A New Month

So Sunday brings to us a new month, and in it, could be many big things.

First, Mia. After much waiting, it is likely we will find out sometime late next week or early the following week what kind of surgery Mia can have and when. We had initially been told it would be today, but alas, we found out last week it would be more than 3 weeks from the previous procedure. Oh well. I can't say I'm terribly surprised. Don't get me wrong, I want her home in our arms in our rocking chair as much as everyone else, but I think I have seen how the system works a thousand times over more than everyone else. Especially in academic medicine. Initially, one plan gets spit out - then, after whatever specialty team has a moment to get together and discuss a complicated case, like Mia's, they decide as a group when a better time would be. I imagine this is what happened; that and coordinating OR schedules between the surgery folks and the ENT folks. Either way, it's still aggravating, but there's no one to blame. At any rate, no one has been able to give us any indication as to whether her esophageal gap is too long for repair or not. There just hasn't been sufficient visualization of the lower part of the esophagus. We know the ends have "grown," but how far is not so obvious.

Otherwise, Mia is doing quite well. She hit the 6 pound mark the other night, and is probably a few ounces more than that today. By her due date, she will most certainly be of average birth weight. She's still on oxygen, and we're not sure why. Whoever is responsible for weaning babies off vents, be it docs, respiratory therapists, APNs, etc., didn't do a good job weaning the vent this last time after her procedure. And she has had trouble being without it since. There seems to be a possibility she will need home oxygen. It is hard to know for sure if the two are related. And while it's like it would be the end of the world, we're tired of dealing with things attached to her other than us. Her eye exams have also been fairly reassuring. One worries about retinal damage in premature babies, especially when they're on oxygen too long (but this is more related to being on the vent at high O2 levels and high pressure, which she hasn't had). While her retinas are premature as expected, there is no irreversible disease to be seen.

In other news, my "rank" list for my intern year was certified. Not that any of this matters, because it's a guaranteed spot for me anyway. It's tough to see all my classmates at their current level of stress. Now that their rank lists were due yesterday, they have to wait three weeks before the result of the match is known. Three weeks! There is no known reason why it should take that long. Everything is computerized, and Lord knows it couldn't more than a minute or two to run the list. And to top it off, it's not like they accept late rank lists. So where the hold up is, no one knows. And it's not like the NRMP will ever speak a peep of why they take three weeks to do it. My match was less than 1 week after the list was due. Of course, I had other things to worry about at the time, so I didn't really get too nervous about the whole thing.

I am also on the hunt - for houses and for day cares. With Rachel working, and I on a couple easy few-hour months at school, it is reasonably up to me to do all the leg work on these fronts. As a freshly starting doctor, I can qualify for pretty much whatever home loan amount I want. Granted, we don't need a $250K house, but we could be approved for that. I think $150K or less is fair. And with today's market, one can get a house listed at $175K for that amount. I have some good neighborhoods in mind - ones I need to drive Rachel around in. Better yet, these are hoods that are nice, big, clean, close to work, and supply potential buyers with tons of options. I'm overly excited about the process, but I know it will be cumbersome. I have done much reading about buying a first home. I plan to talk to a broker within the next week or two, get pre-approved doing whatever I need to, find a buyer's agent, and find a home. While a lot of this depends on Mia's condition on discharge, we should know some of these answers soon. And if things go optimally, the ground work will be done and we can hit it running, getting most everything taken care of before the baby comes home, except of course actually moving. As far as daycare - what a depressing search. I have only found about four out of several that I would put my baby in. Two of these are actually quite good. I would also like to take Rachel to see these places. At least their waiting lists are reasonable, not the six months or more I was warned they would be. I guess that long of a list typically applies more to church-associated day cares. Anyway, as I said before, at least the difficult parts of the searching will be done before Mia is home.

If you've made it this far, I thank you for paying attention. I don't blog just very often, and so when I do, I go quite long. Hold your remarks, honey : ). And Dr. G, if you ever read this, which you won't. Stay tuned as the next month brings much news.

Writer's Block

I haven't really posted in awhile because I haven't had much to say. Everything there is to know about Mia is on Rachel's blog. Everyone's asking when Mia will get to come home, as if there is hope it will be very soon. I'm not being pessimistic, but it won't. Even if she were to have surgery next week, she would need plenty of time to grow more and heal and eat and breathe better. I give her at least two weeks beyond surgery before she comes home, but that's just my unprofessional guess. My AI ended without a going away party. Didn't really learn much other than how to get patients out the front door of the VA. My primary care month in the internal medicine clinic started on Monday. It's pretty cush - I see one or two patients a day, and the best part about it is that when I'm not seeing anyone, I don't have to sit around with nothing to do. I can actually leave if I wish. I went back to the gym today for the first time since well before Christmas. I was somehow still able to run three miles, very close to my usual four, without trouble. We shall see how my legs feel tomorrow or the next day. I made a fair amount of money on call at the eye bank last week, more than I ever have before. This is only party because I submitted my days and referrals from the last time I was on call the week Mia was born since I never submitted anything then.

I thought I would have more paramount things to say when I started this blog, but I guess I just don't.

An Announcement

Now whose tiny hand is this?

So, you already know about Mia, what else could there be? I matched in ophtho. . .At UAMS. . .My top ranked program. That means no more interviews! The intern year at UAMS is a guaranteed spot - no interview or other bs required.

Details will follow.

A Precious Promise Kept

This is Mia Kathryn Thuro, born on January 1, 2009, at 8:29 in the evening. She weighed 2 pounds and 14 ounces, at a length of 15.75 inches. And let's just say that, for being just shy of 30 weeks in the womb, she is doing splendidly. Rachel, I'm sure though I have not read it myself, has written a wonderful blog detailing her experience and feelings surrounding the event. But here are mine.

She was born with us being full aware that there was a problem ahead of time. From the very first official ultrasound, no pictures beheld a stomach. At first glance, this simply means waiting for the baby to swallow some fluid and the stomach will appear. However, after many repeated attempts, everyone failed to visualize her little stomach. This could only mean one thing - the connection between her esophagus and her stomach was missing, if not at least defective. It is known as esophageal atresia; and although it isn't terribly rare, not too many babies are born with such an ailment.

What this meant for Rachel from early on was the high possibility of early labor. The baby while in the uterus constantly swallows amniotic fluid, digests it, and re-secretes it through the kidneys. It is also resorbed through the blood and placenta. If a baby can't swallow, the fluid inevitably builds up in excess within the uterus. Too much fluid, in a very thin amniotic sac, leads to only one kind of outcome: premature rupture of membranes, aka POP!

This was of course a scary moment. We had only just finished watching Ocean's 13 when I decided to take a shower. No longer than I had shut the bathroom door, I hear a small shriek from the living room, thinking Rachel was laughing at something - two sounds which are sometimes surprisingly similar through two closed doors. I came back out to see what was so funny only to see first hand what it meant to have one's water broken - not to mention the fact that there was more than usual to begin with. We quickly dressed and rushed off to the L&D triage center at UAMS. There she was hooked up to a monitor and to our great relief, a baby's heartbeat was present and normal.

We were told at that point that Rachel would be in the hospital until she delivered - be that one day, or one month. It didn't matter. Once one's amniotic sac is ruptured, the risk of infection to the baby and mother is too great to let one go walking around. We were moved into a labor room and awaited greetings by a neonatologist (doctor who specializes in newborns), the obstetrician, and the anesthesiologist. They all got their words in, but the anesthesiologist ended up being of no help. Her water broke at around 2:30 in the afternoon, and she was dilated 1 cm around 3:30. A couple hours and one sedative dose later, she had progressed to 3-4 cm. A few hours later, and in the middle of the anesthesiologist talking to us about epidurals, she was dilated to 10 cm. Buy buy to that doctor, and hello to about three others and a few nurses. Before another 30 minutes passed, Mia was out and whisked away to be stabilized.

An hour passed with great emotion and anticipation. I got to see her briefly in that time, but eventually, when she was safe and sound in her incubator with the Angel One Transport team, she was brought to us. For a few short minutes, we gently touched her hand, and she was then taken to the premier place for sick children in the state - Arkansas Children's Hospital, only twenty minutes from our house.

She was stabilized on the ventilator, and she remains so to this day (1/6/09). The story of her atresia is like this: there's a good part and a less good part. Optimism here. There are five different types. Importantly, the most common is when there is a connection between the lower part of the esophagus and the trachea, or wind pipe. This is not her kind. Mia's is much less common - the kind where no connection exists between the esophagus and the trachea. There are three other even less common variations, but I won't discuss those. With Mia, the lack of a connection to the trachea is a good thing. With a connection, air is drawn into the stomach with each breath. This inflates the stomach, pushing up on the diaphragm, decreasing room for the lungs to expand. This requires higher ventilator pressures to inflated the lungs constantly, which is much more damaging to such premature lungs. So she can now tolerate low vent pressure, and will hopefully wean off of it easily. The unfortunate thing is, when there isn't a connection, the gap between the closed ends of the esophagus is often much bigger, making a repair more complicated or impossible.

So here's what we do. We let her grow for a while. She has had a tube put into her underdeveloped stomach so that she can be fed breast milk, and so that we can get her stomach and lower esophagus to expand. After 4 weeks of waiting, x-ray contrast studies can be done to see how close the ends of her esophagus are to one another. If close enough, the repair will be scheduled. If almost close enough, we wait another four weeks and then schedule the repair. If nowhere near close enough, which is fortunately often not the case, her esophagus is made to drain out the side of the neck and a bigger tube is put in her stomach. Then, at age 6 to 9 months, long after she has come home, they do an esophageal replacement with either stomach parts or intestinal parts. We hope for a repair at 4 or 8 weeks, much more so than a replacement.

Many other things have been checked out on her to ensure that no other accompanying defects had gone unnoticed. To every one's fortune, no other problems have come up yet. There are many times one or several of a list of other problems that can occur with esophageal atresia, but we've been fortunate.

As of now, she remains on the vent, but an attempt to remove the vent will be undertaken tomorrow morning. They will watch her throughout the day to make sure she can hold her own, so to speak. We pray that she can. If she can, then it won't be much longer before we can hold her. Few of you may, but most of you have no idea how hard it is not be able to hold your newborn child for a week or more, no matter how beautiful she is. But we visit her everyday, many hours out of the day, nonetheless. She holds our hands and grips with her toes. She is pretty calm though as she is sedated since she is on the vent and has suction constantly to keep her upper esophagus free from pools of saliva. We don't want her to inhale that stuff and get a pneumonia. But, believe you me, when we get to hold her, you will hear about it.

Other aspects of life have been subsequently inconsequential. I started a work intensive rotation yesterday, but I don't even care. I match into ophthalmology in nine days, but I don't even care. I'd like to find a house we like, but I don't care right now. Some things have just become more important.

A Promise

I promise, I will soon post a blog about our new baby girl, Mia. Not only has that been a huge time investment since 1/1/09, but so has school as I started my acting internship yesterday.

Best Wishes - BAT

Home Based

After much traveling, I am finally done - at least for the time being. My ten ophthalmology interviews are done with. I now have the just as, if not more, difficult task of figuring out how to rank these programs. They all will make the cut since it is too ballsy for me to simply not put a program on the list. Some people do it, but I won't after having spent a decent amount of money an all my travels.

Unfortunately for the couple (maybe four) of readers I have, I shan't post publicly any rank list until perhaps immediately prior to January 15th, the date on which I will find out where I matched. It may be nothing more than paranoia keeping from posting such a list, but I know there are people out there who search for this kind of stuff. My list is due on January 8th, just one week before. That means I have less than a month to figure it all out. You wouldn't think it would be hard, but with as many variables as I am trying to consider, the decision seems impossible. I know what ranks 1st, 9th, and 10th on the list, but 2 through 8 remain undecided.

What do I like about the program?

What don't I like about the program?

How's the city it's in?

What's the cost of living there?

And of course within these questions lie many sub questions, if you will. And with the way this matching process works, there is just as good a chance I will get my second or third choice as it is I will get my first. Must choose wisely.

Outside of this, I have the rest of the month to think about it and to do my Christmas shopping. What does everyone want? I think I want a beer. . . . . . . . . . . . .Well, after that I have not much left to say. I would simply refer you to Rachel's Blog for baby info.

Giving the People What They Want ;)

Before I say much else, I have to just congratulate the Razorbacks for their closing win of the season against LSU. What a thrilling game it was. For the second year in a row, AR has beat LSU for the boot and the glory of bringing it home. Not to mention, they did it with a new coaching staff, no McFadden, and with a crap defensive line. Go hogs!

I'm not just a huge football fan, but I have come to like college football at least if not more than professional ball. Less politics, and just generally more entertaining. Since I am more of a casual fan, surely there are more exciting things in my life, right? Right.

With six interviews down, and four to go, it's hard to believe I started on this trail over a month ago. A month? Really? All of my hours and miles on the road over the last month really haven't made it drag by overall. But while on the road, what a drag! I have many miles on the car, and despite an oil change just two weeks ago, I would technically be due for another here in about 500 miles if I went by the 3000 mile rule. The trail has been fun, though. I have the same people in several places. It's nice to know that at each site, I am up against the same group of people, not a whole different 50 applicants. It makes me feel more confident that most of us have a good chance of matching somewhere. Here's the difficult part: every program has rocked my world in some way. SLU has a bunch of cool stuff to do, but the program seems almost too laid back. UTSW puts up excellent surgical numbers, but Dallas is probably just a little too flashy for me and I am sure the program is more malignant than the residents were leading us to believe. UMKC also put up great surgical numbers, but perhaps were a little too much into research requirements. UAB is a very solid program in a neat town, but the first year is in-house hospital call. OU puts up the best surgical numbers I've seen, is in a great city, and I can't find any true downfalls. MU is a solid, hidden program in a good town, but does very little trauma and so I might not get much orbital exposure. I will critique the remaining four programs in a later blog (as much for myself as anyone) and finally announce my rank list. I may not announce my rank list until after all lists are submitted. I can't see any reason why announcing it publicly would effect or hurt me in any way, but better safe than sorry.

Of course, every time I leave and go 300+ miles from home, Rachel gets some reason to be panicked about little Mia. They have all been good reasons, but at bad timing. I leave for Memphis tomorrow, so there better not be any scares Monday morning, Missy.

I put Christmas lights up this weekend since we can't put up a tree this year. We have acquired additional dining room furniture since the last holiday season and thus have no room. Maybe we'll get a little one footer and put in on top of said furniture. I would supply photos of the lights, but anyone who has tried knows they don't photograph well. But new baby furniture does!

The Mona Lisa will probably find a new home when the baby comes, or the trash can as was the initial plan. We decided to hang it in the room because it matched the green, but it doesn't match a baby. Never mind the stacks of diapers piling up, they will get used quick enough.

My room at the
Crowne Plaza Hotel
in Dallas, Texas.


Hello to all from Dallas! Why am I in Dallas? I am currently on my second of ten scheduled interviews. In order:

SLU in St. Louis, MO
UTSW in Dallas, TX
UMKC in Kansas City, MO
UAB in Birmingham, AL
OUHSC in Oklahoma City, OK
MU in Columbia, MO
UT Memphis in Memphis, TN
UAMS in Little Rock, AR
UK in Lexington, KY
U of Cincinnati in Cincinnati, OH

I was in St. Louis earlier this week and am spending today and tomorrow in Dallas. The first interview went pretty well I think. Before you ask, "Do you think they will offer you a spot?" let me just say that them offering me an interview was offering me a spot already. As noted in a previous blog, a rank list is submitted by the program and all the applicants. So now it's just a matter of how applicants rank that particular program and how the program ranks all the interviewees. Of note, St. Louis has a great program, with hospital-paid benefits. The residents were all nice people, and the faculty seemed nice as well. I wasn't sure what to expect at first since many of the residents at UAMS seemed to dislike SLU. I can't figure why since the program seems as good or better than UAMS - perhaps a few less cataract cases. This is not likely to be too important to me since I plan on being fellowship trained one day.

I would really like to add an interview at Duke to this list, but I haven't heard from them yet. I have been denied by three places, two in Boston and the other being John's Hopkins; I have turned down four programs now. That leaves about 13 programs I haven't heard from just yet. Some of them might not ever respond, including Duke. We shall see.

We're having a girl in case you haven't heard! Mia Kathryn Thuro.

I am off from school from now until we return in January. This isn't the case for all of my class, it's just how I have scheduled it. Many of my peers took July or August off. I couldn't do that for obvious reasons - rotations I needed to get done early. Two months off to travel and celebrate the holidays isn't too bad if you ask me. I'll be plenty busy.

I'm not sure what else to talk about right now, so see you next time!

So What's Going On?

You're probably wondering why I haven't posted anything in awhile. Why, Bradley, your wife has announced her pregnancy - have you nothing to say? Don't you have interviews by now? Has your cat grown a brain yet? Well, the answers to these questions and more may be ahead.

First, and perhaps most importantly, the baby. Rachel has already announced the news, so that's why I haven't had much to say about it here. Don't worry, it doesn't make me any less excited, happy, scared - you name it. Any time someone asks, "Do you know what you're gonna have?" I wanna say "A heat attack." Of course I'm kidding, and then I say we don't know just yet, but I want a girl. This draws up many looks and comments of surprise - "Really?" Maybe it's because I grew up with four brothers and only one sister. We'll find out in about three weeks. Right now we're just in the pahse of buying diapers every week while we shop for groceries, and trying to figure out what baby furniture we want. Adding a family member and needing new furniture means needing to completely rearrange some things around the house. Closets have to be reorganized multiple times, furniture must be relocated or sold, and clothes must be donated or boxed up. This is all happening, but at a slow pace since we have several months to go.

Interviews. It's interesting. Even though ophthalmology matches its applicants two months sooner than the other programs, the interviews aren't much earlier. I know someone going into pediatrics who is interviewing, like, yesterday while I continue to wait for my first one. I have so far booked five interviews, I'm trying to decide on a sixth offer, and UAMS has yet to contact me (which, barring some unforeseen earth-shattering catastrophe, will happen eventually). I am going to Dallas and St. Louis the last week of October, Oklahoma City sometime in November, and Lexington and Memphis in December. Cincinnati is the one I am trying to decide whether I want to go to or not. My goal is to get around 10 - 12 interviews, and since most programs haven't even begun informing applicants of interview selection, I don't think I have anything to worry about. Here's hoping. I have finally begun working on my application materials for the transitional year - yep, a separate application process meaning twice the money and time.


And no, the cat still has no brain. Any unanswered questions can be posed here at your leisure.

Return to Near-Normalcy

Many people asked if I was a Kentucky fan; I told them I was from Arkansas and that promptly ended the conversation.



A week back from Kentucky, and still no blog? Shame on me. Well, my punishment is to sit here and write one. That's right, I'm foregoing studying, foregoing filling out paper work for the eye bank, foregoing cleaning up the weather's havoc on our driveway and porch, to sit down and blog about recent events. I'm so hard on myself (no comments, please, RCT, GMA, and KGW!).

Kentucky was nice. Lexington is a nice area with lots to do within a two hour radius. I can't find any reason in my mind, though, to pick Lexington over Little Rock, or the other way around. Oh, aside from the fact that this is where we already live and live closer to both families than if we moved over to KY. As far as the residency program, it's par with UAMS - not as good for some reasons, better for other reasons - the kind of program that attracts me. If I were to decide to be retina surgeon, Lexington would be the place to go. If I were to decide to do oculoplastics, UAMS would be the place to go.

Let's not get too far ahead, though. I am FAR from a legitimate decision. Assuming I am invited, I will definitely return there for an interview and ultimately rank UK somewhere on my match list. But now that my application is in, and already redistributed to the various programs, it will be a matter of waiting for interview invitations and special requested additions to already submitted application material. I have to get an eye exam for the program down in San Antonio, TX - but this isn't uncommon for ophtho programs. I've gotten confirmation also from SLU. The 28 other programs I have yet to hear from. Time to hurry up and wait.

And study for Step 2, the written part. Yep, another eight hour test to be taken on the 26th of this month, which I am not taking off for study time. Many folks don't take time off to study for this exam, but that doesn't make it any less big or important than Step 1 from last summer. All I can do is come home from school everyday and jump right into my studies. Sorry, babe.

Don't have much else to say right now other than I am happier than ever to be back home and I must get back to studying. Peace.