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Monday, January 29, 2018

What is wrong with you??

Lately, I've been cutting back my hours at work for it to be more in line with the part-time job I originally signed up for.  This resulted in an interesting conversation.

Coworker: "Can I ask you a question?"

Me: "Okay...."

Coworker: "I don't want you to be offended."

Me: "Oh my God.  Just tell me the question."

Coworker: "Why would you want to work part-time?"

He wasn't trying to snark my decision, but was actually genuinely baffled.  Why would I want to work 60% time and earn 60% of the money everyone else does?  Many other people go in the opposite direction: picking up per diem work wherever they can get it.  I know one guy who does per diem work both days of every weekend after working all week.

It was easier to justify to others working part-time when I had babies, although in some ways, I'd rather be part-time now.  My kids are SO much more interesting now.  And while daycare always ended at 6:30, school ends at 3, and I actually have a chance to be there when they come home from school.  I can help them with homework instead of entrusting it to the afterschool program.  I can go to girl scouts.  I can actually be an involved parent.

And the other factor is we don't live large.  I don't like to travel. I don't like to go to expensive restaurants or shows. I'm wearing the same winter coat I had in college.  We have all the same furniture we bought a decade ago at a discount furniture shop.  And we live this way not because we're depriving ourselves, but because I simply don't long for anything different.  If I won the lottery, I don't know if my home would look that different.  But I would work part-time.  That's all I really want.

So if I can, why wouldn't I live like I won the lottery?  Why make a bunch of money I have no interest in spending just for the sake of making money?  We make plenty of money for the life that we live.

And going back to that conversation with my coworker, that was my answer:

"Why do you want to work so much?"

Tuesday, January 23, 2018

Tales from intern year




I am now several months into intern year. The first few weeks... months... of intern year almost seemed like a daze. Wake up. Work. Eat, sometimes. Sleep, maybe. Rinse and repeat. It was only a few short months ago, which almost seems like a lifetime ago, that I was looking back at the trek through med school and wondering what loomed ahead in intern year.

Several weeks after that, I was sitting in an orientation for newly minted residents, listening through a whirlwind of talks about figuring out the EMR system, deciphering HR benefits, wellness talk by the program director, who predicted our intern year trajectory would go thusly: "first 2 months being scared s#@*less, next 2 months starting to feel little more comfortable, and the next 2 months, which puts us squarely in the middle of the long dark nights of winter, being depressed, the gloom of which will start to lift off with more daylight hours".

The beginning of intern year felt so jarring, to one day suddenly have people refer to me as "Dr. Lastname" instead of "Firstname" or "yo medstudent". Not exactly an unexpected outcome, I got plenty advance notice that was coming after 4 years of medical school. But I was so used to being either ignored by nurses or being treated as a nuisance, that when they suddenly started asking or paging me about whether to give insulin to this patient or Ativan to that patient, yeah, my thoughts at the time are illustrated above.

I remember agonizing endlessly over the smallest of decisions in the beginning. "Doctor, this patient is asking for Tylenol". "Let me call you back in 10 minutes after I do a thorough chart review to make sure I don't harm this patient with Tylenol with some contraindication that I haven't thought of as yet". I distinctly recall the jubilant moment of the first day of intern year when my co-intern and I high-fived each other after our biggest accomplishment for the day, figuring out where the restrooms were!

As months rolled on, just by the virtue of doing the same thing over and over, I started to feel more comfortable. Though I have soooo much more to learn and improve upon, reduction of that initial cognitive burden (figuring out the EMR, where the restrooms are etc.) has helped with efficiency. Some things have started to become second nature, with enough jolts to snap me out if I become to reliant on heuristic thinking.

There was something to what our program director said in the beginning of the year. We mostly followed his predicted trajectory, cluelessness --> tenuous comfort --> gloom. Which now brings me to the deep dark cold months of winter, which coincides beautifully with the peak of influenza season, everyone getting sick, chaos of finding coverage, and on a personal front, uncertainties of kindergarten/pre-K lotteries. Perhaps his predicted trajectory will continue, and when things settle down, and there are more daylight hours, gloom will lift?

Wednesday, January 17, 2018

Doctors Make the Worst Patients (Part 2)

You can take the girl out of the mania, but you can't take the mania out of the girl.

That doesn't even make sense, I know, but most of December not long after I was diagnosed with hypertension was senseless. When I went for a follow up two weeks later the nurse asked if I forgot to take my medicine. "Are you on Adderall?" she asked. Heck no. This beta blocker is just about the only prescription drug I've taken in my life besides rare antibiotics. "Well take a deep breath. Maybe I can get some better numbers. You know you've gained three pounds." This, a pet peeve of mine. I hate when I tell them I don't want to know my weight due to my OCD tendencies with numbers and they make comments about it. I reminded her we are in the middle of the holiday, everyone gains weight. She smiled, shrugged, repeated the study. Still sky high. So my doctor started me on a second drug, told me to take my pressure once a day to make sure the numbers were going down, and come back in two weeks.

Sure enough the numbers came down, but I was in despair. Two prescription drugs? Hypertension doesn't even run in my family. I bumped into my cardiologist friend in the cafeteria on call New Year's Eve weekend, and shared my story. He told me to get on a low salt diet, specifically the DASH diet. I promised and walked over to get my normal lunch - a cup of soup, which to my alarm had almost as much sodium as a normal person needs in one day. I withdrew from the soup stand in fear and grabbed some fresh veggies from the salad bar.

Now I've been on a lot of diets in my life for various reasons - gluten free to calm down IBD, watching calories, etc., but I learned over the next few days avoiding salt is like avoiding the AIR WE BREATHE. It's in everything. Last year I was so proud of myself for buying unsalted butter but I needed to get a little more serious this time. Soup was out the window. Soy sauce, even the low salt OMG. Salad dressings. All preserved and canned foods. Most things pickled. The yummy salami and pringles and cheese that my impossibly and aggravatingly fit husband brings to the couch to watch TV after a full dinner every night; somehow he can do this whether he's riding his bike or sitting on the couch for two months and gains not an ounce of fat. My body is not so forgiving. It has to go.

I made a quick trip to the supermarket and bought every superfood to lower blood pressure I could find on Google on New Years Eve. Ordered ground flax seed off of Amazon.  Have you ever eaten naked beet chips? If you do, when you go to get that little bit out of your tooth don't worry, as I did, that your mouth is bleeding. And I guarantee one naked beet chip will be enough for the rest of your life. I drastically cut my food intake. I went back to the doctor for my yearly wellness visit a few days later, ugh. I've visited the doctor more in the past month than I have in years. The nurse, again with the weight thing. "You've lost 12 lbs since you were last here." I was startled. I certainly did feel less bloated. I guess I was so salt overloaded I was carrying at dozen lbs. of excess water weight that took only 10 days to shed. In retrospect I did spend much of the first two days in the bathroom. Current in office blood pressure: 100/70. Whew. The doctor was so impressed he advised cutting back the water pill in half.

Well, that didn't work. The numbers crept up. And thanks to the nurse telling me my weight, I was manically stepping on the scale every morning. The cardiologist informed me that some people have a low tipping point, and mine is obviously one of those - losing a few pounds could help a lot. When four days later my weight hadn't changed despite severe food restrictions and my blood pressure was so sky high it scared me into taking the second half of that pill I had an uncharacteristic ugly cry meltdown in the shower, laced with intermittent screams of rage at lack of control. The very same me that read The Untethered Soul two months back and decided my soul had transcended any Earthly need for control. I took a deep breath. I am the same person that looked at myself in the mirror admiringly a month ago without knowing the numbers. No more numbers. And what was that diet the cardiologist recommended again? I googled and found there was a book! On the DASH diet. Whew. I can do anything with a book. I ordered it on Amazon and learned it is ranked #1 Best Diet Overall by US News and World Report. It was developed as a heart healthy diet and turned into a sensation. And better yet there was a new one published advertising eternal youth as well! Well, younger you anyway.

It arrived Sunday and I skimmed it over an hour. Got the gist. To my relief I can actually add food to my  current restricted diet, a lot of it, if I just eat the right things. And it's really easy, except the suggested recipe part that almost gave me a nervous breakdown. And the part where it gives examples that seem to require I quit my job and tie myself to the kitchen to create such a varied diet. Luckily I can largely achieve the basic formula with food at my grocery store and in the hospital cafeteria. Maybe try a recipe every few months if I get a day off. And it encourages daily red wine! Perhaps not as much as I'd like but definitely a plus. I'm just waiting on my food scale from Amazon to learn what four ounces of fruits and veggies are, guestimating in the meantime. Reminding myself that this doesn't have to happen overnight. Hopefully if I keep it up a few months I can get off of the meds. I'm 44 years young, I've got a lot of days left in this meat suit. I've got to keep it going - there's much more to do.


Saturday, January 6, 2018

To OB or not to OB...that is the question

Career advice wanted

I’m having a mid-residency crisis. I’m halfway into my three year family medicine residency, which means in a year and half there will be much more independence but also much less of a safety net below me.   I want to practice in primary care - so I know that it won’t be hard to find a job, however will be much more difficult to find the right one. I’d like to continue doing underserved medicine of some variety - but not sure if that means staying in the city as I am now or moving to a rural area, possibly closer to family now that Baby is here. I’m currently ruminating on whether I’d like to continue practicing OB or not.

It was a surprise to me how much I liked practicing OB as a resident. I liked it as a med student enough (although I will forever hate ORs - I’m too clumsy with too little body spatial awareness) but doing deliveries of my own clinic patients has been so rewarding and energizing. When I find that precious time to devote to independent learning, I find myself reading OB literature (and staying awake through it) more than any other kind.

Today was the first call for a delivery I’ve had since our own Baby was born. As timing goes, it was perfect for me. I was called at 6 am, ran to the hospital, and was back after a beautiful delivery by 9 am. It was great for me - but maybe not so much for Husband. When I left at 6, Baby was just starting to wake up and Husband had stayed up late working the night before, was already awake and was very much looking forward to a morning nap. He didn’t say anything negative, but his expression was less than pleased.

...and this is a best case scenario when I got called in. Our residents are continuously on call for our own patients with lots of back up as with residency schedule we may be working nights or a hospital shift elsewhere that we may not be able to leave. My husband didn’t realize it was a possibility that I would be going in today, but the reality is it’s pretty much always a possibility as I’m usually within 2 weeks of a patient’s due date and babies don’t always come on schedule. And I think as an attending, I’ll likely be much more responsible for my own patients’ deliveries - although having adequate back up is something I am definitely evaluating as part of my future job.

So my question is... can we do this? Or more accurately, will it be worth the effort to do this? We don’t have family close. We don’t really have an emergency contact nearby who can watch Baby if plans change quick. I think I can handle the lack of sleep and unpredictable hours, but is it fair to ask my family to do the same? What about when we want to leave town and spend time with our family? Husband and I have had several conversations and will continue to do so over the next 6 months as my patients continue to deliver and we’ll see how it goes.

 I just really wanted the advice of some moms who have been practicing outside of residency for awhile. Spoiler alert: this likely won’t be my last post asking for career advice. Are you doing what you want in your careers despite a somewhat demanding call schedule? Or did you find that giving up a bit of call was worth it for a little more overall family stability?

Friday, January 5, 2018

The Little Echo

Almost a year ago, I was worried about her lack of verbal expression. Now, she talks constantly. She knows so many words, it’s amazing. But I'm starting to realize that having a highly verbal child exposes your own verbal ticks.

She adorably engages in imaginary play with lots of critters and stuffed animals. When they “take naps”, she shhhhhs them really loudly and pats them quite vigorously. Hopefully that’s not how she sees my pats and shhhhs. She scolds the dog in the same booming tone and inflection as my husband. She rattles off “thereyago” all the time. Apparently I say this a lot. Along with some choice swear words, particularly the ones that start with S and F, when I drop things or mess up in some way. Bad mama.

But most concerning is actually her use of “sorry”. I’d rather have her throwing around an occasional swear word than apologizing for everything she does. I didn’t realize it, but I do this too. It’s such an easy word to say, yet the meaning is both diluted and potentially detrimental when used to frequently. Saying sorry is apparently epidemic among women. There have been so many pieces written about this in the past few years, but I found this one most entertaining (replete with GIFs). Sasha at Brave Enough gave examples of how sorry is frequently used by women in the OR. After reading this, I'm going to think about what I say the next time there is an anesthesia delay during surgery.

What about you? What do you say that your child echoes back to you, and has it prompted you to change the way you talk?