Monday, February 27, 2017

A Serious Mental Case And I'm Not Even In My Psych Rotation Yet

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     My brother Matthew is so strapped for cash that he has accepted a job of playing the piano for a local parish's Sunday 8:00 p.m. mass on any Sunday evening that he is not on duty. I went with him last night because he has never played piano or organ for a church service and I'm a lot more familiar with the music in relation to the liturgy than he is. The priest officiating at the mass was raised as an evangelical Protestant and apparently still carries a fondness for some of the tawdry praise choruses frequently sung in such settings. One of the songs the priest chose for last night was my new least favorite song ever composed, and it has been continually playing in my head since then. It interrupted my sleep, and it is interrupting my waking activities. I could tell you the name of it or even link an audio or video of it, but I do not wish to be responsible for the song being stuck in your consciousness as it is in mine. I seriously may have to consult a shrink. I really wish I were in my psych rotation, which I will start in early April, because then I would be seeing shrinks at work on a daily basis and could just ask one what to do when a really bad song is stuck in your head. I thought it was bad when I was stuck with  "The Battle of New Orleans" on continuous play, but compared to this song, "The Battle of New Orleans" is "The New World Symphony."

    Concerning rotations, the good news I can report is that my OBGYN clerkship is history. The bad news is that my neurology rotation has begun, and I wish I was back in the middle of my OBGYN rotation.

     I am made of straw and not of bricks or whatever the stuff is of which neurologists are made. I will get through this rotation, but I'm not quite sure how I will do so. It may involve a hell of a lot of alcohol during my time off. The temptation to turn to prescription drugs is strong, though I will withstand it. i understand now why we were subjected to such a heavy dose of anti-prescription-drug scare tactics.

     Yesterday I read a biography written by former professional tennis player Roscoe Tanner.  Tanner took Bjorn Borg to five sets in the 1979 Wimbledon men's singles final and was ranked as high as number four in the world for men's singles. Unfortunately, he developed spending habits that could not be sufficiently supported in retirement and has had numerous troubles as a result of writing huge checks covered by insufficient funds or no funds at all. His financial and other various and sundry misdeeds have resulted in eviction, bankruptcy, warrants for his arrest, extradition, and jail time. Tanner is an unlimited source of optimism as well as a born-again Christian. After each brush with financial ruin and/or brush with the law, Tanner vows to pick up the pieces of his broken life, but he ends up doing something incredibly stupid and getting himself in serious trouble all over again. I googled him out of curiosity. His most recent hit was in October of 2015, when he was arrested and jailed without bond for driving with a suspended license somewhere in Florida. God only knows how many prior arrests he would have had to incur to have been jailed without bond for driving with a suspended license.

     Roscoe Tanner told in detail of his jail time in his autobiography.  While for whatever reason his time was not quite so harrowing as some accounts of time spent in the slammer that I've read,  it was creepy enough to disturb me and to cause me to have bad dreams, complete with the awful praise chorus from mass playing in the background or forefront. The dreams are gone now that I am awake, but I'm still faced with a sense of foreboding as thought I were the one facing one jail sentence after another. This eerie feeling of doom so perfectly interfaces my rotation in neurology that it is as though I am completely and perfectly enshrouded in fog. 

     Today on the job really wasn't all that bad. I was assigned to intakes and consultations, which I will be for the rest of this week. This involves the residents and attending physicians (obviously not me, because I know nothing; I would probably send all the gravely injured or ill people home and admit the ones who have nothing significantly wrong with them, possibly even on purpose) dealing primarily with E.R. patients with either head injuries and stroke symptoms. This is as sunny as this rotation gets. From here I'll progress to sub-specialties in multiple sclerosis, Parkinson's, and seizure conditions,  then Alzheimer's, then the truly weird neurological diseases.

      I can deal with the fact that if a person's head is hit hard enough, he or she will probably incur some damage as a result. Even with the severely traumatic brain injuries, while I certainly hope never to suffer one or have to deal in my personal life with anyone who has, worry about that prospect is not something that keeps me awake at night or invades my dreams. It's Alzheimer's and the weird stuff that gets to me.

     My single greatest strength (and also one of my weaknesses) is my OCD memory. The idea that there is disabling condition out there that, according to current knowledge, anyway, strikes almost randomly (some of the very early onset cases are documented to have clear familial links, but there's no real proof yet other than that) and systematically robs a person's mind of everything he or she has ever known yet sometimes leaves him or her alive in a virtually- vegetative-to-bona-fide-vegetative state for up to five years, is a frightening prospect.  I can accept the premise that if  a person lives long enough, he or she will quite possibly grow a bit forgetful before leaving the planet. Mildly forgetful and Alzheimer's are two very different states, though.

     The weird stuff is not much better. Guillain-Barre Syndrome seems to strike somewhat randomly, but it's one of the illnesses we've all heard about. There are hundreds more that have very bizarre symptoms. You or I could come down with any one of them. When I committed them all to memory in the first two years of medical school, I was able to distance myself from them because they were only odd symptoms I committed to memory; there were no real people representing these freakish symptoms. Now the real patients will be coming sooner rather than later, and I shall have to see many of these conditions up close and personally.

     The bottom line is that I am simply too much of a hypochondriac to be in medical school, but 2.66666666 years and more than $50,000 (in tuition alone) later, here I am, and I've invested far too much time and money to back out. Granted, there are branches of medicine that will not totally cause me to go off the deep end and in which I can arguably even be happy, but I have to get through the rest of this horrible stuff (for good reason; I'm not suggesting that physicians and surgeons shouldn't have a foundation in all areas of medicine) both in clerkship and internship before I can pursue something that doesn't turn me into a complete raving demoniac.

     Maybe every medical school student goes through some form of this psychosis or whatever it is, though probably not quite so dramatically as I am suffering through it. I'm a drama queen; I readily admit it. I would ask my dad about it except that I refuse to admit to anyone in real life that I am struggling. (They don't bother reading my blog any more, so I can safely say it here.) I positively hated OBGYN, but I got my scores back early because I turned in my paperwork early, and I did remarkably well there as far as test scores and evaluations went. The attending physicians thought I was just peachy. They never deduced just how much I detested their specialty. I'm going to do the same thing here, which is to fake it and make these people think I am the most professional and enthusiastic future neurologist on the planet and that I am positively enthralled by everything they do in their specialty. By that time I'll be through with this rotation and onto the next one, and eventually through my internship as well. Then I will never go near another neuro patient again even if my life depends on it.

     I've been on duty since 3:30 a.m. God help me and every neurology patient who comes anywhere near me. 

Friday, February 24, 2017

Tying Up Loose Ends::OBGYN is Almost Over for ME!

Image result for OBGYN medical school humor






This has probably been the longest short week of my life. Starting the week out with a stillbirth delivery has a way of affecting time in that way. 

In my undergraduate program, I had to take a total bullshit class called "Time and Space." It was interdisciplinary -- jointly taught by an art professor and a physics professor. Roughly four years later, I'm still not sure exactly what the point of the class was other than to deprive me of time and money (it probably should have been called "Time and Money" rather than "Time and Space") but one of the themes to which the two professors seemed to keep coming back was that sixty seconds in one setting or under one set of circumstances is not necessarily equal in length to sixty seconds in another.  Again, it was all bullshit. Obviously, time spent in agony is going to seem to pass more slowly than is time spent in bliss, but the clock is still ticking at exactly the same speed. It's obviously all a matter of perception. Still, my perception is that this week is totally dragging.

I will finish this rotation with a swing shift tomorrow (which is technically already today). I would probably get more action in a graveyard shift, as a whole lot of babies are born in the early morning. One of my supervising OBGYNs said it's because labor often begins once a woman has finished what she needs to finish and begins to relax or to actually retire for the evening. How quickly labor proceeds depends upon a whole lot of things, but in general, a mother's first baby will take a bit longer, while labor for subsequent babies may move along a bit more quickly. Obviously this is a generalization. Regardless, the heavy traffic time for actual births tends to be between 4:00 a.m. and 8:00 a.m.  Any given baby may choose to time things differently, and  one of the wild cards impacting mean delivery times and such is the reality that many deliveries are pre-scheduled because of non-emergency c-sections. Inductions figure into this equation as well, though the length of labor can still vary widely.

Other than my stillbirth delivery, all of the births in which I have participated have gone smoothly [which is easy enough for me to say as I'm not the one enduring contractions and pushing babies out] or at least the outcome has been good. I'll hope that tomorrow's shift produces the same results. I can't think of anything much uglier than having something unexpectedly go very wrong during a delivery. I've heard horror stories from both professors and from my colleagues. My brother was present for a labor and delivery  with a placental rupture in which both the mother and baby both came really close to not making it through. In the end, both seem to be fine, but it was more stress than I'd care to deal with even occasionally. For all the good people who choose obstetrics as specialties, my hat is off to you. I, on the other hand, will do something else with my life. I cannot avoid occasionally making a diving catch of a baby in an E.R. or parking lot, but that and whatever I get stuck with in my intern year are the limits of my involvement in the world of OBGYN. Meanwhile, I'll cross my fingers and say a quick prayer that nothing out of the ordinary happens in my final shift of this rotation tomorrow [today].

Next week I'll begin a neurology rotation. Neurology is interesting enough but not my particular cup of tea. I've neither been eagerly anticipating not dreading this rotation. I've done most of the reading that I will need to do for the four weeks already, so it's a matter of putting in my time and getting the hands-on experience. I spend entirely too much time investigating where the person who especially dislikes me, otherwise known as the c*nt, will be stationed. She will be off-duty  for the next three weeks, so I don't even need to worry about her until the final week. I hope she spends her time off studying. My worst nightmare is that she could need to spend a fifth year completing her studies, giving me another academic year to be exposed to her venom.

The school actually recommends that most of us devote an extra year to our studies, but few of us choose to take on an extra year of tuition and fees if we can make it through in four years.  I've been told by more than one professor that even though I'm excelling academically, because of my age and maturity level, it would be in my best interest to spend a fifth year in medical school. I don't have ego issues with the prospect, as my grades speak for themselves, but I'm not throwing away another $40, 000 + dollars just because I'm young and not terribly mature. 

It is tempting in some ways, because if a candidate has completed the requirements, he or she can choose what to study in the fifth year. If the school offered to foot the bill (which they're NOT going to do) I would probably take them up on the offer. A year of relatively low stress, studying specialties that would prepare one well for a residency, isn't the most daunting idea on the planet, especially considering that there's usually generous vacation time in the fifth year unless the candidate is struggling  academically. However tempting it may sound to postpone Hell Year #2 (the year of internship; Hell Year #1 is this year) I can and will complete this program in four years, then get through my internship and get on with my life.

Tuesday, February 21, 2017

A Child Was Born

Even with the relative anonymity afforded by this blog, I won't say very much here. The baby made it out in one piece, which was about as much as anyone had hoped. It was just the parents there. They wanted to deal with the situation by themselves without having to be concerned about other relatives. They probably would have preferred that the medical personnel not even be there, but it would have been stupid to have attempted the feat without medical assistance, and they're not stupid people.

The mother didn't want as much pain medication as I would have wanted in her situation. All of her suffering with very little in the way of pharmaceuticals certainly did her baby no good at all, but it must have helped her in some way or she would not have chosen to go that route.

The baby had not been gone for as long as I had been led to believe.  His death was three to four days ago.  My reason for having been "invited" to the birth ended up being under totally false pretenses. Someone in the department had it in his or her head that I was seriously considering OBGYN as a specialty. I don't know where anyone got that information, as it's 100% false. Anyway, if anyone is seriously considering practicing obstetrics, the program would choose  -- if it had the choice -- for the physician in training to observe a birth with a negative outcome. 

It makes sense. If someone wants to be an obstetrician based on the premise that the outcome is always a healthy baby, it is wise to find out if the person is able to deal with the reality when the outcome isn't a healthy baby, except that in my case, I have no designs whatsoever on a career in OBGYN. The slot I filled today was wasted; it should have been given to someone who might actually have used the experience to determine if he or she was made of bricks or straw, metaphorically speaking.

Last night I studied the procedure for bathing a stillborn baby, so I was prepared for all it entailed. As the doctor finished up with the mother, the labor nurse and I bathed, dressed, and photographed the baby and prepared him to be held by his parents.

We dressed him in an outfit from my personal collection of baby clothing. My grandparents, even though they dislike me rather intensely and probably had begun their enmity toward me by the time I was born, gave me a cedar chest with my first initial embossed in a paler shade of cedar than the rest, as they did all their female grandchildren.  Most of my cousins used their cedar chests as traditional hope chests. My cedar chest was used initially as a church pew in a game I invented to torture my brother. When we were about three-and-one-half, I used to tell Matthew we were playing "church" and that the cedar chest was a pew. You had to sit quietly in church. I would time Matthew to see how long I could get him to sit silently on the cedar chest while I left the room to play with something else. I think his record was twelve minutes. I've been messing with his mind ever since.

Later, my cedar chest was used as a surface to store my troll collection. My mom didn't want me lifting the lid because the lids to the chests were so heavy that one of my cousins lost a finger when she accidentally closed it inside the lid; nothing was kept inside my cedar chest until I was almost eighteen. At that time I decided that even if I never married, I would probably want to have children someday -- probably adopted if I didn't marry, as I'm  too much of a puritan to be impregnated out of wedlock no matter how artificial the means of conception. I began collecting things for the baby or babies I would probably eventually have. Sometimes I used something from my collection as a gift for a baby shower or for when a baby was born to a close friend or family member, but mostly I kept the blankets and outfits that I purchased. My mom eventually gave me things she had saved from when I was a baby to put into the chest as well; she asked me not to give those items away as gifts, but instead to save them for when either Matthew or I had a child.

So last night when I blogged that I bought a baby blanket for the baby that was to be delivered today, I wasn't speaking the exact truth. I did buy the blanket, but not on Monday. I probably bought it three years ago. I also took a tiny boy preemie outfit from the chest.  I didn't know if the baby's parents would bring an outfit or a blanket, but if not, I wanted there to be something nice for him.

After the nurse and I had bathed and diapered the baby (a meaningless cosmetic gesture; the baby would never fill the diaper), she reached for a generic preemie onesie that the hospital provides. The hospital-issue blanket was similar.  They were OK -- certainly better than nothing -- but the outfit and blanket I had brought were both prettier and more cozy. It wasn't that the baby would ever feel the coziness of the outfit or the softness of the blanket, but as a parent, I would want my stillborn baby in the most comfortable outfit and blanket ever made. So I grabbed the bag containing the blanket and outfit I had brought and asked the nurse if we could use them for the baby instead. "Where did you get those?" she gasped. I told her that I'd brought them from home. "They must have been expensive," she commented as she placed his tiny legs into the legs of the outfit. I shrugged. I don't even remember what I paid for them. 

I softly swirled the bit of hair that was on his head. The nurse took tiny scissors to get a swatch of his pale brown hair for his parents to keep. We then put the matching cap atop his little head. The nurse gently wrapped him in the soft blue blanket, then handed him to me. "Take him to his mother," she said. 

I carried the blanketed baby over to his mother's bed and placed him in her arms. "Here is ------, " I whispered to her. I had tried not to cry, but everyone else in the room was crying, so I gave in and cried as well. 

My work was finished. I left the hospital room. 








When Pregnancy Doesn't Have a Happy Outcome: Tomorrow I'm scheduled to scrub in for the labor and delivery of a baby who is already known to have passed away in utero

Image result for newborn babies with emotional mothers  in hospitals



     My OBGYN rotation is winding down. So far, the parents and babies and I have all been very lucky, and everything has worked out more or less as it should have. Tomorrow, however, none of us will be so fortunate.  A 26-year-old mother is scheduled for induction in order to deliver her pre-deceased infant. About a week ago, the mother noticed a lack of fetal movement. By then, it was too late. An ultrasound revealed that the umbilical cord had tightly wrapped itself around the baby's lower calf, almost to the ankle. The baby's lifeline was, in effect, cut off. Doctors don't know how much time elapsed between the cord accident itself and the fetal death. Two-and-one-half weeks ago everything was fine at the regular maternal check-up.

     Some mothers of babies who have died in utero like to wait until labor commences on its own, but there is potential for danger to the mother for a variety of reasons if labor doesn't start reasonably quickly. The OBGYN set tomorrow as the cutoff date. The mother will be induced late tomorrow morning. The mother has chosen to be conscious for the birth, though she will feel as little pain as possible -- just enough to know that it was real and that she experienced it.  She wants to hold her baby. The plan is for her to have have an epidural and anything else that she needs. Anesthesia is limited during normal deliveries for the good of the baby. It's too late for this baby, so there's no need for the mother to suffer needlessly with physical pain when a pharmaceutical product will prevent it. 

     I'm dreading this as much as I've ever dreaded anything, but death is a part of any branch of medical care. It's so very difficult to take when it's supposed to be at the beginning if a child's life. In this case, it's all the harder, because as far as anyone knows, this was a perfectly healthy baby boy who happened to get his leg tangled in his umbilical cord. I don't know if going through this experience now with the couple will make it easier to deal with if I'm ever in charge when something like this goes wrong. With OBGYN not being my chosen specialty, the odds of my being the physician of record when something of this nature happens are reduced. Still, in my intern year, I'll be exposed to all sorts of things, and in some cases I will be the one in charge. For that matter, it doesn't matter if being scrubbed in for this birth will be of benefit to me or not.

     I've been told to be there by 2:00 p.m. It's possible that something will have already happened over the long weekend, or even that labor and delivery will proceed so quickly tomorrow that the baby will have been born before I'm even on duty. Such is not likely, though. Deceased fetuses don't have a lot of natural "push" to them -- that innate desire babies have to be born that moves labor along a bit faster than it would otherwise go. Many mothers feel as though their babies aren't doing much to speed things up, but they are. If those babies were not alive, however long the labor seems to be taking, it would take even longer.

     To show that I'm being cooperative, I'll scrub and be ready to enter at 1:00 unless I'm told to keep out.  I would love to stay in the background, but the very last thing this mother and father need is an extra body "observing," so I'll try to conduct myself as a generic member of the medical team. There is a lot I can do that the assigned labor and delivery nurse would normally do -- even more than is customary since we're no longer concerned about the well-being of the baby. (In a standard delivery, an experienced labor and delivery nurse is often all that is standing between the baby and a lifetime with cerebral palsy or worse. The experienced L & D nurse is the one who notices when things are not right and who gets a doctor into the room immediately when such is the case.) In this case, with the baby's outcome already a foregone conclusion,  the nurse just needs to point me in the right direction, and I can do all the things she (or he) would typically do. I've packed a soft pastel-blue blanket that I picked up a a baby store over the weekend. In the even that no one in the family thought to bring anything along, I'll pull it out at the right time, and the mother will have something softer than a standard hospital-issue blanket in which to bundle her baby as she gives him a first-and-last cuddle. (If the mother or someone else in the family has packed a special blanket, I won't even take the one I brought out of its bag. Instead, I'll save it for a child of parents who appear to be economically deprived.) The only person whose physical condition we'll be concerned about is that of the mother. We obviously don't want the father passing out and hitting his head or doing anything else to himself that would make him less able to support his wife, but that is secondary.

     Another procedure besides induction/labor is a possibility, but seems to be rejected by most parents. Known as dilation and evacuation, it involves the mother being put under via general anesthesia, and the baby removed however the medical team needs to get him out with minimal trauma to the mother. It's much like the technique that would be used for a later-term partial-birth abortion. There's absolutely nothing ethically wrong with the procedure -- the baby's already gone -- but most mothers want their baby out in one piece even if it is no longer living. This case is typical in that regard; the mother wants to hold her whole baby. Furthermore, in cases where the cause of fetal death is uncertain, it's more difficult to reach a clear conclusion as to what led to the baby's death following such a procedure. In the particular case of the baby who will be born tomorrow, his cause of death has been determined.  Tests will be run to see if anything else might have contributed to his death, though at this point no one has any reason to believe that it's anything other than a tragic cord accident.

      The good news for this family, if there is any such thing as good news for this family, is that the condition with the cord is very much a freak accident -- not something to which any mother or baby can be predisposed. Many times when a fetal death occurs, it's due to some sort of condition toward which the family's subsequent children will also be inclined. That is not the case for this family. Their next baby -- I presume there will be a next baby for this family -- will have no greater predilection to a cord accident or any other condition that might lead to fetal death than will any other baby.  There was nothing wrong, presumably, with either the cord or with the baby. The little leg just happened to stick out there at precisely the wrong time, and the currents of the amniotic fluid just happened to help to lead the cord in the direction of the baby's leg. Someone could actually try to make this happen (though God knows why anyone would) but would have no way of influencing the course of events that led to the cord tightening around the baby's leg. 

     If there is any silver lining that anyone can take away from this, it's that these parents have statistics working in the favor of their future children. At the moment, I'm not sure how much that or anything else helps.

     I am of little faith these days, but I'll still say a prayer that everything will happen in as non-traumatic a way as possible and that nothing happens to make it worse for this couple than it already is. I hope and pray that going through the birthing process somehow helps this new little family to facilitate making its way through initial stages of grief. And if anyone has the time and a bit of mental energy to expend on my behalf, please pray or send positive thoughts that my words and actions may be directed by a person with greater wisdom than that which I presently possess, so that I, first, do not say or do anything to add to this family's burden, and, if it's not asking too much, that I might actually be, in some small way, a comfort to them, and an instrument of God's peace and grace. And join me, please, in asking that the grief, while temporarily overwhelming, will not, in the long term, be something that is too great for either of the parents or for their marriage to endure.

     Babies die in utero somewhere in the nation every day of the year. We (speaking collectively in including myself as a part of the greater medical profession) have done so very much to make pregnancy and childbirth as safe as it can possibly be. Some things we have learned to prevent, and others we will learn more about and will be able to prevent even though we currently lack the technology and the knowledge of how to use the technology to prevent such tragedy from happening. Still, as long as babies have limbs and are attached to their mothers [and their only sources of oxygen and nutrients] through umbilical cords, while we may ultimately have tools to alert us to such accidents earlier, cords will twist around limbs or necks.  The real conundrum is probably why it or something similarly tragic doesn't happen more frequently than it does. Babies go through so many hazards from conception to birth, one OBGYN shared his thoughts with me after a particularly nail-biting delivery with a nonetheless happy outcome, that he's amazed any of them make it through unscathed. God or anyone else out there who can help, please be with this couple as they make their way through this dire journey no one one in his or her right mind and in possession of  a conscience would wish on his or her worst enemy, much less on himself or herself, and an innocent baby.




     This is not my video. My mom read the book to me a lot. I especially remember her reading it to me when she was in the hospital with pneumonia following her blood marrow transplant, when I, also sick with pneumonia and its after-effects, would fly to southern California from Florida to visit her. The book represents the order all parents probably wish their departures from the earth would be in relation to those of their children. It doesn't always work out that way, though.

Tuesday, February 14, 2017

Valentine's Day, Older Lovers, and Ionic Bonding: A Love Story

Image result for heart drawn in salt





      Another year, another exciting Valentine's Day . . . It's so enthralling to be the belle of one's medical school. [sarcasm font]

      Seriously, it's only the much older guys who think I'm cute, as in the geriatric hospital patients.  Maybe I should date them. A friend of mine briefly dated a guy who was in his early fifties but looked more like he was in his late sixties.  She's a total knockout. None of her friends could see what it was that she saw in him. Alas, the relationship didn't work out, unfortunately for him. She's now dating someone who looks like he stepped out of an ad for The Armoury or some similarly GQ place hawking men's clothing. I don't know if this relationship will last any longer than the previous one did, but at least the rest of us have someone nice to look at in the interim.

      I didn't get an actual Valentine, but I received one dozen pink long-stemmed roses. I bribed my friend into telling me from whom they came. A married doctor much older than I sent them anonymously. He wasn't trying to be creepy. Chances are that his wife knew about it, and they're not prospective polygamists. He just felt sorry for me because he knew no one else would send me flowers. He's a nice guy. If I were going into the OBGYN specialty I would probably want to work with him.

    Guys my age (actually there ARE no guys my age in my cohort except for Matthew; I think there are only two other guys in the whole medical school who are still twenty-two, and I don't think I want to date anyone who's a first-year med student, as they're still all about cadaver and poop jokes, so I'll substitute it with "my cohort mates") think I'm a complete geek. It's probably because I am.

    I have degrees in music performance, but my real degree (the one that counted if I were to be eligible for medical school) is in biochemistry. So since I'm the consummate geek, I shall talk a bit about biochem.

    Most of us had to take chemistry at least in high school, I would assume. Most of us, therefore, know about NaCl, otherwise known as sodium chloride, otherwise known as salt. Salt exists via a classic case of ionic bonding. A sodium ion has a positive charge. A chlorine ion has a negative charge. And we all know that opposites attract. (This is oddly appropriate for Valentine's Day.) And sodium is floating around with just one of its eleven electrons in its outer shell, and it really doesn't want that one outer electron, but the slut chlorine ion really does want that electron in the worst possible way. Anyway, the sodium ion sort of gives it to the chlorine ion, and, sort of like the Biblical concept of marriage, the two shall be as one. 

     And it's a bond that's a whole lot tighter than any marriage I've ever seen. If you have refined close vision (I don't and never did because of preemie issues, but I used to look at salt with a magnifying glass when I was little, and later under one of my dad's microscopes) and you've ever spent much time looking at salt as we know it, you know that it exists in the form of tiny cubes. If a person took a hammer and smashed the stuff, it would still be in cubes -- just tinier cubes. You can't smash it into anything other than salt in the form of tiny cubes no matter how hard you try. Even something like rock salt,which doesn't look like tiny cubes, will begin to look like cubes if you just take out your trusty hammer and start smashing it. And no matter how tiny the cube, you can probably make it into infinitely tinier cubes if you have a strong enough hammer and a sufficiently sophisticated microscope-like tool with which to view it.

     The melting point of sodium (a metal) is 208 degrees Fahrenheit, or 99.79 degrees Celsius. The melting point of chlorine is - 150.7 degrees Fahrenheit, or - 101.5 degrees Celsius (if that seems strange to you remember that it's a gas, and what makes it a gas is primarily the extremely low temperature it would require before becoming a solid). The melting point of NaCl, or sodium chloride, or salt, however, is 1,474 degrees Fahrenheit, or approximately 801 degrees Celsius. Considering that the average house fire is roughly 1,100 degrees Fahrenheit, 1,474 degrees Fahrenheit is pretty damned hot. Basically, unless you have something really unusual inside your house that would cause it to burn especially hot, your entire house could burn down and your table salt would still be intact. The container holding it would be less than toast, but your salt would survive.  Pretty impressive, huh? Sodium and chlorine are far stronger once ionically bonded than they were previously. No court  nor religious institution on Earth can separate the bond they have formed without at least 1,474 degrees Fahrenheit to back up its authority. Whatsoever ionic bonding hath joined together, let no man put asunder. 

     Perhaps I should have forgone medical school and put my biochem degree to quicker use by manufacturing something like meth. I probably would have made a lot more money a hell of a lot faster, but that's really not my way of doing things. I'm much too far into the process of learning to remove appendixes, repair hernias,  and un-twist colons of small children to re-think my career options now.

     And, on an only marginally related note, salt cannot lose its savor. You know that passage in Matthew 5 where Jesus said, "Ye are the salt of the Earth. But if the salt hath lost its savor, wherewith shall it be salted?" or something like that?
Jesus apparently didn't study very much chemistry. There's really nothing that can happen to salt (other than heating it up to beyond 1474 degrees Fahrenheit, perhaps) to make it not be salty. My mom, who has greater faith than I, said that perhaps Jesus was talking about foods with naturally salty flavors or something different than NaCl. At any rate, we'll give Jesus a pass on this. He had bigger fish to fry than memorizing the chemical properties of salt.
     
     Many people say true love doesn't exist anymore. Some say it never did. They should try telling that to sodium and chlorine.

     Happy Valentine's Day.      





I do not own this video, which is actually just an audio with a still shot, but all the other videos at YouTube with Noel Paul Stookey singing the song were recorded too late in his career, and he had to sing the song in a lower key, and the song doesn't sound right in a lower key. Anyway, if you substitute "sodium" for wherever Noel Paul says "man" and "chlorine" for wherever he says "woman," the song sort of fits this blog -- if you're on drugs, anyway.

Monday, February 13, 2017

Lady Gaga Fat?

Image result for lady gaga super bowl



I don't have a dog in this particular fight as I'm not really a fan of Lady Gaga, though I acknowledge obvious vocal prowess and musical talent. I probably would not have chosen the outfits she chose to wear during her Superbowl halftime routine either for her or for myself. Nevertheless, calling her fat is absurd.  She's obviously very fit.

A Bit of a Catastrofuck





Image result for blonde child with stomach cramps
This is not I, but it might just as well have been



I return to work this morning on a light schedule. I'll report to the office of the OBGYN practice before the first employee reports to work. My normal routine is to show up however early I need to in order to be sitting idly in my car [covertly studying, actually, as time is too precious to waste in this stage of the game], waiting with feigned thinly-veiled impatience for someone with a key to appear and grant me access to the office. It's little more than a game, but, just the same, it's a prudent self-promoting (or self preserving) act for a third-year med student to be the first one on the premises for any given day's assignment. It's a bit complicated for me at this point in my recovery, as it would be ill-advised for me to remain in any place with no restroom access for any extended intervals so I have to arrive a bit later for work and risk the chance of not being in the first car to arrive  in the parking lot. The risk of no restroom access  is attached to far graver consequences.

 Once inside,  I shall begin the all-important work of  trying to convince at least one conscious (all of the office patients should, in theory, be conscious; procedures requiring anesthesia or sedation should be in an ambulatory surgical center or hospital) patient to allow me to perform what is euphemistically termed an internal exam. I've performed my share of internal, i.e. vaginal,  exams on patients who are either drugged, whose view of what is happening to them is occluded by the fabric cover put in place to minimize patient freak-out factor during c-sections and other procedures, and on women in mid-to-late stages of labor who probably wouldn't care if the hospital janitor was the one performing the vaginal exam if it meant the baby would come out faster.  For some reason, conscious women seem reluctant when it comes to allowing medical students who look like they barely escaped high school probe their most intimate areas.  I was denied access by seven patients before my illness and surgical procedure. Here's to hoping the procedure and ensuing convalescence  has had a maturing effect on at least my appearance, though I'm skeptical.  Realistically, my best bet would be at least one sixteen-year-old patient in the office today [without her mother] who, with her limited perspective, thinks I look old.

Last night I experienced considerable abdominal cramping, ostensibly as a result  of my transition to a "full liquid" diet, which includes ice cream. I may have overdone the ice cream ever so slightly.  When the cramping, which had its onset at about 5:30 p.m., had yet to subside by 11:00 p,m., I made the choice to take a Vitamin V. It took care of most, though not all, of the discomfort. Hydrocodone has a soporific effect for most people. For me, it's an opposite reaction.  I cannot sleep after taking it, so I will work today after having been awake for twenty-six hours. Between the Vitamin V itself and the lack of sleep, I should not drive. My neighbor is giving me a ride to work, and I'll arrange transportation home. I'll head home at about 1:30. At that time I'll probably crash for the night.

Last night, in my hydrocodone-induced state of insomnia, I caught a few On Demand episodes of a TVLand "comedy" series Teachers.  It's fundamentally pretty stupid and  - at least I think - doesn't even pretend to be realistic. The characters appeared to be hyperbole versions of stereotypes. I think all the teachers were female, and I'm not sure anyone was over thirty-five. The principal was, of course, male. I don't know where this series was set, but in California, more than half of elementary school principals are now female.  I was a bit too drugged to determine if it was funny. I'll catch a few more episodes when I'm too ill or drugged to sleep or study.

On a totally unrelated note, I've been introduced to an app called "Confide." It allows conversations that cannot be saved, replicated, or forwarded. You really don't want to use it to harass a person (though doing so would be more prudent than doing so using conventional media), but it's a fun place to hold a conversation that you don't want to bite you in the butt at some time in the future.


Wednesday, February 8, 2017

A Public Service Announcement: Order of Operations Problems and Common Core

The Many Banes of My Existence by Alexis: Are you smarter than a fourth (or fifth or sixth) ...:





I absolutely DEPLORE those "order of operations" problems that are posted on Twitter or Facebook or Pinterest or wherever mathematical idiots gather (I'm not implying that everyone who frequents any of those places is inherently a mathematical idiot; I am merely opining that the "order of operations" problems draw the math idiots out of the woodwork  the way Travelodge motels attract bedbugs.. Wherever they are presented. people who have a basic arithmetical background are bored by them and move on, as they mastered the concept by fifth grade. It's  others who have to argue over their incorrect answers for days.

This is not for my regular readers, who have intelligence. This is for the benefit of the great unwashed segments of our population who come here on occasion by hitting the
"next blog" button.

Just remember the "Please excuse my dear Aunt Sally" acronym/mnemonic device. First come expressions with parentheses. Next are exponential expressions. Next are those numbers that must be multiplied or divided. Last are the numbers to be added or subtracted. Once those operations have been satisfied, begin on the left and work to the right to solve or simplify the expression.

A Twitter friend of mine recently mis-solved one of these problems, then went on to deride others, saying that the reason they found the incorrect answer was because of Common Core.  I'm not a gynormous fan of Common Core, but it had absolutely nothing to do with the lady having found the incorrect answer, as whatever education she had was wrapped up long before a few educators and politicians got together, shared a bit of LSD, and in the midst of it devised Common Core.


Eat, Drink, and Be Merry Since I Cannot

Image result for sweetened condensed ,milk humor
I understand its use in recipes, but as for eating or drinking sweetened condensed milk straight, I'm not sure I'd wish it on Hitler or Jeffrey Dahmer. One would think it would be slimy and would just sort of crawl down one's throat much as an under-cooked egg might.




    I should have been back at work by now but I'm experiencing minor complications related to not being able to tolerate any food other than clear liquids. I'm on a new medication that is making me fairly sick but should heal the internal wound. The worst drug I take only twice a day. I couldn't keep it down so I'm now being injected. It still makes me sick for two hours or so, but I cannot throw it up because it's not in my stomach.

     Meanwhile, I'm sitting around and not getting a whole lot smarter. I've taken and passed the bench exam. Practical experience is the hangup here. I probably have had more deliveries thn I'm required to have had by them time I've been present for several in the E.r., a few in the O.R., one in the hospital entryway, and one in the parking lot. that is probably covered. I've yet to perform a pelvic exam on a conscious patient, though. (I'm not exactly looking forward to it.) when we're in on a relatively routine scheduled abdominal surgery, they have us practice internal exams. There's something to be said to working the kinks out of probing body cavities on unconscious patients. Now that I know that, I will put in writing that NO medical students or anyone else will ever use me as a crash test dummy while I'm knocked out for any future procedures.  

     All things consideed, all i really need to do is a few internal exams on conscious patients. I should have everything else in this specialty covered. i'm a bit bummed because quadruplets were delivered (via c-section) yesterday, and i didn't get to scrub in because i'm not yet cleared to return. i got to hear all about it, which almost made it work. I did get to help with a triplet delivery in early December, but quads would have been even cooler. I don't think the quads fared quite as well as my triplets, though. They were quite small, and I'm not sure about their prognosis. Every baby added to the mix in a given pregnancy complicates things and increases the odds of mortality and of complications for all the rest. My supervising OBGYN wasn't the surgeon of record for the quads, but she assisted in the surgery. I haven't talked to her about it yet. I'm interested in hearing her take on the procedure. She usually calls a couple of times a week and stops by here about once a week because she lives in my complex.

     I'm getting bored, but I'm trying to enjoy the boredom when I'm not puking my insides out, because I know that there will be a time in the not-so-distant future when i will wish that I had the luxury of being bored. I'm reading up on my present and future specialties.

     I don't know if this is routine at all and would like to consult an attorney, but the doctor whose shoddy scoping technique punctured my colon sent a paralegal to my condo with a document for me to sign which would, if I read it correctly, waive my right to seek any compensation for the injury to my colon caused by him. I have no intention of suing him, but I think it's positively cheeky of him to ask me to sign a document stating that I waive my right to do so. The action almost seemed threatening. I would like to show it to my surgeon and to my preceptor, though it makes no difference; I have no intention of signing it.  I found the action very bizarre.  If he's trying to intimidate me because i'll do a gastro rotation next year, he's out of luck. I've been assured he'll have nothing to do with my gastro rotation. If it looks like his colleagues will be in any way prejudiced against me, I'll petition to do my gastro rotation elsewhere. Since I'm likely going into pediatric general surgery, there would be some justification for doing the gastro rotation at least partly in a pediatric setting. There's a really good pediatric gastro program near my parent' home, and the adult gastro program is good there as well. For that matter, I could petition to go somewhere exciting like Scotland or Catalonia. It's possible to be granted up to two visiting clerkships. I'll probably take advantage of that opportunity whether it's for gastroenterology or for something else. 

     In any event, I'm not intimidated by the guy. If he leaves me alone, I will leave him alone. He would be wise to do so.

     There were two Mormons fighting it out on Dr. Phil today (technically yesterday). It was rather amusing (what I caught of it, anyway) and is supposed to be continued tomorrow. I will record it because it comes on at a time when I'm usually tossing my cookies.

     On a totally unrelated note, I have a theory that of the neurotypical population with intelligence above the "intellectually disabled" range (the 'mentally retarded' before Rosa's parents became irked and challenged the clinical use of the designation "mentally retarded" in court; I personally don't see what that accomplished, as once the youth of today or tomorrow realize that "i.d." is the new "m.r." they'll begin taunting each other on the playground with that, and then we'll be back to square one) children who are picky eaters tend to have higher IQs than do children who are not picky eaters.  I think it's somehow related to greater cerebral density and increased synapses coexisting with a larger number of taste buds on a person's tongue. Who knows if there's anything to it? If I were going to be stuck at home much longer, I'd write a grant and conduct a study, but I hope to be paroled from this state of disability sooner rather than later, at which time I will be far too busy to trifle with such matters.

     Among my multitude of readers, has anyone eaten flan? did you like it? Has anyone ever eaten or drunk sweetened condensed milk straight? Was it a near-death experience for you?

Friday, February 3, 2017

Am I Dead to You?

Image result for pictures of fake tombstones
Here's my tombstone in case anyone was wondering.




My mom would say it's in poor taste to allow elements of my life that should remain private for the benefit of those who have offended me  to make their way into this blog. Unfortunately for her as well as for those who may have offended me, my mother is not the author of this blog. The author of the blog is, instead,  22-year-old big girl, otherwise known as a legal adult, who is allowed to make decisions without consulting her mother, much less following the advice her mother might give her.

Part of this issue with my mother is that she (my mom) lost her own mom at the age of fifteen (my mom was fifteen, not the mom she lost).  She didn't have the benefit of her mom's advice.  She therefore feels all the more compelled to push her sage wisdom, acquired through years of doing things her own way without following the advice of anyone, and learning from the consequences and successes,  onto me. The only real cognitive dissonance I'm feeling in this scenario is that, from what I've been told of my mom as a young teen, older teen, and young adult, she didn't listen to her mom's advice all that much while her mom was here to give it. Evidence leads to the point of view that she was not suddenly going to have become a hell of a lot more receptive to the advice of her own mother or of any other adult. My mother liked to do things her own way and to learn by trial and error.

In that regard, I am a bit of my mother's child. I will ask for advice at times, and will even take the advice if it comes from a reliable source and the advice seems sane and sound and I've pretty much exhausted all other options that won't land me dead or in jail. Mostly, though, I figure things out for myself.  The school of hard knocks probably has a higher success rate than does any other school in the nation. 

I do listen to advice at times. I have a few sources who have consistently steered me in a good direction and who are not especially pushy in giving the advice. It is to these people that I turn in times of turmoil. Medical school is not an especially great place to learn by trial and error, as the error may result either in harm to a patient (someday . . . right now, thinking about harming a patient is about the closest anyone will allow me to do) or in irrevocable damage to my own reputation or relationships with others who control my future.  I cannot afford to be consistently at odds with administration even if I'm right and they're wrong (which is, admittedly, not usually the case, but it has happened that way at least once). I need to learn to play nicely with those in charge of my program. I already play relatively nicely with my peers, though my lack of tolerance for the slower learning curves of some of those around me has a tendency to make me less than popular with some of said peers if I don't watch my words carefully.

I've found it a good practice to run potential courses of both dialogue and action by individuals a bit older and wiser than I before actually saying or doing things when I have the luxury of time. One of my human sounding boards - one of the wisest and most reliable -- is temporarily unavailable to me because sometimes real life gets in the way of advising fans who have become friends. I may need to wing it a bit and try hard not to say or do anything that will screw up my professional or, for that matter , personal life, though I haven't done too horribly on my own from a personal standpoint. I'm not pregnant, incarcerated, or doing anything that is likely to result in my becoming pregnant or incarcerated in the immediate future. The  solidity of my continued education and professional life is more at stake. I can do this on my own, though. I'm 22, and 22 is the new 30. For the most part, I'll keep my mouth shut except when a response is clearly expected, and I'll think something like, "What would Billie Jean King say or do?" when I'm in a situation when I must say or do something. It helps that I will leave for Canada to complete a portion of my education there in about six weeks.  I'll still be accountable for my words and actions while I'm in Canada, but the distance will, I suspect, act as a bit of a buffer. As long as I don't orchestrate some act of anarchy against the system in which I will be working and studying there, the fallout probably will not follow me back here. I think I can accomplish that for the nearly three months that I will be there.

In terms of allowing things that should remain private to creep into the annals of my blog . . . What would YOU do if a person sent back to you all of the Christmas gifts you gave to her family in December, including one relatively substantial gift to a Godchild that cannot be returned to the store from which it was purchased because the store has a thirty-day limit on returns?  Would you hold a garage sale, which I can't exactly do, as my community is gated, and garage, yard, and estate sales are forbidden within the complex? Would you donate all the returned gifts to the United Way, or to the local Mormon missionaries, or perhaps to the Scientologists?  Would you write the person who sent back the gifts off your Christmas card list forever?  Would you go scour your own home to find any articles she may have given to you in the past (there wouldn't be many, but I think she gave me a box of paper clips last summer; she didn't give me a Christmas gift this year; she did make a quilt for me several years ago; am I obligated to return it? I REALLY like the quilt, but if holding onto it would be even more of a breach of etiquette than those I have apparently already committed, I don't need the etiquette police at my door) and return them to her in tit-for-tat fashion? Would you consider yourself fired as a Godparent, or wait for official word? Who has to OK firings of Godparents - just the parents, or must the baptismal officiant or maybe even the archbishop OK the deal? Could this even involve the Vatican and the Pope in some fashion? And what form would the official firing take -- an amended copy of the baptismal certificate with your name crossed off and someone else's written in its place?  A picture of you (or me in this case) with 666 superimposed upon my forehead, unless it's already there and it's just I who cannot see it?

And it's early in this game. The mother of my Godchildren is just one of many whom I may have offended with my most recent blog.  I may be dealing with far more rancor than just that of a disgruntled mother of Godchildren. Only God really knows just how many people I offended in my previous blog in which I noted the absence of communication from relatives of the side of the family that typically acknowledges my existence.  It appears that, with one known exception, I am dead to these people.

Thursday, February 2, 2017

I'm Truly Not Trying to Approach This Topic from the Perspective of Self-Pity, but, Rather, from the Outlook of Reality as It Appears from My Present Corner of the World


                                                                  PART  TWO






Image result for lonely girl in hospital bed
There are always teddy bears who care




My mom and I were recently involved in one of our less-than-pleasant but far from infrequent conversations in which she was attempting to use her professional skills (she holds doctorates in both clinical and education psychology) to fix  what is broken with me. It is considered improper to the point of unethicality  for a psychologist to practice on his or her relatives. Though she would normally be considered  both a proper and an ethical psychologist and human being, the idea of impropriety and faulty ethics has never gotten in the way of her using her education and professional training to make whatever points she has wanted to make regarding what is lacking in my character. I'm accustomed to it by now, and I won't be making any reports or complaints to whatever associations govern the practice of the fields of educational or clinical psychology (in this case, it's just clinical psychology with which we're dealing; as critical as my mom typically is of me, even she is not going so far as to suggest I have any issues in the psychoeducational domain) at any time in the near future. She's my mother. It's her job, or so she thinks, even at this late stage in life, to transform me from the dysfunctional individual that I am to someone who functions as a proper adult in the real world, albeit as an adult who does everything her mother says to do and doesn't contemplate a significant action without consulting her mother. That, however, is a subject  for another day's blog.

This conversation came up as a result of my father having casually shared with my mom something I had told him in an earlier conversation. I didn't obtain a sworn statement of confidentiality from my dad, which is something I should perhaps consider doing prior to future conversations with him. In any event, I'm confident that he had no ill will whatsoever in retelling what he did. For that matter, I'm exposing myself to a far greater degree by sharing parts of that conversation, of the ensuing conversation with my mom, and of my thoughts on the topic in general here, where people about whom I spoke with both of my parents might conceivably read about themselves. (Most of them read my blog from time to time.) I've considered the consequences of doing so and have decided to go ahead with it. They're my feelings that I'm expressing, and I don't think they're unjustified, and this is my blog in which I'm sharing them. My sane half of the family, including a block of people not technically related but considered  in the greater category of "family,"  can usually be counted on to read something (if they happen to read it), to form an opinion pro-, anti-, neutral, or bits of all three, without turning something blogged by an opiod-influenced twenty-two-year-old (I cop to using  Vicodin  in my favor [besides the obvious need for pain relief] when I benefit from suggesting that it should be considered when otherwise considering my state of mind when I write or wrote something; at other times I will say I'm perfectly lucid whenever taking Vicodin in therapeutic levels as prescribed [which is the only way I take it; I'm admitting the duplicity so that no one need call me on it) and consider the source, thereby not allowing it to ruin they, the readers', days, weeks, months, or years. (Incidentally, I also cop to using my age inconsistently. At times, I am, at twenty-two years of age, an adult in every sense of the word. At other times, I'm just twenty-two, you surely understand. Poor little me, I'm not even old enough to run for congress. You all really need to cut me some slack. Again, I'm admitting to this so that no one else has to call me on it.) And in a way, I'm not being insincere in using my age in such a manner. I really would love to have it both ways. It would be nice to be a fully-empowered adult when it works in my favor, and to be a little girl when that works better.  I understand, though, that I can't have it both ways, and that I am, for all intents and purposes, legal and otherwise, a big girl now.

Anyway, I shared with my mom, which I now recognize as my first mistake, that I hadn't received any acknowledgment of my recent illness from family. The form of my sharing with her was that I asked her if any of the relatives had called or emailed her to ask how I was recovering. (I recognize now that I had everything to lose and absolutely nothing to gain by asking her, and I will never ask again.) I wouldn't have expected them to have pulled out all the stops the way they did the time I was a mere day past my third birthday and sliced my left ulnar artery when I broke a drinking glass and was trying to hide the evidence by burying it into the bottom of the kitchen trash receptacle because I feared my mother's wrath.  An ambulance ride, a transfusion, and God knows how many stitches later, the visits and presents began arriving in droves, even though I'd just been gifted with birthday presents sent from all over the nation a day earlier. I'm certainly beyond the gift stage for hospitalization or surgery, but a card or two or a phone call would have been nice, I commented to my mom, especially since I personally am very good about acknowledging that side of the family's occasions, including illnesses and hospitalizations.

I'm generous beyond what would be  expected considering my age and employment status, with the children of my cousins for birthdays, Christmases, and religious occasions. I acknowledge the adults' birthdays and anniversaries with cards at the very least. I send cards with personal notes for everything. And, lest anyone who read this suggest it as my mother did, I do this because i was taught that it is considered proper to do so. I don't do it because I expect the same in return, and I don't typically keep score in terms of what I have sent out and what I receive in return. I wouldn't know what the score is in reference to this particular illness, hospitalization, and surgery, except that it is such a very easy score to remember: zero.

My Internet friends have been wonderfully supportive, by the way. My co-workers as well have been thoughtful. it's just that segment of people we call family who seem to have deserted me in this particular time of need. Judge Alex, you have more kindness in your pinkie toe than the rest of my relatives have in their combined collective hearts and souls.  I love you all.

And in regard to the 90+% of my dad's family who never acknowledges anything, none of this was in reference to them. They never cared before. There's no reason for them to start caring about me now.

My mom has suggested that the problem is that I've gotten sick one time too many and have worn out my welcome in that regard. She mentioned my just having dealt with myositis last month. I'd be inclined to agree with her except that they, the collective relatives,  didn't acknowledge the myositis thing, either. The ones who were in Austria with me occasionally wandered into my room and asked, "When are you going to get over this thing?" or something similar, but that would have been the extent of the acknowledgment. They weren't exactly bringing me flowers, not that I even wanted them to do so.

I wondered aloud if they send cards and flowers and phone calls to each other or not, and if I'm the only person in the family observing this social custom, or if they extend the nicety to everyone but me. That was when my mother suggested I develop an awareness that I am not the Earth's axis around which the planet rotates, nor the sun around which the solar system revolves.

Do I continue to send nice gifts to Godchildren and children of cousins?  Do I continue with cards and flowers, and with playing the organ for the rosaries of relatives of my Godparents I've sometimes never met no matter how inconvenient it is to me personally, just because it is the uncle of my Godfather and we do such things for people in our families? Do I scale the gifts down to cards and the cards to nothing? Do I still make the phone calls? Or do I continue on with business as usual because my reason for doing any of the things I did was never to receive anything in return?

Meanwhile, I'm recovering. I will return to work on a modified schedule on Monday. To all of the relatives, even though you didn't ask, I'm sure you wanted to know that about me.

Love,

Alexis.