Showing posts with label dr. whoo. Show all posts
Showing posts with label dr. whoo. Show all posts

Tuesday, May 12, 2015

Baby City

There are only three things in this world that are certain: death, taxes, and babies.

Nobody knows this truth better than Emily McCoy, a third year resident working in Baby City, the affectionate nickname for the busy Labor and Delivery unit at a New York City hospital. On a typical day in Baby City, Emily delivers more babies than the number of hours of sleep she manages to squeeze in that night. And definitely more than the number of dates she's been on since she started her training in OB/GYN two years earlier.

As Emily works tirelessly to safely herald baby after baby after baby (after baby) into the world, she becomes well acquainted with the three hard facts of Baby City:

1) Babies never come when you want them to.

2) Babies always come when you don't want them to.

3) You don't know who your true friends are until your baby is sliding down the birth canal.

Baby City was a joint effort, written by myself and Dr. Whoo of OB/GYN Kenobi. Do you remember the wonderful Dr. Whoo, who used to blog here? Well, now she's back… in book form! This book is all about the real events that take place on a labor and delivery unit, based on true stories.

This book is the ultimate book for mothers and medicine. Because it's about mothers (duh), both new and old, and it's written by two female physicians who are also mothers. It's light reading, but it deals with a lot of issues that are important to women and mothers and physicians.

Buy it today on the Kindle or in paperback!

Side note: We are donating 25% of the profits from the book to the fistula foundation, a nonprofit organization that does great things for women in Third World countries.

Monday, January 23, 2012

Call Hierarchy of Needs

Now that I am not on call, all day, every day, I have found there is a certain behavioral pattern emerging on my call days. Something similar to Maslow's "Hierarchy of Needs," if you will.

First Goal - Be able to leave the hospital. You may laugh, but some days it is d*mn near impossible to do. I am always figuring and re-figuring in my head if I am going to be able to go home that night, or if I will wind up being stuck until after office hours the next day.
*First goal bonus if I am able to leave the hospital before my children's bedtime, so much the better to actually *see* them.

Second Goal - Shower at home. This seems like an odd one, I know, but I *hate* to shower in the hospital call room bathroom. It just is not the same, and it also slightly squicks me out. So if I achieve the first goal, I proceed immediately to goal number 2 as soon as I step foot in the door.

Third Goal - Eat. This rule has stayed the same since residency, "eat when you can."
*Third goal bonus if I actually getting to eat with my family or if I am not eating something like Ramen noodles.

Fourth Goal - Spend (somewhat) quality time with family (while obsessively keeping one eye on the computer L&D and ER census for potential roadblocks to goal number five).
*Fourth goal bonus if I am able to tuck my children in for bedtime and maintain a normal evening routine before getting called back to the hospital.

Fifth Goal - Sleep in my own bed. This one is a bit more elusive, as you can imagine.
*Fifth goal bonus if I get to sleep in my own bed *all night long.* (HA HA! Almost never happens.)
**Extra bonus if I get no pages while I am sleeping in said own bed, and wake up the next day frantically checking my pager to be certain the battery hasn't expired. (Again, elusive.)

Let's face it 5/5 goals happens once in a blue (full) moon. If I am able to achieve 4/5 goals, I feel pretty good about my call night. Satisfaction with the night decreases exponentially with each goal not met, naturally. Before I am derided, of course my ultimate and overriding goal is to provide quality care to my patients...and to sleep in my own bed. :)

**Cross -posted at Ob/Gyn Kenobi

Thursday, December 15, 2011

Ob/Gyn: Helping to expand families at the cost of your own?

At its very worst, that is how it feels. Like two nights ago, while lying in bed with CindyLou, who was bubbling away about her class Christmas party which was happening the next day when she stopped and said earnestly to me, "Mommy, you know, you can come to the party tomorrow if you want!" And, ugh! That familiar little stab of mommy guilt shot through me once again. It is never that I don't *want* to attend her daytime school Christmas parties, sign language presentations, or field trips (scarcely ever announced any earlier than 2 or 3 weeks prior to the actual day they are happening, assuring that my clinic schedule will be full, and if that isn't the case, I am likely on call). Every morning as I am leaving for work, my kids ask if I am on call. If I say "no," it is met with cheers. If I say "yes," it is met with boos, extra hugs, and sometimes tears. So, yeah, my kids are definitely affected by my chosen profession. (And we are in a situation that is *light years* better than the one we were in prior!)

Unfortunately, as many have stated, medicine is not as "family-friendly" as many other careers can be, and to many physicians, we don't stop working when we leave the office/hospital. Our chosen profession is all consuming in general, and Ob/Gyn can be demanding in particular. I feel you have heard the following from me before, I am having a distinct case of writer's deja vu The hours? Horrible. Babies have no concept of time and generally it seems that labor gets good and active sometime between midnight and 4 am. The pace? Grueling. In a medium sized practice, in order just to cover the cost of your staff and overhead, you have to do a set amount of deliveries just to break even. We get very scant education about the whole "running a business" part of medicine in our training, and while it would be great to see one patient an hour, the practice would go under in a year at that pace. As others have astutely pointed out, part-time in medicine is hardly part-time in any other sense of the word, and for Ob/Gyn, with malpractice costs, you just cannot feasibly make it work. If you want to do Ob, you have to be all in. That means call, and most of us work 24 hour calls followed by a full office or surgery day the next day...way more than what residents are doing in their training these days (makes for a rough transition to the "real world," to be certain.) No one is looking over my shoulder and counting how many hours I worked this week (hint, more than 80!!) Malpractice environment? Scary. No really. It is.

I can't say how many times I've bemoaned my career path, pulling myself from my cozy bed at 12, 1, or 4 am to make the mad dash to the hospital. I've thrown too many one person pity parties to count for myself as I work on nights and weekends and holidays while it seems the rest of the world is spending time with their friends and family (before anyone jumps me, I know this is *not* the case, but, pity party, you know, work with me here), but, by the same token, if I really try to sit and think of anything that I would love to do better, I couldn't tell you a thing. Because in the moment, I really do love my job. Once I am in the door of the hospital and with my patient, bringing her baby safely into the world is the focus of my attention. I never cease to be amazed at the miracle.

My family knows that the work that I have the privilege to do is important, and this is the reason that sometimes I can't be with them....even when I really want to be. I hope they grow up understanding that having a job they are passionate about is important, as well. My house isn't spotless, I'm not homeroom mother, I barely know any of the kids in my children's classes, I don't pick them up or drop them off at school, I don't go to Zumba, and am seldom well put-together (read: schlepping about in scrubs). So no, I don't "have it all." I have a good career. I have wonderful friends and a great relationship with my children and my husband. I think that is the best for which I can ask.

Tuesday, August 16, 2011

Ob/Gyns are terrible people who need to die, and other common misconceptions

Tempeh writes: Still, I hate to generalize, but I've met far more "toxic" docs in OB/GYN than in other specialties. I always find it odd. The majority of OB/GYNs with whom I have interacted (as a med student and through 3 full-term pregnancies) have been women, who are supposed to have better communication skills, higher pt satisfaction, etc. And they work in a field where most pts are healthy and, in the case of OB, happy to be in the office/hospital because they are pregnant or delivering. Why are they so bitter as a group? It mystifies me. Maybe some of the very pleasant OB/GYNs amongst our MiM writers can shed some light on the specialty.

I'm not really certain if I fall into the category of one of the "pleasant" Ob/Gyns or not, but I will give this question a shot. Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating. I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (God forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have). Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends (remember how much you hate call Fizzy? Would you be bitter if you did it all the time?) It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, the media, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity. Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise (Rh+ and her most excellent example notwithstanding). Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies. Hope this answers the question in a non-bitchy way, please excuse the sentence fragments and horrendous grammar. I had a terrible, horrible, no-good, very bad day today, and seeing some of the commentary on Mothers in Medicine regarding my profession, usually a refuge, stung quite a bit, I must say.

***cross-posted at Ob/Gyn Kenobi

Tuesday, August 9, 2011

Trying not to be "one of those" mothers.

CindyLou, believe it or not, is now 7 (going on 13) and Bean just turned 4 (!). In the days of old, when Mr. Whoo and I were uninitiated to hard-core parenthood and naive to the social rigors that exist in the suburbs, we concocted a wonderful fantasy that each of our children would select 2 different activities completely of their own accord, without pressure from either of us, and while we would always encourage them to finish out a season, we would never be "those parents" who pushed them to be "better, stronger, and faster." Ha. Ha. Ha.

Enter these last few months, where CindyLou chose cheerleading and tumbling (With or without a nudge from her mother? A former cheerleader, who always regretted a lack of formal tumbling training? Ok, probably a little nudge.) Bean chose soccer (pretty much of his own accord, well, that, and the fact that it is pretty much the only organized sport available for boys at age 3). We started out with the best intentions, and really, watching 3 year olds playing soccer is a bit like watching cats being herded on the field. Except, then Bean really started to *get* it, and then he got *really good* (for a three year old). Each game he would score at least a couple of goals, setting his own goal for each game for *at least* five goals per game. Then he achieved that goal, and all of the sudden, Mr. Whoo (assistant coach) felt like he had to take his own son out so other kids had a chance to score. The other parents would ask where or how often we practiced with him (exactly twice, right before the first game and then again right before play-offs), like they were somehow implying that we were driving him to his successes (we were not). It made me uneasy to have that feeling of competitiveness creep anywhere near my sweet 3 year old baby, who was just there to have fun.

Things were no better with CindyLou, sitting behind the glass with the other "gym moms." I did my best to fade into my chair while the other mothers, obviously veterans, systemically analyzed and subsequently ripped apart each girl in the gym, including their own daughters. Despite my best intentions, however, it completely stoked my competitive fire, and made me want to take CindyLou home and drill motions and practice flexibility for hours on end. How dare they judge my babies like that, and, indirectly, how dare they judge *me*? It is a strange new world, the world of competitive extra-curricular activities, where the parents are just as cruel and mean as the kids can be.

Growing up, for me, it wasn't this way. Parents did not hang around at our practices and activities and compare notes. I did tap at 5, piano at 8, softball and cheer in 4th and 5th grade, band (clarinet) in middle school, and cheerleading through middle and high school. Parents were only there for recitals/games. Maybe that made it easier to not be so fiercely competitive. I think this can apply to the academic setting as well, although, to this point, we have had no "real" report cards with As or Bs, just Ms for "meeting criteria." So tell me MiMs, how do you stifle your competitive streak and just keep your cool around other "tiger-like" mothers and fathers? How do we teach our children to be *their* best, without making them feel like they have to be *the* best?

Monday, April 25, 2011

Wishing My Life Away

Do you remember when you were younger and you just couldn't wait for the next birthday? (or holiday? or summer? or Christmas?) My dad used to tell me not to wish my life away. Somehow, I feel like medical training and now, my career, has caused me to wish away a significant portion of my life. Wishing for first and second year to be over to get to clinical rotations. Wishing clinical rotations to be over to start electives. Wishing to get started in residency. Wishing to BE FINISHED with residency (probably one of my biggest wishes, ever). So now, I am here, through all of my training, practicing in what is pretty much an ideal situation as an Ob/Gyn. One weekday call per week. One weekend call a month (with the post-call Monday off). Nice offices, beautiful hospital, great staff, good patients; no doubt, I run from 7 am until 6 pm most days. I think that (most of the time) I am happy, but I still catch myself wishing for the day to be over, wishing for the baby to just come out already, wishing for the next weekend, the next break, to win the lottery, for the next chance to not do what I have spent a significant portion of my adult life busting my tail to learn how to do. What is wrong with me? Burn-out? Have I chosen poorly? Inevitable no matter what profession one has chosen? Is it human nature? Our we destined to continuously wish our lives away? What do you think?

Thursday, January 13, 2011

What It Feels Like for a Guy

*Editor's note: In the spirit of partner guest posts, this post was written by the husband of dr. whoo.

I’m not sure I am worthy of the title of Stay at Home Dad. I don’t have my children all day long every day.

My role to take on more of the domestic responsibilities began in fall of 2008. There was a combination of factors for this decision, but it was largely based on improving the quality of life for our family. Our oldest child had just turned four years old and our youngest, two.

With both of us working beyond full time, we were watching our children grow up in daycare and were limited to an hour or two each evening with them during the weekdays and the weekends were spent catching up on laundry, lawn, grocery shopping and million other items on the must do list. Exhaustion discouraged healthy cooking and exercise, and we ended up eating out or ordering in most of the time. I could continue to list all the reasons, but the truth is we should have done it sooner for fewer reasons. I never thought I would have anything but a long career of continuous development, but my wife had more time and money invested in her career and she was the bread winner. Besides, I have way more patience with children, and all other non-cat related matters.

It has been two and a half years since we made that decision, and it was the best decision for our family. Quality of life for everyone has improved tremendously. Cindy Lou is in first grade now, and we decided that Bean would benefit from the social interaction and academic curriculum at he gets at preschool. I take the kids to school, I pick them up (much earlier than we used to). I cook the meals and clean the house, albeit poorly I am told (seriously, how does dust accumulate so fast?). I pay the bills, clean the pool, and mow the lawn. I also do general repairs, minor plumbing and electrical work and you should taste my stuffed tilapia with white wine lemon butter sauce. During varying times of the day and evening, I work (as needed) to run my unintentionally non-profitable small business with 6 employees. I did get to take a paycheck last January (2010) so that’s good, right?

I now get a lot more quality time….err, snuggling/wrestling/tickling time with the kids which is unbelievably great.

I periodically get a little restless, and send my resume out to test the waters, but every time I get a bite I am forced to reconsider the consequences to my family if I return to the corporate world. Without fail, my decision is swift and clear as to what is best for our family, and that is to stay home. That is to say, stay available. Available for sick children and doctors appointments and field trips and household duties and whatever else needs to be done. My wife’s job as an OB/GYN is stressful and demanding enough, and I cannot help with that or relieve those responsibilities in any way. What I can do is almost everything else, that’s the goal anyway. In reality, she contributes a lot and always has a sense of when I need her help the most.

Anyway, I am unaware of any stigma and indifferent to prejudgments or misconceptions that others may try to attach to me. This works for our family and I am very proud and grateful for this arrangement. I used to think of it as me sacrificing my career for my family, but now I see clearly. We were sacrificing our family for our careers. We’ve both made the necessary changes to end that, and we are a happier family for it.

Wednesday, December 15, 2010

Balancing Act

I come from the generation of women who were raised from a very young age to believe that they can be and do it all. College, career, friends, marriage, kids, and a perfect family life, unhindered by a stellar career, and of course, a kicking body. As most of us in medicine, I have a strong tendency toward demanding perfection, of myself, of my relationships, and especially of my work. Anything worth doing was worth doing perfectly, down to the last detail, or I just wouldn't do it. Ha. Ha. Ha. And then I got smacked, hard, with reality. As others have so astutely stated, the enemy of good is perfect. Many of my posts on MIM have been pertinent to work/life balance, or, more specifically, lack thereof.

At first, I did a really good job balancing self care, school, and friendships. In med school I made a concentrated effort to work out several times a week, studied most of the rest of my time, and while my older friendships got put more or less on hold, I had good friends in medical school with whom to blow off steam after examinations. Then came love, followed shortly by marriage, best decision I have ever made unto this day, and I don't regret it a bit, but the gym was the first to be phased out in favor of nurturing the relationship. And, to quote the Barenaked Ladies "When we are happy we both get fat and still, it's never enough..."

In residency, he was working, and I was working, and we cherished the time we had together. We hired a cleaning lady who also did laundry, and were able to spend most of our free time together nurturing our relationship and our relationship with our family and friends. Life became infinitely more complicated with one child, and we were nearly pushed to our breaking point when, in the throes of an incredibly demanding work schedule, we had our second child. We lived 14 hours away from much of our friends and family. Mr. Whoo was working 10 hour days, I was working 12 hour days (if I was lucky), and our children were in day care 10 hours a day, despite having a twice a month cleaning lady, any spare time was spent digging out from underneath mountains of laundry, and our life together was coming apart at the seams.

There was no more robbing Peter to pay Paul, and we finally had to make some very difficult decisions. The first of which was Mr. Whoo quitting his job to hold down the home front (i.e. find it under Mount Laundry and the River of Dust) and be available for our children and family. The second of which was my decision to break my contract (which cost us a bit financially) and find a more reasonable call schedule in a location closer to our family and friends. In addition to seeing more friends in person, facebook helped so much in sharing my life with my family and far away friends. I'll be the first to admit, my life is far from perfect, but compared to a year and a half ago, my life is a spa vacation. My children are still fairly young at 3 and 6, and they still have very few extra curricular activities. I know more juggling will be in order once they start, but so far we've handled Daisy Scouts and dance class fairly well. The last thing I have yet to get totally back on track is taking care of my own health. I've lost almost 30 pounds since moving here, and plan to find a way to continue to get back into good health. My *final* frontier, but a kicking body? Likely not.

So, in short, we *can* have it all, with a little help from our husbands, family, friends, and by standing up for ourselves and finding a position that allows us to fulfill our calling as a physician and still tuck the kids into bed most nights of the week. Every woman on this board has achieved so much, each of us in our own way. We've done it all, and so can you.

Thursday, October 7, 2010

That's So Meta...

My blogging started off way back in July of 2006. I began blogging for a number of reasons, the first being that one of my good friends had a blog about her life that I enjoyed reading, and loved how it was like a journal that could "talk back" to you, so, I totally copied her idea. The second reason was because I enjoyed writing and wanted a creative outlet, the practice of day-to-day medicine does not often lend itself to creativity. The third, more distant reason, was as an anonymous outlet for the frustrations surrounding my job at the time.

Since that time, my job and circumstances have changed for the better, but, save a handful of people, I try to keep my blogging anonymous. I do worry about being "outed." Not so much because I don't stand behind every word I write (because I do), but because I know that not knowing where I am/who I am affords my patients (and me) additional protection/anonymity. Not to mention the fact that it is more and more tempting to self-censor if your identity is known. I do a lot of "keeping up appearances" in my day to day life. I like to have a place to let it "all hang out." At times I worry about what my new partners would think of my blogging, but, at other times, I also have urges to spill about the blog. My husband knows (and he wants to "out" me all the time), a select few of my friends know, and some of the lovely ladies with whom I blog know "the real me." Sometimes I wish that I were not an anonymous blogger, mostly because I'd like to direct my family or friends to certain posts to let them know how I feel about particular issues, and, let's face it, sometimes because I am proud of the blogs that I write and want to brag a bit. Most of the time, however, I am very content to remain anonymous.

Life often gets in the way of blogging for me, and so many times I am struck with the urge to spill all of the thoughts from my head onto the screen. I love blogging. I love that it brings patients and physicans to a common ground, so the better to communicate as people, rather than 'doctor' and 'patient.' I also love the community of blogging physicians, it is so nice to share stories, laughs, and frustrations with those of us in the trenches, and it is also great to provide information and guidance to upcoming residents and medical students alike. Sometimes, however, I feel obligated to blog. I feel as though I am letting people down when I don't write. Then, if I feel obligated to write, sometimes the ideas don't flow as freely.

Ultimately, blogging has changed the way I think about people, patients, and medicine. In many ways, it reminds me every day to think of my patients as real people and not just problems to be solved or diagnoses to be made (or numbers to force through the treadmill). I try to keep in mind that even though it may be my 9th delivery of the day, it is *the* delivery of the day for my patient. I am thankful to be part of this blogging community, and hope to be blogging for many more years to come!

Friday, September 3, 2010

Little Wonders

I sat with my patient, a new mother, in the examination room. She was there for her first post-partum visit and we were discussing the events of the last few weeks. We chatted about breast feeding, birth control, lack of sleep, how annoying it is that men can sleep through *anything*, and then, I asked, as I always do, about how she was handling things emotionally. I always make it a point to screen for post-partum depression, many times, if you don't ask, they will not tell you how they are really feeling. This time, though she passed the screening for depression, she gave a laugh and said, "For the first time, I know why my mother is the way that she is." She went on to elaborate how she always made fun of how emotional her mother is, and now how she couldn't watch Kleenex commercials any more without bawling like a baby. It is so true. When we become parents we are forever changed, not only do we understand our parents better, but the way that we look at the whole world is different.

For me, it was the same. Before I became a mother, I loved to watch scary movies. The scarier the better. Imagine my surprise when, not long after Cindy Lou was born, and Mr. Whoo and I settled in to watch a horror flick when I realized that I had changed. I could not watch it, couldn't even get past the first 30 minutes. Why? Because there was a little girl child in it who was missing, and I couldn't handle thinking of a child (my child) being lost, scared, and alone. I never realized how many horror films use disturbing images of children before having a child of my own. It changed how I watch movies even now, far removed from the emotional lability of the immediate post-partum days. The same holds true for news stories involving children, footage of the 2004 tsunami devastated me, same for Katrina the summer after. The tears flow more freely now, happy, sad, and wistful. Most of all, music speaks to me, and often moves me to tears. There are certain songs I associate with different stages of my children's lives, and find myself tearing up just thinking of the lyrics. For Cindy Lou, it is "Baby Mine" and "Return to Pooh Corner." For Bean it is "Sweet Baby James" and "Little Wonders." Especially these lyrics:

"Our lives are made, in these small hours, these little wonders, these twists and turns of fate.
Time falls away, but these small hours, these small hours still remain."

So now I know how my mother felt when I was younger, when Cindy Lou turns to find me wiping away a happy tear or two and says, "Mommy, if you are happy, then why are you crying?" Perhaps it is because the transformative joy and wonder of having a part in creating these precious lives fills up our hearts until they break, just a little, from the magic of it all. How have your children changed the way you see the world?

***Cross Posted at Ob/Gyn Kenobi***

Tuesday, June 1, 2010

Happy Birthday, MiM!

I guess I shouldn't be surprised that it has already been another year! Did you know that MiM was born under the sign of "Gemini," with described traditional traits such as being "adaptable, versatile, communicative, witty, intellectual, eloquent, youthful, and lively?" Personally, I could not agree with this description more! Also, based on my long list of friend birthdays this week, this is a great time to be born. Looking over the last year, I see that I've not been the most prolific of bloggers, but I do like the blogs that I have written for the site. I would have to say that my "Tips for Surviving Call During Pregnancy" post was the favorite of my contributions for the year. I also have to mention The Mommy Doctor's post "Why do you have to go to work, Mommy?" because it really touched a chord with me, and I love the discussion generated by the post itself.

I love writing for this blog because I feel as though I am in a great company of not only great writers, but wonderful physicians, mothers, and friends. It is an amazing experience to sit and put my thoughts and experiences as a physician mother to words and to sometimes help another woman who may be struggling with the same thoughts and/or dilemmas. So, thank you, KC for inviting me to write for the blog (two years ago!) and thanks to all of you, dear readers, for making this site such a vibrant and supportive community.

Wednesday, April 28, 2010

Things That I Say Every Day (Home Edition)**

Although the dialogue is less technical, the day to day grind finds me saying many of the same things to my wonderful family. Here are a few of my most well-worn phrases....what are yours?

1. Good morning, sunshines!

2. I love you.

3. No.

4. What do you say?

5. Hmmmmm?

6. Put your clothes in the hamper.

7. Stop teasing your brother.

8. Stop torturing your sister.

9. Sorry, you cannot have mac and cheese for breakfast.

10. Sooooo, whatcha want to do for dinner tonight?

11. Thank you for (doing laundry, the dishes, going shopping) honey!

12. Are you ready for a bath time? A bath time party? This is old CindyLou (and Bean) ready to get that bath time started....

13. So, tell me about what you learned today...

14. I need some snuggles (or, the abbreviated, "snugs")!

15. I missed you today.

16. Did you set the DVR?

17. No, no, it is (CindyLou's/Bean's) turn to sit in the front of the tub.

18. Pick out the book you want to read tonight.

19. What was your very favorite part of today?

20. Good night, sleep tight, sweet dreams...see you in the morning.

21. Ahhhh, adult time!

22. We need to go to bed earlier.

23. I am going to bed early tomorrow.

24. I love this show!

25. Maybe we can work out....tomorrow.

Tuesday, April 27, 2010

Things That I Say Almost Every Day (Work Edition)**

One thing that I love about my job is that it is ever-changing, and there are no two days that are exactly the same. That being said, I have my own daily script that I find myself reciting as I move through the more routine parts of my days in the office and on labor and delivery. My nurse could probably come up with a million more things (since she gets to listen to my spiel 30+ times a day), but these were the first off of the top of my head:

1. That's normal.

2. You're going to feel a little pressure.

3. Are you feeling any pressure?

4. Do you have any questions?

5. In a normal cycle, you have a rise of estrogen, then ovulation, then a rise of progesterone. If you don't become pregnant, then your progesterone level will fall and *then* you will have a period.

6. That's normal.

7. Take a deep breath.

8. Now, wiggle your toes.

9. No one will know your breasts better than you.

10. Tell me about what has been bothering you.

11. Is that interfering in your daily life? How?

12. The definition of menopause is no periods for one year.

13. It takes two 16 oz packages of cottage cheese to equal the Calcium in one 8 oz glass of milk.

14. You can do this.

15. Congratulations!

16. There are risks, benefits, side effects, and alternatives...

17. I'm sorry for your loss.

18. That can be normal.

19. I know it is counter intuitive to "relax" but try to make your muscles as loose as possible.

20. Do you understand?

21. Tell me what you know about birth control, then tell me what you would like to know.

22. That is a normal physiologic change of pregnancy.

23. I promise that you won't be pregnant forever (usually after discussing our elective induction policy of no earlier than 41 weeks gestation.)

24. How can I help you today?

25. I know this is scary, but I am going to talk you through it.

**Cross-posted at Ob/Gyn Kenobi**

Thursday, March 25, 2010

Why Would You Quit?

I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder - why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but of course, I don't want to be so rude as to ask that question to them.

A lawyer and mother of two in Seattle.

I am going to try to tackle this question, even though it is not my current personal experience or decision. I actually went through residency with a woman who did this very thing. She went through medical school, a strenuous Ob/Gyn residency, and then worked in private practice for a couple of years. She was married to another physician who eventually completed an interventional radiology fellowship. During residency, she had two children, and then had a third when she was out in private practice. Once her husband finished his training, she quit practice to be a mother full-time. When people would ask her why, her answer was simple..."because I want to, and financially, we can do this, so why not?"

I know she loved her career, and she was a very skilled, caring, and compassionate physician, but she just wanted that time with her family more, and they were in a position to swing it. She didn't think of her choice as "quitting medicine," she viewed it as choosing her family. It is no different than the other career women (lawyers, executives, teachers, bankers) who make the very same choice. She always planned to return to a GYN-only practice once her children were school aged, and she became board-certified, and kept up with the field via conferences and CME (she had lots more time to read!!) I have since lost touch with her, but I have no doubt that she was very happy with her choice. While most physician-mothers are not as extreme, I see varying degrees of women choosing "lifestyle" specialties or different levels of "part-time" practice after residency.

Even though medicine does require more rigorous training than most careers, it does not necessarily change the way you feel about how your family life should be structured. There have been many times that I have considered cutting back practice hours, myself, in order to enjoy more family (and me!) time. I recently made a move that enabled me to still work full-time, but greatly reduced my time on-call, and therefore, my time away from my family. Currently, I am the bread-winner, and I still have some student loan debt that needs to be paid, so up and quitting is not a viable option for me. However, if I am able to become a partner in my current practice, reduce my in-office time, and still manage a decent living, then I will likely choose that path. There many different ways of finding a work and home balance for women today, and I am thankful that we have the ability to "choose medicine" and we can also "quit medicine" if this is the best thing for us and for our families.

Tuesday, March 23, 2010

Feeling the Love

(*Leah lucked out and had 2 MiM writing in response to her question!)

Leah recently earned a PhD in Immunology and is married to a 4th year medical student/ soon-to-be orthopedic surgery intern. She has a newborn and a 2 year-old.

What are some special things that your spouse has done to make you feel loved/supported during your residency?

There are too many things that my husband did (and still does) to make residency a little less miserable for me. Those listed below are just a few of the highlights....

~ Put his career and plans on hold to move with me and follow me from medical school to residency to my jobs thereafter.

~ Wrote me love notes left on the kitchen counter on the days we could not see one another.

~ Listened to me whine, cry, and gnash my teeth, and provided a broad shoulder upon which to cry.

~ Did his best not to vomit when I chose to share certain details about my day (he tends to be a bit squeamish).

~ Went to the grocery store, folded laundry, got a cleaning lady for our house.

~ Put me to bed when I would come home post-call and pass out on the couch with an un-touched open bottle of beer in my hand.

~ Surprised me with the china hutch I had been coveting one weekend when I was on call, and set it up with all of our china displayed so that it was the first thing I saw when I walked in the door.

~ Took care of me when I was having pregnancy complications, and stood up for me when I was being mistreated by the residents that I thought were my friends.

~ Arranged a surprise 30th birthday party for me with good friends at a time when I was feeling lowly and friend-less.

~ Always, always, always made home a safe, warm place to fall. Thank you, Mr. Whoo....I would have never survived residency without you!

Monday, March 22, 2010

Tips for Surviving Call during Pregnancy

Great timing for Q&A week! I just found out last week that I'll be a new mom in November, making me an official mother in medicine! I've been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here's my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?

From a future mom and Family Medicine resident in the midwest

Congratulations on your pregnancy! I know that being pregnant during such a difficult time as residency seems daunting, but you can (and will) survive! Overnight call is never fun, but with a few small changes, you can get through a 24-30 hour call with relatively minimal discomfort.

Survival Tip #1 - Bring lots of snacks to work with you. As a resident, especially on call, you often have an erratic schedule, and sometimes it is difficult to eat at regular intervals. If you are fortunate enough to avoid severe nausea in the morning, then try to eat before you leave the house. Pack your pockets with snacks that are portable, like protein bars ( bars are really good, more crunchy than chewy, and covered with chocolate. Yum!), hulled sunflower seeds mixed with dried cranberries or raisins, or even the standard peanut butter crackers. Having something on your stomach at all times will help stave off nausea and fatigue.

Survival Tip #2- Some caffeine is still ok! No, really! I am not sure how much caffeine you have been consuming prior to pregnancy, but a small amount (150 mg-300 mg) of daily caffeine has been shown to be safe in pregnancy. The official March of Dimes recommendation, I believe, is 200 mg or less. One (regular) cup of coffee or 2 caffeinated sodas per day should definitely fall well within the safe range, not to mention the occasional chocolate fix (so needed on certain call days).

Survival Tip #3 - Learn how to prioritize your duties while on call. It is likely that you already do this to a certain degree. Do the most physically strenuous tasks (procedures, lines, rounding) as early as you can in the call day, when you have the most energy. Try to chunk as many things as you can on a single floor, and "gravity round" (start at the top of the hospital and go down floor by floor). Don't be ashamed to use the elevator, but by going down steps, you can get a little physical activity without straining yourself. Do your best to anticipate any additional orders (nausea medications, sleep aids, pain medicine, diet orders, etc.) that may be needed throughout the day and write them while you are on the floor, saving yourself middle of the night phone calls for Tylenol during the 2 hours that you may have been resting! Another thing you can try is to do quick PM rounds. Alternatively, call and talk to the nursing staff, floor by floor, asking about any issues that may need to be addressed prior to trying to lie down, thus avoiding the "sit on bed, pager goes off" phenomenon to the best of your ability.

Survival Tip #4 - Stay hydrated. I know it is hard to do, and even more annoying when you have to stop working and actually *use the bathroom* on occasion, but trust me, adequate hydration can stave off multiple discomforts of pregnancy and decrease the development of more serious complications like pre-term contractions. Have a bottle of water accessible throughout the day, and refill it often.

Survival Tip #5 - Don't stand when you can sit, don't sit when you can lie down. Rest as much as humanly possible, even if it is just the short time between one clinic patient and the next. Go to the call room and lie down on the call bed instead of sitting around and chatting at the nurses' station, even if you don't sleep, you will be much better rested and prepared for that inevitable page from the ER at 3 am.

Survival Tip #6 - Bring your meds with you. If you are one of the less fortunate ones (like me) who happens to be plagued with persistent nausea/vomiting throughout the pregnancy, Zof.ran will likely be your very best friend. Bring it to work with you, along with Tyle.nol, Sud.afed, Zan.tac, Tum.s, and your pre-natal vitamins. It will help you to avoid having to get IM shots of Zof.ran from the nursing staff or walking around with an IV (both happened to yours truly) for fluids.

Survival Tip #7 - Utilize any support that you have. I'm not sure if in your program you take solo call, or if you have a junior person and a senior person on call at the same time. If the latter is the case, then utilize your support person to their fullest potential (if they are amenable, that is). Try to "divide and conquer" tasks instead of tackling them together. If you are the senior, then trust your junior to do good work without you hanging over their shoulder. If you are the junior resident, don't be afraid to ask the senior for help if you feel you are in over your head.

Survival Tip #8 - It's ok to whine....but don't whine about your pregnancy discomforts to your co-residents or to the nursing staff. Call your husband or your best friend, or compose a long, whiny email and then delete it if you must. It is normal to feel whiny when you are pregnant, but it may ultimately foster unwanted and unpleasant feelings in your co-workers if you vocalize these feelings. It saddens me to have to write this tip, but this is a mistake that I made in my pregnancy that came back to bite me. Sympathy is not always rampant in the medical community, so try not to seek it there, and you will not be disappointed.

Survival Tip #9 - Be aware of your limits. As you progress in your pregnancy, you should not be lifting more than 20-25 pounds, nor should you be feeling more than 4 contractions in an hour. Don't push your body's limits in order to be a "super resident." It is ok to ask for help if you need it, and don't ignore the warning signs that something may be wrong. Often, we as physicians will push aside our own physical discomforts and keep on working. Don't ignore serious signs like contractions, shortness of breath, headaches, excessive swelling, or increasing abdominal pain.

Survival Tip #10 - When you go home, do nothing else but take care of yourself and your needs. If you need to go home and sleep for 10 hours, then do it, dishes and housework be damned. Celebrate the fact that, in spite of being up all night, you have this time catch up on sleep. When the baby arrives, your call shift will never truly be over. Luckily, in many ways, motherhood is infinitely more rewarding! I wish you all of the best as you enter this exciting new time in your life, you can do this.

Monday, February 22, 2010

Own Worst Enemy

Sometimes I wonder, as a person who has very few "girlfriends" and who tends to gravitate more toward men for friendship, how I ended up in a profession where I am constantly surrounded by women. (Maybe it is because men are whiny babies when they are sick, and I have little tolerance for it. That, or prostate exams. *shudder*) I think I tend to want to avoid the drama that inevitably comes along with close female friendships. I've been burned one too many times, I guess. I've been mortally wounded time and again by women who were supposed to be my closest friends, often for nebulous reasons. We've touched many times along the same topic since the inception of this blog, yet I see the theme being returned time and again, *women* keep women down.

I see this every day in my profession (and, more recently, the blogosphere), where women judge other women's birth choices, from the kind of pain relief they choose to the kind of provider that attends them. Female physicians still don't command the same respect as male physicians, primarily from the predominantly female staff. Stay-at-home moms are aghast at working moms for "abandoning" their children; working mothers "look down" on stay-at-home mothers for not pursuing their own career. Breast-feeders sneer smugly at the bottle-feeders. Women judge other women based on their clothes, their handbags, their hairstyles, weight, and personal grooming (can you *believe* she doesn't *wax*??) It is so pervasive that we automatically apologize for not being precisely groomed. (I can't tell you how many women have apologized to *me* for not shaving their legs prior to an appointment! As an aside, I neither notice nor do I care.) As a happily married woman, I find myself angsting over letting my highlights grow out too long, or running to the hospital with no make-up on. My husband does not care about make-up, and he doesn't have a clue about highlights. I'm not looking to hook-up at the hospital, so why do I care? Because, inevitably, I will get the standard, "Oh, you look so *tired.* Are you sick?" or the snide, "Growing out your highlights, hmmm?" These comments do not come from men.

This extends to the political arena, where any woman that ascends to a position of prominence is viciously and ruthlessly attacked, scrutinized, and her family life nitpicked and torn apart (the phenomenon is bi-partisan, see Hillary Clinton or Sarah Palin). The worst perpetrators of this are not the male commentators. It is the female commentators who render the harshest blows with a glint of evil satisfaction in their eye. Even so-called "feminists" are just as inflexible and intolerant of any woman that does not share their point of view as any conservative male evangelist. I've had women, who (prior to a certain post that tweaked a nerve) proclaimed to *love* my blog, flounce noisily with a searing comment from my blog for simply expressing an opinion that differs from their own (totally within their prerogative, but baffling nonetheless). I'm not saying that I'm not just as guilty of this behavior as anyone else. I am woman, hear me snark. If you don't have anything nice to say, come sit next to me, ad infinitum. I have sinned as well.

My question is: Why?

Why do we do our best, intentionally or unintentionally, to tear other women down? Historically we are supposed to be the collaborative gender, working together for the greater good of our families, villages, etc. So why, now that we have more opportunities than ever, are we snapping at one another's heels? What exactly has feminism done for women from a sociological point of view? Are we jealous? Insecure? Afraid there isn't enough to go around or that it will be suddenly snatched away? More importantly, what can we do to change it? What do *you* think?

Sunday, January 24, 2010

Hey, Jealousy

I am jealous of my husband. There, I said it. A little over a year ago, when our lives were too chaotic to manage with both of us working full-time, Mr. Whoo quit his job in the world of finance to stabilize the home front and get us prepared for the upcoming move. No doubt, it was the best decision ever. Our lives got exponentially better. Shopping, laundry, and errands got done. The kids were no longer in day care 10 hours a day, and we functioned much better as a family unit. Fast forward to now. We've been in Newville for about 6 months, now, and despite a concentrated effort, there are no desirable/worthwhile jobs in my husband's field of expertise. He did decide to take on a "partnership" in a business run by his cousin (which, don't get me started on that cluster, I'm not sure it was the greatest idea) in which he generally manages financial affairs, billing, accounting, and marketing, all for a pittance (not that it matters, but still). This is all done via computer and telephone, so he still is doing the lion share of household chores and kid wrangling to and from school. Here's where the jealousy part comes in...he can do whatever he wants, whenever he wants to do it.

Most mornings, I leave the house before everyone gets up, so he gets the kids ready for school and out the door between 7:30 and 8 am. Then, the day is all his. He can go work out, any time he wants to do it. Then, if he wants to work, he works for a little while. There is no agenda, no set schedule for the day, it is his with which to do what he pleases. The problem is, I'm not really sure exactly what it is that he is doing! Kids are in school until 4-4:30pm. Shopping, laundry, and dishes still get done, but other chores have really fallen by the wayside (we used to have cleaning ladies to do all the "real" cleaning, so that is not getting done regularly and when it is it is done "man-style"). The rental in which we are living is crowded and too small for all of our "stuff" so it never looks uncluttered, and I'm not sure if that is contributing to the decline of cleaning activity or if it is something else. Now, unless I give him guidance, he is waiting for me to get home to tell him what to make for dinner, and I am starting to get a bit frustrated. Not only am I jealous of his autonomy, I am starting to feel like I am starting to judge what he does with his days...and this is not good for our marriage. I know he can' t do it all, but sometimes I feel put upon when he has all. day. long. to figure these things out.

The worst jealousy of all, however, is how much our kids favor him over me. I noticed it when he moved the kids to Newville a few weeks prior to my job being completed. When I finally got to Newville, Bean, who up until that time was very attached to me, was all about Daddy. Understandable, I thought, this will pass. Only it didn't. Now that I have more time to spend with my family, it seems my kiddos want less and less to do with me. My son fusses when it is my turn to lie down with him and night, and says hurtful things like how he is only "Daddy's son, not Mommy's." CindyLou criticises everything I do, because "Daddy doesn't do it that way." I know I shouldn't take it personally, because I know that they love me, and I have been working for so long of course they are going to attach to the parent they see the most. It still hurts, and I am jealous of his place as primary caregiver in their lives, because, well, I'm the *Mommy* dammit. For now, I am doing my best to spend the time that I have with the kids, and enjoying the activities that we never got to do as a family when I was working in my previous job. There is blame to lay on my shoulders, as well. I am trying not to come home and just disengage from the family because I spend all day long problem-solving and taking care of strangers, and therefore have little more to give emotionally. It is exhausting.

Hopefully, it won't be long until we navigate our way through this new life that we have found here. I still believe that having Mr. Whoo at home is far better for our overall family life when compared to having him work outside the home. How do you find your balance as a family? Anyone else married to a "stay-at-home" spouse? Any tips for thwarting resentment and insanity? Ways to reconnect with your kids? I value your opinions and advice!

Thursday, December 10, 2009

A Typical Call Day, Ob/Gyn Style

5:30 am - Alarm goes off.

5:35 am - Alarm goes off again. Unconsciously turn the alarm all the way off, turn over, and snuggle the sweet 2 year old boy who winds his way to our bed sometime between 12:30 and 4:30 am almost every night.

5:45 am - Second alarm goes off.

5:47 am - Finally roll out of bed into the shower.

5:50 am - Stand in shower, mentally plan the day, pray a bit to the call gods.

5:50-6:25 am - Get dressed and ready, pack overnight call bag, double check that CindyLou's Kindergarten homework is done.

6:25-6:30 am - DIET. COKE.

6:30 am - Leave the house before anyone else is awake, drive to work, eat Zon.e bar for breakfast, let air conditioner "blow dry" my hair.

6:45 am - Run the L&D board - check vitals/labs on all post-partum patients, write notes, tuck in (write H&Ps on, examine, check, and discuss the plan for the day) inductions/C-sections/Pgels. Feel a little happy about having two multip inductions, one of whom is already 5-6 cm dilated, and allow myself a little hope about getting home before the kiddos are in bed for the evening.

7:30 am - Scheduled C-section

8:30 am - 9:30 am - Office patients, OB checks, problem visits.

9:31 am - Call from L & D, Induction #1 is pushing

9: 35 am - Back on L &D waiting for delivery

9:40 - 10:15 am Delivery, repair, charting, pictures with new baby and family.

10:20 am - Resume office schedule, 6 patients waiting to be seen.

10:21 - 11:07 am - Frantically catch up.

11:10 am - 11:30 am Check on 10:30 NST for post-dates, notice irregular contractions, patient states she has been leaking fluid since 9 am, confirm ruptured membranes by speculum examination, write H&P, call L & D charge nurse, give verbal orders. Hopes of getting home for the evening? Unfortunately dashed.

11:31-11:47 am - Catch up charting, sign off labs, return patient calls, correspond with the nurses on 18 patient messages new since the beginning of the day.

11:50 am - Grab a stale raisin bagel from the Doctor's Lounge on the way back to L&D, check on labor patients, greet noon C-section, sit down and write H&P for noon C-section, gnaw on bagel.

12:00 - Scheduled C-section

1:00 pm - Back to the office, more labs to sign, more messages to return, eat frozen diet meal in 3 bites. More Diet Coke. Pull up L&D monitor strips on the computer, watch laboring patients from afar.

1:15 - 4 pm - Complete the scheduled patients in the office without interruption (yay!) Peek periodically on laboring patients via computer. All is well

4:01 - 4:25 pm - Call patient with CT results, large pelvic mass, likely malignancy. Discuss differential diagnosis, surgery options, answer questions.

4:26 pm 4:30 pm- Call GYN ONC colleague, discuss patient's CT findings, arrange consultation.

4:31 pm - 4:45 pm - Finish all charting, remaining labs, and straggling patient messages.

4:50 pm - Back on L&D, check on 2 remaining labor patients, accept with a bit of defeat that both deliveries are likely going to be later in the evening, chat with the nurses.

5:00 - 6:00pm - Evening rounds on my partners' post-operative patients for the day, "Wal-Mar.t orders" for the floor nurses, write notes.

6:01 pm - Go to car to pick up overnight call bag, left in the car in hopes that it would not be needed. Boo.

6:06 pm - 6:30 pm - Grab a call room, microwave some canned soup and steal crackers from L&D for dinner, keep one eye on monitor strips, one eye on the ER census via computer.

6:31 pm- 6:45 pm - Call Mr. Whoo, CindyLou, and Bean. Chat on the phone, say good night to the kiddos, sniff a bit about not getting to see them today.

6:46 pm - 7:15 pm - Lie on the call room bed, watch mindless entertainment news, wait for the nurses to change shift.

7:16 pm - Greet evening shift nurses, discuss patients and plan of care.

7:35 pm - ER consultation, admission for PID.

7:37 - 8:03 pm - In the ER, examining PID patient. Confirm ER physician's diagnosis, write admission orders and H&P, have lengthy discussion with tearful patient about her diagnosis.

8:04 pm - Stat page from L & D, patient (Induction #2) that was 5 cm @ 5pm is now complete and on the perineum.

8:06 pm - Arrive on L&D after running up the stairs, pant excessively.

8:07 pm - Gown, glove, prepare for delivery.

8:08 pm - Quick, easy, and laceration-free delivery of a healthy, "surprise" baby boy. I love it when patients wait to find out!

8:10 - 8:27 pm - Charting and chatting with L&D nurses.

8:30 pm - Check on post-dates patient, no cervical change since 5 pm, place IUPC and discuss pitocin augmentation.

8:35 - 10:30 pm - Back in the call room, pull up monitor strip on the computer, lie on call bed, flip channels, drift in and out of consciousness.

10:31 pm - Re-check post-dates patient, good cervical change since 8:30 pm, reassurance given to the patient.

10:35 pm - Find newly admitted PID patient on the floor, change pain medicine regimen, discuss admission orders with her nurse.

10:45 pm - Back in the call room, lights out, try for some rest.

11:45 pm - Call room phone rings, triage patient, 22 weeks with a UTI, who has had dysuria for 3 days, but confusingly (but unsurprisingly) picks the middle of the night to come in for it. Antibiotic prescription written, back to sleep.

12:48 am - Call room phone rings, another triage patient, possible term labor, irregular contractions, dilated 2 cm, have patient walk for an hour and re-check cervix, back to sleep.

2:00 am - Call room phone rings, walking patient with no cervical change, reassuring fetal strip, orders for Ambien and discharge home. Check on laboring patient's monitor strip and notice some early and variable decelerations.

2:05 am - Check post-dates patient, she is completely dilated, but feeling nothing due to super-epidural, decide to allow passive descent.

2:06 - 3:02 am - Chat with the nurses and laugh.

3:03 am - Post-dates patient calls out, "Feeling pressure."

3:04 am - Post-dates patient starts pushing with her nurse. Nurse reports back to me "this is going to take a while." Back to the call room, rest fitfully, peeking at the monitor strip approximately every 5 minutes.

4:17 am - 4:45 am - Called for delivery. Gown, glove, help deliver a 9 pound baby girl, get misty when Daddy starts crying. Collect cord blood for banking, repair perineal lacerations, leave the room to start charting.

4:46 am - Informed of triage patient's arrival, 30 weeks pregnant with possible premature rupture of membranes. Head to triage.

4:47 am - 5:07 am- Talk with patient, speculum examination reveals gross rupture of membranes, bedside ultrasound confirms AFI of 2 cm. Discuss implications with tearful patient and her husband, plan transfer to nearby hospital with Level 1 NICU and Children's Hospital. Orders for steroids, fluids, and antibiotics given.

5:09 am - Call on-call physician for nearby hospital, discuss the patient, transfer of care accepted.

5:15 am - Quickly write H&P on PROM patient, return to triage, discuss plans with patient's family which has quadrupled in size in the last 8 minutes.

5:25 am - Finish charting from previous delivery. Start rounding on post-partum patients, pray for 7 am to arrive, shake fist angrily at the call gods.

6:00 am - Watch PROM leave the unit with the ambulance squad.

6:05 am - Round on PID patient. She is feeling better, no fevers since admission.

6:22 am - Back to the call room. Shower. Clean scrubs. DIET. COKE. Pack up call bag.

6:45 am - Check out with the next call victim, finish post-partum rounds.

7:00 am - Officially off call! Ready for another full office day.

Monday, November 30, 2009

Walking the Talk

After years of unhealthy living, midnight grilled cheese sandwiches with fries because I "deserved it" for working so hard, no exercise, two pregnancies, and too many nights of not enough sleep, I am finally at a place where I can turn my focus to my very own health. I am gradually increasing exercise, wearing a pedometer, and striving for 10,000 steps a day. I started a 3 month physician-directed weight loss program, and have seen a 7 pound weight loss in 3 weeks. I also found out that I am hypothyroid, so being on medication is likely helping as well. Mr. Whoo and I are signed up for a 5 K in January, so I am tackling my biggest hurdle, learning to run (without crying). It isn't easy. I am working harder than I ever have for minimal results on the scale, but the weight loss is real. If I can lose 8 pounds a month, 6 months from now, I will be nearly 50 pounds lighter. Real life weight loss isn't like "The Biggest Loser," and it is easy to get discouraged when the hard work and struggle doesn't result in game-show like transformation. Being overweight, I've never been unsympathetic to my overweight patients, but working this hard has made me a better counselor to direct their efforts, especially as they try to juggle work and family life. Just as having children has given me a unique perspective to counsel from the seat of experience as well as clinical knowledge. As a doctor, I am trying to heal myself. Have any of you had a health issue that made you a better physician? How has it changed the way that you practice?