Supporting an Aspiring Doctor

The Value of Not Being Paid

March 22, 2023 / Jacob Brown

In my opinion, our primary goal when working for someone is to be compensated with money. At our job we spend 8+ hours per day working to make money for the company and are compensated for our time with – money. If someone takes the time to knit a blanket and sell it on online they are compensated with – money. When someone sells their old car to someone who needs one they are compensated with – money. For the most part, in our everyday lives we strive exchange work and goods for – money.

I think there are times in life that exchanging money is not the solution as there is more to learn or experience than money can buy. Now being a father, I have realized there are TONS of things I can buy for my daughter that may give her joy. We probably buy her too many toys frankly, but she enjoys playing with them. We also buy LOTS of clothes for her so she is comfortable in what she wears. Do you think she notices that her clothes fit well? I’d say no, she doesn’t notice whether or not her pants are tight or her onesie is loose. She doesn’t notice at all. Do we (my wife and I) put in the effort to buy her clothes so she is happy? Yes! She gives us nothing in return other than being cute (which is worth it). Buying her clothes doesn’t help us at all, it actually hurts our finances. So why put out money when it doesn’t benefit us directly?

There are many times in life when we have to take a hit financially to possibly learn more or have new experiences. We certainly didn’t have our daughter because she would make us money – so far she has been a money pit. We have gained knowledge and life experiences with our daughter, while also being able to build our own family. Our goal as parents is to provide a better life for our children than ourselves and in order for that to be possible we must make sacrifices. Two of the biggest sacrifices are associated with TIME and FINANCES.

Giving a Helping Hand

Looking beyond our ourselves, there are also times when we can help others at our expense to benefit them. There are people who don’t have the ability, can’t afford or don’t have time to get the help they need. As an example – if someone has grandparents that have a hard time getting around, they may need some help changing lightbulbs, taking out the trash or cooking food. Can we look at what we may do to help and expect to be paid? I don’t think we should. I think we should look at how we are helping them and how much it impacts their life and bite the bullet. With our help we can improve the lives of others while making sacrifices to make it possible.

There will be sacrifices of time and possibly money in the situation stated. To help them out I bring over food for them for dinner. I could swing by the store and purchase a few lightbulbs so they don’t have to go out and get them. It’s only a few dollars, but means more to them than I probably think. A change in mindset on taking out the trash could also be in order – I am keeping them from falling down which could be dangerous for them. A little sacrifice of time and finances goes a lot further for others than it may for myself.

A Future Investment

I have found that when helping others (that are family and friends) there’s usually a future return on my efforts. As an example, I used to do lawn work for a family friend and one day he asked if I could build some things for him. He has a bad back and has a hard time bending over to pet and groom his dogs. He did pay me for the work, but I built him a specific style of picnic table so he could continue to spend time with his pets. I didn’t care how much he paid me for the work – I was happy to do it for him and his wife.

For the same family I built two swings for him to put around his fire pit. Did I expect him to tell me that I can come over and use them anytime? No, but by investing my time into building them and him being grateful for my efforts I now have permission to use them whenever I want. I did not go into the build requesting that if I build them then I must get full access, that would be crazy. Sometimes the people being helped are grateful enough to surpass the agreement (in this case money) and give us something we couldn’t buy.

Not that we should enter into an agreement hoping for something like this, but sometimes we are gifted in return. I gained knowledge about building swings by having this opportunity and am more familiar with the process if I build more in the future.

The Profitable Assistance

As another example, let’s imagine that a man is building a deck at his house. Is the man physically capable of completing the work? Yes. Is the man financially capable of completing the work? Yes. So why help? It seems that he can do it by himself without issue.

I think there’s another aspect of helping people that may not make sense at first so let me explain. I would call it profitable assistance. This would be helping someone by sacrificing time or money while knowing there will be a return that is NOT monetary when the work is complete. I think that this is more common within a family and much less common with strangers. The man is building a deck and a person could help by:

Paying for materials
Building the deck framing
Digging holes
Laying the deck board surface
Staining the deck

Helping with any of the tasks makes the work easier and faster. Some possible returns on the helpers efforts would be:

Sitting on the deck
Coming over for cookouts on the deck

So, if the person wants to use the deck (which they know they will be able to) why wouldn’t they want to help? If someone doesn’t want to help (and give their time or money) is it fair to pay an entry fee? There’s a reason why I said it’s more common with family than with strangers. For working on the deck, the payment is being able to enjoy it and spend time using it. We sacrifice time up front for the work – to have a return of time in the future.

Helping in this situation makes it easier and faster. As they saying goes, “many hands make light work.” Taking a larger project and dividing it amongst a group will make it much easier for each person and faster. It will lessen the load for everybody (especially the man who wants/needs the deck).

Profiting From Lessons

When helping others giving our time or money we profit no matter the outcome. Maybe we help on the deck giving only our time and now we have time given back to us to use the deck how we please. During the process we could be learning how to build a deck for FREE instead of going to a class or school to learn. We might even build our relationship more so when we want to build our own deck they will come help us.

Maybe I make a quick run to the store and buy some lightbulbs to help my grandparents in their home. I could learn something about them I didn’t know prior to having a conversation. It’s hard to tell exactly what I will learn, but I will learn something during the process whether I want to or not.

A Final Thought

Helping others is sacrifice. Sacrifice has a price – time and money are the most common in my opinion. We have a great opportunity to give up some of our time or money to give others something much greater. It’s really an OUT>IN type of situation.

⁶The point is this: whoever sows sparingly will also reap sparingly, and whoever sows bountifully will also reap bountifully. ⁷Each one must give as he has decided in his heart, not reluctantly or under compulsion, for God loves a cheerful giver.⁸And God is able to make all grace abound to you, so that having all sufficiency in all things at all times, you may abound in every good work.
2 Corinthians 9:6-8 ESV

I have found in my life, helping my family and friends reach their goals is huge. I don’t know what I will be doing a few years from now, but I know I want them helping me reach my goals. Being paid for helping is only temporary as the money will eventually disappear, but what we build and learn together will last our lifetimes.

The “How are You?” Dilemma: Freedom in Honesty

February 10, 2023 / Aleena Brown

I must admit, February of Intern year isn’t the best. The high of being a resident has worn off to the everyday stress and anxiety that comes with the job. I spent January on a block of nights and clinic. At our program, we will do a week of nights (Sunday through Saturday 6pm-6am) followed by a week of clinic (Monday through Friday 8:00-5:00). Transitioning to nights isn’t that hard for me. I’ll take a nap Sunday afternoon, drink my latte (thank you Jacob!), and walk to keep myself awake in the hospital. Switching back to days is a completely different story. Trying to get my internal clock to straighten out seems to take days, but the clock keeps ticking and we keep moving forward.

Living in Northern Indiana brings weird weather, comfort food, and kind people. It is common, and almost law, to say “hello”, “good morning”, or “how are you?” when you walk past someone, honestly anyone. When you give pleasantries out like candy, are they actually said in a sincere and inquisitive manner? After our “hellos” and the inevitable “how are you,” I found myself internally asking “do you really want to know?” And one day, I truly asked.

On my second week of nights solo, I came into our work room like a whirlwind. There wasn’t any specific event that caused my stress and anxiety to be elevated, it just was. My lunch was thrown in the fridge and my computer got up and running. The list of patients was completely new to me and longer than I had anticipated. My fellow intern was working in the emergency room and came in to finish her notes. The conversation started like normal: “Hey Aleena”… “Hi”… “How are you?” I looked up from the computer and studied her for one second, and then two. My mind felt like a dumpster fire. On one hand, I could make this conversation stop quickly. I could say “doing all right” or “okay” and it would be over. Or I could be honest. Wasn’t that a scary thought? I knew I wasn’t “all right”, I wasn’t “okay”. I knew this intern was a safe person. I wouldn’t be ridiculed, I wouldn’t be dismissed. How lucky was I to have a friend and coworker that I knew would pause with me. So, I said… “honestly?” Her retort was quick and so much like her I wanted to laugh. “Obviously,” she chuckled. “I’m surviving.” Pause. She turned to look at me then too. She knew, she understood. Even if we didn’t talk about it, if we weren’t honest, interns all knew that feeling of surviving. I’m sure it continues through residency, but getting through this day, this week was all I could focus on. “Yeah,” she said. Her voice was softer and held a hint of sadness too. Our conversation wasn’t long. The job needed to get done, but in that moment I offered myself the freedom to be honest in the “how are you?” dilemma. I cried later that shift, around 3am, when putting my emotions aside no longer became an option and it poured out of me in tears. It wasn’t any specific trigger. Instead it was all of the small things I was carrying for too long: not seeing my husband and daughter, not sleeping well, feelings of isolation, my own imposter syndrome and feeling inadequate, feeling lost and a drift, ruminating on my tough cases, the patients I lost, and those I had to tell terrible news. All the small boxes had grown taller than me and too heavy to hold, it was inevitable that I would trip.

I’ve spoken and written many times about my own mental health, the highs and lows. I’ve talked about my struggles and worked to be honest and open about those things in the last few years. I’m here to tell you it’s still hard. It’s hard to be honest, be vulnerable, and open. It’s difficult to let people see all of you, including the dark and twisty parts of you. I hope moving forward I can be honest in those moments, and I hope I’m given the space and grace to allow that.

I want to encourage all those who read this to be intentional with the words you say, even to strangers. Be ready for the response when you ask a question. Allow your fellow humans to be vulnerable and offer a safe space. If time does not allow for a conversation, wish them well as you walk by. You’re allowed to break tradition with the “How are yous”. If the question is thrown your way, at least be honest with yourself. Take a moment out of your morning to assess your own well-being, and if you find yourself just surviving or just holding on, reach out and get help. You deserve more out of like than just surviving.

My days, and nights, are busier than they used to be, but I am always ready to talk with friends over coffee.

The Delivery

February 8, 2023 / Jacob Brown

Charlotte is our first child, so we don’t have another birth to reference or compare her’s to, but I felt that it was an interesting and scary experience. We spent quite a bit of time in hospitals for testing and monitoring which is nerve racking in itself. The testing was needed because my wife had some changes to her health that were starting to become dangerous. Around week 34 of my wife’s pregnancy, she was diagnosed with preeclampsia.

My Understanding of Preeclampsia

From my understanding, preeclampsia is like a battle between my wife’s body and the placenta. Her body starts to have issues with the placenta, and it starts to wreak havoc on the mother’s body, ultimately having problems with the baby. The mothers’ labs begin to change in ways that are hazardous for her health. She starts to experience high amounts of protein in her urine, liver function changes, and high blood pressure. An achy body and extra water retention is also causing problems. My wife experienced all of the typical symptoms except for pain under her right breast and extreme headaches that are not resolved with the acetaminophen.

Aleena also experienced blood pressures that were exceeding 160/110 which is dangerous as well. There are risks of having a stroke when the blood pressure rises too high. If the state of high blood pressure is extended, it also increases the risk for mothers to have seizures. Thankfully, we didn’t make it that far down the road, but it was a possibility. The physicians and nurses that were caring for my wife during the whole process were able to better control her blood pressure through medication which made me feel more at ease.

[If you want a better understanding of preeclampsia, my wife recommends reading this: Patient education: Preeclampsia (Beyond the Basics) – UpToDate]

The Antepartum Experience

At 34 weeks, Aleena was diagnosed with preeclampsia. She went into a normal prenatal appointment, and they saw her blood pressure was elevated. Her urine had a large amount of protein in it. We were told to go to the OB triage center at the hospital for further testing. This happened to be the Thursday before Christmas. The testing proved that she had preeclampsia; thankfully, she did not have any severe features at that time. We were allowed to go home as long as Aleena monitored her blood pressures multiple times per day. We went back to Indiana to enjoy Christmas with our families.

Christmas morning Aleena woke up and felt off. I took her blood pressure and her systolic was 160s. We spoke with the on-call doctor who recommended being seen in OB triage. We went to Parkview hospital to be evaluated. Her blood pressure came down on its own and Charlotte looked good on the monitors. They started Aleena on steroids to help Charlotte’s lungs develop. We were told to go back to Toledo as soon as possible to be closer to our OB.

Monday morning came and Aleena woke up with severe swelling in her legs that came all the way up to her hips. She had a lot of pain and difficulty moving. My mom took her in to triage in the afternoon after the swelling didn’t go down. Lab work was done which showed progression in the preeclampsia (worsening proteinuria, increased creatinine, decreasing platelets, increased liver function tests – none of which were at the severe level, but trending in that direction). She still did not have severe features, but multiple labs were borderlines. We were admitted to antepartum that night.

For the most part, we were able to just relax and spend time with each other during our time on the antepartum floor. Labs were run every morning (or sooner if needed) at 5:00 am to check her levels. Each morning Aleena’s labs continued to show progression. Her platelets continued to drop, and her liver function showed abnormalities. Her blood pressure continued to be high. On Wednesday, we celebrated getting to 35 weeks, however her blood pressures jumped into the severe range and medications were needed to bring it back down. They ran blood work early at midnight which showed severe range platelets levels. At this point they called it and wanted to start the induction process.

Our Time on L&D

Shortly after being rolled into the L&D room, Aleena was started on medication. The IV stand had 5 different bags hanging administering fluids and medication to her.

Almost as soon as all IVs were hung, they started my wife on a Cook Balloon. A Cook Balloon is used to mechanically dilate the cervix. Being induced early meant her body wasn’t as prepared for labor so the balloon jump starts the process.

She was at the same dilation for a LONG time after the balloon was removed. It was about 8 hours or so before she began making progress. I thought it was crazy how quickly she made progress once it started. She went from the doctors thinking she was not making progress at a checkup at 2:30 am (5cm) to the baby nearly delivered at 3:30 am (10cm).

The Delivery Scare

Delivering a baby has its own set of challenges. There is a lot of stress being put on the mother and baby. My wife was considered high risk due to having preeclampsia with severe features and the baby is at risk due to only being 35 weeks and (barely) 2 days developed.

The delivery itself was very quick. Aleena did a great job and by the third set of contractions Charlotte was in the world crying for mama. Aleena got to hold her for a few second while the cord was cut then Charlotte was taken to a connected room to the team of NICU personnel. Charlotte was evaluated and was doing amazing. She didn’t need oxygen and the NICU team said she didn’t need to be in the NICU.

After the delivery, Aleena began to lose quite a bit of blood. From the report, she lost about 1 liter of blood extremely quick. The doctors pushed medications to stop the bleeding and stitched her up (minor tears). After the doctor got her stitched up, Aleena headed back to our room, and I headed to another room with Charlotte and a nurse. Charlotte was going to do her first sunbathing session to warm her up a little bit.

As I fed Charlotte her first food, Aleena was sicker than previously. They have to keep preeclampsia patients on Magnesium for 24 hours after delivery for seizure precautions. This meant she was going to have that sick feeling added to loss of blood and just birthing a baby. When I returned to the room nurses were checking out Aleena because she had been vomiting and continuing to bleed. I remember vividly that she looked paler than I have ever seen her. She was so sick that she did not have the energy to hold her own baby.

She had lost a lot of blood at this point, and they were trying to stop it. She continued to bleed more than normal and pass clots until approximately hour 12 of recovery. After sleeping a lot, she had stabilized and progressed in an upward direction.

Throughout the course of the delivery, they were pushing Labetalol to keep her BP down. After the delivery her BP finally began to fall and was getting a little low for my preference. At one point she was down below 90/70. It was a good thing she is confined to her bed and not allowed to walk as that is a little dangerous. The nurses did a great job caring for her keeping her within a safe range and on the right track to recovery.

To the Postpartum floor we go!

It was great to finally move out of L&D and get back to a room with windows. We were confined to the middle of the hospital on L&D which meant – no windows. Finally getting to move to postpartum also meant Aleena would finally get to eat again. What was her first food after 2 days without eating? A Rice Krispy treat of course!

We moved to postpartum at approximately 4:00 am, so nothing was open for meals. I ran to a vending machine to get Aleena a snack of accomplishment for all she had been through. She had done a great job and I think something greater than a vending machine snack would have been better.

On the postpartum floor we were able to relax and watch TV together finally getting photos of our little girl now that Aleena was feeling better. Our baby was small, but very lively. She had the quietest little cry that felt almost comical because it was so cute.

Heading Home

Heading home was great. We were fortunate enough to have my parents and her parents waiting for us at our house. They were kind enough to give us food and clean up around the house.

Unfortunately, we were in the middle of a bathroom renovation when we went to the hospital for the delivery. My family was able to help on the bathroom to get it to where the toilet could be used at a minimum so Aleena wouldn’t have to go downstairs to our other bathroom. Charlotte wasn’t due until February, so having her born December 31 slightly messed with our plans.

So what I’ve learned is there’s never an optimal time to have a baby and there never an optimal time to renovate your bathroom.