When we last left our heroine....

(Two freaking YEARS ago...)

I was a wee baby hospitalist.  I was finally "not a resident", but still too intimidated to actually EAT in the doctors lounge.  I had also just finished my first real season of derby, where I actually made rosters and scored points.

The not-blogged about fact what that my husband and I made the agreement to "stop not trying to have a baby... but y'know, after the holidays."

I was pregnant by February.  :)

So 2013 was the year of learning new skills: in the first half of the year, it was how to professionally exit a patients room in order to go vomit, and doing my level best to come up with reasons why I had to miss 6 weeks of derby practice.. "Oh, y, know... work..."  Later, it became how to scoop up Derby girls from the track and intubate patients even though I had... well, a person in the way.  

With our beloved Bone Collector temporarily relocated, I filled in at the team's medic for the season, still attending practice when I could and watching my fresh meat class grow.  :)

Happily, I birthed a healthy baby girl in November, enjoyed my holiday maternity leave and even got right back on the hospitalist horse 5 weeks later. (I may have cried and eaten leftover christmas cookies in the office for a few of the mornings... but I got back to it!)

  And of course, returning to derby!  The excitement was building.  After months of keeping all manner of hormonally boosted emotions bottled up - AND no booze, I was certainly ready to "hit a bish" as we say on the track.

My first practice back, I pulled myself out after an hour because I couldn't do one of the drills in what I felt was a safe manner - seems that gestating does take a bit out of your endurance and cardio status.

So imagine my surprise when at the next practice, I fall and break my ankle doing a totally routine, no impact, low speed, fresh meat drill.

FUN FACT:  You lose a significant percentage of bone density while post-partum and nursing.  Guess when I learned that fact?



Yeah, it sucked.  When I am old and sharing stories with all the other old demented ladies at the nursing home, I'm sure I will repeatedly tell the tale of how I broke my leg and was non-weight bearing for 6 weeks with an infant at home, in a two story house and a husband that worked 24 hour shifts.  (And still going to work!  And nursing!  For every woman who's weighed whether she can have a glass of wine between feeding sessions, I learned how to stretch out a Lortab like a champ...)

Thank God for my parents.  For serious.  Especially because my orthopod nixed my plan to just deposit Diana in the little basket in the front of my three wheeled push scooter.

So 2014 was unfortunately not my triumphant return to skating.  I did sell the shit out of some merchandise, thanks to an adorable little helper.  :)

And where does that leave us now?  Well, my good reader - now that I have finally come to grips with the guilt that defines almost every working mother (see future post "You HAVE to shower" for details).  I'm starting to train back up.

And I'll tell you about how I actually talk to other attending physicians now.  Sometimes I even call them by their first name.

Except for Dr. R.  Because I suspect God himself wouldn't call someone that badass simply "Jim."

Level up

If the fact that I have a blog on the internet hasn't already clued you in, I'm a bit of a geek.  And by "bit of" I mean "was raised on video games and Dungeons and Dragons in the way that most teens gossiped on the phone after school or threw balls at things for points"

So to this day, if you give me some sort of objective number to measure and strive for in order to do a job well, I AM ALL OVER THAT SHIT.  If you really want me to get revved up, there needs to be a level of complexity that I can analyze and figure out if option A or B is the way to make number X go up or down.

Hospitalist medicine thrives on these kind of metrics.  Length of Stay, Case Mix index, mortality rate, core measures, relative value units... you can make spreadsheets for days.

It's funny, back in the day "being a good doctor" meant that all your patients were happy, nobody died when you could help it and you kept your white coat clean.  Now, with pressures from patients, insurance companies, healthcare reform acts and your own hospital, it means:

"make the patient better as quickly and inexpensively as possible in a way that meets national standards and they stay healthy once they leave.... and while you're at it, document everything that you did in a way that will maximize the amount of money we get paid by insurance so we can keep the doors open and the lights on."

(For extra fun, try and say all of the above in one breath.)

But hey, I knew exactly what I signed up for when I got into this whole "medicine" thing.  Because I love it, and I do want to be a good doctor.  So we come up with better history & physical forms to make sure we've documented all our patients' multiple and colorful chronic ilnesses, so we can take better care of them and get more money at the same time.  And my numbers go up and I'm happy.

And then when I'm exhausted from all of the above, I put on my running shoes and flee from hordes of shambling zombies.

No, really.

As a blocker who is thinking maybe.... just maybe this jamming thing might be fun too, (Click here if you don't remember the difference) I've had to up my cardio and endurance training.   Given my crazy schedule, I needed something that could be done at almost any time with minimal equipment... which means running

I hate running.

But I love zombies.

Enter Zombies, Run!, a smartphone app that turns running into a pseudo role playing game - you run, and while you're pounding the pavement, the program breaks in with "radio broadcasts" as you listen to a playlist of songs.  Even better, it tracks how far you've gone and lets you pick up items to take back to your base to build up your defenses and open new missions.  So yeah, all of a sudden running is fun again.

Especially when you turn on the interval training mode and it forces you to sprint by playing sounds of zombie moans getting closer and closer... 

But it was the amount of data they collect on you that really got my motor running.  

Now I know which songs I run faster to, how steady my pace is over the run, calories burned and how I do on the sprints.

I should amend that the data in the first screen cap was on skates.  Turns out the only drawback to using this program while on 8 wheels is that you occasionally come to the end of a neighborhood cul-de-sac and even the fastest turnaround-stop means you get your brains eaten. (Hence why I only evaded 1 mob on that particular mission).

The best part, though?  It's kind of like having Eenie Meanie, the vet I always thought of as my derby mentor with me...or at least the zombie version of her.  (You thought doc-roller girl was a good combo? Try undead derby badass.)

Today You, Tomorrow Me.

One of the things I have noticed among my roller derby teammates is that everyone keeps their gear bag stocked with "extras".  Tampons, tylenol, toe-stop wrenches - the essentials for skating.  And it's an unspoken rule that we all share.... even down to the mouthguards.  (Yes, really. Thanks LowBlo!)

Duct tape is especially crucial. Matching laces are just a bonus

Because we've all been the one to show up at scrimmage night with the wrong colour shirt (which recently led to some interesting announcing as two Maggie Kill'n'Brawls lined up on the jammer line... along with some nasty Maggie-on-Maggie violence.) and appreciate it when our teammates help us out.

The same rule applies in medicine.

It had already been a stinker of a day - the IT system maintenance that was supposed to end "in the morning" rendered every computer the equivalent of a LCD paperweight until late afternoon, we were short staffed despite being at No-Room-At-The-Inn capacity for three days straight.

So when the "uncomplicated pneumonia" patient my colleague received from the ER at 6:30 PM on a sunday turned out to be "Oh, Holy CRAP this one is sick" in that internal medicine way - only fixed by personally calling in three consults tonight, running a battery of tests and remembering which serologic marker is affiliated with which nasty auto-immune disease and marching down to the lab to check on the peripheral smear yourself, we rallied.

I knew one of the lab techs and called over to see if they could whip up a slide for us real quick so I could go down and render my verdict (using my pathology skills, which are limited to "That's screwed up" versus "That looks ok").  Anurita had the consultant's personal phone numbers and called both of them before it got to be too late in the night.  Everette had UpToDate open to see if there was anything we forgot to order.

In the meantime, the originally assigned doc had enough time to go back and review the fine details - oh wait, you started taking a new antibiotic a few days ago? - instead of scrambling to get all of the above done.

Which finally brings me back to the title. 

Recognizing that it could just as easily be you left without extra socks or with a patient who can't leave until someone gets them a prescription for their walker is what makes my teams work so well.  It's why I chose them, and it's why I stay.

We even have lockers.

High School never really ends.

Even though I've recently graduated from what could be considered 23rd grade, the refrain remains the same.  Where to sit, who to talk to, what's my locker combination... even the mortification of a bad yearbook photo is repeated when your well-meaning department uses your passport photo (taken after running into CVS through a rainstorm underneath aggressively unflattering fluorescent lighting) as the photo for the "Welcome to Memorial" slideshow that runs on a cycle in the lounge.

You also have a good view of awesome
visiting pharmacist lecturers

The "where you sit" is a big one.

As a resident, I had risen to the top of the food chain - the chiefs had standing "dibs" on the three seats closest to the door during all noon conferences, ostensibly because we were repeatedly getting called out to fix administrative problems or address concerns from the interns and attendings.  (More honestly, it was because we'd then be chosen after 1st and 2nd years for "And can anyone explain why we don't use cephalexin for complicated soft tissue infections anymore?" sort of questions)

But I had to earn it - I first had to sit allll the way on the lefthand table, with the attendings sitting between me and the door.  As upper levels, you graduated to the table near the door - but you still had to sit towards the front.

In front of said bench, with an early
version of my bout "war paint"

Same as the fresh meat.  We always geared up on the benches closest to the glass - at first because we were terrified of the vets and moved in a pack, like antelopes navigating the Serengeti.  Then it was because that's just where the meat sat, and we always had things to talk about amongst ourselves. (Usually about what new gear we had finally purchased or how we'll never understand the mechanics of "Cut Track, Major")

I'm happy to say now that I feel much more at ease among the seasoned skaters, and have graduated to the back bench on occasion.

The meat still stick together frequently, but now it's just because we're super-cool and have secret handshakes and whatnot.


So the last frontier is the RDL.  The mythical "Real Doctors Lounge", so named by the resident for its tales of free, actual breakfast (true.  And dangerous when there's freshly made biscuits and sausage for the taking) unlimited coffee (true, but... barely coffee) and secret cabals of attending physicians chanting incantations to punish residents who don't do their dictation summaries on time. (none that I've seen so far)

In the resident lounge, you could argue about which subspecialists in the hospitalist were the cutest (one of the gastroenterologists) or what shenanigans had gone on in the call room. (None, that I can verify)  We were all equals in there - equally stressed, equally low on the totem pole.

Now, when I walk through the RDL, I'm fresh meat again.  In derby, you're intimiated because Pinot Gringo's ninja hip checks are deadly or Ira Fuse's transitions are effortless.  At the hospital, it's because the cardiothoracic surgeon has been cracking chests since before I graduated high school, or that the pulmonologist has the precognition of Yoda when it comes to respiratory failure and septic shock.

Don't get me wrong - I'm happy to discuss my patients at length with these people, and I will call them at 4 AM if someone is crumping (highly techinical medical term for "They don't look so good"), and they will be friendly and professional in turn.

I just don't know if I'm ready to sit down at the lunch table and share my fries with them.  We'll see.

eta 15 min

So, the name.

Derby names thrive on puns - either on names (my fellow fresh meat Aurie O' Speedwagon) native homelands (our transplanted Texas Chainsaw Mascara) or other distinguishing characteristics (the adorkable Nerd Degree Burn comes to mind).

I knew I wanted something medical, and to my endless frustration "Anna Flacktick" was already taken.  "Sue De Moan Us" was too obscure and we already had one Catatonic on the team.

And then I was sitting in the lounge, playing the semi-morbid, definitely black-humor mandatory game we play as residents.  It's the response/protocol game.

Each time a trauma victim hits the ER, the team is notified via page of either a protocol or a response.   From there, a strangely elegant choreographed sequence of events take place.  The involved members gear up in bright red leaded aprons over scrubs, the extra-bright, extra-hot overhead lights get powered up and roles are assigned.  One to do the primary survey (the beloved ABC's of airway, breathing and circulation), one to get an arterial blood gas to get immediate results on hemoglobin, acidosis and oxygen saturation, one to fufill the "finger or tube in every orifice" mandate of trauma evaluations.

(And one to in the darkness, bind them.)

I've been in on a handful of Trauma Protocols myself and it's amazing to be among all these fantastically skilled people, moving in tandem to achieve one all-important goal.


Really, there was no option when it came to picking a roller derby name.

The difference between Trauma Protocols and Responses (which does happen to be my dear husband's name) usually relates to how unstable the patient is when they're evaluated outside the hospital.  Intubation and on the ventilator automatically gets you protocol status, same as a blood pressure less than 90 or a glasgow coma scale less than 10. (incidentally, that was also almost my number, but since almost every page is estimated to arrive in 15 minutes, I had to go with it) Responses require injury to 2 or more body regions, spinal cord injuries or to be stabbed somewhere relatively important.  Suffice to say you don't want to be either... and not just for the finger/tube in orifices part.

The photo above is an example of one of the pages.  Demonstrated by "Trauma BROtocol", as James is my brother from another mother, even when he's grumpy from being on said Trauma team all month and I have to cheer him up with artery-clogging breakfasts.

Which (finally) brings me back around to the game.  When the aforementioned pages come through, resident the first holds the pager to their forehead, Johnny Carson-Carnac style, and the rest of us try to divine the nature of the injury.

I am terrible at the game, for the record.  It would help if I stopped guessing things like "accidental spearfishing injury".

Team sports weren't really my thing

The last team I played on for any kind of organized sport was called the "Blue Bombers".  Summer youth soccer, the kind of team where everyone gets play time and the only real identity is based on what color jerseys we were issued.

Though the orange slices that the parents brought for halftime were pretty ace.

That's not to say I didn't love being part of a team - high school, and even residency were filled with great team experiences... however, they were primarily related to medical trivia, odyssey of the mind.. and of course the historic run that was the Port Huron Quiz Bowl 2000-2001.

Doing my part to dispel the myth that derby girls are somehow "cool"

But the trappings of my first "real" game were... new.   Everyone going through their pre-game rituals, figuring out how to patch up "I really need to get new wrist guards" gear and doing our best to guard against floor burn via layered tights and duct tape.

I knew from movie and television tropes that there's a "give em hell" pre-game speech from the coach in the locker room.  It was another thing entirely to look at my teammates in full battle dress as we all listened to the heartfelt and inspiring words, feeling like I belonged with a group of women I'd spent the last year idolizing.

Go ahead, try and figure out who's skating for the first time in this photo.  

I fumbled awkwardly with my helmet for the first few bars of the national anthem, until I could look over and see what the vets did with theirs.   Truth be told, I was absolutely certain that my newbie status would be painfully obvious from minute one, that the other team would see me as a weak link and target me.  (I later learned that while the other team did deal out some profound hits, it wasn't because they scented blood in the water.)

Getting low is my only recourse against these
women and their mack truck hits.

The other trope that is completely and utterly true is that you don't hear the crowd, the announcers, or anything but your captain, pivots and bench managers.   Your focus shrinks to the red jerseys, the rope and tape-lined track boundaries and the steady stream inside your own head "Reform the line! Watch for the jammer.  Get low, brace for the hit!"

Now, if this were television, I'd be back with the story about how we pulled out a stunning last minute win to thunderous applause and my unexpected turn as a jammer.    But because this is real life, we got beaten by a team who had our number - as much as we took the fight to them, worked on strategy for weeks and left our hearts on the track, they were the better team and walked away with a win.

I will someday use this photo as proof to my children that yes -

 for a single moment, your mother was both cool and tough as nails.

The upside is that I learned a whole hell of a lot, and so did my teammates - we learned how to fine tune our offensive and defensive decisionmaking, and ways to control the pack.

And if there's one things you can guarantee from the Savannah Derby Devils is that we're going to have a blast on the track, win or lose.

And as the addendum to what was already an experience to last a lifetime - we were given the opportunity to come back out onto the track to scrimmage our A team at the end of the night.  Talk about ridiculous amounts of fun - even though putting on just worn, cooled off gear is the derby equivalent of sleeping in the wet spot.

Trauma Response

Roller Derby is a Team Sport.

You've seen many of them already, heard me talk about the Devils I skate with for 6+ hours every week.  Women like Ace & Eenie Meanie, a derby wife combo who had endless amounts of patience for us fresh meat when it came to teaching, or Drrty Grrl who never fails to get the rest of us fired up - either by dancing on the jammer line or her patented war cry.

They're the ones who all pile in for the Big Group Photo, to share in that sweaty happy moment at the end of a bout where you're just happy to have played the best damn sport on 8 wheels.

But there's a team you don't see on the website or in the photos.   There's the team who gets dinner on the table when work runs late but we still need to gear up at 7:30.  There's the team who cheers and buys tickets and who will still hug you after a bout when you smell like rancid goat butt.

The parents, for one - they've been my cheerleaders from day one and so now they wear my Derby Name on their shirts and share in my post-bout highs via skype.    It's been so gratifying to see the important people in our lives come together as part of the larger derby family.  From Brute's Quad Squad and Sin Derr Hella's Fella to my little sister reposting my latest bout pics on facebook, our joy is magnified tenfold when we can share it with our loved ones.

But speaking of fellas...

It takes a special kind of husband to say ok to "Hey, I know I have this crazy 80 hour a week job and we almost never see each other, but I'm just going to jump headlong into this equally bonkers sport that requires almost every shred of time I have left over after work."

But this is the man I agreed to run off with - to have crazy adventures with for the rest of my life, so of course he's going to say yes.  And so he's the Trauma Response to my Protocol, my backbone and strength when I've gotten up from that last big hit... and the first person I find to kiss when I come off the track.  (And yes, his name will be explained too - all in due time!)