Showing posts with label gcs15. Show all posts
Showing posts with label gcs15. Show all posts

Wednesday, January 29, 2014

In memory

On January 28, 2014, Dr. Dwight Gustafson passed away in Greenville, SC.

He was the subject of a MiM post several years ago by neurosurgeon gcs15 that brought many of us to tears.

Our thoughts are with his family, his friends, and everyone he touched along the way. If anyone needs any encouragement or inspiration along our path as mothers in medicine, please read that post again.

Thursday, January 5, 2012


I have a friend, another MiM, who is nothing short of inspiring.

Born in the former Yugoslavia, she was raised in Germany and ultimately went through medical training there. Like all of us, she has stories to tell about her specialty, OB/GYN, that range from hilarious to horrifying. Like us, she has a family - two children, both born in Europe during her medical career. Although training in Germany, as in the US, was demanding, she found the time and courage to return to her home country for a short time during the Balkan War. She worked on casualties in a hospital there while bombs dropped in the distance.

When her husband wanted to accept a job offer in the US about 6 years ago, she didn't hesitate. She dropped everything, including her career, and helped organize the move to a different continent. She supported her children, who didn't speak a word of English at the time they arrived. Since then, their family has thrived. Her son and mine play ice hockey together. We are both now rearing teenagers and commiserating about their lack of frontal lobes!

She did all this thinking that eventually she would resume her career here in the States. To prepare for this, she passed all the USMLE steps and met all the criteria for the match. I remember when, more than 2 years ago, she asked for my help in preparing her personal statement. Having fortunately sailed through my own match as a newly minted American grad, I thought, "Boy, this should be easy - who wouldn't want such a brilliant physician in their program, one with such a broad range of experience?" I'm sure she thought, "I've been through OB/GYN residency, a war, and a move to a different continent - how hard can this be?"

Boy, were we naive.

Since then, my friend has been through two matches without even a single interview. She has done research in an academic GYN lab and is published as a result. She spent a summer in the Himalayas doing medical mission work. Despite everything she tried, she had no success.

I am astonished at what I have learned through her frustrating experience. At the two hospitals where I work, I frequently encounter physicians who are foreign medical graduates (FMG's). Because of this, I assumed there were plenty of opportunities for all comers. Not so.

Speaking to two different residency program directors, I heard the same story. These days, it's all about year of graduation from medical school. If you are more than 2 years out, your application is not even considered. It goes straight to the trash - American or foreign grad.

The other factor is the competitiveness of the market. With the economy in its current miserable state, applications to med school are through the roof. Med schools, seeking extra tuition, are expanding the number of spots available. New med schools are opening in response to the perceived worsening shortage of physicians. However, residencies are not adding positions - they are federally funded, and there is no extra government money for expansions.

This translates into lots of applicants for available residency spots - brand new, shiny American graduates. One program director told me that by 2015, there will be more American med students graduating than there are residency positions to be filled. She said, "At that point, we won't even be looking at Carribean graduates, much less FMG's. If she doesn't find a job by then, she's doomed."

Wow. I had no idea.

We hear a lot in the media these days about the projected national shortage of physicians. We are all concerned about this. How will it affect our jobs? How long will our wait times for new patients become? Who will take care of us when we (or our family members) become ill? How will we divide work with physician extenders?
If this shortage is such a huge problem, why on earth are we shutting out an excellent source of new and yet experienced physicians? There must be hundreds of physicians like my friend, eager to work and already skilled in their fields of expertise. These are intelligent, productive people who will support their communities and pay taxes. If there are not enough residency positions available to accommodate them, why can there not be a parallel program tailored to bringing FMG's into the workplace? Perhaps an apprenticeship model would work...

(I do understand the concerns about FMG's. The American system is different even from Europe's, so it is hard for them to adjust. Language barriers can be significant, even crippling. The quality of FMG's is not consistent, so it is hard to know how much remediation may be necessary on the front end. If a physician has been away from training or practice for too long, the knowledge gap may be large. However, medical training is never easy with any group of students - these concerns are not insurmountable.)

Beyond this, I have concerns about future MiMs in particular. If date of med school graduation is a key factor in residency applications already, this means possibly catastrophic difficulties for women who want to take time off for pregnancies or to care for small children. Admittedly, 2 years is a long time, but it seems to me that even one year off could be considered a serious liability in this competitive climate. Add to that the pressure of student debt. What happens to the med students who cannot match, cannot get a residency position, but owe large amounts? With what means will they pay off that debt?

My talented, courageous friend is the canary in the mine. The difficulties she has experienced with the match process are a harbinger of things to come for many of those who seek to follow in our footsteps.

Encouraging note: My friend is now actively in a preliminary general surgery residency position. We are hoping that this will be the foot in the door that will lead to either a categorical surgery position or a primary care match for her.

Friday, December 16, 2011

It's Not Rocket Science...

...but it is brain surgery! Neurosurgery has always seemed to have a certain aura and mystique about it as a specialty. It certainly was glamorous to me when I started out as a medical student. After all, neurosurgeons work in and around the brain, the seat of our very existence. In fact, we work more often on the spine than the brain, but nonetheless, we are "brain surgeons."

I was one of those annoying medical school classmates who started from Day 1 wanting to do neurosurgery, and who continued that path relentlessly, without second thoughts. Having walked the long and difficult road, I will say unequivocally that it is in NO WAY family friendly. It's hard to think of a less family friendly specialty. That's one reason why, even today, only 5% of about 3500 practicing neurosurgeons in the US are women.

There are oodles, scads, of reasons why this is the case.

1. Long and difficult training: Residency is an average of 7 years duration (usually not counting fellowship). Even so, it is hard to learn everything you need to know: patient evaluation, types of pathology, technical skills, reading your own radiographic studies, etc. The days are long and exhausting. I don't know how it is now, since the 80 hour work week, but I suspect it's still very demanding. It's difficult to carve out time and energy for your family. It's also hard to be pregnant during residency, the prime child bearing years.

2. Lots of emergencies: Problems like acute brain hemorrhages and cauda equina syndromes can't wait. In fact, sometimes half an hour makes all the difference. This makes planning your day impossible. As soon as you make plans to go out to the theater with your husband or go to your son's football game, the surgery gods conjure up a subdural. Curse you, surgery gods!

3. Unsympathetic colleagues: This specialty is full of men with stay at home wives who do everything for them. Nothing against SAHM's!! But don't expect your fellow residents or partners to understand taking breaks for breastfeeding. Don't expect them to help you in any way, because they have NO IDEA what your life is like outside work.

4. All or none: There is no such thing as a part time neurosurgeon. Trust me, I've seen it tried.

5. Physically demanding: This specialty demands long hours standing without a break. The sleep deprivation and stress are extremely taxing. Even after residency, there are times when you are so tired that you can't decide whether to eat or sleep first. This is after 24+ hours without a proper meal. Sex? Sleep is better when you haven't slept for 2 days! Add a crying baby to the nights you are home...

6. Culture: In neurosurgery, asking for any help is a sign of weakness. Call me if you need me... but don't call me. This culture is not conducive to supporting things like maternity leave.

7. Help wanted: Out in practice, when most of us are rearing teenagers, it would be great to have lots of partners to share call and PAs to help with the workload. Good luck with that. There is a chronic shortage of neurosurgeons; the ones that exist are difficult to recruit. It took us 4 years to find one to replace a partner who left. PAs are in high demand and would much rather take cushy dermatology jobs than difficult neurosurgical ones. I currently take call every 4th night and consider myself lucky.

8. Social isolation: I didn't expect this to be such a problem. Nonetheless, it has a large effect on our social life as a family. We don't get invited places because friends think I'm too busy. (Or maybe they just secretly don't like me, but this is what they tell me!) At church and school functions, people don't chat with us, they ask me about their aunt's brain tumor treatment. Even neurosurgeons like to talk about the weather and the upcoming football game, y'all!

So having said all that, you may well ask: "Why would anyone ever want to do this awful job?!"

There are oodles of reasons for that, too.

1. It's surgery! How could anyone not love doing surgery? I've said it before... fixing a problem by opening the body and closing it again, and having the patient survive the experience, is nothing short of a miracle to me. It still amazes me after 10 years of practice.

2. Control: As an extreme Type A, I love controlling everything about what I do. I own my practice with my partners, so I am my own boss. What I say in the OR and in the office, goes. My own decisions and actions determine my patients' outcomes, and that's the way I want it.

3. Impact: Every day, I see patients with life-threatening problems. Through my profession, I am able to save lives and keep people out of wheelchairs. Being able to make a real difference in just one person's life makes it all worthwhile. In neurosurgery, that impact on the patient is so often immediate and dramatic. It's high risk, but high reward.

4. Respect: This specialty still commands immense respect, both from patients and colleagues. Not that we deserve more respect than other professions, but there it is.

5. Financial security: It's still a good living, although politics may change that in years to come. Not having to always worry about money is one less strain on a marriage. Further, a neurosurgeon can always provide for herself and her kids should that become necessary.

6. The Challenge: This may be the thing I love most about my job. Every day, every patient, every case brings a new challenge. There are always new things to learn, envelopes to push. I never get bored or complacent, because it's just not possible. Towards the end of residency, I once thought I'd seen it all. Later that day, the nurse at the trauma desk popped her head up to ask, "Hey, are you seeing the guy that got assaulted by the ostrich?!" Never a dull moment!

I love neurosurgery and can't imagine doing anything else. Family friendly? Nooooo. Worth it? Yes! It can be done, although it's not easy. As others here have pointed out, no working mom has an easy time of it. All we can do as MiM's is give it our best and hope that the ones we love understand us and continue to love us back.

Saturday, October 8, 2011

I Have A Dream...

Writing this post, I am sitting in a luxurious hotel room half a continent away from home. Well, actually, this city was home for six years. It still feels like home, in a strange way, whenever I return and drive around its streets for a day or two. This is so, even though it's been ten years since I left. Ten years...

This was an exciting place to live. I remember driving here in the moving van, young and idealistic, freshly married. I bought my first house here, had our first (and only) child. I learned my craft here, entered the fires of neurosurgical residency. After six years, the crucible decanted me into a busy, thriving private practice in my original hometown. Now, I am part of the storied history of my training program, one of only four women to graduate, one of many well trained neurosurgeons this city has disseminated across the front lines of America's hospitals.

I am proud of my training program and its history, its traditions. I am humbled by and deeply grateful to my mentors here. So, when the news came that my program chairman was retiring this weekend, I immediately rearranged my schedule so that I could be here for the celebration.

This man is one of the great names in neurosurgery. He is technically a master of complex skull base surgery. He has held the most august academic positions, has received international honors. He is, quite simply, one of the most brilliant men I have ever known. And yet, as he said in his speech last night, he feels that his greatest accomplishment is us, his residents.

We all have a dream that we spend a life to pursue. We work, we suffer, we make sacrifices - and we keep dreaming.

He said last night, "It's never been about me. It's been all about the residents, the education. Anybody who does this knows that teaching residents is like raising kids. The people I chose to go through this program are a reflection of me; their success or failure is my responsibility. It's been about teaching the next generation, making sure this program lives up to its tradition of greatness."

We were his dream, us and his own five kids and twelve grandkids.

At dinner, many of us had a toast to make, a story to tell. Mine was about a favorite memory from residency. We had journal club once a week, at 6:00 or 6:30 am, over breakfast. One morning, the topic was sports injuries. We reviewed several articles comparing different sports and the risk of serious neurologic injury in each. Ice hockey, soccer, baseball, basketball were all on the charts, but football was way up high at the top of the list. There was a huge gap between it and the next sport down. We spent 45 minutes seriously discussing the ramifications of this.
Then the room got quiet, and my chairman piped up, not having said anything up to this point. He stated cheerfully, "I like to play football." We stared. "Because I like to hit people!" he finished.

We must have laughed for five minutes!

At the end of telling this story, I mentioned that now I have a 13 year old son who plays football. Every time he takes the field, I think of my chairman and chuckle a little. I finished by stating, "Thank you for being the best possible example. You showed us all that you can be a neurosurgeon and be brilliant... but also be a real person, and a great guy."

We will remember our chairman, who could give the presidential address at the big national meeting and then greet us on a Saturday at the local IHOP, driving up for breakfast in his beat up gray pickup truck. We will remember how he always asked about our families, and how proud he was of the number of babies the residents had.

Cheers, doc, mentor, friend. You deserve all the honor and respect you have gained from us all. Your dream allowed us to realize ours. We will pass it on, and on. My dream will help my son realize his one day, whatever his turns out to be.

We all have a dream, probably more than one. That guy playing blues on his saxophone outside my window right now has one. Mine has been to succeed in the most difficult, and most rewarding, career that I could have imagined; to also succeed in constructing a happy, healthy family. We work, we suffer, we make sacrifices. We hold onto the dream. It may come true, or it may not. But in the end, we will know that we have given it our best.

Saturday, April 23, 2011

The Valley of the Shadow

I never expected residency to be a cakewalk. I knew it would be hard, especially as a woman. Growing up in the deep South, I understood the concept of the "good ole boys' club." Believe me, it's still alive and well.

In the dark ages, when I started residency, there was no 80-hour work week. We were expected to stay until the work was done, which admittedly prepared me well for the real world. As a new intern, I thought that if I just put my head down, did all the work, and never complained, that everything would be fine. More than one woman had already graduated from my training program, so I figured the ground had been broken. I was optimistic as I rolled up my sleeves and dug in.

In my PGY-2 year, my fellow residents and I calculated that we were working about 120 hours a week on average, and that came to about 33 cents/hour. We tried not to think of that too often!

In my PGY-3 year, I became pregnant (amazingly, nature cooperated with our plans). I spent my third trimester as the junior neurotrauma resident at the second busiest trauma center in the country. It was known to be the hardest rotation in the program. I caught the expected grief from my (male) fellow residents, but I never missed a day of duties or call. I worked up to 38 weeks as planned. I took maternity leave (after a C-section) during my neurology elective, during which one did not take neurosurgery call; my fellow residents were therefore inconvenienced not one whit.

Things went fairly smoothly after my return 6 wks postpartum, to my mind. Fast forward through lots of backbreaking work to PGY-6, my last year. I had just completed a complex spine fellowship and was looking forward to a happy ending in about 6 more months. It was fun teaching the junior residents basic neurosurgical skills. I had a happy, healthy 3-year-old son and a loving husband. I could see the light at the end of the tunnel.

One afternoon, I went to one of the ICU's to deliver the articles each resident had to present at journal club the next morning. I approached a group of about 5 younger residents and greeted them as usual. One of our attendings was doing paperwork nearby. I held out an article to a PGY-5 I'd worked with for years.

He glared at me and said flatly, "I'm not taking this. I have plans this evening, and I don't have time to prepare. You'll have to do it!"

I stared at him, taken aback, as he stood there oozing belligerence. Then the other residents chimed in. In the middle of the busy ICU, they took me apart, my colleagues who I'd worked beside, covered for, praised and supported.

"You are so lazy." "You have a terrible attitude." "You never seem to be there to help with anything." "We're tired of working with someone so lazy." "This is all your fault."

"Lazy." "Lazy." "Lazy." It echoed, etched itself in burning letters in the air. I don't remember much else of what they said; mostly I remember the looks on their faces, the silence of the one resident I thought I had known the best.

I hadn't known them at all. And they didn't know me at all, these men who all had stay-at-home wives who took care of everything for them, had their children, made them dinner. They could carelessly condemn me without ever having been to my home, met my family, asked me anything about my life. They could never know the phone calls I'd taken for them, the things I'd done with patients in the afternoon so the call guy wouldn't be bothered. So much they didn't ever know, and didn't really care to know. So much hard work I'd done that had made no difference.

I remember leaving the ICU, articles in hand, without seeing anything around me. I paused in the parking lot just outside the door; turning, I saw the attending just behind me, and I knew he'd seen the whole thing. I asked, "Dr. X, could I talk to you for just a minute?"

To my complete astonishment and dismay, he stammered, "Have to be at, ah, a meeting, ah..." and actually *ran* to his car, leaving me standing there. So much for expecting any support from on high.

I went straight home and sobbed on the sofa for an hour, unable even to tell my husband what was wrong. Then, as a good neurosurgical resident should do, I prepared all the articles myself. I walked into journal club at 6:00 am and presented them all. I explained to the chairman that it was all my fault they didn't get distributed. And then I went to the OR.

For the next 6 months, those residents made my life miserable. Every day, I dreaded walking into the hospital. I dreamed about the word "lazy." I never, never asked for help, because you don't do that in neurosurgery. I blamed myself, because that's what you do as a surgical resident, even though I knew better. But I faced them all down, every day. It was the hardest thing I had ever done.

To this day, I still don't know why they did this. I'll probably never know, since I avoid the residency reunions held every year at the national meeting.

I was so relieved to get in the moving van at the end. Shortly before we left, the chairman held the annual dinner honoring graduating residents (there were two of us). My fellow residents had prepared the slide show, including a section spoofing the "Priceless!" commercials on the air at the time. It intimated that getting gcs15 to come in to help with a case was "priceless." My husband and my co-senior resident's wife got the same "spouse's gift" - a dried flower arrangement.

My neurosurgical training was excellent, and it has stood me in good stead over the 10 years since finishing. I have enormous respect and gratitude for many of my professors. I can say that I am a good surgeon with confidence. I love my profession, and I still can't imagine doing anything else.

What I have come to realize, however, is the destructive effect residency had on me. I'm sure I'm not the only one. I love neurosurgery, but I hate its culture. The primary tenets are: don't ever complain and always accept responsibility, even if it's not your fault. Most importantly, don't EVER, EVER, ask for help. If you do, it's a sign of weakness. If you do, you are not worthy of Neurosurgery. Call me if you need me... but don't call me, because you will be vilified. This is true in training, and it's just as true in practice. And if you don't fit the neurosurgical stereotype, you don't "belong."

I have never really gotten through the Valley of the Shadow. I have worked harder and longer than I should have worked to prove to everyone, especially myself, that I am not "lazy" after all, even though I know I never was. I swore that no one would ever speak to me again like those residents did, and I found myself unleashing a tirade on an anesthesiologist once because of that. He started off, "The problem with you is..." and I just snapped. It was visceral. The shadows still darken the valley.

Running a neurosurgical practice is hard, complicated work, but I have made it harder than it should be. Because of this, my family has suffered. I have tried very hard to strike a balance, but it has not been enough to avoid inevitable crisis. Wisdom is only gained through hard experience; I hope I have enough now to finally get past the demons. With this, much of the fault is truly mine. I should have forced myself to exorcise them long ago; I underestimated their menace.

To those who would tread the path of surgical subspecialty, I say it can be done. I know what I must do to correct my mistakes and make things better for my family. You will make your own mistakes and face your own Apollyon, but you too can overcome. One day, the culture will change. We must make it so.

"Now morning being come, he looked back, not out of desire to return, but to see, by the light of the day, what hazards he had gone through in the dark. So he saw more perfectly the ditch that was on the one hand, and the mire that was on the other; also how narrow the way was which led betwixt them both; also now he saw the hobgoblins, and satyrs, and dragons of the pit, but all afar off, (for after break of day, they came not nigh;) yet they were discovered to him, according to that which is written, 'He discovereth deep things out of darkness, and bringeth out to light the shadow...' " - Pilgrim's Progress, by John Bunyan

Sunday, February 27, 2011

I Got Your Lobotomy Right Here...

Thank goodness, we have made it to the end of this youth hockey season!

My 12 year old son loves sports, especially hockey. I'm still trying to adjust to being the mom of a jock (sorry, *young athlete*). It often seems that life is made up of only two things: neurosurgery and watching youth sports.

He plays football in addition to hockey; he's also now the goalie for his school's JV soccer team. I suppose spring will vacillate between operating and cheering for excellent saves.

Hopefully it won't involve any hooliganism...

Hockey parenting has worn me out recently. I get that hockey is a physical and sometimes violent sport. What I don't get is the vitriol spouted by players - and their parents. We're talking about 11 and 12 year olds here. For instance:

Last year, our team was in the semifinals of the league tournament. Admittedly, one of our kids was very big for his age. He therefore drew a lot of attention from everyone, including referees. You might imagine that a kid so big could execute a pretty effective check. Thankfully, he never seriously hurt anyone.

Well, the game is ticking along, and several kids (including him) go down in a pile in the corner of the ice while chasing the puck. As they disentangle themselves, an opposing player grabs our big kid's leg while he's trying to get up. Probably their kid was trying to clamber up himself. Regardless, it evidently appeared to the opposing team's parents that our kid was deliberately stepping on their kid with his skate.

At this point, a mom from the other team standing close by started hopping up and down, screaming abuse at our kid at the top of her lungs. "Did you see that?! He stepped on our kid! Throw him out! ##@*^^&! I can't believe this! $$@#**..." She went on and on in the same vein.

After about 5 minutes of this ranting, I had enough. I turned to her and politely said, "Do you think it's possible that our kid might just have been trying to stand up, and that he might not have been trying to step on anybody deliberately?"

Fuel to the fire! Instantly, her vehemence redirected itself at me. "OOOOhhhhh, no! Look here, I got it all on video! Do you want to see it?! He did.... etc. etc..." waving her video camera ecstatically around her head. I stared, fascinated, as her face turned redder and redder. Finally, she shrieked, "Stop looking at me! You're STILL looking at me!!" Of course I was, sort of like rubbernecking at a car accident... I'm sure my eyes were as big as saucers at that point. What, really, did she expect?

I must admit, I have no experience with this sort of thing. Being a classic nerd, I was never involved in any fisticuffs or hair-pulling in the halls of my high school (although I have witnessed such events). But, surgeon-like, I do have a temper, as I have admitted elsewhere. By now, I was angry at her hooliganesque attitude and the things she screamed at our 11 and 12 year olds. Hence, a few low-level comments did fly back and forth as the game progressed. (I know, I shouldn't have needled her.)

Unfortunately, the offending mom became further inflamed by our team's obvious impending victory. Finally, she appeared beside me, literally dancing with rage. "I'm a dentist, and I can fix your teeth; how about THAT?!" she seethed.

As I mentioned, I am a novice to this sort of thing. Now I was thinking, "OK, if she wants to wage the war of the degrees, she's not going to win..." So I replied, quite seriously, "Well, I can fix your brain..."

This was not received in the spirit in which it was intended!

After I declined her subsequent invitation to come outside to the parking lot, rolled my eyes, and redirected my attention, my less naive husband started snickering. He had been standing behind me, knowing what I was thinking. He told me later that he was muttering under his breath, "Don't say it... don't say it.."

Well, so my knuckles (and my teeth) remain intact to this day. But I continue to be horrified by some of things hockey parents yell at kids on a regular basis. Some rinks, unfortunately, actually sell beer for adults to drink at youth hockey events. You might imagine this doesn't make things any more civil. It's not limited to just hockey, either, from the stories I hear about other youth sports. My son tells me about the profane trash talking he's heard from kids (and their coaches!) on the ice; wonder where they get that? I just can't wait to see what things are like when he's in high school.

Sunday, January 2, 2011

Great Expectations

"I always wanted to build model planes," he said, wistfully examining the partially finished one on the table. "My father would not allow it. He collected stamps, so we collected stamps." - King George VI in The King's Speech.

Of all the dialogue in this outstanding movie we saw on New Year's Eve, this gave me sudden pause.

It is not, after all, too surprising that much might be expected of a king's child. Great privilege is accompanied by great expectations. How difficult it must be to live such a life, especially in the age of ubiquitous media. I feel a certain pity for Kate Middleton, whose life can certainly never be normal again. I actually wept in the theater for King George VI and his terrible predicament.

What a compelling depiction this was of the effect a tyrannical parent can have on a child. Ultimately, George V admitted the respect he had for his second son - too little, too late.

Throughout history, a certain personality type has been attracted to a throne. Genghis Khan, Elizabeth I, Julius Caesar... none of these was a gentle or shy type. I believe many surgeons share this same super-Type A personality. I recognize it in myself. Without some such traits, it is difficult to get through training and be successful in this field.

Rulers must not show weakness; they must appear confident at all times. They must relish control and enjoy making decisions that affect the lives of real people. So it is with surgeons (and some other specialists) as well. The OR is very like a small kingdom in many ways.

It can be difficult sometimes to moderate those personality traits at home with family. Clearly being so Type A has its advantages, but there can be a dark destructiveness to it. King George VI evidently knew that well.

I can understand his father, George V. As a successful monarch, he must have wanted his children to be just like him. Anything less would imply failure on his part to produce equally successful offspring. He must have felt the need to control his children's development as he controlled everything else. When he could not correct their flaws, he felt disappointed, frustrated, even betrayed. He could not countenance failure.

I admit that I have felt shades of this. I suspect I'm not the only one. Like many surgeons, I have always been successful at most things; I have never really had to face a major failure. I have generally been able to make things happen the way I want them to. Raising a child, however, is different.

My son is the most precious thing in my life. My greatest wish is for him to ultimately be happy and successful. I know he is not me; I don't really want him to be. He is a different person, and that's a wonderful thing. I would never push him into a field he didn't love - yes, including medicine. Nothing could change my love for him.

Nonetheless, I have found my Type A side struggling at times. Two things have bothered me the most.

He is not a straight A student. He has the ability, but he just is not motivated to accomplish this. I tell myself that he is just 12 and that B's and C's are OK. He may buckle down as he matures. We make sure he gets his work done, and we try to help him study for tests, but he's just not interested. He would much rather play hockey or watch ESPN. This is so frustrating to me... and I can't understand it. At a visceral level, I can't imagine not having the drive to be top of the class.

Worse, he hates to read. Loathes it! Even before he was born, I dreamed of reading together with him. I imagined sharing the books I have loved all my life, laughing and crying with him over the pages. I know now this will never happen. It may sound silly, but this is possibly the biggest disappointment I have ever known. But I can't change him, make him love something he doesn't.

None of this sits well with the controlling part of me. At times, I'm tempted to yell my frustration at him, force a book into his hands, take away his sports. Obviously, I tell myself, that wouldn't be fair, and it would only make him resent me. Type A or not, I don't want to be King George V, dictating what my son will and will not enjoy, will and will not do.

I've been mulling over the reasons that scene moved me so. I think it had something to do with recognition, and with fear.

Kings or physicians, our children are the most important part of us. We want so much to see the best of ourselves in them. We work so hard in part to give them the best opportunities to build a satisfying life for themselves. We know only one route to success and happiness, the one we have walked ourselves. We fear that their differences from us may spell difficulty for them, or even failure. Where they fail, we feel that we have failed.

Further, we crave a lasting bond with our children, one that will connect us through the years and the inevitable separations. Subconsciously or consciously, we try to cultivate similar tastes and interests, ways to understand each other better. The love comes naturally; the mutual understanding is harder. We fear loss and loneliness.

My biggest challenge may be letting my son grow into a different person without trying too hard to interfere. I can't change my surgeon's Type A-ness, and I can't change him. Nor can I change my hopes for his future. Perhaps my New Year's resolution should be to interest myself more in the things he naturally enjoys instead of yearning to make him over in my own image. I should focus less on my own disappointments and more on the joy of who he is. Truly, there is so much to be joyful about.

Since the time of Dickens and before, parents have had Great Expectations for their children. Let us have the wisdom to recognize our own fears and shortcomings, and to temper those expectations with purely unselfish love.

Sunday, December 26, 2010

Laughter is the Best Medicine

No one wants to be in the hospital at Christmas.

Well, maybe some people do, especially if they're lonely. Certainly everyone whose deductible starts over again in January seems to. But despite the urgency patients feel to have elective surgery over the holidays, I sense that none of them is really happy about it. Neither am I, for that matter. I hate that December is always my busiest month (71 cases this time around).

So, every December, there is generally an undercurrent of "Bah, humbug!" lurking in the hospital hallways, sort of like the invisible coating of drug-resistant bacteria on the ICU surfaces. This never helps me percolate any kind of holiday spirit.

Early this month, I stopped at the drugstore to pick up some toiletries. Next to the shampoo section, my eye caught a display of silly over-the-top antler headgear festooned with blinking Christmas lights. I found myself grinning a little and thinking what my son would say if I picked him up from school wearing a set of those antlers. So I bought a set out of mischief - what are parents for if not embarrassing their preadolescent kids?!

On the way home, wearing those blinking antlers, I realized I was still grinning - and I came up with a very un-Grinch-like idea.

The next day, I arrived in preop holding wearing my white coat... and my antlers. The staff gaped, then giggled. I went to see my first patient and watched the anxiety on her face melt into laughter. She rolled back to the OR still smiling. And so it went, all day long. It was the most fun I'd had on a workday in December since - who knows?

The OR staff enjoyed it so much that on my next OR day, several of them brought in Christmas headdresses of various types: elf ears, Santa hats, snowflake crowns. I myself bought enough headgear that I wore a different set every operating day through the 23rd. My inpatients looked forward to seeing what would come next; one actually wanted to stay an extra day just to see what my head would look like. Every patient seemed a little brighter than usual this month (a lot like my head!).

I have always thought that humor is a key to communicating with patients and making them feel at ease. I use it whenever I can. My Christmas headgear experience has made me realize how big a difference it can really make, not just in the patients, but in us as physicians, too. A laugh can dispel the shadows of fear in a patient's mind; they're all afraid, each in their own way. We, too, are afraid - of the things we can't control, of the grimness of disease and death. Just as the Hogwarts students could dispel creatures resembling their greatest fears with humor ("Riddikulus!"), so do we have the power to help our patients and ourselves grapple with the dread of illness.

I wish we all could recognize this. Interesting, some of the comments I heard from my colleagues when they saw my festive antlers. Twice: "I don't know if I'd have the confidence to have someone wearing those operate on my brain!" "Do you really let your patients see you in those?!" Most telling: "I bet not many neurosurgeons would be seen wearing those..."

No, sadly, probably not. Ours is notoriously such a dignified, serious profession. The classic image of a neurosurgeon is a tall, graying man in a suit and tie with a grave expression who can burst into a tirade at the drop of a hat. No smiles, no fun, and certainly no antlers for him! After all, the patients and the world must hold him in the utmost regard! I have always secretly been pleased to look (and to be) nothing like that classic stereotype. Our field needs more laughter... and more humanity.

That's the comment (from a chaplain) that struck me most: "I am glad to see you wearing that. It lets the patients see that you are human."

Indeed. I couldn't agree more. If I learned anything from my Christmas antler experiment, it is that many physicians still take themselves too seriously. We have an important job, no question. But if we are to give our patients the best care, we must find ways to connect with them on a human level. We need to pay less attention to our dignity and more to empathy, all year round. A little laughter, sometimes directed at ourselves, would go a long way in all our relationships.

In this season, we celebrate the Incarnation, the perfect divine coming to share the imperfect human experience. What a good time to put the physician "God complex" behind us and show our patients that we, too, can listen, can cry, and ... yes, can laugh.

Monday, December 13, 2010

"Perfect" is the Enemy of "Good"

Over the years, I have come to the painful realization that I am not perfect.

OK, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don't read this, patients, because you wish even more than I do that I were perfect (especially when I'm operating on you). But it's true.

Long ago, I remember feeling that perfect was achievable. In my innocence, I pictured myself with a high-flying academic career in a big city neurosurgical teaching program. I would have a handsome husband with a powerful career of his own, 3 perfect children, and a home straight out of Southern Living. (I even subscribed to the magazine.) Of course, I would need no help taking care of the house, because I would do it all myself. I would have no surgical complications, and every patient would love me. I would be Harvey Cushing and Martha Stewart, all rolled into one!

I think it began to sink in that this was a little unrealistic just before the start of residency. My husband and I had just returned from our honeymoon. I had left myself 4 days to move halfway across the country and set up housekeeping before our first day as interns. With one night left, I found myself staring in horror at boxes still sitting implacably all over our new house. Yikes!

Through our years in residency, we added a baby and a hefty dose of realism to our lives. Thoughts of Southern Living fled from my mind. Indeed, thoughts of homemade baby food, beautifully decorated nurseries, and hosting book and supper clubs also vanished. I felt lucky to keep the bills paid on time, the vaccinations on schedule, and the house clean enough to walk through (with my husband doing a lot of the work himself). Despite all this, we both somehow made it through residency with our marriage intact.

Now it is more than 15 years since that idealistic, newly married intern walked through the door of a new life.

Looking back, I'm proud of much that I've accomplished. I have a thriving practice and a family that seems pretty well-adjusted, despite all the gruesome patient stories told over the dinner table. I'm a lucky woman.

I'm not so proud of how I've balanced work and family over the years.

Anyone who goes into a demanding surgical subspecialty knows what it will be like. There will be sacrifices and long call nights. There will be stress and (yes, Fizzy) tears. There will be time away from family. Anyone who loves a surgical subspecialist knows this, too. My husband knew this when we started dating in medical school. But he also knew how much my career meant to me. He knew I wouldn't be happy without it. He married me anyway.

The decision to marry this wonderful man has been the saving grace of my life. He has done so much with so few complaints. In an culture that is still macho in many ways, he has done a lot of laundry and a lot of childcare. He takes our son to school and picks him up. He helps with homework and goes to pediatrician visits. He has been the hands-on parent where I have not. Without him, our family would have disintegrated.

Not that I haven't done anything, in my own defense. When I'm not at work, I'm all about home and family. I have made it to every band concert and the majority of my son's sporting events. I actually made it to every single football game this season, even though they were on Thursdays. For several years, when my son wasn't eating well, I made dinner from scratch almost every night. Some nights dinner was late, some dinners were frozen from earlier weekend cooking sessions, but they were done. I supported my husband when he wanted to make a radical career change, without questions or criticism. I have tried. I have tried HARD.

But I admit, I have spent long hours at work. Because I'm busy at work, I don't fully appreciate the long gaps they feel at home. And I admit, I have taken my husband for granted a lot, which is wrong. I have leaned on our marriage hard, drawing strength from it to keep doing this incredibly difficult job. I worry sometimes that I may have weakened it too much.

Almost exactly a year ago, I wrote an anguished post here about a day in my life. Seeing it in writing and hearing all the feedback made me see that I had to have better control. Since then, I have worked very hard on finding a better balance.

I have now hired a cook to come to our house and make dinner every weeknight. She does the grocery shopping and some of the cleanup. That may seem pretentious, to have a private cook, but it's worth it to me. We also have housekeepers come twice a month, but this is not new. I have hired another physician who helps me with the patient load in the office (although not in surgery). I have committed to taking a big family vacation every summer and every winter (at least a week and a half). I spearheaded hiring a new practice administrator, who has done such a good job that I no longer stress about every detail of running the office. Things are better, although the patients are no less sick, and the job is still demanding.

I now have a Facebook page that allows me to communicate with friends and family more efficiently. My husband and I had our first "date night" last month - dinner and the new Harry Potter movie. It was wonderful and relaxing. We plan to do this every month now.

I actually asked my husband and son what they thought about my work-life balance to get their perspective for this post. Those two peas in a pod both looked at me blankly and said, "What balance?" We all laughed, and I sighed.

As I have finally admitted, I am not perfect. I am, however, doing my best. They know how much I love them, and they know I am trying. We have a saying in surgery: "'Perfect' is the enemy of 'good'." I don't want to be Martha Stewart Cushing anymore. I just want us all to be content.

Friday, November 19, 2010

In the Comfort Zone

There are few things I enjoy more than talking about the spine and the brain.

Therefore, it stands to reason that I enjoyed our state neurosurgical society meeting last weekend. I don't like big national meetings, being an introvert at heart. Our state meeting, however, is small; this makes for a more intimate atmosphere and more outspoken dialogue. Colleagues from across the state can exchange ideas, new techniques, and opinions. We also discuss issues of importance to us locally, such as our lack of a motorcycle helmet law (UGH!).

I generally come away from these meetings with a new idea or two to implement in my practice. I fear becoming a "dinosaur," stuck in the rut of old techniques and outdated technology. My patients deserve my best efforts to stay current, as difficult as that sometimes is. Looking back at the last 9 years, I think I've done a pretty good job with keeping up to date, particularly as related to the spine (my professional passion).

This weekend, I sat in that chilly conference room second-guessing myself.

My colleagues are astonishing. One academic cerebrovascular surgeon showed a video depicting the results of the new non-profit organization he founded recently. Neurosurgeons travel to East Africa in groups to train local doctors in basic and emergency neurosurgery. He envisions such a training network all over Africa, bringing ongoing lifesaving care to thousands. They operate on brain tumors without microscopes, power drills, even electric lights. And the outcomes are remarkably good.

Another colleague, a skull base specialist, presented a series of "eyebrow craniotomies" in which he removes tumors through a single eyebrow incision and an endoscope. It's hard to get less invasive than that. Yet another brought me up to date on the neurophysiology of consciousness and the two biological definitions of time, all over dinner.

I had looked forward to seeing the only other woman neurosurgeon in our state, but she wasn't there. She was in another state doing a fellowship in interventional neuroradiology, learning to coil aneurysms. She already has a fellowship in neurotrauma, and she is laying the groundwork for a new residency program at her hospital system.

Driving back across the state, I tried to envision how my colleagues do all these marvelous things. I don't know how they find the time and energy. I admit that I struggle just to keep juggling all the basic balls: raising a kid, running a practice, taking care of a house and husband, the things we all do as routine. I am doing my dead-level best to just stay current in my field. Professionally, I am inspired by all the possibilities out there; I would love, for instance, to learn to do an eyebrow craniotomy. I probably should learn. Practically, I can't imagine taking time for more training or an overseas mission trip, or anything on top of my current load. I understand Bilbo Baggins when he said, "I feel thin, sort of stretched, like butter scraped over too much bread."

So, this week, despite my glimpse of the shining frontier, I feel myself inevitably settling back into my comfort zone. My familiar routines embrace me like a warm, cozy bed. Just as it's hard to get out of bed in the early dark, it's so hard to contemplate changing the patterns of my practice and my life in a dramatic way. I'm actually alarmed at how much harder it is as the years go by. Maybe it's time to push myself out of the zone and see how much more I can do.

On the other hand, perhaps it's wiser to stick with what I do best, as opposed to scraping myself over even more bread. How important do you think it is to keep stepping out of the comfort zone?

Friday, October 29, 2010

Socks on Stairs

by Dr. Shoes

(The latest in patient educational materials, written after one too many such injuries came through my office...)

I like my socks.
I have 12 pairs.
I wear my socks
Upon the stairs.

1 step, 2 steps...
That's not all!
3 steps... Oops!
I slip and fall.

Bump! Bump! Bump!
I bang my head.
Thump! Thump! Thump!
Ouch! "Help," I said.

I wish my socks
Were not so slick.
My low back hurts.
I'm feeling sick.

I have to see
My surgeon now.
My spine's messed up.
Those socks, that's how

I hurt myself.
I couldn't wait
To put on shoes.
Now I'm prostrate

Upon the floor
Below the stairs.
My vertebrae
Will need repairs.

Be more cautious
Than I have been.
Those socks on stairs
Will do you in!

Sunday, October 24, 2010

The Newest Angel

The OR was hushed on Friday.

Normally, it is a loud, busy place. The staff and surgeons are almost like a big family; we chat with each other and banter cheerfully with patients to help get their minds off the imminent ordeal of surgery. Chaplains pray with patients and families. Sometimes there are disagreements, as in any workplace. But everyone cares about everyone else.

Because of that caring, it was hushed. Instead of talking, people touched hands or embraced. The chaplain's prayers could be heard more clearly than usual.

Thursday night, a colleague's daughter had died. She was 4 years old.

She had been diagnosed with a childhood cancer over a year ago. We had followed her progress through treatment on a Web page her family set up. At first, we thought things would be fine; so many children can be cured these days. The survival rates were encouraging. Her dad, a talented young surgical subspecialist, carried on as usual after the initial shock.

Then the cancer spread. It stopped responding to treatment. One morning we came in to find her dad's cases cancelled at the last minute. Word spread surreptitiously: "She's had complications, and she's comatose now. It's not looking good." In the following weeks, hope slowly evaporated.

Strange; we all live with the presence of death every day. Patients code in the hospital. We make critical decisions about patient management; we do brain death exams and organ harvests. We live with its inevitability and yet find ways to go on. How unexpected, then, the pain when it happens to one of us, even when we know it's lurking just around the corner. No matter how much we know, we are never prepared for its intimacy when it comes. When it's a child, it's so much worse.

This is why I couldn't do pediatric neurosurgery. They see the worst of the worst; head injuries, abused children irretrievably damaged, malignant brain tumors that can't be cured. When I did that rotation in residency, my son was 18 months old. I couldn't help superimposing his face on patients about his age. It was unspeakably difficult. Admittedly, it can be very rewarding, because children do have such amazing capacity for healing. But many don't, and they broke my heart. I have such respect for those who can do this work, and for pediatric oncologists, too.

There must be a way to offer comfort to parents who have lost a child like this. I still don't know what it is. All I can do right now is hug my own son, smell his hair, and watch him sleep as if he were small again. I'll go back to the OR this week wishing I could repair my colleague's wounds like those of my patients. I'll be thinking about his daughter's Web page, purged of all the news of suffering.

Last Friday morning, that page had just one sentence: "There is no cancer in Heaven." Seeing that, we knew the newest angel had arrived.

Friday, October 22, 2010

Jumping in...

Thanks, KC, for inviting me to officially join MiM!

I've been following along for a couple of years, occasionally putting in my two cents' worth. It's exciting to be joining in as a regular contributor. This is an amazing group of women, all great writers with a lot of stories to tell. I look forward to being a part of it all.

Saturday, July 17, 2010

Guest Post: Why It’s All Worthwhile (or What Keeps Me Going)

(I am posting this as a followup to Gizabeth’s excellent, thought-provoking “Disillusionment” post. I wrote this anecdote awhile back but decided to post it now, since it illustrates so perfectly what “keeps me going” and why I’m not disillusioned despite all the difficulties we face. - gcs15)

“Make a Joyful Noise unto the Lord”

In October 2007, the ER called me for yet another emergency. A thin, elderly man lay on the stretcher with his anxious wife at his side. “He’s been more and more confused, Doctor. This is just not like him!” she said. Sure enough, on examination, he had no focal deficits, but he was clearly disoriented. No history of trauma, no blood thinners, just chronic treatment for myelodysplasia (which was stable). His CT scan showed the reason for his confusion: a large subdural hematoma extending over the entire right hemisphere of his brain. Yet another elderly patient with a subdural.

I took him to the OR emergently that night. I removed a large window of bone from his skull and opened the tense, bluish dura. A large blood clot lay on top of his angry-looking cortex; once the hemorrhage had been removed, his brain began to gently reexpand. Successful surgery, but how would things go over the next few days? So many irritated, elderly brains begin to seize postop. The mortality rate for subdural hematoma is 50%. This is one reason many budding physicians avoid neurosurgery; we see a lot of terribly sick patients, and a lot of them don’t get back to a functional life.

Back in the ICU, the nurses told me, “We’ve been getting a lot of phone calls about this patient! How did he do?” Evidently, he was a Ph.D., a professor emeritus of fine arts at Bob Jones University, beloved by hundreds of students and alumni around the country. He conducted their orchestra and had been composing all kinds of opera and classical music for more than 50 years. His children was all bright and successful, some of them accomplished vocalists. In short, my patient was a brilliant, artistic man.

His first 2 days postop were encouraging. He began to eat and joke a little. I transferred him to the floor and gave a sigh of relief. That evening, however, the nurses called me. “He’s not looking so good.” When I arrived at the bedside, he was minimally responsive, pale and diaphoretic. A workup, including a CT head, was suggestive of infection. I transferred him back to the ICU and aspirated fluid from his wound; clearly he had developed meningitis. I started him on IV antibiotics and began to really worry.

He was very sick for a long time, but he recovered and actually did very well. I got to know him and his family a little during his illness. They were delightful, cultured people with a great sense of humor. The first time I saw him stand up, I realized he was at least 6’6”! We talked about his passion for music and his love of God, among other things. I told him, “When you are completely recovered, and you are ready to conduct again, let me know. I want to come.” He laughed and promised. Privately, I wasn’t sure that would ever happen, after what his brain had been through.

About 2 months after he left the hospital, he came back to my office. “What do you think about this spot?” he asked, pointing to his head. The wound was infected again. Over the next few weeks, he had 2 more surgeries and IV antibiotics to remove the bone flap, clear the recurrent infection, and implant an artificial custom-made bone flap in the defect. Finally, finally, he was better, this time for good.

The months went by, then a year; no news from him. I thought of him every so often, hoping that his cognitive function was still improving. By this time, he was 78 or 79 years old.

Just before Christmas 2009, my phone rang at home. “Hello, Doctor! Remember me?” Of course I did! “Remember my promise? I am conducting Samson et Dalila in March, and I want to know how many tickets you need.” What a wonderful Christmas present!

So my husband and I took my 12-year-old son with us to my friend’s opera that weekend in March. I can’t remember ever enjoying opera so much. It was stunning. A cast of 200, including 3 nationally acclaimed guest performers, and a wonderful orchestra took a simple Bible story and cast a spell that lasted 3 hours. As the stars of the show escorted my patient onto the stage at the end for a long standing ovation, the supertitle proclaimed, “This will be the final major performance of his career.” I stood with his family in the audience, hoping my eyes wouldn’t overflow.

I could feel in the thunder of applause the impact he had made on so many of his students, and the love and respect they have for him. I could feel the force of his personality and the persistence that brought him back to his baton at almost 80 years old. And I could hear clearly the Almighty whispering to him, “Well done, good and faithful servant.”

Professor, I was blessed to have played a tiny supporting role. Bravo, and bravo!

About my patient: Dr. Dwight Gustafson was the longest-serving Academic Dean in the history of Bob Jones University. Samson et Dalila took 2 years of intensive preparation and rehearsal; it was the biggest such production done at BJU in the last 20 years. Dr. Gus says of his illness and recovery, “Through it all, I kept saying to everyone, ‘God is good at all times.’” I continue to be inspired by his faith and his example. This is printed with his permission.

Thursday, December 10, 2009

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.