So, things are going well so far. My friend comes over at 6:15, so I wake DD up at 6 and get to the hospital by 6:45. I'm covering three patients right now, and only one is at all complicated, so while I might prefer to have more time in the morning it's really not necessary. However, I have a little quandary. My team got a new attending yesterday. He's really awesome - challenging but supportive about it. Today he told me I'm doing a really good job and asked if I wanted more patients, saying he wants to make sure I'm sufficiently challenged. I KNOW the correct answer is "Yes!", but I don't think I could stand to wake DD up any earlier and I worry that I wouldn't have enough time in the mornings to prepare any additional patients. I said something non-committal about how today was the first day I felt completely comfortable with everything and that maybe I could keep it that way another day and then see how things are, which he seemed fine with. So I'm not really sure what to do tomorrow. I didn't tell him the real reason - I didn't want to sound like I was making excuses for myself, especially in front of the residents that were there. But I also want him to know that I would like to be challenged and would otherwise be willing to take on more patients. Unfortunately he's only with us through Wednesday, which is the day after DH comes back, so I'm not going to get the opportunity to go in earlier while he's around. So what do you think - should I pick up more patients tomorrow? Should I tell him the reason for my hesitation? I want to impress him but I don't want to make things worse for my daughter, and I'm also a little concerned that picking up extra patients and then failing to adequately prepare for rounds would do the opposite of impressing him.

Can you pump in the morning and leave a bottle for her? She knows your friend now, so would it freak her out to have your friend get her ready in the morning ( or be asking too much of the friend)? You could have all else ready with clothes set out, and that way it is just a matter of getting her dressed, giving her the bottle, and off they go?

Just an idea- hard not to see her awake in the morning, but I understand not wanting to wake her!

Good luck! Glad things have gone well thus far!

wow, what a great dilemma you've got there.
are you planning on peds? is he such a great attending you might identify him as a potential mentor? I'm thinking as a 3rd year in newborn/ NICU, possibly pre-peds, I would have said, "I do like to be challenged, and I'm enjoying this a lot, but we're new at the 6 am childcare thing."
another version ---
jump in, take a deep breath and say, I am really enjoying this rotation and I'm glad you've noticed how I'm working. I'd like to take another patient, but although I have great 6 am childcare, I'm not sure I could get in early enough this week to take another pt independently. -- {don't say anything else} or {what do you think?}or {could I shadow a resident and try to take responsibility for the extra pt?}

in the end, though, it sounds like you're making a great impression and either way this won't change that :-)

good luck!

I never THOUGHT of asking med students for back-up childcare. What a fantastic idea.

I would add-why is your DC limited to 10 hours? I know mine is for our base fee but I can pay extra for the extra hour if I need it....

I think it would all come down to if you wanted to go into peds or not. That is just my second-year opinion though (feel free to disregard). I know that I'm going to go balls to the wall, though, rotating in whatever I'm going into just to make sure I get the recs I need to be competitive.

No balls (to the walls or otherwise lol) here during MS3 and matched at my first choice (in IM). I worked hard while I was there, but also tried to be efficient. After all, I had 2 kids at home and one on the way. I think (most) attendings recognize enthusiasm and hard work. I like Ohio's ideas.

I also think you are wise to consider the possibility that you may get overwhelmed with additional responsibility - although it sounds like you'll handle it well, I think the flail of taking on too much too soon is a painful lesson and will not help in any way.

There's always the option of taking on more responsibility without taking on another patient - do a teaching point presentation to the attending and residents on a topic about one of your patients, for example. Or find something else you can work on from home or not at 0600 that will show how excited and awesome you are. Picking up another pt is not the only way to be more challenged...

There's a lot of learning in this thread for those of us that aren't to third year yet....

Enjoying reading the responses you are getting nbp - they are definitely more learned than mine!

Jonesie - glad to know I don't have to kill myself in my desired specialty to get where I need to be either. This will bode well for me next year also.

I spoke to my attending on Friday and said I'd like to take another patient, to which he responded "one, or would you like two?" Eek! I did end up telling him why I was hesitating, which I'm not sure was a great idea - he didn't seem very sympathetic, but then he didn't really seem to care, either. I would have picked up two patients but my team only picked up one that day, so that's all I got (24 weeker at that!). I discharged a patient too, so I'm still at three patients, though now two are challenging instead of just one.

jonesie - funny you say that. I actually got assigned a little teaching point presentation anyway. I guess I'll just try to impress by doing a good job of it tomorrow

docmomof3 - daycare is limited for the child's well-being, as far as I can gather. Even if I could pay for an extra hour, they don't open until 7 (so I'd be getting 7-6 instead of 7-5, which wouldn't help me here).

SW to MD - it's not a bad idea, but I wouldn't have been comfortable with it. DD has literally never in her life woken up in the morning to anything other than me - we'll be trying that next week with DH but I couldn't ask that of her or my friend this week.

Tomorrow is the last morning before DH is back, thank goodness. I think I might still want to stick with my current schedule Wednesday, too, since I think it might be a bit much to have DD skip morning nursing the first day her daddy's back after such a long absence. Maybe we'll give it a day and try it Thursday? Of course by then it will be a different attending... Oh well, one thing I'm sure I'll learn this year is that I can't please everyone and I just need to do what's best for me and my family.

Thanks for all the suggestions and support!

Oh and P.S. - BabyE, I think it was you who mentioned that I'd probably only be able to examine the babies at particular times. Nope, not at this NICU, oddly enough - I can bug those poor little guys whenever it suits me. Not sure that's the best policy but that's the way it is.

Ha, so when I walked in today and saw the board, I realized that two of the three patients I thought I had were gone (one transferred to another hospital, one to another team), and in place were three totally new patients, for a total of four, and all of them complicated (by my standards, anyways)! I had some brief internal panic but I pulled it off, and after rounds my attending gave me some really positive feedback (as well as a little constructive criticism) and offered to write me an LOR! I guess I'm doing something right.

In other news... DH missed his flight and won't be home until tomorrow. @#$%&! Argh. And poor DD was so mad at me when I woke her up at 6 this morning - I guess after the long weekend she was lulled into thinking she could sleep whenever she wanted to again The day went okay though, and luckily my wonderful friend agreed to help out tomorrow too. But boy does DH owe me big time!