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!