Showing posts with label Day in the Life Topic Week. Show all posts
Showing posts with label Day in the Life Topic Week. Show all posts

Thursday, December 10, 2009

A day in the life of a part-time medical oncologist

Note: I am a medical oncologist who works part-time, two full days and one half-day at work and the rest of the week at home with my kids (almost 2, 4, and almost 6). We have a part-time nanny who comes on my 3 workdays. This is my half-day, which probably captures a little bit of both of my worlds.

5:10am Wake up to sound of husband opening drawers as he gets dressed. Open eyes briefly to see gorgeous man a few feet away. Too tired to appreciate him aloud, I smile blissfully and fall back to sleep. I'm married to that guy!!!

5:55am "Mama, milk please. Milk, Mama!" on the monitor. Go get my youngest from her crib who greets me with a toothy grin and nurse her in my bed. Wonder if I am still nursing her (usually once a day, either morning or bedtime, but occasionally both) because I am tired and this gives me a few minutes of snooze or because she likes the bonding or because I like the bonding or all of the above. Fall asleep wondering how I will wean her--she will be 2 in a couple months.

6:15am Wake up to youngest saying "Shhhh! Listen...mourning dove!" She's right. How does she know what a mourning dove cry sounds like? Aren't they supposed to fly south for winter? "Read Tick-Tock, Ears Hear a Clock!" Hop up, make the bed, change diaper, get her dressed for the day, and read her about 15 board books in her glider under a pile of blankets.

7:10am My 4 yr old wanders in with bedhead and slides under the blankets with us. We reread half of the stack of books, as well as two Fancy Nancy books she brought with her. Kids finally tire of reading and start to play together. I pee and brush teeth.

7:50am My 6 yr old wakes up to the sound of his sisters playing together very loudly. He is grumpy because he's still tired. He needs 12 hours of sleep per night or more and seldom gets it because he is such a night owl. Vow to do better at coaxing him to bed early. Start his Pulmicort neb.

8:00am Big kids use the potty and get dressed while I supervise. Dispense kids' Calcium chewables and son's asthma medicines and ask them to identify the pattern (my son's latest kindergarten task): "pink, purple, purple, orange...A, B, B, C" the older two shout in unison. Brush 3 sets of teeth. Start washing machine, loaded up and forgotten at bedtime last night.

8:15am Cook oatmeal while big kids decorate Christmas cards for friends and classmates at kitchen table and baby drives her doll and Curious George around downstairs in shopping cart. Empty dishwasher and finish packing lunches for preschool and school. Think it would be better if I emptied dishwasher and packed lunches the evening before.

8:30am Breakfast with kids. Baby insists on sitting at table, not in high chair.

8:40am Baby dumps bowl of oatmeal and raspberries everywhere. Clean up floor and notice that there's also a LOT of dried-up dinner remnants from last night and random fuzz down there, too.

8:45am Load dishwasher up, then chase kids around downstairs with the Swiffer Vacuum (incidentally, they love this and don't realize that I'm actually doing housework since I run with it like a maniac...try it.)

8:55am Walk 6 yr old son to bus stop for kindergarten. Kiss goodbye. Nanny arrives and drives 4 yr old daughter to preschool with my 22 mo old daughter along for the ride.

9:00am Grab charts, work papers, laptop, gym bag, lunch, cell phone, and wallet. Check email. Move clothes from washer to dryer. Get into car to head for the gym.

9:05am Back at home. Forgot my glasses. On the way to gym again.

9:15am Pilates.

10:20am Surprise preschooler by joining her preschool class in the pool for last half of their rec swimming time (preschool and our gym are adjacent and share a pool). Asked nanny to bring the 22 mo old up to the pool, too, so we all swim around together.

10:45am Shower, dress, dry hair quickly, no makeup (which is the rule rather than the exception lately, though I try on workdays...). Drive a mile to my son's elementary school.

11:15am Help my 5 yr old son and 22 of his classmates stamp snowman shapes onto t-shirts using glitter paint and potatoes.

11:45am Eat a sandwich in the car while driving to clinic. Conference into a meeting about clinical trial design issues, listening through the car's speakers via Bluetooth. Feel glad that we did not trade in our Prius for a second giant family truckster when we had our third child.

12:05am Sign clinic notes, bill outstanding visits, discuss patients with fellows, review two abstracts on which I am a co-author, read and respond to work email. Overhear fellows talking about the new breast cancer screening guidelines. They ask what I think about them. I explain that I can see both sides. Note that all of the female fellows are somewhat sympathetic to the pro-screening side of the argument; none of the men are. Interesting. Wonder how that impacts our counseling of patients. Note that inbox is now over 2000. Wonder what would happen if I just emptied it. Nurse asks if I had exfoliation or something. Thinks I look younger today. I tell her thanks but no. Remember that I'm not wearing any makeup. Look at my reflection in the exam room mirror--maybe she's onto something. I do look younger without makeup.

1:00pm-5:00pm New patient consultations, all breast cancer, often alone, occasionally with fellows. A representative sample:

32 yr old woman with high-risk early stage breast cancer. Recommend a clinical trial. She will need to travel to participate. Could also do aggressive chemotherapy outside of a trial, but not my first choice. Offer tissues to her as she cries periodically and entire tissue box, flashlight, reflex hammer, tape measure, and rolls of gauze to her 13 month old son who is toddling around the room and holding it together remarkably well for the lengthy visit. Mother, also in attendance, expresses outrage over the new breast cancer screening guidelines, which could have killed her daughter. I explain that her daughter is only 32 and wouldn't have been affected by these guidelines, which refer to women age 40 or older. That her tumor was palpated and not visible on the diagnostic mammogram even after the mass was felt. That these very aggressive tumors, such as her daughter's, tend to develop over months, not years, and often appear between annual screenings anyway. Cases like her daughter's are part of the case AGAINST mammograms in young, premenopausal women. She reiterates that no one seems to care that the guidelines could have killed her daughter. I decide I am not being a very effective communicator.

43 yr old woman with a smallish focus of ductal carcinoma in situ. Has had genetic counseling and isn't a BRCA mutation carrier. I recommend lumpectomy with radiation and tamoxifen for 5 yrs, which will reduce her risk of recurrence or a new breast cancer by nearly half. She wants bilateral mastectomies to save her life. Tell her that her prognosis is excellent, that there is no data to suggest mastectomy will improve her survival, and that bilateral mastectomy is absolutely overkill. She has two small kids and doesn't care. She wants them off. Wonder if I might not make the same irrational decision if I were in her place. Print out a patient education sheet from one paper showing no survival benefit for mastectomy. She shrugs and I give her the name of a good reconstructive surgeon. She declines the tamoxifen.

78 yr old woman with a recently resected very large, node-positive neglected breast cancer. Really, really, really don't want to have to give her chemotherapy. Wonder why she ignored this thing for so long. So I ask her. I was hoping I'd die before anyone ever told me I had cancer. Does she want to die? No, of course not. Does she want treatment for cancer? Of course. Recommend chemo in addition to hormonal therapy. Hold breath and hope chemo will do more good than harm. Think it will but never know how old a 78 yr old really is until she gets chemo.

35 yr old woman with stage 1 breast cancer, no family history, diagnosed by screening mammogram. Recommend chemo and hormonal therapy. Talk about fertility preservation and the chances of having a successful pregnancy in her 40s after chemo and 5 years of tamoxifen. She is angry about the new breast cancer screening recommendations. Her life has likely been saved by a screening mammogram, at age 35 no less, that her GYN recommended based upon several years out-of-date guidelines. She asks what I think about the new guidelines. I can't tell if it's a challenge or not from the tone. I spend 15 minutes explaining how there are valid points to both sides of the debate. Again. She seems unsatisfied. I think she was hoping I would agree with her or disagree with her but not both.

42 yr old woman with locally advanced breast cancer that was diagnosed by a screening mammogram, but must have been palpable months before. Wants a second opinion about the choice of preoperative chemo. Also asks what I think about the new breast cancer screening guidelines for women in their 40s. Think maybe I should put what I think on a shirt and wear it to clinic. I tell her that it's kind of like playing the lottery. You'll probably buy a ticket every week (i.e. get a mammo every year) and nothing will come of it. It will definitely cost you, but probably not that much. If your number gets picked and you win, you will think you clearly made the right choice to play. If you don't, maybe you'll regret all those tickets you bought and maybe you won't--that's kind of a personality and values thing. It's the shortest and least meaningful commentary I have made on the breast cancer screening guidelines (which I have discussed about a dozen times a day at work and socially) since they were released. I am tired. "That's the clearest, most thoughtful way of summing it up that I've ever heard," she tells me. Sigh.

5pm Grab charts and rush out to Tumor Board. Run into (literally) an out-of-town patient in her early 40s I had seen almost two years ago with a very high-risk, inoperable triple negative breast cancer. She had flown down to see plastic surgery about reconstruction and decided to stop in to surprise me. When I saw her in 2007, I had recommended that she go on a clinical trial that involved traveling hundreds of miles from home frequently. It would take her away from her school-aged kids. I had agonized about whether it was the right choice--it was a long shot--given all the time away from her family and her potentially short survival if it didn't work. She had been lost to follow-up at our institution. She had done the trial, had the preoperative chemotherapy, had an amazing response. At the time of mastectomy, she had a pathologic complete response (no tumor left in the breast or lymph nodes). PET scans every few months had all been clear. It is likely that she is cured. YES!!!! She hugs me and cries, cries, cries. Tells me that's the first time she's cried since the original call from the surgeon telling her she had breast cancer. I think I might cry too--a combination of joy, exhaustion, and hypoglycemia.

5:10-5:45pm Slide into Tumor Board 10 minutes late. Eat a disgusting pastry left over from some conference earlier in the day. Regret it. Think I should really plan better and bring a healthy snack. I am always famished after clnic. We have plenty of food in our fridge. Why is that so hard to pull off? Discuss my and my colleagues' challenging cases. Surgeons are running the show and have little patience for the medical oncologists yapping on and on, so we end 15 minutes early.

5:50pm-6:10pm Commute home. Listen to NPR for a few minutes and then call my best friend, who also commutes home at this time, via Bluetooth stereo speaker. Love the Prius again!!

6:10pm Enjoy the hero's welcome at the front door by all the kids and hubby. (Incidentally, no hero's welcome for me from the kids on the days I stay home with them!)

6:10-6:30pm Make black-bean pumpkin soup with 5 minutes of prep and quick-steam string beans in the microwave. (Love Aviva Goldfarb's Six O'Clock Scramble website for fast, healthy meals that everyone in our household will actually eat--check it out!) Mix up banana bread from scratch (6 yr old has food allergies, so no mixes for us) and put it in the oven. While dinner cooks, sit down at our kitchen table with a family-sized bowl of strawberries. Help 6 yr old with his phonics homework, congratulate 4 yr old on being selected "Top Dog of the Week" at preschool, and collect a few dozen random items on my lap, brought to me by my 22 mo old.

6:30pm Dinner with the whole family.

6:45pm Chase kids with Swiffer Vacuum again (they could do this all day) while husband loads up and starts dishwaser.

6:55pm Bath time!

7:10pm Everyone in PJ's. Back downstairs to have a bedtime snack of banana bread and apple cider. Love the fall treats!

7:20pm Help son with a Lego dragon he is building. Girls come into the room wearing dress-up clothes and costume jewelry (pajamas off). Make up a story that incorporates princesses AND dragons. Agree to tell the exact same story a second time, by popular demand, if girls will get back in pajamas. Make this request about 10 times. It eventually works.

7:45pm Everyone BACK in pajamas. Teeth brushed. Play Tickle Monster, also by popular demand. The baby old slips in her footie PJ's and falls. Big tears, overtired tears. Boo-boo buddy and special blankie. Evening saved.

7:55pm Husband starts reading bedtime books to all 3 while I fold the laundry on the floor in the room with them. As I finish up, little one comes over to sit in my lap with her thumb in her mouth and a longing look.

8:05pm Nurse 22 mo old in her room. Wonder if I am nursing her because it gives me a chance to sit down and unwind in a dark room or because she likes the bonding or because I like the bonding and decide it's all of the above. Wonder how I will wean her--she'll be 2 in a couple months. Fall asleep wondering. Jostled into the land of the living by my son, who wants me to read the last book.

8:15pm Put little one in crib and tiptoe out. Read the last book. Put my 4 yr old in bed and sit in her chair, her nightly request, for 10 minutes to talk about her day. Kiss her good night.

8:25pm Flop on my son's bed and beg him to join me. He draws portraits, dinosaurs, robots, all the items he would like at his next birthday party (including details of the party favors, pinata, cupcakes, and juice boxes), and does math problems standing at his dresser. I get snapshots of his day with answers to every third question.

9:00pm I tell him I will give him math and spelling problems if he will get in bed. We lie there together in the dark. Ok, how about CHICKEN? Um, C-H-I-C-K (it's CK, right, Mommy?)-I-N. Close, it's E-N. What about THICKET? T-H-I-C-K (it's CK, right, Mommy?)-I-T. Close, it's E-T. Ok, try CRICKET. C-R-I-C-K-I-T, no wait C-R-I-C-K-E-T!! Hey, is this a pattern, Mommy!! Let's do more patterns. Ok, try 2,4,6, blank, 10? He yells out 8. How about 10, 30, 50...? He says 70, 90, 110, 130, 150...I fall asleep while he's still counting. Apparently counting sheep works even when there aren't sheep and even when you count by 20s. At some point, I notice that he has gotten back up and turned the light on to draw again. When he sees me wince, he dims the light but keeps drawing, standing at his dresser. We should get a desk for his room, maybe for Christmas, I think. On second thought, maybe not--he'll never go to bed again. I fall back to sleep.

9:50pm Wake up in my son's bed to my son, now back in bed, asking me to scratch his back. I do and he falls asleep. Vow to get him to bed earlier tomorrow.

10:00pm Find my husband flipping between sports channels and playing Scrabble on computer during commercials. Sit down to watch 30 minutes of stand-up comedy (Brian Regan, totally hilarious). Laugh really hard, but fall asleep at the end of it.

10:25pm Husband shakes me awake, and I get in pajamas, brush and floss my teeth and wash my face. This wakes me up. I decide to go downstairs to pack lunches for the next day, notice that we need their thermoses which are in the clean dishwasher which I then unload, notice that we are out of yogurt and napkins so start a list for the store, sift through the day's mail and notice two bills that I need to pay. Too busy to let them wait, we might forget. Get online to pay the bills and realize that I also need to do our bi-monthly nanny payroll, which I do. Notice on our office desk a receipt for Motrin and Benadryl and fax it into our FSA. Look on travelocity at plane tickets for Christmas, which are now too expensive for the 5 of us...guess we'll be driving. Speaking of Christmas, I still haven't written our Christmas letter or done almost any of my shopping. Get on and order gifts for the nieces and nephews since they all have to be mailed, as well as a few things for the kids. Try to figure out what to get my husband (don't know) or what I want (keep getting that question from my family, don't know). Send my sister pictures for a calendar she is making for my dad for Christmas. Spend 20 minutes on Facebook reading about who is still eating their kids' Halloween candy and who says The Gentleman from Connecticut had better not filibuster, buster and who has found a lonely cow on their farm.

12:05am Join sleeping husband in bed.

12:06am Realize it's cold in the house. Go cover up the girls and put my 6 yr old, who falls out of bed every single night, including tonight, back in bed.

12:08 am Join sleeping husband in bed. Look at the window and realize the Christmas lights are still on. Go down and turn them off. Feel pretty awake again. See New England Journal and Real Simple on the chair by the door. Decide to read Real Simple for just 10 minutes. Read for 15 minutes. Feel guilty. Start reading "Case Records..."

12:30am Wake up when my head jerks forward. Re-join my husband in bed and fall asleep.

A Day in the Life of a Neurosurgeon – SERIOUSLY?

6:00 am – Out of bed, to the shower
6:35 am – Wake up 11 yo son, remind him to take ADD medicine this morning
6:40 am – Feed 3 hungry cats, out the door to work
7:00 am – Sign and update day’s surgical H&P’s, type an overdue office note into EMR so procedure can be precert’d for Friday
7:10 am – Breakfast, grits and poppyseed muffin, with premed student who’s shadowing this month
7:30 am – See first surgical patient in preop, sign chart, dress in scrubs
7:45 am – Call medical records to assure them I did the overdue discharge summaries last night and I’m back on staff
8:00 am – Do first case, small outpatient procedure
8:40 am – Talk with first pt’s family, see next patient in preop holding, write postop orders, handwrite prescriptions since EMR printer not working AGAIN
9:00 am – Start next case, 2-hour outpatient procedure.  Get page about emergency cerebellar stroke pt en route to ICU from sister hospital, need to consult
9:30 am – Review films of stroke pt during short pause in surgery, obviously needs emergent craniectomy.  Book case, give anesthesia instructions while operating.
10:30 am – Still operating on pt #2; get paged about another consult, not emergent but needs to be seen today.
11:10 am – Finish case, stroke pt not here yet.  Speak with family, write postop orders, decide to proceed with next case (1 hour inpt surgery) while waiting for stroke pt
11:40 am – Start case #3 after difficult awake fiberoptic intubation.  Play Christmas music to improve mood.  Get paged about consult #3 – brain mass.  Start getting irritable, since this was supposed to be a short day (get home at 6:30, actually see family and get dinner made, start decorating tree we brought home on Saturday).  There goes any chance of getting home before 9:30 AGAIN, on a day I’m not on night call.
12:45 pm – Finish case #3, talk to pt family, write postop orders.  Run upstairs to see stroke pt.  Awake but with ominous “pressure” headache.  Discover the internist started him on blood thinners 2 days ago (including Plavix), and he had a dose this am.  Delay emergency OR so platelets can be transfused. 
1:15 pm - Cancel last 2 scheduled elective cases to accommodate emergency.  There goes Dec 18th’s light schedule.  Soothe angry patients who have to be fixed before their deductible starts over Jan 1.
1:30 pm – Field call from our other hospital’s trauma committee chief, chewing me out for taking too long to see a trauma patient in their ER two weekends ago on call.  Explain that when I got their call, I was operating on the day’s second emergency case in the other town and couldn’t leave that patient on the table.  Called partner for help, who wouldn’t come in.  After finishing case, drove straight to ER 30 min away at 11:30 pm after operating since 8:00 am. Got stopped by police for speeding. Took pt straight to OR, operated until 4:00 am.  Pt survived and had great outcome.  “Oh, okay, I guess the circumstances were understandable.”
1:45 pm – Drop by doctor’s lounge for a cup of soup while platelets are being prepared.  Watch news about health care reform.  Wonder how many hospitals will have to close with Medicare cuts, and how many physicians will be able to stay out of hospital employment situations.  Realize there’s nothing I can do about it.
2:30 pm – Pt rolls into OR.
3:00 pm – Begin emergency surgery.  More Christmas music, reminding me I haven’t done any shopping or even thought about what to get for which people.
4:58 pm – Still operating.  Get paged about consult #4.  On call partner takes over at 5:00 pm.  Hospital called him first, but he told them to call me.
6:00 pm – Finish emergency.  Speak with family, write postop orders.  Review films on postop pt in rehab with new leg pain.  Can’t tell if his graft has migrated.  Order CT scan.
6:15 pm – Change out of scrubs, see patient with brain mass.  Order additional testing, type consult note.
7:00 pm – Answer text from husband to tell him I won’t be home for dinner AGAIN.  Attach sad emoticon.  Advise him to use olive oil to make couscous for the vegetarian exchange student who lives with us during the week.  Remind him to make sure son takes anxiety meds tonight.  Husband texts back that son only got sent out of one class today for disruptive behavior.  Progress.
7:05 pm – See consult #3, pt with back pain.  MRI films aren’t here, instruct pt’s family to bring tomorrow so we can make decisions.  Type consult note.
7:45 pm – Field question from floor nurses about a postop patient, preventing the need to disturb the on call partner.
7:50 pm – See consult #4, pt with back pain.  Explain to family why I didn’t get here earlier.  Discuss treatment plan, not surgical.  Enter orders and type consult note.
8:30 pm – Check on craniectomy pt in ICU.  BP is 210/130.  Start Cardene drip.  Otherwise doing well.  Hug family member.
8:50 pm – Stop by office to check messages.  Ignore inbox on my desk (known to my staff as “ Mount Surgeon .”)  Review To Do list, realize I can’t mark off a single item.  (There are 18.)
8:55 pm – Glance at call schedule accidentally, reminding myself that I’m on call Christmas (Thurs-Mon) and on backup for New Year’s.
9:00 pm – Rest for 5 minutes to read this blog, am inspired to write this guest post.
9:20 pm – Start wiping away tears as I think about what I’ve just written.  I used to love my career, but I am realizing how sick and tired I am of this workload - of not seeing my family, not being ready for holidays, using weekends to catch up on charts… of being dumped on by partners and pushed around by insurance companies.  I can’t remember what I used to do for fun, and I can’t figure out why I’m still getting out of bed for this, day after day.  Why would anybody want to have a day like this, or worse, 5+ days a week?   I know, it’s supposed to be hard, and the culture of neurosurgery is to suck it up and avoid asking for help, because that’s a sign of weakness.  Maybe my fellow residents were right after all, and I’m just lazy.  Maybe I just need to finally reconsider my options and decide whether this has devoured enough of my life.

Wednesday, December 9, 2009

Day in the life of a physiatrist

Note: I am a PM&R clinical and research fellow.

5AM: Melly crawls into our bed and the kicking commences. If her head is on our pillow, how is she still able to kick me in the ear?

7AM: Alarm goes off.
Me: "I have to shower."
Husband: "No, I have to shower."
Me: "Goddammit."

Me: "Melly, would you like to sit on the potty?"
Melly: "No."
Me: "If you make on the potty, you'll get a treat."
Melly: "No, I'm doing something."
(She's a very busy girl.)

Me: "Melly, it's time to get off the potty."
Melly: "No."

8:10AM: Day care drop-off.
Melly: "Mommy, I don't like day care. I want to go home."
Me: "You can come home later."
Melly: "No, NOW." [tries to slip out the door]

8:20AM: I arrive at my bus stop. Bus is just pulling away from stop. I am waving my arms and yelling, but it doesn't stop. I am certain everyone on the bus sees me and is laughing to themselves. If I am feeling particularly limber, I chase the bus down at the next stop.

8:45AM: Arrive at work, pretending I've already been there for the last fifteen minutes.

Patient: "My back hurts."
Me: "I think you might benefit from a course of physical therapy and/or injections."
Patient: "Can I have Percocet?"
Repeat x infinity

11AM: EMG time
Me: "Please relax your arm while I stick this giant needle into it and move it around."
Patient: "Gaaahhhhhhh!!!!!!"
Me: "OK, you're not relaxing."

1PM: Work on IRB application during lunch, while fantasizing about a long ago, simpler time, before I knew what the hell an IRB application was.

2PM: Research meeting
Colleague #1: "Research is frustrating."
Colleague #2: "There are many barriers to doing research. Let's discuss these."

4:30PM: Head home.

5PM: Arrive at daycare. When I get there, all the remaining kids crowd around the door, crying out, "Mama!"
Me: "Time to go home!"
Melly: "I don't want to go home. I want to stay here."

Day care worker: "You know, Melly really loves babies. You should have a little baby brother or sister for her to play with."
Me: "If she agrees to take care of the nighttime feedings, then no problem."

6:30PM: Dinner. For years, we used to eat in front of the TV, but now my husband wants to eat at our dining table and have "family time." Loser.

"Melly, would you like to use the potty?" vs. "Don't worry, we'll clean up the pee on the floor."

8:30PM: Melly's bedtime. I lie next to her in bed and generally fall asleep myself, waking up 1-2 hours later, completely disoriented.

11PM: Watch one of a selection of TIVO'd programs, including The Office, 30 Rock, Parks and Recreation, Top Chef, South Park, or Glee. In the meantime, I prepare lunch for the next day for me and Melly.

11:30PM: Bed time for real. I drift off to the sound of my husband's CPAP machine.

A Day in the Life of a Part-Time Pediatrician

I am a pediatrician working part-time and mother to a 4 month-old and a 6 year-old.  I work 3 days a week.  My husband is a physician working full time.  Below is a typical work day.
5:15 AM Wake up, try to sneak out of bed without waking co-sleeping baby, shower, get dressed
5:45 AM Eat breakfast, take a pill of lecithin to prevent plugged ducts (I must hold some sort of record for having the most number of plugged ducts by 4 months post-partum)
6:00AM Call hospital to find out how many newborns to round on then call other docs to come in if reinforcement is needed
6:30 AM Get to hospital and round
7:50 AM Pump in NICU pump room while reading Us Magazine
8:20 AM Drive to clinic and start seeing clinic patients
12:30 PM Done with AM clinic, answer Mommy calls, Pump, drive home to kiss baby a million times and have lunch
1:30 PM  Start seeing clinic patients
4:00 PM Pump
5:30 PM Done with seeing patients, answer Mommy calls
5:45 PM Pick up 5 year-old at After-School program
6:00 PM Make dinner (I have help with making dinner on work days), play with baby, help 6 year-old with homework, wonder why first-grade homework is so demanding, try to keep baby awake until hubby comes home
7:30 PM Baby is now irritable and wants to sleep NOW, hubby comes home and spends a bit of time with baby, I put baby to bed
7:45 PM Eat dinner
8:45 PM Hubby and I help 6 year-old floss, brush, pick out clothes for next day
9:00 PM Pump then time to relax!!!  TV, internet, read for fun
11:00 PM    Bedtime
1 or 2 AM     Baby up to nurse, change diaper
3 and maybe even 4 AM     Baby up, sometimes I nurse, sometimes I don't and just let him settle down on his own, depending on how tired I am
Yes, I am exhausted but feel so privileged to be able to work part-time.  On my non-work days, I get to play with my kids all day long.  It is truly having the best of both worlds.     

An Average FD Weekend

December 5 and 6, 2009

I am an assistant professor in the family medicine/osteopathic manipulative medicine department at a medical school. My job includes teaching on campus and two days of clinic per week. I do not work with residents or do hospital work at this time.

0530: Hit the snooze.

0600: Get up, shower, dress, meet Husband in the great room where he is feeding Daughter breakfast. Have fifteen minutes "share time," a luxury in our marriage.

0730: Pull into parking garage of local hotel which is hosting the winter cme program sponsored by the medical school for whom I work. This is the final day of the program. I am both presenting and moderating today and must stay through the last lecture.

0745: Have a frightening conversation with an elderly family practice doc, retired, who "never believed in mammograms. " Wow.

0755: Cardiologist thought he was to speak at 0800, my speaking time, and he has to get his son to a soccer thing. I trade spots with him because I'll be here all day anyway.

0845: I give my lecture on EMR (history, political stuff, choosing and implementation). To my surprise, it went very well and was well-received. Spend rest of the day basking in the glow of good feedback.

1200: Had to cut the financial planner's discussion short as it was clear he was overtime and wouldn't be stopping anytime soon. I don't feel too bad as it was basically a sales pitch. I apologized profusely to him and the audience and he kindly left the room. I'm pretty sure I see his tail tucked between his legs.

1300: Final lecturer finishes and I realize his area of interest is mine, too. We briefly collaborate and agree to start a project together, trade contact info. I realize my self-imposed deadline to identify an area for my academic research by the New Year has been met. I give myself an internal high-five, which may or may not feel like a Kegel exercise.

1340: Fill up gas tank, decide to go to WalMart, closer to my house, rather than Target, closer to the gas station, for my quick errand of getting pantyhose.

1400: Leave WalMart SEETHING that they no longer carry Just My Size. Queen size is the biggest they carry now and for my height that means no heavier than 185. Am I the only obese WalMart shopper? Hmmmph! Go through Taco Bell drive-thru as I'm sure a taco will ease the psychic pain.

1415: Back at Target, telling Sister via iPhone about the WalMart incident. She asks me to pick up panty hose for her, too, while I'm there. She too has her work party tonight.

1500: Now at Catherines all the way across town because Target also doesn't carry Just My Size. Picked out a festive party blouse for my work holiday party tonight. Threw in some cheap costume jewelry for safe measure. Retail therapy. I feel calm and somewhat refreshed.

1530: Deliver Sister's pantyhose to her house. She leans in to take them from me and notes my nasty chin hairs reflecting the sunlight. I produce a pair of tweezers from my purse and she plucks them as I sit in my car in her driveway.

1600: Home. Son is playing Noggin games on the computer. Daughter is grumpy, so I give her a bottle and put her down for a nap. Husband jumps in the shower. We need to leave for the party at 1745 and his mom should be here to watch kids by 1730. My mom, apparently, also will be here at 1730 to pick up library books she checked out for Son. After an all out search, we find only two of the three books.

1630: Update my Facebook status and start this post.

1700: Gettin' purty - makeup, sparkly top, jewelry and perfume. Mom-in-law arrives to watch the kids.

1830: Husband and I arrive at the most expensive and exuberant employee party EVER. The Las Vegas theme was complete with showgirls, elvis impersonators, a great band, aerial artists a la Cirque du Soleil, food, booze and gambling (fake money). Many of my colleagues are in costume. We'd planned to stay 30 minutes then ditch out but stayed for the duration. On the way home, Husband notes that the atmosphere was different than he had ever experienced because it was clear everyone, from the president of the university to the maintenance people and cafeteria workers, was part of the same group. "You all seem to really like each other," he said. I agreed. Best Job Ever.

0000-0530 Sleep!

0530: Wake up and straighten house for cleaning lady. Mom-in-law spent the night and agrees to watch the children, for whom a long church day is exhausting because nap time is missed. Husband makes our turkey sandwiches for breakfast so we can eat in the car on the hour trip to church.

0730-1300: Travel, choir practice, School, worship then travel home.

1300-1600: Skip lunch in favor of a nap. I wake when Daughter is crying on the monitor placed by her crib and note that at some point, Husband has taken Son for their weekly parent-child bowling league.

1600-1730: While Daughter plays, I finish up just a few outstanding EMR reports so I can start with a clean slate in clinic tomorrow. I then check the upcoming week's, practical exams for the students, serial committee meetings and Husband will be out of town Tuesday through Thursday.

1730-1830: Dinner with the fam. Turkey casserole that Husband made yesterday while I was at the conference. I note that Daughter shares my love for all foods and I feel a pang in my heart. It will important for me to try to model some healthy habits for her, but first I must adopt them.

1830-1900: Bathtime and bedtime for kidlets.

1900: Finish the medical records catch-up and this post.

2100 (anticipated): Fill my weekly medication dispenser then Go. To. Bed.

A day at the refugee clinic

I get up at 6:40, always reluctantly. I shuffle downstairs to eat a bowl of granola with yogurt while checking email. Ten minutes later Ariana shouts from her bed, "I want to wake up now! Time to wake up!" and forty-five minutes of prodding three kids through the morning routine begins. If they are dressed and seated at the table by 7:30, I make them tea in a white elephant teapot.

We wind our way out of Deep Cove, dark waters to our left and hulking mountains to our right, with CBC Radio 2 playing. I adore Tom Allen's voice and think how my patients would benefit if I could speak in such kind, good-humoured tones. Forty-five minutes later and I've dropped two kids off at school, the youngest at preschool, and parked the van in a neighbourhood five blocks from the clinic.

As I walk to work, I often dread a day of seeing patients. I wish desperately that I were a pathologist working at VGH, looking up from my microscope periodically to gaze out over a view of False Creek. I feel immense pressure to be fully present for each of my patients and in the moments leading up to the start of my day it sometimes feels unbearable.

I am one of five part-time family physicians at the refugee clinic. I typically have five 30-minute appointments booked for the morning.

9:00 My first patient is a 27-year-old Ethiopian woman with a new diagnosis of HIV. I break the news through the interpreter, who is clearly shaken. The patient is distraught. I explain that HIV care and prognosis is different in Canada than it was in her village. Grim though this task is, the face-to-face, front line provision of care to this crying woman seated before me strikes me as an incredible privilege on my part, and any longing for the detachment of a pathology lab slips away.

9:30 The next patient is an elderly Afghani widow with hypertension and depression, well-known to me. At the end of the visit she tells me that when her son was severely wounded in Afghanistan years ago he became a pastry chef. She produces two Ziploc bags of cardamom-flavoured pastries, one for me, the other for the interpreter.

10:00 A 42-year-old Burmese woman comes in for her first well-woman check. I do a pap smear, bimanual exam and breast exam. She had never heard of these exams before I introduced the concept at her last visit. The idea of screening for disease, rather than treating it as it presents, is a novelty to her.

10:30 An elderly Bhutanese man, illiterate in his own language, presents with symptoms of prostatic enlargement. I pull up a diagram of the prostate on Google images and he stares at it. I am not sure how effective my teaching is.

11:00 A Congolese woman comes in for follow-up of her PTSD. She also needs documentation of her torture scars for a medicolegal report. She weeps as she describes how each wound was inflicted. I make detailed notes and feel ashamed of the human race.

The morning is not quite that orderly. One patient brings her two children, and because they've spent ninety minutes getting here on public transit, I feel compelled to fit them in. Two patients are late. The other physician and the psychologist tussle with me over the Farsi interpreter. An infectious disease physician calls to discuss my patient with echinococcosis. The nurse taps on the door to ask for a signature on a parasite medication prescription.

I leave for a quick lunch with my colleague at the Indian place a block away. We head out the back way, bypassing the waiting room that's already filling with the afternoon patients. The clinic is so busy that taking time to eat or pee induces feelings of guilt.

I see prenatal patients on Tuesday afternoons. I have a medical student today. I let her palpate fetal parts and find the heartbeat with the doptone. She is thrilled; I can tell she's going to tell her classmates all about it tomorrow and I feel nostalgic for those fresh and glowing medical student days.

I'm ravenous with hunger by the end of the afternoon, and briefly consider the Fibre One cereal samples, Tums smoothies and chocolate Caltrate Soft Chews in the cupboards. I resist and head out into the December cold to pick up Ariana.

Forty minutes later we pull into our driveway. The cedars are stirring from the wind blowing up Indian Arm and the docks across the water are decorated with Christmas lights. Deep Cove is serene and worth the commute.

I open the front door and the entrance way is strewn with backpacks and toques. We head up to the kitchen where Pete - who cooks every night - has prepared a meal of grilled salmon, asparagus and French bread. Everyone tells anecdotes from their days, including me, but the story I attempt to tell Pete is interrupted so many times that it fizzles out and doesn't seem worth finishing.

I put the kids to bed at 7:00. I crawl under the covers with my five-year-old for a few moments and he suggests, "Hey! How about you move out of Daddy's room and move in here with me?"

I answer any urgent emails and then watch a movie, too often something like Blood Diamond or The Killing Fields or Lost Boys of Sudan, one that turns out to be overwhelming after a day at the clinic. If we've thought to chlorinate the hot tub, Pete and I will spend ten minutes before bed with piping hot water up to our necks, gazing out at the towering spruce trees across the way and the moon on the water.

And then bed, the sweet, delicious coolness of sheets and pillow, and I am asleep in minutes.

Tuesday, December 8, 2009

Day in the Life of a Middle Aged Full Time Student/Mom/Wife/Friend etc .etc. etc.

I'm Peggikaye 
I'm a 45 year old wife and mother who, after 20 years of being home decided to go back to school. Majoring in psychology with the goal of becoming a clinical psychologist to work with families of children with disabilities (and provide a service that was lacking when I was going through the diagnostic and adjustment period as a mother of a kiddo with disabilities). When I went to school 22 years ago, I'd gained all of 24 credits before I became too ill with Myasthenia Gravis and Lupus to continue. I'm not in remission, but I don't feel any worse at home than I do going to school so ... WHY NOT?

As a wife, mother, full time student (during finals time no less) I sometimes get a bit shocked when normal problems crop up. (like pharmacy misplacing my medication)

My favorite statement when someone is causing me difficulty is "Stop messing with my midlife crisis!"

I've been a reader and occassional commenter on this blog since it's inception. I comment under Dreaming Again.

6:00 AM … wake up even though alarm isn’t set until 9 am. 
Know that if I get up, son #2 (17 years, 11 months and 2 weeks old) will ask for a ride to the bus stop a whole 3 blocks away.  After all, it’s colder than the arctic out there!! It’s all the way down to 27ยบ (he’s really going to not like me when it’s in the single digits, which it will get to)
So, lay in bed, reminding myself that I didn’t go to sleep till 3 AM so it’s just as well. REST PK REST!!
7:10 AM
Hear front door shut and get up to work on speech that did not get quite finished at 3 AM when my body gave up.
7:12 AM Start the coffee (most important job of the day!)
7:15 AM Find all the information that I left on the computer desk at 3 AM that has been moved. Evidently someone got on the computer before school this morning. (it’s ok, he’s allowed. Just wish he’d leave my stuff be!)
7:20 AM Sit down with coffee (yum!) and start to figure out where I left off with the speech.  (and randomly go to Facebook for a distraction)
9:00 AM FINISH speech!! Realize morning is getting away from me and jump into shower.
9:18 AM Grab second cup of coffee
9:22 AM Finally get around to taking my turns on my word games (Lexulous and Wordscrapper, my life would be so tense without you!)
9:27 AM Start to get ready for school : Breakfast, make up, hair, dress. (While doing hair realize that I miss my long hair …wash and go!)
9:55 AM  Realize I’ve got an errand to run (Pharmacy) before school and I need to be at school early to print off report for Personality Theories (10 page paper, developing my own personality theory …while using the text book theories to support my theory. I am still unsure how this isn’t just a review of material as well as still protesting the assignment in general. This is graduate level assignment ...not undergrad and certainly not freshman/sophomore level!)
10:00 AM Leave for school/pharmacy.  Argue with pharmacist about the medication they say they have no record of ever having.
10:10 AM run back home, grab Mestinon Rx bottle and go back to Pharmacy to *SHOW* them that I get Mestinon there every single solitary month, without fail … They tell me it needs a refill authorization.(the bottle clearly states 3 refills) They tell me they can’t help it and it could be Monday before they get it back. I ask to speak to the main pharmacist. I ask him if he knows what Mestinon is and what it’s for. He says yes, I tell him that I have 2 days of medication left and there is no way to wait 5 days. He agrees and finds my refill in the computer. (Amazing!)
10:20 AM Finally get onto school, now running later than planned. Stop at Quiktrip to grab an extra caffeinated Mighty Mocha Cappuccino that I wasn’t going to get but after Pharmacy rigmarole, need it!
10:30 AM Arrive at school and calculate if I have enough time to print off all I need to print off. Decide to try it walk as fast as possible to get to library and pray there is a computer!
11:00 AM get to Speech class, unsure if I have to present my speech on talking about critical care medical choices before the time comes to need them. 
Sit through speech class impressed with my young classmates at the seriousness of their choices as well as the quality of their research. Listen to final speech and about get knocked out of my seat with the offensive nature of her conclusion.
12:20 PM Head over to Personality Theories, more nervous about turning in this 10 page paper than any speech I’ve ever had to give.
1:50 PM Review over, paper handed in, it’s all over but the crying.  (Something is wrong when a science phobic, stage frightened Psychology Major enjoys biology for non majors and speech class above and beyond their psych class!)
2:00 PM Walk into 17 year olds school to check him out early to go to a doctor appt to get toenail removed.
2:45 PM Arrive at doctor’s office and check in. Check in sheet says we’re there to get results of flu test. Um, no, we’re really not. We got those the day we got the test. We’re here to get is very infected toe fixed. (again, this will be the 3rd time to remove his toenail!)
3:10 PM get called back, they weigh and measure my son who was 6’ tall just 6 weeks ago …he’s now 6’1.5’’
3:30 PM Here a male voice outside the room sounding like he’s in a panic. “I can’t do that! I’ve never done it!!”  While I try to keep my OCD teenager in the exam room till we find out what is going on.
4:00 PM Office manager comes in to explain that we, #1 needed an appt with a doctor, not a medical student (yes, I asked for one …) and #2 it’s a procedure and we had to have and we have to have an appt for the procedure room. (Which had it been booked, the computer would not have allowed her to assign a medical student nor resident to his case) (yes, I know, I specifically asked for a procedure appt, we’ve been through this before) They leave, come back and apologize, give him antibiotic to help infection and reschedule for Tuesday. In the middle of my class … where I must give my speech. Husband gets the honor!
5:00 PM Finally make it home. Work on homework and play on Facebook until time to figure out dinner. Realize we don’t have anything and a grocery store run is in order.
6:45 PM come home with readymade chicken from the grocery store.
8:00 PM Sit back down to computer to work with philosophy portfolio. Wonder if I’m really ever going to finish this. I’m 12 chapters worth of reviews behind and it’s due next week.
8:30 PM Decide to email speech professor about the offensive speech. There is nothing she can do now, it’s already done, but maybe she can keep it from happening in future semesters.
3:00 AM stand up from computer to stretch and look at the clock. Realize it’s 4 hours after I’d planned on going to bed. Shut down computer and get ready to start the whole thing over again around 7 am.

The Family:

Don 54 (hubby and sometimes child)
Samuel 20 (going on 21 going on 12 going on 40)
Benjamin 17 years, 11 months and 2 weeks (I refuse to put 18 and the fact that both my children are leagal adults one moment before I have to!)
Myself ... Peggikaye ...45 years old

One day in my clinician-educator internist's life, last week

2:15 am Daughter appears in bedroom doorway. Blanket has fallen off bed. Why she is unable to replace is a mystery, otherwise very capable 4 1/2 year-old.
2:15:30 am Back to my room, door slightly ajar. I fear the worst. The cat has infiltrated the sacred sleeping space. Allergic to cat.
2:15:35 am Back into bed.
2:17 am Cat jumps on bed. Turn on the light and spend next 5 minutes looking for him. (Husband away on business - am alone dealing with cat highjinx.)
2:45 am Never found cat. Can't sleep. Thinking about 1,000 things. Eventually fall asleep.
6:19:30 am Wake preemptively to 6:20 am alarm, then set it for 6:40 am. So tired.
6:40 am Awaken to alarm.  Let cat out of room - he is peeved to have been trapped inside all night. The nerve!
6:55 am Daughter enters my bathroom as I'm getting ready - she hangs out a bit then watches some Super Why while I finish getting dressed.
7:10 am Son awake and summoning me with a pressing "MAMA! MAMA!"
7:20 am All are dressed for school, head downstairs for breakfast.
8:00 am I'm out the door after goodbye kisses. Nanny will take kids to preschool.
8:50 am Walk into office, answer emails etc
9:10 am Arrive at Team room - first day back as ward attending. Start rounds, we are on-call. Take advantage of teachable moments. Only gentle, encouraging pimping.
10:30 am Done with rounding, resident and I meet with interdiscplinary team for discharge planning. I love my social worker and case manager.They are the greatest.
10:45 am Back in office. Starving -skipped breakfast - eat grapes, saltines. Wonder how early I can eat my lunch. More emails. Do some writing for a manuscript. Multiple, multiple emails with various collaborators on different research projects.
11:45 am Start calling ward teams to find good patients with physical exam findings for physical examination round teaching session for third-year students at 2pm.
11:55 am Eat lunch (leftovers) in between calls to teams to find patients, writing, email, and 28,471 other things.
2:00 pm Meet students, show them picture of Osler and have them guess who it is. Need hints. Introduce him as the Father of Modern Medicine and read an inspiring quote about the art of observation as segue to physical exam rounds.
Divvy up students into 3 groups to go with 3 faculty mentors - I have one group.
2:15 pm See first patient together. Student notices his great example of clubbing. Discuss causes, pathophysiology, correlate to current patient.
2:35 pm See second patient with interesting heart exam. No one else can hear his murmur. Have them all listen multiple times in same spot but 2/6 systolic ejection murmur continues to elude. Patient is wonderful with us, wants to help, has fun.
3:02 pm Call in two minutes late to conference call with collaborators (who are also friends) for a research study.
4:45 pm Finally done with very productive call - head to team room to see how call is going.
4:55 pm Leave- with husband out of town, have to pick-up daughter at school.
5:45 pm Pick up daughter
6:10 pm Dinner altogether, made by godsend nanny
6:45 pm Up for daughter's shower, read story to both, changed into pajamas. The two roughhouse a bit until someone ends up crying.
7:10 pm Resident calls with run-down of admissions so far. Son and daughter chant her name over and over, much to her delight.
7:15 pm Son tucked in with bear and lullaby - he is starting to sing along - I've sung this to him since he was a wee bug.
7:20 pm Do daughter's Stars for the day - I'm generous and she gets all 5 today (say please and thank you; try not to whine; share; clear your plates; make bed). Daughter tucked in. Same lullaby by demand.
7:35 pm Curled up on couch under throw blanket, writing for leisure and work. Miss husband.
10:00 pm Call husband. Then stay up working on side project (essay on health policy) --my usual routine when he's away (otherwise asleep by 10:30).
11:20 Done. Sleep. Hope blankets don't fall off beds tonight.