it's funny how life has it's ups and downs. with every passing day here, it is more obvious to me that I was not ready to come home yet. not that I don't like it here, but I don't feel settled. that and I have yet to meet people that I actually like enough/are around enough for me to want to hang out with. that's the worst part of it. what I can't help thinking to myself, which my sister pointed out, was that this is what it would be like anywhere I went that was new. I've been lucky in the past to move to places where I already had friends or was put in a situation where I could meet people easily. That is not the case here, since the one place I spend the most time (work) is not really a place for me to meet friends.

for now, I am studying for the boards and enjoying something in my every day. for the future, who knows.

If you have gmail, I'm sure you've noticed that the ads they show on each page are directly related to the emails you send/receive.

I just broke up with someone (again). in our last emails to each other, we spoke of what went wrong/how he hurt me, etc, without mentioning the words break-up. this is the ad google posted on that page:

"can't survive a break-up? survive-a-breakup.com- proven ways to survive a breakup without losing your mind".

I'm not sure whether to cry or laugh.

He is 19 years old. Let's call him Chris. I know something about his that no one else knows. It's not anything good

Chris was not my original patient; rather, his unborn fetus was. His girlfriend (let's call her Kelly) is 19 and pregnant. She has bleached blond, long straggly hair and dark circles under her eyes. There is a smile on her face, an obvious glow from her pregnancy, which she is happy about. I can only see her smile once in a while, since she is constantly with her head down or looking slyly at Chris. He has brown hair, a bob cut. He's wearing a black sweatshirt with lined silhouettes of bare pine trees in white, blue and green. Immediately, and incidentally because of the pattern on his sweatshirt, I felt connected to him. You see, trees are my absolute favorite thing in the world, and being around them makes me feel happy.

I knew the reason why Chris and Kelly were in to see me. Still, I asked them if they knew, because not many people did. They knew. One week prior to our first session, I had offered to take on Chris and Kelly's case. I thought it would be a good lesson for me, and I'd always been intrigued by this disease. Chris's mother has Huntington disease. For those of you who know what this is, you've probably just realized that this story will not end well. For those of you that don't, you might know it if i said Woodie Guthrie died of this.

Huntington disease (HD) is a progressive neurodegenerative disorder where you begin to show symptoms in your mid-30s, with a gradual deterioration in skills and cognition for 15-20 years after the initial diagnosis, until death comes, typically by choking or asphyxiation from respiratory distress. When it starts, your behavior changes, you begin to have trouble walking, and you lose many voluntary movements of you body. Then you lose the ability to swallow, your muscles increase in rigidity and you cannot speak. While all this progresses, your brain knows what is happening, but cannot respond to to the environment. This is an autosomal dominant condition, meaning if a parent has this, any child has a 50% to have it.

Chris's mother had this, she is currently living in a nursing home. She is 42 years old, and has been there several years. Chris did not know his chances of being affected. I told him. He didn't know the natural history, so I told him. He didn't know that it was a triplet repeat disorder, meaning if he passes it on to a child it can expand and cause an earlier onset and more devastating course of illness. I told him all this.

He looked at me, almost through me, as I spoke; I'm not sure he was getting this. His eyes were shallow but bright, and he said he was ready to be tested. It was obvious that to him, mid-30s seemed light years away. He said, I just don't understand why everyone is making a big deal out of this. I thought, time goes faster than you can imagine. Apparently, his father didn't want him to be tested because he is so young, but he is an adult now, and can make his own decisions. We discussed insurance discrimination, and how his job at Burger King most likey would not be his last. This whole time, his girlfriend was sitting next to him, head down, coloring a picture in a children's coloring book, a picture of a giant hot air balloon floating off into the sky. I scheduled Chris for a follow-up appointment for his results, urged him to bring someone with him again, and sent him on his way.

Chris's result came back positive today, so he will develop HD. I will tell him this, and I cannot stop thinking about what this will mean to him. What will happen to him after this? What will he do? Obviously I am projecting my own fears of hearing a diagnosis like this onto him, and. I can imagine when I tell him, he will act as though he is calm and ok, but I truly believe that no one could hear a diagnosis like this and not be affected by it.

I wish I could write more about this, but my mind is slipping into sleep-mode. at least I can still do that pretty well. my main point is, what a fuckin mad world this is sometimes.

I recently realized two things about my life at this present time:

one. I think too hard at work. my brain hurts almost every night when I come home. I sleep "late" on the weekends now to make up for the energy it takes my brain to process information at work. late means 9 o'clock. I am still loving what I'm doing but I'm getting better at it, and I'm seeing a shit-load more patients, way more than my fellow genetic counselors. now if I could only fix the multiple deep giant gaps in the infrastructure of our department, bring in some new docs that can help us/respect us/understand what we do, and possibly move the entire hospital out west say, to Oregon, I would be the happiest camper in the world :o) for now, I'm just happy to love what I'm doing, where I'm living and being near family.

two. I like being alone just as much as I like being with someone. It's a great thing, but it can be a problem if you're dating someone who wants to spend every minute with you. that's why I'm secretly happy that the guy I'm dating lives one hour away :o) well, I'm not happy about it, I wish he lived closer, but there's something to be said for some guaranteed :me: time at least twice a week. such as tonight- I did nothing but catch up on phone calls and watch a DVD of what not to wear (there's only a few of them, I'm savoring since I don't have cable).


in general: life is good, and it's heading in the right direction.

today, I had my best genetic counseling moment to date. it was completely unexpected and surprised the hell out of me.

the scenario in brief: a patient of mine, several weeks ago, found out her baby has a chromosomal abnormality. this happened after several mishaps with her testing results (none of which were my fault, just a side note). She cried every time I saw her, every time I called her on the phone. She even said to me "I don't know why, but just the sound of your voice makes me want to cry". Not exactly the kind of effect I want to have on people, but that is the nature of the beast.

We talked at length with this couple about whether or not they wanted to continue the pregnancy, and last week she had a termination. This is the first patient I have helped through this process. I thought about her all week, through the weekend, wondering how it felt to come to the hospital with a 17 week fetus growing inside you, and then 2 hours later, leave without it. maybe she feels empty, guilty, sorrowful, relieved. I sent her a thinking of you card and some information about support groups, and resigned myself to never hear from her again, always wondering how she was coping.

Today I got a phone call from the front desk saying that she was here and wanted to talk to me briefly. I got extremely worried about what she wanted to see me about- I had felt throughout our consultations that there was a disconnect between us, that I wasn't supporting her as well as I could, or not saying the right things. I found her and told her I would be happy to have her come into my office. The nurse took her into my office after they had finished, her eyes already red and swollen with tears.

Before she even sat down, she said she wanted to thank me, so much, for being so kind and helping her through this. That she was so grateful for all that I did and how much I helped them. At that point I was already fighting back the tears, but I could feel my soul just leaping into the air. She said she'd been thinking about me all week and just wanted to come see me and say thank you in person. I told her that I had been thinking about her, and wondering how she was, and that's when I started tearing up. We ended with a hug, and an equal desire to never have her in my office again, unless it was for routine screening.

After this happened, I went and told one of the GC's in my office what had happened, and how profound of a moment it was for me. With very strong intonation, she said "hold onto that. hold onto it, because you'll need that feeling in the future". And she is right. In the four months that I have been doing this, I have already experienced ups and downs in considering the depth and quality of my skills as a counselor. This experience I had today has lifted me up for now, and I'm sure many more in the future will, but there will also be ones that drag me down. I can't let it get to me, and even though I know I will, I recognize that there will always be people I can help, and some that I cannot.

what an awesome job I have.

in the last few weeks, I have been on 4 dates with different guys. the only thing I had in common with three of them were that they were jewish, and the only thing I had in common with the fourth guy was that I didn't want to call him back. is it so hard, forces-that-be-in-this-vast-universe, to connect me with someone with whom I have an INKLING of interest in? a spark, even if it lasts for just a few moments: it would be just enough to remind me that I'm capable of feeling passionately about someone again.

Actually, there is something else I have in common with these failed dates. We are all searching, some of us more desperately than others, for that spark with anther, the kind or spark that cannot die. We see other couples who have it, and we wish it were that easy for us. And when we meet another person who we fail to connect with, it makes us that less sure that it will ever happen again.

Ironically, my life in Utah was a lot less complicated than it is now. At times I find myself wishing I lived there again. It's a different kind of pressure now, with completely new and different expectations. There are many things I still need to learn for work, and I know they will come in time, but it's not easy getting there. Now that I'm here and meeting new people, I find myself trying to hard to make it work. This is not how I should go about it, but I feel pressured by everyone and myself to meet somebody. And I'm not used to not having a buddy, someone that I just hang out with whenever I feel like having someone around. Yes my sister is here and that helps a LOT, but she's got a family, and it's harder for her to hang out for solo time.

Well that's it, that is the crux of what is floating through my mind these days. That coupled with the fact that I wake up in the middle of the night reviewing charts or counseling people. I guess that means I'm working overtime, right? Even if my body isn't, my mind sure is these days.

I need to stop dating for a while. The disappointment is just too damn much. That and I can't seem to give guys the hint when I'm not at all interested, thus the resultant 4 bad dates. I need to find other things that I find fulfilling. I need to go hiking some more. Anyone care to join?

I miss Utah. a shitload. If someone told me 5 years ago that I'd miss living in Utah I would laugh till I peed my pants. Those mountains, that jagged silhouette against the blue sky, that was something to see every day. Inspiring, really.

My arms are getting way less muscle-y again. Time to ask wolverine man for a free physical training session! let's get physical, physical! yeahh. In all seriousness though, I think I've found my favorite gym! The things I love include the classes, my new friends in the classes, the hot hot men, and the windows all around. Oh and there's a sauna in the locker room!

Who will be the next president of the US? I worry about McCain, I worry about Obama.
Obviously I will vote for Obama, but not because I like him very much. Only because I disagree so strongly with McCain/Palin on so many important issues (abortion, drilling, war). The abortion issue alone is a dealbreaker for me. I cannot in any good conscious respect someone when they outwardly judge the choices of others.

Will that patient's child have Down syndrome? Will she have EDMD? Today we found a common chromosomal inversion in one of my patient's, and it was the first time I got a result that I was completely not expecting. It didn't mean much, and the patient was the perfect person to give it to since when we met, she told me "you don't have to sugar-coat this stuff. just tell it to me like it is". I LOVE what I'm doing, I love that I'm the first person that was called about this result, that I was the one who calls and explains this to the patient. love. it.

Him. I only liked him for the sake of liking someone, wanting to be liked back. and also, how is it that in all my last three serious relationships, the guys all met someone right and started serious relationships after breaking up with me. NOT encouraging. I almost want to keep in touch with him to find out if this is a pattern. Anyway, I am lonely again, even after three dating offers in one week. no good.

Will the cancer win? If so, when? and what will it be like when it happens...

I know, it's been a while.

I'm looking back at pictures now of all the places I've been in the past few years. So nostalgic am I that the cream of the crop are going into a folder to be transferred to my work computer as my new screen saver. There is a giant, wide, toothy grin on my face right now. For the memories, for the fun, the knowledge, the views, the people, the place. And for the new life, different though it may be, because I can feel it's heading in a very, very good direction.

my job is...incredible. or maybe it's not even the job, but it's the fact that I am REALLY doing genetic counseling. like, for REAL. genetic counseling for REAL. wow, how did I get here? look how far I've come...

and today was a good day. My first patient cried when we discussed her stillborn baby, my second patient kept saying I was "supergreat, really supergreat" as I feeding her information about prenatal diagnostic testing, and I GOT MY FIRST PAYCHECK. let's just say that I am no longer in the poor house! *

But the best part of my day, the part that's got my heart swingin and my feet dancing on air- Today I inspired more than one young woman to become a genetic counselor. I did a lecture for a high school women's summer science program at smith college about what genetic counseling is. After my lecture, a swarm of teenage girls surrounded me with questions, comments, and excited smiles. Two girls told me that what I spoke about struck something in them and they now want to be a genetic counselor. How does it get any better than that? For those who don't know, I found out about GC in high school, and it has always been my DREAM to teach high schoolers about the career that I love so much.

This next statement may seem like it's a bit of an exaggeration, and I assure you, it is the truth. the other day I realized that every year of my life has been better than the last. this may not be a good thing as now I have some serious pressure on each coming year to top the last one.

this is how it's supposed to be.

*well except that I have about one million people to pay back, but I'm ignoring for the moment.

the epic journey is over. what used to be a new beginning, two years of unknowns that loomed ahead of me in the distance, has now become a distinctive and unforgettable part of me. i am back where i started, not in the exact same place but in very similar circumstances. i didn't know what to expect, or how i would feel, and i'm still grasping for reality during many parts of the day. utah is over, there is no going back now. noho is my future, i am running towards it faster than i expected or could imagine.

yesterday i watched as several nurses dripped saline and toxins into my father's arm. he lay on the pale blue chair, and the machines beeped at the slightest bend of his arm. it seemed almost normal, though it was my first time going with him. he is skinnier now. the night before we celebrated my master's degree with greasy chinese food and a scorpion bowl for two, which got us both buzzed immediately. he has chemo brain, evidenced by questions he asks that i answered moments earlier, or simple words such as "kareoke" that can't make it into his mind. it's more real now, i will be seeing it more often.

it smells so green here, that is one thing that i missed living in the desert. you can literally smell the odor of plants and moisture in the air. it's a very comforting smell, and reminds me of summers past when i used to ride around in the warm summer nights to meet up with my friends. sitting on the cold sand of massapoag lake and jumping in sans clothing; making out in the damp grass at borderland state park under the stars; hanging out in cool, dank basements, watching monty python and playing pool; driving home with the wind in my hair, the late night streets empty and mysterious, dreaming about what was to come.

i can see now what is becoming most important to me. family, friends, my job. there is no order, the value i place on each is equal in my mind. i am happy to be near my family again, and my wonderful friends. i will miss utah more than i can say or express to any of you. i am a different person now; i can't explain how except that i look at everything differently. my life is about the journey, where i will never stop changing. and you are all part of it, always will be.

the last time I moved I was terrified of all the unknowns...where will I live, who will my friends be, what will it look like?

this time I'm scared not because of the unknown, but of what I know I am moving towards. I have changed since living here, and my heart now desires the strangeness of a new place rather than the familiarity of my settings. not to mention, my home now is this place, these mountains, these people.

I don't think anyone takes easily to change, there's always the promise of the new mixed with the sadness of leaving it all behind. But this will be an especially hard transition for me. I fulfilled my dream job, I am smarter than I've ever been, and I'm the most happy I've ever been with my direction in life. the one thing missing, of course, is a man. I will focus my efforts on this soon enough though. I came out here for me, and I have had the time of my life.

the truth is the west has won me over, and I do not see myself staying away forever....

ok I was just editing my Jdate profile (no I'm not JOINING again, merely looking to see what's available and maybe joining when I get a paycheck again soon). Anyway, at one part, I had the option of entering my income bracket. I was curious so I looked, and I am in the SECOND HIGHEST ONE NOW. I went from nothing, to SECOND HIGHEST BRACKET! Granted, I am very low in that bracket and some of the people still make double what I do, BUT STILL! I was excited and had to brag :o)

One thing I've been talking about with my friends here recently is that I consider myself a lucky person, not because I will be making a decent salary, but because I truly love what I do. I will go to work everyday and I genuinely want it to become a substantial part of my life, of who I am, and what I think about. And I feel lucky, because not a lot of people can say that about that about their job.

I left my income bracket response on my profile. I'm proud of it, but I guess I'd rather brag about loving my job so much instead of how much they'll be paying me to love it :o)

I have big news for those who have not heard. big and EXCITING news!

I got a job! I'm gonna be a REAL genetic counselor! The job is in springfield, MA, so I will be living in Northampton where my sister and my cousin both live! I'll have my own office! I can do all types of counseling! I loved the people! I am so happy about this that every sentence MUST end in an exclamation point! Really, I just tried writing this paragraph without the exciting punctuation and it just did not do it justice!

To put it into more perspective, I've had very similar dreams the past few nights. In these dreams, I am offered another job in addition to the Springfield one. I feel very torn because both job offers are appealing, but I was so looking forward to moving to Northampton and taking that job. It's almost as if my mind is unconsciously speaking to me and telling me that I made the right decision.

This is something I learned when I began interviewing for grad schools. Never in a million years, never ever did I see myself living in Utah. I love who I have become here, and I love that I came here. But I know, for more reasons than just my father's recent diagnosis, that I am meant to be back home. At least, most of me knows this. There are a lot of doubts in my mind as to whether or not I'll be happy there, and most of the time I think I will be. There are always doubts when you change to something very new, especially when you've just had the time of your life. I didn't think I'd go back, but for some reason it just feels right.

What makes this easier is knowing that the parts of me that have changed here will always come with me, wherever I go. One thing that has made this time so special is that I've had people here just as nerdy as me to talk about genetics as much as we want. I miss that when I go home. But I'll have new people to talk about it with, and my fellow GC's are just a phone call away for the times when I need to bust out a dorky genetics story.

I only slightly remember what I was like before I came here. I was scared, and sad to have left all my friends. Yet I was hopeful that it would all work out...and it did. My immediate enchantment with the beauty of this place has not faded. I will miss this place that is now my home, I will miss these beautiful mountains and the people that surround them, and I will move on to the next chapter of my life.

I have been waiting to post this journal entry since I was 17 years old when I was all bright-eyed and bushy-haired. Many things have changed since that time, thankfully one of them being my addition of hair products and eye liner. Many things have stayed the same, like my wonderful, amazing friends. My favorite song then was by rusted root, it was called send me on my way. I'm listening to it now, and it brings me far, far back to a time when I was happy....and I believed in myself.

I remember telling people that I was going to college to get a degree in biology so I could become a genetic counselor. I didn't know what it meant at that time to be a genetic counselor, and looking back at it, there was no way I could have known. But still, everything I did from the age of 17 on has led me to this place, right here.

There is no question in my mind that my arrival in Salt Lake City was nothing short of a coincidence. I can't imagine having lived the past two years of my life any differently than I just did. So much good has come to me here, so many lessons learned and knowledge gained. There have been tough times, that goes without saying, but whenever I leave here I want to come right back. The mountains are hard to stay away from, they just never get old.

The one thing I have learned here is to always, always believe in myself. I knew this in high school, but I needed to go through graduate school to really, truly understand this. It is the most important thing. Have confidence in yourself, and you cannot fail.

Coming to Utah was the best decision I have ever made. I came here for myself, because I wanted to, and I had the best time of my life. The places I have seen, the people I've met, it will all travel with me to my next destination. The contours of the mountains will be forever etched into my memory.

My life has changed. I have changed. And I love it all.

i am completely exhausted today. my body has literally struggled through every activity from morning until the present moment where it's even an effort to type these words. i remember being this tired just a few months ago when the shit hit the fan, but it doesn't help the fact that i feel like i could fall asleep at any given moment.

that being said, i was productive today, only because i have no choice but to be productive every day from now until april 25th. each day is jam packed with presentations, clinics, meetings, classes, and writing. in the next three weeks i need to:

-defend my thesis (due april 11th)
-write my paper (april 21st)
-presentation in URLEND (april 18th)
-present case in prenatal conference (april 18th)
-write URLEND paper (april 25th)
-clinics (3 days a week)

etc etc. i guess the only positive is that i am now able to make a list of assignments i need to complete before i can graduate, and that's pretty much it. there's a few loose ends to tie up, but that is it. the light is there people, i am moving towards it which is all that matters.

i picked up my cap and gown the other day and i have them hanging in my living room. i need a constant reminder that the end is near, otherwise i'm not sure how i'll make it through.

at this point, i am driving home the first week of june and i am planning to stay in the area. i have interviews at jobs in springfield MA and bangor ME at the end of april. these seem to be my best options for the time being, so we'll see what happens. i'll be excited about this once my thesis is written, but until then i am stressed the fuck out.

it's weird how one minute you're moving about in your life and nothing is different, and then suddenly something changes, and it feels like you're in an entirely new world. a world where people are now sick, or where they have betrayed you, or where you have met someone important. those are moments: big, huge moments when your world shifts and it changes.

the weirdest thing about it is that some things stay the same, so even though this immensely earth-shattering event or piece of news just punctured your ears, you still have to wake up and take a shower every morning. you still plug in your ipod and sing along to kanye west in your car on the way to work. you still saute up some veggies, boil some rice and make s stir-fry for dinner. you still laugh with your friends when something funny happens (like being flashed in class)

along the way you are hit with the realization of this new world and are thrown back into it and the magnitude of change left in its wake. but every time it happens it becomes more and more normal until you realize, it's your reality. you can't escape, you can only live it. so you might as well live it well.

i am home now, and it is wonderful to be with my family. even though the weather completely sucks, it is so good to be here. i can see my dad, and know that for now he is ok. he had his first infusion yesterday and is feeling fine, just a little tired. i hope he continues to have good responses to the treatments. my sibs and i bought him a durag just in case he loses some hair. gotta laugh at these things, cause it's the only way to get through sometimes :o)

the conference in phoenix was great, if for no other reason than i made some great contacts with people for job opportunities. my choices are ranked as follows:

1. children's hospital of seattle. yes it's far, yes it's got some gloomy weather, but i would be able to go to alaska one week every other month for outreach clinics, and i would be responsible for furthering and maintaining this program. a-maze-ing, dream job, not sure if i could pass up this opportunity. i had an interview with them at the meeting: one GC and three geneticists. pretty intimidating, but i think it went very well. i'm waiting to hear from them. they would probably want somebody to start this job right away.

2. baystate medical center, springfield MA. not the best location for a job, but i could live in northampton, which i love, and then i would be near my sister and the rest of my family would not be far away. plus i'd get to do all types of counseling, which would be a great opportunity. they basically want me to interview, and would be willing to wait until the summer for me. very good chance i will end up here.

3. eastern maine medical center, in bangor ME. it's pretty far, and it's pretty isolated, but it would be beautiful and a great learning opportunity. they basically want me to interview also, so we will see if/when that happens.

at the very least, i have some options at home that i did not have before. i feel better about that. now i can begin to really focus on my research, which has been flat lining lately due to my lack of motivation and my disinterest in the entire writing process. i basically write about 3-4 sentences and then have to stop, go do something else, and when i come back i am fine. at this point i am not able to just sit and write, write write for a few hours. i don't know how people can do this, and enjoy it in any way. i am never doing research, ever!

that being said, it is getting done very, very slowly, and i will finish it. i don't care if i win overall, i just want it to be done.

today is my dad's 65th birthday, and as of today he is officially retired. time to spend time doing the things he's always wanted to do with the people that mean the most to him.

remember a while back that my biggest problem was my toothache? i had my dental appointment today, feeling strange to begin with since the only dentist i've ever known was my father. i went in 90% sure that i would be leaving with a filling of some sort.

they took an x-ray, and the resident* came back and told me i needed a root canal. then he grinned and said "nah, i actually don't see anything at all". we examined the films together, and he poked around in my mouth, but everything looked fine. it was the best news i'd heard in a long time.

i guess there's nothing wrong with hoping, it can never hurt. so then i will hope that he will be around at this next year, and everything in between.



*not the right place to write this probably, but the resident was incredibly adorable and i was hearing dreamweaver as we spoke. and there's nothing wrong with hoping...about anything...

I have been avoiding writing, mainly because I just don't know where to start. I have exhausted my own brain so much that every morning it is a struggle to wake myself up. It's not that I'm not getting enough hours of sleep, believe me. It's because every night I have a dream where I am fighting for my life. Last night I was being chased by a tornado, and then filling out endless amounts of paperwork. I woke up feeling stressed and anxious immediately, my mind racing even seconds after my alarm went off. I have woken up feeling this way every morning. I think it's obvious I manifest my feelings in my dreams. It leaves me feeling incredibly exhausted, essentially burdened down with my thoughts.

There is too much going on here, too many big things to be thinking about so often. So many unknowns, in such huge aspects of my life.

I do feel the way I feel in my dreams:

helpless. and trapped.

i'm just plain tired of it.

yesterday I had a half day in clinic and I was close to the mall, so I decided to treat myself to some nice things. I bought some very nice, very $$ pants from express, two sweaters (on sale) and then used my Macy's gift card to buy two really cute going-out-on-the-town tops, one of which could double for work. it's sad that now when I shop, I only want clothes to wear to work.

amidst all the crises that keep occurring and the stress of finishing school, I realized I completely love what I am doing. it wakes me up in the morning, easily. I love genetics. And counseling. I love it a lot.

my dad is scheduled for surgery on Feb 15th. He is lucky, Dana Farber will give him the best care imaginable. We are hopeful he will get through this without any problems. Thank god.

now I can breathe.