Monday, August 31, 2015

See.... the problem is post call (esp when I get <2h of sleep on call), even after my nap, I'm still a bit of a mess.  But then, I'm "available" (and apparently don't look tired), so all sorts of people ask me to make decisions. 

"Am I off this weekend?" (I don't know, ask my husband)  And then, 20 minutes later, "Is it ok if I have [] day off?"
"What do you want for dinner?" (I don't care, as long as I don't have to move from this position.  If you weren't here it would be cereal or ice cream, so really, knock yourself out.)
"What's the plan for Dylan's interview schedule?" (F if I know.)
"Where is my [object]?" (No idea.)

My ability to make decisions that aren't completely automatic is basically reduced to nothing.  Fortunately none of them actually matter all that much, or are particularly urgent. 
Unfortunately if I say that, or defer the decision to someone else or until a later time (at which point I will probably be at work), or say, "Figure it out yourself," then I get to be giant bitch mommy-boss. 
Woo.
Not being able to win sucks.
How do you respond when you're post call and it's now afternoon, and someone remarks on how wonderful it is that you have the day off?

Just curious. 

I'm picking Dyl up from school today (she asked me specifically this morning), and I am expecting an onslaught of those type of comments.

Perhaps a cheerful, "Oh, I'm post-call," would suffice.  Only, I'm pretty sure a lot of people don't know what that means. 

As a side note, I found out that people who mop the floor at the airport make considerably more money than I do.  Fortunately when I found out, I didn't have a lot of time to reflect.  In retrospect it should have annoyed me more since the person who told me mentioned ze was considering going on permanent disability (even though in reality ze was more than able to work) despite the good deal ze had. 

Also fortunately, I will not make this little forever. 

Made me think about how we value labor, and how in a competitive market wages get set. I mean, really, mopping the floor is actually quite valuable -- people actually *could* get hurt if it wasn't done, and people should be compensated fairly for that.  OTOH, any able bodied person can do it, so you have an oversupply of workers.  Anyway.
Holy cow yesterday was the longest 24 hours I've ever had.  I was on call, and it was just case after case after case, unrelentingly all day and all night long.  Very little downtime.

I did learn a lot.  A LOT.  It's true that we get harder cases while we are on call that extend our skills.  That's good, I guess.

My arms are sore from squeezing blood through lines.  We -- the whole call team -- did that for 4 hours from 2-6 this morning.  Crazy.  Object lesson on how much faster you can infuse through a Cordis (9Fr) than a triple lumen (18Fr) central line. 


Saturday, August 29, 2015

So apparently there's a Facebook group for physician moms.  I found this out on call at 2 am a few weeks back when a colleague asked me if I wanted to join (apparently it's invite only).

I said sure!

And then I asked whether it was primarily a forum where moms talked about how guilty they felt for working, or whether other viewpoints/emotions were also expressed.

The other person snapped at me that feelings of guilt were perfectly valid emotions and that I should respect that.

Sigh.

I never did get invited, but it's probably better that way.  For my mental health if nothing else.

I am tired of being told that guilt is the only way I am permitted to feel about being a doctor mom by other doctor moms.  *My* emotions are valid too.  I don't want to talk about how awesome it is to take 24 hour call and to be away from my family constantly either, but I don't feel guilty about it, and I don't want to be a part of any group that tells me I should feel that way or that ostracizes me if I say that I don't.  It makes me feel a little sad that to be alone through all of this, but it's better than feeling bad about myself all the time and self flagellation.



Dyl is sick again, and of course it is a case of the snots, which I almost always contract myself (having juuuuust gotten over a sinus infection that lasted 7 weeks). 

I also am on call tomorrow and lates for the rest of the week, so my time with her -- except for today -- is going to be very limited until Labor Day weekend.

I was a little sad about this, but now I am starting to view it as a potential opportunity to reduce my exposure to this virus.

Glass half full?

Thursday, August 27, 2015

Today we finished early, AND I had taken the bus in so I had to walk home.  So I decided to pick up Dyl at school on the way (after calling AP2 to make sure she wasn't already on her way).  Usually I dread this.  I'm so tired and numb by the end of most days that daycare / preschool pickup is, well, torture for me.  But today, I don't know if it was the weather or what, I actually had energy and felt GOOD.  So I went for it.

And it was really nice!

Admittedly, while Dyl continued to play with her friends, I was the only adult who sat down on the playground (and also later while we were waiting at the bus, I sat down on the sidewalk), but still.  I'm glad I did it.  It also helps that she no longer goes to school with a stroller, and that the only extra stuff I had to bring home was her lunch box.  I got to see who she was playing with (all boys, no surprises there), and talked to another parent, which was very pleasant. 

Even though I had to wait like 30 minutes for the bus I was *still* in a good mood when I got home. 

I know, right?

And my husband was a freaked out mess about work when he got home and it barely fazed me.

AND I did 10 M5 questions tonight.

AND I did 12-17-13-13-12 push-ups. 

You're thinking they might have slipped some crack into my lunch today, and to be honest I am kind of wondering the same thing.

So for the record, my goals for the evenings are:

1) Avoid picking fight with husband
2) Avoid feeling bad about lying on the couch when I should be playing with my daughter

(i.e. Low bar, if you catch my drift.)

And today exceeded that by, well, a lot.

Coincidence?  Perhaps.

At any rate, I don't expect this to happen again.  Ever. 

Wednesday, August 26, 2015

Lately I've been coming home from work and collapsing on the couch like a limp dishrag.  This is somewhat concerning to me, since many much more exhausting rotations lie ahead of me, but also is not totally unexpected.  I've ALWAYS felt like this when I come home from work, even when I was only working 40 hours per week. Even in college, for goodness sake. 

Anyway.  In light of this, I've decided to set more reasonable expectations for myself when I get home:

1. Shower
2. Enter cases into case log
3. Avoid picking fight with husband (requires participation on his part)
4. Don't beat self up if daughter prefers to play with au pair before dinner
5. Eat dinner
6. Lie on couch watching TV with daughter
7. Do M5 questions (optimally 10 of them, realistically 5)
8. Upstairs by 7:30 (usually ends up being 8)
9. Bed by 8:30 (usually ends up being 9)
10. Pet dog

I assume that when I'm at work until 6:30/7 or later, some of these will be abandoned (not 3&4 let's hope), but hopefully I will be able to maintain some of these even on those nights. 

Tonight I even managed to walk the dog with my husband.  Some talking ensued, and it was ok... but my husband only wants to talk about work (and specifically things that are not interesting to someone who doesn't work there).  I have a similar problem, but I really try hard to limit it to non-medical things so that it is not quite so insipid to listen to. 

I know I'm not the only one who has the after work blahs.  How do you manage to prevent a conflagration at your house?

Tuesday, August 25, 2015

Today I did more blocks.... AND I placed a 22g IV into a vein in a long term dialysis patient's index finger.  That was very satisfying and might have been the best thing that happened all day. 

I also explained modes of mechanical ventilation to a medical student (I think she even understood), and explained the major differences between succinylcholine and non-depolarizing neuromuscular blockers, as well as how neostigmine and glycopyrrolate work for reversal and why we use them. 

Basics, I know.  But I surprised myself at how easily I rattled off a coherent explanation. 

And then we went over the difference between peak and plateau pressure.  I actually looked this one up to make sure I gave her the right answer, but it turned out I was right.  :-)

I also got a bit better at the blocks I did.  Got better at finding my needle tip and directing it appropriately.  Got better at setting things up. 

AM TIRED!!!

Monday, August 24, 2015

This week, I've found myself on a regional anesthesia/blocks rotation.  Which is awesome, since I'm not supposed to get that experience until CA-2 year.  I did a bunch of nerve catheters today, and a bunch of single shot anesthetics.  It was fun! 

Next week I go back to the ORs. 

OMG though.  I feel like I am still drowning in stuff to learn/read.  I don't think that's going to end any time soon.  I hope that my 10 M5 questions a day will end up being enough.  Sometimes it's a struggle to even get through that.  And tonight I wanted to re-re-re-review the brachial plexus and some upper extremity blocks too, since I'll be doing some of those tomorrow.

Anesthesia is definitely fun, but tiring!

Sunday, August 23, 2015

So, my husband and I have an actual activity planned for date afternoon today: Art Museum.  I was really looking forward to it last week, but now I have mixed feelings.

Why?

- I had a nice day with Dylan yesterday, and I want to spend more time with her.  Since I'm such a crappy companion for her during the week, I want to try to make it up to her on the weekends.  It also doesn't help that she literally begs me to spend more time with her.  CONSTANTLY.  It makes me feel terrible.
- But, if I cancel the au pair (again) for the afternoon, she will be annoyed because she'll have come back to the city early today for no reason (she's out in the 'burbs visiting her friend).  Not a problem if I cancel early enough.... haha like I'll be able to make up my mind before then.
- Of course I could call her now, but I feel like I should go on this date.
- I have this idea that time with my husband will be fun, but often it's really really blah. Since we decided no more kids, we really don't have anything to talk about besides chores.  And I really really don't want to spend my date afternoon talking about chores.  I tried talking about future vacations, or where in the country he'd eventually like to move, but those conversations tend to be sort of one sided.  He complains he doesn't have anything interesting to say, and well... he's right!  And let's be honest, he probably doesn't want to hear about the details of whatever anesthetic I administered last Friday, or about the social drama of residency either.
- I also feel like I should study at least a little since I'm doing regional anesthesia for a week to cover for a CA-2 who is going on vacation, and I don't know anything about it.

I thought date afternoon was something I am supposed to look forward to, and now it feels like an obligation mixed with anxiety about work/dealing with au pair/desire to have more quality time with my daughter.


This sucks. 

Edit: My parents (who were visiting for the weekend -- which was really nice, actually!) are still here, so I think instead of museum, we will end up doing pool and grocery shopping this afternoon, with a chance that we may visit/bestow baby supplies on a friend who has a new baby (depending on whether she feels up to it).  Gah!  Too much to do, and so little time.  OTOH, I feel less stressed out, so I think maybe I should just roll with it.  

Thursday, August 20, 2015

One more day left this week, and then the weekend off.  I am tired!  The fact that Thursday is our "late" day will never cease to strike me as ironic since we have lecture at 6:30, which means we actually have to come in early to set up our rooms so we can make it there on time.

*Sigh*

I am so, so dumb.  Intubations are getting a bit easier I think.  So are IVs.  Last IV I really focused on planting my right hand so that I could advance the catheter with my index finger more effectively.  It helped.  But OMG I know so little.  I started doing anesthesia questions in the OR, and I got like 20% correct.  Admittedly it was on anatomy which I literally have not studied in years (and frankly found it boring even then).  And at least I will have plenty of time to study and practice before the ITE in February.  I'm aiming for 50-75 questions a week, plus supplemental studying, so hopefully that will be enough.

God I wish I had something more interesting to post than to complain about being tired.  This isn't even a hard rotation!

Anyway.

So.  Question for the masses:  I have the option of requesting the weekend off before my upcoming vacation in October.  The thing is, I would want to actually do something fun with it, otherwise I will end up with a guaranteed evil Saturday call with nothing to show for it.  Oh!  And it would either have to be local, or I would have to bring the offspring because we don't "just" have a family member available who can sweep in and take care of the kid while my husband and I run off and frolic.  Au pair + overnight = illegal.  (To all of you who do: I hate you.)

Any thoughts as to what we can do that won't totally suck?  I'm not looking for amazing.  Just not wretchedly horrible. 

Tuesday, August 18, 2015

So, it has been suggested to me by someone who has been there done that, that to do the most research during residency, I should leverage my statistical/epidemiological expertise and help with projects people around the department are doing.  And I agree!  That would be way easier -- at least for now -- than starting my own.

My quandary is this:

People come up to me all the frigging time and ask me stats questions.  COMPLICATED ones.  Like, how do you perform regression diagnostics on my model.  Or please explain to me the difference between a sandwich estimator and a random effect in 2 sentences or less in lay terms that I will understand.

These sorts of conversations require, in general, more than the 60 seconds I have between cases, but I also worry that if I don't provide an answer right away they will think I don't know what I'm doing or don't want to help.  I also have a hard time producing stata code off the top of my head.  Gah. 

I think I need to practice saying the following: "This is a great question, but I need a bit more background to give you the best answer.  How about we meet/can you send me a brief email telling me about your project, dataset, and the kind of model you are using?  (I would meet, but my schedule may not allow it since I don't have any post-call days during the week for a while.)"

The only foreseeable problem to that is that I feel like everyone wants an immediate answer to their problem rather than something that will take even an hour to do a good job.

I think I have a hard time negotiating this because I am afraid I will be perceived as stupid or incompetent, neither of which are true.  I just need some time to gather my thoughts and present a solution to them.  A working meeting would be ideal.

How do you handle this sort of inquiry? 

Monday, August 17, 2015

Was trying to come up with a positive way to reframe it when a work colleague/superior tells me to my face that it's better for the kids if the mom stays home with them when they are small.  Two for two out of the last two weeks.

The only one I could come up with is that they think of me as a colleague / doctor / man(?) first, and a mom / wife / woman second.  Or maybe they just feel super comfortable around me.  I'm gonna go with, for now, that it's not because they want to tell me that they disapprove of my lifestyle, but maybe that really is the truth.

Guys, STOP TELLING ME THIS.  It makes me feel judged, and anyway it's not true.  Kids do best when both parents are happy, that's what the research indicates, anyway.

That is all.

Sunday, August 16, 2015

Yesterday really frustrated the crap out of me.  I was post call, and got home at around 7:20.  I did actually get to "sleep" overnight from 3:30 - 6:30, but it was shitty call room sleep.  When I got home, Dyl was still sleeping, so I sat on the couch waiting for her to wake up.  Finally at about 8:00 I gave up and just woke her up so I could see her before I went to bed.  She was in a really really whiny mood, and after about 15 minutes I gave up and went upstairs to sleep.  I slept until 1:45.

Now, according to most doctors, I should be fully functional on what, if you add it up, amounted to 8 or so hours of sleep.  And compared to my last call where I didn't sleep at all, I was!  But the thing is, I woke up to a bunch of extra work to do.  See, I'm starting a new rotation next week, and I wanted to read about those kinds of cases before Monday.  I also need (and still need) to complete 4 busy-work "write-ups" from my last rotation -- 1 page single spaced apiece -- about "interesting" cases we had.

Let me be blunt: there were no interesting cases from the pre-op rotation, and looking to the literature to answer some of the questions that I did have was... rather disappointing (anesthesia literature is notoriously poor, which was one of the reasons I went into anesthesia).  The rotation was 100% scut, and the first week was so busy there was no time to do such a write up.  Last week was less busy, and I did do one, AND I picked out the topics for my other three.  But realizing that nobody will ever read a single one, I still need to do the work.  If only cutting and pasting the phone book wouldn't get me a lecture on professionalism if I ever were to get caught, I would totally just do that.

But anyway, while Dyl was still napping when I woke up, so I got about 1/2 my reading done (actual real work that needed to be done).  Then while my husband lay on the couch (he was having an attack of the blahs and for some reason had decided to do caffeine detox that day.  I'm sure you can imagine how sympathetic my post-call self was to his plight.), I handed my child the iPad while I finished the reading.  Then I told her to stop bothering me --nicely -- when she (repeatedly) asked me to help her play her various video games.  Mother of the year over here.  At least I more or less finished my reading.

The husband wanted to go out to dinner for pizza, and because I really wanted to take a walk and have a beer, I didn't argue.  It was fine (imagine me saying this in an Eeyore kind of way) .  We got home at 7.  As we were coming home I ran into my neighbor who commented how nice it was that I had the day off (apparently she had to work).  I said, well.... I was at work til 7 this morning, so it wasn't exactly "off."  I know that she just wanted to chat and didn't mean it in a bad way at all and was trying to be nice, but I still had to restrain myself from yelling in my best succubus voice, "ARE YOU KIDDING ME?  WOW BOO HOO YOU HAD TO WORK.  WAS IT 25 HOURS IN A ROW?  I DIDN'T THINK SO."  But I didn't.  Instead I just sort of stood there trying really hard to be pleasant back, hoping that I wouldn't tip over from heat/exhaustion/beer, or that my resentment of her normal life would show through.  Thankfully, Dyl was there and was being utterly charming, so that helped a lot.

When I finally got inside I lay on the couch like a limp dishrag.  At 7:45 (noticing my husband had become zombified in front of the computer) I said we needed to take Dylan upstairs to do the bedtime routine.  We dealt with the nightly enormous tantrum, and then passed out ourselves at 8:45.

I slept til 8 this morning.

But I feel so stressed out!

I want/have to:
1. Go for a run and do push-ups
2. Do something fun with my daughter this morning, goddammit.
3. Finish at least one of those *&&^& writeups
4. Talk with my attending about tomorrow's cases (thankfully the pre-ops are done)

My husband started talking about date afternoon the minute I got up, and I got so upset because he wanted to go to the pool this morning and to the Art Museum to the Impressionist exhibit which leaves town in mid-September in the afternoon.  I freaked out.  I feel like I don't have time to spend 5 hours doing that.  In reality, I probably DO have time, but I don't think I'd enjoy it with all that other stuff to do.  Nap time is the only time I can get shit done because when we're home, he's a total absentee parent/compulsively cleans all day and my daughter bugs me constantly to pay attention to her.  It will be too hot to run in the afternoon, so that has to happen NOW.


I also want/have to (but less pressing):
5. Go to Target and buy a new wallet since my old one broke (they don't have what I want on Amazon)
6. Get a treadmill (my husband won't do this because... he just won't)
7. Go to CVS to re-up the face lotion which of course ran out like 2 days after my last trip to CVS. 
8. Work on Dylan's school applications

OMG we are never going to get any of this done.

Now I am going for a run goddamn it.  At least if the rest of the day goes to crap then I will have accomplished that.

*****

I think I need to let go of the idea that I am going to be able to feel happy, satisfied, or productive on my post-call day.  If I really think about it, as post-call days go, it was damn productive but I still felt horrible because of my interactions with my family.  Any thoughts on how to optimize?  It's super hard for me having a kid who really really wants to spend time with me and play with me and is super happy to see me, but I feel like utter ass, and then on top of it I need to get work done.  Any suggestions/words of wisdom?  This problem is going to recur on at least a weekly basis for the next 3-4 years, so I really could use some advice!  I thought about utilizing the au pair for the afternoon so I could rest and get work done, but then I just feel bad because my daughter just wants to play with me.

Wednesday, August 12, 2015

I got to do a fiberoptic intubation though an lma today.

Eeeeeeeeeeeeeeeee!!!!!!!!!!!!!

Good night.

Sunday, August 9, 2015

I just wanted to say that after all my angsting at the end of last week, in the end we had a really great weekend.

I went to bed at 9:30 or so on Friday night, and slept until (wait for it) NINE AM on Saturday.  I did have a 90 minute bout of insomnia in the middle of the night, but with a 9AM wake up it didn't matter at all.  Daddy got up at 7 to tend the Dilly Pickle.

We went to the park, and I had a lovely conversation with the mom of a former med school classmate of mine.

Stayed for over an hour, midday!  And it wasn't even too hot!

Went to Whole Paycheck and got sushi and cookies for lunch.

Naptime for Dyl, reading for me.  I got 1.5 chapters read in baby Miller this weekend, which I was pleased with.

Went for a run.  Lifted weights.  Did pushups.  Felt better for it. 

Hung out on the couch watching movies the rest of the afternoon.

Really nice bedtime routine with reading and snuggles.  I ultimately just left and told Dyl to go to bed when she was ready, which she did!

Went to bed at 10 or so.

And today I slept until 8!  Then we went to the Bug Show at the Academy, which was a lot of fun.  Dyl pet a bee, a cockroach, a millipede.  We saw a show featuring grubs and a centipede (the centipede ate a cricket -- it was VERY scary.  FOR ME.).  And she got a bug tattoo and ate a cricket.  I couldn't bring myself to try one.  I know, lame.

Then we did lunch, movie, and naptime, and I snoozed with her for a little while on her bed.

Then we did date afternoon.  I finished a chapter in baby Miller, went for a run-walk with my husband, assembled a futon for the basement (more like, I watched him do it, but whatever), got a beer and wings, and then came home and did some more reading while Dyl watched an episode of Daniel Tiger.

I don't know what's up with me, but I was just in a really good mood today.  Maybe it was the weather?  Maybe I was just more relaxed than I usually am?  Not sure what accounts for that.  I just every weekend could be this relaxing and fun.

My goal for this week is to think of times I feel happy, and try to pinpoint why I am feeling happy.  I can tell you that I feel unhappy when I don't feel like I know what I'm doing, and I worry I'm going to be yelled at.  But happy?  I definitely do feel happy too, it's just harder for me to identify the causes because I don't usually think about them because I'm, well, happy.

Have a good week!

Saturday, August 8, 2015

I just want to put out this public service announcement about what anesthesiologists actually do, since I'm not sure this is known.  It turns out, we actually do an H&P and see EVERY SINGLE PATIENT WE ANESTHETIZE before we take them back to the OR.  We also discuss each case with our attending and customize bits and pieces of our anesthetic plan for each patient/procedure we perform.

This is STANDARD.

So, when I get a call from an inpatient team requesting an anesthesia consult a week before a patient may or may not have a procedure, and the question they want us to address is standard intraoperative management for [specific procedure] among patients with [her specific but fairly commonplace type of] hemodynamic instability, neither I nor any of the attendings I talked to know what to do with this since we already do this for all of our patients.  Really.  We're not trying to be obtuse, we're just trying to understand whether you want something else, or whether you just don't know what we typically do for our patients. 

In all honesty, I think the question stems from a lack of understanding of what anesthesiologists actually do.... Do people really think that the patients just roll back to the ORs and we don't know anything about them ahead of time?  I think the answer to that question may be yes.

Anyway.

It seems anesthesia may have a PR problem.

Thoughts?
I've been struggling a lot with my weekends lately.  I actually have had reasonably decent number of days off lately (soon to change, of course, after which point this post may be moot), but I inevitably find myself sitting on my couch Friday evening with no freaking clue about how I want to /need to spend the next 36-60 hours.

After sleeping 10 hours last night and feeling a bit less zombified, I tried something different: Rather than think of a "perfect" or even "fun" weekend activity, I tried to remember what I did before I had a kid.

1. Exercise -- I almost always swam, ran, lifted weights.  Often at a gym.
2. Studying -- In med school I planned on 5 hours or so each day, and when I was done I could go have fun.
3. Grocery shopping -- Bleh.  I actually do enjoy doing this sometimes, but I barely have time to eat dinner these days (didn't even happen for the past 3 nights since I got home so late), so.... It's not even really for me, it's more for the kid.  Who only wants to eat watermelon and yogurt anyway.
4. TV -- I watched movies and tv at home -- I miss that!

Occasionally I'd do other things like go out with friends or shopping, but honestly not all that often.  I do remember feeling the blahs occasionally, but not this impending sense of doom that I currently feel every. single. weekend. while watching my few hours of freedom drain away.

What's keeping me from doing these things now?

1. Exhaustion
2. The offspring (Can't watch my tv shows with her around.  Or study.  She needs to be entertained constantly, which is.... Ok... but what a three year old finds fun is not always fun for an adult. For hours.  Exercise used to happen with the husband, now we have to pay a sitter if we want to exercise together.)

So yeah, I'm not sure what to do about this.  We're taking her to the park now, which will probably not be horrible.... (Better than the museum at any rate, even though she's refusing to get dressed and doesn't want to go), but yeah.  There's no time to relax or do anything at all for myself.  Ever.  But also, since I work do much I want/need to spend time with her.  And I want it to be fun not totally suck (crying, tantrums, endless activities I don't enjoy that only exhaust me further, i.e. the norm).

This is probably the main reason for my blahs.  Not sure how to fix it.  Probably the answer is to work more or to have an office with a door that locks.

Tuesday, August 4, 2015

Did my first 24 hour call last night.  It was, dare I say, kind of fun?

Did 2 cases and an emergent airway in one of the ICUs.

The first case I was all off balance and couldn't intubate, couldn't place an easy IV, messed up some dumb things with the OR setup.  I was done around 10, and got to lie down for a little while after.  I basically lay there thinking about my gross incompetence and wondering whether it was going to get any better.  I just kept coming up with additional things I had done wrong.

I got called for a false alarm at Mn, right after I fell asleep (naturally).  Went back to bed, then got another case assigned at 2AM.  As we were waiting for the patient to come up from the ED, got a call for an airway.

The airway ended up being fine.  Observation: it's hard to mask ventilate with those crappy ambu bag masks.  My arms got really tired!

The case ended up being totally perfect for someone at my level of training (i.e. very, very, easy).  I intubated successfully, ran a vasopressor infusion, and placed a somewhat challenging IV on the first try, despite the surgery resident seizing the patient's hand immediately after catheter insertion as I was reaching for the tegaderm and flopping it around in order to remove a ring (I was like, "Do you mind?"), nearly dislodging the IV.  Fortunately, it didn't fall out and it still worked!  IT was the confidence boost that I needed.

:-)

Was talking to someone about why she "opted out" of academic medicine.  Thinking about it, it's kind of funny how doctors in academic medicine view it as "opting out" if you elect to take a full time job outside of academics that doesn't have (much) call and pays well.  The difference is that you won't be doing research or resident teaching anymore.  You will be off tenure track (or partner track if you are in private practice).  So... you still have a 50 hour a week job.  Yes, in academic medicine, that is considered "opting out."

I do have a tendency to develop tunnel vision about this since I am deep, deep into the medical culture at this point in time, but stepping back for one moment.... let's just say that it in NO WAY should be considered "opting out" to take a job that -- is still FULL TIME for goodness sakes! -- just because you don't want to enslave yourself to the capricious NIH funding mechanism or a call schedule that rivals what you did during residency.  Ultimately in the end you have to look out for yourself and do what is best for you.  I hope to eventually be able to take the approach to work where I get to keep doing research as long as it stays fun and rewarding.  This is not about being a "good" mom or feeling "guilty", this is about feeling empowered to create for yourself a healthy, balanced life doing something you love. 

Sunday, August 2, 2015

I read something recently on the challenges of being a "sick" resident.  It was one of these poignant pieces that is meant to show you what the doctor has learned from the experience, and how it made them a better person/physician/blah blah blah.  Unfortunately, the reality, especially if your illness is not life threatening is not poignant or educational in any way.  It just sucks.

1. Everybody will be annoyed at your coughing.  They will ask you if you've seen a doctor, a faux attempt at sympathy, but they really want you to just stop.  Ok?  Just stop coughing already.  You are embarrassing me.  Plus patients will not like it.  JUST STOP OK???

2. They will make comments on how you should take better care of yourself.  Even though URIs tend to run their course no matter what you do.  You will be reminded how unprofessional you are for not taking care of yourself.  How as a doctor, you are obligated to take care of yourself so that you can take care of your patients.  Your failure to recover immediately will be taken as a sign of your lack of professionalism and/or your inability to "handle" residency.

3. You will be urged to seek medical help, but will be unable to get an appointment either a) at all, or b) at a time that does not cause someone to draw attention to the fact that you are missing work, you lazy piece of shit.  And oh how wonderful they are for letting you go. 

4. You will be scolded for not having a primary care MD.  Even though check ups have been shown to be non-cost-effective for anyone under the age of like.... 50.  Even though you just moved here.  Even though you can't get into see one for three months (if you can find someone who is taking new patients) even if you wanted to, and it's basically impossible to schedule that far in advance since you don't know what your call schedule will be. 

5. After the appointment, you will be asked what the diagnosis was, and what meds you're on.  And then be subjected to comments all the rest of the week about why aren't you better yet.

6. If you DO have to take time off (see: febrile and vomiting), you will be told how NICE the program is to allow you to do this.  Also, how you have put out all your colleagues, you selfish piece of shit.  You will be reminded that you will have to extend your training if you do this sort of thing too often.

7. If you are febrile and vomiting and DON'T take time off, you will be reminded how unprofessional you are for exposing your colleagues and your patients to whatever it is that ails you.

As you can see, being sick in residency is a totally awesome way of getting everyone to think you are incompetent and unprofessional.  It rules.  You should try it sometime.

Saturday, August 1, 2015

I forgot to mention.  Last week my husband was out of town Weds-Friday, and on top of being on 1:1s and being sick, I also got to man the house and dog all by myself at the end of the week.  Joy!  It wasn't all THAT bad in the end, but not great nonetheless.  Things that kinda grated on me included:

1. Conversations with co-residents wherein I revealed that my husband cooks and cleans for me.  But do you do ANYTHING AT ALL?  They cried.  I'm the brains of the operation, I said.  And it's true.  But more seriously, where do they get off?

2. AP2 rolling her eyes at me when I relieved her 30 minutes late on Weds night, which we had warned her might happen.  And then stomping off and not talking to me when I relieved her 30 minutes early the following night.

3. Attending asking me probing questions about whether I was taking adequate care of my family/husband/etc. if I was getting enough sleep, and being admonished to build my "support network" so that I could receive help from friends and family if I needed it, and that I could talk with him if anything was bothering me (I think he is the last person in the world I would ever talk to.).

4. Getting criticized about blowing an IV in a very obese woman with tiny veins.  Personally I was delighted I even got a flash, but apparently anything less than perfection is insufficient and a marker of my poor gross motor skills (actual words used) and generalized lack of competence.  Oh yeah, my hands were rock steady while I did this, and you took 15 minutes to place her IV yourself, so bite me. 

5. Being told that my H&P was inadequate by my attending because I hadn't asked a patient with small bowel obstruction about recent nausea and vomiting.  Only I HAD asked, quite extensively actually, he just hadn't been paying attention.

6. Being told by my attending how obnoxious I am when he yells at me for doing something wrong, and I ask a clarifying question about my thought process, or say I did something he thought I hadn't done yet.

7. Trying to take a nap today, and husband forgetting to take daughter to pee before HER nap, resulting in her waking me up when he left for the grocery store, and AP2 rolling her eyes at me for having been disturbed.

8. Persistent post-nasal drip and the continuous stream of commentary from anyone and everyone about how I should see a doctor/take vitamins/oh my God that sounds awful/get more sleep.

All in all, I actually think things went really freaking well this week, all things considered.  I only forgot to feed the dog once, I managed to get 8 hours of sleep most nights, feed myself and take care of the offspring.  I wasn't late to work.  Sure, I didn't read at all Weds-Fri, but you know?  I am going to cut myself a bit of slack on that one.  Maybe next week will be less horrible.  I can hope, at least.