Friday, June 29, 2018

The end

I finished residency today.  It was every bit as bittersweeet as I thought it would be.  As I walked home in my OR jacket that I may never wear again (not allowed at peds hospital) wearing my scrubs with the combination to our call room written on the leg so I wouldn’t get locked out by accident, I felt a little naked without my ID and only carrying one phone.

I am still displeased about my CA1 year, but everything has worked out fine and I will get over it.  I got through this with the support of my program director and chair mostly.  I wasn’t close with most of my classmates, and I doubt I will be going out drinking with them tonight.  I got damn good training though.  Our program beats you up, but I think it would be almost impossible to graduate and not be well trained.  Right now though?  Mostly I just want to shower and have a beer with my husband, who has put up with so much shit these past four years.  Thank you, sweetie.

I am hopeful about my fellowship and the direction my career,  even though I am simultaneously sure that elements of fellowship will likely be as hard as or harder than residency was.

So now I embark on a month long vacation where I will go to Italy, study for my boards, submit an IRB, and exercise and sleep as much as possible.  Fellowship starts 8/1.

Goodbye residency.  Don’t let the door hit you on the ass on your way out.

Tuesday, June 26, 2018

Horse

My daughter has started taking riding lessons once per week.  She's gotten posting down pat and did ground rails and even cantered last week (I wasn't there, but video evidence of this was What's Apped to me).

My daughter FREAKING LOVES horses and her riding lessons.  But, she is shy with the teacher and doesn't talk.  She concentrates so hard during her lessons trying to do what she's told just right.  She is so excited to go every week.  I do not exaggerate when I say that this is far and away her favorite thing to do.

But here's the thing.  Somehow, her teacher thinks she doesn't like it.  She was very concerned that Dylan wasn't happy because she... I don't even know!  Because she doesn't run around all ADHD?  Because she listens to instructions and concentrates really hard?  Because she doesn't run up to strange adults getting all up in their business, interrupting and talking about herself constantly like some kids her age do (which personally, I find incredibly obnoxious, but that's just me).  I just don't see how I see this kid who is completely obsessed with riding, and the teacher sees... I don't know.  Does she see a pushy mom who wants her kid to ride because she did it when she was a kid?  Christ, I WISH Dylan weren't interested in riding.  It would save me a lot of money and anxiety about her getting hurt!

The way she is, aloof and shy, is a lot how I was when I was a kid, and how I am when I'm in a new situation and not feeling very comfortable yet.  I still occasionally get feedback that says, "Aloof," "Serious," "Doesn't fit in," and it still feels very unfair.  I think when I am feeling uncomfortable in a new situation and don't talk because I don't want to say the wrong thing, other people must feel rejected or something.  Which is just weird.

Anyway, the bottom line is this: people bring a ton of their own garbage baggage to social situations.  Whenever someone acts like a dick to you, just remember it's just as likely it's because you remind them of someone who was mean to them when they were 12 as you having done anything legitimately wrong.  If you are quiet, in this society of extroverts, many people will probably feel rejected if you don’t appear like what they think happy looks like.

It's hard to go through this personally, harder still to watch it happen to your kid, powerless to do anything about it.

Sunday, June 17, 2018

Weekend

So sad my vacation is almost over.  This weekend turned out lovely.  Yesterday I slept in until 8 and then exercised before taking Dyl to swimming.  We came home and relaxed for a few hours (I read and did anesthesia questions while Dyl watched Coco) and then went on a date with Luca where we walked around and grabbed a glass of wine.  Came home around 6.  Then we relaxed on the couch and watched some TV.  Dyl played on the iPad.  I know, lots of screen time.  Obviously I should feel bad about that.

And then today I set my alarm for 7, but actually woke up at 6:30, got up and made pancakes and bacon.  Then we ate breakfast together, and I took the dog for a walk, did some yoga, and took a shower.  I also did some anesthesia reading. Then we took Dyl to another riding lesson, which... she freaking loved.  She is beginning to get the hang of posting.  The barn really seems to aggravate Dylan's allergies, so we stopped by the CVS to buy some children's Zyrtec (though it turns out to be the same dose as mine, so we may just give her that) and some sunscreen, came home and relaxed for a while, I did some admin stuff I needed to do, and then we went to the pool.  I did some laps while Luca entertained Dyl and then we switched.  I somehow -- amazingly -- convinced Dylan to wash her hair at the pool shower so that we wouldn't have to do a bath when we got home.  And then I did edits on a manuscript and just sent it to be reviewed by the PI.

Such a great weekend, and very little of it was planned in advance.  We only had swim class Saturday and riding on Sunday planned, and basically everything else fit around those two events.  I decided that I had to exercise in the morning before we left the house because otherwise I have a tendency not to go at all.  I also fit in bits of anesthesia reading while I relaxed on the couch.

Man I hate planning.  It works much better if I have events that I want to do and plan my free time around them than if I have blocks of free time that I then have to fill with all the hundreds of million tasks I need to complete.  That just stresses me out.  I also have trouble coming up with things I want to do -- honestly exercising, lounging, reading, walking the dog, FINISHING work -- those are the activities that make me happiest.  Well, and also seeing my daughter do things that make her happy makes me happy too. 

Sigh.

Now back to the grind.  Actually it shouldn't be half bad.  I only have two weeks of residency left.  Yay!

Friday, June 15, 2018

I have read literally zero books for fun since.... I don't know.... March?  First I was focusing on getting my research work done (and I DID get a lot done), then I had a month where I was in the Main OR working ~70h each week and where I also had to prepare for three separate presentations (on different topics.  of course.).  Now that month is over, and it's only... seven? weeks until my boards and I really feel like I need to study.  Oh, and also get this goddamned manuscript out the damn door. 

I have also been trying to have some fun with my kid, occasionally exercise, relax a bit, and get enough sleep.  So.... I guess I have just been prioritizing other things above reading.  And if I'm really going to use bits of time to read (argh WHY???) I should be reading for my BOARDS and not for fun. 

Oh the positive side, at least I've made some progress in rewriting my manuscript this week, and have made time to study for about an hour every day.  And exercise.  And spend time with Dyl.  So at least there's that.  And I guess it's also true that I could read at night instead of watching SITC reruns with my husband (who seems to enjoy it as well).  Though, I have been doing questions and exercise while I watch TV, so... perhaps it's not such a time suck after all. 

Sigh.  I think I should spend less time analyzing and optimizing and more simply being. 

Thursday, June 14, 2018

Yesterday my husband took the day off and we went climbing together as a family.  It was... ok.  Because Dylan needed to be belayed all the time so she wouldn't get bored, neither of us got to climb as much, and I never really warmed up, and my finger tendons hurt.  We left after about 2 hours.  I came home and lay on the couch watching Sex in the City, Dylan played with this new horse app on her iPad (it's actually pretty decent), and Luca lay in bed doing God Knows What.  Eventually I got my butt up and did some weights while watching TV, which felt really good, and we ordered in Thai food from a new restaurant near the being-renovated former West Philly High School.

So... overall I ended the day feeling good, but overall it was pretty meh.  Luca was going to take Friday off too so we could spend time together as a family, but now he has changed that to, "I might take the day off," which feels like, "If you can come up with something fun to do, I'll consider it.  Otherwise I'd rather go to work."  Which kind of sucks! 

Annnnyway. 

On the docket for today is a riding lesson for Dylan!  We finally found a barn in the area!  Yay!  Then We're going to go down to Forbidden Drive and have a picnic lunch.  Then.... I'm going to come home and AP#6 will watch Dyl and I will work on my manuscript, go swimming, and otherwise have me time.  It will be nice!

Still contemplating what to do with tomorrow.... with or without my husband.

Wednesday, June 13, 2018

Dorney Park

Vacation day#4 (otherwise known as slack-off day) continued with a trip to Dorney Park.  We had originally thought about going to Hershey Park, but Dorney Park is closer and (I was told by a mentor) has basically the same rides.  The major difference is the lack of theme characters and shows at Dorney Park which I (and the person who recommended it to me) considered to be a major plus.  

I decided to bring AP#6 because she can handle roller coasters.  We also invited Dyl's friend from school. 

OMG it was so much fun.  We started out with the kiddie rides, and then moved on quickly to the bigger kid rides like the Boat Splash ride and some roller coasters.  The girls rode the Tilt a Whirl 8 times (fortunately) by themselves.  After all that we went to the waterpark.  I distinctly remember my parents refusing to take me to water parks when I was a little girl (they were "trashy" according to my parents -- a sentiment they now deny, of course), but.... it was completely awesome.  They did a bunch of the big water slides and were completely adorable hauling their water toboggans up the giant ladder behind the much bigger, older teenagers.  Dyl and her friend had a blast, and it was so much fun seeing them running around looking so happy.  Much junk food was consumed.  On the way home AP#6 played DJ and everyone sang along to Katy Perry and Shakira.  I was shocked they didn't fall asleep in the car.  We dropped the friend off at her house around 8:30 PM.  Hopefully that won't get us banned from bringing her again!

Amazing.

(I even did 20 minutes of work on my manuscript before we left, which... I am proud of myself!)

Today Daddy is taking a day off of work and we are all going climbing at Gravity Vault for a couple of hours.  I am assuming that sushi, Chipotle, or pizza will follow.  I've already worked on my manuscript for an hour or so, and taken the dog for a walk. 

Hooray for awesome staycations!

Monday, June 11, 2018

Today

Franklin Institute FTW!  A fun time was had by both of us.  Yay!

We also got ice cream on the way home.  Minimal whining took place. 

Tomorrow: Dorney park.  With a friend from school and our au pair so that I don't have to ride the roller coasters.

Sunday, June 10, 2018

It turns out Sex in the City is free on Amazon Prime, and I just finished watching season 1.  It's interesting watching it now.  It came out when I was graduating from college.  That was the world I entered when I started working.  I mean, perhaps the show is a bit of a caricature of the world in the late 90s, but some things really have changed.  For the better!  Examples:

1) One of the men on the show videos himself having sex with models without their consent.  It's discussed as a little icky, but that's about it.  That would NOT fly today.

2) Everybody smokes.  My residency colleagues never believe me when I tell them that smoking used to be cool.  You could smoke at my high school with parental consent, and faculty smoked in their offices.  When I started college there were smoking and non-smoking dorm rooms.  One girl I knew who became a Rhodes scholar smoked.  I'm pretty sure that would disqualify her now.

3) They shit talk other women like it's their job.  Doing that today is not considered cool at all.

4) Miranda is considered uncool and unattractive.  She's the only non-asshole among them by today's standards as far as I can tell.

In other signs of the apocalypse, I got breakfast in the hospital cafeteria the other day, and there was a table full of white man residents. In fact, they were ortho residents (big surprise), but actually it was, because I know there are several woman residents in the department now, and it was actually odd to see a gaggle of white men sitting at a table having a meeting.  The attending I was with said this was progress.  10 years ago it would have been commonplace to see only white man doctors sitting together.  Now it just looks weird.  So, yay!

*****

I just finished a really really rough weekend.  We had a party on Friday night and were out until midnight, and then yesterday was our graduation dinner and we were out until 1AM.  I know.  And today I had a brunch that lasted 3 hours.  I had planned on coming home and doing some work.  Instead I came home and beached myself on the couch.  I need a break from all this socializing.  I can't believe some of my colleagues do this every weekend.

*****

I decided eff it a bit with regards to getting shit done this week.  My original plan was to take this week so I could spend some QT with my daughter.  But the specter of all the things I need to do kept hanging over my head, and kept me from planning anything fun.  I know that no matter what I do there is no way that I will get everything I want done, and if I try, I will have a crap week with my kid and won't enjoy myself at all.  So, I decided to try and let it go.

Tonight, for real this time though, I am going to go through my emails and make my to do list for a) fellowship, and b) residency end.  And this week I absolutely must do my IRB continuing review for one of my projects and start revising a manuscript.  I know that once I start, I will gain a little momentum and it will get done.  However I cannot control my coauthors, so I know no matter what it's not going to get submitted by the end of this week no matter how hard I try.  So I will not try to do something that isn't actually possible.

*****

Tomorrow: Franklin Institute.  Dyl picked the museum and the weather's going to suck, so why not.

We're going to have a blast.


Saturday, June 9, 2018

Tonight is our residency graduation dinner!  Somehow I’ve been in Italy the past two years and missed it.  I hope it’s fun.

I also started a week of vacation.  Last night I went out to celebrate with a friend who is getting married.  We stayed out until 1130, which... is super late for me.  Had a good time.

I’ve been stressed out all week about all the things I want to get done his vacation.  Which is absurd.  Of course I scheduled it when Dylan is out of school so that we could have some high quality mommy daughter time, but now I find myself a) not knowing how I want to spend it with her, and b) with a burgeoning to do list for myself.  Naturally I received several action emails for residency and fellowship this week too.  🙄

So I feel overwhelmed.  I haven’t even gotten my act together to make a list of what tasks I need to get done.  Was planning on doing that today, but.... did not.

Tomorrow then the plan is:
1) sleep in
2) exercise
3) go to brunch
4) come home and try to figure out my week

I think I will have to go to the coworking place to do this since so far I’ve been completely unsuccessful at doing this at my house. However that will necessitate that I get off my ass and out of the house which is easier said than done.  I will probably fail.  I can feel it already.

What would be fun to do with Dylan?  Hershey Park maybe?  But I hate roller coasters.  The beach?  I dont think she’ll find that fun (she never has before).  She has a rising lesson on Tuesday which will be fun for her I think. Luca said he would take two days off this week and we talked about going climbing as a family.

What do I need to do?  Study for my boards and complete revising a manuscript.  I also have to find a way to entertain Dylan since camp doesn’t start for another week.

What do I want to do?  Exercise daily and do some pleasure reading.

I have: our au pair to help and my husband, who most likely will only make things more complicated.

Also, I have been almost a complete failure at exercising in the afternoon so that has to happen in the morning, non negotiable.

I am not going to be able to get everything done on both my want and need to do lists, that much is clear.

Gah!  This is so horrible!  Why can’t I come up with a plan!  I hate myself!

Help!

Sunday, June 3, 2018

Reflections on anesthesia training

My last week (in theory) in the Main OR went really well clinically.  I'm sure this had as much to do with the patients deciding not to misbehave under anesthesia as with my clinical acumen, but still, it was a nice way to go out.  I did an awake crani that went really quite smoothly (despite three blown IVs, because yes, sometimes that just happens), and on Friday I pretend DPd* and took care of some pretty sick patients.

What does anesthesia residency do to you?

1) Almost every single day of last month, something was "wrong" with my setup.  Not dangerous wrong, but wrong enough that you'd want to fix it.  One day my gas analyzer (that measures end tidal CO2, O2, and the anesthetic gasses) wasn't picking up end tidal oxygen.  I just noticed that one of the numbers on the monitor that I refer to from time to time wasn't there.  So I called my tech who called clinical engineering, who came and fixed it mid case.  In the process of doing this I also discovered that the gas analyzer wasn't recording the values in our medical record, so I manually input them.  I was thinking that when I started, I a) never would have noticed such a minor detail, b) would have had no idea how to fix it, c) wouldn't have fully grasped the clinical significance of it (oxygen monitoring is one of the required ASA monitors, and is so important that we have two so that if one fails there is a backup), and d) the idea of clinical engineering fixing this for me mid case while the patient was under anesthesia would have freaked me out and thrown me for a loop.

2) One day the cleaning crew inadvertently dislodged the cable that connects my vital sign cables to my monitor display.  I noticed this while I was setting up for my next case that we had no vitals on the monitor, and I saw a cable on the ground that I strongly suspected was not where it was supposed to be.  I looked around for a socket to plug it into, to no avail.  I called my tech and attending, neither of whom could figure it out.  Clinical engineering was called.  Finally I thought to myself, why are we messing around with the socket over THERE when the brick is over HERE, and I got down on the floor and found the hole the cable plugged into and fixed the problem myself.  The case was only delayed two minutes.

3) Last week my anesthesia machine kept failing its leak test during my early morning pre-case machine check.  I went through the usual steps to fix it, none of which worked.  So, I called my friend to hold the flush down while I rummaged around behind the machine to find the loose connection.  Sure enough I diagnosed the problem and fixed the leak without having to call someone else.

4) I was second call last week, and I had the chance to observe one of the CA1s (she's really VERY good) during induction.  The attending started trying to teach her while she was intubating and then right after when she was running around setting the patient up for the surgery.  It was obvious she wasn't really able to pay attention to both things at the same time and that the talking was stressing her out.  I remember feeling that way when I was a CA1 during routine things.  If the situation is scary enough now, I still feel like I can only focus on one thing and require silence from other people (the hard part is having the balls to ask for it, and to say it calmly enough that people don't call you a bitch, but with enough authority that they actually do what you say).  Contrast that with last Friday where right after induction, a patient became hypotensive, and I simultaneously treated it, did 5 other things, and had a conversation with my attending.  I bolused a variety of pressors until we found one that worked for her, and ended up hanging an epi infusion.  This would have really stressed me out as a CA1, and now it did not.  It's kind of like learning to drive a car.  When you're first learning how to merge onto the expressway, you need silence so that you can focus on merging.  When you get good at driving, you can carry on a conversation AND merge at the same time because the mechanics of merging have become automatic.

5) I went to a code last week, and was asked to put in an a line.  I put in three: a radial, a femoral, and assisted while my colleague did a brachial.  While the patient was bouncing up and down as they were doing chest compressions.  I've become the person they ask to do this!  It wasn't easy or smooth, and there are definitely people better at this than I am, but still.  It was cool to be asked.

It may seem weird to you that a sizable part of my job as a doctor involves crawling around on the floor fixing equipment, but.... that's anesthesia for you.

Anyway, none of this is to say that I am God's gift to anesthesia or that I know everything and can fix everything all by myself.  It's just to say that learning anesthesia is as much about noticing minor details, knowing how to fix things and what to do for backup while they get fixed, training your brain to do mundane tasks automatically so that you can focus on other things, and asking for the help when you need it, as it is about getting good enough at procedures, anesthetic planning and management, and making your patient and family feel relaxed and confident before you take them back to the OR.




*Direct Provided -- It's when the anesthesia attending provides the anesthesia without a helper like a CRNA or resident.

Saturday, June 2, 2018

My blog is not interesting anymore.  Blogging is passé anyway.

I wish I could talk more about work things, and anesthesia but obviously I can’t talk about colleagues.  And Unfortunately talking about anesthesia frankly and openly makes people fearful of having surgery, even though it is safer than it ever had been over the course of history.  It’s a shame.  On one hand part of our job is to put on a show to make patients feel safe and secure. On the other if nobody knows how we are adding value, then people start figuring that we don’t and try to eliminate our jobs.  You can’t win.

Plus, in this day one can’t really talk frankly about ones life because you never know who is reading or who might take offense and miscontrue something you’ve said.  This is not unique to medicine certainly.  My husband and I were chatting this morning and he was saying when he runs into friends, neither side can really share fully about anything that is happening at work or in life.  Nobody really knows anyone anymore.  Work and life have become so integrated that we must put up walls around ourselves and maintain a professional facade in all areas of our lives.  Has it always been like this?  Because It sucks.

Anyway, nothing is wrong, and things are good.  I’m happier than I’ve been in years pondering this next transition to fellowship, knowing that it will be hard as I am starting over again.  I am excited for the opportunity to learn this field, and make new friends, but also sad that most of my close friends from residency will be moving away and I will be alone again.  I hope it isn’t as bad as I think it will be.  But it probably will be worse.  It’s really aggravating to think that at 41 I still can’t choose both where I live and what I do, but in medicine, at least in academics, that’s what it is.

Oh well.  I did this to myself.