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.