I PASSED MY BOARDS!!!!

June 25: no poetic ramblings, just daily stuff

For those of you check regularly, you are not crazy that the prior posting wasn't there on June 15th, but it is when I wrote it.  Hey: three posts in one month, at least I'm trying! 

In looking over the blog, as occasionally I do, it is a reminder of several things.  A lot of it is a reminder of just how far I've come physically & psychologically.  Thank you, readers, for giving me the incentive to continue to write, although there is less now to report--a good thing.

Still waiting for the results of the PA test, will be two weeks on Thursday.  When last I checked the site they were saying three weeks for results. 

Physical: it's amazing to me how much better my chest is, comparatively speaking.  I no longer wake every day with pain, and am doing more yoga moves that apply pressure to the area in hopes of strengthening.  My right shoulder, however, is a different story.  I've mentioned it before: thought for years it was part of the pain from the thoracotomy, only started to realize in the last two years that it is it's own entity.  It may well be from that surgery, all it would have taken was someone pulling my body by grabbing my arm when I was anesthetized.  I don't know how I could have injured it, because it's been 'favored' ever since the first surgery where the anterior thoracotomy was on the right side.  My suspicion is that it's a bone spur, possibly with adhesions.  The pain is unpredictable, it occurs especially when I raise that arm up, but not every time.  I can go for days without an issue, and then all of a sudden am in excruciating pain, feeling as if my arm can't be lowered without being dislodged from the socket.  

So why haven't I done anything about this, especially when my current health insurance is so splendid?  Because an X-ray won't be enough to see the problem, a CAT scan isn't good at showing bone pathology and I can't have an MRI with all the metal in my chest, which means even for diagnosis it will take arthroscopic.  And that can't happen without me being off Coumadin for several days, using heparin as a bridge to thin my blood and keep clots from building up on my valve.  Then would be the procedure, then restarting the heparin while the Coumadin level goes up again.  While all that is inconvenient and time consuming, the main issue is the increased risk of stroke from all that back and forth.  And that's what keeps me from pursuing it.  Because what goes through my mind is: 'Is the pain bad enough that it's worth the risk of a stroke?', to which the answer is (sometimes through gritted teeth) a resounding 'No'.  I should, of course, still go and have an ortho person check it out, but trust me that the outline above would be the course.  Pragmatically there is a further argument for that: right now it might be something that could be fixed during the arthroscopic, as opposed to it getting worse and needing an open procedure, which would be more risky.  This is the answer to the question 'why didn't they just replace the valve on the first surgery?'  Because this is what it's like to live with a mechanical valve, and the younger someone is when they get one the greater the risk that this sort of debate comes up.

In other health news: I'm tired.  No, really.  Exhausted.  Constantly.  I don't even feel really rested after a full night's sleep, and my sleep is off as well.  Is it maybe because I'm finally realizing how tired I am that it seems to be worse?  Is there something new going on?  Is my body once again hiding some mysterious horror that will come popping out?  I re-read 'Monster in your body' from Nov 2009 (I think that date?) and it helps explain the terror of this possibility.  My suspicion is that it's just more of an awareness, my body confirming that I need to move towards taking disability rather than the constant push to keep going.  In discussing with my cardiologist, and of course blaming the multiple heart surgeries and tiny valve opening, it was a surprise to me that his reaction was to get a sleep study.  I don't have sleep apnea?!  What straw is this he's grasping at?  I told him I would get one only to humor him, and he made it clear that he would not support disability unless a sleep problem was ruled out.  No one, not once, has ever heard me snore.  In any case, my sleep study is Thursday night.  While I'm expecting it to be fine there is the chance that something physical is going on that's keeping me from a really good sleep.  And then I think about wearing a CPAP at night--wow, what a wonderful cacophony of sounds: blowing of that and my heart clicking away.  Let's not go there....

Just came across a sampler verse done by a great-great-great-great....grandmother of mine in 1797.  I was looking up a reference for the sampler I have, done in 1788, which reads 'While with the needle every tint is wrought/Constant industry adds new wings to thought/And as on canvas letters are imprest/Each growing virtue springs within the breast'.  Not a real rallying cry for anyone, but from a Puritanical outlook is a reason for young ladies to spend their time stitching.  Well, apparently things must have gotten worse from there, because the sampler done eight years later now tells the subsequent generations: 'Be virtuous and industrious/And happiness will attend you/If you do not expect too much'.  Now isn't that a lousy teaching point?!  Keep your expectations really low and then you stand a better chance of being happy.  Methinks they were all too stressed, and wouldn't you be with no electricity or indoor plumbing?

It's the small things that sometimes give the biggest tickle!  Thanks for checking,    Laurie

June 15: Gratitude of hours on the swing

I’ve taken a break these last few days, recovering from studying for my Boards on the 13th.  Many things have been neglected, and there are many things that I should be doing and really need to be done.  On this most beautiful of recent days, with a clear sky, low humidity, a few white fluffy clouds floating and the perfect amount of breeze I don’t feel like doing any of them.  I promised myself that I would get out for a walk, and on coming back from morning errands and the farmer’s market I parked my car out front with the intention of driving to one of the places that I enjoy ambling.  But, for a time, my outside enjoyment is confined to my swing.  I’m looking through my rather extensive library for a short story or reading on gratitude in preparation for the service I’m doing next month.  It is appalling how few things there are on being grateful, even in the book entitled ‘Love & Gratitude’.  There are lots of essays on asking for things, patience, experiencing the world, love, harmony, meditation.  But almost nothing on gratitude.  How can this be? 

Swinging gently, back and forth and back and forth, my body is comforted by the soothing of the regular motion.  As I put down the last of the books I’ve brought out to peruse, I look around my backyard.  My yard is not particularly special, or large, or well landscaped.  There are, however, four trees that are well established, and right around my swing are my sage plants and my glorious lavender bush that is currently in full bloom.  A white butterfly and a bee flitter around the blossoms, seemingly oblivious to each other, each getting their particular insect pleasure out of the tiny purple flowers that cluster on each stem.  The butterfly, as these creatures are known for, flits from branch to branch with no obvious change visible.  But the bee makes itself known.  Each cluster of flowers he lands on bends, he rides the motion like a tiny winged surfer on an undulating wave.  He finishes his business on one stem, then flies to another, without any seeming pattern, and once again the stem bends down from his weight. 

 

As the sun moves I have to switch sides, my swing is two seats that face each other, with a roof that protects me from too much sun, and the set-up allows me to easily move as the sun arcs across and changes directions.  Sitting on the side that I don’t use as much I look up to see a perfect spider’s web, poised between two non-moving areas and so intact.  It is an incredible work of art, although probably not very satisfactory to the spider since there is no dinner contained in its delicate pattern.  As I admire the lacy handiwork a shaft of sun comes through, lighting the strands with the colors of the rainbow.  I grab my cell phone camera and take several photos, the dance of light and colors changing dozens of times in a few seconds depending on the breeze affecting either the web or the leaves allowing the sun to cascade through.  There are actual circles caught by the camera lens which I can’t see, each a separate color which creates a collage of multi-colored beauty.  It makes me wonder if someone musically talented could perhaps play a tune from the changing light on the strands, a melody of nature that I can only guess at.  I send the picture to several people, wanting to share this moment of natural miracle.

 

 

It occurs to me that my regular camera might do even better, and I go inside, disturbing a very content Zerla who was enjoying the warm sun streaming through the screen door.  (The cats are not happy about the upgraded windows I put in a few years ago, which control the temperature beautifully, but in doing so eliminate the warmth of the sunbeams which lie on the floor, making them much less satisfying to bask in.  This limits sunning areas to those which receive light through non-upgraded windows.  It makes me feel badly to decrease their enjoyment, but with the recognition that it has lowered my fuel bills, thus decreasing my human footprint and their paw prints on the environment being a greater cause.)

 

Camera in hand I resume my prior position, but the fancy digital lens wants to focus on the tree through the web, rather than on it.  I do get several pictures of the sun on the strands, some with more vibrant hues than the cell phone took, but none with the special dancing circles of color that enchanted me so; I hope that prints from the pictures will capture those first colored dancing rainbow.  Is this a lesson that beauty does not always improve through a more expensive lens?

 

Now in photo mood I wander the small distances in between trees, capturing the Japanese maples’ delicate coloring and shape silhouetted against the sky, then trying to capture the jagged edges of the elm tree’s leaves, finding more in the pattern of the leaves than just the edges themselves.  From there I move to the holly tree, shooting up the trunk to try and capture the wonderful curving of branches that come out of the trunk, bending at odd twists and bends that are so different from the generally straight pattern of the other trees.  While the butterfly has moved on there are now two bees feeding from the lavender’s nectar and again I watch the bob-bend-flit of their black and yellow bodies amongst the purple and green of the plant.

 

As I sit on my swing, in the perfect weather, I do one of the things that has come much more easily since my illness. In the days BS, or before sick, I rarely took the time to just sit and observe like this, and the times I did were fleeting, not with the luxury of time.  This is one of the gifts which I have received from being ill and forced to slow down: a greater appreciation of the seeming minutiae which surrounds us all the time.  And yet there is so much that goes into each of these scenes, so much that works separately and together which allows them to happen.  The perfect collaboration of sun, clouds, earth, sky, rain, breeze which lets each one of these trees, plants and insects all flourish and come together in perfect harmony, creating a dance of color and movement that are entwined and yet separate, individual and yet part of a whole, creating little vignettes of nature.  This is not minutiae, but rather an entire microcosm of the natural world that I have been privy to.

 And so I observe, appreciate the delicacy and grace of nature which surrounds us all, which we take for granted so often.  And I am grateful.  For now I realize that it is much better for me to have experienced this than to have read someone else’s written words.  While someone else’s writing might be more polished or erudite, it cannot compare with the actual experience, so much more personal and therefore valuable.  In my search for someone else’s expression of gratitude I have experienced it instead.

June 11: Test coming

Briefly: Started taking the practice tests for the Board recert.  According to the scores I'm getting there I should not be allowed to be treating patients.  It's SO much worse than I remember: gynecology, pediatrics, OB, ortho (which I've always sucked at), rheumatology, dermatology, opthamology, endocrinology, vitamin deficiencies, genetic disorders, ENT, pulmonology, developmental milestones in kids, hematology, oncology, penis problems, neurology, psychology, every bacteria and virus that can get into your brain, reproductive organs, lungs, skin or gut, and not nearly enough cardiology--not one ECG--not one!  Every time I finish one of the practice tests I feel so stupid.  In all fairness, the questions are perfectly dreadful!

Rescheduled the sleep study so I could try to absorb more today.

Have logged in over 27 hours on-line (more than a whole day!) doing the practice tests, which then have a study section where you go over everything.  It's one thing to know stuff, it's another for it to be put in a question.  And they pick the stupidest, ridiculous, obtuse stuff in there.  Honestly: do I really need to know that African honeybees respond to the honeybee alarm pheromone?  On seeing that as one of the answers I thought it was a joke.  And do you know that gonorrhea is now fluroquinolone resistant in California & Hawaii only?  Someone is totally obsessed with Hirschsprung's disease, which is seen only in about 1 in 5,000 (numbers vary from 2,000 to 7,000) births, so not exactly everyday, even in delivery.  Why do I need to know about Monckeberg's, which is an incidental finding at best and usually found on autopsy with no clinical relevance? 

So yes, I'm freaking out!  Test in less than two days.  Entire ability to continue to work is based on this.

Work tomorrow, yoga tomorrow night, full night's sleep (I learned a long time ago to never sacrifice sleep before a big test), and then at the testing center at 11:00 am, which is a very reasonable time.

Just let me whimper. And just a little bit of sympathy would be nice!    Laurie

June 1: 'Duh' epiphany

My posting now is a combination of the shock (as usual) that it's been a few weeks along with my general disinterest in doing anything else at the moment. 

Work: less stable.  They laid off two of the billing girls Friday last.  I had a talk with G, more changes will have to come.  Reimbursements are down substantially.  This is how medicine is going to go, it's 'new normal'. I'm in a difficult position, because how the practice has flourished, and by extension allowed them to be so generous with me, is part of the problem overall.  Let me hasten to say that they aren't doing anything wrong or illegal, just playing the game.  But the game is changing.

You may have already noticed, but by the time I post on here I've already done the necessary ruminating, planning and recognition.  Sometimes the issues are much more obvious to everyone else than to me, and reactions often can be 'what took you so long to recognize that?'.  So before I launch into my latest epiphany, let me update you on life....

The last three weeks have been somewhat busy, but not extremely, and with a lot of down time as well.  A few more doctor's appointments that usual.  Pulmonary doctor was not impressed with my sleep history, but we agreed that a sleep disorder needs to be ruled out.  So a sleep study is scheduled for June 10, right up the street and very convenient.  They promise to not cut my hair or shave my head!  Had an eye appointment the 17th, need a new prescription, not unusual.  Worked last Friday.  Dentist on Tuesday: that was unpleasant.  In 50 years I have never had a cavity, until now.  Three of the damn things, with a 'watch' on a fourth.  They were able to fill all of them, fortunately covered by my excellent dental insurance.  Weekends with stuff off and on, I always give myself one day of almost total rest, rarely schedule more than two things to do on the other weekend day. Had a couple meals with people, stayed in while on call Memorial Day.  This past week was easy, then, with only working two days and less stress tests than usual (also, therefore, a little concerning).

Yesterday and today the floor was refinished, the last of the storm damaged stuff to be done on the house.  I knew it was scheduled, but didn't think about the practical stuff until Wednesday night when I suddenly realized I had to pack up some things, move stuff onto the porch, decrease chance of anything breakable being out.  So I packed up lamps and such, moved the small photos from the bookcases, etc into boxes, worked for about two to three hours to get things handled.  They finished today and the floors look great, except one of the major issues was taking care of where tape had been placed and then ripped off the top layer of wood in the bedroom, and it still doesn't look right.  Otherwise, they are so shiny you could skate on them.  It's hot, but not too bad, low humidity, a breeze; I'm trying to not turn on the AC yet as it's still cooling down overnight and not that humid.  With not being able to walk in my house I spent time on my swing, studying for my Boards at the kitchen table, and then finally several hours on the couch last night.  Today an easy day as well. 

So why am I boring you with all this minutiae?  Because I don't think this is a huge amount of activity, at any point.  This is how my life goes.  Why, then, am I ALWAYS utterly exhausted? Well, gee, maybe because I have a heart condition?  Maybe because even this 3 or 4 workday schedule is still too much?

As a concrete example: the flooring guys moved my furniture back in place, but I know it will take me weeks, literally weeks to months, to get everything back in place again.  This is a certainty, because despite the fact that I've been back in the house since late January there are still tons of things out on the enclosed porch that I haven't had the energy to deal with.  (The porch is basically another room, but doesn't have any insulation, so does get too cold during winter months, has an AC unit for hot.)  I had to stop repeatedly Thursday night and Friday morning because of getting not just tired, but the bad place of nauseated and dizzy, which then takes days to recover from.

I'm tired of living in my constant state of mess because I'm too fatigued to cope with stuff.  I'm tired of having everything categorized into urgent, immediate, needed and wouldn't-it-be-nice with only the first two categories ever getting any attention, because after that I'm just too tired.  There are dozens of things that have never been coped with, despite my being here for six years now and in better health the last 2-3 years, but are still not done because there just isn't enough energy.  (Cleaned off my kitchen table and found a work holiday party picture still out--from 2011.)  There is the time--except it's spent resting because my body is so overwhelmed it just shuts down. I'm tired of being tired, even after days of rest.

And so here's the 'duh' moment:  I have a heart condition. I avoid saying 'bad heart' because it isn't a bad heart, it's a splendid heart that has stood me in excellent stead and coped with way more than anyone would have thought possible both before and after diagnosis.  It's an incredibly wonderful heart which has withstood more emotional and physical and surgical traumas than possibly any other heart out there.  It's just not a normal heart.  While it's allowed me to recover beyond the medical community's wildest expectations, it does have it's limits.  And I'm finally, almost six years after the last surgery, coming to terms with those limits. 

What can I say?  It's a process.

So, I'm going to start accepting those limits more.  And, possibly more importantly, that they aren't going to change.  Things will not get better than they are now from a physical standpoint.  There is no more 'fixing' to be done.  This is as good as it's going to get.  Please understand that I'm not complaining, but finally recognizing that this is the most my body can do, and it's telling me that the current amount is too much.  It shouldn't take an entire weekend to recover from working 3-4 days a week, with few other demands. 

What does this mean?  It means I'm finally going to do what everyone thought I should have done years ago: I'm going to start looking at going on disability.  I've fought the good fight, given my body enough time to see if it would improve, gone through years of struggle because it was the best thing to do financially.  But I think I'm done. 

As far as I know, no one from my work life reads this, and if you do, please keep this to yourself.  I did give G a heads up, and this is not something that I'm looking at in the next couple of weeks or even months.  According to my contract, if either side is terminating the employment then three months notice is required.  Not sure if that applies here, but I'm not going to leave them in a lurch. And it may not even entail leaving completely, since apparently you can earn up to $980/month, which would be a help.  Maybe by this time next year? That doesn't sound to most people like it's a big announcement, I'm sure.  But considering that up until recently I'd been telling myself that I was just going to have to struggle through until at least 62 years old, thinking about next year is a big change in my thought process. Further proof of all this being a good decision is my overwhelming sense of relief that my current schedule and constant fatigue is going to have an foreseeable endpoint. That's always been the acid test with me: does it hold up as the right decision, or are there niggles of doubt?  No niggles, just trying to figure out all the practicalities of doing this.

So, as much as is wise, I will let you know the progress.  Thanks for checking in,    Laurie

P.S.  Just realized that I hadn't mentioned: it's Board recertification time again!  The scourge of all PAs: having to put your life and employment on the line by taking a comprehensive exam every six years to keep our certifications.  Major stressor.   Scheduled for June 14, which means there would be time for me to re-take it again before the end of the year.  Back to studying....