Just a quick note to reflect on how much more sane I feel these days. Between the relief of making my decision and the fairly normal clinic hours for the past week, I feel pretty human. I did have to work a 10a-10p shift in the EC on Sunday, and it was draining, but I'm okay. My mom remarked on the phone this afternoon that she hadn't heard me sound this relaxed in years. She didn't mention this when I was struggling to make my decision about career path, but she said I've sounded to exhausted and depleted that she was genuinely worried about me. She didn't want to influence my decision, however, and risk having me feel like my family had pushed me to make a certain decision. I really appreciate that.

This is my decision and I do own it. It's completely different from all those years I spent trying to talk myself out of medicine and into some other career plan where I felt railroaded into it by my situation. Those were difficult years and I plan never to go down that path again. Now I'm deciding things FOR myself and my family and it feels awfully good. (as does the prospect of not being pimped anymore in 18 short months!)

Okay, time to go make dinner. Time to make a healthy dinner and to plan to shed those last 10-15 lbs before my 40th bday! lol!

My beeper isn't going off.

You have to understand that this doesn't make any sense to me. I'm on call for the entire weekend (Fri 7am-Mon 7am) for the Neurology service at our children's hospital. If there's any Neuro question, consult, problem, etc I get paged first. I did this for 24 hrs on Monday and Wednesday last week and it was a killer. I got about as much sleep on home call those 2 nights as I would often get on in-house call last year. The bad part was, home call hours don't count, so there was no "post-call" day afterwards. Just another 10hr workday. But miraculously this weekend I have gotten 2 pages overnight on Fri and thus far exactly zero since I got home at 6pm on Saturday. Granted, it was an 11hr workday in the hospital yesterday. But, as we all know, just 'cus it was a long day doesn't mean it can't be an even longer night.

I don't particularly like Neurology. I hated the floor service last year and got assigned to it twice. But my two weeks of outpatient clinic weren't bad at all. And the hours were fantastic! lol Inpatient is still not so much fun. It saddens me to see these neurologically devastated kids. But I feel like we've helped some of these kids this week and that's a very good thing. Well, it's basically the reason I went into medicine in the first place, to help sick kids.

Things are going well at home. My mom is here and one of my brothers and his family are due to arrive tomorrow, followed by my dad, and then an uncle, aunt and step grand-dad on Wednesday. We're also expecting my in-laws and my best friend and her husband for Thanksgiving day. It'll be a house full of happiness and tons of good food! My brother loves to make this outrageous Thanksgiving dinner, including a turkey, a ham and 11 side dishes. Lucky me, I just have to provide the groceries and a helping hand. Genius!

I'm so proud of my daughter. I came home yesterday evening and she had found some of my fall decorations (still stored away because I've been working too much to think about decorating!) and made some lovely arrangements for the kitchen, dining room and living room. She also made her grandmother an impressive Mediterranean sandwich for lunch after she arrived yesterday. I taught her how to make the sandwich about 1-2 weeks ago and now it's her thing. It's quite good; whole wheat roll, hummus, cucumber, feta, tomato, avocado, greens, and sundried tomatoes.

One of the boys got honored at his school this past week along with a handful of other kids for excellence in academics and citizenship. And guess what, I got to go to the ceremony! The Neuro fellow covered my new consult in the morning so I could attend the little reception in the school library. I missed that kind of stuff last year and I'm really happy I got to go for this.

My other son isn't doing much of anything right now. He's scraping by in school and no extra curriculars. We've tried telling him no extra curriculars until his grades come up, but I'm afraid we've just created a situation where he doesn't do anything. I'll need to figure out what to do about this.

Ah, motherhood. It's the best and most difficult thing I do with my life.

And medicine? Well, it's a close second! lol

It's 4:30 in the morning and I've already been awake for nearly an hour. The reason for this is that I'm starting in the PICU today and I don't want to. The very thought makes me anxious. Part of the reason is that I'm intimidated by how sick some of these kids are. Kids in the PICU sometimes die. The other part is that I know how unpleasant some of the fellows and attendings are to work with. I had a very negative experience working with some of these people in the PCU last year. My worst rotation of intern year. So my level of dread here is pretty high. Not very rational of me, I know. Not a very useful reaction, either. It's silly, really, to sit here for the last day or so dreading my next month of work.

I need to see it as a useful learning experience and a stepping stone to finishing residency. I just wish I felt that way. I wish I could have slept better, instead of waking up every hour or so all night. Part of that was due to my husband, who has a cold, snoring and sniffing and getting up multiple times during the night.

I'm tired of being a resident. I wish I could spend a month in an outpatient clinic right now. Matter of fact, I wish I could spend several months doing that.

One foot in front of the other.

In other news, I had a fantastic Thanksgiving holiday. I was off for 5 days! The majority of my family came to our house and it was wonderful. The dinner itself was outstanding, maybe the best I've ever had, thanks to my little brother who orchestrated the whole thing. I also just got to spend some quality time with my mom, my sister in law, my brother, etc. Wish I could have had a little more time with everyone, though it is nice to have my house back to normal again.

Okay, things to be grateful for and things to be gotten through. Guess I'll make the coffee and start getting through this day. With any luck, things won't be as bad as I fear and I'll be writing with relief in a few days. First PICU call night is Wednesday, so at least I have a couple of days to adjust to the unit.

Believe it or not, the PICU hasn't been that bad. It's not that it isn't stressful, it is. It's not that the patients are seriously ill, they are. But somehow, I'm maintaining a level of sanity and even optimism. Perhaps it's just that this isn't as bad as I had dreaded it would be. Our team is good. I really like my fellow residents. The fellows are generally pleasant. Our attending last week actually cracked jokes. Our patient load was exceedingly light and my first call was a no-hitter. As in, no admits! I still spent almost the entire night at the bedside of one very sick child and only caught a 60 minute nap at 4am. But, it wasn't nearly as bad as I had imagined. And now that I've had some experience, I feel like the bad calls and rough days will somehow not seem so bad.

In addition, I had Friday off this week. My husband had the day off as well! (the dog gets every other Friday off, so jealous!) We got actual snow on the ground here, which is flat out amazing! My husband and I ran some Christmas errands in the snowy weather. Later, the kids came home and we decorated our Christmas tree. It was the perfect holiday season day off. I feel so very grateful to have such a wonderful family. I'm so fortunate to have good relationships with all my kids as well as being happily married for over 18 years. It's truly a remarkable thing. Sorry for the gushing, but I really am feeling grateful for my life right now. Thanksgiving reminded me of the many things in my life that I enjoy, including my family. It also reminded me that even in the midst of this intense training, I do have time to enjoy the things and people I love.

I have to write this down so that when I'm miserably post-call from an 80hr week and beat down by a grouchy attending next weekend I will be able to remember why I'm still doing this!

My Uncle told me something over the holiday that I want to remember. In response to me talking about my schedule and feeling stuck in the middle of my residency, he said "Don't just hang in there. Excel at what you do." It reminded me that one of the ways I enjoy my endeavors is by having them be a challenge to me. Just like tackling marathons while in med school, I need to feel like I'm striving towards something and not just marking time.

Tally ho.

(Note: I wrote and attempted to post this on 1-14-10 but for some reason it wouldn't show up...)

Wow, I had no idea I hadn't posted since early December! I suppose the PICU and the holiday kept me pretty busy. It was pretty rough trying to have a Christmas holiday with only one day off a week and averaging 77 hrs a week. I handled things well enough until the day after Christmas. I only had Christmas Eve off, having to drive in to work at 5:30am Christmas day. My kids woke up at 5am to make me a breakfast! That was such a wonderful thing for them to do! We opened gifts that afternoon after I got off of work. Not ideal, but everyone seemed happy enough.

The day after, however, I had a minor meltdown in front of one of my coworkers and a nurse. It was just a few tears in my eyes and the confession that I couldn't do it all and I felt awful and just miserable that my kids had to do without a relaxed and happy mom for their holiday, hanging out in the kitchen baking cookies and decorating the house. I know, I know, they're not babies. My daughter did most of the decorating (besides the Tree) and we did make some cookies. It just wasn't the kind of holiday my own mother would have done and that's enough to make me feel like I failed at something.

Plus, dammit, (and i know this doesn't make me look particularly good) I missed the holiday while everyone else was home on vacation and having a great time!

I didn't want to resent my work and my schedule and my husband and kids' 2 weeks of vacation, but I did. It really made me feel sorry for myself. It didn't help that I was in the PICU and we had some very sick kids and a few kids who died in that time period, either. Work was getting more and more depressing, my colleagues were hating life in the PICU, and most folks in the hospital are miserable around the holidays.

We switched rotations between Christmas and New Years and I went from Christmas Eve to Jan 7th without a day off. Why? I don't know, because the scheduling gods hate me? :p Seriously, though. I went from last call in the PICU to clinics to working 5 straight days of 12 hour shifts in the EC over the New Year's weekend. Happy frickin holidays.

Yup. still bitter about that.

I finally had a few days off last weekend and spent 2 days in bed with a horrible head cold and cough. Naturally. Work too many hours, get run down and get exposed to every coughing, wheezing, snot-ridden child between 2 weeks and 20yrs of age in the metroplex and you're bound to catch something. ( and yes, we're seeing "children" up to the age of 21 yrs in our county hospital now. When did I sign up to do adult medicine???)

So here I am. It's January. The big Houston Half Marathon is this weekend. I've barely run any miles at all in the last month and a half. Seriously, maybe 30 miles total in that time instead of 30 miles a week like I should have been doing. I'm at the very same weight I was last year, which I swore I would do something about after last year's HM. I'm so frustrated about that. It probably doesn't make sense to y'all reading my blog, I know. But I want to be a runner, and residency is keeping me from it. I get too tired, too stressed, too rundown. There's too many demands at work and too many needs at home. And frankly, when I get home from another 12 hour day in the EC, all I want to do is stuff my face. I know I'm using food as stress relief and it's stupid and embarrassing, but it's true. I wish there was some magic way to stop that. I wish there was some non-harmful way to remove the stress of being a resident, of dealing with sick people and their unhappy families all day. I know one of the answers is to be done with residency and out practicing in my own office where I answer to myself and my patients, but not to the hierarchy and their stupid rules and their punishing schedules.

wow, I've got a serious vent going on here!!

Right now I wish I'd chosen a residency that had more focus on outpatient clinical medicine. I'm sick of the EC and I know I'll be doing something like 5-6 more months of it next year. *groan*

Uggh. Now I'm just fed up. And I know my husband is sick to death of listening to me vent about it.

I need a happy place. I need a place where I can be okay with 17 1/2 more months of this. And I need to be okay so I can chill out about the eating and get some exercise and be relaxed and happy again. I need to feel like myself again!

Guess I'll post later when I'm feeling better.

Right now I need to call our pediatrician because my son is home sick with the worst croupy cough I've ever heard on a teenager. Didn't even think you could get this after preschool. And, I have to work this afternoon. Thank goodness I have this morning off. I suppose the good news is, my illness and my son's illness have come at times when I was/am able to be off work. But, it also stinks to spend my days off in bed or with a sick kid. Yeah, that's how bad I'm feeling for myself right now. Poor pitiful me.

It's Saturday and I'm feeling a bit better now. I wound up staying home the rest of the day Thursday with my sick son. I worked a regular 9-4:30 day in county hospital Peds clinic yesterday. It was such a relief to have normal-ish hours and see daylight before and after work!

Last night we went to dinner with a bunch of my former running buddies. One of my very good friends is in town along with her husband for the Half Marathon this weekend. They moved out of state about 6 months ago and I have truly missed them. It was gret to get to see them, even if we had to share their attention with about 20 other people. She was (and still is, via email) my dietician, running coach and good friend. The dietician part doesn't work as well on email, I must confess. I need that face to face "so what have you done this week?" to keep me motivated.

Actually, speaking of motivation, I've come to the realization that I keep waiting for someone else to create the motivation in me to work out and eat right. But that's not going to happen. And trying to motivate myself by thinking about how I want to look on my 40th bday (this March!!! ) hasn't done it, either. I'm starting to think I'm going to need to do this for the very same reasons that I counsel my patients and their families about. I need to take care of myself so that I can be the best athlete I can be, so that I can be healthy and energetic, so that I can live a long life with as much good health as possible, and so that I can feel good about myself each day.

Funny how hard it is for us to live by our own good advice!

Well, anyway. I hope I don't injure myself doing a half marathon tomorrow that I'm not prepared for. My husband I will probably be strolling most of the way. lol. Hey, at least I'm out there and at least I can be grateful for the time off and the good health to even dream of jogging 13.1 miles.

As usual, time flies and I forget to write.

I did complete the Half Marathon with my husband, and we ran the entire 13.1 miles, by golly. Towards the end of the race I was really truly struggling and my husband looked at me and said "Wow, I've never seen such determination on your face before!" Haha. No one but those of us in medicine understand just how much determination each and every day takes in residency. I think my "race face" is a reflection of what's going on inside of me most days/nights in the EC.

Residency is a long haul and it's grueling, I won't kid you. I think my mistake this year was thinking it would be so much easier than intern year. In reality, in my program, it really isn't. We have 5 call months instead of 7 or 8 (I had 8 intern year), however several of them are higher acuity months (PICU, NICU) and/or have supervisory roles. Plus, we get to be the "work horses" of the county EC, whereas in 3rd year it's more of a supervisory role. Anywho, it's tough.

But I'm hanging in there. I'm also happy because I'm going to a regular floor month starting next week. Yes, it's a call month, but I vastly prefer inpatient work to the EC. I also prefer outpatient clinic to the EC. So basically...I hate the EC! lol. And I'm working there for the next 2 nights... But hey, it's my last 2 EC shifts until at least July!

I'm on track with my eating habits and exercise again. It was partially motivated by the HM, partially by the need to follow the advice I give patients, partially by my embarrassment at my kids noticing my poor eating habits (ouch!) and also partially by my husband agreeing to a very big treat for me in late June if I make my weight loss goal. *teehee* Yes, even doctors need a carrot to encourage them from time to time. The catch is, he has to lose the extra 15lbs he's gained as well. What this boils down to is I get to harass him into working out with me. Nice!

I've started Bikram yoga. Never really tried yoga before, except for one or two classes at the YMCA. Everyone keeps telling me I need to find a way to relax and disconnect my brain from time to time so I thought I would give this a try. It's very interesting. Yoga can be tough. Doing it in 100 degree heat for 90 minutes is really tough! I can already feel a difference in my flexibility after 2 classes. That's saying a lot because I have really tight shoulders and hamstrings and running makes it worse.

I'm going to have to write something soon about being the mother of teenagers. It sure is different from having babies or little ones! Scary in so many different ways. Difficult in so many different ways. I'd write more now, but I'm needed as a taxi driver again in a few minutes. You'd be amazed how much of my (our) free time is spent shuttling our children around. Much more so than when they were in elementary school! There's the high school musical rehearsals for my daughter, jazz band and quiz bowl and band sectionals for one son, boy scouts and sectionals for the other son. Soon it will be soccer season and driving lessons. How on earth am I old enough to have kids this old???????

Did I mention there are more grey hairs and wrinkles popping up since residency and teenagers? I was aging without evidence until this deadly combo!!! lol!

Gotta post and run, hope there aren't too many typos!

I'm going through a particularly tough time now. I've been working on our Cardiology floor this month. It's not an ICU floor, but the level of acuity here is definitely higher than on a regular hospital floor. As a matter of fact, 2 patients have died this month. One of them on my call. A baby. You can imagine the effect that has on me, as a resident, as a mom, as a mother of a child who had her own open heart surgery as an infant.

My last call ended with 2 children going to ICU's. I'd like to think they did okay through the night because of my interventions, but there's the fear that I should have done something different or sooner. Not that anyone has said anything of the kind. Matter of fact, I was praised for having picked up on the signs as early as I did. Nonetheless, the fear remains, that and the feeling that I coulda/shoulda prevented something. A curse of being in medicine, I suppose.

I haven't gotten more than 7 hours of sleep on any given night this month. It's too hard to get to sleep by 9am with teenagers. They always need something; homework help, a ride home from rehearsal, etc. It was easier to sneak into bed at 8:45 when they were already in bed too! And I have to be at work prerounding by 6:15am. And then, oh lordy, we round until nearly 1pm! (need a vomiting smilie here.) Seriously, from 8:15 to sometime after noon we are standing around at patients besides talking. It's so painful!

And to top it all, and I'm very embarrassed to admit this, I have sympathy fatigue. As in, I'm so damn tired and worn out that I can't seem to experience the sympathy and compassion that I am used to feeling for my patients and their families. Most days I just want everyone to go away and leave me alone. I know that's fatigue. I know that's the pressure of feeling like children's lives are at stake and a mistake on my part might contribute to a bad outcome. I know that's a reflection of how demanding training is and how long it's been since I had a vacation. If you don't count a few days at Thanksgiving, it's been 6 months since I had a vacation! Put together all the 30 hour calls and 70+ hour weeks in between and you've got yourself a recipe for burn-out. My vacation starts March 10th and I hope and pray it is the rest and rejuvenation I need to make it another 16 months.

16 months seems so very long and I am so very tired.

And of course, I'm facing my 40th birthday next month. And no, I didn't lose those 10-15lbs. Matter of fact, I've gained a couple this month. Thankyouverymuch Mr No Sleep Too Much Stress Monster in my brain that makes every carb that crosses my path enter my mouth these days. *sigh*

Far from being super mom, super wife, super doctor.
1) Have 2 children with failing grades this 6 weeks
2) Have stressed out husband who needs my attention and who doesn't need to hear for the umpteenth time how miserable I am.
3) Appear to have lost a great deal of what I learned in med school and intern year. I can no longer recall which antibiotics cover which bugs or the standard workup for anemia off the top of my head. I swear I've gotten stupider this year.

If somebody told me I could take a month off without consequences right now, I would take it without a second thought.

If somebody told me I could press a restart button back to 6 years ago knowing what I know now, I'd do some serious thinking.
Wait, no I wouldn't! What am I saying? That I wouldn't pursue medicine??? If I hadn't done this, I'd spend the rest of my life wondering "what if" and having regrets.

I know I'll get through this. I know I can find a way. I know that my well-earned vacation will make it possible for me to regain my equilibrium and enjoy pediatrics again. I just need a little time and a little breathing room.

And a reason to run, and to train. I'm always happier when I'm doing that.

One more weekend. One more call. And then it's "Radi-holiday" as our radiology elective is fondly known as. Hope I have something more uplifting to say after that!

Started my radiology elective today. Some call it Radiholiday. I started work at 8am and was done at 1pm. I could live with that. Here's a few things I learned today

1- What actually happens during a VCUG. Good to know, since as pediatricians we have a tendency to order those things.

2- Quiet dark rooms make me sleepy. No surprise there, after all, I'm a resident! I can sleep in not-so-quiet brightly lit rooms!

3- When I see something interesting on an image (like a huge heart on an xray for a newborn with "respiratory distress"), the first thing I want to do is go to the bedside and examine the patient.
Yay! The reason this makes me happy is that I was starting to fear that I didn't want to see patients anymore. Burn out is burn out, I'll get over it and go back to liking my job.

It really is amazing to me how much of a difference it makes to have the pressure off for a few days. I haven't had to diagnose or present a patient in 4 days. I've had 8 hours of sleep a night and not worked more than about 6 hours each day. I'm like a new person!

Someone told me the other day, in reference to my exhaustion, to find those opportunities to take mini breaks and just work them into my day every few hours. For example, she said, go get coffee, take your time stirring in the milk and sugar and then stand in the longest line to pay.

Wait. Longest line???? Has she lost her mind???

And then I thought about it.

How often do I get pissed off in traffic when the person ahead of me doesn't accelerate fast enough to make the traffic light? How often do I get impatient walking behind someone at the hospital that doesn't have my "doctor's walk" kind of speed? How often does my BP rise when the line at Starbuck's is more than 3 people long? It's a daily thing for me to get impatient and annoyed. And just how often am I truly late? Never. How often has patient care suffered because I stood in line for coffee? Never. When have they ever threatened to fire me because I didn't walk down the hall fast enough? Never!

Oh my goodness! What a small and simple and yet profound revelation for me!

I have smiled while sitting in traffic for the last 2 days. I have stood aside and let other people get in the checkout line before me and been rewarded with a smile in return. I have merged less aggressively into traffic. And by golly, I feel like a happier person. Of course, I'm a happier, rested, practically part-time person this week. But I think it all plays a part.

I went for a run this morning and it was fun! For the first time in months (maybe 20 months), I wasn't stressing about getting out the door by a certain minute to get back by a certain time in order to be out of the shower and drying my hair by a certain time, etc. I just put on my ipod and went for a run. Those 4 miles felt easier than many of my 2-3milers lately, and I ran them just as fast. And guess what, I wasn't truly late to work and no one cared that I showed up at 8:07 instead of 8:00.

This afternoon, I decided to make a pot of coffee. Somehow, the filter basket wasn't properly locked into place and my combo grinder/brewer proceeded to spew coffee grinds and how water all over my counter and floor. Normally, this would have upset me. Last month I probably would have started crying with frustration. Today? Today I laughed, cleaned up the mess and took it as an opportunity to clean out the whole unit, run some vinegar through it and start over again. I did some radiology online chapters while waiting for the various cups of water and vinegar and more water to run through. Refreshing.

Maybe I should have been a radiologist.

Just kidding!

But it really does bring home for me just how much of the anger and irritation and fatigue I've been feeling these last few months is based on my physical and mental fatigue due to being a resident. There's nothing wrong with me that my normally sunny disposition has been eclipsed. It's all related to how much pressure I've been under.

But I'm finally starting to see the light at the end of the tunnel. I only have 16 months to go. It still seems like a long time, and when I'm q4 for 5 weeks in May it probably seem like a lifetime again, but it's doable.

And right now, while I have the time and luxury, I am brewing coffee in the middle of the day and cooking dinners for my family and reconnecting with friends and running in the morning and generally being on vacation. I have an actual week of vacation starting next week and a meeting in sunny FL with the family in tow the following weekend.

*happy dance*