Good heavens, I turned 40 today! I cannot believe that's my real age. I look in the mirror and I don't see 40. Although a quick glance around my life points to the fact. ;)There's the high school Sophmore in skinny jeans and a tank top madly texting on her "cellie." There's the two 13 year old boys taking cell phone pics of our cats investigating a cheeseburger brought home from school lunch so they can post a pic on icanhazcheeseburger.com (AKA LOLCATS). There's also the store bought cards and the handmade card and the facebook wishes and the flowers from my parents... (Man, must they feel old! lol!) There's also the pile of dirty dishes in the sink, piles of laundry half strewn out of luggage on the floor and the "pile" of radiology cases I need to read. Oh, and Lady Gaga on my iTunes.

10 years ago we were living in New Hampshire. We'd been there a little over a year and were about to find out that we were getting moved back to TX soon. But I didn't know that yet. I was in the middle of my first year in a graduate Speech Pathology program. I liked it, but I already knew it wasn't going to satisfy my interest in medicine. Still, it got me out of the house and gave me an excuse to have the boys in daycare a couple of days a week. Something I had learned early on, I wasn't cut out to be at home all the time. Still, a lot happened between that 30th bday and this one. Some of it wasn't pretty, including a very rough patch in our marriage and my husband's 3 years of weekly traveling to the west coast for work. But some how, some way, through it all, I've become the doctor I was still dreaming of being at my 30th birthday.

Amazing really.

Thank goodness I've had enough rest and downtime to be able to appreciate this now. In fact, I've had so much downtime and vacation that I quite enjoyed being in clinic today. I saw a coupld of 1 month old babies, a 1yr well child check, a 3 year old well child, a 4 yr old with a sore hip, a 16 yr old with a cough, an 8 yr old with persistent hematuria (blood in his urine) and another child with a swollen lymph node. It was fun! I'm looking forward to finishing the next 15 months of my training so I can spend all of my time with these clinic patients.

The good news is, I turned in my schedule requests for my 3rd and FINAL year of residency yesterday! It's a great feeling to be able to contemplate actually finishing my training. It surely has been a long trek, and sometimes a rather difficult one. Yes, I think I would still do it again. It's rather like having a baby. During and right after labor, you thinkg "why did I ever decide to do this???" I'm hopeful that it's like childbirth later on, too, where the pain of the moment receeds and you feel so grateful for what you've accomplished. Haha!

A song I've been listening to a lot lately. "Say Hey (I love you)" by Michael Franti. If you need to smile, listen to this song. It is happiness.

Color me surprised, I'm on my Adolescent Medicine rotation and I actually like it. *eek* Seriously though, I used to cringe at the thought of seeing a kid over the age of about 13. That's usually because they are difficult to talk to and have complicated illnesses with a fair component of psych issues. (see 2 teenage patients hospitalized for "abdominal pain" and you know what I'm talking about.) Somewhere along the way I've gotten better at talking to them and dealing with their particular ways of communicating. Maybe it helps to have a few of them in my own home. Eating disorders are particularly interesting, in part because of the pathophysiology, but also the psychological dimensions and the nutrition aspects. All things that I find interesting. Additionally, we learn very little about eating disorders in med school and residency. So, new relatively cool info. Way more interesting to me than running a list of possible infectious causes of fever and, say, rash. :p

Kids are doing well. Disney vacation was a blast. In 2 weeks I have another random week of vacation. I'll be hanging out with my mom at a B&B kinda place. I wish they had spread my vacation out more evenly over the year, but it sure is nice to have 2 months in a row with time off. Makes up for carrying the pager 24/7 this week and working Easter weekend. *shrug* Such is the life of a resident/fellow/attending. Somebody has to do it!

I can't think of anything else to say at the moment except that I am happy, rested, running regularly and taking care of myself.

Unexpected Confessions.

There are times as a doctor that I learn things about my patients, or their families, that really makes me pause. Sometimes it's privileged information that I'm not all that certain I deserve to know. There are times when the privilege of being a physician means knowing deeply personal or intimate things about your patients that you would otherwise have no business knowing. A small example of that would be knowing that the young woman who came into the clinic for STD testing gets a bikini wax. There's no reason I would know that other than that I did her pelvic exam. Other examples include knowing the menstrual history of the mother of the teen I'm counseling about PCOS, or the impending parental divorce for my young patient being evaluated for ADHD.

Some time ago I was seeing a young teen for a disorder that involves chronic headaches, dizziness and other, for the lack of a better word, ephemeral complaints. We have diagnoses for these types of disorders and the knowledge that antidepressants are frequently helpful in managing them. Now whether that's because mood disorders can manifest in these physical complaints or whether these types of illnesses contribute or lead to mood disturbance is beyond this blog. Be that as it may, there are certain themes in the patients and families that I see with these types of issues, including enmeshed parents and timid children.

Okay, back to my teen patient. Being a good doctor, I sent her parent out of the hospital room so we could talk about periods and other "teen things." Since the parent was a dad, it was easy enough. Naturally I started the private conversation with the explanation that our conversation was private and I would only tell her parents something (with her knowledge) if she was thinking about hurting herself, was being hurt by someone, or was planning to hurt someone else.

In the course of that private conversation, she told me she had been sexually active. This surprised me, given she was a young teen. Then she explained to me that it was not consenual, that it had happened in 5th grade, and that she had never told anyone.

You can imagine my shock and sadness.

I think I did a good job of remaining neutral, because she kept talking to me about it. She explained how that person was not a family member and that the person no longer lived near them and she had not seen him since shortly after the incident. She also explained to me that she had no desire to "bring up that trouble now." She claimed she was "over it a long time ago" and that there was too much stress in her family right now for her to want to add to that grief with something that had happened years ago.

Of course I counseled her on the benefit of talking to someone about it. Offered to help her tell someone if she wished. Advised her how to deal with it when she did feel ready to talk about it. But ultimately, that secret rests with her. And with me, now.

I will probably never see her again. But I'll never forget.

And yes, I have to wonder if all her physical complaints don't stem from that kind of secret. But, I'm the first person to my knowledge that she has told and I'm not about to destroy her trust in the patient-doctor relationship by telling her secret without her permission.

I found out yesterday that a classmate from med school has recently divorced. They'd been married 10+ years, long before med school and residency. I feel sad for my classmate and a little dismayed to see someone who always seemed to have it so together in this situation. Not that she doesn't still have it "together" so to speak. From what I hear, she did the right thing walking away from a bad relationship. Still, it's a little distressing to see what seemed to be a solid marriage fall apart like that. It goes to show you that you never really know what's going on in people's lives.

I confess it makes me worry a little about my own marriage, too. Having been married almost 19 years now, I feel awfully rock solid and secure 99.9% of the time. But every once in a while I'll run across an unexpected divorce (or infidelity) like this and wonder. It seems like after 19yrs and all the things we've weathered together, we'd know if there were any problems lurking in the shadows. Maybe it's pride to think that we're immune. Then again, maybe I have just been that fortunate and we've worked that hard to make it through the rough patches. I guess that last little bit of certainty has to be based on a little faith.

Of course, we all wonder and speculate if the marriage fell apart because of medical school and residency. Certainly the demands of training put a tremendous strain on a relationship at times. I know it is far from easy to be the spouse of a resident. Who wants to be with someone who is chronically tired, cranky, and stressed out? Well, I think most people can endure that stress. I think the marriages that fail at this point are the ones that were already in danger and the stress of training just tipped them over the edge. Then again, maybe I'm wrong and just thinking in a way that makes me feel more safe.

I'll always remember the words a family friend and pastor said to me the very last time I debated PA school vs Med school because I was worried about my marriage and my kids. He said my kids were going to be fine because I wouldn't let it be otherwise, he knew I would look out for them. And with regard to my marriage, he said that there wouldn't be any issues in medical training that weren't already there in the relationship. Nothing new would arise to surprise us. That made me feel a million times better and actually gave me the mental permission to pursue medical school.

And he was right. My kids are still my top priority. I've given up the idea of a fellowship in part because I'm tired of my training taking away my time with them. And my marriage is as it ever was. I still wish he would spend less time on the computer playing strategy games and more time in the laundry room. haha! And I'm sure he still gets tired of listening to me overthink every decision I make and then rethink it all again. But at the end of the day, I'm so grateful this man is in my life, that he's the father of my children. If anything (and I know I've said this a million times before) our marriage is stronger because I feel like a fully realized person in this profession. With the exception of long call months, I love what I do.

So it's Monday, I ran 20 miles last week, lifted weights, discovered I like working with adolescents better than I tought I would, and this week is shaping up just fine. The sun is shining. My son hugged me this morning and said he hoped we could spend more time together one-on-one like we did yesterday. My daughter starts driving school today. My other son is going to the State Math competition this weekend. My husband has his annual guys' weekend with his friends this coming weekend. And next week I have a random week of vacation which I will be spending with my mom in Eureka Springs, AR at a cabin in the mountains, shopping in artsy stores and cooking like girls.

Life is good.

Life continues to be good. I've started a Level II nursery month, which I had not been looking forward to. Q4 call (every 4th night, that is) and 5 weeks makes for a pretty exhausting month. However, our census is low and our attending is pretty relaxed. That means, not too many patients to see each morning and not getting raked over the coals everytime I present a patient. In addition, the hospitalist that we worked with this week is really wonderful. I love his bedside manner, enjoy his jokes and appreciate his teaching.

I honestly feel like I am enjoying residency again! I jokingly asked my husband yesterday what drug he was sneaking into my water bottles! lol. Seriously, though. I have been in a funk about residency for most of this year. It's been hard and I've been tired. Giving up the fellowship plan was painful and I really felt adrift when I realized I wasn't going to do either of the subspecialties I'd been planning on since I started med school. But things are looking up. I'm starting to get back to "owning" my patients instead of surviving day to day.

I don't know whether it's the healthy eating and exercise that is making me feel better or that feeling better has made it so much easier to eat well and exercise. Truly, it doesn't matter! I know the fact that I have had enough sleep and downtime has helped tremendously. Another check mark in the box of "job with normal business hours" for me!

I need to start working on my resume and thinking about the job I want 14 months from now. While it may still seem far away, I want to make the best possible choice because it would be wonderful to find the right thing and be this happy when I'm out in the world of private practice. I'll write about my job search experience and I hope I'll still be a regular blogger when it's "married momof3 pediatrician" or maybe it should be "married momof3teens pediatrician." Too scary to think that 2 years from now my daughter will be graduating from high school!

Lots going on, as usual.

I hurt my knee last week when I went out for a run and caught my toe on the edge of the concrete (or small rock or something). I landed right on my knee and wound up with road rash covering my knee cap and bruised the entire thing. As luck would have it, I was on call the next day and in significant pain. I made it through the call, but my knee swelled up pretty badly. The good news is, the bruising and swelling is almost completely gone and I was able to go for a short run this morning. Always a good thing for me. Life is better when I can run.

My last call was a doozy. I admitted 9 patients in about 12 hours overnight. Not a lick of sleep. Some were straight forward, but a few were complicated and I didn't have the time to spend on them that I would have liked to have. Had to play catch-up just a bit when the various attendings came around to see them. Our nursery admits all patients from "outside" who are under a month old, and up to 2 months or so. So, lots of different hospitalists and private pediatricians to talk to. The reasons for admission varied from 2-5 week olds with fever to abscess post drainage to seizure in a newborn. Overall, I'm still enjoying it. More evidence that I like a little bit of everything pediatric.

I'm starting to rev up the job search process. My husband and I have been discussing where I should apply. We're inclined to just apply in our current hometown since he has a very good job and the kids are in school here. But, things can change and we're talking about casting the net a little wider. It's so complicated being married and being a parent of older children and trying to make major career decisions. What's best for the career is not always what's best for the family. My husband has suggested I use a professional resume writer. At first I thought that sounded weird, but the more I think about it, the more it makes sense. I want a professional position and I want to be taken seriously as someone who has a lifetime of experience to bring to my career. So, we'll see how this goes. Might be interesting.

There's going to be a new blog format for MomMD that I'm thinking about doing. It'll take away what little anonymity that I currently have, but it'll have a broader spectrum of readers as well. I'm not sure what to do. I enjoy writing and I enjoy knowing that what I write can have a positive impact on other women doing or thinking about doing what I'm doing. Hmmm. If anyone has thoughts on this that they'd like to share with me, please PM me. (the moderator doesn't allow replies on these blogs) I would definitely appreciate thoughts from anyone in practice who has thoughts about having my name out there where patients/parents might recognize me. I certainly wouldn't be writing about specific patients (as I don't do here), but I would have to be even more careful and circumspect about what I write regarding my personal life, family, etc.

Just wanted y'all to know that I am tired. So tired, in fact, that I came home from work in the middle of the afternoon and fell asleep on the floor in the middle of my living room. Really. If my daughter hadn't come home from school, I'd probably still be asleep. As sometimes happens with me, I'm on a very busy call month and I'm not sleeping well on the nights between calls. Only getting about 6 hrs of sleep a night. Some of this is due to having to wake up ridiculously early in order to get in a run before work, some of it to work-related stress, and some of it to my teenagers needing to talk/cry to me about something right before I crawl into bed at night.

I wrote last time about a doozy call night with 9 admits in the nursery. Well, I broke the record with a full 12 admits the following call! The babies love me, I guess. I'm on call tomorrow, which means instead of breakfast in bed on Mother's Day, it'll be (hopefully) waking up in a call room and rounding on patients before I get to go home and see my kids. One of the drawbacks of being a resident. Call.

But it's okay. I see the light at the end of the tunnel a year from now. I'm working on my CV. I'm thinking about what it is I want to be doing 14 months from now. And it sure doesn't involve waking up in a call room on Mother's Day or any other weekend holiday! Or any other morning, for that matter.

Gotten a few replies from practicing docs advising me to maintain my privacy and I find I have to agree with them. May need to see if I can blog with an alias or just stick to our forum. But don't worry, I don't plan to quit!

Well, the call over Mother's Day weekend went pretty well. I got several poor quality hours of sleep in my call room, so stayed up on Mother's Day to spend the time with my kids. Also, I was in the middle of a 12 day straight working "week," so I wanted what little time I had with my family. The day went well, but I paid for it in spades on Monday. I felt like I'd been hit by a truck! I even had a dizzy spell, probably due to dehydration, during rounds. I don't know about everyone else, but I know that I often try harder to act like life is normal and I can do everything that other moms and working women do on a regular basis, despite getting little to no sleep every 4th night and racking up 70+hr workweeks. Sometimes it catches up with me.

I finally had a day off yesterday. I slept in, didn't run, and had margaritas and Mexican food to celebrate. Probably should have skipped the 2nd drink, but I was in the mood to act like a "normal" person out on Saturday night. Forget that I got up at 5am today and am on call...again. I read the article on the main MomMD page about phsyician desire to quit being highly correlated to number of work hours per week. Is it weird that when they made the cut-off 50hrs/week I wondered why it was shorter than a normal work week? Then it slowly dawned on me that a normal work week is 40hrs and that my perspective is really skewed. Suffice to say, I am really looking forward to having "only" 50hr work weeks in just over a year.

I finally wrote my CV, with the help of a friend who does professional writing and resumes. I'm hoping and praying I really can find a good job. It's been a very long time since I was on the job market for a full time job. I was the underdog in my previous job searches due to my liberal arts degree and then my alternative teaching certificate. The speech therapy position fell into my lap because it was at my kids' elementary school and they were desparate to find someone quickly. Anyway, it's pretty stressful to contemplate. I know I could find something pretty amazing if I was willing to relocate to a smaller town/community, but my husband's job and my kids' schooling makes that a poor choice. I'm not willing to give up his salary yet, we have my school debt and 3 kids to put through college in the next few years! Don't take that to mean I feel trapped, however. I'm very comfortable practicing in large cities and their suburbs. I also enjoy having access to shopping and airports and theaters and parks, etc.

I'm rambling. It's quiet in the level II nursery today. I'm sure there will be a slew of 2-4wk olds with fevers in the EC shortly after midnight, though. :p I should take a nap, but I'm wide awake. Prophylatic sleep doesn't work well for me. lol!

Had one of those incredible Mom moments yesterday. Maybe it was more of a Mom HOUR or half-day or even Excursion Into the Unexpected Abyss.

Here's what happened. My husband and I have been talking back and forth quite a bit about my job search and what it should entail. One of the major questions being, do I search far away from home? All the way across town? Out of town? Out of state? There are certainly other parts of the city and other cities that we would love to be in. Don't get me wrong, our suburban neighbourhood is quite pleasant, we have a gorgeous home, and the public schools are very good. But as adults, we'd love to be closer into town, near the theaters and the foodie markets and such. So we had a lark and decided to go around and see some open houses in an area of town we would ultimately like to live. We brought our teenage daughter because she loves window shopping and loved that part of town when my husband took her there a couple of weekends ago to a specialty Nursery (as in lawn and garden...)

BIG MISTAKE!

We found a gorgeous, gorgeous home with a floor plan that my husband and I were both drooling over. We looked at it twice. We fantasized about moving there. We ooed and awed over the amenities, the trees, the proximity to everything. We lamented the need for private schools. We discussed the possibility of commuting the kids to their current schools.

My daughter FLIPPED OUT.

It started with a lot of whining about how tired she was and couldn't we just "leave now?" This was followed by moping, complaining and general unpleasantness. I knew what it was about and it really got under my skin.

I asked something when we got home that I rarely, if ever, voice and boy did I regret it. I asked, "Is it really a given that because I am a wife and mother that anything I want to do has to be approved by the committee of my husband and children? Can I not make any decisions based on my own needs and desires? Must I live by their consent?"

Now, if you've read my diaries over the last 7 years, you know I live this way in my own head. I never think of doing anything without first weighing the consequences (as I perceive them) to my husband and kids. Heck, med school waited 9 years for them. I moved across the country when I was almost ready to take the MCAT in 1999 and was sidetracked for 3+ years! (husband's job) I admit, those were rough years and the bitterness I felt about that made for some difficult times. But overall, I have always been about family first. It's my own priority and one I gladly have. I turned down fellowship because I didn't want to live the life of a trainee for another 3 years. (I digress)

This time, the question really upset me. There were tears from my daughter, accusations about how I can't take her away from her school or move out of the neighborhood. No, commuting wasn't an option. Moving wasn't an option and I'd better not do that to her brothers either! I tried to calm her down and she got more hysterical.

Finally, I lost it and was a sobbing mess after the last episode of arguing over the dinner table.

My feelings were hurt. I know I shouldn't expect my 15 year old to understand what I've given up as a mother first. But damn, it hurt for my wants and needs to be so completely ignored and so completely unimportant. Typical teen? Yes, but painful nonetheless.

And hey, I'm q4 and sleep deprived. In part, because of this same daughter's angst about her boyfriend at 9pm every night I am home. Never needs to talk about it at 6pm, only after I've gotten in bed and am less than 8 hours from the alarm going off again...

We made up, finally. I promised not to change her world. I had my big blow-up. My husband still likes me.

I won't change her world because in actuality, it's not time. We need to save a little more money and we aren't prepared for private school. The move into town or to another town is probably a 5 year plan now. I'm okay with that. I like my current house and as long as I can find employment within a reasonable distance I'll be happy to stay here.

But wow. Sometimes motherhood brings you up short in ways you can't imagine.

I need to apologize to my mom for that time when I was a young teen and she went on "strike" because she was sick of cooking and cleaning up after us with no one pitching in unless dragged into it. I think I told her that cooking and cleaning for us was part of her "job" when she became a mom and she couldn't go on strike. While it may be true, I see now the feelings that prompted her (brief) action and I wish I'd handled it better. Probably all she needed was a hug and a voluntary kitchen clean-up.

Speaking of surprising moments, my 13 yr old son went to a girl's house to watch a movie yesterday evening. There was supposed to be a bunch of kids there, but everyone else cancelled. So it was my son and this girl who texts him all the time (and her family, of course). Not sure if he lucked out, or she's that savvy. *sheesh* I'm barely coping with the one teenager and her romantic rollercoaster!

Kinda makes the level II nursery seem simple by comparison. I remember when they were all tiny and needed me to feed and bathe and rock them. It's endlessly more complex now! lol

It has it's rewards, don't get me wrong.

Back to work for me. I'm on call again, bogging during the dinner time lull!

Oh, I didn't finish the teenage flip-out saga. My daughter continued to behave as if she'd lost her mind that night while I was on call. My poor husband was all alone at the house with the boys and his daughter. She got herself royally grounded. She's lucky she's still allowed to see the light of day! Interestingly, she's been so much more calm and at ease since she lost access to the phone and computer. Hmmm...

But I actually got on the blog to tell you that I'm having a little freak out myself. My husband is suddenly very busy at work. He's having to work a full 7 day week of 13-14 hr days starting today and he'll be doing this every 4th week for the forseeable future. Seeing as how I count on him to be the available parent with the "normal" working hours, this is throwing me for a loop. In addition, I'm doing another call month in June. So, no lighter schedule for me. It's mostly q6, which is helpful in terms of my fatigue. But, this still leaves me with all the responsibility for feeding and looking out for the kids, mom-taxi and all that.

On Tuesday I'm starting a new rotation that I'm fairly nervous about. I'm working with the hospitalist service, which I really like. The attendings on that service are some of my favorite in the entire hospital. But, my role for this rotation is that of "upper level" resident, which means organizing our service and helping the intern and teaching the med students. You wouldn't think this would worry me, but I don't feel particularly comfortable with resident/med student teaching. I tend to freeze up when I need to regurgitate textbook material and I still tend to look up a lot of things, especially when it comes to ID and rheumatology issues. I don't feel smart enough to teach these people! (so embarrassing to admit, but true.)

On Thursday I'm going to have lunch with a pediatrician I've been introduced to over email and we're supposed to talk about whether they might have space for another doctor next summer and whether I might be interested in being there. The practice is less then 20 minutes from my house! I'm nervous. I don't know what to say, don't know what to ask. Don't know if I'll come across as personable and knowledgeable or as nervous and weird. lol

Also on Thursday, my daughter is having her first big party at our house. It's the last day of school and she's having 10-20 high school kids over. She and her father planned it all, seeing as how I'm on a call month and a new rotation. Oh yeah, but now he won't be there at all!!! So after my lunch with a new, possible future co-worker and my first attempt at an "interview," I'm going to finish my day on a new service about which I am nervous and then rush home to ensure my daughter has a great party. Oh, and I'm on call the next day.

I think I could eat an entire bag of Oreos now.

*sigh*

It's been over a week since I went for a run.

How sad is it that I want my mom right now?

That is sad, and I should probably erase it, except that it is honestly how I feel.

Well, there's a few loads of laundry to fold, the grocery shopping to do, a kid who needs some t-shirts, I need a new blouse for my lunch meeting, and there's still dinner to fix and loads of little tasks waiting to be done.

One thing at a time.

Maybe I'll start with the Oreos...