a neonatology resident who studied English for only 6 months.  Her English was great and she seemed to really enjoy the experience. I am in awe at how well many of the Mongolians speak English.

Monica and I, and the Mongolian neonatal physicians.

The last day we were there I was giving a talk on "The Transition and Disorders of the Transition." I was making my case to my colleagues that the transition from fetal to neonatal life is the most important transition in life.  Not sure I convinced them, but alas I digress again.  After my talk I was introduced to a neonatologist from the Mongolian countryside who had travelled 6 hours by train to hear my talks.  Humbled, I shook her hand and listened to her stories of medicine in the countryside of Mongolia.  I couldn't believe that she had gone to such efforts to hear me, me.  I am no one, just a doctor in LA trying my best. Yet she travelled for hours to hear me.  Wow!!  With a double dose of wow.

A guy I used to have thing with delights in commenting about how I remind him of how trivial his job is,  (Maybe why things would have never worked out there) but more to the point, I have never considered myself as extra ordinary.  I'm just me, the same girl I was 20 years ago just with more grey hairs and wrinkles in my skin.  As I have progressed in my career, I have always seemed the same, from the inside looking out.  I still have my idealistic side even if it does become ever more jaded and is now balanced by some skill in my profession.  I was awed by this women's desire to go to such exremes to meet me, me. I hope I didn't disappoint.

Traffic Mongolian Style...

After I upload my pictures from the country, I will finish my travelogue from Mongolia.  For now, there have been little vignettes of observation that have captured my attention.

Mongolia like many emerging countries with ever increasing access to newer technologies and ways of doing things has changed rapidly. According to those in our group who have been coming to Mongolia for over 14 years, 10-14 years ago, there were few cars in UB and people still got around on horses, even in city.  There were few apartment buildings.  Even in the city people still lived a fairly traditional life.  As modernization has snuck in with ever increasing strength, the city has multiplied without benefit of city planning.  Buildings have popped up everywhere.  Cars have multiplied in a manor that would make rabbits seem impotent.  The streets have few lights, few rules, no cross walks.  In general it is mass chaos.

Getting in a car is an act of great faith, crossing the street even worse.  We had cab rides to go 2-3 miles that took 45 minutes. On one fateful cab trip the 4 women of the group each told each other our wishes in case we died, and we weren't exaggerating although we were laughing.  (Maybe my parents had a point with the whole will, power of attorney thing.) When the Lama was driving us to the infamous dinner, he declared that traffic rules were beneath him and proceeded straight.  Prompting us to declare "breaking the law with the Lama."  We hopped his karma would extend to us and keep us safe.

Walking across the street took guts and courage, we got better over the week, but still.  One day leaving the hospital, there were two small children (4-6 year olds, I'd guess) crossing the street completely alone.  There were cars whizzing towards them and they just took off into the street.  Feeling protective and horrified, Monica and I tried to cross the street with them, figuring we at least were taller than the hoods of the cars.  The children looked at us like we were insane.  That we didn't see traffic accidents every moment was shocking to me.

The head of our group had a meeting with the minister of health one day while we were there who said the number one thing he'd do to improve health and safety in Mongolia would be to install traffic lights and enforce seat belt and car seat laws. From what I saw that would be a good thing.

Mongolia strooling acoss the street with his hand up, to say "hey don't kill me"

Our group walking purposefully across the street trying to not get killed.

A brief nonrepresentative snapshot of what traffic was like.

Mongolian Ingenuity

The other day Monica and I were doing some teaching with the Mongolian doctors and nurses about hand hygeine and central line care.  We were trying to make the point that careful attention to infection control could make a huge difference for them.  An interesting conversation to have in a hospital that doesn't have toilet paper and in which it takes an act of congress to wash your hands.  They did at least have alcohol gel readily available throughout.  But I digress,

A baby returned from the operating room after getting a colostomy for imperferate anus.  We were busily documenting the way they transported the baby with a pillow filled with oxgen that they squeezed to fill the mask they were using to bag the baby.  Crazy..

Amira, my translator, hooking the oxygen pillow up for transport.

Then they got the baby in his isolette and began to set up his ostomy.  They were attaching a latex looking thing with a dam of sort that they tied to the skin.  I looked at Monica and said "is that a.." She replied "female condom, yep!"    There you go they had attached ties to a female condom and were using it as a colostomy bag.  Brilliant really..

Ingenious really!  Who uses them for barrier protection?  They are cheap and readily available.  We were amazed.

Day2-3 Mongolia

Day 1 in Mongolia was amazing..

Day 2 even better..

Day 2 dawned with another beautiful sunrise.  Another early morning breakfast with the team and then Monica and I headed to the hospital where they had asked me to round with them and to give a couple of talks before our afternoon lecture series.  They presented some fascinating cases to me, I helped as I could, I gave my lectures.  For 3 hours, I spent time with the doctors in the NICU in UB, answering their questions, awed by the combination of what they could do and what they couldn't.  We discussed the plans for the next day and we headed to a late lunch with our team.

My jet lag demanded an easy afternoon, so we went back to the hotel.  I helped Monica fine tune her talk for the next day, finished mine, caught up on some things and headed downstairs to meet up with our group for our evening.  On tap that night...

A visit to the High Lama of Mongolia who had granted us a private audience and then agreed to dine with us afterwards.  After a cab drive in which my new friends and I all told each other our wishes for our funerals and where our wills were, we arrived at the Buddhist temple that is the Lama's home.  We spent about an hour with him discussing the ways to integrate Eastern and Western medicine.  He presented each of us with Buddhist prayer shawls and an envelope of sacred earth that we were to put in a water way at home when we make a wish.

A portion of the group with the Lama!

Then we headed out to dinner with the Lama as our culinary gruide.  We went to a "hot pot" restaurant.  Much hilarity ensued.  I have never laughed so hard or been so entertained by my company.  We all ate bull penis and you know what, it isn't bad.

Thoroughly content we headed home.  Day 2 in Mongolia= undescribably amazing!!

Day 3 was tame by the prior days standards, but more of the same.  We awoke early, dined with the team headed to the hospital. Spent the morning teaching on the NICU floor.  Gave my talks in the afternoon.  Dinner with the other women on the trip.  Day 3 may have been tame by the standards set by the prior days, but filled with laughter and hopefully, good experiences for both us and the Mongolian physicians we are trying to support...

Mongolia: Day 1

So, after my millions of hours of travel and a few inflight naps and a little uncertainty, I arrived in Mongolia.  I was actually met at the gate by the lovely woman coordinating our trip and two Mongolians who would take me on my first heart stopping drives through the Mongolian streets.  Given my state of exhaustion, I begged off dinner ate the remainder of the baked chicken and settled in to get some  desparately needed shut eye.

Actually managing to sleep, I was awoken the next morning at 6 am by a gnawing emptiness in my stomach.  I then rolled over and saw some light poking in through the curtains I hadn't fully shut the night before.  I got up open the curtains and saw the beginnings of sunrise over UlannBataar (UB- to its friends).

Appreciating what looked like an amazing city, I prepared myself for the day ahead.  I had few expectations, no real knowledge of what I was heading into.  However, I trusted the people who invited me here, and so fueled by my thirst for adventure, and my headache that needed coffee, I headed down to breakfast with the team, and to figure out where the day would lead.

Team over breakfast my first day (their third) in Mongolia

We discussed our plans for the day and then divided as per our duties with the majority of us heading off to the hospital.  My first impression was the the hospital looked like a Russian jail.  It was a big industrial building in the middle of what appeared to be a construction site with random gates and random roads and cars parked everywhere and kids running through the parking lot.  That there was order in this chaos was amazing.  There standing at the doors was one of our translating physicians, who guided us through this maze and brought myself and the ebullient neonatal nurse, Monica, who is my partner in crime this week to the NICU. Our lead physician came with us as he had never been to the Mongolian NICU before and wanted to see what was the deal.  (He probably wanted to check on me too.)

Anyway, we met our lovely translator, who is a neonatal resident with amazing English skills.  We toured the NICU talked about several babies, met some of the families.  We were able to learn what their needs were so we could tailor our teaching for the rest of the week.  We rounded on a couple of the babies with them. 

 The woman on my right is the translator, on my left is the head neonatologist and then the other residents. In the back is Dr. Ross.

The baby they wanted help with the first day.

A preterm baby in the isolette in a room with her mom.

Our day continued on with lunch with the head of the hospital and the secretary to the minister of health where we discussed on going educational needs of the Mongolian physicians and then we did two hours of our formal lectures. 

After that I was about to die from jet lag, so Monica and I and Kate, the adolescent fellow, went for a walk to a Buddhist monastery.  Where I saw the third tallest gold Buddha in the world.

Waking out of my jet lag stupor after my brief emersion in the culture, we headed off on a walk with a bunch of the Mongolian expats.  We were put on a bus and taken out into the countryside outside of Mongolia to climb the hill and watch the sunset over the river and the planes. A 45 minute walk with some fascinating people.  There was the woman whose kids were finally grown up so she had joined the peace corp and just moved to Mongolia with her husband to be the Peace Corps chief medical officer, a couple of teachers at the Mongolian interntational school, embassy workers, and the guy who introduced himself by saying he driven from Detroit to UB (going with his car by boat from New York to London- he admitted).  Such amazing people, fascinating conversations, lovely views- what an end to my first Mongolian day.

Made it to the Asian Continent!

Deciding to go to Mongolia and Bali in the same trip is sort of like deciding to go to LA and New York because you’re going to be in the US.  They aren’t exactly close to each other.  However, I have never been known to do things the easy way.  Plus, I had enough miles to get me round trip to Asia in business class which made my route of travel even more suspect. Therefore, here I sit in the Hong Kong airport, wishing I had enough time to explore the city becuase the little that I see out the window is really pretty.  I actually managed to get some sleep on the plane so I am feeling somewhat rested and ready to continue on to Seoul and then finally tonight I will arrive in UlaanBataar, Mongolia where I will be met at the airport by the Mongolian physician who is to serve as my translator for the week.  Apparently, we are then going out to dinner.  All said and done I am hopeful that I will be able to sleep once I finally get there despite the 15 hour time change that has my days and nights swapped and threatens to send my body into a severe state of confusion.

Am I fully formed?

Leaving the US for the first time in a couple of years, I am reflective about my prior trips. The things that have had the biggest impact on me- my time in school in Spain, my trips to Nicaragua, being in Greece over 9/11, realizing that residency wasn’t the cure to jet lag, but that our lives were conducted in a constant state of jet lag. These events, disparate as they are were all so formative in developing who I am now. Lessons that I learned from each of those trips come up all the time. When people are getting to know me it rarely takes more than a few conversations for one of those trips to come up. They are fundamental to my view of the world and to my persona, such as it is. Will this trip be formative? Or am I already formed? There is so much to be told.. Stay tuned this is only the beginning…

Is medicine going backwards?

One of the talks I am giving to the OBs, Pediatricians and Midwifes in Mongolia is reviewing neonatal resusciation and the reasons for using room air v. 100% oxygen.  This is a relatively hot topic in the neonatal community as there an ever growing body of evidence that 100% oxygen in the first minutes of life isn't a good thing.  There have also been several studies recently that have demonstrated that babies resuscitated with room air do just as well if not better.  The problem is that several of these studies were not approved to be done in the US because they couldn't get IRB approval due to the strong belief that oxygen was needed, that they would be "doing harm."  Further, at least one of the early trials had the Oxygen arm in developed countries while the room air arm in the developing nations.  Again a way to bypass IRBs, but also potentially treating those in developing nations with less respect.  An interesting issue to deal with when giving the talk in a developing nation.  I'm trying to be sensitive to these concerns without ignoring them.  It is a fine line.

Further, in tangentially talking about this the other night over dinner, we wound up discussing how medicine might be about to start going backwards, or at least stop forward progress, given the need to have everything so tightly monitored and watched over.  So many of the great advances in medicine occured through happinstance and use of questionable techniques.  If Alexander Fleming complied with current standards of cleanliness and research protocols, we might not have penicillin.  If Jonas Salk wasn't willing to consider injecting people with cow pox, small pox might not be erradicated, and the concept of vaccines might never have been born.  These are major steps forward that occurred in ways that would be considered unethical now.  There are more recent examples too, a study completed in England in the 90s was considered unethical in the US because it was potentially witholding life saving therapy even though that therapy had never been proven effective, nor rigorously studied. I'm currently trying to get a research protocol through my institutions IRB and the amount of red tape for something simple is mind boggling.  

Is it possible for medicine to continue to move forward in this era?

How do we continue to move our therapies forward and respect all people equally? because just taking the studies out of the US is not the answer...

Gap Born To Fit!

A couple of weeks ago I got invited to this party by my friend the Slackmistress where I was told I'd get a new pair of jeans, but I'd have to take off my pants.  Interesting catch phrase to get me to a party of a bunch of fabulous blogging women.

I arrived at the party in the Gap Pop-UP store, where I was greeted to free parking, free sangria, free appetizers and a shopping consultant to help me pick out jeans that would complement my figure.  Seriously, these people know how to throw a party!  I tried on the "Sexy Boot" jeans, went down a size and had the following photo taken of me.

Modeling the Gap "Sexy Boot" Jeans

Photo by Janet Barnett

Although, I may not like my smile, this photo was labelled by Nina as Dr. McDreamy.  Um thanks for the confidence boost and prompted the following tweet from my friend Kim "HOT pic of you, dear @lkkelly http://bit.ly/eMOqg".  So needless to say I am now a huge fan of these "sexy boot" jeans.  With my friends supporting my ego like this, I want more....

The Slackmistress is now giving away a coupon for a free pair of Gap jeans from her blog, details here.  In order to win you have to tell a story about your favorite jeans, your old fav jeans and/ or tweet about the contest. Got it.

I am a Spring, so I always get to wear jeans and have always loved jeans.  In college, I had these old gap skinny jeans that were my favorites.  I had worn them for years and as I was gaining the freshman 15 that ballooned into more like 20-30 they grew tighter and tighter on me, but I loved them still. They were worn in just right, the fabric was soft.  They were like a security blanket, but by the time that snow had been on the ground of South Bend for 4 months they were TIGHT.  One day walking to the dining hall in the bitter cold over the snow and ice, this Soutern California girl bit it on a patch of ice.  Seriously, I fell over like a comic book character, feet flying into the air, landing with a carumph on my now padded derriere.  Rip went those jeans below each butt cheek.  NICE!  I refused to take off my jacket for the rest of the day (which was fine as it was subzero in March), and then borrowed my roommates sewing machine and sewed patches on the backside of the jeans that made them even funkier (not to mention roomier).  My favorite jeans were saved to last several more years.  I was in college after all.

Can't I focus on the Awesome?

I have travelled a lot in my life.  I've been to some exotic places.  I've been to the third world before, I've been in the jungle along the Rio Coco, I've done Central America, the Carribean, Europe, Australia, etc. Like I said, I'm not a novice international traveller.  I was stuck in Greece after 9/11 and found my way home with some ingenuity and help.   I was once stranded in Nicaragua, and found a way out of that one too.  OK, I've never been to Asia before, and it is half a world away, but it is just a really long flight and some serious jet lag, culture shock and language difference away, right?  Or so I keep telling myself.

Aside from this being a remarkably amazing opportunity and a trip I am so seriously looking forward to, there are those around me who are a little concerned about my safety.  My parents, in particular.  I take it to mean that they love me, but... really?  For the last few weeks they have been on my case about setting a power of attorney, a medical power of attorney, making a will, etc.  I know that these are all good things to do and once they are done you can forget about it.  It is supposed to give you peace of mind.  It is supposed to be a good idea.  However, it is making me feel vulnerable, mortal, and alone.  I don't like it, not one bit!

I'm not sure why they have chosen this trip to freak out about, but I want to just focus on the pure awesomeness of my upcoming adventure.  Please... thanks!

I have an addiction

In medical school, we learned the CAGE questions to judge if someone had an addiction problem.
CAGE is an acronym to prompt you to ask these questions
Have you ever felt..
the need to Cut down?
Annoyed when people ask you about your...?
Guilty about the behavior or something you did under its influece?
the need for an Eyeopener?

If you answer yes to more than 2 questions, the teaching is, the patient has a problem.

After an irrational response to the caferteria lady, I asked myself the questions related to my addiction problem behavior...

C- cut down, yep.
A-annoyed, clearly- I'm writing this post aren't I
G- guilty, yep I often try to hid the evidence
E- eyeopener..hmmm-  Well, if defined by once you start, you can't stop.  Yes, undeniably!
Henceforth, why I set rules to control my indulgence (Sounds like that should be the 5th one- do you set rules?)

What is the offending substance-  Garden Salsa flavored SunChips - you got it!

I only indulge at work, and I only indulge when I get them for free from the neighbor hospital. I can't let such things in my house, because I have no will power.  Still when the check out lady comments on it a few days a week when I give in, I have to fight the urge to scream.  Hello, I have like 21% body fat, let me have my chips without comments from the peanut gallery.  That isn't rational, right?

So for I just smile and chuckle.  Then spew here.  Thanks

Thanks and I haven't even done anything... Yet

Just got this email and I have even done anything yet.  


Dear doctors, nurses, and medical professionals, from CHLA and Southern
California.

I want  personally to think you for volunteering your valuable time, energy, skill and wisdom in furtherance of our unique effort to help the women and children of Mongolia.

When we began this program circa 1995 little did we know that so many of you from CHLA would be attracted by our program.  Some of you are now returning for the second time.

I am wishing you a safe trip and a seamless transit to Ulaanbaatar, Mongolia.

 And, I am wishing you as well a successful medical experience and MEEP program.  I hope you make some good new friends, and I know you will make a lot of Mongolian people happy and grateful.

Again,  Thank you very much.  Good journey and good program.



I can't believe that I leave in less than a week, and with all the travel time will be arriving in Ulaanbaatar in about 7 days.  So much to do before I go, but I can't wait for the adventure....

Destination: The Far East- revisited

This post originally appeared here a few months ago, but since I couldn't figure out how to just transfer a few posts from my old blog I am revisiting....

I've done my share of travelling. I've done my share of medical volunteer work, locally and abroad. I've been to Nicaragua several times and had to cancel a trip when I got sick. Ever since then, I've been searching for opportunitites to get back in touch with that side of me that is fueled by being involved in something so much bigger than yourself. I have had many opportunities presented to me over the last year, but for one reason or another none worked out. However, a few weeks ago I was contacted to join CHLA's trip to Mongolia as they wanted to focus on some more maternal- fetal- neonatal health issues this trip. The trip works with my schedule, works with my plans and so I'm in. Plane tickets are reserved and will be paid for by the end of the day. I've never been to Asia, I'm a little nervous, but I'm really excited.

One of the big issues with this kind of work is to find a way to make sustainable differences in the healthcare in developing nations.  This is a huge topic and used to be a source of much dialogue amongst the Nicaraguan group.  Certainly they need supplies, but also standards and education.  The thing I really like about the approach of the CHLA Mongolia mission is their appreciation of those issues and the dedication to going there in order to provide not only education and support during the time that we are there, but also working with the health ministry to establish some standards for continuing education for physicians in Mongolia. Also, there is some effort being spent on extablishing internet based education and support materials for the doctors and nurses there.  I had lunch with the organizers yesterday, and got quite excited about what they're doing.  So now I'm trying to convince a few others to join me. Either way it is a great opportunity.

After spending a little over a week in Mongolia, I am going to continue on to Bali for some vacation while I am on the other side of the world.  I can't wait.  More to follow...

I leave on this journey in less than two weeks.  For now, my days are occupied with writing talks for this trip and my evenings largely planning for the journey. I am beyond excited even though there is so much to do.