Subscribe Living the Dream: Jonesie's blog

Internal medicine physician and mom of 4
This blog is no substitute for treatment, and every recommendation is not right for everyone. We try to avoid errors, but blogs don't have editors, and inevitably will have inaccuracies. Do not change your treatment or medications in any way without first consulting your own therapist and physician!

A story untold

The contrast was stark. It had been an unusual day, to be sure. This day did not start with five home visits on the schedule. And yet, here I am driving through the beautiful countryside for miles on end - leaves falling, colors changing almost while they fall.  Nothing but the hum of the road in my ear. In a land too far for radio waves or cell coverage to reach, I round each bend in the road with less and less speed. I am relaxing into the afternoon, a forced slowing to a too-busy day. After the final mile on a freshly graveled road, I turn into what must be the address, albeit u......
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On life, and death

I’ve been working on trying to schedule one home visit a week lately. It seems that there is usually at least one patient who for a myriad of reasons cannot make the physical trip into clinic. It is not as easy as it sounds to schedule a home visit. Although the patient and family often have flexible schedules, finding a solid hour in my day can be very hard for my staff – especially when the request comes last minute, as it often does. The last few home visits have been with hospice patients. The last two have been patients in similar situations, and I’ve been truly honored to be a part ......
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And the shiny wore off

When I was a little girl, I loved nothing more than the shiny trinkets found in the checkout aisle, at the dollar store or in goodie bags at birthday parties. My most treasured possession at age 5 (besides my imaginary pet goat) was a silver colored ring with a fleck of pink colored plastic "stone". It had been given to me by my kindergarten sweetheart. Wanting to protect the ring from loss, theft, meteorites, and my mom I buried it in a shallow grave under the tree in the kindergarten playground. Where it promptly became forgotten. Eventually, I remembered the ring and spent the rest my kind......
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Day One...

is quickly approaching. The remaining days are filled with squeezing every last glorious drop out of this beautiful late summer, kissing chubby baby cheeks, parading to the park, hiking to waterfalls, exploring our new city, and trying to remember that I do know enough to practice medicine all by myself. For years now I've heard that this transition to Attending is the hardest yet. Of all the transitions in responsibilty throughout medical education, this is it. The proverbial buck, the culmination, the pot at the end of the rainbow. The summit. I suspect that like many other transitions ......
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And the band plays on

Tears course slowly down my face as the marching band approaches the bend.  Soon, the last row will be in sight.  There - the tallest tuba player.  Focusing intently, he is unaware of the tears or my feeble attempt to capture the moment with my outdated camera phone.  The band marches on, their joyfully loud music fading a little as I realize I am standing here in this crowd crying. It is hard to name all the emotions swirling around me in this moment.  Pride for my son's hard work and excellence, joy for being able to share this moment with him, love for the little boy he was, the young man......
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well, well, well...

here we are. I've been thinking a lot about time lately - how we spend it, how it passes, that it marches on whether we want it to or not. Some current times: 28 weeks pregnant 9 weeks left of residency 16 weeks until boards 14 weeks of maternity leave (what is THAT?!) 2 new daycares in our new city (the infant daycare we chose is inside the high school) 1 new primary care job 4 days a week at my new job (which day should I take off?) 4 more overnight ICU shifts 16 t-ball games left and one amazing life! The dream lives on :) Yes, we have finally decided on a future after residency. Having ......
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a single step

I have been blessed with an inherent sense of personal responsibility, finely honed by my environment as a child.  I learned at an early age that my actions and decisions carry meaning and consequence.  This is a trait that has served me well over the years, at times providing opportunity to grow through recognition of my own failings, and at others freeing me from shouldering responsibility where it was not mine to carry.  Personal responsibility is an important value that I strive to pass on to my children and one I am proud to see developing in Teenage Boy.  Financial responsibility is an ......
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It hurts so good

I've come to the conclusion that internal medicine residency is precisely 273 days too long. Yes, there is more to learn. At this point in training, however, the protective womb of attendings can start to become a bit suffocating. Like the last month of pregnancy, the end of residency is perhaps meant to be painful in some ways - it does make a person really really want it to be over, therefore making the pain of transition a little less. By now, many of my classmates have decided exactly what they will be doing 274 days from now. I'm still having a bit of an identity crisis, and every time ......
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Simple favors

Today, in an effort to make more than we spend for once, I started working extra shifts for a company who does social security disability exams. I do not decide whether a claimant is disabled, I merely compile the history and physical exam so that someone else who will never see the claimant can make the decision. It was an interesting day, and some of the claimants had been waiting months for their exam. I have just a few thoughts for everyone out there needing objective documentation of the functional limitations they have which may qualify them for federal funding. Please, when you show......
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concession to the grocery store woman

For the last many years of my medical training, I have grown accustomed to intermittent feelings of inadequacy and uncertainty.  As perpetual learners, most physicians balance medical knowledge with some degree of uncertainty and "is this the right treatment path for this patient?", as every patient-diagnosis pair is unique and most don't fit tidily into treatment algorithms.  In fact, we are taught to deal with uncertainty and self-doubt in medicine so that these feelings don't cripple decision-making or cause unnecessarily and potentially harmfully conservative treatment plans or overuse of ......
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Never say never

LifeFlight lands and the flight nurses come running down the hall, chest compressions underway, into a room with our waiting code team. I run the PEA arrest code with a team I've worked with countless times before, everyone efficiently doing their part. After 4 cycles of CPR, finally, a shock-able rhythm. 48 hours of drips, arrhythmias, shock, complications, desperation, tears, and hope. Slowly, the young mother starts to respond to her husband keeping vigil at her bedside. Extubated and with normal vital signs, she transfers out of the ICU on day 5 – only to be replaced 30 minutes later ......
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Put up or shut up

Many people have felt it necessary to comment on my choice of career of late.   One of my own (Dr. Karen Sibert) has published an editorial in the NY Times chastising me and thousands of other women for choosing a balance between work and life.  http://www.nytimes.com/2011/06/12/opinion/12sibert.html I'd like to set the record straight on something.  I do not have an obligation, moral or otherwise, to work full time as a physician.  I do not "owe" society my life, my happiness, my balance, my being.  I am a better physician when I have some time away to replenish the well.  Today for morning......
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On princesses

I met a woman today in line while selling back used books.  This is quite the environment to meet someone in.  It's surprisingly personal to unload boxes of books, presenting little pieces of your life to complete strangers in exchange for money.  I'll have to admit that the $27 cash I walked out with was about 0.01% of the once-upon-a-time "value" of those books, but the happiness of not having those boxes in the place-where-we-used-to-keep-our-cars was worth a lot more than that. Anyway, this woman somehow started telling me about the sheer lack of princesses in her life.  She has proudly r......
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The machine

Healthcare is a machine.  A giant machine with a thousand parts.  Sometimes the machine is efficient, well maintained, oiled, and produces a product that will withstand the test of time.  Other times the machine is missing parts, hasn't been stroked by the loving hands of a caregiver in years, or churns out partial pieces of the final product. I have spent years living in the machine, a small pixel in a big picture.  I try to be efficient and not be the rate limiting step.  I try to make sure the patient comes first do whatever possible to lessen the load a little or to brighten their day.  E......
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nutrition services

I miss nutrition services.  Which is to say I miss the daily voice AND emails from nutrition services.  And I quote: "This is a message from nutrition services.  A child in your household by the name of teenage boy has a negative school lunch balance in the amount of two dollars and thirty five cents.  blah blah blah idle threats here" After nearly three months of voice mails and emails, teenage boy has *finally* remembered to turn in the checks we gave him.  I wanted to write a check for two dollars and thirty four cents, but Honey wouldn't let me. Someday, it'll be Sallie Mae calling.  An......
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some days you're the totter

or is it the teeter that's on the bottom? I'm on elective and should be reveling in the time I have away from work and sewing my fingers off.   While I am enjoying down time away from emotionally and sucking-the-hours-out-of-your-week draining rotations, I'm struggling personally.  I find myself at a complete impasse with my internal career decision pathway and overwhelmed with the possibilities (what a problem, eh?).   And honey isn't convinced we especially need another babe.   And I'm starting to seriously wonder how the hell all of this will be paid for.  *see http://benbrownmd.wordpress.......
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The quiet within

This morning I parked in the physician only parking spot of the first nursing home I ever worked in, on my way to visit one of my clinic patients.  I remember years ago when I worked there looking at that parking spot and thinking to myself - one day, I'll get to park there.  :) Yesterday in clinic I found myself spacing out while auscultating a patient's lungs.  I suddenly realized that the poor lady had been taking deep breaths in and out for quite a while while I was seemingly mesmerized by the soothing rush of air in and out, in and out.  After reassuring the patient everything sounded gr......
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By the time we get there...

... the kid won't even be dead anymore.  What a great quote.  Those boys in Stand By Me embarked on a destination and ran into a journey.  I've always wanted to be a doctor, and that destination has truly become a journey I never expected.  What a great ride. I'm finishing up my first month as a senior in the ICU.  As much as I liked night float, I l-o-v-e the ICU.  I love the acuity of the patients, the skillset of the nursing staff, how quickly things change, and how amazing it is to see someone get better.  I love helping patients and families navigate difficult end of life decisions and w......
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Have fun with your friends

Night Float is Sun-Thurs nights from 8pm to about 8am.  My ability to sleep during the day is intermittently efficient, but I typically have a few hours with the kids before I head out to work in the evenings.   In the mornings, I sometimes see the kids briefly before they go to school - I always say "goodbye, kids.  Have a good time at school, have fun with your friends" to remind them that leaving a tired mommy at home really isn't all bad.  The last few nights I've gone to work, Big Girl has said "Goodbye mom, have fun with your friends at work!".  Which makes Honey and I laugh.  The funn......
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Teen Spirit

Age Thirteen. My parents (and I) will be the first to tell you that I have made mistakes and bad choices in my life (sorry, mom!).  How I avoided life-altering consequences I will never know.  Therefore, I am somewhat sympathetic to the bad decisions of others.  *Somewhat* Today, I voraciously defended Big Brother's honor on the phone with THE MIDDLE SCHOOL REPRESENTATIVE who demanded I "have a conversation with my son regarding the importance of telling the truth to every adult at all times" and emphasized the "serious problem" evidenced by Big Brother's behaviour  (in the grand scheme of t......
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