Little Monica Goes to the Big Apple

We have returned home! Seth and I spent 5 days in NYC over Christmas this year, and the experience was many things. It was magical! and fun! and amazing! but also exhausting, expensive, and crowded. 

What I LOVED:

1) I LOVED all the parks we went to. We walked down High Line Park Christmas morning, which was amazing. This park is an old elevated subway line that was no longer in use so they turned it into a park. So it's really long and skinny, but it gives such a different perspective of the city and the park itself is beautiful. Everything from the benches to tree placement was very thought out. Then we made our way down to Washington Square Park, which has the really big iconic arch. So beautiful, nice open space amongst the sky scrapers. Lastly, of course Central Park. We didn't spend a lot of time walking around, and the park is HUGE, but the small section we saw was so beautiful. I found myself wanting to go for a nice relaxing jog through it. 

2) LOVED eating. Fav eateries:

       -George's. It's a little hole in the wall family owned diner, and the food is delicious but nothing   too unique, but it's right around the corner from Wall St. by the World Trade Center and Battery Park so it's a good people watching place. All the Wall St. businessmen and big shots of NYC seemed to eat at this little po-dunk diner, so it was fun little experience.

       -Angelo's Pizza. AMAZING pizza and its right above David Letterman's studio on Broadway. So not only was it the best pizza I've eaten, it was in such a cool spot!

       -Maison Kayer had french food. We just happened to meander in here starving, and were very happy with our Christmas brunch here. Really delicious and something unique, but a tad on the expensive side but not too bad.

      -The China Village. We ate Chinese food in Chinatown for Christmas dinner, and how cool is that!? Enough said there.

      -Serendipity. Such a whimsical little place famous for their GIANT sundaes and frozen hot chocolate (also featured in the movie Serendipity with John Cusack and Kate Beckinsale!). It looks tiny on the outside and is easily missed, but you go in and the decorations are just over the top and it goes back forever. They take reservations if you actually eat food, not for dessert though. We waited almost 2 hours to have dessert. Although totally worth it, either make a reservation and just eat dinner there too or put your name on the list, go somewhere else to eat, then go back. 

3) The 9/11 Memorial. There are no words. It was just beautiful and moving. I was in 5th grade, Seth in 6th, in Alaska when it happened. We have always known it was a big deal obviously, but we were so far away and didn't even know anybody who lived in NYC, but to be there and see people's names who died inscribed around the reflection pools of the old World Trade Center foundations was touching. As we were riding the ferry out to the Statue of Liberty, I was just looking at the skyline trying to imagine being there on 9/11/2001. It's just another day and all of a sudden you look up and planes crash into each of the Twin Towers. I just couldn't even imagine the horror. 

4) The Ballet. Oh. my. goodness. Not only the actual ballet itself was amazing, but I think it's beautiful to see people dress up in there best dresses and suits they have to go celebrate somebody else's incredible talent. I was in awe of the beautiful Lincoln Center, the stage, and the experience. It was beautiful. People are beautiful, and I love that we create beautiful things like ballet and plays. 

Things I DID NOT love

1) It was a holiday, and with that comes 1 million extra people in the city, and it was CROWDED. There was a line for everything. To see the 9/11 Memorial, to skate in Central Park,  to go in Serendipidy, etc. 1 Hour Minimum. Note to self: if we go back, go on a random week when there's no holidays, because the city was PACKED and we were always waiting in lines. 

2) THERE ARE NO BATHROOMS. You can be guaranteed a bathroom in Starbucks (and there's one every block it seems like), but the line for the bathroom is at least half hour. If you go, scope out churches (most of them are just open so people can look in them), and TGI Fridays. Those are go to spots for bathrooms, otherwise NOBODY has bathrooms. I spent a large part of the week doing the potty dance, because I had to pee!

3) Consumerism is hard. We went in the big famous Macys, FAO Schwartz (big famous toy store), and many more stores just to see, and all I could think about is all the STUFF. There was just so many THINGS in each of those stores. Macys was kind of neat, because whatever you could ever want was in there, which is convenient, but that's also heartbreaking. I want a coat, but do I really need 500 (literally) different options? Is my life so consumed by having EXACTLY what I WANT? Those stores just screamed "I WANT THINGS. I WANT STUFF. I WANT I WANT I WANT!!!!" We just consume things and don't even think twice about where it comes from, who made it, was it ethically made, do I really need it, why do I want this, etc. 

4) Times Square was meh. Cool to pop in for 5 minutes and just see it, but when you really start looking around it's mostly just typical advertisements with lots of sex, more stuff to get upset about not having, and propaganda. Meh. 

Overall from our visit to New York, I can't decide if I'm in awe of the creativity of human beings and our innovation to make a place like NYC or if I'm in total horror of the fact we have basically laid one solid slab of concrete over such a large surface area. My inner Alaskan who is used to untouched land and big open spaces cried a little inside. Regardless, it's always good to be home. I missed my dog and cat a lot. 

Hodge Podge Post: Being nice to students, diabetes, lying, and NYC.

I have a random assortment of things to address today.

First: Be nice to medical/PA/nursing students. Often people will ask me outside of my rotations what I have gotten to do. I'll then elaborate, explaining that I'm further learning suturing, coming up with my own treatment plans (ex: what antibiotic a patient should be given for xyz symptoms), giving injections, etc., and it seems like responses are almost always followed with a horrific facial expression with some comment like 'Have you ever done that before!?' or 'You could really hurt someone!!' Yes, there are potential for fatal allergic reactions to medications. But my preceptor sees everything I suggest and discusses it with me before a final decision has been made. No, I haven't drained an abscess before but I did for the first time the other day. I've only sutured wounds up a handful of times, and yes I did it for the first time by myself the other day. Before that joint aspiration yesterday, no I'd never done one. People are just shocked by this, but please explain to me how I'm supposed to learn how to do anything if I don't just DO IT!??!?!? I can watch and watch and watch but eventually, I have to just DO IT. Anyone who is an expert at anything had never done it before at one point too, so please be nice to students. We have to learn somehow, and if you are going to ask us about it, please refrain from being judgmental or in utter disbelief. We're already nervous enough, we are trying to learn, and please trust that our preceptors wouldn't let us do anything they didn't think we could do well. With that being said, please also let students do things on you. We are sincerely sorry for the additional pain we may cause that an experienced clinician may not inflict, but just think of it as an act of altruism. The next person I do it on will be better! :)

Second: I need to make a confession. I get frustrated with diabetes (type II to be specific), and this is bad. First of all, I want to make it a point to say that anybody can get type II diabetes, not just overweight, generally unhealthy people as often the stereotype is. "Oh you got diabetes because you're over weight and eat poorly." Sometimes true, sometimes not true. Type II diabetes is certainly very much influenced by those things, diet and exercise is the cornerstone of treatment, and with our country's obesity problem diabetes has skyrocketed, but there is actually a stronger family history component with type II diabetes then type I. This seems counterintuitive considering type II is so strongly affected by extrinsic factors like diet and exercise, where as type I is an autoimmune disorder, but even skinny healthy people can get type II diabetes. But back to my confession. Type II diabetes is the #1 cause of  adult onset blindness, non-traumatic lower limb amputations, and kidney failure. Diabetes is also a HUGE risk factor for heart attacks and stroke. So my frustrations are this: I know eating well is hard.  I know exercising is a pain in the butt and takes time and money and is difficult to do. I know taking medications is hard to accept, costs money, and easy to forget. But I get frustrated, because if people with diabetes don't do these things, the consequences are dire for them and their families. I don't want to see anybody go blind or anybody have to take care of their spouse who had to get their limb amputated just because they weren't willing to do the hard thing. It's hard for me to not be judgmental and think people are selfish when they don't at least try. Be brave! Be courageous! Be bold! Do things you never thought you'd ever do! Try medications; explore eating better; explore different types of exercise you might enjoy. Nobody is asking you to eat lettuce for every meal or become an olympic triathlete. So anyways, I get incredibly frustrated and my entire day gets consumed by these frustrations, which I really need to work on. Seth and I have multiple family members with diabetes, so we see first hand how difficult it is to deal with, but I just know how worried we get about them, so to see somebody with diabetes not work on it I just want to say "Do you KNOW how worried your family is!?" How long is grandma going to live? Is Uncle so and so going to get his foot amputated and need living assistance? Is/when is dad going to have a heart attack? My end message is this though: be nice and encouraging. Sure, our country is obese and many people have diabetes because of that (fat tissue is an endocrine organ all in itself, but we won't go there today), but nobody WANTS to be obese, have diabetes, heart problems, etc, and nobody is inspired to make life changes by being told how terrible you think they are. They already feel bad enough, so be nice. Celebrate little victories and always be aware of your own biases and judgements.

Moving on...

Third: I'm a big liar. I swore to never run again, but I have been. Just 2-3 miles every few days so nothing quite like the half marathon training. I want to exercise, but even though I don't LIKE to exercise it's important to my health, and I feel better after I exercise even though I don't particularly like it while it's happening. And! I don't feel quite as guilty about all the cookies and candy I eat (calories in = calories out!). So! I'm also doing those T25 videos once or twice a week, but those really are designed for you to get strong, and I am currently not strong so they are difficult. I also don't care to be strong, which makes it hard to make myself do them, but running is easy now! Post half marathon, a 2-3 mile run is easy peasy, only takes 20-30 minutes, burns a lot of calories quickly, and sometimes I can get Cooper's exercise in too (half the distance is typically spent trying to find the perfect place for him to poop. He's a diva about that...). So in my daily struggle to find time, energy, and motivation to do some physical activity, that is where I'm at.

Lastly: Seth and I are going to NYC in 6 days for Christmas, and I am so excited I can't even stand it!!!!!!! That is all. :)

Old People

I've started my second rotation, primary care, but it's actually in an urgent care. I don't mind that though. We aren't doing a lot of chronic disease management (ex: high blood pressure, diabetes, asthma) that you would see in primary care, but the environment is still very primary care 'esque.' All the staff know all the patients, because the patients continue coming back to them over and over and you can see those so very valuable provider-patient relationships you get working in primary care. I am enjoying it. I love that I actually have time to talk to people, they genuinely are so grateful for what we do for them, the staff are all friends (quickly discovered liking who you work with highly surpasses importance of where you work), and since it's a privately owned office, one of the doctors is able to bring his little dog with him, and who doesn't love that!?

So this post is about old people, and I mean OLD people. 90 and 100something year olds. We see a handful of them everyday, and I am intrigued and sometimes horrified by the sheer difference of actual 'age' people can be. For example, I saw two 75 year olds back to back. One of the 75 year olds was just as agile as I was, easily standing, sitting, laying down on the exam table, etc. Their mind was still young and lived by themselves, and only on one medication. The next 75 year old I saw was brought in by wheel chair, could barely sit forward so that I could listen to their lungs properly, in chronic pain, had a long long list of health issues and medications, and the poor thing had lived in an assisted living home for many years already. And the terrifying part of these two people is that they were both the same gender, same prior occupation, same number of kids, neither had ever smoked, both grew up and had lived in/around Roanoke their entire lives, both widowed recently, etc. They seemed to live fairly similar lives and yet they could not be on farther ends of the spectrum as far as health.

I like to think that Seth and I do a fairly ok job taking care of ourselves (aside from the atrocious amount of candy/sweets we eat (btw, I haven't had a candy bar in 3 days. This is a HUGE deal for me)). We both are fairly active. Post-half marathon, Seth has began lifting and I've started these 'T25' videos my sister lent me. We eat well. We try to make meals proportionally heavy in veggies, we do our best to buy organic meat, only eat whole grains, and really if we even need a fat source to cook we use olive oil. We really just drink water; Seth occasionally relapses as a recovering sodaholic but nothing crazy, and I'll have some tea a lot of mornings. Neither of use tobacco, once in a blue moon I'll have some wine and Seth will have a beer, and otherwise don't really have any bad habits. With that being said, I hope we become old people who are not old, but meeting people like the last two I described really makes you wonder. You can't do much to control your genetics. Seth and I both have a handful of healthy older people in our families and instances of longevity, but we both have a handful of really not healthy people in our families. So who knows. Hopefully our lifestyle choices now will help us out if we didn't win the genetic lottery.

Other examples of interesting older people I've met:

-A 90some year old woman who is wheel chair bound, hasn't walked in years and can't lay down (has to sleep sitting up in a chair), but totally mentally intact and in high spirits, unashamed of her disability bossing me around to help her move her leg here, lift this, pull that, etc., still puts on lipstick every day and curls her hair.

-An 88 year old woman who still works a few days a week as a cashier, because she gets bored. Oh, and she gardens, manages a bee hive, cans her own honey, hunts, and lives by herself.

-One of the most beautiful things I saw this week though was an older gentlemen (70s maybe) who brought his father in for a cold, who was in his 90s. I don't know why, but I just found it so moving to see this older gentlemen himself taking care of his even older dad. He was in really good health, really high energy and super cute with his exaggerated southern politeness. His dad had a little dementia, so he was fairly unresponsive to my questions as I was trying to obtain the appropriate information I needed to develop a diagnosis and treatment plan, but when his son talked to him he answered every question, and they conversed rather normally. How amazing would it be to be in good enough health ourselves to take care of our parents when we're that old, and our parents to really be in good enough health in their 90s that we could do it on our own!?

So anyways, I've learned age is just a number. You could be a very young 70 year old or a very old 70 year old. I also want to take a moment to make fun of Seth as I close, because Seth is a math genius. Literally. I'm not just saying that. Sometimes I think he has some sort of super power. However, last night as I was telling him about some of the older people I've seen, he said "Babe...we could live to see the year 3000." ....really? The year 3000? Modern medicine is pretty good, but not that good. As I looked at him quizzically, he followed up with "Ya! We would be 110!" Ooooooohhh my. Then I started laughing hysterically and as he realized his mistake, he didn't find it quite a cool to say we could live to see the year 2100. This guy understands incredibly complex calculus, really advanced probability, and physics, but sometimes messes up on basic addition. Maybe he doesn't have a super power after all. :)