And so begins the residency blog...

Here's a link to my (lengthy) 4 year blog covering my med school years.

http://www.mommd.com/ubb/ultimatebb.php?ubb=get_topic;f=22;t=000015;p=1

It's June. The orientation for my Pediatric residency starts June 16th.

The very brief rundown on me, for those who don't want to comb through 20+ pages of previous blog:
I'm in my late 30's, married nearly 17 years to my college sweetheart, and have 3 children ages 13, 11 & 11 yrs. One girl and fraternal twin boys.

My road to med school was long and complicated and I could not begin to tell it here in a sentence or two. Suffice to say it was a 9 year journey with many interruptions.

I'm starting residency at a large children's hospital, in the program that I have wanted to be in since I first realized I wanted to be a doctor. I'm very interested in Neonatology and think I will likely do a Fellowship in Neo after my Pedi residency.

I like to run. I discovered this while in medical school. Never an athlete of any sort in my entire life, I have completed 2 marathons and scores of shorter races in the last 3 years. Running gives me the outlet and stress relief and social life that helps make the stress of medical training doable for me. It's probably the one thing I do for myself that isn't school or family life. I hope and pray I can stick with it through residency and that it will continue to be the source of smiles, fitness, weight management and stress relief that it has been for me in the past.

I'm a little neurotic, more so since med school. I'm a bit of a perfectionist. My daughter would laugh at me for the use of "a bit" since she claims I'm harder on myself than anybody else on the planet. She's a smart kid. But I am a bit perfectionist about my life. Afterall, I have a husband and 3 kids counting on me to find that perfect blend of balance and high schievement in my professional and personal life. Medicine doesn't allow you to "mail it in" too often, and neither do kids. So, a lot of my blog posts wind up being about my struggles to blend hard work in my career and being active and present in my family's life.

I figure the whole point of keeping this blog is to show other women interested in medicine that it is possible to do this with a family. I also figure it is my responsibilty to show some of the ups and downs as I experience them. I'm an optimist, as those who've read my previous blog know. But I do have my bad days, too.

One other note: Patients are NOT real!!!
This blog is not about writing about real patients and their real medical stories. I may write about patient scenarios from time to time to show that aspect of my life. I will make up details and change details and sometimes borrow from other people's stories to make a point. I will never violate any patient's privacy, or their family's privacy for that matter. As I've said before, this blog is about me and my experiences as a wife and mother in medical training.

Hope it's good enough to keep you reading!

How 'bout something boring and mundane? Every time I open an email from my residency program, I feel like a tree has to die! Seriously, the amount of paperwork is staggering. Far worse than any job I've ever had. And I've worked with kids before, for school districts even. There's the occupational health forms and the State forms and the employment forms and the license applications and the job application (didn't I already apply for the job when I applied for residency???) and the forms for the hospital badges (1 for each) and the forms for parking... it's endless! :crossfingers: Next time won't be nearly so scary and that's maybe the best thing I've gotten out of this. Confidence can be everything.

Speaking of confidence, I've had some interesting discussions with my daughter lately. She's quite the artist. She's mostly self-taught, but did spend a couple of years taking once a week classes at the Glassel School of Art back when I was preclinical and had a predictable schedule. She had a scholarship the 2nd year that she won. All that to say, she is actually a pretty talented young lady. My brother (also a very talented person) is the owner of his own game company. When he was in town a few weeks ago he saw her work, was really impressed, and asked her to do some concept art sketches for him.

I was proud and impressed. She was terrified! She's spent a lot of time in the last week telling me all the reasons why she can't or won't do the work. I finally told her yesterday that it was her right to choose not to do it, but that I would be sad if she didn't. A couple of hours later she came creeping into my room while I was watching election results to ask me if I was really mad at her. Of course not! Was I sad? Yes. I told her I was sad for 3 reasons. 1- Her uncle had made a genuine request and she was refusing him. The request came from him, he's not doing her a favor. 2- I would be so proud if one of her drawings was incorporated into a game that I could point to and say "that's my daughter's character!" 3- I'm sad because I know that it's a lack of confidence that's keeping her from doing it and not a lack of talent or ability or even ideas.

That had some effect. I pointed out one other thing and that was that I understood her fear and that I feel much the same way about writing the research paper and submitting my work for other's to read and critique. I think that had more of an effect than any other argument I'd made in the last week. She thought for a minute and then declared that she would do the drawings afterall.

My point in relating this long story which is almost entirely devoid of medically related issues is that it shows me quite clearly how going through all this training at this point in my kids' lives has some unexpected positive effects. Instead of having a mom who is established in her career with stories about her training and successes and failures, my kids get to see the entire process up close and personal. They've watched me study my way through weekend days and agonize over difficult rotations and they've cheered for me when my abstract got accepted and they stood by me and beamed with pride at my graduation. They have no doubts about how hard I work, how I sometimes struggle and how that work and struggle gets rewarded. I think that's a good thing. I wouldn't time family and career for this specific purpose, but it has been a nice side effect.

My kids certainly seem to be more goal-oriented about their lives than I was at their age. Even at 20 I was pretty clueless about where I wanted my life to go. I knew who I wanted to spend my life with and I knew I wanted my college degree, but I had spent precious little time thinking beyond those things. We'll see if my own kids find it easier than I did, or if it will just be different.

12 days to orientation!

Life continues happening, even when you want to put it all on hold.

I took my daughter to see a plastic surgeon today. Now before you get any crazy ideas, it's because of some scars she has due to her heart surgery as an infant. Her midline scar healed very well and although it is very obvious, hasn't caused her any trouble. She's remarkable blase about it considering she's a teenager. The scars from the chest tubes (for draining after surgery) however are the ones causing the problems. At least one of them is adhered to the chest wall and interfering with normal growth. She would be furious with me if I said directly what the issue was, so I have to dance around it.

So we saw the surgeon yesterday and he wants to do the scar revision asap, as in his patient care coordinator called me a couple of hours later and asked if we could do it next week. I was hoping, expecting, it to get done this summer, but this was with more urgency than I anticipated. I know I shoud have brought her in sooner, but getting a self-concious teen girl to tell you she has a problem is difficult. I had to balance between asking her occasionally if the scar was causing problems and pestering her about it as she was/is hitting puberty. So, probably would have been better to deal with this last summer. I feel crummy about that.

But what's already happened is behind us now and I need to focus on helping her get through this. She was mortified to have to take her shirt off and let the doctor look at her. To compound this, she had to have 6 different pictures taken (shirtless of course) so that he could plan the surgery. If you've ever watched on of those plastic surgery programs on tv, or had a similar surgery, you know what I'm talking about. Luckily, the person taking the pictures was a woman and she was very sensitive to my daughter's discomfort. My daughter cried between the visit with the doc and the photos. It broke my heart, but I had to tell her that if this is the worst consequence of her heart defect and surgery that we ever have to deal with, I'm grateful. I thank God for her and for the surgeons and staff who made it possible for her to be this vibrant intelligent and sometimes self-concious teen that she is.

So... it's hard for her and it's hard for me. No doubt I will be even more edgy this week than I would have been with just my residency looming a week away.

Thank goodness I'll be home to take care of her after her surgery next week. It could be worse. I could be already working as an intern and it would have to be her father sitting at home with her the day after her surgery. :boggled:

Life happens, regardless of your plans.

But again, though I'm distressed at the thought of a surgery and the possible appearance related issues she may continue to have (surgeon indicated we may have to do other things in the future), I know how incredibly blessed we are and I will never forget that.

...

Picked up my PALS and NALS (pedi/neo life support) training manuals yesterday. They're each an inch thick! We're supposed to teach ourselves all the material and take a test online before attending the actual classes (2 days) our week of orientation. The manual starts by saying "you should already be proficient in CPR and AED use..." What??? I wish they had told me this a few months ago! I haven't taken CPR in probably 15 years! I kept thinking it was something that would be covered in med school for heaven's sake, but never was. *sheesh* So that's what I'll be doing this next week when not taking care of my daughter. (I think I just felt my BP go up!) :boxedin:

In other somewhat medically related news... my manuscript was submitted yesterday! This is big news, actually. I'm afraid it's barely registered in my mind because of all the other things that piled on yesterday...

...

Back to the personal stuff. I didn't mention that while taking my daughter to her appt I had to pick my boys up from a friend's house where they spent the night. One son has had his glasses chewed up (lenses badly damages) by the family dog and the other son got beaten by a neighbor kid! He has a giant 5x5in bruise on his thigh. Apparently he and this other kid (a girl?!?) were playing swordfight and she got mad at him. He had a little plastic sword and she had a metal pole. So when she got mad she just beat him with it. The story is, her parents beat her for it (this is not the right answer in my mind!!!) and then they left early this morning to take her away for the summer.



I have no idea what the real story is here. My son is strangely vague about the whole thing. "no one" saw what happened. And of course I get this 30sec explanation at the door to their house while I'm in a rush to get my daughter to her appt for which we are already running late.

So today we're hanging out as a family and I will endeavor to find out what really happened. I'm trying to keep things light since there are so many obvious stressors in the back/foreground at this moment. What a way to start summer vacation!

(sorry for the long post!)

I would like to say that I am calmly organizing my life, studying my ALS courses and getting a few last days of leisure in. But I'd be lying.

Son's glasses replaced after friend's dog chewed them to pieces. Other son's fight with friend's neighbor discussed and dealt with, more or less. Daughter's surgery schedule for... Thursday! When that surgeon said "asap" I guess he wasn't kidding! I've covered nearly 80 pages of the 1st of 2 ALS texts, 250 pgs each.

Both boys have head colds and I'm sneezing today.

You know what isn't compatible? Reading about the indications for endotracheal intubation after finding out your daughter is having surgery in less than 48 hours is not conducive to relaxing thoughts, focus or concentration. :rotfl:

Okay, some deep breathing and writing and I'm feeling more like myself again. At this point, I just wish the surgery were over and I was at orientation. The anticipation of both is killing me.

Did I mention I'm starting on one of the wards with the reputation for being the worst for interns? Heme/Onc. However, the call appears to be a blessed q6 with 4 late stays (5pm is late?) and at least 5 shifts of H/O clinic 'til 6pm or possibly later. All in all, not so bad. This floor used to be q4 like all the others but I suppose it was rough on the interns (demanding unit with very sick kids) and the program has grown enough to accomodate the q6 call. The following month (Aug) I'm on the floor where I did my sub-I and apparently q5 there.

I'm babbling. Cross fingers for my daughter that all goes well and smoothly. She's scared but she's putting a good face on it. Now let's just hope I can do the same!

btw, I meant to write some thoughts about this "alpha mom" thing I ran across. One of the moms on my son's soccer team used that term when refering to me. She doesn't know me, so I guess it's just the mom and medicine part that leads her to this assumption. I had to look up the term because I wasn't familiar with it. Don't think I'm an "alpha mom." My kids had cocoa krispies for breakfast and have been playing Wii (my mother's day present!) for quite a few hours already today. :p Google it if you're curious. If I have time, I'll write more about my thoughts on this later.

Thanks to everyone who sent well-wished for my daughter. :goodvibes: She did extremely well! Her surgery was moved up a bit before 9am, she was out before 10am and we were home by 11:15! This kid is one tough cookie. She woke up from general anesthesia and started telling jokes to make sure she was really awake! :rotfl: She had minimal nausea, minimal pain (a tylenol last night and an advil this morning is all she's taken since they loaded her with the "good stuff" during surgery)and a fantastic attitude. Her surgeon was pretty pleased with the result in the OR, though he made it clear that she may need further work in the future to get the best result. Apparently he was so concerned about getting the scar revision done quickly that he kicked someone else off the schedule to get her in yesterday. All I can say to that is, wow. Glad we picked him!

I finished reading the Pediatric Adv Life Support materials today, at last. (PALS) I also started the Neonatal Resuscitation Plan text. I like reading the NRP material because it's a little more user-friendly and because I've seen quite a few neonatal resuscitations on my NICU sub-I, so it's easy to put it all together. I've only seen mock codes (practice codes done for residents and floor teams) in pediatrics.

I alternate between feeling excited and terrified while trying to learn this material. On the one hand, it's exciting to think about finally being a part of the medical team actually doing something for a patient in critical condition. On the other hand, it's terrifying to think that one of my pedi patients might actually need me to know this and know it well. My title may be "doctor," but I feel far from having the knowledge to claim it.

Still, I'm actually going to be a resident in 11 days! Orientation starts this Monday, but the real work starts on the wards a week from Tuesday. My long white coat arrived yesterday. I ordered it online because I decided I wanted to be picky and have a cotton coat and cloth buttons. :p (hate polyester!) I put the coat on and feel like an imposter! I remember feeling that way about the short white coat in med school. At first it made me feel vulnerable because I was afraid it meant I should know things I didn't know yet. But by the end of med school, it sometimes felt like a shield and sometimes like it was holding me back. There were days when being able to say "oh, I'm only a med student," felt pretty safe. Other days I wanted to burn the thing and be done being a student.

But the long coat means I'm supposed to know some things that I'm pretty sure I don't! The rational part of me knows that there are layers of back-up and protection for both me and the patients. The other rational part of me wonders who thought giving me this degree was a good idea! :laughing:

Well, I'm obviously relieved at my daughter's excellent recovery and the progress I've made with my texts. I feel very hopeful right now and looking forward to starting the part of my career where I actually get to do what I want to be doing. Taking care of kids! I should say, medical care of kids. I have my own kids and I've been taking care of those for a while now...

Hope I'll have some interesting stories to share from orientation next week. And for those who remember that I'm always dealing with my weight (25lbs lost in med school through hard work with dietician and lots of running), I rejoined the world of Weight Watchers this week. I'm a lifetime member from back when my boys were a year old. My goal weight back then was 125lbs! (I'm short) Well, I'm not there right now and I don't know that it makes sense to try and get back. Losing another 20lbs and keeping those off while in my late 30's sounds a bit daunting. But I'd like to lose another 12-15lbs and stay there. And I know for sure that I'm not going to let the long hours and stress put weight back on me. I've been there before and it's not fun. I don't think I have it in me to lose that kind of weight again, so I'm just going to have to prevent it in the first place! My very close friend is also doing WW (lost a bunch of weight last year) and is in residency with me, so we'll be good support for one another.

Okay, I thought I was done writing about 2 paragraphs ago!

Stay tuned for actual intern posts!

Good news! I survived the first day of orientation! :goodvibes: I know this won't happen with a great deal of frequency as things get busier and more hectic (kids back in school, practices, late nights, call nights, etc), but it felt like a good omen to have this on my first day at work.

Today I feel like we can handle anything together.

I've survived and passed my neonatal resuscitation and my pediatric adv life support courses. PALS was quite the ordeal. I'm glad I took the time to read and study well ahead of time. Learning to run codes (as in, patient in respiratory distress, or heart stops or is in shock, etc) is both harder and simpler than you might think. It's hard to be the team leader, even though leading is something that comes naturally to me. Even in these mock cases with plastic dummies, it's very stressful to see asystole (absent heart beat) on the monitors and realize you have to direct a team on how to try and save this "kid." Whereas working with actors playing patients was often annoying and tedious, working with dummies and scenarios of emergency codes is still stressful and nerve-wracking.

Needless to say, 3 very long days that I am grateful to be done with. I have no idea how I will actually perform when the time comes with a real patient, but I have more confidence now that I at least know where to start and how to proceed. (you learn a very specific set of algorithms and approach to these situations.)

We also met our faculty advisors today. I'm excited to have another neonatologist faculty member as my advisor.

Oh, our manuscript (my research) got rejected by the first journal we sent it to. Bummer. My mentor has another journal in mind. We'll see what happens. It seems the first journal basically didn't want a chart review. Their comment was something about the work being important information but that the research did not "control for the complex nature of the disease." Well, duh, it's a chart review. :p I can't control for that with a retrospective study. Essentially, it was rejected for being a chart review. Maybe a little luck will come through and it will be accepted elsewhere. Regardless, I got an abstract and a trip to Hawaii out of this already. I'm disappointed, but I won't complain!

Can't believe I keep seeing my name with "MD" following it. Can't believe I start my life as a doctor seeing patients on Tuesday. Can't believe how tired I am just from orientation.

The usual fears are running through my brain. If I'm so tired now, what's gonna happen next week? What if I don't remember anything? What if I'm a terrible doctor? What if the attendings this month hate me? What if it was all a mistake and I'm not supposed to be an MD??? Like I said, the usual stuff! :laughing:

Okay, time to relax a tad before heading back to orientation at 7:30am again tomorrow. I may feel like quitting some day, but not today!

Just a quick note to say that I have survived my first two days as an intern and so have my patients. Tomorrow is my first call night. The intern on service last night never even saw the call room and still doesn't know where it is. I'm pretty sure that means I'll be more than a little busy tomorrow night! Starting on the Heme/Onc floor has been intimidating and overwhelming, but also really good. The attending and the fellow are on the floor all day because the patients are so complex and sick. It's not like other floors where the attendings show up to round and then aren't seen again until the next day. Our attending and fellow are the nicest, smartest docs. I really mean that. They've made us feel comfortable with the fact that we don't know much yet and have to ask a million questions. I really couldn't ask for a better team. I have 5 fellow interns on this service, so we're q6. Very nice!

So far the hardest part of this has been leaving at the end of the day. It's hard because of the fear that I missed something or wrote an order the wrong way or forgot something, etc. I feel like I should just sit in the doctor's room and wait for the inevitable pages and calls. But, that's why we have a call intern and that person carries the pager and phone at night. That person will be me tomorrow. Hopefully I'll still be as happy with my new career when it's over as I feel right now.

Is it weird to be happy? I honestly thought I would come home crying every day my first week. Instead, I'm hyper and happy. I don't know if it's denial or if I'm just that lucky. I won't question it too closely, however!

Okay, so I didn't cry my first 3 days of internship. I've more than made up for it the last 24 hours! I also admitted 9 patients that night.

You know how sometimes you're really worried about something and you fret about it and then it turns out to be not nearly as bad as you thought? Well. My first call was worse than I feared. Hands down hardest time I've ever had. The worst thing about it wasn't the relentless pages or the really really sick kids, it was how awful I was at managing it all. I forgot a couple of things. I missed things. I did things wrong. It was awful. I didn't hurt anyone, but there were a couple of kids who probably would have felt better sooner if I'd been more efficient at what I was doing.

I'm usually pretty hard on myself, so you can easily imagine how much I've beat myself up about my less than stellar call night. I was so exhausted and overwhelmed by rounds that the attending and fellow stopped asking me for complete presentations.

Today was a much better day. Since it was the weekend, there were no official rounds and no lectures. I had time to actually chat with my patients and their families. I had time to think through my plan and look up details. I had time to ponder the TPN orders. Yeah, I'm still pretty slow, but getting better.

I also remembered to bring a couple of dollars so when the coffee cart came by and it was 1pm and I hadn't had lunch I was able to buy some PB crackers! It's the little things that matter when you're working this hard...

I finally got my lunch at 3:45pm when I also had the good fortune to meet a fellow MomMD. I really enjoyed talking with her. Hope she wasn't too disappointed in the real TR!

I confess I'm still exhuasted. I could have fallen asleep the minute I got home today. The only thing keeping me awake was the desire to hang out with my family. Don't know if I'll make it much past 8pm though!

We'll see if this renewed organization and planning helps me survive my next call on Wednesday.

Hubby is taking the kids to my parents on Fri July 4th. I'm alone for the holiday, but working. So, I guess it doesn't matter much. He'll be back Saturday night and I'm off on Sunday. That'll be weird, the 2 of us alone in the house on the weekend. It's been a year since that happened. This time we'll have something like 3 weekends without the kids. crazy.

Wish me a better week!

My 2nd call was sooooo much better! First of all, I only admitted 3 patients. Secondly, 2 of them arrived before midnight! The third didn't arrive until 2:30am, but I was already up and dealing with a very sick patient, so it didn't matter. I even got a couple of 20 minute naps between 2 and 4am. It's not much, but it does make a difference at rounds. I was also able to leave the floor for about 15min and have dinner at 7:45pm.

So, in a nutshell, fewer admits a couple of cat naps and food at a decent hour. :goodvibes:

So I'm off for the rest of the day and my hubby has driven to Arkansas with the kids to drop them off at my parents' house. All by myself. So bizarre! I can't decide if I should sleep, cook for the team tomorrow, watch tv, go see a movie or just sit here and type. :laughing:

Happy 4th of July! :unitedstates:

Wow, more time has passed since my last post than I realized.

I really miss my kids. They're coming home on Saturday, which is also my day off. :guilty:

Sorry for needing to write about all this. I can't get it off my mind, though. It's hard to have a day off when all I can think about is this patient who's parent initiated the withdrawal conversation with me yesterday. I feel responsible for them both and they aren't even mine. I was cross-covering for a fellow intern who had the day off yesterday. I can only hope that the continued conversation today goes well. I feel my obligation is to make sure that the conversation goes as comfortably and with as much dignity as possible.

*phew*

What's going right? I think I'm doing pretty well. I'm getting better and better at multi-tasking and prioritizing. I'm getting better at anticipating things and looking ahead to the next step. I'm also better at communicating with team members and families. It feels very good to be a trusted confidant for these families. My attending is very happy with our work and even told us so yesterday. Compliments are always nice!

Today my husband, best friend and I are going to eat at an Ethiopian restaurant. I haven't been to one in at least 15 years. I've only ever been to a couple of them and none here. After that we're going shoe shopping. No, I'm sure my husband isn't interested in the shoes. I think he's willing to do anything today to distract me and see a smile of my face. I'm a very lucky woman. :yes:

On call again tomorrow. 4th of 6 calls for this rotation. My last 2 have been much smoother than the first. I think I could even handle 9 admits again with a little more grace this time.

Turning a sort of corner.

I'm not sure how to start this post or exactly what to say, but the title came to me. I figured the words would follow.

I was on call this past Monday. The day started rough. I had this strong suspicion that we would have a mock code on my call day. I was right. I wish I could say that I had rehearsed everything in my head, reviewed my PALS course material and things went flawlessly. But they didn't. I did rehearse a few things in my head and I did look at my PALS material. What I didn't do was figure out how a mock code really runs. It's like being in a play and not knowing what your lines are.

Oh, I should probably explain a bit. Mock codes are practice codes where everyone (doctors, nurses, RT's, etc) pretends like a patient is coding but it's a plastic doll in the hospital bed. We have one each month on the wards and this was our first one of intern year.

I'd better also say that while it didn't run smoothly, the parts about it that didn't work well had more to do with not knowing how to conduct the "mock" aspect of the event and not the not knowing how to resuscitate a patient.

For instance, I was running the code because I was the on call intern that day. As the "code" was being run, I kept drawing blanks because I was staring at a plastic dummy and trying to decide what to do next. It took several mintues for things to kick in and for me to ask all the right questions. In a mock code you have to ask the person creating the scenario what the patient looks like, what the monitors say, what the history is, etc. You'll only get the info you remember to ask for!

Anyway, the code was a bit of a bungle. My fellow interns were as completely frazzled as I was. That was the start of my day.

Shortly after lunch, all my fellow interns and my upper level left for various clinics and an inservice exam. I was alone on the floor by 1:30pm. Then the admissions started rolling in. Around admission #3 at 1:45pm (literally), my husband called to tell me the vet had called him to say that our elderly cat was terminally ill and we needed to put her down to spare her pain and suffering. We've had this cat 17 years, since we got married. My husband was catching a flight at 5pm, so I would have to go to the vet the next day when I was post-call (having worked a 30+hour shift) and take care of our kitty. Then I got 2 more calls for admits.

So I'm walking down the hallway sniffling, grieving my cat, coaching my husband on how to tell our daughter (who has been caring for the cat as her own for the past 5 years and sleeps with her every night), all while taking pages and organizing my notes for what is now 5 new patients on the floor in the space of about 45 minutes.

I wish I were exagerrating.

One of my fellow interns had popped back up to the floor from clinic to check on something and saw my distress. There was a collection of consultants outside her patient's room who wanted to speak with the "intern" about what to do with the patient that afternoon. Normally that would have fallen to me, the on call intern. But I just couldn't handle it at that moment. I asked my fellow intern to go late to her clinic and take care of her consultants so that I could see the possibly septic leukemia patient that had just arrived to the floor. She took pity on me after I told her about my cat and my dilemma. Eventually she called the oncall upper level to come help me out.

Thank goodness for that because one of the new admits was a child with a DNR receiving palliative care whose family was trying to get home before she died.

There are no words for this.

The rest of my night did not really improve from there.

My husband, bless him, took off from work that afternoon to see about our kitty.

I was finally able to call my kids (still at grandma's house) and talk to them at 9pm. :guilty: You can imagine how distressing the whole evening was for me.

So what about this was a turning of the corner?

Well, I think this is when I fully realized what it means to be a doctor and to have a commitment to patients that can challenge your own commitment to yourself and your loved ones. Of course if the death had been a friend or a family member instead of a pet I would have asked for back up to be called and would have gone home or whatever was needed. But for a beloved pet, well, the patients needed me more and my husband and my parents were there for the kids. And for me? Well. Nothing staves off crying like having work to do and people waiting on you.

It helped me realize something too. I signed up for this. I chose this. And, I wouldn't change it. As much as I suffer emotionally working with some of these kids and their difficult situations, I wouldn't change for the world the fact that my being there might somehow make it better or easier or somehow less awful. If only by being a listener and a sympathetic ear when parents have to ask the tough questions or tell the bad stories.

And there are good things about it as well. I got to discharge a baby who'd been in the hospital since April yesterday. 99.9% of it had nothing to do with me, I'm sure. But I'll still take some of the credit for advocating hard for my patient and helping him get strong enough to be home today. There's also all the kids who've been sick and gotten better while they've been on my service. If I'm going to suffer for the ones who don't do well, then by golly I'm going to take pride in the ones who do do well.

Call is tough. Life is tough. Sometimes life is tough while you're on a tough call. But I did survive. I did my job and I did it well. I'm finding my way and starting to think ahead and formulate my own thoughts and plans and going to the fellows and attendings for clarification and advice instead of answers. That feels good. Surviving a week like this feels good.

Plus, my kids are coming home on Saturday and my son has promised that he owes me about 100 hugs. I plan to cash in on those!

Life can be chaotic. Things happen all the time that we don't plan for, even that we don't want. Blessings happen in the same way, often unlooked for and unexpected. The blessing I find in all of this is that I am getting stronger and better at what I'm doing. I like what I'm doing and I want to do it well.

And hey, I'm still running 4-5 mornings a week! What does that mean anyway? Does it mean I'm crazy? No. Does it mean I'm rail thin? Nope, I've even put on a couple of pounds thanks to the baking talents of some of my compatriots and my tendency to eat when stressed. But what it does mean is that I can still take care of myself and that I'm still claiming something that is exclusively me and mine. I run for no one else but myself. Precious little else in the life of a wife, mom and doc is about that!

ps- I shouldn't have said last Sunday that I could handle 9 admits again, 'cus that's exactly what I got! :p

My kids are home! :goodvibes: After lots of talking and hugging, they are now upstairs watching tv and playing on their computer. I think they're really really happy to be back in their own spaces. I sure am happy to have them here! I can't believe how mature they look. I mean, I know I have a child about to start her Freshman year of high school, but I didn't really realize it until I saw her at the airport gate. She's a teen! And the boys have this swagger that older boys have...

I enjoyed sleeping in this morning, until 7:45am! You know you're an intern when you consider this "sleeping in." But hey, I was in bed at 10pm, so it counts.

Life feels pretty manageable again. This week was rough with all the emotional issues layering on top of the physical and mental demands of our service. But I keep reminding myself that every time I survive a call or day like that, that it'll never be that hard again.

Now that I'm getting past some of the hardest first days, I need to think about taking better care of myself. I've been eating loads of carbs and sweets, partly because I'm tired and emotional and partly because that's what people bake/bring and what's easy to buy anytime of the day or night. But it isn't really healthy. I think I may have gone a couple of days last week without a single fruit or vegetable. Not a disaster once in a while, but not a good habit to form either. So this week or next I will work on perfecting the "bring your own healthy food" approach to feeding my body and brain.

Only 10 more days on this service and then I can move on to something different. I'm enjoying aspects of my work, but oncology is definitely not for me!

I was about to post a good ole vent when I noticed my blog is on the Features sidebar. Now I feel like I should write something useful and insightful...

But I can't think of anything...

All I can think about is how unsettled I'm feeling at the moment. My kids are out of town again. They're at camp this time. They were home for 48 hours and I was on call for about 28 of those hours. They did come up to the hospital with their dad and bring me dinner Sunday night. That was lovely. But I've just been so homesick for them! My house is too quiet, my sleep uninterrupted. There are no stories about friends breaking up on AIM or new Wii games coming out or stories from the poolside. What's a mom to do? Add to that the sick kids I see everyday and all I want to do is come home and hug my babies. Not that they're babies anymore, as evidenced by the AIM drama and the Wii reports.

Anyway. I haven't run in 3 days. Monday I was postcall. Tuesday I was tired and cranky. This morning it was pouring rain and I told myself I'd workout after work. Right. Ha. It's almost 7pm and I'm in my pj's! The mental and emotional and physical fatigue are leading to me eating everything in sight. Yes, I know that food doesn't make up for lack of sleep and certainly doesn't make me feel better for more than the time it takes to finish the m&m's, but I've seriously slipped right back into the old habits that got me starting med school 40lbs overweight. Now I'm only about 15lbs over my goal, but I seem to be trying to sabotage myself! *grrr*

Okay, enough about that. I'm going for a run tomorrow morning (ellipticle if it rains again) and I'm eating grilled chicken and salad for lunch. And no cookies, donuts or whatever other evil gets put on our table during rounds tomorrow! :p

Oh man. I know what it is. It's the stress. This week I sat in on the initial diagnosis conversation for the parents of a young boy who was being diagnosed with an inoperable brain tumor that responds poorly to the current therapies available. :guilty: Today I sat and listened to the parents of a kid, who is actually doing well, recount their struggles with another physician and the trauma they went through with his diagnosis and treatment. [I know I can't stop talking about the bad outcomes and tough stories on this rotation. It has really affected me. sorry!]

Yesterday I started my continuity clinic. That's a half day each week for the entire residency at a private practice pedi office. Nice pediatrician. Long time established practice. We saw at least a dozen patients... I don't like general peds that much. I was really hoping I would love it and that would simplify my plans for the future. You know, the part where my husband interviewed for a job in another city and where if I wanted general practice I would be done and out in the "real world" in 3 years. Instead it sorta confirmed to me that I am an intensivist at heart and Fellowship is in my future. Dang. Not the convenient answer I was looking for!

As if in confirmation of the path that I'm supposed to be on, the second journal we submitted my paper to has tentatively accepted it with some requested revisions. Also, I've been asked to assist in the writing of a handbook for Neo (along with a couple of other residents who have expressed interest in the field).

So why so crabby?

Maybe it's the adjustment to the 70+ hour workweek and only having one day a week off.

Maybe it's the lack of children at home.

Maybe it's the sleep deprivation.

Maybe it's the lack of time and energy to do things that distract me from work, like running and hanging out with friends and reading for leisure.

Maybe it's all of the above! :yes:

As always, I feel better for having written about it. Tomorrow is another day and I'm going to start it by doing something for myself.

You know, I just reread the quote in my sig and realized that I could sit here and feel bad about how things are right now or I could go do something not related to residency for the next 90 minutes. Duh! :laughing:

"All you have to decide is what to do with the time that is given to you."

So I worked out for 20 minutes or so and towards the end of my workout the song "Say" by John Mayer comes up on my playlist. I was sitting there, cooling down and listening to this song when I realized I haven't really said what I need to say. So here it goes. My apologies in advance.

Cancer sucks.

Death sucks.

Children dying of cancer has got to be one of the suckiest things I've ever witnessed.

I grieve for the parents.

I grieve for the children.

I can't accept the death of a 5 year old boy.

I can't accept the death of a girl just about to graduate from high school.

I can't accept the pain, the suffering, the need for hospice care, the massive doses of morphine that don't take away the pain and suffering.

I can't accept that this is a world in which there is a diety who answers prayers. Because surely, surely in a world where He was actively participating there would be no call for this.

I'm sorry. I'm sorry for the death I can do nothing about. I'm sorry for the suffering I cannot fix. I'm sorry for being witness to these most dire moments without anything to offer but my own tears.

I feel helpless in the face of this. I don't want to write DNRs for preschoolers. I don't want to send children and their families back home to the countries they left in search of a cure, only to find there is no magic, there is no answer.

I know there's another side to this. I know His hand is in all this somewhere. But right now all I can feel is the raw grief of standing at the bedside of a child at death's door with the devasted parents on the other side and having nothing to offer or say to make it right or better or different.

What I need to say is that cancer sucks and I cannot bear one more death or devastating diagnosis right now. I don't want to do it anymore and I cannot wait for this month to be done.

I'm sorry, but that is what I needed to say tonight.

Today is my day off for the week. I'm on call this weekend, thus the weekday break. On the one hand, it's nice that I can do things like go to the grocery without a crowd or make calls for business type things that only happen on weekdays. On the other hand, everyone else is at work! I think I'll appreciate the quiet weekday now and again when my kids are home and life is busy with them and their activities. Right now it's just...quiet. :p

I thought I would write a few words about being on call since many readers may not know what it's really about. I've been surprised at how poorly people understand what happens when a resident is on call. Then again, I shouldn't be surprised. Why would anyone not in medicine know these things?

So, as a resident, taking call on the wards means being the only doctor on the floor overnight. Wards are the inpatient floors with all the rooms full of patients. For most of us, call starts on Day 1 at 7am, technically. (though many of us arrive between 6-6:30am to get a jump start on the work.) Once the shift starts, you carry your pager, the code pager and the hospital phone (cordless phone only works in the hospital). The code pager goes off whenever there's a code (as in, a patient is not breathing or has no heartbeat and needs immediate resuscitation). If the code pager goes off, you respond immediately. (There are also things called RRT, rapid response teams, that are also called over the code pager, you only respond if it's on your floor. That's another story.)

So, from 7am Day 1 to 7am Day 2, you see every patient admitted to your floor and do a thorough history and physical and initiate whatever medical workup that patient needs. Since there are 36 beds on each of our floors, this can be a large number of patients! The record for # of admits that I'm aware of is 17. Considering that you would need a minimum of 30 mins just to get to know the patient, his history and current issues and decide what course of action to take, I can't see how that number could be done. On average on my floor, we admit about 6 patients each call. The most so far has been 10.

Additionally, you take all cross-cover calls. That means that once the other residents have left the floor for the day (often as early as 1pm because they have to go to clinic, etc), you take care of their patients. On a floor like ours, cross-cover is the majority of the work for the on-call resident. Sometimes your pager will go off 40-50 times in a call shift! Each one of those pages has to be returned and the patient seen/assessed on a heme/onc floor. You can't just order tylenol over the phone for a patient with a fever and no immune system to speak of.

Yes, there is back-up. There is an acting chief who is an upper-level resident who provides back-up for 5 floors worth of patients. (that's 36 beds x 5 floors)We have had fantastic acting chiefs who have really helped us out this month. For the h/o floor there is also a fellow on home call, meaning he/she will answer the phone/pager anytime day or night for oncologic/hematologic issues with their patients.

As you might imagine, calls come at all hours of the day and night. Patients seen in the ER at 4pm come up the floor and have to been seen and taken care of at 2am. Patients spike fevers, get nauseous, have pain, develop breathing trouble at 3am as well as 8pm. You don't get much sleep on call. On our floor, 2-3 hours sleep is considered a really good night. Most nights you just don't sleep at all because by the time you finish taking care of that 2am admit, the 3am fevers are spiking. :p

But call isn't just those trying 24 hours. It's also the regular day's work that you have to get done on Day 2! So you arrived at ~7am on Day 1 and you usually get to leave at 1pm on Day 2. Technically, you get "kicked out" at 1pm because there is a 30 hour time limit to call shifts.

On day 3, unless it's your one day off that week, you show up at 7am and put in your regular 8-10+ hour day!

Since we're only q6 on my floor (that means on call every 6th night) I'm only averaging 70 hrs/week. Other floors are q4 or q5 and push the 80 hour/week limit. I'm just grateful that we have this limit now! Speaking of which, I need to log my hours for the week, a required duty to track our time over the weeks and months.

Okay, so I'm meeting my husband for lunch today and then going to look for a light-hearted book to read when I'm not working.

Oh, I think I forgot to mention that my paper has a conditional acceptance from a journal! It's really just beginning to sink in, even though I heard about it a couple of days ago. That means my other duty today is to locate some numbers from my data set so that I/we can make the requested revisions to the paper. I'm very excited, now that I think on it. I may be a published author soon! :crossfingers:

Tomorrow is my last day on the Heme/Onc floor. I would be lying to say I was anything but hugely relieved! :goodvibes: I can't wait to pick them up from the camp bus! I know they'll be exhausted and sad because camp is over, but I just can't wait to have my home messy and full of kids again. I'm going to hug them as much as they'll let me. (which isn't much with 11 yr old boys!)

My husband is being courted by the client he's working with and he's very happy about it. I don't know that he'd really want to go work for them, but it's very flattering and if nothing else sorta increases his value with his own company. He's looking for a major promotion next Spring.

Time to think about where to eat dinner tonight. We still haven't cooked since the kids have been gone and I'm tired of frozen dinners. :p

It's been an interesting week on the new ward. We cover 2 floors with Neuro and Surg patients as well as general peds. We only see the surgery patients if general peds is consulted. The work load is about the same in terms of number of patients for the team. What's vastly different is the nature of the illnesses we're covering. On the neuro floor there are a few rooms reserved during the weekdays for video EEG monitoring for patients with seizures or suspected seizures. Then there are a number of different neuro cases such as seizure disorders, stroke, altered mental status, global developmental delays, etc.

More than one person has remarked on my improved mood and acting more like myself this week. I think it has a lot to do with surviving my first month and also with finishing heme/onc. It was a mentally tough time for me. I'm much happier being on a floor where I can actually "cure" some of my patients. I've had a recent influx of patients with neck abscesses (lymphadenitis) which responds very well to some good ole antibiotics after some good ole I&D (incision and drainage.) I don't do the I&D's in this case, we leave that to ENT. I do get to prescribe the antibiotics however! :goodvibes:

Is it really possible that I haven't written in 2 weeks already? Where'd the time go???

Being on call does make the time pass quickly because you always feel like you're trying to catch up. Catch up on sleep, catch up on work, catch up on family life, catch up on laundry... All because of those 30 hr shifts that leave you exhausted and useless the afternoon you get home. So that's 2 out of every 4-5 days where things don't get done in the usual way.

It is getting easier, however. I'm not nearly as exhausted and mentally slow as I was the first month I was on call. I even managed some intelligent conversation after my nap yesterday.

...
But here's the thing on my mind right now. The death of our great leader, Dr Ralph Feigin. http://www.texaschildrens.org/DrFeigin/default.aspx

The sense of loss and mourning at the hospital is profound. He touched so many lives in so many ways. For me personally, this hospital and Dr Feigin were the reasons I wanted to go to my medical school. I knew where I wanted to do my residency even before I applied to med school. After meeting Dr Feigin and participating in his famous "Feigin Rounds" as a 2nd year med student, I knew I wanted to be trained as a pediatrician under him and his program. It is a source of great sadness for me that I will not be able to claim myself as one of his trainees. And apart from that personal/professional loss, there is the tremendous loss to the medical community and to the children who benefitted from both his remarkable intellect and compassion.

For me, and many of us, the best way to honor his memory is to try and emulate his compassion and his passion for knowledge.
...

Other things on my mind include the kids going back to school next week and my husband's interest in a job change. The job change is something that I've been expecting for a while and think will be very good for him. Fortunately it's not the out of town position that I was alluding to last month. *whew*

As for the back to school stuff. Well, my son who never wanted to do his homework and turn things in on time last year has now been moved down to regular classes. At the middle school level, you're either in all advanced or all regular classes. You have to keep an 85 in all classes to stay in advanced. Not really appropriate, in my opinion (and I do have a teaching certificate to back that up). Plenty of kids have strengths and weaknesses and to demote a kid for having issues only in Math is maddening to me. Of course, I'm also not the kind of mom to force my kid. I didn't punish him for his poor grades in math and I didn't force him into tutoring. I figured now is as good a time as any to learn the lesson that you have to take responsibility for your own work. Still, as a mom, it's awfully hard to watch him take this consequence. Of course he was devastated when he found out they really did put him in regular classes this year. You can imagine how tough that is on a kid whose friends are in Adv and whose twin brother is an A+ getting kind of kid. :ouch:

So my son's plan is to make very high grades those first few weeks and see if they will bump him back up to Adv. We'll see what happens. I'm crossing my fingers like crazy and praying this all works out for him while trying to look like mom is totally calm and at ease with whatever happens. Of course it's crossed my mind that if he stays in Reg this year he might have an easier year and build up some of his confidence, etc. He can take separate Adv reading and science classes in Jr High next year if math is still troubling him.

Well, that's a lot more than I thought I would write. I've been so down since the loss of Dr Feigin last week. On top of that, I think I was sick because I had headaches and fatigue that just wouldn't get better for about 5 days. It was a huge relief to wake up this morning, feel rested and actually feel like running again.

So much to say and write about that I'm not even sure where to start and have started and deleted several times already in the last week. Maybe I'll break it down into spheres of my life and see if that doesn't make it more manageable.

Pediatrics:
Had a crazy call night last weekend where I admitted 11 patients and wound up sending one to the PICU. Heard my name "Is that TR?" coming down the hallway the other day. It was a patient of mine from my Sub-I over a year ago. Actually, it was his mom. She remembered my name and asked me how school was going. You can imagine the smile on my face when I told her I had graduated and was now one of the doctors! Her son looks so much better than he did when he was last admitted. He had been so ill and I was sure that he wouldn't be around by the time I finished med school. Turns out they were able to discover the source of his feeding intolerance and he's gained something like 30kgs!

He's one of several severely handicapped patients I've taken care of now. They are really difficult patients to have, and yet I feel very compelled to do my absolute best for them. I suppose that's because very few others want to take care of these patients and it's obvious how much frustration and disappointment these parents have dealt with over the years with doctors nurses and techs wanting to avoid them where ever possible. I feel like doing something right for a kid who can't speak for him or herself is one of the best things I can do in medicine. Guess that's why I love Neo as well.

I'm trying to remember what my other big plus was the other day. Another positive patient encounter. Wish I had written it down at the time. There are definitely days when it is good to be able to review these little pearls of positivity.

Oh, I remember one! It was really simple. I took care of a former 28weeker last weekend (for transient synovitis) who is so smart and bright and obviously a happy ending for a NICU patient. It was nice to see that not every very preterm child winds up somehow devastated. (there are days in a hospital like this where you think severe disease is commonplace and childhood cancer and devastating organ disease lie around every corner.)

Family life:
Kids went back to school today. My daughter started her first day of High School. She was quite nervous, but seems to have done marvelously. :goodvibes: She's thrilled to find several friends in her classes and is excited about all the goings-on. The boys just walked in the door and seem very happy, except for the part where they have to go to school!

Husband:
Looking at changing jobs. Don't know why that's stressing me except that he's stressing and so I'm stressed... It's not a bad thing, it's a good thing to have this opportunity. It just means a little upheaval in our routine.

Me:
Gaining weight. Not eating right. Barely running at all. *sigh* Not sleeping enough either. Need to do something about this ASAP. Don't know what resources I have to apply to this issue. This is always the thing that has to "give" in my life when something's gotta give. P=MD is good enough for med school, but not acceptable as a resident. Not sure how I'm going to handle this yet. Balance is harder and harder to come by.

But overall, life is good.

Today is my last day on the regular ward for a month. I've survived 2 months of call now. Starting tomorrow I will be in the well-baby nursery learning the newborn exam and filling out scads of paperwork. TBH, I think this rotation is more about the slave labor for the paperwork on this very busy delivery service than it is about learning the newborn exam. You don't need 4 weeks and 10 patients a day to learn that! Still, I'm excited to be seeing babies on a daily basis. I'll still be working 6 days a week, but no overnight call and only 2 late shifts in the ER for the month. That'll come out to only about 50hrs/week! (woohoo? :goodvibes:

Guess I don't have all that much more to add today. I'm sitting at home right now because I got called for jury duty today. I drove straight from the hospital after a 24 hour call shift (which I had to end early, it's normally 30hrs and peers had to cover for me) an hour away to the county courthouse. I sat there for an hour and then was told to come back at 1:30pm. I drove a half hour home in hopes of catching a nap but can't sleep because of the caffeine required to drive all that way postcall this morning. *sigh* So I guess there will be no postcall nap today and I'll just have to hope that no lawyer wants a sleep-deprived doctor on their jury!

Oh yes, and I engaged my dietician friend for a couple of sessions again. It's just one of those things I can't seem to manage on my own when so much of my life is more immediately demanding. So my solution is to ask for help!

I love, love, love the newborn nursery!

One of the boys has started tennis lessons with a college student who lives in our neighborhood. He seems to really be enjoying it and I know he's happy to be doing something that his siblings are not doing.

School year has started off pretty well for the kids. Somehow it's been much less stressful than in previous years. I don't really know why. Maybe because the kids are so much more settled now. I'm sure it helps that this is their 5th year in the district.

If I have any interesting stories from the storm, I'll be sure to share!

A quick post to say that my family and I are fine. I did spend 48 hrs in the hospital with the hurricane Ike. My hubby and kids road out the storm at home with a week's supply of canned and dry goods and all the doors and windows covered with plywood. Minimal damage to our home. Our city was hit pretty hard though and there are still lots of folks without power here in the big city and surrounding areas. My kids haven't been in school since the Friday before the storm. 1/3 of the campuses in the district are without power, so home they'll stay for a few more days. My week of vacation (1 of 2 this year) happened to fall shortly after the storm, so I've been home with the kids. We got our power back on the 3rd day. I lost a lot of money in lost groceries (no power, no refridgerator), but I cannot complain. Many people lost far more than we did.
I'm burnt-out on my job and program right now. But, I have 2 more days off and some time to recover. I think it hasn't helped having the death of our leader and the hurricane occuring in the first couple of months in residency. Things seem pretty bleak in the program right now, but I have hope that things will turn around.
I'll write more tomorrow. I've been without internet access at home until today, so lots of catching up to do!

Don't laugh at me, but I think I made a very important connection today.

I've been pretty unhappy with my program lately. I struggled with my frustration at being put on the ride-out team (again) and spending 48 hrs in the hospital with limited contact with my family and the outside world. I never got a full day off that weekend. Our relief team came in at 7am on Sunday morning so we could go home, but we had to return on Monday morning. I also just found out that I am on call on Thanksgiving day and that I don't even have a day off that holiday weekend until Sunday.

Add to that a recent phone call with my very good friend and fellow resident. Her apartment got water damage from the hurricane. The carpets had to be replaced and she had to move all her furniture into her garage while waiting for the repair and replacement work to be done. She took a day off when she was sick and had to pull all the carpets out shortly after the storm. Then she told me she might take a day off again in order to move all her furniture back into her apartment. I found myself getting angry.

Wait, angry? At my friend? For taking a day off? During my run this morning I had to ask myself why I was angry. I had also noticed I was ticked off at my husband for saying he had to leave work early today to coach our son's soccer team. Why was I mad?

Then it hits me. I'm angry because I have needs that aren't being met while my husband and friend have needs that are being met. Why are they getting what they want and need while I'm not??? Duh! It's because I don't ask for anything!!! :crossfingers: That my kids are back to school tomorrow. At this rate they're going to have to add 1-2 weeks onto the end of the school year!

I'm not 100% sure what I'm going to write today. Usually I sit down to write when I know what I want to say.

Things have continued to be rocky. I took a personal day on Wednesday when my kids were still not back in school. I was concerned about having my boys home without adult backup after the bus incident. (If I didn't already mention it, it involves a nutty neighbor dad who threatened my son.) I went to work Thursday and things were a little crazy. We had a mock code in the nursery which went well enough. Problem was, I felt completely unprepared for it and took a total backseat.

Then Thursday night I got some kind of food poisoning. I was in and out of the bathroom from midnight until shortly before my alarm went off. I felt horrible, but went to work anyway because, well because I'm supposed to go to work! I was still sick, however, making frequent trips to the BR and thinking about how pissed I'd be if I was a mom and a sick doctor was seeing my baby. On the surface, it totally made sense for me to be at home. But, there were a lot of patients and my co-interns would have to cover for me (again!) and I was supposed to have a late shift in the EC as well. :guilty: You can imagine the guilt I was feeling. I finally had to give in, though, when I broke out into a cold sweat right before going in to see the first patient. I thought it was just food poisoning, but I couldn't take the chance that it was contagious. Plus, I didn't relish the thought of puking in the patient's BR!

So I came home. Someone had to take my EC shift yesterday, I'm sure. I feel bad about that. Even though I know that's what back-up call is for, I feel guilty. But I know I'll be that person next year taking back-up call and maybe this'll make me more understanding of other people's illnesses! (I'm so rarely sick that I have a hard time understanding other people calling in sick to work. It's a fault of mine.) After taking a personal day this week and then having a sick day, I'm worried my fellow interns and upper levels must think I'm a slacker. I guess I'll just have to get over that.

Here's the thing I'm conflicted about. I find myself backing away from running codes, letting other people take procedures and generally not looking for opportunities to "get in there." Is that a personality thing or am I just scared? If I'm scared, why? When I was on my surgery rotations, I wanted to do procedures. I drilled in people's femurs on Ortho and thought it was great! I intubated and started lines on anesthesia and enjoyed that pretty well. I decided I didn't want it for a career, but I thought that meant I was a procedure kinda person.

So why am I suddenly squirrelly? And who can I talk to about this? I really feel like I need some guidance at this point about both my lack of confidence and my conflicted feelings about the demands of the job. I find myself resenting the hours I'm working already. I didn't expect this. I also find myself contemplating a LOA because I suddenly can't remember why I'm doing this. Whereas last month I told anyone who asked that I wanted to do Neo, now I'm wondering if I want to do any fellowship at all. The thought of extending this workload into 6 years is just...horrible!

Sure, rationally I know that intern year and first year of fellowship are the hardest and that the other years are more reasonable, but right now my more primitive response is "let me out!!!"

I suppose that's natural. At least, for some. I don't know. What's wrong with me? Dammit.

Usually writing helps me solve things. Today I've just worked myself into a tizzy. :boggled: I'm tempted to delete this all, but it's a much more accurate portrayal of my life as a resident than if I only posted the more upbeat stuff.

Hopefully I'll be back later with some resolution. Anyone who's been through this and has some thoughts or advice is welcome to PM me.

You know what? A couple of minutes after I posted this I realized something. Nothing is going to make me love the schedule. :p Really, liking the job and being happy being in medicine does not have to equal wanting to work six days a week for 50 weeks of the year. Nobody wants to do that! I'd be a little crazy to not wish I had more time off. :rolleyes:

What I need to do is go back to work tomorrow and jump right into things. I need to volunteer to do procedures and take lead in mock codes and do the things that will increase my confidence. Then I can have my confidence back!

And no, I don't want to stay home. My kids are gone all day anyway. I wouldn't have anything to do but turn into a desperate housewife! :laughing:

I love medicine and I love working with kids. I just need to focus on the things I like about it and deal with the downsides. Just like every other job on the planet.

You know what's funny, between the last post and this one, my pager went off. It's my day off and I could have ignored it. Instead, I found I wanted to answer it and be connected to what is going on at the hospital. So I suppose that right there answered my dilemma.

Don't laugh at me, this is how I work through things...

I heard this song the other day on House (I watch this show for the characters, the medicine is highly inaccurate). It's by Dave Matthews, one of my fav artists. The lyrics suddenly meant something to me today.

"You Might Die Trying"

To change the world,
Start with one step.
However small,
The first step is hardest of all.

Once you get your gate,
You will walk in tall.
You said you never did,
Cause you might die trying,
Cause you might die trying.
Cause you---

If you close your eyes,
Cause the house is on fire.
And think you couldn't move,
Until the fire dies.
The things you never did,
Oh, cause you might die trying,
Cause you might die trying.
You'd be as good as dead,
Cause you might die trying,
Cause you might die trying.

If you give, you, you begin to live.
If you give, you begin to live.
You begin, you get the world.
If you give, you begin to give
You get the world, you get the world.
If you give, you begin to live.

Cool song and I like the meaning. It goes very well in step with what I've been thinking since my pager went off this morning. I just need to jump back in there and start living again, as it were.

Busy, busy, busy back on ward service at the big children's hospital. I like it so much better this way! I feel like I'm doing much more for these sick patients than I did for the well babies. I also like the bigger teams with more folks to talk to and interact with. My team is cool, too. Laid back, but friendly and hard-working. The pulmonary patients are interesting and as always, the acuity is interesting.

This weekend is our intern retreat. I'm excited. It's a weekend away from home, with the family in tow, and the room and board is paid for!

In the family news, my daughter wants to go to homecoming and has announced she needs a dress and high heels! :scratchchin: She's never asked to wear nice heels before and she's never much cared about school dances either. Luckily, she also announced that she and her friends decided they didn't need boys to have fun and would be going together, without dates. *phew!*

Time to start the evening tae kwon do/tennis lesson shuttle service. Need to fit in some reading inbetween as I will be having fun this weekend.

Life is good.

Our intern retreat was fantastic. :goodvibes: Not only did I have 3 days off in a row (the first day was my regularly scheduled off day for the week), but I got to hang out with my friends and family at a nice resort. The resort was very family friendly and my program even put us up in 2 rooms, one for the kids and one for me and hubby. They have a very nice pool with 2 giant slides. The kids spent the entire Saturday afternoon at the pool. I sat poolside, read a few pages of a silly book, chatted with fellow interns and enjoyed the breeze. October in Texas can be quite pleasant when it wants to.

I was a little anxious getting back to work yesterday. I had to present noon report, but that went well. Today I ran into the Neo fellow who helped me with my research paper. (Did I mention it's getting published in a few months???) We had a nice chat. Afterwards I dropped by my mentor's office just to check in and see what was new.

Finally, I dropped by our resident office and picked up the results of my inservice exam. We took this exam back in mid July, just a few weeks after starting residency. Residents take it every year. I believe it's supposed to let us and our programs know how we're doing preparing for the big board exam at the end of residency. I didn't stress too much about it at the time because I knew I wasn't expected to do all that well. Afterall, how much could they expect me to know in the first 3 weeks of training when they're testing me on board preparedness? I was told by many not to study for it anyway because the goal is to improve your score from year to year.

I was pretty nervous anyway because my 2 Step exam scores were a big disappointment for me. I was never near the top of my class in med school and didn't expect to be, but struggling to stay in the middle of the pack has bruised my ego numerous times. So, my plan was to get the printout, walk to my car and call my husband. I figured he would be able to help me adjust my mindset so the score wouldn't be too much of a blow. I hoped to get around 50%, but was genuinely afraid it could be as bad as 35-40% having never studied for it. Well, my plan didn't work because my printout was not only not in an envelope, it wasn't even folded over!

Good news is, I did better than I thought I would! I did better than average and my score was good enough that 90+% of takers with my score in the first year go on to pass the board on the first try. That just makes my day. I don't know what the average is for my class at my program and I really don't want to know. I'm just going to bask in the glory of standing up well to the rest of the country and not worry about it! :p

Tomorrow starts of week that includes 2 afternoons in clinic and 2 call nights. It's been over a month since I've done this. Let's hope I'm not too out of practice! (haha) I have a couple of nice dinners out to look forward to next week, however. Plus a good friend's wedding I will be making a regretfully brief appearance at and my boys' 12th birthdays this weekend.

Hope I'm still smiling this time next week!

This day just keeps getting better. We just got our December schedule and I have Christmas day and the day after off! :goodvibes: I also have a golden weekend the weekend before Christmas! That means both Sat & Sun off, a rarity during intern year.

I'm not exactly sure what the explanation is, but being on ward service this month has been infinitely easier and more pleasant. I'm postcall today after a 9 admit night and only a couple of hours of sleep overnight. Yet my mood has been good and call just didn't seem that bad. I got a 3-ish hour nap this afternoon and I feel relatively normal now. A couple of months ago I would have been much more tired and cranky at this point.

I'm not sure if it's that I'm more comfortable in my roll as an intern or that I like the pulmonology service more than Neuro and Heme/Onc (without a doubt!) or if it's that I stopped waking up in the wee hours of the morning to run. I'm definitely getting more sleep since I gave up the running. If only I could not gain weight along with my additional hours of sleep. I guess that battle will never end.

Anyway, my point is, I'm kinda enjoying residency right now.

Whoa, where'd the time go?

Actually, I can tell you where it went. It's been a busy month, as usual, but with a few twists.

First, I've been enjoying this month. I like the pulmonology and endocrine patients. Lots of cystic fibrosis, asthma/reactive airway, and diabetes. All of these diseases make sense to me and are, for the most part, very treatable. Even the CF kids do so much better now than they did 20 years ago. I'm treating adolescent CF patients who are graduating from HS and starting college, etc. CF is not without it's sad, sad stories, but it's not as heart-breaking as Neuro and Oncology were for me. Additionally, I really like my team. We're very different personalities, but get along very nicely. Great upper level who is very practical and pleasant to work with.

I've had more experience with the mom-in-medicine issues this month. Last Friday night I was on call and my daughter attended her first Homecoming game and dance. :laughing:

Hubby and I have started a friendly competition over healthy eating and exercise to encourage one another. It's going to last 3 months and the winner gets to spend a bonus I received for being on the ride-out team for Hurricane Ike. (something good did come of that!) The 3 months is to get me past the holiday food hump and help me get ready for the half marathon in January. I'm only in the race to complete. I need the bragging rights to motivate me to run! (haha!) Also, the amount of unhealthy food and candy sitting in front of us all the time at the hospital is ridiculous. Today the lunch was pizza and cookies and the lecturer was handing out candy to people who answered questions. Plus, there's candy at the conference tables, etc, because of Halloween. I just cannot eat that stuff and it's just a fact of life. My metabolism is that of a 38 year old with a family tendency to obesity. *shrug* I have to deal with that. So I'm bringing my lunches as much as possible, even if it's just a PB&J on wheat, yogurt and an apple.

I'm chatty today!

Hope everyone is having as good a day as I am.

I think I wrote some time back about how hard it was for me to deal with some of the critically ill patients I cared for in my first month. I don't think I got around to saying that one of those patients died a month or so ago. The unfairness of that loss is too difficult to put into words. That child was the same age as my kids and prior to the illness that took his life, was as healthy and vibrant and alive as my own children. He was uniquely talented and poised to make the most of those talents. The illness that took him was one of those horrid random things that lurks in the corners of life and sometimes makes it hard for parents to sleep at night. Like a bolt of lightening or a driver asleep at the wheel, we have no power over these things and yet they have the power to take everything from us.

It's a tragedy and there's no way around that. No words of solace. No easing of that particular pain.

And yet here we are. We continue to move forward even when the knowledge of these things looms large in our sight because to do anything else would be giving up.

The best medicine we had couldn't save that child, but it could save something like 90% of other children with similar diagnoses. That's what we as physicians live for.

He won't be my only patient to die if I go into critcial care. But he will always stay in my memory as a terribly brave and amazing young man with an amazing family and I will never forget him.

Ups and downs.

I'm sitting here at 9am in my pj's. It's my day off. I just worked 7 days straight for a total of 90+ hours. If this keeps up, I'll definitely be in violation of our work hour rules. Believe me, I wish I wasn't. I'm doing everything I can to be efficient, but this rotation is very demanding and time consuming and there is no effort made to manage our time in the hospital. We were told on day 1 to expect to be in the hospital until 5pm on every day that we aren't post-call or in clinic. We work 7 days straight with one day off between and we're q4. So that means 2 x 30hr shifts and then 3 other 10+ hour days which easily passes 90 hours a week. Well, if they give me any grief about the duty hours, they'll get my opinion on the whole thing! :p

I think it wouldn't be quite so bad if it wasn't q4 or if there was more support. We get fussed at a lot about all the little details that need to be taken care of with our mostly critical patient population (I'm in a progressive care unit, a step between ICU and regular floors with patients on vents and iNO and trachs and such). I understand and respect that this stuff needs to be done, but how am I supposed to make it all happen for 8 critical patients before 9am?

I'm venting and I probably shouldn't be, but I am. I'm exhausted, my son is having really awful trouble at school, my husband is facing a career dilemma, and all I've wanted to do the last 2 evenings is come home and cry.

Thank goodness this rotation is only 4 weeks long and will be over in about 2 1/2 weeks.

Last month I felt like super mom, making a Homecoming corsage and Halloween costumes and starting a family healthy eating and exercise plan and getting back into the swing of things. This month I feel like loser mom. :ouch:

Win some lose some, huh? Next month will be eons better and even includes a golden weekend (both days off, which only happens twice in intern year!) and a mini-vacation because I have Christmas and the day after off. I'm hoping to have my parents come and stay with us.

Well, this is probably the rotation I was dreading the most this year, so at least I'm getting through it and it'll be over and I can move on.

I've been bringing my lunch to work and packing lots of healthy food and snacks for my call nights. I've even lost a couple of pounds thanks to my "no junk food" and 5+ fruits/veggies a day commitment.

As you can probably guess, my half marathon training is in the toilet this week. :p Yes, I'm crazy. I'm just trying to run enough that I can complete the race without dying in January. It's just a way of holding onto my fitness and my hobby despite the demands of being an intern and mom. My daughter ran with me a couple of times last week, which was fantastic. Extra talk time and bonding. Always a good thing.

Now I'm debating either a nap or a trip to Old Navy to buy some flannel pj bottoms and thermal tops to lounge in on my rare days/evenings off. Comfort measures are important to doctors too!!!

Haven't been writing because I've been working so much. Well, that, and because I haven't had anything nice to say this month. :p I seriously dislike this rotation, have a personality mismatch with my upperlevel, and have been pretty much miserable every working day. I bounce back when I have a day off, only to wind up tired and pissed off again the very next day.

I did have a fantastic Saturday with my family this weekend. It was my first weekend day off this month. (and yes, still pulling 90 hr weeks) My daughter and I went and got haircuts. I got to see my son's last soccer game of the season. Finally, my husband and I went out for a very nice dinner and saw a comedian in concert. I stayed up past 1am on the day before call, but it was worth it! Laughter is the best medicine and if you can combine that with date time with the man you love, life is pretty darn great.

Too bad my mood was ruined by the end of rounds this morning. I'm sure some of it is my own lack of "getting it" with all these complicated chronically ill children. But a good piece of it is also the passive-aggressive fellow and the constant feeling of having to defend myself. Oh, and then there's having all the responsibility of patient care and none of the authority. The bane of intern year made a million times worse by the passive-aggressive fellow and the tendency to let us interns take the heat from angry consult services.

Ugh, I wasn't going to vent here, but I can't help myself. Likely a sadistic hope that the people I work with will read this and realize I'm talking about them. Not very healthy, is it? :rotfl:

Things are looking up. 6 more days on the rotation. New people to round with for the rest of those days.

But best of all, we've helped some of my sickest patients. One of my patients was smiling today for the first time since I admitted him. It just made my heart melt. Another patient is acting more and more like the school-age child that she is with each passing day. These are the kind of things that remind me why I love medicine. Making life better for a child, and thus for the family as well, is what it's all about.

And it's not even dark yet outside and I'm already home! :crossfingers:

I'm off Sunday and hubby and I have a sitter scheduled to hang out with the kids so we can spend the day together. I'll probably take the kids to a movie on Saturday afternoon when I get home from work.

*keep thinking happy thoughts*

It's finally December and I'm out of the misery that was my critical care rotation. I'm naturally inclined to make the best of things, but there really wasn't much to make the best of last month. Okay, not entirely true. I had some good and interesting patients. I worked with some families that taught me about their children. I learned more about the art of caring for complex critical patients and for patients with chronic medical problems. I learned better how to negotiate with parents who've been dealing with their child's medical issues for longer than I've been in training. I've also learned a few things about what not to do. As is always true in life, not every teacher is someone you want to emulate. Sometimes you learn what NOT to do.

I'm now in outpatient clinics at our county hospital, a lifetime away from the ivory tower and critical care. My hours are more like 8-5. So very sane! I do have a 12 hour shift in the EC on Sunday, but that's a far cry from the 30 hour shifts every 4th day.

In other news, my husband is taking a new job starting in just over a week. He's been out of the continental US for this entire week. How I hate it when he travels like this. On top of that, one of the boys has been home sick all week with Fifths disease (common childhood rash illness caused by Parvo). He's had a bad case with 5 days of fever, athralgias and myalgias. Poor kid just hurts everywhere.

This is my life isn't it? I finally get off the bad month and I've got a traveling husband and sick kid at home. :rolleyes: My inlaws have been staying with my son during the day, thank goodness. My kitchen has been a disaster this week. Dinners have consisted of mac-n-cheese, scrambled eggs and pancakes, and leftover mac-n-cheese. I still haven't slept over 7 hours a night due to my son running fevers and my tendency to still wake up at 5am.

Oh, and as a topper, I arrived nearly 30min early to work this morning because traffic was extra light and I always leave ample time for bad traffic. (I detest being late.) While sitting in my car I realized I didn't have to be at lecture until 8:30, not 8:00 like usual. Oh, and it's Grand Rounds and no one cares if I show up. So basically, I'm 2 hours early for work and already paid for parking. *SIGH*

:laughing:

I have to laugh because otherwise I might just cry this morning, more out of frustration than anything else. I need a funny movie this weekend and some TLC. I need to come down off the high pressure/high performance run I've been on and try to be more normal again. I'm still functioning as if I'm in crisis and really, I'm not.

Maybe I'll do some Christmas shopping online.

The kids are all well again and back at school. My husband is back from his trip. I only worked about 50 hours last week. I got to wake up in my own bed without an alarm both days this weekend. And to top it off, my 10am-10pm EC shift on Sunday ended at 8pm when my attending sent me home. Clinic is crazy at times, terrible inefficient and not the way I would like to run things, but it's such a lovely break from the rigors of ward months and call nights.

I feel almost giddy. I smile for no particular reason. I feel like myself again.

The good news is, it took less than a week for me to get back to my happy optimistic baseline. The other good news is that I don't dread going back to the wards in January.

Now I just need to get back to exercizing and eating right. A few weeks of rarely eating and being too exhausted to work out really killed my good habits. It's so hard to get back, too. Why is that? Life would be so much easier if treats and watching tv didn't equal weight gain and flabbiness! :laughing:

Hmm, I could have sworn I'd written since this last post. Maybe it didn't take.

Well, I'm just checking in to say that all is well. I've been enjoying my month of sleeping in my own bed every night and never working more than 12 hours at a time. :p

My kids have been sick and my husband was laid out with a bad head cold for nearly a week, but it's still been a good month overall.

I just have one issue now. I don't want to delve into too much personal stuff, but it's a "female issue." :rotfl:

Christmas was wonderful and perhaps even more appreciated since I only had 2 days off for the holiday. (and I was lucky to get that!) The visit with my parents was really nice. Both of them seem much happier than they have been in recent years.

I'm on another ward rotation this month. Q5. Can't really complain except that I somehow wound up with the Neuro floor again. *sigh* Every resident repeats one of the months, but it could be anything including a non-call month. Why I have to repeat this floor when Neuro is perhaps my least favorite specialty is just Chance laughing in my face. :p I did this floor as a Sub-I, as a 2nd month intern and now again halfway through intern year. I've seen all I need to see of seizures. They make me sad and they make me feel powerless. Not a favorite physician combination, to be sure.

Kids are back in school. Husband is working new job and seems very happy. Sun is shining. Life is good.

You really never know what you are capable of until you try.

I ran the Half Marathon yesterday. Hardly trained at all. Haven't run more than 5 miles in over 2 months. Probably haven't run a total of 40 miles in the last month. Maybe less than 30.

But, I had signed up for it last year and I thought "What have I got to lose?" Well, actually, what I feared losing was my self respect and the respect of my running buddies. I'm 7-8 lbs heavier than I was last year and in nowhere near the same fitness shape.

But by golly, I decided even if I had to walk 3/4 of the race, at least I'd be able to say I did it.

So I got out there and I just started jogging. I took it easy and just kept saying nice things to myself, uplifting things, positive things. And would you believe, 10 miles into I realized I was gonna run (jog) the whole damn thing! I finished in 2 hours 31 minutes! I had told my husband to expect 2:40-2:50 and he missed seeing me at the finish line because I was so early! :goodvibes:

Fatigue and burnout happens to us all.

I woke up yesterday morning at 4:30am as I have been doing for a couple of weeks now. I usually try to roll over and wait for the alarm at 5:20, but often just lay there wide awake. So yesterday I decided to go for a run instead. I barely eeked out 2 1/2 miles and felt crummy the entire time.

I stopped at my Starbucks as I do every working morning and got my grande soy latte (lactose intolerant). I also got a berry stella, since this is supposed to be a healthy option and I'm painfully aware of the weight I've gained thus far in intern year.

I was still tired and cranky, which is unusual for me. A run will usually wake me right up and start my day feeling a little righteous. Instead, I struggled to wake up. Drank my entire coffee before I even got to the hospital. My eyelids felt heavy during the drive. I closed my eyes briefly at a stop light and then abruptly jerked awake. It had only been a few seconds, the light was still red, but it scared me.

Once at the hospital, I felt resentful that I had to be there. I wanted to throw my pager across the room everytime it went off and it only went off a couple of times in the first hour. I felt like every patient was being difficult and every attending/fellow/consultant was trying to make my job harder. I wanted everyone to go home and leave me alone.

At about 9am, having missed Grand Rounds because I was moving too slowly, I decided it was time to try eating more breakfast. Something I forgot to mention was that I was also getting mad everytime I walked into a patient's room and smelled their hospital pancake and bacon breakfast. Now that's just crazy. I knew something wasn't right! So I went to the hospital cafeteria and got a "heart healthy" breakfast burrito and more caffeine. I sat in the doctor's area on the floor, ate my breakfast and tried to write my morning notes. Slowly I started to feel better.

For the rest of the day, I just tried to get through. I made a visit to the NICU to try and remind myself that there's a career ahead of me that I want. I told my upper level I felt burned out. I ate M&M's with a fellow intern and commiserated over the fact that I hadn't had a vacation since September and wouldn't have another 'til March.

I went home and talked with my kids. I ate chips and a burger for dinner. I tried to watch tv and didn't like anything on. I tried to read a funny book and got annoyed.

I went to bed at 8:15pm.

I woke up at 8:20am.

I'm not mad anymore. I realize I'm exhausted. It's January of intern year and it's wearing me down. I have 6 1/2 more weeks of wards and then a "light month." In March I have a golden weekend (both days off) and a week of vacation.

In the meantime I need to find some balance. I need to find a way to take care of myself. I need to eat right and not gain weight and I need to exercise. But I also need to do it in a way that gives me energy, not wears me down.

I emailed my Dietician friend and asked for her help last night. You'd think as a doc I'd know what to do. You'd think as someone with as much experience and as much interest in exercise and nutrition as I have, I'd know what to do. It's not the knowing, it's having the mental energy to devote to the execution of that knowledge that's dragging me down.

Perfectionism is a blessing and a curse. It's a necessary trait for a physician, but it's also something that works against our ability to find balance and peace. It's a risk factor as well as a coping strategy.

We are, afterall, only human. But we deal in human lives everyday and the sense of responsibility is at times overwhelming. The desire to either do everything right in my personal life or to blow it all off because I haven't the energy to devote to it is a constant struggle. The middle ground seems so hazy and hard to identify.

For some reason, I'm willing to write things down here that I wouldn't say elsewhere. That's probably a good thing and a bad thing. I do try to keep things realistic. If I'm happy, I'm happy. If I'm struggling I try to share that, too. It's only fair. I've been accused of having rose-tinted glasses, but that's my personality. It's also my life, to be honest. I'm extremely blessed.

So the thing that's been weighing on my mind and apparently affecting more than I realized is a certain appointment I had to day. I saw my Gyn a month ago and she referred me for a mammogram and ultrasound. I wasn't expecting that. I'm a little young for someone with no history of breast CA in the family to be getting a mammogram. I'll jump to the good news, everything looked fine. *whew* It's not that I really thought anything was wrong, but when your doctor is a little concerned, it's, well, scary.

Nothing like being a patient for a few hours to remind you about how little fun it is to be on that side of the stethoscope, so to speak. Also, tiny little "cape" gowns in a waiting area are neither comfortable nor humane! :laughing:

I feel a huge sense of relief now that this is over. I'll never dread it the same way either. Mammograms aren't fun, but they're not nearly as bad as I've heard some women describe them. I guess it's kinda like labor, everybody has horror stories.

As for being an intern, I feel more prepared to keep working now. Guess I just didn't realize how much the fear for my own health was affecting me. I suppose when you're chronically tired, things that seem small can have a big effect. Fatigue changes how well you deal with life's twists and turns.

Still, 5 more days of the Neuro floor and that's just fine with me. I hear my next floor is equally trying, but at least it's something different! :p

There's something I want to write about, but don't think today is the day to do it. First of all, I'm postcall and tired. Second of all, I'm still pretty raw about the whole thing.

Med school prepares you for a lot of medical questions and pimping on wards and likely pathogens, physiology, and all that good stuff. What it doesn't prepare you for is the majority of day to day stuff you deal with on the wards. You learn how to do cross-cover by doing it. You learn how to talk to parents who've received bad news or give bad news by doing it. You learn how to field phone calls from angry parents and their lawyers by being the unfortunate intern on call when the phone rings... Yeah.

It's a little disappointing how much it's "every man for himself" when this sort of thing happens. Times like these when I'm so grateful that I've had previous work and life experience that allowed me to handle things coolly. Still, that didn't keep me from having a stomach ache for the rest of the night and from feeling like my job really sucked.

So I'll write some more about this later.

Fortunately, I really like my team this month and the floor is pretty cool.

Thanks to Residentmom for the reminder that I haven't been blogging.

Let's see, what to write about?

I'm on Developmental Pediatrics this month. A very lovely rotation for the simple fact that it is an outpatient month mixed with lectures and clinics and NO call nights. If Neonatology doesn't wind up being the things that makes me not care that I'll be on call for the rest of my career, I'm doing Developmental Peds. It's right my alley with my background in education and speech therapy. Development is the specialty that addresses normal pediatric development and whether or not those former premies or kids with autism or sensory deficits or learning disabilities, etc, are developing as they should be and whether or not they need additional services.

Clinics often consist of interviewing parents and playing with kids, literally. It's so much fun! And so much less stressful than spending your morning rounding in the hospital and trying to figure out what to do today for all the really sick kids and then defend that plan to every upperlevel, fellow, and attending you meet.

A drawback to my program, I think, is the complexity of most of the patients we see. Sure, we see the kids with bronchiolitis. But we also see kids with much more complicated illnesses. Matter of fact, I had 3 patients last month that I inherited from the resident who took care of them in January. I had to hand those same 3 patients off to the March resident last week. Didn't manage to "fix" them at all. Although one did finally get his diagnosis during my month, HIV. Another can't eat anything by mouth and is dependant on total parenteral nutrition (TPN), fed by a tube in his vein. The third had a couple of complications secondary to some major surgeries. They'll all go home eventually, it just didn't happen on my watch. Very frustrating.

I'm tired of intern year. I was ready to quit when my last call came around. It's not that it was bad last month. It wasn't. (except for the threatening lawyer incident) It's just that being on call is exhausting and the complicated patients are exhausting and working 6 days a week all year long is exhausting. I had a 2 day weekend for the second time this year this past weekend. It was wonderful! Time to sleep in, time to talk with my husband (poor man got an earful all weekend long!) time to hang out with my kids, take them to a carnival, etc.

So you can see why Developmental Peds is sounding really really nice right now. It's stuff I know and I know I'm good at it. It's clinics and it's no call. There are no developmental emergencies. No phone calls in the middle of the night. "Doctor, patient spiked a fever. Do you want tylenol?" :banghead:

Ooh, I forgot how much fun blogging is! I have to go get ready for work now (it's nearly 7am and I'm still in my pj's!!! ) I'll write more later!

Amazing what a week of decent sleep and no overnight call can do for my mood. Which is good because I'm about to tackle a somewhat longer week now. I've got a 10a-10p shift in the EC Sunday, a regular workweek, followed by another 10-10 shift on Saturday.

But once that's over, I'm on vacation for a week! I know I've got to let her learn her way around these issues on her own now, while I can still help if things fall apart. Better that she learn how to make schedule changes happen now than wait until college to call me and say she screwed up and didn't get registered for classes in time... Or better yet, lie about it for an entire semester until her parents want to see the grade report... (know a girl who did that in college!)

I still want to remind them to wear a jacket and eat a snack and do their homework and practice, etc. But I also know that my nagging no longer changes their behavior much and if they don't feel some consequences now they'll learn it the hard way later. Am I repeating myself? Probably because I'm trying to convince myself that it's okay if she doesn't get her schedule change or if my son gets put in regular classes next year because he can't be bothered to turn in his assignments. I can't do it for them, not anymore. *sigh* The thing that makes me crazy is that I was just like that when I was their age. I never "worked to my potential" and I paid for it in the sense that few of my teachers realized how smart I really was and neither did I. I'd love to spare them that heartache, but I can't. At least, I can't do it without forcing them into it. At least I got my act together in my sophmore year of college and pulled out a 3.5 GPA. And at least I always prided myself in ace-ing standardized tests. That went a long way in keeping doors open for me.

You can tell my kids' education has been on my mind a lot lately.

As for medicine, well I had to make up my schedule requests for 2nd year already! And believe it or not, it's already time to start thinking about Fellowship applications. Applications open up at the end of this calendar year and interviews are a year from now. Time flies, eh?

I've been looking at various programs around the US and trying to decide what's important. Sure, I'd love to stay at my home program. But is that really the best thing for me? Med school all the way through Fellowship at the same program? I'll be so indoctrinated into "The Way," that I might not be able to think outside the box anymore! :p Besides, there are other cities and even states in the US. We never intended to stay here as long as we have. But then, my husband has a very good job with a lot of upside right now in an industry that is fairly limited geographically. My daughter will be starting her Senior year of HS when I start Fellowship. That's no time to uproot the family.

So, we'll see. I have plenty of time to consider my options.

Tonight I'm going out to dinner with my husband and wearing my red cashmere sweater dress that I got on a ridiculously good sale. It's 45 degrees here this afternoon, rather unheard of is these parts in mid March! Think I'll wear my boots as well. Look out world! :rotfl:

Time flies.

Another bday gone by this week. My last year to claim I'm in my 30's. I can't really wrap my mind around the fact that I'll be 40 next year. I don't feel almost 40! If I think about it, I feel like I'm in my early 30's. I like my 30's and definitely could hang around here for another decade. :goodvibes:

The kids were tremendously helpful and cooperative with all the camp chores. If only they could be like that at home!

Now I still have 5 days of vacation left and I'm thrilled. I've been sleeping nearly 10 hours a night! It's fantastic to be so rested and relaxed. Really brings home just how exhausted and stressed I am on a day to day basis in residency. But you know, I'm not going to dwell on that. I love my career. I can't say I love the job of being an intern everyday, but I know where it's taking me and where I want to be. Besides, before I started working this hard, I never really appreciated time at home like I do now.

As an aside, I was just thinking about how is it that I'm so fortunate that my kids think I'm great and really respect what I do? I think I know the answer. I think it is, in part, because my husband thinks I'm really great, admires what I'm doing, and respects me. Now how I got to be so fortunate to have found him, well I don't know. But I will be forever grateful. Our marriage has not been all roses or rainbows, no marriage is, but we have worked through quite a few things and ultimately we love and respect each other.

Anyone else watch Desperate Housewives? Thanks to tivo, I still do! I love the stories. Anyway, I was watching Sunday's episode last night and thinking about poor Bree and her business. Granted, she has done a lot to drive her husband into the situation he is in now. She's done more to verbally unman that guy than anyone would think he'd put up with. However, he wanted her to completely give up her business and her passion so that she could focus all her energy on being "Mrs Orson whateverhislastnameis." Wow. He wants her to give up the very thing that makes her want to wake up in the morning. The accomplishment she values most. That's not love.

So, my point is... despite the long hours and the exhaustion and the greater workload for my husband at home, he encourages me every step of the way because he knows how much this means to me. That kind of support is what makes my life possible. It's not that he's at home washing dishes or changing diapers, I did that for 10 years thankyouverymuch. I supported him through grad school and 10 years of career path, including nearly 3 years of weekly travel. It's that he recognized along the way that I couldn't do that for the rest of our marriage. That I had dreams and aspirations and desires for a career of my own. And he chose to support and encourage me.

Now we have adolescent kids and 2 busy careers and it'll be interesting to see how things pan out. His career is starting to accelerate again after being in a holding pattern for the last 4 years. I encouraged him to it because I know he wouldn't be any happier than me in the long run if he totally gave up his goals. But adolescent kids still need a lot of time and energy. :yes: How will we be as parents of teens? Will we be around enough to prevent those pitfalls of sex and drugs, etc? Those things happen when parents are at work, as we all know. We can't be home from 3-6pm every day to monitor the afterschool stuff and we're well beyond the nanny stage.

More questions to answer, more puzzles to, well, puzzle over. Parenthood doesn't get easier as they get older, just different. Different challenges, different worries, different needs.

In other news...
I've settled on Neonatology and I'm really happy about it. I struggled to keep an open mind about other specialties for years and now I'm happy to be at peace with the decision.

Sorry for the long post, I have so much free time this week!

Hmm, I was certain I had posted since the March post. Did it disappear? Matter of fact, I remember writing it quite clearly. Bummer.

Well, no real new news to report. I'm q4 in the Level II nursery this week. I was in the NICU for a couple of weeks earlier this month. Absolutely loved it! It is without a doubt what I want to do for a career. :goodvibes: I even got my first umbilical lines in a tiny, tiny premie last week. First try! Few things feel as good as getting a line on your first try. Too bad I haven't been so fortunate with my taps (lumbar puncture)so far. I can only console myself with the fact that no one else was able to get the tap on those two patients either. (small consolation for me and the patient, of course!)

Life is good. I am (im)patiently waiting for my schedule for the next academic year. I want to make some plans for the summer, but nothing happens until I know what kind of schedule I'll be working.

Kids are good. Had to read the riot act about some grades on the last progress reports. We'll see if it worked. I basically told 2 of my kids if they didn't get their acts together they'd be in summer school instead of on the family vacation come June. Yes, that thought makes me queasy. They'd better not make me stick to my guns!!!

I'll have to write a "day in the life" entry about being on call in the Nurseries at the end of the month. Some funny stories!

Prepare yourselves. I'm going to muse on facing the last 2 months of my intern year.

Truly though, we just got our schedules for the next academic year and I cannot quite fathom that I am about to be a 2nd year resident. Finishing intern year has it's ups and downs. It certainly is nice to be doing something next year besides being buried on the wards for most of the year. It's also nice to step out of the low-man-on-the-totem-pole role. OTOH, now I'm supposed to know something! No longer able to hide behind the "lowly intern who doesn't know much yet" bit.

To be honest, I'm currently recovering from my last month in the Level II & III nurseries at our county hospital. It was a very good month, but I was pretty ramped up the whole time. Mostly a good thing, just being excited about being in the NICU. But also a little nervous, wanting my attendings to think well of me, wanting to do well, etc.

Frankly, it's nearing the end of intern year and everyone is tired. There aren't quite as many smiles going around these days. Nerves are a bit frazzled, reserves stretched thin.

And somehow one week off for all of us at the end of June needs to fix that... :rolleyes:

Actually not that bad. It's amazing how quickly you can recover once the pressure is off for a few days. I'm usually super cranky for a couple of days on an easier month, as if letting the pressure off lets me really feel how tired and worn out I am. Then a little extra sleep and no dreaming about patients allows me to get back to baseline once more.

Ah, swine flu. Preparations are ramped up. Everyone in patient care is getting fitted for protective face masks. *sigh* I predict much more will be made of this flu than is acually necessary.

Uh-oh, time to be taxi-mom!

*Ugh* Sorry, I'm going to vent about motherhood.

My son. My son has brought home uninspired B/C report cards all year. No amount of cajoling, pleading, grounding, etc. has changed that. A couple of weeks ago he brought home a progress report with an F in Math. I read him the riot act, told him he'd be in summer school and miss our vacation and generally laid it out for him. Then his dad went to a parent/teacher conference and they devised a system where he has to get his planner signed every day by each of his teachers. He's finishing 6th grade. I would have thought we'd be past that kind of hand-holding by now. Regardless, he brought home an improved report card last week. One C, a couple of B's and several A's. What a relief!

My highschool freshman daughter also brought home a poor progress report. We took away the cell phone. At the end of last week I asked her if the report card would be improved and if she had earned her cell phone back. She said "yes" and got the phone back over the weekend. Today I got her report card. It's the worst one ever! It's not like she was ever a straight A student, but this was atrocious. She flat out failed a 6 weeks of English. English??? My child who reads a book a day? Whose vocabulary beats most adults'? *arrggggh!*

I demanded the cellie, the ipod and sent her to her room in order to preserve her life. Okay, I exaggerate about the life-preserving. But still, I'm so furious! She's on the verge of having her first boyfriend. She asked me if she could wear a bikini this summer. She has a great social life. (finally, after several years of bullying and difficult friendships) And now this. It makes sense, of course. Her mind is on friends and fashion and boys, instead of school.

Why do I have 2 underachieving children and how on earth do I change them??? They are so very capable of the work and so very failing to turn it in. It's not that they can't do it. They just aren't doing the assignments or failing to study for the tests.

The thing is, I did this at their age too. I remember. And you know what? Nothing my parents did changed my behavior. That's what scares me. My SAT scores saved my butt and allowed me to get into some good universities. Once at college, I was able to see why I really cared about my grades.

But what if one or both of my underachieving kids actually manages to shoot themselves in the foot and misses out on important opportunities?

And before anyone thinks about this being an issue of a medical mom not having time for her kids, my mom was a SAHM. And like I said, I did the same thing. I could be home every afternoon when they walked in the door, but if they lie or withhold info about assignments I can't do anything about that. Okay, maybe I could call the teachers daily and follow them around school, but I don't think that's appropriate at this stage. (besides, they'd hate me and find other ways to rebel, wouldn't they?)

Dang. I'm just so frustrated. No idea what to do next. That's the thing about parenthood. Just when you get one part of parenthood figured out, they throw you into the next stage and you're completely clueless again!

*sigh*

-Tired Mom

I was so annoyed by this story today, http://www.slate.com/id/2217798/ , that I sent Oprah this email. (though I doubt it will get read)

Dear Oprah,
I watched your show daily for many, many years. I read your magazine and I support the fantastic work you have done for so many charities and organizations. I have to tell you, however, that I am deeply upset by your support and promotion of Jenny McCarthy and her anti-immunization campaign. I am the mother of 3 children and a pediatrician in training. You and I both know that there is no scientific proof that vaccines cause autism. There has been no decrease in the rate of autism since the removal of thimerosol from vaccines. There have been, however, increasing numbers of cases of children becoming very ill with vaccine preventable diseases. We've seen it at my hospital. We're seeing it all over the country. It deeply saddens me that you are lending your good name to the campaign against vaccines. Please reconsider, for the good of your viewership, your readership, and their children.

Maybe I shouldn't have been bragging about never getting sick... I'm home sick today. Nothing horrible, just upper respiratory junk, headaches and a bad case of the blahs. Just shy of a fever, too. And since my husband is also home sick, pretty sure it's contagious. :laughing:

I had dinner today with a friend who is finishing her Neonatology fellowship in about a month. Very happy for her! And jealous, too! I wish I were on the verge of being done instead of looking at 5 more years. But then, I know I'm no where near ready and I'm supposed to be enjoying the process. Living in the moment and all that. :laughing:

Anyone who knows me knows I'm not good at living in the moment. I'm always a day, week, month, year, decade ahead of myself. Great for planning, bad for managing anxiety.

Today was the kids' last day of school. Can't believe I have a Sophmore and 2 boys in Junior High now. I've met my daughter's boyfriend a few times now. He seems nice enough for a hormone-ridden adolescent boy. :laughing: One of my sons is very concerned about the fact that they kiss when no one's looking. I honestly don't know how to feel about it. I guess I know I wish she wouldn't kiss him, but I also know it's pretty normal for her age. Freaking out about it would just lead to her hiding things from me. So I've told her how I feel about things, and I've done my best to make sure the lines of communication stay open.

Wow, it's taking up a lot of my mental space lately, isn't it? I just one of those stages of parenthood I just wasn't ready for and here it is. Potty training seems so much easier now...

Yeah, so what am I doing at the hospital these days? General inpatient pediatrics at the county hospital. It's very strange to be at the end of intern year, still playing an intern role. I have an attending right now who tells me what to do and makes me carry charts from bedside to bedside and borrows our stethescopes because she doesn't carry her own. :rolleyes: I think she's younger than me. :p I want to say something to the effect of "Excuse me, I'm not a chart carrier. I'm a member of the medical team who happens to be the one who admits, writes the orders, and makes the discharges happen. Perhaps you could treat me that way?" Can't really say anything else about the floor or cases since I'm far from anonymous around here. I'll try to dream up some representative type cases to write about this month. I miss blogging regularly!

Can't wait for our family trip to Colorado in a few weeks! Cooler air, mountains, great coffee shops and great hiking/biking and other activities. Love it!

The training for my next half marathon is going well. It'll be interesting to see how it goes once I have to do day and night shifts in the ER in July and August. As always, my weight continues to plague me. If only I could stop eating! To be honest, I wish I could eat like my daughter. She eats like a bird, as they say. I remember when people used to accuse me of that, oh so many years ago.

Well, it finally happened. TR got sick. :p

I got sent home yesterday morning with cough and sore throat and spent the day on the couch. I felt so crummy I didn't even read email. I've had contact with several Flu A positive patients recently (as in H1N1 "swine" flu) and a fellow intern who has the flu. But fortunately no fever for me, thus no need for flu testing.

Today is my call day. And, I'm home again. Oh horrors! Really, though. Missing call is about the last thing on earth I actually want to have happen. While it sounds good in theory, I have this horrid sense of letting everyone down. I feel like I'm somehow weaker, not a top notch resident because not only did I succumb to illness, but I'm letting myself miss call for it.

OTOH, I have body aches, a constant cough and no energy. Which fellow nurse or resident would like to work with me tonight? Which patients or parents will be happy to have me coughing while examining them? From a reality standpoint, I know it's best to keep my germs at home.

Still, feel like a wimp.

The good news is, the way this rotation is arranged, there is a second intern on our team who is on call with me each time (an anesthesia rotator who is quite good) and an upper level who admits patients with us. So they probably won't need to call in any backup. The last few calls we've only admitted 2-3 patients a night. (yes, it's super slow at the county hospital in the summer as far as admits go!)

So here I am, at home, feeling like poo. :laughing:

Only 5 more intern days! *happy dance*

All in all, it's been a very good year. Would I do it again? Yes. Not, would I repeat the year (heaven forbid!), but would I do it knowing what I know now? Yes, knowing what I know now I would do this again. The world did not end. My family is as well-adjusted and happy as ever. My marriage is as healthy as ever. I'm a little worn out and exhausted at times, but I'm also still running and camping and going to the movies when I have a chance. Sure, things aren't perfect. But hey, they weren't perfect before I started residency either!

Did I mention the other day that I was really tired... Oh wait, I just realized that was the day before I realized I was sick. Well anyway, there are definitely days when I ask myself "why, why are you doing this very difficult thing?" But the answer is always, because it is what I want to do and it makes me very happy to be a doctor. My least favorite rotations this year (including the current one!) have been the ones where I was treated like a secretary and my thoughts and opinions and plans for patients were not heard or largely ignored. Even if I'm wrong, I prefer to have a voice.

The attendings I respect the most, by far, are the ones who allowed me to be the main doctor for my patients. They asked my plans, asked for my reasoning, and guided me to correct answers when my thoughts were wrong. I have learned the most from them. I may have been dead wrong a few times but I sure learned from voicing those wrong ideas and being guided to the right ones. I learn very little from attendings who just tell me what they want done. Medicine is a thought process, not direction following!

Ah man, I am utterly miserable. Since I posted yesterday my 99.8 temp decided to climb to 101. I got a rapid flu test, which was negative. I'm both relieved and frustrated. At least if I had flu I would have an excuse for missing so much work. My temp is 100.5 this morning, but I'm taking my advil and going to work. Guess I'll just have to wear a face mask while seeing patients and hope I can last 6 hours or so.

The headache and bodyaches are the worst. The constant cough is annoying, but the aches make me miserable. I'm a total wimp 'cus I haven't been sick like this in years. I had strep in 2nd year of med school, but got antibiotics within 24 hours and was fine in 48. Now I've been sick since late Tuesday and there's no end in sight. Oh yeah, the other good thing about if it had been flu was that I could have taken tamiflu.

Instead, I'm just suffering and trying to remember what I tell my patients to do when they have viral illnesses! :laughing: It's very unsatisfying to leave a doctors office with no medicine to "fix" things. My family doc did give me a script for a Zpack, just in case. I have no bacterial infections symptoms, though, so a zpack won't help.

Wah wah wah. It's 4am and I can't sleep. Been awake since 3am, more or less. I have to go to work today. Can't leave my team a man down for another day unless I'm in the hospital or flu positive. That's my rule, by the way. Not sure what my chief resident and upper level would say if I told them I still had fever. They'll have to see me and send me home, though. I'm too afraid everyone will be thinking I'm exaggerating or making this illness up just to avoid work.

What a crummy situation. And I have no days off this weekend because of our attempt to go see the shuttle launch last weekend. I used two days off last weekend and gave up the one for this weekend. No shuttle launch, too little rest, and now I'm sick and supposed to be working until Wed.

Tuesday is my last day as an intern.

(about the only positive thing a very grumpy TR can even think of now.)

Good news, I survived my "not flu," and my last week as an intern. Once I got over the fever, it still took the better part of a week to feel like my normal self. No one else at home got sick, luckily. I think it was the exhaustion and the travel in the middle of a call month that did me in. I was just so worn down.

But now I'm back. We just got back from a week in beautiful Breckenridge, CO. The temps there went from mid 40's to mid 70's. It was bliss! Meanwhile, we missed the 100+ degrees at home in TX. :p The family had a great time. We hiked, biked, shopped, joked around, ate in restaurants and basically spoiled ourselves. No video game consoles and no computers meant the kids spent a lot more time hanging out and talking with us. My 12 year old sons even held my hands a few times while we were strolling down the streets looking for interesting shops or hiking across snowy fields.

I tell you the truth, I did not want to come home!

I felt like a kid when you've had a great summer and suddenly school looms in the near future. I wanted to cry and refuse to get on the plane! :goodvibes: I'm so grateful that I'm not a clutz with procedures. They always intimidate the heck out of me, but I'm always so grateful when they go well. It's such a good feeling.

So maybe 2nd year isn't so bad, after all. Maybe I will survive another year. My schedule this month still stinks, though. I got the short end of the stick with only 7 days off all month and no 5 day break like the other interns get. "Someone has to get the short end of the stick." Fair enough, I've been pretty lucky with scheduling thus far. I also have a string of 8 nights in a row at the end of the month with only 1 day off in the middle of it. That's going to stink, big time. All our ER shifts are 12 hours, either 8am-8pm or 8pm-8am. Not much time for seeing family, sleeping, showering, and running. If something's gotta give, I guess I'll be one stinky resident this month! Hahahaha.

Did I mention my daughter has recently announced she wants to be a doctor? That just floored me! She's never said that before, and I figured with my kids old enough to see everything I'm going through in order to become a doctor that they'd just run in the other direction. Most doctor's kids don't become cognizant of what their parents do until they are practicing physicians, making money and not taking call every 4th night. Well, I think it's terribly cool and take it as a compliment.

I'll write about the joys of having adolescents home on their own in the summer on another day. This post is looking pretty long already.

Oh my word, I haven't had a mental break since my last post. I haven't watched a moment of tv. I haven't read a book, played a game, gone for a run, or done anything that resembles relaxing. I have worked 7 days straight and the last 4 days were 12 hour shifts in our big pediatric emergency center. I am mentally and emotionally exhausted.

At last, today I had a clinic this morning and nothing in the afternoon. Tomorrow is my first day off in a week. I came home and took my boys to see Ice Age. Not so much because I wanted to see the movie, it was okay, but because I wanted to be near my kids and be mentally "off."

The EC is interesting, but not for me. I dislike the rushed feeling and the lack of continuity. I keep wanting to know what happened to that patient I admitted, the kid in the accident, the one who went home on antibiotics... The pace is rushed, as well. Where I could easily wait hours for a consultant to come see a patient admitted in the hospital, in the EC I have to start harassing people if they haven't showed up in 15 minutes. I don't like it. And patients and families have this expectation that being seen in the EC should be fast and efficient. It might seem that way, but with 4 residents staffing 25 (!) EC beds, it's not fast. And if a trauma rolls in...

Also, EC's are so noisy! There are no quiet moments. There's no chance of a moment of privacy if you're frustrated or tired or want to eat your cold french fries in peace. Nurses have breaks and a dedicated lounge with a door. Attendings can just decide to walk across the street to Starbucks. We can't. Well, anyway.

The plus side is, I'm learning a ton. I'm seeing a ton of things that I didn't see on the floors. I'm getting better at quick evaluations of sick and not-so-sick patients. I was already pretty good with your standard ear infections and viral syndromes, but now I'm getting better at stomach bug vs surgical abdomen (needs an operation, like appendicitis). You'd be amazed at how much there is to learn.

And of course there's the ever-present pressure to know more and be more competent than I was as an intern. That's been weighing pretty heavily on me. I hope the feeling lightens up soon. It's a lot of additional mental pressure right now.

And then there's home...
The teenage daughter with the first boyfriend who came home with a hickey on her neck the other day. At the end of a 12 hour day, totally exhausted, I'm supposed to deal eloquently with that??? It's all going too fast. A few months ago I was counting myself lucky because she'd never even held a boy's hand and now it's kissing at the movies and a hickey. Where did the time go?

Lately, I've also been feeling the pressure to be a better mom/wife and envying women who stay home. Weird, huh? My husband has this former colleague from work, married many years, who now stays home. They don't have kids. She goes to museums and has started a creative writing group... I'm tired and grumpy again just writing about it.

I thought the end of intern year meant not being so exhausted so much. I'm disappointed and wondering how I can do 2 more years of this.

Hmm, maybe I should take a day off soon. :p

I spent hours with my kids yesterday, had a great time and feel so much better about life.

I took all 3 kids out to dinner last night and we just talked and talked. Then we strolled down to the bookstore and then had an icecream together. Tons of conversation and jokes. Afterwards, my daughter and I sat in my bedroom and chatted about friends and boys and school and her future plans. It was an excellent conversation and really made me feel better about things. Among the things we talked about were the fact that she had griped out her boyfriend for the hickey and told him never to do that again. She also told me that she and her "besties" (best friends) had a pact to be virgins through high school. Now I know this doesn't guarantee anything, I'm no fool, but it does make me feel much more comfortable to know that she and her friends are talking about this and that they have their heads on straight about it.

Today I have the full day off. I did my hair and put on a cute bracelet. Plan to get a pedicure this afternoon. :laughing: Went for a short run this morning. Not gonna let this crazy schedule get me too far down!

The kids are going to my parents house this weekend and will be staying there for 2 weeks. That should help me feel a little more sane since I won't feel as much like I'm not around enough for them this summer.

Off to take daughter and her friends to the mall and the boys to buy socks and tshirts that fit before delivering them to mom's house.

Hanging in there the best way I know how...

How to say the things I'm thinking without sounding like an awful person?

My kids have been at their grandparents for 2 weeks now. Frankly, it's been great. I haven't had to shuttle my teenage daughter around, haven't had to pick up her boyfriend so they can visit each other, haven't had to break up any fights over computer access and haven't had to decide what to feed them every night. I've had wonderful homecooked meals with my husband. We've watched movies together on the couch and not been interrupted. We've had time for romance! We had friends over for a nice dinner and games and I didn't have to think about what the kids might overhear us talking about or whether I should make them a separate dinner, etc. Oh, and I haven't had to adjust my meal plans to meet the pickiness of anyone or my daughter's vegetarian needs. I've had more time and less stress, basically. My husband and I have had so much time for each other it's like it was before we had children. It's been wonderful. I'm not ready for them to come home. It's not that I don't want to see them, it's that I'm not ready to deal with all the stressors again. I hadn't realized how much of my mental energy and non-working time was still devoted to the act of being "mom." I've already had a tense discussion with my daughter over the phone about when I was going to pick up her boyfriend for a visit next week. Of course she wants it to be the first day I'm "free," and of course that "off" day is the day after my 8th night shift in a row. (I'll be dead to the world that day) Anyway, I guess that's it. I'm just not ready to spend all my time negotiating meals and rides and activities and the emotional roller-coaster that is parenthood of teens.

And of course I feel terrible that I feel that way. I watch my pregnant and new mom fellow residents and neighbors who all look so pleased with motherhood and miss their precious babies whenever they're away from them and have everything planned to perfection and I wonder why I can't be that person.

Add to that my feelings about being a resident right now and the picture is even worse. I should start this by saying this is my one night off in the middle of a run of 8 night shifts in the EC, working 8pm to 8am. That's 8 out of 9 nights at work. This also explains why I'm blogging at 1am. I need to keep some semblance of my schedule tonight so that I don't die when I start the next round of 4 tomorrow night.

I really dislike the EC. It's loud, it's bright, it's busy and it's full of people who don't want to be there. The doctor's area is small and crowded and there's no privacy whatsoever. It's just a cubby off the main hall that everyone walks down, without a door. The only bathroom for staff constantly has people knocking on the door and jiggling the handle. There's no place to step away and decompress for a moment. I have very quickly become less tolerant, less understanding, less patient and generally a less good doctor in my opinion. I find myself resenting every chart that gets put in the rack. I want every parent to go away and stop bringing in their kids. About 80% or more of the time, the problem is something that could and should be handled by a general pediatrician. So between the fatigue, sleep deprivation (night shifts and runs of 12 hour days), and overstimulation, I just want to run away screaming. Maybe it would be different if the hours were more tolerable. Maybe it would be different if we didn't have to deal with so many attending personalities. And believe me, there are some personalities there!

I haven't run in a week. I feel fat and slobby. Oh, and next week starts my next rotation. At the county hospital. In the EC. Again. :banghead:

All of this combines to make me want to spend tonight searching for a cheap plane ticket to Arizona. Why Arizona? Because no one would think to look for me there.

*sigh*

I still like seeing some patients. If I could just stay in the moment, in the room, talking with the parents and the seeing the kid or the baby, I think it might be okay. The problem is having to step out of the room, fill out the paperwork, find a fellow or attending to present to, make my case, defend my choices, fill out more paperwork, follow up on labs and radiographs, deal with the consult services, make my case to attendings for admits, deal with the parents when the 30min problem turns into a 3 hour wait due to lost labs, etc...

I just want to walk away from it all. My vacation in Colorado was supposed to recharge my batteries. I came back from there exhausted and although the first week with my husband and no kids was lovely (the 2nd week has been night shifts), I'm even more reluctant to show up to work everyday now. I wish I could walk into my chief resident's office and tell them I want a month leave of absence. I want off the merry-go-round.

I certainly don't see how I'm going to endure the next 2 years, much less a fellowship.

I know I have so much to be grateful for and I know I have the perfect life. So why am I so miserable right now?

I think I know the answer is my absolute incompatibility with emergency medicine and this terribly long run of night shifts. But I still want to search for that plane ticket...

Well, there's nothing like a good venting and 8 hours of sleep to make things look better.

The kids are on their way home and should be here in 90minutes or so. :goodvibes: I did really enjoy my free time with my husband, but I'm not ready to have grown children just yet. It has helped me realize, however, that some things are far more complicated than they need to be. Maybe it's not necessary, afterall, that I spend so much time trying to make everyone happy. I do need to draw some lines and make some boundaries. It's okay if I make a meal that isn't everyone's favorite. It's okay if my daughter doesn't get to see her friends each and every time she wants to. It's okay to sit on the couch sometimes just because I can. I think that will help me be a happier mom. I do worry too much about how my job takes me away from home when my kids are there and I try to make up for it when I'm home. But what I've created is a cycle of me trying to do special things for them with all my non-working time. Simply exhausting way to live. I push and push myself until I get sick or a bad headache or just horribly crabby and then everyone has to avoid me for a day. That's not really a good solution! *rolls eyes at self*

As for residency and the EC. Well, the worst of it is just about over. My second month in the county EC is a better schedule. I still have to work some nights, but it's only 2 at a time and not back to back runs like I'm doing now. The pace will also be slower at the county hospital. I just need to keep my chin up for the next 2 nights at the children's hospital and remember that I'm there for the kids. The rest of the youknowwhat can just handle itself. :p

After blogging last night I found some interesting posts about neonatology on another site and I was immediately drawn in. The interest is definitely there. I need to stop attributing fatigue and a crappy month to my feelings about medicine in general. It's all gonna be okay. I need to take care of myself, enjoy my family and take the good that I can from the patients and families I see at work.

I also spent some time surfing the web to get info about Farmer's Markets and green grocers, etc in our area. Houston doesn't have too much of that, but at least there's some! Useful websites www.eatwellguide.org and www.localharvest.org I'm tired of trying to diet and thought it might just be better to eat more fresh fruit and vegetables and food that's closer to what we're meant to eat. My husband and I have been doing that since the kids were gone and I've noticed that I feel physically better while working long shifts if I eat grilled chicken and vegetables from home instead of McDonalds and packaged foods. Who knew? :rotfl:

Yes of course it is! We can have it, but it requires a lot of effort, planning, and support to make it happen.

And no, I'm not about to quit residency. I didn't even check the ticket prices...

This has been a truly difficult week. I finished my super long run of nights on Wednesday morning. I hadn't slept particularly well during the days since my kids got home. They've been quiet enough, I just didn't feel as relaxed.

I came home Wednesday morning with the intention of taking a 2-3 hour nap and then staying awake until a normal bedtime. You know, to get myself back on a normal daytime schedule. That didn't work. I woke up 7 hours later and then it took me another 2 hours of dozing off before I could get myself out of the bed. I had dinner with the family and gladly crawled back into bed at 9pm, still thoroughly exhausted from my long and draining week. And then I woke up at 2:30am. And couldn't go back to sleep.

I laid in bed for a couple of hours and finally gave up sometime before 5am. I went for a short run with my husband around 6am and felt pretty decent. I even said something quasi optimistic. Unfortunately, I sat down on the couch to watch the morning news at 9am or so. Then I pulled up a blanket because my feet were cold... Then I laid sideways on the couch to prop up my head... I'm guessing you can see where this was going. I dozed on the couch on and off for over an hour. After that, I struggled for the rest of the day to do anything other than sit on the couch with my eyelids feeling heavy.

But, I made it to 9pm without falling asleep again! Fell asleep around 9, woke up at 1:30am... Still awake... I felt like a complete zombie in clinic today. I never expected to have so much trouble with night shifts.

And much to my dismay, I'm still feeling very much like I would like to stop being a resident. I can't quite bring myself to say "quit." I know this is going to pass. I know it's going to get better. I made it through my entire intern year without trying to give up. I think the night shifts have caused some sort of depression. Kinda like living in NH in the winter, no sunlight. I dunno. :guilty: I'm grasping at straws. All I know is I don't want to show up at work these days and it worries me.

But you know what, it's not the patients. I saw 2 newborns in clinic this morning, a 2 week old baby and a 7 month old little guy. I enjoyed seeing them all. They made me smile. I enjoyed talking with the moms as well. I enjoyed my role as a 2nd year resident, with the attending taking my word for the majority of the exam and findings. I spent a few minutes looking up a patient I had the other night, as well. Just following up on what happened to him. Poor kid had come in after an injury to his leg a week and a half prior, still unable to bear weight. Turns out he has a terrible fracture that should have been in the OR the day it happened. I think the lack of insurance and parents' legal status kept them away. I care about what happens to this kid. I feel invested in his medical care. That hasn't changed.

I think I'm tired of the grind of being a resident; the paperwork, the grief from difficult attendings, the schedule that makes a zombie of me.

I'm blessed with a 3 day weekend this weekend. I sincerely hope that a few good nights' sleep will recharge my batteries. We have plans to do a little redecorating upstairs with the kids on Sunday. I actually wrote it on the calendar so no one would make other plans! (ah, life with teens) We've brought the tv out into the open gameroom (it used to be in a closed-off media room) where the teens can hang out and where privacy is not an option. Funny how you want your 10yr old to play video games and watch movies in a closed room where you don't have to hear it, but you want to know every little thing your 14 year old is up to!

I just hope some of my equilibrium returns. I need it back, badly!

Tonight there will be chamomile tea (who cares if it's 97 outside) and maybe a soak in the tub. I've been trying to avoid benadryl, which is what everyone tells me they take to sleep when their hours get screwed up. Well, if I wake at 2am again, I'll try the benadryl. I don't like the idea of sleep aids, but at this point if I don't get enough rest they're going to have to find my replacement! :p

ps- I do still enjoy seeing patients. It's the schedules and the hoop-jumping that seem to be wearing on me.

It's now Tuesday and I finally slept past 4am this morning. The alarm clock woke me up at 5:30 and I wanted to throw it out the window! :p Well, I dragged myself out of bed anyway and went for a run with my hubby.

We're supposed to run a Half Marathon a month from now and I barely made it 5 miles today. Ah well, at least I'm sleeping again and at least I was able to do the 5 miles. I also went to my private continuity clinic this morning. It felt good to have my regular routine back. Shoot, it felt good to have slept nearly 8 hours, who am I kidding? Insomnia is such a bear.

I did enjoy clinic today. It's nice to see the healthy kids there for annual exams and sports physicals. Nice to be reminded that most children are, in fact, well. It's also nice to see parents who aren't tired and frustrated, as they often are in the EC (with good reason). I laughed at myself this morning when I first glanced at a chart and saw "diarrhea and vomiting" and immediately felt annoyed. Then, remembered I was in clinic, not the EC at 6am and it was totally appropriate for them to be here! :rolleyes: The EC has made me bitter! After that little "aha" moment, I relaxed and enjoyed the rest of the morning. I'll be back in the county EC on nights at the end of the week, but only 2 at a time for the rest of the month.

Getting into the back-to-school swing around here. It makes me a little neurotic (or, more neurotic as the case may be ). Trying to get everyone's schedules figured out, band camp and school supplies and, oh yeah, the summer homework assignments started! I always feel like the totally clueless mom at the beginning of the school year. But I was talking with another highschool mom yesterday and she said the very same thing. It's different once your kids are out of elementary school. No more letters from teachers at the end of summer and newsletters and hand holding. You have to hope your teenager remembers to tell you she needs a sports physical again (because the one from May is no longer valid??? Ridiculous!) at least 48 hours in advance of the due date! And let's not forget the clothes and the haircuts and the new backpacks!

Last night I was trying to talk my daughter into not panicking and dropping out of her AP World History class. I think she's totally intimidated by the summer assignment and by the workload reputation this class has. I was describing to her about how I'm always a little afraid when I have to do a LP (lumbar puncture = spinal tap) and how I'm always nervous and worried about messing up and worried about hurting the baby or missing the tap or upsetting the parents but how I have to just accept that nervousness, take a deep breath and do my job because that's what I'm there to do. Take care of that child. And then I remembered that this is why I'm there and this is why I'm doing what I'm doing. And suddenly I felt a bit better about my job, less resentful of the difficult hours and the crappy scheduling. Now if only that pep talk worked as well on her as it did on me! :laughing:

So between a week away from the EC (clinic duties and a long weekend) and enough sleep last night, I feel like my equilibrium is returning. I hope I can keep it that way for the remainder of the month. My schedule ramps back up with lots of 12hr EC shifts from the middle to the end of the month and only 2 days off in the last 2 weeks. But I have September to look forward to. A week long vacation with my husband and a month elective in Pedi Gastroenterology. I hope it will be a good month that will give me some more insights into what I might like to do with my career, research-wise. Or, it could just be a nice month with good hours and interesting patients. :p I guess not everything has to be profoundly important, does it?

I know, I know. I go months without posting and now I'm posting nearly daily. :laughing: It's that I have this weird schedule with a bunch of days off this week and then back-to-back 12 hr shifts for 2 weeks at the end of the month. :rolleyes:

Yesterday turned out to be such a good day after a early run and a nice morning in clinic that I just hit a wall around 5pm. Doesn't make sense, right? I think what happened is that the anxiety and tension finally drained out of me and I was left with the accumulation of 2+ weeks of sleep deprivation and tension headaches.

I dozed off on my couch at 5:30pm for about 15 minutes. I made myself get up and ride with my husband while he drove one of the boys to Tae Kwon Do. I nearly fell asleep in the 15 minute car trip. When we got home, we discovered our daughter had not taken out the trash (garbage truck already gone) and the other son hadn't done the dishes I had requested nearly an hour before. Last straw! Hubby and I declared "parental chore laziness day" and refused to make dinner. I walked into our bedroom, saw the bed in front of me, and next thing I knew it was dark outside and nearly 8pm.

I tried to get up at that point, thinking I would be awake at 1am if I kept sleeping. I think I got a drink of water, looked around the kitchen at the grumpy husband and kids...and went back to bed!

I finally woke up at 4am this morning, after about 10 hours of sleep! I felt fantastic. I laid in bed until about 5:30, then woke up hubby for a 3 mile run. Afterwards I made us an healthy breakfast and sent him on his way to the office. I felt bad for "abandoning" him to the kids last night, who were very rude and uncooperative. He's a good guy, said he was just glad I was finally able to sleep.

Today I'm tackling the kid issues again. The boys have been reading their summer assignments, so I'm just kicking them off the computer and tv and making them go to the pool or visit a friend. (such a mean mommy!) Having them at home alone while we're at work means they get as much electronic time as they can stand when we're not around. Not ideal, but we're doing the best we can. Daughter, however, will be spending the day working on the copious amount of summer work for her AP History course. I'm sure this will lead to many tears and begging to be let out of the class and threats to change her schedule without telling me. *sigh*

By the way, everyone with kids should pay attention to the new research on Vit D levels in US kids. A little sun exposure (as in, 15 minutes a day) and a multivitamin appear to be a good thing. The sun exposure recommendation has to be taken in context, of course. If you live somewhere like I do where it's 98 degrees in the afternoon and 15 minutes of no sunscreen = sunburn, then you should probably aim for 10minutes in the early morning or evening when the sun isn't so intense. Yahoo link http://news.yahoo.com/s/nm/20090804/hl_nm/us_inadequate_vitamind_1

So I'm sitting here in the county EC and it's dead quiet. It's my second night in a row and it's a million times better than last time. Some of that is due to the slower county hospital pace, no doubt. Some of it is also due to the relative peace and privacy of having a physician's area around the corner from the EC main desk. Just having a place to retreat and make a face, if necessary, helps tremendously.

It also helps that I slept a full 8 hours during the day yesterday. Sleep deprivation just does bad things to mood and coping, no way around it.

Tonight I was able to listen to the very long and involved story of my older adolescent patient who'd gotten into a fight and was brought to the EC by the paramedics because she was crying and saying she wanted to die. (suicidal ideation = trip to the EC) I was able to listen with sympathy and heart. I had the time to advise her about how to proceed and what she needed to do to protect herself in the future. Not only did I feel like I cared a lot about what happened to her, I also felt like I was able to make a difference. Maybe what I said to her won't change a thing, but perhaps she will walk away with some sense of deserving better, being capable of taking care of herself, and walk away from an abusive relationship. I suppose it's the first time in just over a year that I felt like I could really connect with a patient like this. Most of the time it's so rushed and the attendings are so uninterested in these cases and the resources are so scarce that you feel like it's pointless to try and help. I (we) are so much better at handling illness and trauma than we are at dealing with the social and psychological issues. This city is not a good city to be in if you are a child with few resources and a lot of need in the psycho-social realm.

So, I think I'll finish my residency. I think I'll try to remember these 2 days and that for every bad week or rotation there are these moments when you remember why you're here and why you're working so dang hard.

It's no coincidence that I've recently gotten a good amount of sleep and run 3 or 4 times in the last week. Whatever I do career-wise, it's going to have to include enough sleep and time to run.

Things continue to chug along. I just completed another 2 night stint and now have only 1 night shift left this month. The county EC has been really, really quiet this weekend. That's a good thing for the kids, but it does make for some painfully slow 12hr shifts. I can't wait to be done with my last shift on Aug 30th. September will be an elective month in GI (gastroenterology), which is my favorite subspecialty after Neonatology.

I can tell that school is just about to start again. The boys are doing fine, no stress whatsoever about starting junior high. Once again, one of the boys got put in a regular Eng class because of his grades last year. We were able to convince the counselor to put him in the advanced class again for the first 6 weeks with plans to see how his grades come out. This same son has also decided he really wants to be involved in drama, which our schools have removed from all but the high school level due to budget constraints. He wants to try out for a local kids theater company, so we told him he had to make the grades this year if he wanted permission to do it. I sincerely hope this makes him care more about school this year. He's so smart and capable, it's maddening to watch him bring home C's and the occasional F when he's reading 300-400 pg books every couple of days.

My daughter, now 15, just got herself sent to her room for the remainder of the day and grounded for the week. She got into some verbal tiff with her brother and decided to throw a tv remote at him. Hit him in the head. Then when I called her downstairs she knocked over the other brother's popcorn all over the carpet. Then she gave me the evil eye when I told her to go to her room! :rotfl: I don't know if it's hormones, or a fight with friend/boyfriend, or anxiety about starting school but she certainly isn't going to act like that in our house. It's like a flashback to when she was 10-11 yrs and being bullied in school. She would turn right around and bully her brothers when she got home. I think she's failed to notice that they are as big as she is now. :rolleyes:

Well, needless to say, between her drama and the pest-control guy ringing the doorbell, I'm not asleep. :p Getting 4 hrs of sleep between night shifts is tough, but I'm surviving. Tomorrow I'm back on days.

There's another thunder storm rolling in here, so I'd better post and turn off my computer. Our power goes out nearly every time.

The county Pedi EC has been eerily quiet this weekend. I worked 12hr days Fri & Sat and saw a grand total of about 7 patients between the 2 days! Some of that is due to the number of other folks working (med students and interns) who take patients before I do. As a 2nd year, I also have the job of following up on labs for patients seen in the EC (such as cultures that take days to finalize) and answering "mommy calls" when the clinics are closed. Since it's been quiet, though, the days have been painfully slow.

Now I'm on a 12hr night shift, the last of this month, thank goodness! I could not be more happy to finishing these dreaded long night shifts. While none of them has been as painful or as insomnia-inducing as the 8 night run last month, I still dread each and every one. 4 more day shifts after this and I'm done with the EC until Jan!

I switch to my Pedi GI elective next Monday :goodvibes: and leave for a week vacation a couple of days after that. I'm so excited to have a vacation coming up so soon! I told my husband that my top priority was getting at least 9 hours of sleep every night. Nope, not the incredible vistas, the fancy restaurants or even the blue, blue ocean, or the half marathon we are participating in can take priority over sleep! Never have I treasured it so much in my life as when I was so sorely deprived of it at the beginning of this month.

In other news, my kids go back to school tomorrow. I'm relieved for many reasons, not the least of which is that it was getting increasingly difficult to keep them entertained and they were starting to bicker constantly. My husband was fielding phone calls from home to referee arguments on a daily basis last week. The kids all seem pretty happy to be starting school as well. The first 6 weeks will be rocky, I know. The kids will come home piled high with homework. That's okay, been there, done that.

Also in the TR news this week, I'm starting weight watchers again. I became a lifetime member back when the boys were approaching their first birthday, way back 12 years ago. I have about 10 more pounds to lose this time and no babies to blame it on. Oh well. My good friend and dietician has moved away and honestly I need to do this for myself now. I've let all the working and running I do become my excuse for eating too much. It's not that I eat junk food. I rarely do. It's that I eat too much of the mostly healthy stuff. That, and I'm a bit of a foodie who loves good restaurants. Probably one of my favorite things to do with my husband is dress nicely and eat out at a good restaurant. I tend to eat too much of the good stuff I make at home as well. I hope to be celebrating my 40th early next year with a body that looks like I run as much as I do! That's probably because I rarely voice any enthusiasm for it. For me, well visits (or even most sick ones) with kids from 4-18+ are just not that interesting. My best friend in residency just loves it, and I can see how she loves it and I often wish I felt the same way. But, I don't.

So, I must bite the bullet and sign up for 3 more years of intense training so I can be the Neonatalogist we all know I'm supposed to be. Just gotta get over the fear that I'm not smart/capable enough to be a critical care-type doc. Silly, isn't it, after everything I've been through I still have so many doubts about myself? (I need to remember to read this post periodically when application season starts in Dec)

Well, it's been 2 hours and I haven't seen a single patient yet. Hope it stays quiet so I can catch a nap! :p

How on Earth can I be sick again??? And not just kinda sick, but up half the night coughing, ear pain, sore throat, headache, and runny nose sick. That's twice this summer! I never get sick. I'm annoyingly healthy. :p This stinks. Figures after 2 solid months in the EC that I would finally run into a virus I hadn't met before.

I actually scheduled an appt with my GP this afternoon. I got sent home from the private clinic this morning because I was coughing so much. I have 3 12-hr shifts coming up this weekend and I need to be able to work. Of course no one sent me home from my 12-hr shift yesterday in the EC while I was trying to hack up a lung. :rolleyes:

Yesterday was interesting, I confess. We were much busier than we have been in a while. The EC was a zoo. And suddenly I realize I'm not the intern anymore. I'm the resident seeing patients, writing orders, doing the "doctor's checks" in triage (when the nurse needs help assessing acuity or needs orders for radiology), following up all the pending labs and calling patients to change antibiotics according to their culture results or to inform them that they have a STD, field "mommy calls" after clinic closed, coaching the intern through a lumbar puncture, and having med students present their patients to me. I must say, it was a nice feeling when the attending came by to say another intern had missed the LP after 2 attempts and asked if I could come by and get it. I said yes and, thank goodness, I got it. As an intern, our only job was to see patients and write their orders.

Well, weight watchers and I are getting along just fine. I've been too busy at work each day to care how hungry I am. :p It's actually helping me save money, too. I've been making my own coffee and bringing all my own food for the long shifts. That probably saves me about $10 (or more) each day. I know that seems obvious, but when your schedule is as busy as mine, buying food on the run just seems so much more convenient. But really, 15 minutes at night is all it takes.

Cross your fingers I feel better soon. I dread the thought of working all weekend while feeling like this.

:goodvibes: Sure, he was selling his program and I'm not foolish enough to think that I'm that special. But, he was talking about expanding the faculty in my interest area in the coming years...

You can imagine how flattered I am. You can imagine how I'm thinking that this sounds awfully appealing, an academic career in a field that is looking for people with my interests. And my doubts about being in critical care, about the hours and the call nights for the rest of my career and the intensity of it all wearing me down, well I wouldn't have that problem in GI. I would have the problem of seeing vague abdominal complaints in clinic, some of my least favorite patients to see, right after the adolescent males who complain in the EC that it "burns when I pee..." :crossfingers:

A quick update to let y'all know that I survived the emergency centers! :rotfl: If there was a dancing smilie, I'd use it! 2 months of EC is more than I ever wish to do and I'm thrilled to be away from it until January. It was very busy this weekend with all the kids back in school sharing their various viruses and showing up in the EC with "fever" of 99.5 and cough (NOT an emergency!).

I wasn't 100% sure I'd make it through all three of my 12hr shifts. I'm recovering from the bronchitis and was still having some pretty impressive coughing fits up until yesterday. I only had to walk out of patient rooms twice today with a coughing fit. No one wants to watch the doc hack up a lung in the exam room.

I started my GI rotation today and am thrilled to be back in clinics. I don't enjoy general clinic, but I do really like GI.

Vacation starts Thursday and I'm looking forward to getting lots of rest and relaxation. I truly value sleep and rest as a resident in a way I never did before!

Back from my wonderful, wonderful vacation. I am well rested and have been full of smiles all week. Hubby and I ran a half marathon in Kauai and it was the most beautiful race course you can imagine. The people were so friendly and the race well organized. It was my husband's first HM and he couldn't stop talking about how great it was.

I spent some serious time pondering my future while sitting relaxed on the porch of our hotel room. A few things became pretty clear to me in that time. I'm sorry to say that now that I'm back home, I feel pretty cloudy and distressed about the decision again. I guess it's to be expected from someone like me who tends to overthink things and who is finally contemplating the final path my training will take. My day to day future career depends very much on my decision. No pressure there! :rolleyes:

Fortunately, I also spent quite a lot of time taking pictures of gorgeous scenery, relaxing by the ocean and the pool and reconnecting with my husband. :goodvibes: Can you believe our first date was 21 years ago, Labor day? Time flies! Heaven knows I don't feel old enough to claim that length of time! But then I look at my daughter, who needs a homecoming dress and wants to go out to dinner with her boyfriend, and my sons needing rides to band sectionals and fretting over haircuts and I see that I will not be able to continue to pretend I'm in my late 20's much longer... :rotfl:

As my decision gets made and I start my application process for fellowship I will let y'all know how it all came about. Sorry for the mystery right now!

So I just sat and read the last 2 pages of my blog. I think it's interesting how well it really does reflect the life of a resident. There were lots of happy posts and tired posts and posts about wanting to quit and posts about future career... There were posts about running (my hobby), lots of posts about my kids, posts about weight, posts about missing friends and family. All the usual stuff, I suppose!

This is an interesting post for me because I've come to a decision and it isn't the one everyone has been expecting from me. I've decided to apply for fellowship in Pedi GI!

It seems sudden, and indeed the decision has happened over the course of about 3 weeks. My insightful conversation with the GI director as well as the wonderful days I've spent in clinic thus far played a huge role. The fact that I was being strongly encouraged by some folks I like and respect didn't hurt, either. Ultimately, though, I've been struggling with this decision since GI first hit my radar in med school. I did Neo and GI electives in med school. My research bridges both fields and I've long known that my interest in Neo has been very GI-focused.

(For those who don't know, GI is Gastroenterology. The field is actually Gastroenterology, Hepatology and Nutrition. So that's, esophagus to colon, liver and nutrition. They treat everything from chronic constipation to reflux to colitis to hepatitis to malabsorption disorders to liver transplants and so on.)

Back to what I was saying. The 2 fields have been vying for my attention a long time. I've been very comfortable saying "Neonatology" when asked about my career plans for over a year now, though. It was definitely my comfort zone. And believe me, it was very hard to give up the idea that I would be a neonatologist.

However, GI has many things that I want from my career. It just took me a while to see that these things were vital to me. One of those vital aspects is patient continuity. I want to be able to follow my patients over time, see the results of my treatments, watch them grow up. I had thought clinic time wasn't that important to me. Turns out I just wasn't in the right clinic! I also really enjoy working with the kids who are old enough to talk back to me. I do love working with babies, but some of my favorite patients recently have been the 3yr olds and the 12 yr olds that I connect with. I enjoy the interaction.

And here's another thing, once I started making the decision to go with GI, my feelings about residency started to change as well. I lost a lot of that "what am I even doing here?" feeling. The resentment over all the hours and weeks started to fade, too. I think somewhere in my head I knew I didn't want to do the Neo fellowship and it turned into not wanting to do residency at all. Now that I'm excited about my path again, I feel better about the whole thing.

This is not to say anything bad about Neonatology. I still love the field. I still hope to work closely with Neonatologists and want to focus my academic work on GI problems that start in neonates. Neo will always be close to my heart and I hope to spend a little time in the NICU on a regular basis. And I will always be grateful for the fantastic mentorship I received. :goodvibes:

So now I just have to get my brain to realize the decision is made and I can stop obsessing about it. :laughing: I actually had to tell myself in the middle of the night that I could stop weighing the positives and negatives in my sleep!

It's the weekend and I have the day off. I'm on 1st back-up call tomorrow, so if anyone calls in sick, I have to go in. I dodged a bullet at the beginning of the month when I was on back-up and didn't get called. Doubt I'll be so lucky on the weekend. But we'll see. I could be the "intern" on call tomorrow night. ugh! :laughing:

Good news, I didn't have to be the back-up "intern" on Sunday. Instead, I took the risk and went to get a pedicure while carrying my beeper. I figured the worst that could happen was that I'd have to ask them to take off the polish if I got paged in the middle of it. Worst that could happen is I would sit around all day, doing nothing but watching my pager and waste a perfectly good Sunday. Lucky for me, my gamble paid off!

I've been on the Liver service for a grand total of 3 days now. I love it. The learning curve is crazy steep and I feel about as smart as a rock, but it's really interesting and engaging. The happiness I feel on this service spills over into my continuity clinic as well.

If only I could open the top of my head and pour in a couple of textbook of information! :goodvibes:

Whoa! I'm gone a few days and we get a facelift! I knew it was coming, but had forgotten. Thought I would post today just to get used to the new stuff. I'm going to miss the old smilies, though.

For the first time I also noticed the number of views my blog gets. Not that many! Maybe my blogging isn't as interesting as I thought it was? Well, I mainly do it for myself and in the hopes that some other non-traditional moms will see it and think "If she can do it, so can I!"

I started in our giant Level III NICU today. It's rather intimidating. There's room for about 75 beds and most are full. Luckily, we residents only cover about 32-36 of those. We can each carry up to about 8 or 9 patients at a time. Doesn't sound so bad until you see just how sick some of these tiny babies are. For privacy reasons, I can't talk about our patients, but suffice it to say that being in a tertiary referral hospital in a large medical center at a children's hospital means we see some of the sickest newborns anywhere. My first call night there is tomorrow night. The good news is, there's also a fellow and an attending in-house at all times. *phew*

Oops, just realized it's time to go pick up my son from band practice. One of those rare days when I'm able to do that. Gotta pull my weight around here! (kidding! )

Working in the NICU this month at the children's hospital. It's exhausting! I fell asleep on my bed, face down, in my scrubs after work today. It's q5 call (every fifth day), but the calls are very little to no sleep. Checking blood gases every few hours on sick patients, plus admissions and minor crises along the way. I've had the chance to intubate a 900gram baby twice now. I got the first one on my very first try :D, but the second time around I was too nervous with mom standing at bedside and didn't get it. Later on, however, I got an LP that someone else wasn't able to get. Procedures are that way sometimes. *shrug*

Boy was I right about not being critical care material. I can do it, but it doesn't suit me well. In the middle of rounds, when patients are trying to decompensate and the Cardiology folks want to round with us on their patients right now, and I'm trying to present and some administrative person is haggling me about paperwork XYZ, I just want to walk out of the unit. It's too much stimulation for me! When things quiet down in the afternoon and I have time to think and go at my own pace, I like it much much better. I certainly like the patients and think it's interesting, I just don't care for the craziness at times. Good that I figured that out. If I had started this month still thinking Neo was it, I would be incredibly stressed right now.

Kids are doing well. Autumn is around the corner for us. It might actually cool off enough this weekend to feel like October. Funny that autumn is my favorite season and we get so little of it in Texas. I do have to apply to some east coast programs and Denver and others for GI. Maybe I should consider a relocation! lol. The boys would love it if we moved to Colorado. My daughter would be furious, since it would be her senior year. Family obligations abound, as ever. Speaking of family, one of my brothers and his family, my parents and an aunt and uncle will be in town for Thanksgiving. Can't wait!

This is one of those days when I am "so over" residency. Seriously. It's sunny and 78 degrees outside and low humidity, which is remarkable for this part of Texas. I'm tired. I'm working nearly 80 hour weeks in the NICU and it's exhausting. It's also stressful. And somehow I never noticed this before, but all the fellows and attendings are very somber and sometimes grim folks. They rarely smile! It's bad enough being around stressed parents and sick babies, but to not even be able to smile at your co-workers is miserable. I know they're not all that way, but I never realized how somber this group is. Also, got fussed at for not having some details in my interim summary for a patient we transferred yesterday morning. Hmmm... I was oncall that night before and some one else is supposed to write discharge summaries. But that person was at a concert instead and just assumed my summary could be sent without anyone looking over it. (I need a :rolleyes: smiley here.) Needless to say, I'm not feeling too bad that I was working my butt off on call while that other person was at a concert not writing their own summaries. (besides, the missing detail was in my transfer order...) Nope, not bitter. Just over it.

Nothing, by the way, prepares you for hearing that both your just-turned 13 yr old sons have dates to the first school dance in a few weeks.

I wish I had the weekend off. I wish I could just kick back and be mentally off for 48 hours now. But I have to work tomorrow. Oh, and starting Monday, I have 3 calls and 12 days straight in a row without a day off. That'll be about 150-160 working hours. Did I really sign up for this???

Some days make me think being in primary care, being my own boss and being DONE 20 months from now sounds pretty great. I think it's time for a margarita...

My apologies to the person whose post got deleted. Please send me a PM and I'll be happy to reply. We're not supposed to respond directly on the blogs.

I'm not sure what I'm going to say just yet. I'm tired and stressed and I know I'll be venting. Also, I'm uncomfortable with the fact that I am not so anonymous.

I just ran smack into the wall of fellowship application season. I had somehow misunderstood that applications opened in Nov/Dec. Instead, they are uploaded and become available to programs to view in Dec. *sigh* I didn't realize I was supposed to be gathering documents and writing "why I want to be a specialist" essays. *groan* Good heavens I feel too old and tired for this! Doesn't help that I'm on day 9 of 12 straight in the NICU, including 3 calls. *more groaning* I'm tired and drained and ready for a break. My schedule even managed to violate the "average of 1 day off each week over a 4 week period." I've only had 3 days off in the last 4 weeks! This is made up for by my having both days off this coming weekend. Yipee? I mean, I'm happy to have 2 days off, but I'd kill for a morning to sleep in right now.

And, as has happened to me before, my sleep schedule is getting very disrupted. The more sleep deprived I get, the harder time I have getting restful sleep. Makes sense, right? No, it doesn't make sense! *ugh*

But now I need to write a clever essay that makes me "stand out from the rest."

Maybe I'll just copy an entry from my blog...

I miss the actual rolling "rotfl" smilie...

Who wants to write a brilliant essay for me? I can pay in Starbucks gift cards!

Just kidding, folks. Really.

But seriously, I feel to "old" to be doing this. I'm nearly 40. Shouldn't I be reading other people's applications by now? Shouldn't I be my own boss by now? Shouldn't I be the one deciding my fate by now? Dagnabbit.

You see my frustration and why I feel like I shouldn't express it. Someone might read it and think I'm less than 100% perfect for this fellowship. But I'm human and I've always wanted my blog to reflect that. Otherwise, how will other women be able to gain anything from my experience? Sugar coating things would only lead to other people thinking I'm false or that their own struggles mean something bad about them. And only talking about the negatives would make everyone wonder why I ever bothered in the first place.

So I said it. I don't want to write an essay today. But I need to do it, this weekend will be soon enough I suppose. My application won't be the first one completed (as were my med school and residency apps submitted on day 1). But you and I both know I'll get it done. Because that is what I do. Persevere.

Yay me.

I'm not applying for fellowship.

I'm going to do general pediatrics.

Surprised?

I'm not.

Seriously, this year has been a roller coaster thus far. Actually, that's not entirely true. It's been a drag with one hyperactive month in which I thought I had found the solution to my problems.

I'll try to lay out the decision process for you. It all started with the need to apply for fellowship right now to start in July 2011. That August my daughter will be starting her Senior year of high school and my boys will be Freshman. I had to have a couple of talks with my husband about the Match process and how I would need to rank programs not in our hometown or risk not getting a fellowship position. This was quickly followed by the realization that there is NO way that I was going to a) make my daughter move her Senior year, b) leave my daughter with her grandparents while the rest of us moved that year, or c) split up the family in any other fashion. Talk about a recipe for depression!

So then I began contemplating waiting a year to apply for fellowship or risking the single program application. Although my home program has showed a great deal of interest in me, nothing is guaranteed. The more I mentally wrestled with the idea, the more I found myself saying "I don't want to apply for fellowship!" Then I thought about doing general peds for a year and waiting and I thought about how much more sane my hours would be than they have been for the last 4 years.

That's when it finally sunk in. I don't want to be in training anymore. My family has made enough sacrifices already. I've made enough sacrifices already. I'm a doctor. I take care of children. I don't have to be the most highly trained, highly specialized physician I can be. While that highly trained career had a great deal of appeal for me professionally, it is not in line with what I want for the other parts of my life. I want to be home for dinner most nights. I want to be free most weekends to be with my family. I don't mind a Saturday morning clinic once or twice a month, but I'm done with being on call and night shifts and all that. I've seen how much the attendings work, especially the young ones who need to establish their research and pull the weight of the service.

I love working with kids and there are many, many ways to do that in Pediatrics. I had a long talk with my continuity clinic preceptor and I came to the realization that general pediatrics can be a very satisfying and sane life. Not that GI can't be, it'd just take me any extra 3-5+ years to get to that point and by then my children will be leaving home.

So there you have it. I feel tremendously relieved. I don't have to keep pushing through and persevering. I can be a pediatrician and enjoy my free time, too.

Like I keep saying, every woman has to decide what works for her. And for me, I need the flexibility in my life again. Since I made this decision, my husband's boss has brought up the possibility of him spending some time at the home office in London. If I'm not in fellowship, I can actually contemplate doing that...

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*

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...

Something interesting happened today. I've been very cranky about work the last week or so. At first I thought it was the longer hours and the result of the incredibly busy week I had when my husband worked 96 hours a couple of weeks ago. It didn't get better as the week proceeded, it got worse.

Then, this morning I had to see 12 patients, 8 of whom were completely new to me and I was so angry. I was all torqued up and ready to yell at somebody. But do you know what finally cooled me off? What made me remember why I was here in the first place? What brought me around was dealing with a difficult anesthesiologist and getting the LP under very pressured circumstances. I advocated hard for my patient, made something difficult happen and got the procedure done.

Sometimes I forget that what makes me miserable is feeling useless and spending all my time filling out paperwork instead of having ownership of my patients. My "supervisory" role this month has mostly consisted of standing around and making sure the paperwork and phone calls happen like they're supposed to. I would SO much rather be the doctor and make the decisions and then execute the plan. Supervision, apparently, doesn't make me happy. I suppose that's why I enjoyed the Level II nursery so much. I was given a lot of leeway to manage my patients and they were my patients.

Okay, so now I need to decide if I want to go to the end of the year banquet or go out somewhere with my husband that has better food. Haha!

Got a new attending this week who really pushed me to be the team leader. That lead to some great things and some not-so-great things this week.

Great things: Feeling in charge makes me feel like there's a reason I'm dealing with all the paperwork and chasing down labs and consultants and such. I've had a much better rapport with my families because they have viewed me as the primary doctor instead of waiting for the attending to have the final say in the family centered rounds. I've felt responsible for the good things and the things that went well

Not-so-great: The flip side of the coin is, I've also felt much more responsible for the things that haven't gone well. The patient with the complex problem with multiple consultants and conflicting day to day (and even hour to hour) plans is weighing even more heavily on my mind. I got an email about an incident report that I was involved in where I was listed as the primary doctor. I've learned a couple of unpleasant lessons about documenting and about clarifying plans with consultant teams.

So, I'm both happier and more frustrated. Makes sense, right?

Today, post call, I want to run away. :p Upping my game, as it were, also means upping the intensity of the experience. It's tempting to go back to deferring to the attending, to having conversations planned out ahead of time (which we don't do in these family centered rounds) and to having the attending lead the difficult discussions.

Of course, in just over a year from now there won't be an attending to bail me out if I start flailing. I will be the attending. That's both exciting and terrifying.

Yesterday I talked to a parent sobbing in tears, another parent who was terrified for his son because of something that happened to a sibling years ago, and the parents of a 3rd child who may well have lost vision in her eye permanently and might have a tumor.

Maybe I should post more about this once I've gotten some more sleep. Nothing is as bad as it seems when you're sleep deprived.

How does one make really big decisions? I think most of us make decisions based on more of the same and things that feel safe and familiar. I think there's a place for that. But I also think that being afraid of change makes us stagnate. It makes us sit in one place because it's where we're supposed to be and not ask ourselves what is the truly right thing to do.

I had a great conversation with my (new) advisor this past week. It was brief and mostly consisted of his telling me that every option is open to me and that I need to seriously think about what I want from my life. Additionally, he wants me to prioritize my life, my needs over my career and the needs of everyone else while making my 5 year plan. He asked me what I wanted for myself in the next 5 years that had nothing whatsoever to do with my career or even what my family wants.

What do I want to accomplish just for me?

Not work related???

It was shocking just how blank my brain was after he asked the question and just looked at me. After so many years in medical training and fighting to make adequate time for my husband and kids within that, I really have no real personal "plan" for myself. Hell, I'm just treading water, personally. I don't think losing 15 lbs is a personal goal. I don't think "be better" is a personal goal either!

So here I am, trying to decide what kind of pediatrician I want to be, where I want to work, what I want my life to look like and how the heck do I balance that question with a husband and 3 kids. This month I've grown to enjoy hospitalist medicine in a way I never thought I would. I've finally had the opportunity at my giant academic institution to be a supervisory resident, make decisions on my own, and really sit down and talk with the parents of my patients in a way that the previous rotations just didn't allow for. (I love our hospitalist service.)

The last 2 months really, have showed me that working with inpatients and clinic patients can be good for me. I had swung so far from subspecialty peds to general peds without any hospital responsibilities that I was feeling utterly lost. I think the burnout and the frustration with my program was making it hard to remember why I was doing this in the first place. I'm still frustrated with all the changes that are happening in my program, but I am a mere 3 days away from my last year of residency. So maybe I should hang in there.

Anyway, I'm trying to ask a really hard question and avoiding it in my own blog. lol. Do I have the right to move my family for an opportunity with a really great practice in a place that will be a much smaller town than we are used to?

Lots to think about and discuss with hubby.

Oh my. I'm sitting here waiting to hear from a recruiter about a very good job opportunity. Well, not literally waiting to hear any moment, but waiting for the last couple of days since I decided to pursue some options out of town. I probably stumbled on someone's vacation week. *sigh*

This is starting to feel as stressful as the medical school application process, except that it isn't. Med school was begging for someone, anyone, to see that I had the potential to be a doctor and decide to add me to their class. And there were lots of excellent potential candidates. Now I'm looking for a job and it's really just a matter of finding a good match. The ratio is definitely more in my favor this time!

I wish someone would tell that to my anxious little brain, though. I'm back to waking up in the wee hours of the morning and feeling like my neck muscles are in a knot. The real reason for that is that this particular job would mean a big move, but it would also mean my husband having the opportunity to quit the corporate life and pursue the teaching and entreprenurial interests he's always had. (I think I spelled that wrong, but no time to spell check! lol)

Anyway. I'll try to write more later.

Today is my last day of 2nd year. One more year of residency!!!

TR

So far, so good for 3rd year. That is, I've been on vacation.

It was a vacation that was given to me by the chiefs. At first I was annoyed to have vacation this early in the year (after having vacay in March & April!), but I'm sure glad I have it now. I've had a bad head cold and would have been miserable at work this week. I did get to take the family to visit my brother and his family this past weekend. That was good. So many of my extended family members have been benignly neglected by me over the past 6 years between med school and residency.

I think I'm about to get my first real job interview in the next couple of weeks. I've been told they will contact me to arrange the dates. Seems crazy to be doing this a full year in advance, but the opportunity is there and it may well be a once-in-a-lifetime type thing. I'm trying not to hope too hard, but it's not easy to be cool about it. Y'all know I'm not the most patient person.

So far my teens are handling the idea pretty well. I'm specifying that they are teens so that you can be aware just how much it means when I say they are handling it well. You may recall my posts about my daughter's spectacular freak-out when we contemplated moving into town away from our current suburban location. This would be a 4 hours and whole 'nother world away from our current situation. To say that she's handling it well is to imply a minor miracle is occurring.

My son. My dear son, upon hearing about this potential move for the first time over the weekend (he'd been out of town) contemplated it quietly for a few minutes and the then said (more or less) "This sounds like an incredible opportunity for you and for Dad. So, I support you 100%." You coulda knocked me over with a feather. Not that this was totally unexpected from him, he's a very intuitive emotionally connected kid, but they way he said it and the understanding he had of why I might do this to him was astounding to me.

Of course a little later he told me he was thinking he might like to live with his Unlce in Austin for a year and see what high school in Austin was like...

You could knocked me over with a feather again, but this time because my heart was breaking a little. My son could contemplate living without me for a year when he's only 13??? Oof!

But you know, he'd just spent a week with my brother working at my brother's game design company and it was probably the coolest thing he'd ever done. My brother has an amazing company and my son was surrounded by some very, very intelligent designers and artists and programmers and business men and women and they all treated him like an adult. That's heady stuff to a 13 year old! I was just hoping it would give him a reason to work a little harder in school so that he could hope to someday have a cool job like that. Who knew I was paving the way for him to contemplate leaving the nest so soon!

Motherhood just takes your breath away. Two of my best friends is expecting their first babies. Awesome coincidence that they are within 2 1/2 weeks of each other. We've been friends since med school. One is in Pedi residency with me and the other is in Surgery. I watch them talking about their morning sickness and maternity clothes and nursery plans and it seems like a million years ago since I was in their shoes, and yet, not. I'm having flashbacks of my kids as toddlers, running around in their "daddy shirts" as pj's. They always like my husbands t-shirts better than any pj's I bought! I remember their sticky hands and flushed faces when we went berry-picking in the summer. I remember how good it felt when, as babies, they would settle into my arms and fall asleep.

*I just got interrupted on my walk down memory lane by my son calling from Scout Camp. He was wondering if I'd be gone on the interview when he got back. I think he's very relieved to know I will be here when he comes home. Guess I still have a role to play! *

Anyway, motherhood is astonishing. We always talk about the miracle of birth and those first bonding moments and the first babbling and the first steps and all that. But really, the teen years seem so much more breathtaking in a way. I think it's because that's when all the first moments are turning away from you as the mother instead of towards you. You know, first steps usually collapse into your arms, first words are your names, first smiles are into your eyes. But first date is staring into someone else's eyes and first driving lesson in headed away from you and first college tour is all about them leaving you. As they should! Don't get me wrong. I believe the point of parenting is to raise healthy well-adjusted adults, not children. The end goal is for them to walk out into the world and have a job and a family and a life of their own. But it is tryly stunning to see that start to happen. It truly is.

I feel like I need to tie this up in some kind of way. Like I should somehow make it all relate to medicine or at least have something medical to say in my blog. But here's the thing, what I'm experiencing right now is what mothers experience the world over. Whether you're staying at home, cleaning houses, occupying a cubicle, working 2 jobs to make ends meet, or working 80+ hour weeks in the OR, this is universal to motherhood.

*whew*

It's nearly midnight and I'm up with a cough and a sense that life is about to change tremendously.

After all these years, all the time it took to get to med school, the time in med school and the time in residency, I'm about to interview for my first "real" job. Oh, I've had real jobs before. I've been a case worker and a teacher and a speech therapist at one time or another. It's just that ever since my daughter was born and we discovered her heart defect and she had open heart surgery I've been struck (stuck?) with this feeling that I'm meant to be a pediatrician. And now here we are, nearly 16 years (16 years!?!) later and I have my first interview. This might be my first job as someone else's pediatrician. Not their med student, not their resident, but their real live doctor.

That's somewhat astonishing to me. It's almost like, after everything I've been through to get to this point, how could it actually be arriving? It's humbling. It's amazing.

Perhaps I'm making too much of this. Afterall, this might be one of many interviews. Plus, there's still this whole 3rd year of residency ahead of me. But it feels like I'm turning a corner. And it's weird too, but I finally feel like I have the right to steer the family ship, as it were. I mean, I'll be making enough money to merit heavy consideration in the "what happens next" part of the discussion. My husband, bless him, has been in corporate life long enough that his earnings have always far exceeded mine. Our home, our cars, our standard of living are based on what he makes. Until now, I could never dream of keeping us at this level. A year from now, though, I will be fully capable of doing just that. I never went into this for the money, but it has recently dawned on me just what it means to have this earning potential. Wow. I wonder if that will change anything in my relationship with my husband? I don't think so. I think mostly he will be thrilled to share the burden of keeping this household in the black, financially. lol

I've been so quiet and moody this week. I'm sick and the anxiety of waiting to hear about the interview really had me in the dumps. When I finally got the official word today, I thought I would be elated but instead I was even more quiet. It wasn't until I realized tonight just what this means that I was able to think about it more clearly and start to get excited about it.

More than anything, I just really want to be a good pediatrician. I want to do for other families what my children's doctors have done for us. Help keep them healthy and safe and pick up on problems before they become something worse. A daunting task when one writes it out that way. But really it's just about doing the job to the best of my ability each and every day. That, and then coming home to my husband and family and loving them the best I can. And finally, making sure that I am healthy and happy and have things in my life outside of medicine so that I can turn around and do it again the next day.

Now I need to finish my tea (with honey, for the cough) and try to get some sleep.

I had a wonderful day in clinic yesterday. I saw 10 of my preceptor's 16 patients in the morning. Just enough to keep me busy but slow enough that I had time to chat with some interesting kids and their families. I talked to one young lady who is about to leave for a prestigious private university on the east coast. Another young lady about to start her senior year of high school who wants to major in something called "Business of Television and Film." I didn't even know such a major existed! Another young man informed me he is going to Comedy Sports Camp in a couple of weeks. Apparently there is such a thing as competitive comedy improvisation. Who knew?

I love chatting with my patients and learning things from them. I love having the time to talk and since they were all in for well-checks, there was no stress or illness involved. Well-checks are such an important part of taking care of children and adolescents. It's easy to see the important teaching moments for parents with young babies, but there are equally important moments for pre-teens and teenagers and their parents. And yes, even for the college students, though it hardly feels like pediatrics when they're full grown (but not financially independant) adults!

I did see a couple of interesting medical cases as well. One wonderful family whom I have seen a few times over the 2 years now brought in the middle daughter who has a disability. Poor child had the worst case of gingivostomatitis I have ever seen in someone not on chemotherapy. Another guy was brought in by his mom for migraines that are increasing in frequencey. First time for me to prescribe the intranasal migraine medication. I think the rest of the patients were a couple of viral cough and colds and more well-child visits. The morning flew by. I'm looking forward to having a full month of clinic time in August.

Tomorrow we travel for my interview and to check-out the town. It'll be interesting. I'm glad I've had time to go from "Oh my gosh, I have to get this job!" along with my husband wringing his hands and searching real estate on line all day to "Is this the right job for me?" and my husband agreeing that we have it awfully good here and this job will need to be truly amazing in order for us to uproot and move again. I feel like I'm back on solid ground compared to the other night when I felt like I absolutely had to make this happen.

More changes in the wind. The residency program is preparing to make yet more adjustments for the upcoming new recommendations from the ACGME regarding intern workloads and duty hours. Normally I'd be very involved, but as an outgoing 3rd year who just had her residency altered under her feet, I can't work up too much enthusiasm. I'm ready to be out in the workforce where I have some say over my life! Also, our hospital is having financial troubles. Not a big surprise of course, with the way the economy is going. People aren't coming to the hospital as much. The inpatient census is low. Hope that doesn't bode poorly for our job searches this year.

Cross your fingers for me that the interview goes well and there's no major teenage meltdowns during the car trips! lol

So, the interview and the visit did go well. They called me with a job offer yesterday!!! It seems so bizarre to be considering a job an entire year in advance of completing residency. This is a pretty amazing job, however, and I think it is probably the right job for me and my family.

A nice part about the job is that it is in a mid-sized city that puts me several hours closer to my parents and to other family members. It keeps me close enough to a large metro area to have easy access to shopping and swanky restaurants on the weekends should I want them, and I admit I do want them from time to time! But, I will be able to live 10 minutes away from my office and the hospital in a neighborhood with trees and good schools.

I'm off to a meeting in VA with a couple of residency friends today. Wow, now that I'm thinking about my actual practice a year from now, the little things seem so much more relevant. I bet that my ER months will be a lot less annoying when I think of them from the point of view of "what if this was MY patient in the ER," instead of as a cog in the wheel helping my training hospital churn through the vast number of patients we see each day.

Wow. A real job as a community doctor.

That is an amazing thing to contemplate!

Whoa! I had no idea it had been so long since I wrote!

I'm sorry to say that while I have verbally accepted the job I was offered back in July, I still do not have my final contract in hand. Never have I experienced so much delay and excuse making related to a job contract. It makes me want to reconsider the job! But, I know that the issue is primarily the corporation that owns the hospital. They are the ones who will be guaranteeing my salary for the first year and their corporate machinary is apparently grindingly slow.

There, I vented.

I still think it's a great job.

Residency is residency. I'm grateful this is my final year and that I will not have to deal with all the upheaval related to the new workhour recommendations. My program already made some major changes this summer (for the better, I think) and I admit it's not fun to get through at first. All change, when it requires a shift in mindset, is a bit painful. Or so I think. Well heck, it's my blog! I do think changing the way things are done in residency is painful! :p

I REALLY wasn't looking forward to being in the EC this month. (those who read know I hate the EC) But, so far so good. Yes, the 12 hour shifts are painful. This time has been a bit better though. I think it's that I feel so much less clueless. A year ago when I did 2 months in the EC, I had just finished intern year and all I knew was inpatient care. Now I've spent months on outpatient services and finalized my decision about where I'm going to be once I finish residency. That helps a lot!

Ah, family life. My daughter is now a Junior. Anybody remember when I started blogging and she was in 4th grade??? I started med school and she started 5th grade. Crazy. She's still a good kid. She's taking 3 AP courses and 3 Pre-AP's this year. She's also started MMA. For those whose husbands don't follow UFC, that's Mixed Martial Arts. Am I thrilled? No. But is it totally her style? Yes. She's a cute, smart, 5ft 95lb martial artist who loves to doodle kittens and threaten to kick boys' butts. Lol. That's my girl. She drives me crazy sometimes, but that's just motherhood.

The boys are on the brink of puberty. Suddenly my sweetheart son has an acerbic edge. Sigh. Let's not even discuss the appearance of their rooms or the loads of clean/unclean laundry piles on the floors. I try. I honestly do!

I'm fairly certain I have blogged since September...

Well, anyway. I've decided not to take the small town community doc job. There are lots of reasons, including what my children and husband need, but it was a tough decision. I still really wish I could have that job, just transplanted to my large city where my husband has a fulfilling career and my kids are in great schools.

So, I had my first local job interview recently. It didn't go well. If the small town job and physicians were an A+, this place was a C- at best. During the initial interview, the other docs complained about how much they were working, made a few negative comments about their patient population, told me in very clear terms what days I could not have off (as they had already claimed them, apparently forever), indicated they did not like their call group, and asked me more than once how I felt about working nights/weekends. Needless to say, I hope they don't call me with an offer. I don't think they will, because even though I stayed upbeat and agreeable, I don't feel like we "clicked" at all. Very stuffy, very put-offish. Not the kind of folks I would want to be looking at every day. (Their "offices" are one single "Doctor's area" with computer stations along a wall.)

I've got another interview the week after Thanksgiving and I'm hoping for a 3rd one with a community group out in the suburbs near my husband's office. We'll see. I'm considering a hospitalist position at this point because there's some uncertainty about my husband's job. They may ask him to move out to the home office for a couple of years. If that happens, I need to be in a flexible situation beforehand. Don't want to dump a new practice after 16 months. Since the home office is a place I'd really love to live for a couple of years, I'm willing to keep it as a possibility. Though, if I'm lucky enough to find another dream job here I will take the moving option off the table.

Don't have much to say about medicine these days. I'm tired of being a resident. I have a bad case of senioritis.

I survived my 2 months back to back in the EC. Not nearly as bad as last year. A little experience and confidence goes a long long way!

Ooh, I have Christmas Day off this year! Last year my kids sent me off to the PICU with a 5am breakfast on Christmas morning. So I'm extra happy to have a "real" Christmas this year.

Let's see, daughter is coloring her hair tonight for the first time. She wants to be a true brunette instead of the dark ash blonde she is naturally. I'm surprised. I always thought she'd wind up highlighting or going lighter. Instead, she's headed towards my color! lol

Joined Weight Watchers. I've gained back about half the 20lbs I lost (through hard work) in med school. Kept it off for nearly 4 years, but started back sliding this summer. I was recently home for my Grandmother's funeral (too sad to write about that) and being with my family and overeating the way we do when we're together really pressed home how important it is to me to stay a healthy weight. I'm so worried about my brother. He's so heavy now, and his cholesterol is sky high. It's scary. I don't want to be on that slippery slope.

In case I don't blog again soon, Happy Thanksgiving to everyone. I hope you all have many things to be thankful for, I know I certainly do!

Hrm, I've been really terrible at keeping up my blog the last few months.

I'm still interviewing for a job. The Hospitalist interview went well. I really like that group and would be happy to work with them. The only real drawback is the hours. Nights and weekends just aren't fun. And I've commented many times on my poor ability to switch back and forth from days to nights.

I had another interview with a community group this week. I really like the other docs, love the efficient friendly office and also really like the community it's in. It's a suburban practice and an area that I like. So, we'll see. I've got all my fingers and toes crossed. (haha)

I've been "pre-tending" (a pun on Attending) as the most senior resident on my service this month. The attending plans to have me carry the attending admission pager and do the billing later this week. Should be interesting! This whole month has kinda been a long job interview since I'm working with the hospitalist group that interviewed me. I have to say, I like the work. (but still worry about the night hours!)

Uh-oh. Hubby and son are home and already arguing about chores. *sigh* Why does puberty for boys mean arguing with their fathers??? That and the apparent necessity of hitting your brother on the arm every time he walks by. I swear they wrestle more now than they did as little kids! lol One of the boys is staring me in the eyes now, so strange that he was so little for so long and now he's about to be taller than me!

What is it about job interviewing that turns me into an anxiety-ridden sleepless eating machine??? It's horrible! I think I gained nearly 20lbs the year I was interviewing for med school and then waiting to start med school. I lost that weight first year of med school through a great deal of effort. Now I'm well on my way to regaining all that weight.

I wish I could just sit back and say "Hey, I've already been offered one job. I just decided not to take it. Certainly other good opportunities will come my way." And then I could just be calm and relaxed.

ha!

You'd think I'd never applied for a job, or med school or residency or anything else. I feel as anxious and insecure as I ever was. It's not that I don't get good feedback. It's not that people haven't expressed interest in hiring me. It's that the one job I'd really like to have hasn't made up their mind yet and I know I'm competing with several fellow residents and at least one established pediatrician for the job.

Wah, wah wah. I know. I should be grateful I'm not looking for a minimum wage job and trying to put food on the table for my kids.

Which reminds me. I had a patient a while back who was around 6 months old and hadn't gained weight in several months. She was thin and a little developmentally delayed. She got the full workup, lots of blood tests, nutrition consult, genetics consult for an known disorder that shouldn't have included failure to thrive and developmental delay. Well, after several days and many ways of asking it finally boiled down to... food. Mom was diluting the formula to make it last longer and practically starving herself (she's so thin we worried about HIV for the both of them!) because she was only getting $125/month in food stamps for a family of four, only 80% of the formula needs from WIC and both she and dad are out of work. Breaks my heart! Babies in America shouldn't be sufferring from lack of food!

Oh, and the CPS cases this month. These kids often wind up on the hospitalist service because they don't have pediatricians. They often come in for "failure to thrive" or some mystery injury or worse.

Some days I don't know what I want more. To be a hospitalist and help these poor little ones the best I can (which is limited in this capacity) or work in a clinic as a general pedi and see mostly healthy kids with families who feed them and take them to their appointments and worry over every runny nose and bug bite.

And also, why do kids have to grow up? I know, I know. I've been impatiently waiting for more independence from my brood. Now that they're so independent though, I find myself sad that no one wants me to bake cookies or play a game or read a story to them. They've got set building and beta testing and online gaming and "things to do." Some days I come home all excited that it's the weekend and I'm finished early at the hospital and then no one needs me at home...

Okay, I'm wallowing. But some days call for that. My patients at the hospital today made me sad. I'm stressed about the job thing. I'm stressed about my pants being too tight. I'm overly tired, as often happens on call months, and not sleeping well.

I should probably just go take a nap.

I suppose a few updates are due before I launch into the reason for my post. I know I've been way overdue and probably lost my readership by now. It's just that I haven't felt like there was anything entertaining to write about!

Let's see, my pants fit again! I just reread my last post and I'm happy to report that I started a family "biggest loser" competition with my parents, brothers and husband. While I'm certainly not winning, I'm very excited to be losing less than my family. My dad has lost over 20lbs! My mom is at a weight she hasn't seen in over a decade. My husband is talking about getting back to his "pre-kid" weight and one of my brothers is going to run a half marathon next weekend. I'm so proud and happy for everyone. The fact that I've lost 8lbs and am back to the weight I was when I started residency is a great benefit, too. I'm running regularly.

But the thing that got me to wanting to blog again is the job search. Yes. The job search.

And yes, I had a great job that I gave up in the fall because it wasn't the right location and timing for my family.

Since that time I've interviewed at 9 different places. 2 of them I visited twice! I think I need to break it down by location so that you can follow my interesting journey. Remember, I live in a large city in the southern US.

Nov/Dec
#1- The Giant Pediatric Group (GPG) In Town Locale: 2 docs both working mostly full time (4 & 4 1/2 days/week). At the start of the interview I got the "once over" from the head doc (you know, the look that says "is she prettier than me?")This was followed by repeated questions about my willingness to work evenings and weekends (Saturdays yes, evenings no) and too numerous complaints from THEM about their call, their workload, their location, etc. Oh, and I don't speak Spanish which they said wasn't a problem but clearly was when I saw the patient demographics. (Who wants a pediatrician who can't communicate with them???) Anyway, they didn't call me back. No skin off my nose! The became known as "the whiney ones" to me and my fellow residents.

#2- The Hospitalist Job. Okay, it was a bit of a fallback when I became unsure what our plans were for the next few years. Plus, I really like and respect our hospitalist service. I got pressed really hard though about my commitment to hospitalist medicine. Did get a hug at the end of the interviews, though, which is always nice. lol. I know the director well. Anywho...haven't heard back from them although they promised decision over a month ago. But that's okay, I don't really want to work nights and weekends anyway. We've been over that.

#3- Private Practice Tier 2: Nice interview. Practice owner been there for 20 years. It's her practice. Cramped office. Didn't meet one of the docs. The other one barely made eye contact. Not a good sign! I worried about practicing in "her office" with "her patients" and whether I would be asked or expected to compromise the medical care I deliver. EMR looks dicey. She offered me a job in January and I thought about it. But eventually I said no because I don't want to be someone's wage earner. Plus her offer was well below the going rate and she wanted a 3 (!) year contract.

#4- GPG Productive Suburban Locale: Loved them!!! Busy office, gorgeous, clean, roomy with well-respected practitioners. I liked them. They liked me. I went back for 2nd visit. They chose someone else. *heartbroken* They wanted someone "now" because one of the docs had left them with 2 weeks notice. Couldn't wait for a resident. Not that they told me that. I heard it through the grapevine. *grrr* Would have been an ideal set-up for me. Would have put us closer to my hudband's work as well. I'm still disappointed.

Job Hunt Continued...

Jan/Feb:
#5- Premier Private Group New Locale- 2 docs looking to add a third part time. I don't want to work part time, but this is a well-respected practice that is expanding to a new office. They said I could become fulltime once I got my patient #'s up. Okay, no prob! Also, wanted me to work fulltime in summer while one of the docs on maternity leave. No problemo! (the extent of my non-medical spanish) I know one of the docs as she was a senior resident when I was an intern. Didn't get a good impression of her because she was rather nasty to me on my first (ever) call night...as an intern...on the oncology floor...Anyway, I tried to let that pass. Her slightly condescending attitude still showed through during interview, but beggars can't be choosers, right? There were other red flags, however. The website bio's for both of them spend a paragraph each talking about their churches and their activities at the churches. Then the chief resident and assistant program director hear who I'm interviewing with (both apparently trained at my program) and told me not to join them! I've never heard either of these people gossip and both told me independantly that those 2 docs were selfish and self-centered and difficult. Hmmm... THEN, I get a phone call from one of them saying the part time job is actually just locum tenems because their financial partners won't let them hire anyone permanently yet. Okay...but I'm still game and spend the afternoon with them when they call me back for a 2nd interview. God and religion come up not once, but twice unsolicited while talking to patients. I dunno, I don't think my religious views belong in the work place. But whatever, 'cus after giving me a big hug (again with the hugging?) and saying they'll call me next week... Nothing. Good riddance? Yeah, probably.

#6 GPG Way Out Suburban Locale- Another weird interview. Lead doc is...odd. Other 2 docs are strangely quiet. GPG Area Director is present at interview. Also odd... I learn they have major staffing issues. Nurses unhappy. Docs seeing patients 'til after 6pm when last appt is at 4pm. One doc leaving suddenly (surprise, to the suburban locale I loved so much! *grrrr*). Then I find out they had to fire their office manager! And they can't find a nursing supervisor. Hmmm.... Is it just me or are there a whole lotta issues? They haven't called and I haven't heard if they've made a decision. I'm scared if they offer me the job I might have to take it!

#7- GPG Continuity Clinic- Has an opening. I've been there my entire residency. They are old and give antibiotics for colds and do CBC's for no good reason and xrays for constipation. But hey, it's a job. Only then they basically tell me they only want to hire a man. Chauvanist Pigs. End of conversation.

#8- College Town Dream Job- Interviewed recently. Evidence based medicine. They trained at my program. They are located in my college town which hubby and I have dreamed of returning to since we left 17 years ago. It's never been the right time... No weird vibes, no neurotic docs, happy nurses, great location... If they call me I will be there so fast their heads will spin! Oh god, will they call me??? I was first interview. *ahhhhhhhhhh*

#9- I have to write about this one a little later. It's hilarious! and scary! and hilarious!

...and I meant to say, and forgot, that I am being very picky. You can probably tell! But seriously, I'm 40. I've done the bottom rung crap jobs already. I've been the scut monkey. I've worked with the difficult, miserable people because I was just happy to have a job. I can't do that anymore. I'm too old!!! lol

I've decided I can't write about my last interview because I'm not totally anonymous. Suffice to say, during the course of the interview I was told one of the docs had found the cure for ADHD and Autism and they are keeping it in a large plastic bag locked in a cabinet in the office.

Yes. That is really part of what transpired.

Moving on...

I got 2 excellent job offers! One of the suburban practices and the College Town job! !!! Hubby and I are very excited about the College Town job. We've been talking about getting back there for 17 years. I can't believe I found us the way to do it! I'm thrilled. And nervous. And excited. And I have a BAD case of senioritis. Good thing I'm on Spring Break with my kids this week! lol

Oops, I forgot a few things!

I got an offer from interview #5 as well, for their locum tenems spot. And I want to clarify a little. I have no problem with docs letting their patients know that they are members of a certain church or faith. What I had concerns about was that I don't share their openness about my religious beliefs and I'm not comfortable discussing it with coworkers and patients. I also happen to feel it isn't appropriate to bring up your religious views while caring for a patient unless they have brought it up first. So I worried I would not fit in with them, or feel pressured to talk about my faith. Anyway, I didn't accept the job. It wasn't the right one for many, many reasons.

What was truly odd to me last week was that I got 3 job offers in a 24 hr period! After waiting months and months for something to come along that I could comfortably sign on with, I suddenly have 2 good offers.

College Town it is. Of course, that means relocating. That will be a saga all its own!

I was thinking I might not blog anymore after finishing residency because I feel like I've run out of Mom in Medicine kind of things to say. But being a mom trying to manage dual households (boys will move with me, hubby staying with daughter to finish Senior year here) with 3 teenagers and starting new as a pediatrician might be worth reading.

I know this is your blog, so please delete my entry after you see it, but please please keep blogging...I love reading it, as it is inspiring. I think for those of us still at the bottom of our training - it really helps to know what is on the other side. I love your stories.

Thanks for your contribution here.

Umm, please continue to blog about raising teenagers while being an attending (this is my life!) thank you for your blog, really enjoy it!!

Please keep writing.

My apologies for being AWOL.

My blog title is no longer accurate! As of midnight tonight, I was no longer a resident.

I suppose if I start a new blog, it'll have to be "married momof3 pediatrician2011." Wow. Doesn't sound as unusual since most pediatricians are parents. I tempted to call the new one something like "the circuitous route."

Nonetheless, after all my fears and anxieties, sleepless nights and marathon rotations, I have finished residency still happily married (20 yrs this month!) and still with 3 amazing kids who don't appear to hate my guts. *phew*

I was filling out the post-residency survey for the AAP tonight and one of the questions was "knowing what you know now, would you become a physician again?"

I had to think about that for a minute. My initial response was "probably not" and my husband asked me what I would do instead. I pondered that one. I mean, there are so many easier ways to train to help people. There are so many jobs that pay well and don't require half the number of years of education to get. There are so many fields that don't require 80 hr work weeks as part of the preparation.

But I honestly can't think of anything more fulfilling. I've done some of those other things and none of them came close to the moments of personal gratification I've had when I've made a tricky diagnosis, relieved pain or anxiety, held a patient's hand in comfort, or explained something scary and technical in a way that put families at ease. All it takes is the memory of one young patient looking up into my eyes, telling me I'm a good doctor and handing me one of his stickers to put a smile on my face.

It's not that I love everything about medicine. Don't get me wrong. It's that at the end of the day, I really can't imagine being this fulfilled doing anything else.

***

My life is about to change fairly radically. I'm joining a practice in another town, building a house, moving my family, and dealing with the fact that I'm not sure when/if my husband will be finding a job in our new town. There may be years of his commuting/traveling ahead of us again. Not the end of the world, by any stretch, but also not my ideal situation. But you know, I'm fairly good at dealing with the not ideal situation. Been doing it for a good 10 yrs now between hubby's travel before and during med school as well as all my medical training with 3 kids and a husband with a demanding job. I kinda think I'm at my best when under a little pressure. Haha!

I can't believe in a couple of weeks I'm going to be THE doctor. Seems so funny to say that, but after years of having someone always second-guessing my diagnoses and plans, it'll be strange not to "check out" to someone. Strange and wonderful!

You might wonder why I'm writing all this at 3am. Well, it's because I finished my last month of residency in the EC (emergency center) with lots of switching between nights and days. Always guaranteed to mess up my sleep for a couple of weeks afterwards. So glad to be done with that! Forever!

I'm off on vacation with my husband in a couple of days. After that, I start my new-ish life as a pediatrician. I hope I'll be inspired to blog again. I miss the writing and I miss encouraging the members of MomMD.

Yes ladies, it can be done! I may be in my early 40's with 3 kids in High School (!) this fall, but by golly I did it and so can you. (now hit the books )

TR

I can't believe this is the end. I feel like u took me on this long journey and I can't believe your school is over. I am soooo excited for u. Congratulations! Keep us posted on how your job is going. Thank u for bloging. U will never know how encouraging this has been for me and my family. Take care

AGREED....I saw something new in this blog and was so excited! This whole story, from start to finish, gave me the hope and motivation to keep going some days. I am 2 months from my MCAT, and my application is taking shape for this next cycle--but I'm not sure I would've had the courage to start were it not for people like this wonderful woman and her family!!!!

I think I speak for many when I say... MORE, please!! =) Please don't stop writing!! =)