Yesterday was a bit of a struggle bus day. My resident did some things that scared the crap out of me, and we had some IV struggles in some little kiddos, leading things to take a bit longer than usual. No patient was harmed in any way whatsoever, but I do see how some attendings can start to adopt a defensive/antagonistic stance to trainees. Trying not to do this myself.
I ended up giving negative feedback, and received minimal pushback. I told her that sometimes it's just a difficult day, and that it's really easy as the attending to feel frustrated with how things are going and then to displace their feelings of frustration onto the learner. It can be hard to sift through the struggles of the day to distill events into lessons to take with you moving forward, and then to communicate those to the learner in a supportive, or at least non-hostile way. I hope I was at least a little successful at doing this.
What was interesting was that the trainee expected me to give negative feedback about missing a couple of procedures, and in one case giving too much opioid (I did tell her what dose I would have given), but truthfully the patients in those cases were never in an unsafe spot, and I don't actually expect trainees to be able to intubate babies or place IVs in chronically ill toddlers with any sort of reliability whatsoever. I don't expect them to understand all the intricacies of caring for a patient with a syndrome. That's what peds anesthesia fellowship is for, and quite frankly a lifetime of practicing medicine.
I do expect them to adhere to best safety practices that apply to adult and pediatric anesthesia, to ask me if they have questions, to do a thorough job with their preops, to listen and remember the anesthetic plans we discussed, and to call me if there are concerns intraoperatively if I am not in the room at the time.
Lesson #1 of being an attending: It's hard to be responsible for people whose behavior you can't control. How to be present when you can't physically be present?
Wednesday, February 26, 2020
Sunday, February 23, 2020
things making me anxious
It has occurred to me that maybe I shouldn't write about the awful parts of residency. Or maybe even residency at all. I worry that people who have supported me in the past might withdraw that support if they perceive me as badmouthing my program, for instance. Or that people might choose to do a different specialty or residency at a different institution, thinking somehow that will prevent these sorts of things from happening to them. This would be silly, as these sorts of exchanges are not limited to my specialty or my program, but then people do dumb things in the face of imperfect information.
On the flip side, writing about it is incredibly therapeutic for me. Much of the stuff that is out there about residency talks about the poignancy of patient interaction (and they can be), or writes about the mistreatment in a way that can be entertaining and hilarious, but largely skims over the huge psychological impact that being chronically mistreated and sleep deprived can have on a person. I'm capable of writing that kind of thing too, but... right now I am doing this. Perhaps I will write a post on why I chose pediatric anesthesia (hint: it's because I was able to feel things again) one day. But not now.
For instance, I could make a joke about how ridiculous it was when one of the CT surgeons made a nasty comment to me when we were on bypass on my very first day on that rotation, saying, "God you can't even tilt the bed correctly," which was honestly so ridiculous and over the top that even I laughed at her (on the inside), or how I received feedback on that same day from an attending that I should, "Make fewer mistakes and take more initiative," which just another way of saying, "I want you to read my mind," and was in no way productive. I also laughed at her. But what really killed me on that rotation was one attending who would vacillate between trying to be your friend, and absolutely ripping you a new one over something trivial. For instance one day I was calling the blood bank to check on what we needed to do to release the units of blood for the case. The blood bank person was being incredibly sweet and helpful (which is not common, and I want to encourage this!) and this attending walked in and started screaming at me to get off the phone in this out of control diatribe that lasted over a minute. There was no emergency. There was no patient in the room. There was, quite frankly, no urgency even, except for their desire to be in the preop area 30 seconds faster. I guess I could have been more efficient if I had rudely interrupted the blood bank person or just hung up on them (which I'm sure I would have been reported for as well), but it didn't seem like the right thing to do given the circumstances. This person's volatility made it really difficult to function in the OR with them, and I still feel a little nauseated whenever I'm in the same room with them.
Anyway. I guess I'm just saying that writing about what actually happened, and how it really made me feel, is something that just isn't out there. And it needs to be. If some people label me weak and whiny for talking about this, then guess what: you're part of the problem.
*****
This weekend we spent a LOT of time decluttering and packing boxes. We also rented a storage unit, and I think we may hire movers to transport our stuff to it in a few weeks time. My husband was really helpful with this as I had to spend a decent chunk of time working on a manuscript. Trying to get Dylan to choose which stuff of her's she's willing to part with, and even what is going to go into storage now is an ongoing challenge. I've been trying to spend more time with her. She's been especially snuggly lately, and I started reading The Tale of Despereaux to her. It's quite good.
Anyway. This is a new week, and I get to go to the Bahamas for a conference. Anesthesia may have a significant anti-intellectual contingent, but they definitely know where to put a conference so that people will go to it. Trying to focus on the present and riding the wave of good fortune that has come to my family of late. It will come to an end, but no sense catastrophizing how that might happen lest I ruin things prematurely.
On the flip side, writing about it is incredibly therapeutic for me. Much of the stuff that is out there about residency talks about the poignancy of patient interaction (and they can be), or writes about the mistreatment in a way that can be entertaining and hilarious, but largely skims over the huge psychological impact that being chronically mistreated and sleep deprived can have on a person. I'm capable of writing that kind of thing too, but... right now I am doing this. Perhaps I will write a post on why I chose pediatric anesthesia (hint: it's because I was able to feel things again) one day. But not now.
For instance, I could make a joke about how ridiculous it was when one of the CT surgeons made a nasty comment to me when we were on bypass on my very first day on that rotation, saying, "God you can't even tilt the bed correctly," which was honestly so ridiculous and over the top that even I laughed at her (on the inside), or how I received feedback on that same day from an attending that I should, "Make fewer mistakes and take more initiative," which just another way of saying, "I want you to read my mind," and was in no way productive. I also laughed at her. But what really killed me on that rotation was one attending who would vacillate between trying to be your friend, and absolutely ripping you a new one over something trivial. For instance one day I was calling the blood bank to check on what we needed to do to release the units of blood for the case. The blood bank person was being incredibly sweet and helpful (which is not common, and I want to encourage this!) and this attending walked in and started screaming at me to get off the phone in this out of control diatribe that lasted over a minute. There was no emergency. There was no patient in the room. There was, quite frankly, no urgency even, except for their desire to be in the preop area 30 seconds faster. I guess I could have been more efficient if I had rudely interrupted the blood bank person or just hung up on them (which I'm sure I would have been reported for as well), but it didn't seem like the right thing to do given the circumstances. This person's volatility made it really difficult to function in the OR with them, and I still feel a little nauseated whenever I'm in the same room with them.
Anyway. I guess I'm just saying that writing about what actually happened, and how it really made me feel, is something that just isn't out there. And it needs to be. If some people label me weak and whiny for talking about this, then guess what: you're part of the problem.
*****
This weekend we spent a LOT of time decluttering and packing boxes. We also rented a storage unit, and I think we may hire movers to transport our stuff to it in a few weeks time. My husband was really helpful with this as I had to spend a decent chunk of time working on a manuscript. Trying to get Dylan to choose which stuff of her's she's willing to part with, and even what is going to go into storage now is an ongoing challenge. I've been trying to spend more time with her. She's been especially snuggly lately, and I started reading The Tale of Despereaux to her. It's quite good.
I'm also having a bit of decision paralysis about what we should do for the summer with respect to Dylan's camp and a family vacation. I am off much of June for my scheduled vacation (three weeks total), and the admin who does the OR schedule messed and scheduled all my days before 6/30 so I have no OR days in July at present, though I may be able to moonlight if I want to. And then I don't start my new job until 8/24. So I certainly have time for a vacation. The question is WHEN???? And also WHERE??? It's still early, so trying to push this planning off to the back of my mind for the moment, so I can focus on other, more pressing things.
Luca was talking about taking Dyl on vacation to Italy to visit his family... but then I discovered that his company has restricted travel to Italy because of the coronavirus. I worry that if he takes a vacation there with Dylan in the intervening time the state department will impose travel restrictions and they won't be able to come home. I... actually don't think this is a silly concern.
This, of course, prompted me to check on the status of the coronavirus outbreak and subsequently discover that it's getting much worse. I wonder when we will have our first case in Philadelphia or where I work currently. Hey, at least it only kills between 1 and 3% of people (unlike the virus in Station Eleven which killed everyone who got infected -- DO NOT READ THIS BOOK RIGHT NOW). That is still a lot, though. 77,000,000 people is 1% of the global population? Actually probably more would die than that given the strain it would put on the health care system. This mostly just makes me anxious about moving and planning for summer and my new job. Family whose house we are renting is moving to Japan. Trying not to ponder how messed up things could get with that also.
Anyway. This is a new week, and I get to go to the Bahamas for a conference. Anesthesia may have a significant anti-intellectual contingent, but they definitely know where to put a conference so that people will go to it. Trying to focus on the present and riding the wave of good fortune that has come to my family of late. It will come to an end, but no sense catastrophizing how that might happen lest I ruin things prematurely.
Saturday, February 22, 2020
esophagus
I remember one day, during my second month of CA1 year. I was in what used to be OR 15 (before OR 15 and OR 14 were merged to create one mega-OR from hell). I believe we were doing a thyroidectomy that day, but honestly I can't remember. I DO remember some other details quite vividly.
The circulator and scrub RNs were Queen and Bee, and my attending was Dr. Imveryimportant who went to some other institution. There was a general surgery resident there too -- Blondie. In residency, it was our job to place the IV in the awake patient in preop, and then wheel the patient back to the OR by 7:15. As I recall, this had all gone smoothly that morning. When I arrived to the OR, I discovered that all my monitors -- the EKG, BP Cuff, and pulse ox -- had all been thrown onto the floor*, despite my having laid them out perfectly on the OR table 20 minutes prior.
I called Dr. Imveryimportant to tell him that the patient was in the OR, and we were getting ready to move over to the OR table. He started talking about how I needed to stop and wait. Keep the patient on the stretcher. He was going to teach me how to make a ramp for the patient, who was obese. Creating a ramp is one way to get an obese patient into a better sniffing position to help with laryngoscopy.
Anyway, I try to tell Queen and Bee to stop moving the patient to the OR table, and they look right at me, roll their eyes and ignore me, continuing to move the patient to the table. I try to tell Dr. Imveryimportant, but he shushes me and tells me not to interrupt him. I try to say, "They've already moved the patient over, do you want me to have them move her back?" but he shushes me again, and talks continuously for another 2-3 minutes. He even tells me that he's the best anesthesiologist in the department. I give up and resign myself to getting yelled at.
A minute after hanging up the phone with him, he comes into the OR room, and says, "Oh, so you think you know better than I do, huh?" I start to say, no, and explain what happened, but he interrupts again and lectures straight for another couple of minutes about... I don't even remember... something about how horrible I am, how I don't listen, how my setup is a mess, and why on earth did you throw the monitor cables onto the floor. You can imagine. In front of the entire OR staff and an awake patient.
We go to induce. I try to put the breathing tube in and fail, twice. Can't get a view. Dr. Imveryimportant keeps asking, "What do you see? What do you see?" and I say, "I can't see the cords. Or epiglottis. Back of pharynx?" He and everyone in the OR rolls their eyes. I receive a litany of frustrated and patronizing comments from Dr. Imveryimportant. The patient is hard to ventilate and my hand is starting to hurt a lot. He scoffs. Makes a comment about how terrible I am at this. Then he then tries to put the breathing tube in himself. He also puts it in the esophagus**. Twice. He reaches for suction which has popped off the cannister. He screams, "Did you EVEN CHECK IT????" I don't remember how we finally got the tube in the trachea, but it did happen somehow. He yells at me some more. I look at Blondie, Queen, and Bee like, "Help me." Silence. Staring at me. I'm holding back tears. I am NOT going to cry in front of Dr. Imveryimportant and everyone else. Dr. Imveryimportant says in a mocking tone of voice, "Oh, are you going to cry? Good. If I hadn't made you cry I wouldn't have been doing my job." Leaves.***
Nobody else in the OR talks to me for the rest of the day. They all talk among themselves as though I'm not even there.
I do eventually get out for a break and go sit in the PACU. The PACU resident looks at me and says, "Who are you working with today?" looks at the board with the assignments and goes, "Yeah." And that's the nicest thing anyone said to me the entire day. Week, maybe.
I was really happy to hear that Queen and Bee were eventually fired for something unrelated. Blondie got ripped a new one in front of me by an attending surgeon a few weeks to months later. Dr. Imveryimportant is off being even more important at another institution now. Interestingly, when we worked together after that, he was always quite pleasant to work with, which makes me wonder whether this was some weird hazing thing he did. He never did become a better listener.
*I found out years later that Ryan, one of the neuromonitoring people, used to routinely throw the monitor cables onto the floor when he came in to do his own set-up. He always arrived at 7 exactly, which was right after we'd leave to see the patient. I found this out because another circulator told me that they had eventually asked him to move them to the side rather than throw them on the ground because it was damaging the cables. They admitted they also felt a little bad because the residents were always getting yelled at about it. Ryan had probably dislodged my suction as well, though it was known to pop off spontaneously sometimes as well. My head literally exploded (literally. brains all over the wall) when I learned this.
**Highlight of my day
***No patients were harmed. I don't think the patient even desaturated.
The circulator and scrub RNs were Queen and Bee, and my attending was Dr. Imveryimportant who went to some other institution. There was a general surgery resident there too -- Blondie. In residency, it was our job to place the IV in the awake patient in preop, and then wheel the patient back to the OR by 7:15. As I recall, this had all gone smoothly that morning. When I arrived to the OR, I discovered that all my monitors -- the EKG, BP Cuff, and pulse ox -- had all been thrown onto the floor*, despite my having laid them out perfectly on the OR table 20 minutes prior.
I called Dr. Imveryimportant to tell him that the patient was in the OR, and we were getting ready to move over to the OR table. He started talking about how I needed to stop and wait. Keep the patient on the stretcher. He was going to teach me how to make a ramp for the patient, who was obese. Creating a ramp is one way to get an obese patient into a better sniffing position to help with laryngoscopy.
Anyway, I try to tell Queen and Bee to stop moving the patient to the OR table, and they look right at me, roll their eyes and ignore me, continuing to move the patient to the table. I try to tell Dr. Imveryimportant, but he shushes me and tells me not to interrupt him. I try to say, "They've already moved the patient over, do you want me to have them move her back?" but he shushes me again, and talks continuously for another 2-3 minutes. He even tells me that he's the best anesthesiologist in the department. I give up and resign myself to getting yelled at.
A minute after hanging up the phone with him, he comes into the OR room, and says, "Oh, so you think you know better than I do, huh?" I start to say, no, and explain what happened, but he interrupts again and lectures straight for another couple of minutes about... I don't even remember... something about how horrible I am, how I don't listen, how my setup is a mess, and why on earth did you throw the monitor cables onto the floor. You can imagine. In front of the entire OR staff and an awake patient.
We go to induce. I try to put the breathing tube in and fail, twice. Can't get a view. Dr. Imveryimportant keeps asking, "What do you see? What do you see?" and I say, "I can't see the cords. Or epiglottis. Back of pharynx?" He and everyone in the OR rolls their eyes. I receive a litany of frustrated and patronizing comments from Dr. Imveryimportant. The patient is hard to ventilate and my hand is starting to hurt a lot. He scoffs. Makes a comment about how terrible I am at this. Then he then tries to put the breathing tube in himself. He also puts it in the esophagus**. Twice. He reaches for suction which has popped off the cannister. He screams, "Did you EVEN CHECK IT????" I don't remember how we finally got the tube in the trachea, but it did happen somehow. He yells at me some more. I look at Blondie, Queen, and Bee like, "Help me." Silence. Staring at me. I'm holding back tears. I am NOT going to cry in front of Dr. Imveryimportant and everyone else. Dr. Imveryimportant says in a mocking tone of voice, "Oh, are you going to cry? Good. If I hadn't made you cry I wouldn't have been doing my job." Leaves.***
Nobody else in the OR talks to me for the rest of the day. They all talk among themselves as though I'm not even there.
I do eventually get out for a break and go sit in the PACU. The PACU resident looks at me and says, "Who are you working with today?" looks at the board with the assignments and goes, "Yeah." And that's the nicest thing anyone said to me the entire day. Week, maybe.
I was really happy to hear that Queen and Bee were eventually fired for something unrelated. Blondie got ripped a new one in front of me by an attending surgeon a few weeks to months later. Dr. Imveryimportant is off being even more important at another institution now. Interestingly, when we worked together after that, he was always quite pleasant to work with, which makes me wonder whether this was some weird hazing thing he did. He never did become a better listener.
*I found out years later that Ryan, one of the neuromonitoring people, used to routinely throw the monitor cables onto the floor when he came in to do his own set-up. He always arrived at 7 exactly, which was right after we'd leave to see the patient. I found this out because another circulator told me that they had eventually asked him to move them to the side rather than throw them on the ground because it was damaging the cables. They admitted they also felt a little bad because the residents were always getting yelled at about it. Ryan had probably dislodged my suction as well, though it was known to pop off spontaneously sometimes as well. My head literally exploded (literally. brains all over the wall) when I learned this.
**Highlight of my day
***No patients were harmed. I don't think the patient even desaturated.
Friday, February 21, 2020
house
Had the contractor look at my house with our agent yesterday to see what they think "needs" to be done in order to "make it ready" to sell. It was.... interesting.
So, they brought the listing agent with them for some reason (who is a separate person? idk) and they went through the house and pointed out "egregious" things that ostensibly would be "huge" problems in selling the house. A lot of things were incredibly minor, and stuff we have fixed ourselves in the past. It was fine, really. Not many surprises, and plenty of bullshit.
I finally got a look at the popcorn ceilings on the second floor, and they actually appear to be in excellent shape in all of the bedrooms. (No they are not asbestos popcorn ceilings, for the love of God.) Only the central corridor has some flaking. So that was really good!
The kitchen only requires minimal cosmesis to look fancy.
They went on and on about how awful the bathrooms were, but.... actually the entire problem occurred when the house was built in 1936. And we just had one completely regrouted (they still would not shut up about how awful it was). So, perspective. They aren't "new" (I prefer the term "vintage") but I sure as shit ain't redoing them now. I confess that this exchange did make me feel mildly nauseated.
However perspective was also provided. They went on and on about how the ceiling in the basement desperately needed to be repainted, and it is literally impeccable. We painted it a few years ago, and there is nothing peeling, no dirt. It is quite literally perfect, pristine, white paint. There are a few pipes in the basement with a couple of small spots with peeling paint (over which they dramatically discussed lead paint among themselves -- which, ALL houses built before 1970 have lead paint), but it is definitely not the "whole ceiling." Annoying as it was, this exchange provided the grain of salt needed to recall that most of these fixes are actually totally optional.
Bizarrely, the listing agent who was tagging along said at some point, "It's so interesting going through this process with sellers. Is the process making you anxious??" like he somehow would have enjoyed that. I just said, "Eh, it's not like I'm actually going to have to DO any of this." He also told me both of his parents were doctors, I guess to relate to me? I just told him I was sorry.
The electrician comes next week to tell us that we need to spend $15,000 to get rid of the knob and tube wiring, but I also know that of all of the circuits in the house, only one still has knob and tube, leading to exactly 4 outlets. Also, every. single. house. in West Philadelphia has knob and tube. So. I am skeptical that anything at all even needs to be done
So yeah. Just like anything else, this will require that we use our own brains and decide for ourselves what needs to be done, and stand our ground despite the hysterical display put on by our agent in order to get us to spend more money. I feel quite comfortable about what the market is like around here, so at least there's that. It's just going to be like when the surgeon pitches a fit about some decision you make about the anesthetic plan (yes, the patient really does need an a line, for instance.). You just have to calmly stand your ground. It's merely very annoying.
So, they brought the listing agent with them for some reason (who is a separate person? idk) and they went through the house and pointed out "egregious" things that ostensibly would be "huge" problems in selling the house. A lot of things were incredibly minor, and stuff we have fixed ourselves in the past. It was fine, really. Not many surprises, and plenty of bullshit.
I finally got a look at the popcorn ceilings on the second floor, and they actually appear to be in excellent shape in all of the bedrooms. (No they are not asbestos popcorn ceilings, for the love of God.) Only the central corridor has some flaking. So that was really good!
The kitchen only requires minimal cosmesis to look fancy.
They went on and on about how awful the bathrooms were, but.... actually the entire problem occurred when the house was built in 1936. And we just had one completely regrouted (they still would not shut up about how awful it was). So, perspective. They aren't "new" (I prefer the term "vintage") but I sure as shit ain't redoing them now. I confess that this exchange did make me feel mildly nauseated.
However perspective was also provided. They went on and on about how the ceiling in the basement desperately needed to be repainted, and it is literally impeccable. We painted it a few years ago, and there is nothing peeling, no dirt. It is quite literally perfect, pristine, white paint. There are a few pipes in the basement with a couple of small spots with peeling paint (over which they dramatically discussed lead paint among themselves -- which, ALL houses built before 1970 have lead paint), but it is definitely not the "whole ceiling." Annoying as it was, this exchange provided the grain of salt needed to recall that most of these fixes are actually totally optional.
Bizarrely, the listing agent who was tagging along said at some point, "It's so interesting going through this process with sellers. Is the process making you anxious??" like he somehow would have enjoyed that. I just said, "Eh, it's not like I'm actually going to have to DO any of this." He also told me both of his parents were doctors, I guess to relate to me? I just told him I was sorry.
The electrician comes next week to tell us that we need to spend $15,000 to get rid of the knob and tube wiring, but I also know that of all of the circuits in the house, only one still has knob and tube, leading to exactly 4 outlets. Also, every. single. house. in West Philadelphia has knob and tube. So. I am skeptical that anything at all even needs to be done
So yeah. Just like anything else, this will require that we use our own brains and decide for ourselves what needs to be done, and stand our ground despite the hysterical display put on by our agent in order to get us to spend more money. I feel quite comfortable about what the market is like around here, so at least there's that. It's just going to be like when the surgeon pitches a fit about some decision you make about the anesthetic plan (yes, the patient really does need an a line, for instance.). You just have to calmly stand your ground. It's merely very annoying.
Thursday, February 20, 2020
the hole
Sometime during my CA-1 year I stopped blogging. The reasons were multifactorial, but mostly related to being extremely unhappy during residency. EXTREMELY. Like, I wondered if I was wasting my life. I worried that what I had trained to do -- to be a physician scientist -- was not really going to be possible within my clinical specialty, or more specifically, at the institution I had chosen to train at. I felt like I was failing at everything. I was exhausted. I felt totally isolated. I felt pretty terrible all the time.
I was tired of all of my blog posts being the same bullshit. I had nothing good to say, and then people would comment that, "You should get help," or, "You complain too much," or, "You don't know how good you have it," or, "Maybe you're too weak to be a doctor," or, "You know, lots of people have jobs they hate," or, "You know, you're actually lucky. Most people hate what they do." I couldn't come up with anything besides, "I worked in the OR today again and I hate everybody I've seen for the past 72 hours. I can't think of a single interesting or stimulating 60 second exchange I've had with another person for the past month. Nothing good has happened to me besides me not failing to put this damn breathing tube into a patient for the 200th time this month (which would have caused my attending to roll their eyes at me and probably say something shitty), and I have accomplished nothing." Nobody wants to read that.
I tried to do the gratitude exercise of thinking of things that I was grateful for, and it had the opposite effect. What was I going to say? I'm grateful that I am working 70 hours a week, that I feel terrible all the time, that I hate what I'm doing and everyone I work with, and I think I may have made a huge mistake to do this at all, but I can't bail out because what if I'm wrong and that really would be throwing the past (at the time it was 12) years of my life away. Really, when you think of things you are grateful for as a way of boosting your mood, the only thing you can come up with was that you don't live in some war torn part of the world, it's a pretty shitty mood booster. I had to laugh when my program director said that one of the things she was grateful for was that her car had taken her safely to work that day. Honestly, if that's your bar, your life kind of sucks, and I couldn't even say that. I was kind of like, shit. The bus got me to work today. I wonder if I'd have been better off if I'd been hit by it instead. At least then I wouldn't have to be trapped in a room with a bunch of abusive nurses and an absent (at best) or abusive (at worst) attending all day long for 13 hours (at least) EVER AGAIN.
Ultimately getting out of that environment was what made things better. I did try the University EAP and gave up going after a) being verbally abused by a medical assistant who called me when I was post-call presenting during rounds, who insisted on administering some intake mental health screening questionnaire RIGHT THEN, even though I told her calmly and politely that it was a bad time (I ended up having to hang up on her), b) I got paired with an incompetent psychologist whom I disliked intensely, c) as a result of a&b I had concerns about confidentiality, and d) the only time I had to go was post-call. Really? I stopped going after four visits.
Anyway. I was afraid I would say something I'd eventually regret. That some future employer would see and not hire me, and I would never know why. Or that my current employer would see and a) lecture me about social media being "public" and "permanent," b) flag me as a problem, or c) tell me I was wrong to feel the way I felt, and explain to me very patiently how everything was actually my fault.
So I stopped blogging.
Nothing like that ever happened, but man I was afraid it would.
What made me think of this? Two things:
1) Was a post by lagliv where she talks about falling into "the hole" where she thinks nobody likes her. To which I'm like WHAT???? Of course people like you! I guess you could say I fell into a two year long hole. F*** you, residency.
2) I worked with a CA-1 resident from my old program in the OR yesterday. She was green! And didn't know how to do stuff! And was (quite frankly) exactly where she was supposed to be knowledge and skill-wise. She was post-call and the resident the day before had done a shitty job preparing her for her cases, and she had no idea how to set up the room for the most basic things. Her attending (I was just helping) hadn't prepared her either. So I tried to orient her as best as I could, took the time that was needed to keep the patient safe, and suppressed every impulse I had to sigh or roll my eyes, or say something negative. The RN in the room kept making nasty comments about her performance to me in front of her, and refused to help with induction (normally the RNs are very involved with induction at my institution). And she still did fine! I ended up having to do the airway, but otherwise she nailed all her procedures on the first try, even the caudal block which she'd never done before. I honestly wish I'd had more time to go over stuff with her because I think it would have helped.
It's the stuff with #2 that pushes people into the hole during residency. I want to be part of the solution, not part of the problem.
I was tired of all of my blog posts being the same bullshit. I had nothing good to say, and then people would comment that, "You should get help," or, "You complain too much," or, "You don't know how good you have it," or, "Maybe you're too weak to be a doctor," or, "You know, lots of people have jobs they hate," or, "You know, you're actually lucky. Most people hate what they do." I couldn't come up with anything besides, "I worked in the OR today again and I hate everybody I've seen for the past 72 hours. I can't think of a single interesting or stimulating 60 second exchange I've had with another person for the past month. Nothing good has happened to me besides me not failing to put this damn breathing tube into a patient for the 200th time this month (which would have caused my attending to roll their eyes at me and probably say something shitty), and I have accomplished nothing." Nobody wants to read that.
I tried to do the gratitude exercise of thinking of things that I was grateful for, and it had the opposite effect. What was I going to say? I'm grateful that I am working 70 hours a week, that I feel terrible all the time, that I hate what I'm doing and everyone I work with, and I think I may have made a huge mistake to do this at all, but I can't bail out because what if I'm wrong and that really would be throwing the past (at the time it was 12) years of my life away. Really, when you think of things you are grateful for as a way of boosting your mood, the only thing you can come up with was that you don't live in some war torn part of the world, it's a pretty shitty mood booster. I had to laugh when my program director said that one of the things she was grateful for was that her car had taken her safely to work that day. Honestly, if that's your bar, your life kind of sucks, and I couldn't even say that. I was kind of like, shit. The bus got me to work today. I wonder if I'd have been better off if I'd been hit by it instead. At least then I wouldn't have to be trapped in a room with a bunch of abusive nurses and an absent (at best) or abusive (at worst) attending all day long for 13 hours (at least) EVER AGAIN.
Ultimately getting out of that environment was what made things better. I did try the University EAP and gave up going after a) being verbally abused by a medical assistant who called me when I was post-call presenting during rounds, who insisted on administering some intake mental health screening questionnaire RIGHT THEN, even though I told her calmly and politely that it was a bad time (I ended up having to hang up on her), b) I got paired with an incompetent psychologist whom I disliked intensely, c) as a result of a&b I had concerns about confidentiality, and d) the only time I had to go was post-call. Really? I stopped going after four visits.
Anyway. I was afraid I would say something I'd eventually regret. That some future employer would see and not hire me, and I would never know why. Or that my current employer would see and a) lecture me about social media being "public" and "permanent," b) flag me as a problem, or c) tell me I was wrong to feel the way I felt, and explain to me very patiently how everything was actually my fault.
So I stopped blogging.
Nothing like that ever happened, but man I was afraid it would.
What made me think of this? Two things:
1) Was a post by lagliv where she talks about falling into "the hole" where she thinks nobody likes her. To which I'm like WHAT???? Of course people like you! I guess you could say I fell into a two year long hole. F*** you, residency.
2) I worked with a CA-1 resident from my old program in the OR yesterday. She was green! And didn't know how to do stuff! And was (quite frankly) exactly where she was supposed to be knowledge and skill-wise. She was post-call and the resident the day before had done a shitty job preparing her for her cases, and she had no idea how to set up the room for the most basic things. Her attending (I was just helping) hadn't prepared her either. So I tried to orient her as best as I could, took the time that was needed to keep the patient safe, and suppressed every impulse I had to sigh or roll my eyes, or say something negative. The RN in the room kept making nasty comments about her performance to me in front of her, and refused to help with induction (normally the RNs are very involved with induction at my institution). And she still did fine! I ended up having to do the airway, but otherwise she nailed all her procedures on the first try, even the caudal block which she'd never done before. I honestly wish I'd had more time to go over stuff with her because I think it would have helped.
It's the stuff with #2 that pushes people into the hole during residency. I want to be part of the solution, not part of the problem.
Tuesday, February 18, 2020
things
As soon as we decided on a place to live, a better one came up, so we decided to go with that instead. At the suggestion of a N-IRL (i.e. social media only) friend, I happened upon the site called sabbaticalhomes.com, and found a place owned by a family going on sabbatical. They have a kid around my daughter's age, and an au pair too. Their house is 6 BR. It's not *quite* as nice a neighborhood as the first house, but it is twice as big. So. We are currently going through the process of getting approved to lease it. We are very excited. Move in date is 7/1. The leasing agency who is managing the property while the family is away is going to give us a facetime tour of the place in the near future. It will be partially furnished. They allow the dog. The school is excellent. It's near enough to downtown that any new au pair wouldn't actually have to drive, and we could restrict her car use pragmatically until she got her US State License. It's 0.4 miles from a swimming pool with -- quite literally -- 20 masters swimming sessions per week with drop in payments allowed. My husband (and I, partially) nearly fainted from joy when we saw that.
Exhale.
Things are good. Only downside is that we'd have to vacate in a year, but hopefully we will know what we're doing a bit better by the time that happens.
For the house in philly, we are having the realtor and his person come and take a look at the house to let us know what needs to happen repairs-wise so that we can figure out what to do with this piece. At the suggestion of a reader, I am strongly considering vacating the place on July 1 and then having the repairs and subsequent showings done in an empty/staged house. I would be able to hole up in the basement for my eight (I hope) or so OR days that month and then fly back and forth. Honestly, the benefits of doing a spring sale seem massively outweighed by the benefits of a) not having to keep the house showing-ready every. single. day. with a dog and a child, b) not having to live in the house while it is fixed, c) being able to have it staged. Will see how realtor advises me, but am strongly leaning in this direction.
We made up a budget to figure out how much we need to be saving each year, and if we were to buy in [] how much we could afford, with the idea of trying to pay any new mortgage off in 10 years.
I got rid of a bunch of books.
I bought some boxes. Still need to pack them....
I even convinced my husband that we may need to buy 1-2 new cars in the next couple of years. Despite the fact that our cars are 8 and 11 years old, he had resisted this idea mightily, preferring use duct tape to hold the cars together rather than buy a new one. I am not in a hurry to do this either, but... having a reliable automobile is important, so I do think it will be necessary to do in the not terribly distant future. Which one do you vote for replacing first, guys? The one that has started to guzzle oil? Or the one with the rusty muffler? (I am thinking the oil guzzler may need to go first even though it's our younger car.) It's somewhat sobering to think that we will be kissing goodbye around 60K on this. (Ew.) I hate spending money.
Husband and I had a conversation about change, and about how this process has made him realize how much he enjoys working. So, yay! I already knew this, but periodically would be on the receiving end of a rant about how as soon as I was done with residency he was going to quit. I know it's all an act, but I was happy to hear it expressed so cogently. I know he's terrified about working remotely, and whether his employer will start to consider him superfluous if he is not physically in the office all the time. I can't answer this for him, to be honest, but I am optimistic that they firmly came down on the side of keeping him when he told them about my new job and they offered the remote option to him.
I am really trying to get everyone in the family to reframe this move as an exciting adventure rather than a terrifying change of doom that may lead to the end of everything. It may be working. Will let you know how it goes.
Daughter told me yesterday that she wants to be a doctor, which I took as the high compliment that it is. She also wants to be an astronaut. I assured her that the path to astronaut can go through doctor, so she can actually be both. She is masticating on that one. I will be happy if she ends up gainfully employed and not on heroin or with an abusive significant other.
Husband last night told me he had been really impressed -- between finding a place to live, and finding a real estate agent, as well as all my own work, medical license and credentialing stuff at my new job, all in the past week and a half -- at how much I had gotten done, essentially entirely by myself. He may have called me a machine. I felt proud. :-)
Only one super annoying thing happened: the person who makes the OR schedule was trying to schedule me for 93 days between 8/1/2019 and 6/30/2020 rather than 7/31/2020. She was planning on starting over at zero on 7/1. Fortunately, my contract is very specific about the dates of my contract, and the number of OR days I am committed to, and how I need to get paid out by the day for any extra OR time I do. I sent this to her, and she said that she had to "meet with some people" because this was "different than what she'd been told." I feel pretty confident that this will get resolved in my favor, given that this is explicitly spelled out in my contract (although never underestimate the ability of an employer to bend you over a log, especially when you're on your way out the door), but it did cause me to vibrate not insignificantly for a couple of hours this morning. I am also concerned that she doesn't seem to be able to differentiate between me and a colleague whose name begins with the same letter. **headdesk** Hopefully this will be resolved in the next week or so. Hopefully.
Onward and upward!
Exhale.
Things are good. Only downside is that we'd have to vacate in a year, but hopefully we will know what we're doing a bit better by the time that happens.
For the house in philly, we are having the realtor and his person come and take a look at the house to let us know what needs to happen repairs-wise so that we can figure out what to do with this piece. At the suggestion of a reader, I am strongly considering vacating the place on July 1 and then having the repairs and subsequent showings done in an empty/staged house. I would be able to hole up in the basement for my eight (I hope) or so OR days that month and then fly back and forth. Honestly, the benefits of doing a spring sale seem massively outweighed by the benefits of a) not having to keep the house showing-ready every. single. day. with a dog and a child, b) not having to live in the house while it is fixed, c) being able to have it staged. Will see how realtor advises me, but am strongly leaning in this direction.
We made up a budget to figure out how much we need to be saving each year, and if we were to buy in [] how much we could afford, with the idea of trying to pay any new mortgage off in 10 years.
I got rid of a bunch of books.
I bought some boxes. Still need to pack them....
I even convinced my husband that we may need to buy 1-2 new cars in the next couple of years. Despite the fact that our cars are 8 and 11 years old, he had resisted this idea mightily, preferring use duct tape to hold the cars together rather than buy a new one. I am not in a hurry to do this either, but... having a reliable automobile is important, so I do think it will be necessary to do in the not terribly distant future. Which one do you vote for replacing first, guys? The one that has started to guzzle oil? Or the one with the rusty muffler? (I am thinking the oil guzzler may need to go first even though it's our younger car.) It's somewhat sobering to think that we will be kissing goodbye around 60K on this. (Ew.) I hate spending money.
Husband and I had a conversation about change, and about how this process has made him realize how much he enjoys working. So, yay! I already knew this, but periodically would be on the receiving end of a rant about how as soon as I was done with residency he was going to quit. I know it's all an act, but I was happy to hear it expressed so cogently. I know he's terrified about working remotely, and whether his employer will start to consider him superfluous if he is not physically in the office all the time. I can't answer this for him, to be honest, but I am optimistic that they firmly came down on the side of keeping him when he told them about my new job and they offered the remote option to him.
I am really trying to get everyone in the family to reframe this move as an exciting adventure rather than a terrifying change of doom that may lead to the end of everything. It may be working. Will let you know how it goes.
Daughter told me yesterday that she wants to be a doctor, which I took as the high compliment that it is. She also wants to be an astronaut. I assured her that the path to astronaut can go through doctor, so she can actually be both. She is masticating on that one. I will be happy if she ends up gainfully employed and not on heroin or with an abusive significant other.
Husband last night told me he had been really impressed -- between finding a place to live, and finding a real estate agent, as well as all my own work, medical license and credentialing stuff at my new job, all in the past week and a half -- at how much I had gotten done, essentially entirely by myself. He may have called me a machine. I felt proud. :-)
Only one super annoying thing happened: the person who makes the OR schedule was trying to schedule me for 93 days between 8/1/2019 and 6/30/2020 rather than 7/31/2020. She was planning on starting over at zero on 7/1. Fortunately, my contract is very specific about the dates of my contract, and the number of OR days I am committed to, and how I need to get paid out by the day for any extra OR time I do. I sent this to her, and she said that she had to "meet with some people" because this was "different than what she'd been told." I feel pretty confident that this will get resolved in my favor, given that this is explicitly spelled out in my contract (although never underestimate the ability of an employer to bend you over a log, especially when you're on your way out the door), but it did cause me to vibrate not insignificantly for a couple of hours this morning. I am also concerned that she doesn't seem to be able to differentiate between me and a colleague whose name begins with the same letter. **headdesk** Hopefully this will be resolved in the next week or so. Hopefully.
Onward and upward!
Sunday, February 16, 2020
Notable people
I’m growing increasingly irritated by this notable people thing that my daughter is doing at her school. It seems like it is more of an assignment for the parents than it is for the children! Want to hear all of the things we are responsible for?
*****
- Supplementing the research they do at school with additional research done at home. “Optional,” but of course encouraged. We are encouraged to identify and read this material ahead of time before giving it to our children to use as material.
- Some of this research can be online, but we must supervise it to make sure it materials are “appropriate” (I.e. make sure your child doesn’t accidentally find porn during their internet search). We also don’t have a “family computer” for her to use.
- Help them memorize their lines
- Prepare an authentic costume for them to wear. It must be ready the week before.
- Food for luncheon. They think they are being kind to us by saying it can be store bought, but we still have to think of something appropriate, purchase it, and somehow get it to school for the event.
- Oh yeah, there’s a dress rehearsal that happens at 11am the day before that we can attend if the actual performance doesn’t work for us which happens at 12pm the following day (how generous of them 🙄).
Honestly? This is more work for me than it is for my kid and I am borderline wanting to tell the teacher she can stick it up her ass vs. not doing it at all. My parents never had to do anything like this for me when I was growing up. Why is it acceptable to require this kind of thing for this generation?
🤯🤯🤯🤯🤯🤯🤯
*****
I’m other news, Dylan’s birthday party was last night, and that was a resounding success.
*****
Also, we may have found a place to live in []. It’s in a fantastic school district, has a detached office space that’s about 300 sq feet we can use with Ethernet. It’s a little small compared to where we live now, but I think that’s ok, especially since there’s the separate office space.
Lease would start 8/1.
So. That leaves a few things to decide:
Do we try to get our current house ready to sell while we are still living in it? Or do we wait until we vacate and move to the new place? The advantage of waiting is that it will likely be easier and cheaper to fix the house while we are not living in it. It will be less disruptive to our lives also, and we could have the house staged to look nice once we move out. We wouldn’t have to worry about showing it while still living here.
The disadvantage is that we would have to pay rent and our mortgage at the same time, which we can afford. It’s not even a stretch really, and 2/3 of our mortgage would be going towards equity anyway because of how the payments are currently structured. We would also then have to sell while we are not living nearby. However, my husband is going to be in the area for work, so it’s not as though we are going to be gone for good from the area. He’ll still be able to oversee things somewhat. We would also miss selling during the spring/summer months which typically garner higher prices, though we could theoretically wait to sell until the following March as well, which would only be 6 months into the future. This could limit our ability to buy a place in [] if indeed we decided we wanted to do that, if for some reason we could not sell the philly place quickly.
If we hustle and move it could be over and done with, however.
My other question is whether it’s possible to register Dylan for school with a signed lease even if we don’t physically live in a place yet? My sense is yes, but I’ve never done this before so I don’t have a great sense of how this works, when I’d need to register her, and what documents I need to show proof of residence. The school district rules says you can send your child if you live there, and there is no lottery, so that makes things easier.
Anyway... lots of things.
Thoughts???
******
Oh yeah, I’m fully cognizant that my anxiety over the school stuff is somewhat displaced anxiety over moving in general and all of the logistics. Yay for self awareness.
Lease would start 8/1.
So. That leaves a few things to decide:
Do we try to get our current house ready to sell while we are still living in it? Or do we wait until we vacate and move to the new place? The advantage of waiting is that it will likely be easier and cheaper to fix the house while we are not living in it. It will be less disruptive to our lives also, and we could have the house staged to look nice once we move out. We wouldn’t have to worry about showing it while still living here.
The disadvantage is that we would have to pay rent and our mortgage at the same time, which we can afford. It’s not even a stretch really, and 2/3 of our mortgage would be going towards equity anyway because of how the payments are currently structured. We would also then have to sell while we are not living nearby. However, my husband is going to be in the area for work, so it’s not as though we are going to be gone for good from the area. He’ll still be able to oversee things somewhat. We would also miss selling during the spring/summer months which typically garner higher prices, though we could theoretically wait to sell until the following March as well, which would only be 6 months into the future. This could limit our ability to buy a place in [] if indeed we decided we wanted to do that, if for some reason we could not sell the philly place quickly.
If we hustle and move it could be over and done with, however.
My other question is whether it’s possible to register Dylan for school with a signed lease even if we don’t physically live in a place yet? My sense is yes, but I’ve never done this before so I don’t have a great sense of how this works, when I’d need to register her, and what documents I need to show proof of residence. The school district rules says you can send your child if you live there, and there is no lottery, so that makes things easier.
Anyway... lots of things.
Thoughts???
******
Oh yeah, I’m fully cognizant that my anxiety over the school stuff is somewhat displaced anxiety over moving in general and all of the logistics. Yay for self awareness.
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