Monday, January 25, 2021

conversations

One of the things I hated most about residency was having conversations with other services who (it seemed) were only interested in avoiding coming to see your patient.  There would be variably hostile, passive aggressive, rude, statements made in order to "block" your request for a consult.  The person you were calling would insinuate you were lazy or stupid or rude, and that was the real problem, and refuse to see the patient.  I remember more than one time I encountered such a person on the phone -- who literally screamed at me so loudly that the entire office could hear her -- who then complained to my program director that I was rude.  Suffice to say, it was incredibly stressful.  Last spring, I had a resident demand to speak to my attending.  Fortunately she backed off when I told her that I was the attending.  

Now, as an anesthesia attending, one of my least favorite things is receiving a call from another service and having them bullshit you about the urgency of a case in order to manipulate you into doing a case that is not actually urgent.  

I know what is happening is that some attending or fellow taking care of the patient has told the resident who is calling me, "You have to convince them that the case is an emergency or else anesthesia won't do it on a Sunday / now."  So the resident will pretty much say whatever they have to, even if it isn't true, in order to do what their attending has asked them to do.  If they have to report that anesthesia refused to do the case, their attending will be irritated, and that irritation is likely to spill over onto them, resulting in negative consequences.  And no, most attendings are not actually insightful or mature enough not to do this to the trainees.  

Do you want to know why we don't do non-emergency cases during off hours?  Because if something untoward happens to the patient, then we don't have backup available to help.  

Do you want to know why we wait until the patient hasn't eaten for 8 hours?  Because patients DO vomit and aspirate.  Sometimes they die.  I have seen this happen more than once.

Do you know why we don't anesthetize patients for things like IVs and N-G tubes?  Because anesthesia has risks, and basically everybody should be able to tolerate an IV or N-G tube awake, even though it is unpleasant.  Even if that person is a kid.  

Personal convenience for the surgeon is also not a reason we need to violate NPO to proceed with the case.  And no, performing the anesthetic in a location that is not an operating room doesn't all of a sudden change the rules.  

Fact: We are all supposed to be in the business of providing the patients the best care we can provide.  My goal, when I talk to people about potential cases, is to figure out how we can facilitate getting this patient the care they need in an appropriate time frame.  

*headdesk*
*headdesk*
*headdesk*

I honestly wish sometimes that my phone had a voice scrambler, but instead of scrambling it to something indecipherable, it scrambled it to a deep baritone white male voice.  Half of these conversations could be avoided if the person I was talking to recognized that I am the final word on whether the case will go, and that this is true, even if I do sound like a 13 year old girl.  

On the positive side, my call last night went very smoothly, and yesterday only one service tried to pull some shenanigans.  So, yay!

Saturday, January 23, 2021

Birthday!

Ahem! Excuse me! Alert!

We now have a NINE year old!

Technically, this was Dylan's second birthday in MI, as I was out here interviewing with my family during her birthday last year. 

We celebrated over the course of the week, which was nice because I got to buy her MarioKart and give her a second remote control for her Nintendo Switch last weekend and we got to play together almost every night this week.

What else... 

She also got a new sled since she put a hole in her old one sledding over rocks, some light sabers, a bunch of the Dog Diaries books, the Pony Club guide to D level horse management, and some random other plastic that hopefully she will lose interest in so I can throw them away things .  Our AP cooked her an orange cake, and it was delicious.  She got to pick her own special birthday lunch yesterday.  And she got to have a Zoom birthday party today with her friends from Philadelphia, and two playdates outside with her local friends.  

I'd say it was a pretty damn good birthday!

As for me, well I am having trouble making myself workout, focusing on completing manuscripts, getting all my admin done, figuring out what I'm going to write a grant on in the next six months.  You know, the usual.

I am on call AGAIN tomorrow.  Here's hoping it will be better than last Monday. 

Thursday, January 21, 2021

Welcome to 2021!

Welcome to 2021!

I suppose it's fitting that 2020 ended with a wicked night on call, my 2nd COVID shot, and sleeping (or lying on the couch in a stupor) for 36 hours, but now it is Thursday 1/21 and it's time to finally start the new year.

Watching the inauguration in Twitter clips after my mega nap yesterday I felt... nothing.  I finally identified it as the feeling of not having despair or dread.  Of lightness if not elation.   

I watched Amanda Gorman’s oration and felt moved.  I heard people compare her to Robert Frost but he’s not even in her league.  Her poem to me was more reminiscent of Coleridge or even Dylan Thomas.  She wants to be president of the United States?  I believe she will do something way more important than that.

I had held off on making goals for myself, hanging on by my teeth as it were for the past couple of months.  But I think it’s time.  I divided them into two categories - personal and professional, and honestly they fall mostly into the professional category.  

So here we go!

Professional Goals:
1. Write a grant
2. Finish 1, 2, 3, 4, 5(?) manuscripts?  One is awaiting comments from co-authors. Two is about 2/3 written.  I think it’s doable. 
3. I have two ideas for thought pieces which I think are kind of cool
4. It would be really amazing to get invited to give a talk, assuming that we will be doing that again this year
5. Complete first industry sponsored project.

Personal Goals:
1. Start swimming again (assuming pools will open again sometime this year)
2. Continue lifting and going for walks
3. Make some new friends and meet up with them

Oh also, I woke up this morning and feel like myself again, so yay!  Would suggest if you can avoid planning anything exhausting the day after your second covid shot, do so.  It will most likely be fine, but it would certainly be kinder to yourself to take it a little easy.  

Happy 2021!

PS -- Oh yes, I also saw this post on scarymommy.  I thought it was an interesting take on the reopening of schools.  

Wednesday, January 20, 2021

post-post

Had a brutal call on Monday night where we did several emergency c-sections, two ICU transfers, and an emergency hysterectomy, and was awake all night.  If I have to be honest, it was kind of fun.  I like complex cases.  My team was also excellent.  

Then I got my second COVID vaccine and got in bed at about 10AM.  

I'm not sure why I am no longer able to sleep in the mornings post call, but yesterday was no exception, so I got up and hung out until 3 or so, at which point I went back to bed and slept until 6:30.  I finally went to bed at 9:30 PM and slept until 7:30 this morning.  Initially my whole body hurt and I had a headache, but I have to be honest, I didn't feel that different than I normally feel when I am post-post call from a difficult call except that I also had a fever.  Fortunately, everything improved with 1000 mg of Tylenol, and I've been able to get some work done.  Yay!  

I had to record a video to go with a virtual poster I'm presenting at AAHPM.  God what wretchedness.  I dry shampoo'd my hair and put on makeup, but I still hate my voice, the faces I make when I am talking, and the fact that I can't stop lifting my eyebrows when I talk.   Ultimately I gave up trying to smile and talk and remember my script all at the same time and just submitted the damn thing.  Hopefully it will be well received.  

Next: prepare for my meeting tomorrow with my primary mentor.  I feel frustrated by my lack of progress this last month, so I really need to get cracking on this.  

My husband and au pair signed up to be vaccine volunteers in Wayne country starting in February being administered by the department of health.  They have to stand outside for 8 hours at some center in Livonia directing people where to go.  BUT!  If there is vaccine left over at the end of the day, the volunteers can get vaccinated.  My husband is hoping this will enable him to fly to Italy to see his father one more time before he dies.  

Oh, Happy Inauguration Day, everyone!

ETA: Ok I took a three hour nap and I have to admit that I still feel like I've been run over by a bus, and all I want to do is crawl back in bed.  Myalgias, synovitis of my hand, headache, and fever are resolved, but I am just soooooo sooooo tired.  

Sunday, January 17, 2021

On volunteering

Do any of you volunteer on a regular basis?  I do not, largely because I haven’t had the time for ohhhhh about 14 years.  

I signed up to volunteer at the covid vaccine clinics because I felt like it was the right thing to do.  When we signed up, we could request to be vaccinators, greeters, or check in people.  However when I arrived this morning I was told that they were only allowing us to be greeters.  I don’t know if this is an every day thing, but today it was not busy at all so it was unclear - to me anyway - whether my presence added any value at all.  So, I was there for about 2 hours, but between driving there and home, it really took up more like four hours of my time.  I feel tired and cranky and I still have to do all of the things I need to do for today.  

I also had to be on the receiving end of a nurse bitching me out because I sent someone to her station before she was “ready” (they had signs to indicate when they were ready, but nobody including her had been using them).  And then she engaged in a deliberate slow down just so she could show me who was the boss.   

Honestly the experience kind of sucked and was also mind numbing.  Maybe it will be busier next week and I won’t feel like I wasted most of a day on this?  Is volunteering for things always like this?  If so, fuck it.  I’m not going again.  


Friday, January 15, 2021

Friday DONE

Today it snowed!  My only sadness is that it was really warm, and it started to rain at the tail end of it, turning it into mush.  However, if it gets cold enough tonight, it should freeze up and make for decent sledding tomorrow.  So yay!  Furthermore, our self imposed quasi-isolation after our neighbor tested positive for COVID has ended, so the Dylan can go outside and play tomorrow, which honestly will be SUCH a relief.  Double yay!

*****

I asked Dylan whether she wanted to do anything special for her birthday zoom party, or if just zooming with all her friends was enough, and she just wants to zoom, so thinking about that any further can now be crossed off my list of things to do.  

*****

Amusingly (I guess) I've started receiving targeted advertisements for a) makeup for old ladies, and b) bras for women with small chests.  I wonder if some bot captured an image of my face and hair on zoom and decided I was between 55-65, which seems to be the age the ads are targeting?  As for the bras, I can only imagine that happened because I asked not to receive ads for bras for really large breasted women any more, maybe by clicking "does not apply" or something.  Sometimes we have only ourselves to blame.  

*****

I got my abstract submitted today!  I surprised myself at how quickly I could crank one out.  This one took about three hours total, which isn't too bad IMO.

*****

Then I took a nap.  I don't know why I am so tired, but I am, so I slept, and it felt really nice.  Woke up to attend an evening faculty meeting and do some more work.  So basically I've been working on and off (mostly on) since 6:30 this morning.  I am telling you this, dear internet, so that I don't have to feel guilty about my 1h nap.  I did go for a walk during part of the faculty meeting, so that was something.

*****

Goals for this weekend:
1) Review my online CV and make sure it is up to date
2) Create a 2 min video for my AAHPM poster (It's about children who have do-not-resuscitate orders who need anesthesia for surgery and non-surgical indications.)
3) Do vaccine clinic on Sunday 10-12
4) Spend 1h each day editing my manuscript

I have a bunch of other things to do as well, but this is really the minimum I want to get done.  

See?  I did deserve a nap today.  :-)




Thursday, January 14, 2021

Bedtime update

Thank you SO MUCH for all your helpful comments yesterday!  OMG it is so freeing to think that actually it's ok that we allow our kid to put herself to bed, and don't have some elaborate bedtime ritual.  I do think having a hard stop on electronics will be immensely helpful, so we have decided on 8:15, which should still allow mommy plenty of evening writing time.  

Last night we piloted this and though some pouting occurred, we ended up actually having a pleasant evening?  Dyl got ready for bed, and then decided she wanted to play horse and so we ran cantered around the first floor of the house chasing each other (which admittedly wasn't the most relaxing activity pre-bedtime, but whatever).  Then we went upstairs and read together as a family in my bed for 20 min.  Dyl finished Little House in the Big Woods, which she had previously refused to read when I had suggested it, but then some teacher at school did and she was all in.

Whatever.  I will take it.   

Lights out happened at about 9, maybe a little after, which was GREAT!

She was still a grump this morning, but I suspect she is like her mommy in that regard.

So -- WIN!

(We will see how long this lasts.)

******

In other news, my geriatric parents have their appointments to get their first COVID vaccine in CT.  I am so excited for them, though still had to remind them that they wouldn't have anything approaching good immunity until 2-3 weeks after the second shot, so they still needed to behave themselves.  Still, I will actually be able to visit them this summer, potentially, which is so nice!

I also signed up to administer vaccines to patients this Saturday at the stadium, which I have never actually been inside of.  So excited to do this!

******

Zoom birthday party with Dyl's Philly friends has been arranged.  Any ideas on what to do for the party?  Generally the girls play video games together, but I'm wondering whether I should do anything else.  I've seen some posts from moms who did elaborate things like mail craft projects for everyone to do together over zoom, but I have to be honest -- even under the best of conditions I wouldn't have the bandwidth for that.  Would welcome your thoughts, especially those that say -- Don't worry!  Let them all talk and play video games, and have an organic gathering!

******

Submitting abstract tomorrow, better get off my ass!