November 17, 2008

My feet hurt....

I think I saw about 42 kids today. I'll know tomorrow when the nurse counts up the tally. See. I really do go faster if I don't have to lug a laptop & EMR.

Today's theme was totally "snot" and teenage boys.

Snot's easy. Teenage boys -- not so much.

Last patient before lunch was the 14 year old who was depressed because he's not circumcised and he feels "inadequate". He felt so strongly that he wants to be circumcised that he didn't even flinch when I [a "girl" doctor -- Eeeek!] walked in the room. He didn't even complain when I told him that I had to do a "groin check". If it wouldn't have been crass & offended his mom standing in the corner, I could have reassured him that "inadequate, he's not" -- more like "hung like a bull." But truly, that's another blog topic all together....

Then the afternoon boys were a handful.

One was in a car wreck earlier today and sent home from the scene without really being assessed. So I see him hours later and he's hurting all along his spine, his wrist is hurting & swollen, and for good measure he's got blood cells in his urine. "Do not pass go. Go straight to the ER and we'll call them to let them know you're coming...." If you remember, I saw a similar trauma kid in July.

Teen Boy #3 was in for "review results on hip x-ray". That's all the info I had going into the room. It would have helped me to know: 1) he has diabetes 2) he has ulcerative colitis 3) he has a horrible social situation. Because 30 minutes later, I was still repeating myself to mom that his joints hurt because #1 & #2 are not controlled and the huge amount of inflammation in his body is expressing itself anyway it can, i.e. joint pain. As I walked out of the room, I could feel mom's frustration & my frustration. Hers at having a really difficult set of problems to deal with. Mine at her "not getting it" -- when in fact, she's in denial as much as he is about his health problems. As I told them today "I'm not going to be able to fix this today. I can tell you that these joint pains are not because of a joint/bone/muscle problem. I can tell you that a MRI is not going to add to or change any treatment you might try. You have a complicated situation [Which I can totally relate too, BTW] and until you get the diabetes and the gut under control -- everything else is going to be in chaos." I could tell she didn't want to hear anything I had to say, so all I can do is document, walk away, and shake my head....

I'll be curious to see what comes in tomorrow....

November 14, 2008

"If you can't say something nice...."

Then you should talk about your dog.

Well. I certainly got quite the hit count in the past few days, but no comments. I guess my overwhelming "sunshine" attitude makes it a bit difficult to say anything. I told Michael Wednesday night that I feel like an enormous black hole of negativity, working to suck everything happy & light out of the universe. Which I followed with some dramatic sound effects that now apparently I will be forever remembered for. What can I say? These last few posts are my reality. And it sucks. Frankly, none of this is news. I've felt this way since about, ummmm August 30, when it was apparent that I was going to live, but with "strings attached." I just haven't really written how I felt. But I'm feeling beaten up enough that the filters are going down.

So moving right along. Let's talk all things Zoe. She cracks me up. Here's some recent pictures. She's suddenly sprouted legs [I hear ZZ Top's "Legs" in the background when she prances around the kitchen.] and her weight is now 10 pounds. She's growing like a weed and it's amazing to watch. Her newest trick is that she loves baby carrots & sliced granny smith apples. Open the fridge door and she can almost help herself out of the produce drawer. She can definitely point to it though! I feel like I should call the breeder who warned us we'd have a hard time finding training treats since Zoe's dad was so fussy. I wonder if she ever tried carrots???

I call this "Puppy Cheesecake":

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And here's the "I'm so Cute!" Pose:

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And this is "Zoe on Stilts!" Actually, those are her own legs....

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We've discovered that she LoVeS playing "Red Dot" which is the game where we send a red laser dot all over and she gets to chase it. Michael particularly likes to make her run in circles around the island & then crash into the cabinets. Almost like Nascar....

November 13, 2008

So I'm "out in the wild, fending for myself...."

And thought I'd continue the saga from Monday.

I got my blood drawn early-afternoon on Tuesday (11/11) and then Wednesday checked in at the internist's office. I was amazed, floored & gob smacked even, that I got the insurance forms signed in less than 30 minutes. I really planned on sitting there for two hours just to get that part done. Apparently, the fact that I've gotten a lot more cavalier about throwing my doctor title around is starting to get people to cooperate.

A total of three phone calls, two nursing line phone messages, and one out-right threat (from me this morning to continue calling back) I finally learned what my INR on Tuesday afternoon was at about 1pm today. Seriously. 48 hours after it was drawn.

And this past 48 hours has really not been fun. I was convinced that I'd finally swung to "too high" because of the nausea, loss of appetite, belly pain, the fact that I bled for 25 minutes from the lab stick and from a dog scratch to the face (Zoe now bounces like a pogo stick.), and then started with random bleeding like nosebleeds two nights ago -- well it all goes along with my INR finally got up.

When I got a call from my doc today, I was in stunned disbelief to learn that my INR on Tuesday was actually 1.7. So in spite of increasing my dose from 35mg/week to 42 mg/week (a 20% increase) -- and my INR DROPPED. I mean -- really? ReAlLy?? I know that if it were any other patient besides me, my doc would be giving me the third degree about what have I been eating/doing/cheating with that's screwing my numbers up. And sadly enough, I have been so "toe-ing the line", that there's nothing to change -- except my dose of rat poison. Yup. Going up, AgAiN.

You can ask Michael and "The Girls", I'm being such a "goody-goody about this stuff, it's disgusting. Absolutely no salad or greens last week. I have this list nearly memorized. If that's a bit overwhelming -- try this one. It's "Vitamin K for Dummies." [And then be really glad that it's not you dealing with this.] I even stopped taking my calcium & magnesium, even though theoretically -- they shouldn't have an effect. No alcohol. Not a drop. My last drink was some time in Late July/Early August before I even had sinus surgery. If anything, the one item that I have cheated with is the occasional Advil. And my doc knows. I 'fess up. She's not thrilled since throwing an NSAID into my gut right now is not much different than throwing a lit match into a dry forest, but my only other alternatives include: a) living in pain -- which I'm not a fan of or b) taking narcotics -- which I'm not a fan of because I prefer to be awake. For me at least, they don't make pain go away, they just make me care about it less & sleep a lot. Not so practical when I'm either busy "playing Mom" or "playing Doctor".

Two more items to add to the "Loss List":

  1. dental cleanings- Since I'm spontaneously bleeding from the gums now. That makes my dentist twitchy. Makes my cardiologist very not happy, since increased bleeding at the gums increases the opportunity to bring bacteria into ones blood stream, and taking my usual prophylactic antibiotics to protect my floppy heart valve will just crater my INR.
  2. pumpkin pie - Too much vitamin K. Which makes me very very sad since that's one of my favorite things about Thanksgiving....

So the current plan was this evening at "Rat Poison Time" I took a dose of 10mg. That is technically the most one may take in a 24 hour period. Then for the next three days I go back to the 6mg dose. Then on Monday, somehow, by the grace of God, I have to get out of clinic, get to a lab, get blood drawn, stop bleeding, call my internist to let her know I've had the labs drawn, and then get back to clinic. I'm so not confident about this plan. Just so you know....

Oh and clinic. Yeah well I sucked it up since I didn't really have a choice. Residency either beats you to smithereens or it tempers that inner core to just "git'er dun." It was a peachy 12 hour day. 9 hours standing on the hardest flooring surface known to man, I might add. About 2 hours in the car. And about 45 minutes for lunch, most of which was spent on the phone.... The clinic has the potential to be a fun place. All of the staff has been awesome. The other two docs are nice. The patients are very appreciative (Something I find more often in these "Medicaid clinics" more than the "higher end places"). The only downside to this place is the EMR (Electronic Medical Record). I managed to crash three separate laptops in about 30 minutes this afternoon. I was starting to feel a little "special" when the computers suddenly started doing the same crash for the other docs & all the nurses. Then I just went with a whole "Thursday the 13th" theme. The clinic as a whole saw 117 patients today. I saw 23. Here's hoping that the computer "force" will be with me tomorrow and I'll be speedier. Otherwise it's going to be a really long two+ weeks....

The view on my kitchen counter:

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November 11, 2008

"Pity Party! Table for One... Now Seating...."

By anyone's assessment, this has been less than a stellar year for me. Really.

It's probably been my worst year since 2003. And Lord knows that 2003 was tough. My last six months of residency were emotionally some of the worst because I was caring for and losing some of the sickest kids to date. We lost two of our younger cats within two months of each other. We moved, again. Only this time was across state which was nearly 500 miles. And I discovered within three weeks of starting my job, that my partner was a Mr. Hyde/Dr. Jekyll remake.

So let's review 2008 so far:

  • January found me encamped with my family for a "living wake" while my beloved grandmother finally succumbed to end-stage Alzheimer's.
  • Mid-February I displayed major coordination & fell out of the jeep while tripping on a curb, which lead to finding out in March that I had a stress fracture of my left leg.
  • Late February found the demise of Hamster #1, Speedy
  • April was when we lost Molly
  • In May, I should have clued into the overall theme for this year when my birthday went like this....
  • June found me getting a refresher course in "Back-stabbing 101" as well as the loss of Hamster #2/3
  • July we lost Mia. While she wasn't my dog, she was my niece-dog and I'd known her for 9 years.
  • August found me having sinus surgery and then for good measure, pulmonary emboli .
  • September was mostly spent trying to breathe, adjusting to life on Coumadin and trying to come to terms with a life-threatening event.
  • October, I mostly behaved while being exhausted. Still I managed to do 7 days in "Locum tenems Hell" at a practice that I wouldn't send my neighbors' cranky cocker spaniel to.
  • November finds Tabitha in fine form....
  • Then this month, last week even, we lose Tessa

The straw that's breaking this camel's back is that today in my in-box I had two rejection notices and a phone call at 9:45am from a total of three separate physician recruiters all saying the same thing: "Thanks but no thanks." One e-mail was a group that waited until after 5pm to contact me and completely stood me up for a 2pm phone interview that they had arranged. In the past ten days, I've had 1 university, 1 locums company (after I filled out the 22 page application & faxed it twice), 2 more locums jobs at yet another agency, and 2 physician recruiters for permanent positions all turn me down. The conversation usually goes "We really think you're probably a great doc, and you've got outstanding references, but since you've failed the boards four times we really can't work with you until you pass the exam...."

As I told Michael "I'm starting to feel like the pariah of pediatrics -- might as well have leprosy...." De.Light.Ful. And since the next board exam isn't until October 2009, and those scores won't be available until January 2010 -- I guess that means I've got another 15 months to go being completely stressed by not having consistent work & income. Earlier today I was fantasizing about being a cashier at Hobby Lobby. Over the holidays it would be steady work, I'd get the employee discount, and I do know lots about arts & crafts. I'd just have to lie, lie, lie on the application & leave off the whole med school, post-grad training part of my life....

And then start adding up everything that I've had to give up since August: riding my bike, step-stools & ladders which means holiday decorating at my house, not getting to restart rock climbing [all due to the risk for head injuries], spinach, salads, steamed broccoli and stir fry veggies, cranberry juice, green tea, vitamins [Yeah. Try finding a multivitamin without Vit K and without Vit E. I dare you!], travel [Can't do anything that has me sitting for more than 1-2 hours to avoid potential clots], alcohol [Not like I was a slush or anything, but I miss having a rum n' coke 1-2 times a month], Advil, juggling knives [Ok. That was just to see if you were still paying attention....]. There's more I'm sure, but this is what comes to mind this late.  I think that most people would agree by now that this has turned out to be a helluva year. I'm starting to feel beaten down enough by it all, that it really feels like it's not ever going to get better.

I could continue, but even I realize that gets old fast.

Two highlights this year: Tabitha's baptism and adding Zoe to the family. Does that balance the scales? Not hardly. But I wanted to show that I'm still trying to look for the positive -- it's just getting harder & harder & harder....

November 10, 2008

"It's 7pm...."

"Time for my daily dose of Rat Poison."

That's one of the finer points of medical trivia related to blood thinners, anticoagulants, and clotting "stuff" in general. People tend to be terribly startled when I make that comment. But it's true. The history of warfarin/Coumadin is actually kind of cool. Best summary I found was here. And funny how it all started with cows....

Intellectually, it's quite the leap to go from "Hmmm, Rat poison. Wonder if it would work in people?" So it helps advance science/medicine when different people decide to experiment with themselves. [Again very true. The bacterial origin of ulcers wouldn't have been found if not for this guy.] So to quote from this website, here's how the rat-to-human leap was made:

"Turing a rat poison into a widely used drug for humans may seem odd, and its path to success was paved by an unusual series of events. In 1951, a navy recruit unsuccessfully attempted suicide by taking rat poison. He had consumed over 500 mg of warfarin (100 times the standard clinical dose of the drug as now used in humans), seemingly more than enough of a rat poison to cause death. Yet, he made a full recovery. This led to research into the potential of using warfarin instead of dicoumarol in humans, since it was a more potent anticoagulant, yet not acutely toxic. In fact, early testing showed that it was far superior to dicoumarol, and clinicians soon discarded dicoumarol in favor of warfarin. The rat poison turned drug was introduced commercially as a human anticoagulant in 1954. It was soon put to very good use: President Eisenhower was treated with warfarin following a heart attack during his early presidency, in 1955, and it is credited, along with other medical interventions, with saving him. He remained president until the end of his second term (January 1961) and lived until 1969 (reaching the age of 79)."

Crazy, Huh? So rat poison gets the credit for keeping me from forming any more clots, at least as long as my levels are therapeutic.

Now for the flip side. Damn near anything makes my levels be non-therapeutic. My life now revolves around not taking in too much Vitamin K. Alcohol is out. [And just when between Tabitha-drama & a dead cat, I could really, really use a drink....] Antibiotics make the levels go wonky, as do infections [Hmmm, Chicken vs Egg....] Tylenol & Ibuprofen potentially make the levels go higher. Salads and green leafy vegetable drop the levels. Cranberry juice is dangerous too. So try adding a Warfarin diet to a gluten-free diet and about all I seem to consistently be allowed is cheese, cokes, and potato chips.... OK. So maybe I exaggerate a little, but it sucks. Try figuring out how to eat out with friends. The Girls & I went for dinner a few weeks ago and it was Italian. Ummmm. Pasta - bad. Cream sauce - bad. Salad - way bad. I'm screwed. I ended up crossing my fingers & had fried mozzarella with a small Caesar salad. Then spent the next two days with gastric distress because my gut no longer remembers how to handle roughage. Like I said, I'm screwed.

I never seem to go too high. [Ooooh -- too high = spontaneous bleeding.] Instead, I just keep dropping too low. [Ooooh -- too low = no protection from clots forming, while still experiencing side-effects.] Fab.U.Lous.Do not pass go. Raise the warfarin dose. Restart weekly blood draws to verify the current levels.

Besides the fact that I don't particularly like having my blood drawn. And besides the fact that now that my dose has been bumped up twice in the past 4 weeks; I now feel constantly cold, I fatigue in half the time that I used to, I'm constantly nauseous, my stomach hurts & I still have chest pain. To "add insult to injury," I go along and have days like today....

My lab drawn a week ago had a level of 1.8. It wasn't in that happy 2 to 3 place that we like it to be. So get results at internist's office last Wednesday and increase dose of warfarin to 6mg a day. Go get another level drawn after five days -- which would have been today, right? So starting at 9:30am today, I called my doc's office lab to make sure they had my orders. Nope. No can do. As a matter-of-fact, they're positive that I have standing orders at the local Quest lab, since that's where they've been sending my blood. So I get a Quest lab phone # from them. Call what turns out to be the main company number and after one of those phone-trees from H*** I finally got someone who gave me the location & phone number of the lab closest to me, which is 12 miles away. So I called them. Spoke to a really nice lab tech who looked really hard and never could find any orders. <sigh> [Look at clock. It's now 10:15am. And I wonder how it is that I ever get anything done....]

I called my doc's office & left a rather pithy message on the nurse line that I really needed lab orders & that I really needed them today. At 11:30am I got a call back from the nurse that she had gotten my message. [Hallelujah People!! I can see the light!!] But, she would call me back later today once she got the orders approved. [Huh?!?! WTF? I'm just trying to do what my internist told me to do last week. Is it asking too much to get you people to work with me?!?!?!] So in spite of the fact that I actually have my doc's cell phone#, I decided to play along and wait for my call back. Which never happened. No lab orders. No blood draw. No INR level as requested by my doc. Tomorrow, my doc is at their satellite office, which might as well be outer Siberia. Wednesday when she comes back, I'll probably have to start over at square one. Then, to make everything that much more sporting, on Thursday, I start a new locums tenems job in a different county an hour away. Which lasts until the end of the month. Every day. Until the end of the month. So from 8am to 6pm I'm occupied and can't get to a lab. Sporting. Did I mention sporting?

One of the tasks on my "to do" list last week was to research home PT/INR monitors. Turns out that they're pretty accurate and the technology has gotten as good as the home glucose monitors. I called my cardiologist's office to find out who they use for these gadgets & his poor nurse really was at a loss for what to tell me. Dr. T likes me because I'm not his typical patient. Seriously. I'm not 80+ years old. I don't have a pace-maker, nor stents, nor a heart attack history. I just have questionable genetics & bad, dumb luck. That and we like calling each other "Dr. T." [Odd medical humor -- just roll with it.] That being said. At his office, most of his patients would be pretty challenged to use a home monitor -- so they don't.

They gave me a phone number to try and there I talked with a delightful lady named K. She listened while I explained my predicament of 38 year old pediatrician with pulmonary emboli and a non-cooperative INR. On so many levels, I was not their usual client either. Turns out that the list price on these gadgets is $2499. As a doc, I can order direct and get a complete kit, including testing supplies for $799. Or we can try going through my insurance, with me jumping the usual paperwork hoops and having my internist sign them, and possibly get the same thing for about $400-500. What can I say. With an erratic income, I'm cheap. So I've got the forms all filled out, and Wednesday I expect to have my internist's office staked out until I get lab orders & paperwork signed.

In the meantime; I'm frustrated. I'm angry. I'm very disappointed in the system. I'm scared for all those other people out there who don't know as much as I do. I am feeling quite low right now and I really don't know how I'm going to "get it all together" for Thursday.

I'm going to borrow a quote I read today from another member on a pulmonary emboli forum I belong to. It resonated with me a lot, because this sums up what it feels like to be me right now:

I don't think there's a lot published on recovery because, frankly, either you die or you don't. For those that don't die, you are treated and sort of sent out into the wild to fend for yourself....

 

It feels so tremendously quieter in here right now....

I miss how Tessa would chirp & chatter at me. She would have liked that tonight I pulled out the space heater & have the temperature somewhere between "Tahiti" & "Hawaii" in my office; just because I'm feeling very cold tonight.

Tessa could make a toy out of bubble wrap, string, ribbon, literally anything left laying around. While we were in Corpus, Michael won an eBay auction for a large computer monitor. It arrived in a jumbo box wrapped in layer after layer of bubble wrap. After Michael & I unpacked the thing we shoved all the bubble wrap into the box and later we found Tessa bouncing around inside there, happy as could be. She was the first cat I had who had an obsession with licking plastic bags. And she could be quite the canny little thinker. At one point she blew a jump & twisted a front paw. She discovered very quickly that if she held up that paw & limped she got extra attention. So randomly she'd have a spell of limping & holding up a front paw. She never realized that we were on to her when the side held up, didn't match the side limped on....

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She also learned how to brush herself. She loved being brushed and would purr like a freight train. She especially like the "zoom-groom" that we got earlier this year.

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I spent seven hours Saturday cleaning in my office. It feels empty even though it's not. Out of the corner of my eye, I still catch glimpses of her moving about, even though I know it's my mind playing tricks. Except for Pixel this afternoon, none of the others have wanted to come visit. I never really considered that by my office being Tessa's primary space, that once she was gone, I could miss her even more....

Well Michael's got the midnight "Zoe-run" and it's late, late, late -- so I'm headed to bed.

This has been such a downer of a weekend....

November 07, 2008

"And then there were four...."

Cats that is.

Seven hours ago, we had to put Tessa to sleep.

As much as I feel surprised, I don't. I was peripherally aware that this week she was having a hard time eating, and she was vomiting on a daily basis. Not really that unusual for her this past few years. Every few months she'd have a spell like thisand then bounce back. We attributed it to a belly mass that was found in 2004. She was 10 years old then and our household policy is that once the furries reach double-digits no extraordinary or invasive measures are required. So when she'd have one of these spells I had injectable nausea medication to give her, and she'd bounce back.

Only, today at about 1pm, it was blatantly obvious that she wasn't bouncing back, but she was rapidly declining. She couldn't balance to walk. She'd fall over and her paws would all stiffen. She wanted in the window to soak up the sunshine and after I put her there she fell off the window sill. Eventually, she reached the point that she wanted to just be held. So about 2:30 I called Michael to let him know that Tessa wasn't well. Then I called the vet to see if we could get worked in. Shortly after that the seizures started....

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As best as I can tell, her belly mass was bigger. With not eating well this week, 5 days of vomiting, and yesterday & today not much oral intake at all, I think she was in full-blown renal failure & was uremic. She certainly had changes in her mental status and seemed like some of the extremely elderly patients I had taken care of with similar situations.

At 14 years 2 months, Tessa claims the title for the longest living being whom I've been directly responsible for, besides myself.

And so this is Tessa's story....

She came into my life at the sprightly age of 12 weeks old, directly because of Michael. She was the first Christmas present he ever gave me, the first year we were dating. I had moved into my own apartment over that Summer and was terribly lonesome because I had had to leave the family dogs back home with the family. So it was the first time I had been without any furries. Michael's cat, Milo, had convinced me that cats could be cool and for the first time ever, this stalwart dog person considered taking on my own cat. Within a few weeks, Michael & I were found at the pet store that our future brother-in-law worked at. They had gotten in a collection of kittens & Michael was excited for me to go pick one out. After a great deal of consideration, my choices had been narrowed down to two. The first was a pretty looking black & white cat who purred like a freight train every time that I held her. The second was a solid grey boy who was feisty & wanted to play with everything when I picked him up -- he was a wiggler. So I went back & forth multiple times, but eventually the black & white kitten's huge purr won me over & she was my choice. She also had a splotch of black across her chin that made her look like she'd been drinking chocolate milk. I didn't take her home that night because BIL was going to make sure she had her medicals done, and that she'd been freshly bathed & groomed. Michael then went whole hog-wild stocking me up with everything kitten that I'd need to care for her.

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Within the week, BIL got his part done and we met at Michael's grandmother's home for me to get her & bring her home. She was in one of those cardboard carriers & she wanted nothing to do with that. So much so that she figured out how to escape and settled in my lap for the car ride home. That first weekend actually found us staying with my parents in my old room because I went home on the weekends to work my pharmacy technician job. She recoiled some about the barking dogs, but she wasn't particularly upset. The dogs were tremendously interested in the new smells from my room, but the weekend flew by and then she & I headed to our home at our apartment.

This was Tessa & I when she was 14 weeks old.

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Her name Tessa was short for "La Contessa Tessalon Perle". She carried herself with a very regal tone, so she needed a title of some type. And at the time I was working my way through college as a pharmacy tech. The two pills that I thought were the prettiest were Chloral hydrate and Tessalon Perles. Even though the chloral hydrate ones were a deep green, translucent capsule, it just didn't seem like the right kind of name. The tessalon perles were a lovely translucent golden yellow sphere and added into her name, it just sort of rolled together fluidly. So Tessa it was. In residency, one of my fellow residents was named Tessa and I had to bite my tongue often to not keep telling her that my cat was named the same.... Tessa the resident always seemed miffed that she shared a name with a cat -- but really she was a dog person....

I sometimes really missed those days when it was just her & I. That first winter she would sleep under the covers with me. At least until 2 am, when she'd get up & play with her beloved "snowball" toy. It was a white rabbit fur covered ball with jingle bells that hung from an elastic cord mounted high above her head. She could make quite the racket and wake me up. With just a little bit of training, I learned to put the snowball to bed, before we went to bed.

She was a delight & joy and helped me look forward to going home to the apartment instead of feeling so lonely. She was my shadow when I was home, although the semester that I took CVA [Comparative Vertebrate Anatomy] and had to dissect a cat, she would give me a wide berth until I'd showered off the "dead cat" smells. She slept on my textbooks while I studied and most definitely absorbed more organic chemistry than I ever did. I only had a 5 inch TV that we'd watch E.R. on every Thursday night and she'd sit with me watching every bit of activity. When I ate a bowl of after-dinner-mint ice cream from Braums, I had to sit on the kitchen counter to keep her out of my bowl. And she adored buttered spaghetti that she stole off my dinner plate. Otherwise, with Tessa, unless it came from a container clearly labeled "for Cats" she'd turn her nose up at it. She particularly liked sleeping on my sweatshirts & she could make a nest out of them very easily.

She was the cat who I held & danced around the apartment with on March 5, 1995, minutes after I finished my congratulatory phone call from the Dean of Admissions at the medical school I would later graduate from. She merely meowed when I told her that her mom would finally get to be a doctor. She was the cat I held in my brand new long white coat for pictures on my first day of internship. And she was the cat who snuggled with me in my office every chance she had when I was in there.

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Five months later she & I moved to a new apartment closer to the medical school. This one was on the second floor with a fabulously thick tree just outside the bedroom window. She could finally bird watch to her heart's delight. She was just shy of her first birthday & still had a mischievous streak. Because I was gone for such long periods of time every day, she got good at making her own entertainment. She kept track of where I stored a jumbo pack of rubber bands and one night I returned home to find 5000 rubber bands strewn from one end of the apartment to the other. And the bag was still intact except for one small inch-wide hole at the bottom. She had painstakingly pulled out each rubber band & flung it around the apartment until she decided that she needed a new one. After that, we got a beta fish so she could have "cat TV" while I was gone. She became quite the naturalist between the birds & the fish.

About a year later we moved in with Michael & Milo. Tessa never did like Milo. At least for her part, she decided that they were sworn enemies. I think it went back to when we had tried to introduce them when she was only 14 weeks old and weighed 4 pounds and Milo was this gigantic, orange, 15 pound Maine Coon who pounced on her because he wanted to play. She was so not amused, and I guess never really got over that experience. So for years she merely tolerated him and she would self-limit her space to usually be my office, or one certain window or table, just to avoid him and any other cats she didn't approve of. Turns out that Tessa was very biased about who she would associate with. She only approved of other animals who were black, or white, or grey, or some combination there of. Two cats we had were her close buddies when we lived in Corpus, but they died in rapid succession just before we move back to North Texas. I think she was as heart-broken as I was at losing them. She also was fond of my brother's dogs when they came to visit. Kona is the white American Eskimo & Mia was the black mixed breed. When they would stay with us, penned in the kitchen, we'd routinely find Tessa hanging out on the counter visiting with them. Even when every other cat in the house had taken to hiding under our bed. So that kind of gives credit to the idea that animals have personalities & quirks too, just like us.

Milo & Tessa:

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During medical school, someone attempted to break into the house we were living in. That was the one & only time that Michael has ever paged me with "911" in the phone number. By the time I arrived all the cats were accounted for and many hours later I noticed that Tessa seemed to be keeping her left eye closed & couldn't open it. When I went to touch her face, blood was on my fingers as she pulled back. She had multiple cuts that were hidden by the darkness of the black fur on her face. Minutes later Michael, Tessa, & I were headed to the emergency vets. She had the cuts on her face, but the worst injury was a shard of glass that had gotten lodged in her eye. The e-vet gave us medication & eye drops to use and the next day our regular vet got us an appointment with a veterinary ophthalmologist. For the next few weeks it was touch & go. Dr. Munger was hopeful that we could save the eye, but maybe not the vision. So she & I made the trip to North Dallas 2-3 times a week and finally she started to heal. Her vision was never the same, but after a couple of years to adapt, she started to make jumps more confidently and she'd hang out on windowsills again. Long story short, based on the BB pellets I found across the room and fragments of window glass with BB holes, we suspected that the kid next door to us saw Tessa lounging on the windowsill in my study & he decided to use her for target practice and she got caught in the shattering glass. Then to cover up the BB holes in the window, he smashed it with a golf club, messed up stuff on my desk & tossed the golf club in our back yard. Other than circumstantial evidence I wasn't ever able to prove what happened, but a few weeks later I came across him standing in his yard pointing at my windows with a pellet gun. At that point I got Michael's shotgun & pointed it at the kid until he backed down & went away. I never did seem him back there again. Lesson learned and a cat scarred for life....

Tessa lived in six different home with us. Moved a total of seven times. Was an intrepid car traveler. Loved & lost three companions and two others who weren't favorites in the past 5 years. And this past August she surprised us all by celebrating her 14th birthday -- unfortunately we curled her whiskers from the heat of the candles on her cupcake. For the past two years she's been my steady room mate in my office. It's the one room that I could easily close her off from the others so that they wouldn't harass her. And I got very used to our evening routine. I'd come in after Tab got to bed & Tessa would hang out either on my desk or in my lap as I checked e-mail, surfed the web & played with my photos. At 14 years old, the equivalent of being a 98 year old human, I should have realized better that this wouldn't last forever. I just wasn't expecting how lonely it would feel in here without her. The other cats don't want to come in right now, and I can't bring myself to start cleaning up all of her things & her fur-drifts off of the floor. Maybe tomorrow, but not right now.

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She was stubborn and more than a little hard-headed.

She shed a lot. Year round.

She had a tendency to pee when & where she felt like it, hence the lovely stained concrete floor in my office.

She & I adored each other and she will forever be my "first cat"....

Tessa, "La Contessa Tessalon Perle" 

August 23, 1994 to November 7, 2008
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November 06, 2008

SO continuing the trauma drama....

I decided that being rude & saying hurtful things to me, and other people it turns out, was behavior enough to require a week of "tough love". So this week, while Michael has been out of town (and our buffer is gone), Tabitha got to experience what life would be like if I really did not love her. I've been courteous but cool all week -- and really it hasn't been much of a stretch emotionally. Monday afternoon when I broke with the usual routine to go get gas & dinner at Sonic Tab asked "Mom? Are you OK?" "Yeah Tab. I'm just fine. Why do you ask?" "Because you're not really talking very much." "Well Kiddo, you need to learn that if you're going to say mean things, you need to be ready for the consequences. So since you think I don't love you -- let's pretend all week that's true and you can decide what you really think at the end of the week." <Very long silence from the back seat....> "Oh. OK."

So Little Miss has been very quite all week & I've treated her like she was a roommate who is a necessity but not exactly the most favorite person in my life. There's also been no friends checking on her in the afternoon. Turns out that some of the neighborhood girls haven't been so keen on stuff she's been saying lately either. Of course, the fact that I told her that if any one rings the doorbell she can't play and she has to explain why: "I can't play because I've been rude to other people and said mean things." Seeing as how she hates admitting responsibility for anything -- yeah this was tough to take from her point of view. Which would be why she let everyone at school know not to come by the house in the afternoons....

She also got educated on how to do laundry and informed that I and her Dad will no longer be doing her laundry. It's all up to her now. At first she was excited about that, but I think the towering stack of clothes in the corner of her room are starting to be a bit intimidating. Michael has been informed that he is no longer to add her clothes in with ours -- she's completely on her own. He agreed. So we'll see how long it takes for her to realize that she needs to get started this weekend.

In general this has been one of those weeks where as much as I would have liked to have scrapbooked a bunch, I never really was in my office long enough to get started. Actually I was mostly going in to rapidly skim e-mail & care for Tessa and then I was back to juggling everything else in the rest of the house. I'll have to type up my "to-do" list for today alone, but that's another post. All I can say is that you know you're tiredwhen at 11:30pm you realize that the reason your bra has been uncomfortable all day is because you put it on inside-out at 6:45am....

This has also been an interesting week because Zoe has just grown at an astounding rate. I weighed her and she's now at 10 pounds - twice her weight when we brought her home. She's also gotten these long tooth-pick legs that run like wild-fire. She bounces like Tigger. So Tuesday I left her out of the crate for 10 minutes when I went to pick-up Tab from sports, and when we got back, Zoe had managed to pull loose an entire panel of kitchen wallpaper from the ground to about 10 feet up. That last two feet was all that was holding it up & with a light tug, that came down too. So I looked at Tab and said "Well Dad & I never liked the wallpaper anyway. Guess Zoe's letting us know she hates it too. We couldn't decide whether to paint over or take down & then paint, but I guess now we have to take the paper down first." So Tab & Zoe took out about 3/4 the rest of the wall paper in the next 24 hours. I need to get some more pictures -- the change is quite something. Michael's comment was "Well, I really can't leave you girls alone, can I?"

On Sunday, Tab got to experience what true defeat feels like. Her cousins got 5 to 8 "call-backs" from agents interested in them, and Tabs got a big, fat zero call-backs. I had a really hard time being empathetic, so I just kept agreeing that "Yes, this sucks." So it really was $800 down the drain for her to learn so rather hard lessons. It turns out that partly there really wasn't much work for girls right now, but also because the agents had been paying attention to the three kids all day on Saturday. My brother got asked who the redheaded girl was that they had eaten meals with & he explained she was his niece. So in hindsight, I'm sure they recognized some of Tab's less-than-stellar moments....

Oh. And it turned out that my locum tenems paycheck was delivered to the house on Saturday, so we managed to stay solvent this week, by the Grace of God....

November 01, 2008

Weekend Adventures....

So first off: Halloween was a blast. Tab has gone through her candy and has it almost sorted. Then we'll have half a garbage bag's worth to sort that is the "left-overs". Naturally, I didn't get any Mounds bars when I was stock piling, so for the most part -- this is all candy that I don't like. LoVeLy!!

Second: I got word tonight that I did not win the layout contest at the Rockin' R. Soooo very sad.... I could so use a weekend away because Tab & her drama are getting to me.

Third: The entire reason the boys & family were even here is because today & tomorrow are dedicated to the three kids going to this invitational event in Dallas. This past August the Proscoutfolks were in central Texas first. Oldest nephew has a yen to act, so when mom learned about talent scouts in the area, he got to audition. Younger nephew was along for the ride and got invited as well. So then mom gets so excited she calls me to tell me that the scouts are headed to DFW next. So seeing as how Tabs can't get enough of "pretending" to sing/dance/act/entertain, I asked her if she wanted to try this out & she whooped shouts of joy. She passes through the first screening visit and then all three of them had this weekend to prepare for.

Tabs picked a scene from the Summer's American Girls Movie to memorize. She actually took it very seriously and memorized everything pretty well. When it came time to perform in front of a crowded ballroom to two judges and about 100 observers -- yeah well she choked. Actually she delivered her lines well enough, but her body language & posture going into line & into the room -- totally not cool. She had her hands up over her face & kept peeking out from behind them. And then she was just hunched over like she was already beaten down. Not exactly screaming "Pick ME! Pick ME!!" I don't think that she ever quite understood that how you present yourself starts before you even present yourself.

The officials also told us that we all needed to be on our best behavior today because the talent scouts were just out & about incognito and already starting to make selections based on how people looked & acted. So what does Tab do? Whine, Whine, WHINE. Any time we had to sit still she fidgeted, got up & wandered around inattentively, rolled on the floor, or stretched out across three chairs & took a nap. I decided that I didn't want to be the stereotypical "stage mom" so other than a few sessions of kneeling down to her level & explaining ad nauseum how & why I wanted her to behave. I tried very hard to not make a gigantic issues of things. Oh yeah, C. the 5 year old, was way more in control than Tabs nearly the entire day. Talk about disappointing.

The real "smack in the kisser" was during the 45 minutes that she & I went outside to take a break, after a bit of lighthearted cartwheels, and conversation with other folks from out of town I tried to explain again that she's going to have to speak for herself & present herself with a bit more confidence. Tab decides that out of nowhere she's gunning for me with, "Why do you care?! You don't love me! You never wanted me anyway!!" Any thoughts on how you'd handle that situation -- out in the atrium of a very public hotel, in the midst of an enormous convention? Yeah. I thought so. The deep breathing kicked in reflexively while the brain rapidly spun around "WTF just happened?!?!" And then I just got very emotionally blunt & honest with her. Eventually brought her to tears. She got a grip. We went back inside & joined the others. And then for the past 11 hours I just feel like I've done nothing but fail this kid if after 33 months here this is how she feels. Topping off the delights of the day, she didn't get "called back" to repeat her monologue tomorrow. Gee Really??? With that stunning entrance earlier??? So she was distraught enough to just throw in the towel tonight. She's decided that if she doesn't get an acting job tomorrow -- then she's just quitting.

On so many levels I am just wrung out right now.

And in this economy, my gut is tied up in knots that we've wasted the $800 it took to get her to this event. It didn't sound like that much money back in mid-August while I was still doing lots of locum tenems & insurance exams and prior to my pulmonary emboli adventure. But basically knock me out of a regular work schedule for a month and the household finances get extremely tight. [As an aside: since I'm an "independent contractor" I don't have benefits: no disability, health via M's job only, no paid vacation, no sick days. etc. If I'm not working then I'm not paid. Seriously relieved that I did finally get life insurance this past Spring, since apparently I'd have a horrible time qualifying now. Plan Ahead People! Plan Ahead!!] This is heart-breaking in more ways than one, since I wasn't able to make my malpractice payment for today, and I'm hoping that my paycheck from my last locum tenems job will miraculously appear. And this will all happen by Monday so that I can juggle money enough to keep my malpractice from lapsing. Such fun.

I am honestly at a loss for what to do with this kid & these situations. I'm exhausted too after being up at 6am and not getting home until 8pm. And I have the joy of knowing that we're doing this all again tomorrow.... Say some prayers. We could all use them.

 

October 31, 2008

Happy Halloween....

So my nephews (D. & C.) made it up to our place Friday evening to partake in the local Trick or Treating. I took tons of photos most of the evening, but still forgot to get photos with each kiddo & their costume & their "take". <Sigh> Seems like I really do need to make a checklist for "Don't Miss" photo-ops. Amazingly enough, it was 85+ degrees on Friday, so even I was able to round the block a number of times in a short sleeve top. I dressed up like Martha Stewart -- but did I get a picture??? Nooooo. Even Zoe got dressed up for a few minutes in a dress like Sharpei in High School Musical. [Inside joke: Zoe the mini Aussie Shepherd wants to be a Sharpei! Really. I guess you had to be there....]

Since Halloween was on a Friday night this year, and our neighborhood is the happening place to be, I and all of my neighbors expected blow-out crowds. Usually we go through five jumbo bags of candy easy. So to be prepared I & Michael had bought 8 or 9 bags of candy total. I even picked up a spare on Friday afternoon at the grocery store. So instead, imagine our shock to discover that Trick or Treating was a total bust. There were lots of kids & teenagers, but probably 2/3 the usual volume. So we're still very heavily "candy endowed". Butterfingers anyone???

So some favorite photos from Friday night:

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Notice Zoe's long legs? She's been on a growth spurt the past few weeks and suddenly we noticed she has the form of a real Australian Shepherd -- just in mini size. So far she's not eating us out of house & home yet.

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The only close-up shot I got of Tabs in costume, with Miss E as Tinkerbell in the background. This will be the year that I had to safety pin Tab into her costume as we mistakenly bought at least one size [maybe two!] too big.

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The adorable Baby X's First Halloween. He hated the hat unless he was chewing on it!

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The nephews with Uncle Michael & the talking candy bowl....

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Simply cousins together, having fun. Warms the "cockles of my heart!"

And my favorite "mood shot" of the night:

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And as is traditional now: Tabitha with her candy haul!

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