Well, despite everything, the sun still came up this morning. I feel a bit foolish for writing what I did yesterday, but I honestly was feeling as low as I could get last night. After writing that I sat on the floor in my bedroom and cried.

I didn't feel any better after crying. My husband said he's seen me mad and sad in the last few months, but never so demoralized. In the light of day, however, things aren't looking nearly so bad.

My attending is just insensitive, and possible a jerk. I don't think it's intentional, he just doesn't pay attention to people's cues. While he was griping at me yesterday, he made the patient and her husband very uncomfortable. Bless them, they both went out of their way to say nice things about me during the rest of the exam. At least I didn't anger the patient or compromise her care. She felt like I had taken an extraordinarily careful history. (of course, so does anyone seeing a neurologist, it's about the most thourough exam out there!)

Another case in point with this attending, he was fired by a patient yesterday that we saw with him last week. I knew he was angering the patient and making her feel belittled and criticized, but he was not getting that message. It wasn't until she started crying that he backed off his interrogation-like style of interviewing headache patients. I know why he does it, and I understand the necessity of getting the details straight, but he forgets that very few of us are accustommed to being questioned for 20-30 min's about the nature of our headaches.

So, today I'm feeling like I'm back in the driver's seat. I don't like this attending and I know I don't want to be an adult neurologist, but I can still learn an awful lot that will help me in the future to be a better doctor.

I need to take my time, not rush, and not be flustered my unfamiliar illnesses. What counts is taking the full history and doing the exam methodically and recording every single bit. That is more important than recognizing the disease or knowing the nuance of neurological symptoms that I can illicit in the history. That will come with time and experience.

When I was really down and out last night I realized my greatest fear is that I won't be good enough to become the kind of doctor I want to be, whether ortho surgeon or pediatrician. Well, the only way to take care of that is to keep working, keep studying, and give myself a break.

Thanks to the folks who PM'ed with support. :grouphug:

When it rains, it pours. :rolleyes:

Our poor au pair is really quite sick. She was throwing up this morning and running a temp. Bless her, she never complains and always tells me she can handle things, but when I told her this morning that my MIL was going to get the kids after school she said, "okay." That's when I knew she was really sick! She does seem to be feeling better this afternoon, but my hubby is already arranging his day to work from home in the afternoon just in case.

My daughter has been kidnapped by aliens and replaced with a rude, angry 11 year old. Frankly, she's been bullying her brother. It's distressing for many reasons, but more so because she has been struggling with the issue of being bullied at school and it troubles me to see her turn it on her own family. That, and she's argumentative and short tempered with me and her dad! I was so mad at her this morning I wanted to smack her sassy face, to be honest. I didn't, of course. But, I realized just how far I've let her go with the attitude that she would feel like it was okay to treat me that way when she was getting in trouble for pushing her brother down.

All in all, I feel like I'm at the end of my rope and I'm not quite sure how I'm going to finish out this rotation. I'll finish it, I know, but I've got to make time to study and such and I just have no motivation whatsoever.

Can being tired and overwhelmed make you quick to get angry? I sure have been angry a lot this week; at the attending, at my daughter, at my husband, even at strangers in the parking lot! I'm completely off kilter. Oh, and of course I have to have cramps today too. Why not? :p Oh, and a gray hair sticking straight up outta my head and waving at the whole world! Thank you, I needed to be reminded this week of all weeks, that I'm not 20-something anymore.

I feel like sitting my butt down in the asst dean's office and saying "you know, I was wrong. I can't do it."

:yes:

And if that doesn't work, this always makes me laugh http://www.weebls-stuff.com/toons/kenya/

I seem to have an endless amount of words this week.

Today I saw a very memorable patient and I learned something that I like about myself.

The patient I saw came in with a complaint of migraines. The minute I walked in the room I felt bad for this poor lady. She was in her late 30's, but looked older. The exam room has floor to ceiling windows on one side, which happens to face East and it was 9:30am with the sun shining brightly in. She was sitting in a chair with her back to the window and her head down on the exam table. I immediately closed the blinds and offered to turn off the overhead lights. My mom suffers from photophobic migraines and I know how much overhead lights hurt when she has a headache.

This patient was really grateful that I did this and seemed almost surprised that I would offer. While I was taking her history I noticed that she said things that made her pain sound less bad than it really was. For example, we often ask our patients to rate their pain on a scale of 1-10, with 10 being the worst pain ever. Most migrainers will tell you their bad headaches are a 9-10, I've even been told "12" several times. This lady told me her headache was currently a 3. She also told me her headaches were generally a 3-5, but that sometimes they were bad enough that she couldn't stand up to walk to the bathroom.

Anyway, I took the history, I listened, I told her she wasn't crazy and I sympathized. Afterall, I'm just a med student and couldn't offer any solutions! :p

She took my hand and shook it and thanked me for taking the time and caring. Her husband looked a little startled and shook my hand as well.

I didn't do anything all that special. I guess I just had the luxury of time and maybe some extra attention to see what she really needed. That's not the first time this has happened with this doc in the last 2 weeks. I feel good because someone left the office today feeling that their voice had been heard and that they were understood and could get help.

(Edit: I removed part of what I wrote here because I realize that I do not have anonymity at this site. I write too much that makes it easy to figure out who I am. )

Just because someone is considered an expert in their field does not mean they have a bedside manner worth a bag of poop! :no:

I'll keep my bedside manner, thank you very much, even if it means not honoring every rotation.

I feel like myself again. :goodvibes:

Had a discussion with the attending that lead to being released "early" at 5:45pm today.(we often stay until 7pm or later) Got to see a hospital patient with altered mental status this morning. First time I've done that. Rather, first time I've taken a H&P on such a patient. Fortunately her son was there or it would have been a very brief visit. Every new experience is worthwhile. Took a H&P on an office patient today with neck pain complaints. I've heard depressed patients described as people who "suck the life out of the exam room." I always thought that was a cruel description, but it is fairly accurate. Overall I find neuro to be a pretty depressing field. I admire those docs who do it and enjoy their work.

We had a wonderful weekend with the kids. That's probably a big part of why I feel better. I got to watch my son's Tae Kwon Do belt test on Friday night. He's earned 3 belts in 3 months already. On Saturday we participated in a 5K organized through the kids' elementary school to raise funds for a track at the school. My husband ran hard and was very pleased with his time, especially considering he's never trained to run. I envy his natural athleticism! I stayed back with the last kid and he even beat his previous 5K time by 3 minutes. Then, the boys played a soccer game that afternoon! My daughter ran the entire race and then had a good friend over to the house Saturday afternoon. We had dinner with another couple Saturday night. We ran errands and did yardwork yesterday. It was a great family weekend.

I worked out with weights this morning and plan to return to running 3x a week. I feel better when I get enough exercise. I'm only 13 lbs away from my major weight goal, too. I'd like to complete that goal by the end of the year.

I'm looking into talking to some private practice docs in pedi to get a better idea of what their lives are like. I'd like to base my decisions about specialties on real world info and not just the conventional wisdom. It's amazingly difficult to find info about hours, lifestyle, call, compensation, paperwork, etc from internet resources. Sure, I look things up on FREIDA, but those avg work hours, etc aren't accurate for the residents I talk to.

I'm feeling further away from surgery now that I've had a few weeks to contemplate it. I'm afraid, basically, that I will have to give up my family life for the 6 years of training to become a pedi ortho doc. But like I said, I'm just thinking about things and trying to get better info.

I'm generally very upbeat and that is reflected in my blog. I wonder, though, if that might give some people the impression that what we mom med students are doing is easy. It isn't easy. I don't want to paint bleak pictures because I don't feel that my life is the least bit bleak. And, I don't want to focus too much on what is difficult about this process because my fear of the difficulties kept me from medicine for nearly 8 years.

The reality is, there are sacrifices involved, most of which I have yet to face. Med school is tough, and studying and balancing a marriage and family is very demanding and takes a lot of energy and dedication. It also means knowing that some things will fall through the cracks, like housekeeping and having much of a social life outside of the family. I'm nervous about my residency because I know I will have to take call every 4th day for a year, at a minimum. (I recommend FREIDA for anyone who wants to know what the training stastics are like. http://www.ama-assn.org/ama/pub/category/2997.html )

I can only imagine how many TKD belt tests and 5K's I will miss in those years, while my kids are preteens and teens, not to mention the reduced time for relaxed conversation.

That being said, if you want to have it all, medicine family marrige, you have to arrange your life to make it work and you have to have the desire and energy to slog through the bad times as well as the good ones. That in no way is meant as a criticism of anyone who decides to forgo one of those things. I know for a fact I would not have lasted as a med student with little babies. I would have just been too overwhelmed. I would have hated not being around for the little steps of their early years. Of course, between the little steps was a lot of unhappiness for me because I felt so incomplete as a person. The thing that makes all this possible for me (besides the supportive husband and the live-in nanny) is the fact that I love what I'm doing and I feel like a completed person by the pursuit of medicine. It wouldn't be worth it otherwise.

So what am I trying to say? I guess I'm worried that I may be giving a rose-tinted impression here and I don't want to do that. But, I do want to let women know that this is possible, that it is wonderful, and that if it's in your heart you can make it work.

I spent hours yesterday with my daughter running errands and shopping for clothes. We had a blast. We had lunch together first and got so giggly that the waitress would just smile and roll her eyes in a friendly way when she walked by. I really enjoyed that time with her. Now that she's 11 (12 this summer) there are more and more times when I feel like she's trying to be independent and push me away a bit. I know it's normal development, but it still makes me a little sad. Yesterday, though, we had great fun. :goodvibes:

I'm preparing for my Neuro exam on Friday. I feel bad because this crummy attending situation plus the other stressors has meant that I have not given my best effort to this rotation. I know I could have done better. But, it's okay. I just need to move forward and be grateful that those weeks are behind me.

I process things verbally, so what may look like me changing my mind a lot is me going through all the possibilities in my mind. That's how my husband puts it when I criticize myself for "waffling." He's a great guy, and nearly 15 years of marriage have their benefits!

Some more career thoughts:
Here's why I think I might be happiest as a general pediatrician. I really enjoy talking to kids and their parents. I enjoy helping people figure things out and come up with solutions. I also like looking at problems and puzzling out answers. I like fixing things. I like variety. I think as a surgeon, I would enjoy the fixing, but miss the conversations with patients.

I am also frustrated by seeing a problem that isn't, say surgical or neuro, and ignoring it because that's not the doctor's specialty.

oops! time for the Easter Bunny! I'll finish my thoughts later! :rotfl:

Well, I was on a roll this morning, but now I've kinda lost track of what I was saying. Regardless, my point here is that I may not want to specialize in something so focused that I lose or neglect other skills. For example, becoming an orthopedic surgeon who doesn't ever listen to a heart. I think, maybe, I'd prefer to address the whole child and not focus too narrowly. This means that I won't be fixing most of the problems. If I see a badly broken leg, I'll call an orthopedist. If I hear a funny heart sound, I'll refer to a cardiologist. But ultimately, the patient would return to me to take care of the usual things and discern the unusual ones.

We shall see. Who knows how I'll feel in a few weeks? :laughing:

One thing that bugs me. People who have to play devil's advocate all the time. Sometimes I just want to give voice to my thoughts and I don't need even a well-intentioned picking apart of my reasoning or counter-point to all my ideas. Sometimes it's nice to just let ideas stand on their own for a while, even if they ultimately aren't the direction I'll be taking.

I'm baffled as to why family members would support me considering surgery and disuade me from general peds. These are the same people who told me I couldn't do medicine and motherhood when I first started talking about med school! Now they're encouraging me to take the most demanding paths! :rolleyes: silly people.

Several people have reassured me that something will leap out at me and say "this is it!" I dearly hope they are correct. In the meantime, everyone has to listen to me struggle with the process.

Neuro is done at last!!! :goodvibes: I'm sincerely hoping to find my bliss in pediatrics. I expect to love it and I know I've really enjoyed the pedi experiences in the past, so it's just a matter of proving myself right.

I know I've written before about my doubts with regards to being at such a competitive med school. Many times I've thought I would be less personally stressed and more confident if I were at a school that put less emphasis on grades and achievement.

Those doubts were really put into perspective last night. The head of TX Children's Hosp. gave a talk last night about the various academic pedi residencies around the country. This man has such a formidable intellect that he gave the talk about all ~170 programs off the top of his head! (he knows them all that well. He also knows all the Baylor students by name) The upshot of his talk was that Baylor has one of the top 5 residencies in the country (#1 according to him ) and that as Baylor students we are pretty much guaranteed a spot in the Baylor Pedi program. Guaranteed, ours for the asking, no Match stress. :cloud9: From there, he says, we can pretty much write our ticked to whatever we want to do in peds, private practice, academic, fellowships, etc.

Well, sign me up.

So all I have to do for the next 8 weeks is not make a fool of myself or tick anyone off. :cloud9:

Well, I'm on Pedi and really enjoying seeing the patients. I'm doing 2 weeks of ambulatory right now. That pretty much means seeing either non-emergency ER patients (sore throats, etc) or clinic patients. I've been in the Rheumatology and the Nutrition/GI clinics so far. It also means being in the Pedi ER from 6-11pm every third day, along with the daytime clinics. So, I'm pretty tired. With the evening shift, we don't get reduced responsibilities the following day like you normally do with a call night.

You know, I like the patients, and I look forward to clinic each day, but it's not like ortho surgery. It's not exciting in the same way. I wonder if this is a problem for me, or if it just means that I haven't had good exposure to the right pedi field yet. The next 2 weeks will be in the NICU. I've been told I might really enjoy critical care, so we'll see.

Honestly though, I'm afraid I won't like anything as well as I liked surgery. Then what? 5 years of surgical residency are not in the future I envision for myself and my family. :boggled:

Maybe I'm just a little too tired today. I have been very busy this weekend and had call twice last week. I have call again twice this week.

Here's what really bugs me. I spent 15 hours at the hosptial on Friday. In that time, I only saw 5 patients. 5! That's a lot of sitting around, waiting for xrays, waiting for residents and attendings to hear my presentation of the patient, even having a long lunch and dinner. :banghead: I don't want a long break, I don't want to sit around, I want to be busy working and doing things for the kids!!!

I know. I'm crazy. I should appreciate the extra time and easy atmosphere. But it's boring. Studying is boring. I learn best from patients and I want to see more of them. Or do more for them, because we don't do much of anything at all for them. We do the History and Physical (H&P), present it and then watch residents and attendings repeat our work, decide the diagnosis and recommend the therapy. *sigh*

You know, that's why I loved surgery, especially Ortho. I was in the OR actually doing something.

Must. be. patient. :laughing:

Bad news first. I'm sick. Laryngitis, sore throat, headache and stuffy nose. Got it from my husband. :ouch: He stayed home from work one day last week. Me? I'm in medicine. I went to work! Who ever heard of the doctor being out today because she was sick? :laughing: Luckily, there was only 1 patient in clinic this afternoon so I was able to come home early. (normally I would have gone to another clinic or looked for cases in the ER)

Good news next. I'm enjoying peds much more this week. I think it's because I'm seeing more patients and doing more for them. I diagnosed a case of scabies today, even though I hadn't seen it in person before. I also saw a kid with spina bifida who is having a bowel and bladder surgery in a couple of weeks and a boy being treated for allergies who needs testing for ADHD and learning disorders. All great patients to talk to and work with. I had a similarly good experience with the endocrine patients yesterday. Both were 13 years old, one with short stature and one with possible hypothyroidism.

I like having the clinics where I go in and see the patient, take the H&P and report back to the attending. I've also had 2 good attendings who don't pimp a lot, but allow me to venture opinions and support them. The best way to learn.

So I think I've learned this much. What I really enjoy is being a busy, active member of the team. I like working with kids and families and I like being efficient and on top of things. (who doesn't like being on top of things??) Anyway, I think I can stop stressing about surgery being the only excitement I've felt. It's more a matter of being excited about being an integral member of the team and learning good stuff.

I'm off to bed now with my books and some tea. Hopefully I'll be feeling better tomorrow. At least I don't have call until Friday!