January 23, 2013 marked Day 108 of our Citty Kitty adventure. And it was a memorable day because Callie Cat was finally…POTTY TRAINED!!

Ok, I lied. Today is actually important because we have finally moved on to having the full third ring removed. Yes, we’re 58 days behind where we originally planned to remove the third ring. That day was Day 55, but due to suspicious behavior on her part and subsequent bathtub poop, we slowed the process way down.

First off, I just want to say that we waited a little longer than Cal probably needed. Between Day 58 and now, we’ve had no bathtub or any other incidents at all. We went back to a half size ring two with the insert tray until about Day 63 and then each week cut away a bit of that until only 10% remained. That was most likely Day 84. Our adorable fur ball could have handled full ring three size by Day 91. But it was winter break and we were lazy and I just let it go. We also got a new kitchen table, which could have stressed her out, so we just wanted to minimize her fears for a bit longer.

But last week, I removed the insert tray and left her with the tiny piece of ring 3 that had thrown her into such a panic on Day 56. We held out breath, waiting for the Freak Out…and Cal acted like nothing had changed at all. No issues. Today I took out that tiny piece. She seems a bit wary of the toilet now, but tolerated some petting there and was purring when I sat down to write this.

Only two rings left! Hopefully it won’t be another 108 days before we’re through!

As of today, February 3rd, Day 119, Cal is starting to notice that she has indeed been eliminating into…water! Oh, yes, it is as if she is just realizing it. That may have something to do with her bath last week, but whatever the reason, she has become fascinated with the water inside the toilet and has been caught several times with her entire head and a paw disappearing down the hole. She is also withholding, and hasn’t pooped in almost 24 hours. We’ve cut a bit off the ring, just a sliver around the back end, but that was almost three days ago and she didn’t seem to notice at the time. At any rate, this process is certainly a long one, but at least the hole is getting big enough that a) she basically just uses the tray to stand on at this point, making clean up nothing more than a flush and refilling a bit of litter, and b) we humans don’t have to remove the tray to use the toilet if we’re feeling lazy. Yay!

In conclusion, potty training takes over twice the advertised amount of time…and we might even suggest quadrupling that time by the end of this adventure.

Good luck, kitties!

-E

Oh the good ole days of ring 2…

Ok, folks. Not much is going on with me lately (first cardiopulm exam next week…gearing up to enter “study mode” for the next 10 days, laundry skills slowly failing again…same old same old), however, Callie has some updates.

We began the CittiKitty experience on October 1st. We spent the first week with the CittiKitty tray on the floor next to the toilet (after a couple weeks with her litter box moved into the bathroom without any problems). After that first week, we moved the tray to the toilet and began our adventures. That was October 7th, or Day 1. It is now Day 58, two days past the advertised “8 weeks!!” to potty train a cat with the CittiKitty. And she is soooo not potty trained. Let’s recap:

Day 1 to 7: CittiKitty tray in the toilet, not especially stressful. Successes all around. Self-congratulations.

Day 7: First ring removed. Panic ensues. Floor pooping incident. Bath mat vigorously cleaned. Insert tray used with a 1/2 size ring. Much better. Cautiously proceeds.

Day 8-13: Successes! Very little stress seen. Slowly transitions to full size ring 1 removal and insert tray is put away. We are doing great. This is fun, this is silly!

Day 14: Second ring removed. Panic ensues. Floor pooping incident…in the bedroom. Carpet vigorously cleaned. Insert tray put back in at step 1 size. All seems good.

Day 15-20: Half of ring 2 cut out of insert tray. Seems fine for a day or two. Then, two accidents, despite toilet paper method, many treats and assistance. First accident in the BATHTUB. Second on the bathmat. Bathmat and bathtub vigorously cleaned. All feel hopeless.

Day 21: Toilet paper method used with the 2nd ring ring cut out. Tentative success.

Day 22-27: Successes had. Stress decreases. No major incidents. 10 days without incident, toilet paper gone by Day 25 or so. Everyone seems pretty okay. Decide to keep ring 2 for another week.

Day 35: Instead of immediately cutting out ring 3, only small sections are cut away, almost imperceptible. Or so I think. She is discovered mid-poop in the bathtub. Firm scolding (and vigorous cleaning!) takes place. One inch of water is placed in the bottom of the bathtub. An hour later, determined to finish her poop, she jumps in and freaks the F out. Splashing and crying, she can’t get a grip on the linoleum and ends up traumatizing herself. Guilt and depression felt all around. Once dry, she is very clean. One small silver lining. Back to toilet paper method.

Day 36: No trouble seen besides a bit of nervousness.

Day 37-42: Pretty uneventful. One bathmat accident early in the week due to human/husband error of leaving the CittiKitty tray on the floor and not replacing it when he left for work. No kitten repercussions. Reassurances all around…and (you got it) vigorous cleaning.

Day 43: A bit more of ring 3 is cut away, less than before. About half of ring 3 remains now. Cal doesn’t seem to notice. No incidents.

Day 44-49: No troubles. A bit more of ring 3 is cut out. No troubles. We are all feeling very stress free and happy. Have we figured out the CittiKitty secret?!

Day 50: A bit more of ring 3 cut out. There is now only about 10% of the ring left before we have only two more rings. She continues to do great. Full size ring 3 set for Day 55.

Day 55: Husband reports suspicious bathmat behavior. He placed her on the toilet and put the bathmat up off the floor. She does her business and we raise an eyebrow and proceed with removing all but a very small piece of ring 3.

Day 56: Bathtub poop. Callie is reprimanded, bathtub is cleaned and filled with an inch of water, Callie is placed into the bathtub. She freaks out, but manages to get out of it a lot quicker than last time. We stay in the bathroom together for about an hour, getting dry, and having a few treats on the potty with lots and lots of encouragement. Callie seems distrustful at first but begins purring after a few minutes. She even offers a little kiss. Guilt is a bit assuaged.

Day 57: No troubles per se, but she seems to be holding her poop and is cautious of the bathroom. Will run out of it if anyone approaches when she’s near the door. Successful potty use in mid-afternoon. Towards the end of the evening, she starts sniffing around the bathtub again. She is given a menacing look and runs off. Before bed, the shower curtain is pulled tightly closed and shower gel bottles put on the ends to dissuade nighttime bathtub pooping. The drain isn’t good enough to keep an inch of water in all night, so we hope this will be enough.

Day 58: Today. Husband reports bathtub poop. Shower gel bottles are not disturbed. She must have actively slipped under the shower curtain like a little jewel thief! Bathtub cleaned. No reprimands given…it’s too long since she did it and I can’t handle her freaking out again. Instead, I find a small cup and place it over the drain, creating more suction and fill the tub with an inch of water. It doesn’t drain. So I leave it there hoping that it will dissuade her from jumping in. I find it pretty unlikely she’ll go there if there’s water. I also went back to the toilet paper method (it’s been almost three weeks since we’ve had to do this!). Right now, she’s stretched out on the couch sleeping and seems completely stress free and happy. She hasn’t been into the bathroom yet.

not a care in the world…

Overall, I think we are actually making progress. I’ve discovered in my research that most people give up at about the two month mark if they aren’t seeing success. I have to admit that I thought about throwing in the towel myself this morning. However, compared to many of the quitters, Callie has actually had a lot of good days and 95% of the time she poops in the toilet (and 100% of the time she pees there, no pee trouble since Day 1!). It’s the transitions that are difficult and that’s where we have to be understanding and not move too fast. This process DEFINITELY does not take 8 weeks. If she does okay for another week, I’ll go to the full ring 3 and I’ll probably keep her on that step for a week before I even start slowly cutting away at ring 4. Honestly, I think this might take closer to 12 or even 16 weeks to complete. But I’m hopeful! And we really have saved money and energy already. I NEVER have to deal with cat pee and the litter is immediately flushable. It’s not a bad deal. It just takes a heck of a lot of patience and time. And cuddles. And sometimes water in the bathtub.

Anyway, just thought I’d give a little update. And now it’s off to memorize some cardiac electrophysiology. Woo!

-E

Callie gave me a little Thanksgiving kiss when we got home after dinner at my brothers’ place…also I have super short hair now!

Happy Thanksgiving!

Yesterday was full of food and lazing around as is required, but also provided ample opportunity to reflect on what is wonderful and awesome in our lives. For me, that’s easy: I am healthy and pretty good looking (especially with my new short hair cut!), smart (enough to be doing well in med school!), have the coolest and craziest family around, a super sweet husband, an adorable kitten, and am fortunate enough to be an American and to have a place to live and food to eat and a very bright future. I still don’t have a kitchen table…but I am very grateful for where I am today

I am thankful for all the wonderful teachers and mentors who have helped me along the way, for all my brothers (and now two sisters-one by birth and one by marriage!) who have made me always want to be a better person and role model, and for the rest of my family, and especially all my parents, who have shaped me into who I am. I’m certainly flawed, but I always try to do good by my family and for the world. I’m also thankful for Scott (yep, he’s going by his middle name, now!), who has been absolutely wonderful during the last year of transition; this year has been at times overwhelming and inchoate, and frustrating and seemingly insurmountable and yet so perfect, and the whole time Scott has been patient and always in love with me. In the almost year that I’ve been home, I’ve had to relearn how to exist here without going crazy and it’s not easy; readjusting to America is hard…even more so when your temperature gauge is way off, you live at home for six months, and plan a wedding, a marathon, a move, and starting medical education! I’ve not been easy to live to with, I’m sure, but he must like me or something because he keeps coming back.

So anyway, I made a Tofurkey yesterday. According to my brothers…and husband…it was pretty gross. Well, I didn’t mind it! I thought I did a pretty good job, actually.

Ok, so it looks like a blob. SO WHAT?!

I took a lot of photos from the baking process, intending on putting up a recipe on here, but since NO ONE liked it, I’m just going to have to assume that I’m way too biased and that it actually is gross…so I won’t subject you all to my recipe. Maybe next year!

Celebratory nachos. The best kind of celebration and the best kind of nachos!

On a related note (er…okay, not really related at all actually), we just finished up Inflammation and Immunity (I2) and I managed to get a Sup.

I’m not sure if I’ve described our grading system, but basically a Sup (pronounced “soup”) is a “Superior,” which is essentially an A. High Satisfactory (“High Sat”) is a B, Satisfactory is a C, and anything below a 71.5% is failing (ie. Unsatisfactory). Getting a Sup (also called “Souping the module”) in I2 is difficult and I’m still surprised that I made it. After taking the final exam I had missed the cut off by 4 points, which is TWO questions. When they did the regrade, we got back several questions, though, and I lucked out and got 3 questions (6 points) back…pushing me to an 89.5% in the module which rounds up to Sup.

Needless to say, I was stoked. Thus the nachos at Tom Fooleries, a bar on the Plaza in Kansas City. I think it may have been the first time I’d gone out for a drink since my birthday…it was fun! I also saw the new James Bond movie, Skyfall (I know, TWO EXTRAVAGANT EVENTS?!) and admittedly went to the last Twilight movie which I enjoyed IMMENSELY.

We started Cardiopulmonary this week, just three days of lecture before we broke for the holiday, and we’ll be working our way through this module for 7 more weeks. We have 3 weeks of material and a week of exams before Christmas break and then we come back for the second half of the course which isn’t over until the first week in February. This module is our first real organ systems one and is actually starting to feel more like “medical school” with an anatomy focus. In fact, when we come back in January, we start gross anatomy lab dissections, a quintessential rite of passage through medical school and our first experience truly using our hands in medicine.

I submitted my campus selection form…and picked Kansas City so that I had more time to decide. I can always switch to Wichita but I can’t change back to KC. So we’ll see. I still have time to decide but I’m starting to lean toward the place that will give me the best clinical education in a city with the best cost of living…for some reason I’m still scared to make it official, though. I’ll probably wait and see if I end up on the lottery list.

All is well in other regards; Callie is doing great with the CittiKitty…she’s on ring 3 right now (well, more like 2.75 and we’ll go to the full 3 this weekend) and has been accident free for almost two weeks. It’s sort of hilarious and adorable to watch her run into the bathroom and then a couple seconds later hear the tinkle of her peeing in the toilet. I half expect her to flush! She’s a cutie.

keeping her paws up when she sleeps so she’s ready to attack the zombies

She loves the Walking Dead but she is not a fan of Andrea!

Life is good! I wish we had more money, but we’re getting by and I’m grateful for all the good things we have in our lives. Now if we could just get a dining room table and chairs…

Oh and I REALLY need to start working out again. I’ve been massively lazy, choosing sleep or studying instead of just getting out there and working it! I think I probably need to pick a race or something to train for, otherwise I’m not nearly motivated enough. Luckily I haven’t put on a million pounds yet! I’m grateful for that for sure!

I’ll leave you with the giant concept map I made for I2. Don’t let it scare you. Ok, you can if you want; it’s pretty epic.

Isn’t it AWESOME?!

Ok, folks. I’m going to use my day off to memorize cardiac anatomy and congenital heart malformations and embryology. Yay!

~Elaina

She had a couple accidents when we first moved to the second ring. I don’t want her to be stressed about the process, but at the same time I know that once it’s all figured out, we’ll all be much saner than with the litter box. So for now, we’re sticking with it and as of yesterday, she seems to actually be doing quite well. In order to facilitate this, I did four things:

1. We invested in a new toilet seat cover. The original was hard plastic and very slippery with a slight downward angle that made it very difficult for Cal to stand on comfortably. It was also really cold all the time and I was happy to switch for people use as well! The new one has more of a matte finish and is softer and easier for her to grip. The brim is a little wider, too.

2. The toilet-paper method. This is something I have invented to supplement the CittiKitty training techniques. Essentially all you do is take a long strip of TP (about 10 squares or so) and stretch it across the bowl of the toilet. Then you place the CittiKitty tray on top of it and gently push down the TP showing through the hole to make a bit of space. Sprinkle some kitty litter on it. This is great to do for the first day or two after removing one of the rings. It helps her feel a little more secure and obscures the long drop into water below while she figures out how to adapt to the new larger hole without worrying about the water. After successfully using the toilet once or twice (with replaced TP each time getting progressively lower to the water/2nd tray below), you can leave off the TP completely with just the 2nd insert tray below to block most of the water (but we had the first 2 rings cut out of that one as well).

3. We removed the insert tray. This step really freaked me out because I was very nervous that she would be too scared of the open water below like she was initially. I was also concerned that she’d scratch ALL of the litter down the drain and I’d have to keep buying $12 bags of litter every week. However, she’s been fantastic. She hasn’t had an accident in 2 days since we’ve removed the lower tray and she doesn’t scoop ANY litter down the hole when she pees and only scoops a handful down when she poops. She has been using the CittiKitty as intended. I am ecstatic.

4. LOTS of rewards. I keep her treats in the bathroom and when I think she has to go and is feeling nervous, I’ll go in there with her and set her nicely on the litter and give her some positive reinforcement. Usually she figures it out and goes and immediately I get her a treat. Sometimes she doesn’t and in those situations I’ll leave and let her be in there for a few minutes alone. This fixes the problem 90% of the time. What you don’t want to do is say “oh, she really has to go but seems scared, but I’ll just let her wander the house until she decides to go in the potty” because she WON’T go in the potty, but somewhere else. That was Sunday (first day of ring two).

I think each time a ring is removed the following steps will be taken:

1. Remove ring.

2. TP method for two days

3. Day 3-TP method with TP very low in the bowl

4. Day 4-Bathroom positive reinforcement

5. Day 5-7: Free range with treats after successes.

She’s a good kitty!

Another decision coming up is WICHITA. I’ll have more in another post later, but basically first year students at KUSOM have to decide where to do their third and fourth year clerkship rotations. There are 50 spots at the Wichita campus and 120 (I think) at the KC campus and regardless of our choices, that’s how many people will end up at each, even  if it means that some people do not get there first choice. There’s a lottery process if our picks don’t line up and final placements are final in November of 2nd year. Most people want to stay in KC and some choose Wichita. Usually what happens is that 10 or 15 people end up assigned to Wichita despite wanting to stay in Kansas City. There are pros and cons to both locations and a lot of it has to do with personal reasons based on family or location or what specialty you think you’ll be pursuing. I have to submit my initial decision by mid November, so I’ll get on here and lay out my thought process soon. My little sister lives in Wichita which is a compounding factor…but KC has arguably more academic medical specialties to follow…but you get a lot more hands on experience in Wichita…but…but…anyway, it’s a tough decision.

So cute! How can I not go?

Another thing I’ve been thinking about lately is my specialty choice. Now, I’m pretty firmly sure that I’ll be choosing pediatrics. I’ve been pretty peds focused for about three years and my Kansas Medical Student (KMS) Loan dictates that I must choose a primary care specialty in order to ensure that I do not have to pay any med school loan money back (except for a small Stafford loan that I also take). These acceptable specialties (set by the KS legislature) are: internal medicine, pediatrics, geriatrics (IM with a supported geriatric fellowship), family medicine, and emergency medicine (recently approved residency). All other residencies do not count and loan money would then have to be repaid at 15% interest. The great option with peds is that I can do that residency, practice for four years in an underserved KS county, and then decide to do a fellowship in almost anything and then practice wherever. I could also do a med-peds residency (since both IM and peds count, a joint residency is okay, too) and do a fellowship after service. I’m having a current dilemma, though, in that I am sort of falling back in love with women’s health. I volunteered yesterday at JayDoc (also a great topic for another post!) and it was Women’s Health night. The patients are under or uninsured and we provide the services completely free of charge. I was able to assist on several prenatal exams, including a pap exam and ultrasounds. I also helped counsel women on sex and reproduction and found myself completely at ease and loving it. I’ve been focused on women’s health for a long time but for some reason at some point I decided not to go into obstetrics/gynecology. The last few months I’ve been saying “I need to not get too involved with the OB/GYN interest group because I’m afraid I’ll fall in love with it” and I’m starting to worry that I might fall for it anyway. The problem is that KMS does not cover an OB/GYN residency and basically I’d be screwed on paying back a crazy amount of money. If I decide that I have to do OB/GYN I would need to cancel my KMS Loan immediately so that I do not end up with loans that I have to pay back at 15% interest…and just have a normal insane amount of med school debt like most physicians. But, I’m not sure. I’m not even a little bit sure. I’m still 85% set on pediatrics. Really, I wish there was a specialty that was OB/GYN/Peds because that’s what I want to do. I want to be a woman’s primary care doc, help her through pregnancy, deliver her baby, and then be the baby’s doctor, too! Oh well. So this is a decision I have to think about a bit. I don’t really have to know for sure until like June (it’s too late to get rid of KMS for this year). If I’m still deliberating then, I’ll probably take the KMS again. We’ll see. The fact is that many many women use their OB/GYNs as their primary care physician and the specialty really should count toward the goals of the KMSL program (to get primary care docs in areas in Kansas that really need more physicians), but right now it doesn’t count. Maybe I need to write some letters to my representatives!

Of course the other big decision is political. I know who I’m voting for, do you?! Whatever you want to see this country become and whatever your beliefs about who can do the best job, just make sure you get out there and vote! I’ll be driving back to Topeka to cast my ballot! Don’t forget to research the other positions up for grabs. Most change and action that directly affects your life comes from local politics, so invest wisely!

That’s it for now, folks. I’m off to study some major histocompatability complexes and antigen presentation. FUN!

~Elaina

PS. I rocked that Gen-Neo final exam, even on three hours of sleep! Next time, though, I’m limiting my caffeine intake!

The highlight of my intellectual week: targeted therapies in cancers part 3. Yeah, it’s a 3 part series; I can’t write small enough to get it all up at once! Aren’t you mad jealous of my day?

First let me explain a little about how our curriculum works here. Instead of taking several different courses concurrently throughout the semester culminating in a week of final exams before winter break (like, say, in college…or like anywhere….ever), we take one course at a time, cramming all the material into a few weeks before taking the final. Afterward we move on to the next course. These 4 to 8 week blocks of time are called “modules.” Foundations of Medicine, the first module, was 8 weeks long and included a lot of seemingly random bits of information (Biochemistry being the focus, but also clinical introduction, professionalism, patient encounters, problem based learning sessions, metabolism, basic genetics concepts, and disparities in health care) that was intended to form the “foundation” of the “art and science” of medicine upon which all of our subsequent modules would build. In retrospect, it probably has done just that, although it seemed disjointed at times when I talked to med student friends at other schools who were taking Biochem, Histology, Genetics, Clinical Medicine, and Whatever else. I actually like the module format despite the fact that I basically have an anxiety induced final exam every four weeks or so and it really limits my ability to plan anything! Essentially the only free weekends are the ones immediately following an exam and they get progressively less available as the next one rolls around. I feel pretty guilty telling people ‘no, I totally can’t hang out this weekend…I have to study.” But I’m getting used to it…because it’s very nearly literally ALL THE TIME.

This module (the one I should be preparing for the final exam for by SLEEPING right now) is Genetics & Neoplasia (or Gen-Neo) has been not as biochemically strenuous as the last one and I’m actually a little frustrated. It’s a short module, just 4 weeks, but I feel like we could have really been made to sweat with many cancer pathways and hundreds of drug names and pharmacological mechanisms…but maybe memorizing 50 drugs and only half a million details of neoplasms is effective, especially when the knowledge that the next module is REALLY HARD is creeping up on me. Inflammation and Immunity (or “I2″ as it’s creatively known), is supposedly a tricky one with lots of pathway memorization; at least it’s also 4 weeks. After that, we are officially going to be moving onto systems based lectures, starting with Cardiopulmonary which will carry us through past the couple weeks of winter break. I’m actually looking forward to I2; I like a challenge and getting excited by immunology is genetic (Hi, Dad!).

Well, here’s a little nerd alert from FOM: One of the coolest things we focused a lot on during FOM (and obviously, in Gen-Neo, too) is various signal transduction pathways. Basically, guys, signal transduction is why biology happens, and it’s way fun to know exactly what a Ras protein is and how it can induce the constitutive signaling of a growth factor pathway by a mutation inhibiting its GTP-hydrolyzing activity (the most common defect in oncogenes in human cancers! Who can tell me the most common defect in tumor suppressor genes in human cancers? Ooh, a nerd challenge!). Anyway, the process of a signal leading to a functional action by a cell through various pathways is central to everything. In FOM we learned that the Beta Adrenergic Receptor (a G-protein Coupled Receptor-GPCR) is activated by the neurotransmitters norepinephrine and epinephrine. These guys act as “ligands,” or “binding proteins” for the receptor. When they bind, it causes a conformational change in the receptor that activates the intracellular attached protein, the G-protein. This G-protein is made up of several different subunits; one of them is the alpha protein and it is functionally equivalent to Ras protein mentioned above. It is activated by a GDP to GTP transfer from a GEF (sorry, I know this is already way too much information for anyone who actually cares but at this point I’m on a roll and it’s actually mildly relevant to my test tomorrow…mildly). The activated G-alpha activates an effector protein called adenylate cyclase which helps transform ATP to cAMP and cAMP (a so called “second messager”) activates Protein Kinase A (PKA) which leads to an increase in calcium levels in the cell (by doing several things that I’m not going to elaborate right now). Increased Ca++ levels are directly linked to increased cardiac output, heart rate, breathing rate and other feelings associated with the fight or flight systemic response. Which makes sense because the ligands are essentially ADRENALINE. This racing heart stuff is normal most of the time, but sometimes pathological (severe stage fright, immediately following a myocardial infarction-heart attack), so sometimes it needs to be shut down. BETA BLOCKERS (Beta-Adrenergic Antagonists like atenolol) compete against the catacholamines and “block” the beta receptor. This leads to a decrease in cAMP upregulation of calcium and a lowering of heart rate and cardiac output. Whew, I feel like I could use a beta blocker right now…as it’s 4am and my TEST IS IN FOUR HOURS AND IT’S NOT EVEN OVER ANYTHING RELATED TO BETA BLOCKERS OMG.

Ok, well, that was just way too much information. I think I’m going to keep the next two parts of this post short and sweet (respectively).

SHORT:

CALLIE IS POTTY TRAINING. Yes, we’re using the Citti Kitty and she will be a toilet trained cat if it’s the last thing I do. We are officially on Day 13, and it’s been 5 days since our last accident. This process is actually pretty hilarious, so hopefully I’ll be able to get on here and give you some updates.

She definitely uses it now, but she could revert at any moment to floor pooping. Note the red duct taped lid…so no one closes her litter box…which would result in the inevitable return to said floor pooping.

Pic showing the different rings as Cal sniffs around, suspicious. We’ve removed the first ring (which was way too big for Callie, so we put the plastic insert underneath-see next pic). Today I cut away a bit more of the second ring, tomorrow I’m planning on taking it half out. The litter is flushable, which is good because she scratches pounds of that stuff down the hole.

This is the extra insert that has 1/2 sized rings for slow learning kittehs or ones that need to go back a step. When I realized I could just put it down beneath the main seat I probably saved myself hundreds of dollars of kitty litter that would have been scratched down the drain. Now I can just dump the clean litter that falls back into the main dish on top. In this pic I’ve taken out the tiniest ring just to reintroduce her to the idea that there is water under there. I’ll take out the next ring when I remove the full second ring from the top tray (set for Monday-1 week accident free!)

As far as SWEET goes:

I had a brief and glorious time a couple weeks ago where I remembered how much I loved to bake and actually ended up making a pumpkin tiramisu pie (some of which went to a pediatrics group bake sale) and pumpkin-butterscotch cupcakes (most of which ended up staying with me…haha). I also made some homemade butterscotch sauce which Colt and I then ate on top of everything from waffles (pumpkin-cinnamon flavored naturally) to icecream. I’m pretty sure I had some on ramen. I’m kidding (or am I?). Enjoy the random photos; I am so totally going to bed now…hopefully three hours will be sufficient!

~E <3

PUMPKIN-TIRAMISU-DELICIOUS PIE

Kitchen Aid handmixer mixing up some pie stuff…yummy

making butterscotch is a delicate process that involves lots of brown sugar and little taste tests

not your average cupcake (have you ever heard of Biscoff?!)

pumpkin waffles with butterscotch sauce and pecans with some hazelnut coffee…made in my birthday present Keurig coffee maker whatup

**First off, I just want to say that I felt reflective today and decided to write. I realized a few minutes in that it was September 11^th, a day that always seems to inspire a bit of pause for me. Eleven years ago I was almost a month into my 8^th grade year, watching the news in my 2^nd hour gifted class. That day became a part of our collective memory and shapes us all. It was later that year, in that same classroom, that I first began thinking about medicine as a possible future. I cannot believe it has been so long when I remember that day as if it were yesterday. I hope we all can continue to remember the sense of unity we felt as a country then and that we can work together to make this country as great as it has the potential to become. GO AMERICA!**

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White Dress, White Coat

…And so with a sheepish shrug, she simply resumes blogging with her first M1 post without lengthy apology for her rather lengthy absence…

But here’s a short apology anyway: med school is crazy busy, getting married is crazy busy, and my life, in general, is just crazy busy right now! I’ve started realizing that I’m definitely missing out some much needed self-reflection, however, and since I’m also starting to find my groove in which I can actually breathe and contemplate doing anything other than study, I decided now was as good a time as any as to put down some thoughts about the last three or four months. So, sorry for being MIA! I’m still here, I promise!

When I wrote last, I was newlywed but didn’t really talk much about it. Talking about your wedding is one of those things that you end up doing ad nauseum for like the rest of your life, so I really won’t say much about it here (let the pictures speak for themselves!).

Getting ready in the morning (note the pink hair)

It was June 9^th and it was a perfect day, sunny with a breeze, but not too hot, out by the old stone gazebo at the Lake. I wore my African dress, a homemade wreath veil, went barefoot, and wore rainbow hoop earrings and henna. The boys wore dark brown slacks and vests with casually rolled up linen shirts and red gerbera daisy boutonnières. The flowers were sunflowers and red daisies and bright ribbons decorated the trees.

The boys

Everyone looked fantastic and it was amazing to really open up unabashed about our love to everyone we care about most. C and I are not particularly sappy and I think a few people were sort of surprised and moved by how sweet our ceremony was. I was a bit surprised myself, actually!

so pretty!

Our best bud, Zach, officiated the ceremony for us wonderfully. Our best friends stood up with us and four of my five brothers each had a short reading (an excerpt from Louis Berniere’s Captain Corelli’s Mandolin, a quote from the 2003 Massachusett’s Supreme Court ruling, an excerpt from The Velveteen Rabbit, and a quote from the movie, Serenity). Two of my brothers also strummed it up on the guitar, along with one of the groomsmen and a lovely a capella by a family friend (the songs were: I Summon You by Spoon, Somewhere Over the Rainbow by Israel Kamakawiole, At Last by Etta James, and an acoustic Hey Ya by Outkast as seen on Scrubs).

Best first kiss photo ever.

Colt and I both cried during our self-written vows (and mine definitely included a note about the zombie apocalypse) and the party afterward was full of fun, cheap champagne, a Boulevard Wheat keg, nachos, dancing, and espresso and lemon cupcakes.

Lemon cupcakes and chocolate espresso cupcakes with buttercream meringue icing. Homemade naturally.

Our first dance was to Regina Spektor’s Samson and I cried into my new husband’s shoulder for all 3 minutes and 10 seconds of it; I’d been dreaming about that dance for a long time.

awwww

The evening culminated with several members of the wedding party (including me, sans wedding dress) diving into the lake and splashing around until Lake Security arrived and kicked us out. It was a perfect wedding and the honeymoon (in Wellesley, Massachusetts, my college town) was perfect and relaxing, too. We had a very hedonistic dinner at the restaurant where he proposed and managed to sit in the very same seats as that night, which was two years and three months previous.

The trip was amazing and simple and I loved being back on campus after two years. Time passes so quickly these days; sometimes I’m surprised at how fast college and the Peace Corps went by. Didn’t I just graduate from high school like yesterday?!

Yes, I’m the huge dork on the left. Yes, my HS BFF was also my maid of honor at the wedding

So then we moved! We’d both been temporarily camping out at our parents’ houses and finally we packed up and shipped out to the big city…getting an apartment that is two blocks away from the Medical School (side note: parking is so terrible at said school/hospital that my apartment parking lot is actually closer than the general employee/student lot for the med center). C and spent about a week unpacking at our new place before we headed off to Colorado for part two of our honeymoon. We stayed with my very chill aunt and uncle at their place in Colorado Springs and just hung out and enjoyed the weather (about two days after massive wild fires caused evacuations in the city) and the mountains. We went up to Pike’s Peak and went hiking/jogging in the Garden of the Gods. We really recharged after all the tension of moving and writing thank you notes and getting settled.

When we returned, mellow from the West, it was time to begin…Medical School Orientation…the simultaneously helpful and frustrating 6 days before classes began on July 30^th.

Before I start in on this whole med school thing (which does and will consume almost all of my attention from here on out), I just want to briefly mention my job for the last four months before school. Rather luckily, I ended up working as a legal assistant for the state department of health and environment. Every day I got to go to work in the legal division in the Office of the Secretary. I learned so much about state laws and regulations and very much enjoyed it and many of the attorneys and support staff (I even contemplated law school for about five minutes). I also experienced the…joy…of acting as a personal assistant to very important people, a job both challenging and rewarding in its responsibility (but definitely not something I could enjoy for any serious length of time…I’d get way too grumpy and/or casual with People Who Must Be Respected haha). I totally loved my boss and actually had many opportunities to speak with and get to know Secretary Moser, a Family Medicine physician from the western part of the state with ties to the Med School. In a random turn of events, Dr. Moser was actually invited to be the Key Note speaker at our Class of 2016 White Coat Ceremony.

After finally leaving my job with the state after the wedding and double honeymoons, I officially began medical school at my state school…which I’m sure everyone has already determined (all three of you loyal followers, haha)…and if you haven’t, you could just Google “Dr. Moser” and figure it out pretty quickly. Or just keep reading because I’m probably going to just spill the beans since the application process is over and I know my online identity matches my true IRL identity (squeaky, shiny clean!).

Orientation was an informative 6 days (too long) where we received our much awaited HP Elite Tablet Notebook computers, had practice lectures and labs, learned about the testing system and grading system, were informed about the clinical years and Step One test, heard many speeches from a long line of middle aged white guys, learned about balancing med school with the rest of our lives (HAHAHA), determined our learning personality styles, had the opportunity to visit the other satellite campus where we can choose to do our clinical years (we have three campuses total, I’m in the largest and longest established), met with learning specialists and psychologists, talked about managing serious relationships in med school (actually a really great panel discussion), and met all of our well accomplished and talented peers, all while making friends and forging the bonds of a lifetime! If it sounds like a lot, it was. But it was fun because it was new and exciting! And weirdly enough, I did actually make a couple of pretty cool friends (TIP #1: Because the time after orientation is so whirlwind busy, those friends you make in orientation really are the closest friends you’ll have for a while, so use that time wisely to network, people!).

The last day of Orientation culminated in the White Coat Ceremony. All 170 or so of us (and our max of 8 guests each…don’t tell, but I had 9 ½) crammed into the county Memorial Hall to listen to many speeches by many middle aged white guys (and one from a middle aged white woman!)…speeches that were actually pretty decent. The message really brought home the magnitude of the path upon which we were just beginning, all fresh and new. I have to admit that while I was sitting there with my nicely dressed and anxious looking peers, gazing up in awe at the long, distinguished line of White Coat cloaked lifelong professionals, teachers, physicians, and would-be mentors, I was a little bit overcome…with a terrifying urge that I should run—get out while I still can!—take my HP Elite and disappear into the bright afternoon, forgetting all about this madness! It was a disconcerting feeling at a time when I expected to feel only pride and excited anticipation, but c’est la vie…ou bien?

We recited a professionalism vow to seal the deal (cue Hippocratic Oath as future bookend comparison)

Needless to say, I did not run away screaming (although there may come a time in my life when I wish that I would have). I stood with my alphabetized line and walked across the stage when my name was called and The White Coat was slipped over my arms. I signed the Honor Code book and was flattered when Dr. Moser stepped up to shake my hand before my photo was snapped. In a bit of a daze, I took my seat and waited for the ceremony to finish. Once outside, we all took our giant class photo (I was reminded of Wellesley class photos and really wanted to dash around the photographer to the other side of the class so that I’d be in the photo twice…but restrained myself).

looking a bit shell shocked I think

We chatted with parents and classmates for a bit, had more photos taken, and then I headed back to my apartment with my family (and just so you know, our tiny apartment is WAY too small for 9 ½ extra people plus me and Colt!). I got to play with my baby sister, Millie (Amelia, who was born on February 4^th and is a freaking cute little ray of freaking sunshine) and see all my favorite people in what became my last real afternoon of relaxation! It was awesome

Millie and Me! (although now she’s way bigger!)

In the six weeks since then, I’ve sort of become a bit of a hermit, although I am definitely beginning to emerge from my dark little crabby shell (good analogy? Probably). I’ll talk more in future posts about specifics (don’t worry, I promise I’m not leaving again for four months; things happen too quickly these days to wait that long), but in general, I am having a blast. I love medical school. There have been a lot of really stressful moments, especially before our first test and anytime we must don The White Coat, but overall, I am happy.

I am learning an incredible amount of material, and I get to have that thrill of understanding something new every single day. It’s intense and exhausting and constantly exhilarating. I am both immensely grateful and absolutely terrified of the magnitude of this path upon which I have just begun. I really do need to plan how I spend every single hour. That doesn’t mean I have to study every hour (although I sort of just realized that at about week 5), but it does mean that relaxation time is absolutely precious. It means that I may not be able to join all the clubs and groups that interest me right now because I’m still trying to figure out how to make all of this work. I’m still a newlywed with a husband (still a little strange sounding haha) who works full time and I really try to make sure that I’m spending some of that precious time keeping that connection as strong as it was on our wedding day. I’m doing my best to stay active and fit, but my training schedule is a bit behind for the half marathon I wanted to run next month. I’m trying to figure out study methods (making flashcards online, making flashcards on cardstock, taking my own handwritten notes vs. taking notes on the tablet, going to lectures vs. watching the podcast, studying at home vs. studying at the library, using a white board…etc).

For every hour of lecture, I need to study on my own for about two additional hours. When you include prep for and attendance of required histology labs, clinical skills labs, and PBL and/or small group sessions, I am doing medical school for probably 60 to 65 hours per week. That is absolutely more than a full time job…not all my peers require that much time and some should be spending more (and the week before a test is probably closer to 70 for me), but that’s a lot of time and definitely does not match Colt’s 40 hours/week. It takes compromises and planning for every hour. I’m figuring it out day by day and it’s definitely getting easier. The lifestyle changes and management are a big part of it, not just the difficulty of the material itself…although it’s a pretty massive amount of material! Everyone warned me but I didn’t really get it—med school is kinda hard. But man, is it fun!

I have a stethoscope that I actually know how to use (and have used it on simulated and real patients…yes, REAL ones…yes, already…yes, I’m terrified 100% of the time) and my White Coat to mark me as one of the elite club of future physicians. The Coat is short, waist length, to differentiate the students from the long Coats of the True Physicians. My short White Coat is still very white indeed and quite a bit stiff in the collar and arms, starched from not being worn all that often yet.  I’ve taken to rolling the sleeves a bit for a less intimidating and cooler look. The pockets are slowing beginning to fill up with stuff—a small flip chart reference, a couple pens, my school pin is through one lapel and an LGBT club pin is pushed through the other—but the Coat is still just about as shiny and new as I am to this whole thing. I did put a cute little kitten magnet around the tube of my stethoscope and yes, I leave it in even if I’m working with an adult patient.  I think I’m starting to get it, this new life I’m suddenly navigating. Having a pretty new iPhone also helps (seriously, email always available? I never even check it on my computer anymore!) and having a new adorable kitten named Calliope (Callie) is also a bit of a lifesaver (and a husband who is fun and understanding is always appreciated).

kitten cuddles next to me while I study

I’ve met most of my goals for this 2012 year, too, by the way, although I haven’t been working on my martial arts as much as I’d like. I hear there’s a pretty cool krav maga place just down the street, though, so who knows? My love of baking has also somewhat ended up on the back burner (haha, pun definitely intended), although I still try to make the occasional treat. Colt says that I always want dessert at 9pm so maybe I should try to keep a few more things on hand. We have a massive amount of very nice new kitchen stuff from the wedding and I’m slowly working on using them (anyone have any good vegetarian crockpot recipes? What the heck do you put in crockpots anyway??).

So, life is good and I am self-reflective once again. Yay!

And now I really do need to go study. Our final test for our Foundations in Medicine module is next week and I need to catch up on my embryology flashcard making (I know, exciting stuff!).

University of Kansas School of Medicine Class of 2016! (Can you find me in there??)

Keep it classy wherever you are and I’ll keep fighting the good fight here in Kansas City at the KU School of Medicine. Rock chalk Jayhawk!

~Elaina

Gathering outside the Court; I wish I was there! (Reuters photo)

In a surprising move, Chief Justice Roberts sided with Sotomayor, Breyer, Ginsberg, and Kagan for the 5-4 decision upholding the individual mandate of the Affordable Care Act, dubbed “Obamacare” by opponents (and even used affectionately by supporters).  The ruling today ensured that millions of uninsured Americans will have access to affordable coverage, although the Medicaid expansion was determined to be relatively weak. 

Chief Justice Roberts: The individual mandate “makes going without insurance just another thing the Government taxes, like buying gasoline or earning income. And if the mandate is in effect just a tax hike on certain taxpayers who do not have health insurance, it may be within Congress’s constitutional power to tax.”

The Medicaid limitation is perhaps one of the more significant aspects of the ruling. Essentially, the Court decided that Congress can indeed require that states expand their Medicaid funds, but that ”Congress is not free…to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.” This means that states can basically ‘opt-out’ of expanding their Medicaid funding without financial penalties from Congress. Almost 30 million more people would qualify for expanded Medicaid coverage under the ACA, but now individual states can choose to not allow it. I wonder what Kansas will do?

I work with state healthcare and Medicaid attorneys and the office is buzzing today! “Kennedy wrote the dissenting opinion!” “Justice Roberts sided with the liberals!” It’s been an interesting morning, full of calls to the Help Desk to allow access to the SCOTUSblog, loud phone calls, and overlapping excited conversations by the water cooler.

While certainly not my primary interest, thinking about the political implications of the decision is interesting. I mean, Mitt Romney did say on Tuesday: 

 ”If Obamacare is not deemed constitutional, then the first three and a half years of this president’s term will have been wasted on something that has not helped the American people.”

I guess he wasn’t just twiddling his thumbs over there, huh? (The idea that the President of the United States of America, regardless of politcal party, EVER wastes their time is just completely ridiculous and disrespectful. But that’s for another time!)

The fact is that penalties for not having insurance do not take effect until 2014 and this ruling essentially puts off the final decision until we start to see the real effect of the mandate. For now, a tax is just a tax. Because every person will need to use healthcare at some point in their lives, there is no ‘choice’ about participating in the healthcare market and the individual mandate gets more people paying into the system which reduces costs to everyone overall.

Of course, Republicans have already decided that they will try to repeal the Act again. Eric Cantor (R-VA), House Majority Leader, said “the Supreme Court’s decision to uphold ObamaCare is a crushing blow to patients throughout the country.” Justice Kennedy, in his dissenting opinion said that “in our view, the entire Act before us is invalid in its entirety.” Whoa, heavy.

The fact is that this decision is huge, but at the same time, it’s a bit of a technicality. The individual mandate has been upheld as a constitutional “tax,”  finding that the Commerce Clause is not sufficient for the mandate to be held constitutional. Because the Constitution permits a penalty tax, which the insurance requirement can reasonably be assumed to be, it is ”not our role to forbid it or to pass upon its wisdom or fairness” (National Federation of Independent Business v Sebelius, 567 U.S. _ 2012).  It doesn’t necessarily mean that this fight is over, although it does appear that a battle has been won for healthcare reform today (although listening to a few conservatives, somehow Chief Justice Roberts ‘tricked’ the liberal judges into something sneaky…not sure where they’re getting that idea, but I’m curious to hear!)

However, I do sort of like the idea of taxation paying for healthcare. From the Health Care Blog: “In any rational society health care ought to be a public good financed through taxation and distributed in some manner that makes rational sense. America has never officially believed that. Now it at least has affirmed the concept.”

It is important to note that the Chief Justice included his own additional comments after the Majority opinion and that the dissenting opinions were varied as well:

-Majority Opinion written by Chief Justice Robers

-Additional Comments by Chief Justice Roberts (not in the Majority opinion)

-Concurrence and Dissent in Part by Justices Ginsburg, Breyer, Sotomayor, and Kagan

-A dissenting opinion by Justices Scalia, Kennedy, Thomas, and Alito written by Justice Kennedy

-An additional dissent by Justice Thomas

This decision was not as simple as a 5-4 liberal/conservative split. This issue is complex, the ruling is complex, and the future of the ACA and American healthcare reform is not at all straightforward (ie. it’s complex!)

Tom Goldstein’s (SCOTUSblog) bottom line: “the entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.” What no one is really admitting yet is that this ruling was a massive victory for judicial restraint and conservatives really should be pleased in the long run. This decision was a nod of  respect to the actions of Congress and the will of the American people who elected them.

The full text of the decision is here.

The Health Care Blog’s take.

And an update on my life will certainly be forthcoming. I DID get married and stuff : )

~E

I’ll leave you with a little teaser (I have been a veeerrrry busy little baker lately). Let it ease your annoyance at my absence (although I’m sure my two readers have already lost interest at this point lol).

These are super easy, but taste like they came from a wicked fancy Italiano ristorante! Enjoy!

Tiramisu Cheesecake Cupcakes

Not my pic but close enough

Serves: 30

Total time: 50 min

Prep time: 25 min 

Ingredients:

60 vanilla wafers (Nilla Wafers are the crispest, although off-brand would work)

5 tsp instant coffee (Nescafe works the best)

3 Tbsp hot water

32 oz cream cheese (softened at room temperature)

1 cup granulated sugar

8 oz sour cream (I used light sour cream, but full flavor would probably taste richer)

1 tsp vanilla extract

4 eggs (or 2 eggs and 3 egg whites)

8 oz cool whip (thawed…I used low fat; usually I make my own whipped cream, but it doesn’t hold its shape which we need for  that thicker tiramisu topping)

2 tbsp unsweetened cocoa powder (I used unsweetened dark cocoa powder for that bitter kick)

¼ cup mini chocolate chips (I used regular sized, but minis would be way cuter!)

Directions:

1.      Preheat oven to 325. Line 30 cupcake tins with liners and put one vanilla wafer at the bottom of each cup.

2.      In a large bowl, beat cream cheese and sugar on medium speed until well blended. Add sour cream and vanilla, mix well. Add eggs, one at a time, mixing on low speed after each one, until just blended, scraping often.

3.      In a small bowl, dissolve 3 tsps coffee granules in 1 Tbsp hot water. Remove 3 ½ cups of cheesecake batter, put in medium bowl. Stir in dissolved coffee until well blended.

4.      In small bowl, dissolve remaining 2 tsp coffee granules in remaining 2 Tbsp hot water.

5.      Lightly brush each vanilla wafer with the coffee (using a marinade brush; drips from a teaspoon would also work), just enough to moisten the entire cookie.

6.      Evenly divide coffee-flavored batter over wafers, smooth evenly across the cookie and make sure to spread it to the sides of the liner as the batter will cook in the position you leave it in!

7.      Place another layer of vanilla wafer on top of the coffee batter and brush with the dissolved coffee mixture.

8.      Evenly divide the remaining plain cheesecake batter over the wafers and smooth evenly across the cookies to the edges of the liner.

9.      Bake 25-30 minutes, until the edges are slightly puffed up.

10.  Cool to room temperature. Spoon Cool Whip (thawed, not chunky at all) over each cheesecake and dust with cocoa powder. Sprinkle mini chocolate chips over that. Refrigerate for at least 3 hours (overnight was perfect).

11.   Store in refrigerator.

12.   Enjoy with iced or hot coffee to bring out all the flavors! Extra points for straight espresso. : )

Mine got eaten so fast I didn’t even have time to snap a photo!

Well, I did my first workout session for the April marathon. This picture is me running the Boston Marathon in 2010 and yes, I tweeted the run.

Today’s workout was…unpleasant. I ran three miles at a little slower than my goal pace of 9 minutes/mile. I also did some basic weights, too, and sit-ups. It was seriously the first time I’d worked out for real in about two months. I am definitely out of shape! But this is a good thing. I’ll kick it back into gear, getting my workouts higher up in intensity each day. Hopefully I’ll be ready for my first long run on Sunday, 10 miles!

Right now, that makes me pretty nervous, haha. Tomorrow I’m doing an hour long run with a 15 minute warm up and cool down and some sprints. it should be…fun?

Tonight we’re making chili and I’m busting out homemade cinnamon rolls with walnuts. I’m only going to have one! If they turn out awesome, I’ll post my recipe.

Stay classy!

-E

5. Be at peace. I want to meditate more, live in the moment, enjoy life as it is now. Help people,  focus on my own happiness, not get too stressed out with work and school and relationships, and money. I just want to maintain this awesome happy feeling that I’ve had the last few months and be a good person! I know, vague. MEASURE: Laugh every day.

4. Get married! I want this wedding to go off without a hitch (heh, except us!) and have a first year of a happy marriage. My goal is to plan and execute the thing happily and without too many tears. MEASURE: An awesome honeymoon.

3. Work on my ADD. It’s time I tried all my options. I’m sick of it running my life. I’m ready to be clear headed and focused. Just in time for med school. MEASURE: Organized and successful first semester of med school.

2. Be healthier to my body. No smoking. Eat better and eat less, and exercise regularly. MEASURE: Fitting into my size 2 skinny jeans/reaching goal weight of 116 lbs.

And my number one, goal for 2012 is:

1. Get stronger. I want to be tougher. I know I’m a black belt, but I still feel like I could become a victim at any moment. I’m gonna take things into my own hands! Weight lifting, marathon training, heading back to my dojo and maybe starting some MMA classes. MEASURE: Running the April marathon in 4 hours or less.

So that’s that! I’ve started marathon training for the marathon on April 21st. I’ll post some stats and training schedules at some point, too. This will be my second marathon. I ran Boston in 2010 in exactly five hours. I want to take an hour off my time and do it in 4 or just under. That’s a goal pace of 9 minutes per mile. It’s gonna be tough. It’s been a while since I’ve regularly ran and I have not been particularly good to my body in the interim. But dang it, it’s time to step up! No more excuses! I’m going to lose the weight and get strong and healthy again!

I might not be baking quite as much haha. But I’ll supplement with running and training info instead. That’s almost as awesome as cheesecake, right?

Yay!

-E