little clip of my art room and journals

I was asked to make this clip for an upcoming retreat I am teaching at.  It's a pretty bad video (I have no skill in this area) but I thought I'd post it anyway for the fun of it.

5x7 drawing journal

 I just realized that I had posted some of my older pages on Facebook but not on my blog.  I like to have everything on my blog.  It's a great way to archive my pages.  That's why I post nearly every page I make.
 The eye on the octopus was a tutorial I followed on pinterest.  It was super easy and I think it turned out pretty good.  Definitely learned a few things by doing it.
 I was playing around with making a christmas card in my journal one morning while at the coffee shop, but I wasn't crazy about the figure so I never finished it.  It was inspired by a sweater that one of the customers was wearing.

Someone told me that they liked my old style better than this current style.  I appreciate the feedback but it made me stop all journaling in this smaller (drawing) journal and start a large one where I went back to my old style (see previous post).  Which...actually...felt really good.  Like putting on an old familiar favorite sweater.  But looking at these drawings again makes me want to pick up my pencil & pen again.  I need to meld the two better...something to work on in 2013.

Journal pages

 Newest Journal:  Moleskine sized 8-1/2 x 12" with stiffer paper.  Loving the large size again.

 oops...scanned in with the bookmark.

Just fine

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"There is no such thing as reproduction"

(At least, that's what I'm told this book says). And it's true.

At least once a day, I have the discussion with a pregnant patient about the limitations of prenatal testing and ultrasound. "Let me share with you," I'll say. "I realized, about halfway through my counselling session with the geneticist during my second pregnancy, that what I was really worried about? Was autism."

[Break to explain, especially for readers with an autism-spectrum disorder, or who are raising kids with one: I was worried about autism not because of the diagnosis itself, but because I thought I would be really terrible at parenting an autistic child. This assessment was made with woefully limited information at the time, but regardless I had this whole fear about how it would combine with my native social anxiety and my general impatience in a bad way, and that this kid - my kid - would suffer more because of my particular inadequacies.]

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 my 5x8 moleskin journal.  On these 8 pages I used collage, tombo markers, copic markers, hi-tec pens (I like the .5 size), rubber stamp, colored pencil, japanese tape, pencil, smudger.

October Hurricanes

Here's my October:

"Your son is in a bad situation."

followed shortly by: 

"We're all in a bad situation."

To no one's surprise, my anxiety level is high. I'm not sure when it will come down. 

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Emergency Leave

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We're ok

Hey all -

Smoosh is out of the hospital, and despite some setbacks (requiring a second procedure a few days ago, and  a scare-that-was-nothing yesterday), we seem to be proceeding with healing.

I'm trying to remember what regular life looked like, and to resume it.

Thanks for caring. I'll be back at some point. But we're doing ok.

- C


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My Smoosh

He's pretty sick, but stable. He's in the pediatric ICU, and getting great care, but I'm really scared. Pray/think/do a good deed for us, if you can.

Thank you.

Hand-eye coordination, or not

Things that I am embarrasingly bad at, that are more embarrassing because I think people will assume that I am a bad surgeon as well:

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In my defense, the anti-frizz hair cream bottle looks a lot like my face sunscreen bottle.

I was going to write a whole post on busy labor floors and safety; I wanted to address anonymous's very important comment. The post was going to have a tiny umpire on it and be titled "Yer Safe!", but it's going to have to wait.

Here's the abridged version of the last month or so:

Week 1:
Return from family trip to my parents' house. Wonderful, exhausting seeing family. Traffic means that the last 7 miles of the trip take almost as long as the preceding 150. We unpack after midnight.

This week, Smoosh stops sleeping through the night, then starts again. Work is busy, I'm still adjusting to the new office (the one near Whole Foods!). I cap off the week with a night on call, and it's nonstop, including a postpartum hemorrhage right at 8am when I'm supposed to go home. I get home late, but I find parking right away which is no small blessing.

Week 2:
Uneventful weekend.

On Monday, Rav and Dav move to Smoosh's daycare. We have a smooth transition during the day, but Dav starts screaming for 1-2 hours at bedtime if you leave his room, or really even stop making contact with his hand.

I can't be there to drop the babies off or pick them up because I'm the MFM attending on service, taking care of the antepartum hospitalized patients during the day as well as overseeing our antenatal testing center.* It is...hard.

There are several cardiac patients, one truly terrifying-may-not-survive-this-pregnancy patient. I follow a colleague's plan to deliver a sick pregnancy, baby dies for unpreventable reasons. I make the call to deliver another very unexpectedly sick pregnancy; it's a non-controversial decision, and I didn't have much choice. The baby dies for unpreventable reasons on day-of-life 3. I spend a lot of time with the patient and her husband. I don't cry.

I come home late almost every day. On Friday, I come home at 8, put the kids to bed, and then sign charts until almost 11 pm. When I stop, I'm not on service anymore, and I go to sleep.

Week 3: 
Weekend of school planning. Smoosh needs supplies, because he is going to real school (pre-K).

On Monday, Smoosh starts new school. I completely fall apart at dropoff, and am so surprised that I am still in the room with him when this happens. "But he's been in school since 12 weeks of age," I bawl at the nice administrators who try to pat me on the back.

This week, school has "transitional schedule" (AKA let's fuck with working parents**). Ninety minutes of school the first day, 2 hours the second, no bus until next week. Friends help us out, the Bearded Economist and I both cut corners when we can, and we get through. But what I really want to say to those school administrators who are patting me on the back is this: "If you want me to stop crying, you could help a lot by not making this week's schedule completely impossible for any family not living in the 1950s." I refrain.

Things feel stressful and like we may, at any point, find one of our children wandering the streets. This does not happen.

I spend a lot of time at work seeing patients, but also cleaning up from last week - following up plans I started, billing for visits that I didn't have time to submit, checking labs on people that I sent home.

I go to a yoga class, held on a roof at sunset after kid bedtime. It rains, but we keep on going. It feels just a little bit crazy, and  I can't stop laughing.

Dav stops screaming at bedtime after a lot of bedtime routine adjustments. In exchange, Rav starts waking up, inconsolable, at 2 am. On the weekend, I'm so tired that I put hair cream on my face.

Week 4:
Busy weekend. Everyone has a cough. I'm planning Smoosh's birthday party.

I can't fall asleep because I am worried about Smoosh riding the bus tomorrow, and because I am sure a baby will wake up at any moment. Everyone sleeps until 5:30. Smoosh gets on the bus, and I think he's ok. I only cry after the bus turns the corner.

I have a research day today, but I'm writing this instead of editing my paper.

*This will be mined for many, many future posts. I just need a little distance, is all. 
**Oh, yeah, I'm mad. I'm perceiving this entire school schedule as warfare on working parents. What the hell, schools? I can guarantee you that the "transition" may have been "gradual" at school, but the measures we had to take to make that possible meant that the net gain of trauma-free-adjustment is negative. And yes, I am aware that this is merely the harbinger of years to come. 

The Beginning of Your Night on Call

There are nights (and days) on labor and delivery that defy both description and credibility. I think that when I talk to laypeople, the sheer density of what can happen in a short period of time seems overly dramatic. But it does happen, and when it does it's...crazy. It feels almost like what I think war must feel like, a bit.

I wanted to give you a taste of that, and my attempt is below. It's a pretty reasonable re-enactment of the clinical load of my first few hours of my call last week (although clearly, not of the actual patients). The labor floor is not always this dense - we spend a fair amount of time shooting the breeze at the nursing station - but when it's bad, it's bad. Here is a partial description of the start of one very busy night on call, and I think it's a pretty fair one.

Aside from changing all the patient details, I also omitted the other attending. But that's actually because he had his own stuff going on, including a patient with an ectopic pregnancy that he took to the OR. So although there were more resources available to me at times, I dealt with a lot of this as the sole attending. I did have a great cadre of experienced senior and chief residents, so I wasn't as alone as this post makes it sound in terms of getting stuff done; but I was alone in terms of higher-level decision making.

 I also omitted a large part of doctoring, which is documentation. Everything below that I did is something i then had to sit down and write a note about. It's not exciting, but it's necessary, and it uses up an enormous amount of both time and brain space. But it isn't exciting, so I left it out.


You walk onto the labor floor at 5 pm, after a long day at the office.

Patient A. is 38 years old,  pregnant at 36 weeks with chronic hypertension and three prior cesarean sections. She was sent in from clinic with very high blood pressures, which are not that unusual for her, but things then calmed down. The day team has de-escalated, stopped her magnesium sulfate*, but now she has a headache, although it's mild. You ask the team to give her tylenol, and recheck her pressures, which are a bit high but pretty well-controlled.

Patient B is a young healthy woman 8 days past her due date who came in with her water broken. She progressed to 4 centimeters, but is now incoherent, and asking for a cesarean section. She's hyperventilating, and the fetal heart tracing looks kinda bad, probably because she's not breathing that well. Over twenty minutes, you talk her down; together you decide to try an epidural. When she's doing the yoga breathing that you do with her (with an oxygen mask on), the baby looks a lot better.

Patient C is a patient with a quiescent auto-immune disease who is 27 weeks pregnant and fell down three stairs, hitting her belly. She has no contractions, but she's very tender all over her abdomen, so you put her in the PACU** No steroids for lung maturity yet; let's see what her labs show.

Patient D had a cesarean section yesterday with uterine atony1. She had a blood level hematocrit of 21 after her surgery, so she was transfused two units and sent to the floor. The resident tells you that her hematocrit is now 20, which means that those two units of packed red cells you gave her did absolutely nothing. Concerns include that perhaps we wildly underestimated the amount of blood she lost, or that she is continuing to lose blood. You ask for a stat repeat hematocrit, and that the patient be brought to the PACU so that you can watch her more closely. She may need to be re-operated on..

Patient A's headache is now a bit worse, not better, an hour after the tylenol. Her blood pressures are still ok, and she does admit to having rare migraines in her pre-pregnant life. Perhaps this is one? She also has not had protein in her urine, so she doesn't technically yet meet criteria for pre-eclampsia. You hem and haw, but eventually give her one tab of a stronger medication, which should knock out a migraine. If that doesn't work, you'll have to start thinking that this is actually pre-eclampsia, and if the headache gets worse, it could even be a stroke.

Patients F, G, and H are all scheduled inductions in the waiting room. You can't accomodate them all safely during this busy night so you review the charts. F has a good clinical reasons for induction that should not wait; you'll bring her in as soon as you can. G will get fetal testing in triage and be rescheduled in 1-2 days. H's dating, upon review, is wrong - she's 38, not 39 weeks, and as such really shouldn't be induced for another few days, especially since the indication for induction is pretty soft. You walk out to the waiting room to talk to Patient G, who is very nice about it. Patient H is not, which is understandable, and spends about 20 minutes yelling at you, which becomes slightly less understandable as it progresses in aggression. You call her doctor on her cell phone and talk to her together about the plan and about the small but real risks of delivering a baby before 39 weeks who didn't need to be. The patient grudgingly accepts an induction in 5 days' time; she'll work the details out with her doctor. She doesn't look at you, and slams the door on her way out. 

While you're finishing up the paperwork from these discussions, Patient E rolls into triage, screaming that she has to push. She is examined in a chair - there are no available beds - and yup, fully dilated and head is at  +2 station. On the wheelchair towards a labor room, you get out of her that she had a prior cesearean but wanted a trial of labor. The triage nurse tells you that she was here earlier today but was not dilated at all. You bring her in the room, and get ready to have a baby.

Patient A now has blood pressures in stroke range, 180s-190s systolic. You cross over to her room, and push some more medications. Her blood pressure goes down; you ask to restart the magnesium, send more labs, and you go back to Patient E.

Patient E delivers. It's a girl! Pink baby girl with lovely curly black hair. The chief resident delivers the placenta  and finishes up while you keep an eye on A's pressures in the next room over.

A resident stops you in the hallway. Patient D hematocrit has come back, and praise be, it's 25.2. That earlier one must have been drawn downstream from an IV and been a diluted result. The patient looks - and feels - pretty good, so you  write a note about her adventure, and back to postpartum she rolls.

The 27-weeker with the abdominal trauma, Patient C, has labs that are mostly reassuring, except that her blood clotting level is strangely low. That result could be a sign of a large abruption. The story doesn't really fit, as she overall feels well aside from the aches and pains from the actual fall. No vaginal bleeding, no contractions, the baby looks great. Weird, so you decide to resend the labs and some other ones and watch her closely. Given the labs, and her gestational age, and her overall abdominal tenderness, you start the antenatal corticosteroid course, just in case she does go on to deliver soon.

Patient B's nurse is calling. The patient is comfortable overall, and got some much-needed rest, but is feeling some pelvic pressure. You examine her and she has an anterior lip of cervix left2, with a baby that is quite low and ready to be born. You debate having her try to push while you reduce the little bit of cervix, but your nurse is needed in another room, so you decide to let her labor down for 30 minutes.

Patient A with worsening pressures and headache on the magnesium. Labs are still normal, but you note that she had some protein in her urine at the clinic visit. Regardless, she's getting pretty sick pretty fast. You make the plan to start to head to the OR to deliver, but the headache worsens suddenly and dramatically. Plan change: get blood pressures under control, then a fast trip downstairs to the head CT scanner, with a doctor and the magnesium in tow, to assess for stroke. If head CT negative, return to the OR for delivery. If head CT positive positive? That's an excellent question. If positive, you'll call neurology and figure out how you'll get her delivered with them.

Patient B is now feeling the urge to push. Now that she's rested and is calmer, she turns out to be lovely and pushes with great energy. Twenty minutes later: it's a boy! The new grandmother is in the corner, actually jumping up and down with joy. You say congratulations and run out.

There's blood on your scrub top somehow, so you run out to change. The resident stops you to tell you that there are three new admissions in triage. Perfect, you say. Once I do this section, I'll have three more rooms for them.

You run upstairs, strip, change, glance at the clock. Somehow it's only 10 pm, with miles to go before you sleep.
Epilogue: It never calmed down, and in fact, got rather busier with a sick antepartum patient, a cesarean that became unexpectedly complicated, and a bus full of laboring women (well, three) who all came in together at 3 a.m. I ran almost flat-out the whole night long. I think I was pretty openly grumpy about this [to staff, not to patients], which I am embarrased by now.

At some point around 4:45 am, I lay down because I needed to, and I think I slept until I got paged by an outpatient about her renal infection. I went home at 8:30 am, snuggled Rav and Dav, took Smoosh to a doctor's appointment and then crashed very, very hard. Later that day, I found an enormous bruise on my left leg; I don't know how or when during the night I got it, which seems appropriate.

*Used to prevent the onset of seizures in pre-eclampsia. 
**Post-Anesthesia Care Unit; the area where patients recover from surgery, but we sometiems use it to monitor other patients who aren't in labor.
1The uterus does not contract after delivery of the baby and placenta, leading to large amounts of hemorrhage. 
2Basically, she's 9.5 centimeters dilated., 

Attending to this, attending to that

Being a new attending the first time around was really stressful. I was a new generalist, at a lovely community hospital, so the level of acuity that I was seeing was low. Regardless, I remember worrying about every decision anyway. I felt like I had homework all the time because I would a) see a patient b) make an interim plan c) have them come back very soon - a few days, or a week, even for something relatively routine and d) run and frantically look up stuff and email attendings from my residency.

I wonder now if that wasn't so much "new attending-ness" as "new-situation-ness". That is, I probably would have been more comfortable in a place with a higher level of acuity and sicker patients (similar to what I had seen on a daily basis as a resident). I also was very worried about what other providers would think about me: that I was dumb, or lazy, or just a bad doctor. 

So I was really apprehensive about this new attending thing. And, shockingly, it's been actually mostly...totally fine. Sure, the patient with intractable eclamptic seizures that was in the ICU on my very first on-call night wasn't exactly relaxing, but we managed it (although I remain grateful that she actually came in to the hospital before my shift. Then I read a lot. Next time I'll be ready!) 

It helps that the faculty that has hired me seems genuinely excited to have me on board. They know me already, so I don't have that social/professional anxiety. 

I did a difficult cesarean with the residents - it went ok. I managed a complicated patient on blood thinners before, during, and after her extremely preterm delivery - she did ok. I spent a lot of time this week talking to women at 24 weeks gestation with little or no residual cervix about their options - and that felt ok.  I said to one of my attendings (excuse me, ahem, one of my new practice partners), "The truth is, every time I see a patient and I actually know what to do, I am a little giddy." 

I am braced for the patient with conjoined quadruplets and a rare platelet disease, but in the interim, it seems that I've actually trained well for the job I'm doing, with the people I do it for. 

I'm scrambling to finish a little geocoding study that I've been working on, as well as getting my thesis project published, and I find myself - as usual - oversubscribed. But not, for the moment, overwhelmed; and that is quite nice. 

A Kaleidoscope of Creativity

Over the past few days, Circus house has been buzzing with wonder and excitement as we further explore creativity!  We’ve focused our animation to examine the existence of and potential for creativity in everyday life.  After collecting audio interviews from different community members and animating a menagerie of household objects, we’re bringing it all together!  Concurrently, we have been exploring questions of process and collaboration in how we make animations together.  Daily group discussions have informed our storytelling and editing processes, and we are all looking forward to sharing the results.  
The newest Tiny Circus animation will be screened tonight at a Circus House hosted potluck with dance party to follow...
In DUCK NEWS: More excitement and more ducks! Four newborns hatched in one day, increasing the current duck count to 14!

Creativity and Ducks

Exciting things have happened at the Circus since our last post. Most of our animation for the Creativity Project has been shot and we're moving on to editing. Our sound department, which was a team of one for a while, has moved past its first edit and has welcomed new additions in recorded material and in team members. The project is moving forward and it's looking good. The whole circus is excited and rather passionate about the project at a personal and professional level and we all want to see it finished and done right. Everything we do seems to both intentionally and unintentionally shape the direction of our project. From our daily discussions at the drawing board to the actual shooting of the animation, everything seems to be serving a purpose that goes beyond just making an animation to creating something truly compelling as a fully collaborative community.


We've also put up some handmade curtains sewn by our very own circus folk.

And as for the most exciting news of all our ducklings have grown quite a bit! They've joined the big ducks in the yard and have grown tail feathers!

Summer Session 5 --- June 15 - July15, 2012

Summer session #5 is underway here at Tiny Circus Central. We come from local and far-away parts of the country this summer, California to Tennesee.  Over the last few days,  we've been talking and thinking about what Tiny Circus is and does and how to better engage our workshop participants and audiences in our process.  With this in mind, we've begun an animation about creativity - what it is, how it manifests in all of our lives, how thinking about the creativity that exists in our daily lives can make any activity more magical.  We've interviewed college students, ourselves, and folks from the local retirement home in order to get a broad sense of how people think about this topic - then we've talked for hours about how to create an animation about the topic.  

And after a good few days of work, we set up the speakers in the studio and invited some friends for an evening. 

Grin City Collective is a residency program in Grinnell that draws from a national applicant pool.  Residents come to work for a month in the summer, both on their own work and a collaborative project.  

More to come.  We'll be joined by more folks over the next few weeks. 

Middle Tennessee State University

Tiny Circus spent the week at Middle Tennessee University, creating an animation with a group of about 15 college students. The group decided to make an animation that doesn’t fit neatly into the History or Trap categories. We centered in on the topic of fear, and the first day we recorded interviews asking people about their childhood and adult fears. After we listened to the hours of raw audio gathered, we discussed what we heard – themes and words that stood out – and created a short audio piece to be our film’s soundtrack, and guide the conversation of our visual story.

Figuring out what visual story to tell alongside the audio piece, and coalescing around the finer points of how each of us imagined it took many hours of discussion and hard collaboration sitting around a table – about 18 hours if you really want to know.

On Day 4, the animating began. Childhood object selection, shadow tracing, then shadow cutting, followed by animating the shadow movement required patience and precision, and at 11 pm when we finished the first half of the film, we decided to remake (i.e. simplify) our ideas for the second part. Throughout the epic day of animation, there was an exciting collective energy. We were working together, making something. 

Day 5 we brought the sound and images together. Editing as a group with the Final Cut file projected on a screen, we talked through various ways of arranging the images and how many moments of looking felt necessary. Sometimes it was hard to find words for why we liked one arrangement more than another, but striving for those words feels like a necessary challenge. 

Fear debuted at the MTSU Student Film Festival. 

[A special thanks to David Kamp, our documentarian for the week, who took many of the photos above. Keep an eye out for a short documentary of our week that David is creating.]

A Sidewalk Show at Artspace in Raleigh, North Carolina

On Friday night, Tiny Circus presented a sidewalk show outside of Artspace, projecting our animations out of the airstream for all walking by to see. It was a lively night in downtown Raleigh, with many people passing by on their way to the First Friday music and art exhibitions at Artspace. We were thrilled to present our two new animations from the local Brentwood Boys and Girls Club. We witnessed some parents having to pry their children away from the sidewalk.  
We talk a lot about communicating with our audience as we create a film so it's always interesting to watch the people watching the animations for the first time. How are they reacting? Which parts of the film are people responding to in particular? After spending so much time with each story, creating the animation, it's pleasurable and sometimes surprising to watch the films alongside those with fresh eyes.

The Brentwood Boys and Girls Club

Tiny Circus lifted off from New Orleans last week, rolling to Raleigh, North Carolina for a week of animation-making with the Brentwood Boys and Girls Club through Artspace, an art center in Raleigh.

In one week we created two animations. An enthusiastic group of second and third graders in the club decided to tell the story of The History of Vampires. Biting off a topic that has been a dark and thrilling fascination for storytellers for ages, this is not an animation for the faint of heart (or tomatoes).

With the fourth and fifth grade group, an animation about bullying was created that developed out of two days of serious and thoughtful conversations. It was striking to be around a table with fifteen fourth and fifth graders and a handful of adults, with differences of age, race, religion, and a whole lot else – all of us drawing from personal experiences and observations with bullying. We reflected on questions about what bullying is, why a person may bully, and the many ways we all respond to the act. All the while, the conversation was driving towards creating an animation: how do we visualize this? How do we craft this story?

Once we decided to use fruits as our characters, a discussion about how the fruits could reflect certain feelings and actions to our audience became important. And there was even room for laughter with the enticing possibility of eating our animated objects. (Note to animators: complete shooting before eating, or the project may involve extra trips to the grocery store.)

We distilled our story to The History of A Bully and we know it can’t tell a complete story of a complicated behavior and it’s devastating impact. Our small film is what we collaboratively jostled out of a big matter. We hope that the animation that emerged from the conversation in the art room of the Brentwood Boys and Girls Club will resonate with those outside of it, sparking more fruitful conversation and action.