Saturday, December 11, 2010

New Month... and it's going to be a long 0ne

Wow, it's been a lot longer than I realized. There really aren't even any excuses for it being a month since there's been a new post. Seriously, wow! It is nearly mid-December!

To quickly get you back up to speed, it is a new month and a new rotation. November was wonderful!! The first two weeks were a crash course in Dermatology and it was awesome. There was so much I needed to learn, and it is good to finally have a decent grasp on the biggest organ in the human body - our skin. Then, the last two weeks of November was outpatient clinic, and some much needed vacation time. And can I just say: I love my clinic almost as much as I love my vacation!

But now... I'm not having so much fun. lub. dub. Cardiology. Known to be one of the busiest specialties at UNMC, it is living up to its reputation. What's worse is that our fellow who is running the service is terribly, I mean painfully, inefficient. My Type A, left brain is spinning. When we have a 2-page list of patients to see I don't think we need a meeting on the other side of the hospital to go over the same stinkin' thing three times a day. AHHH! My eyeballs hurt from rolling so much. And, by the way, I'm not the only one. The other residents on the service share my pain. The secretary that rounds with us said something. Even our attending made a comment. Yep, it is that bad. Oh boy... it is going to be a long month! We joked on day #3 that we needed to have end of the month margaritas. On day #4, we changed it to mid-month. By day #5, weekly. Say a little prayer for me and my sanity.

Tuesday, November 9, 2010

Dawn of a New Day

The day has come. The end is near. The fat lady has sung. Pigs are flying. The ship has sailed. The tide has come in. Extra, extra, read all about it. No matter how you say it, it is the dawn of a new era. At least a new era in the Newman house.

Years and years ago man invented fire. And then the wheel. And then an even more genius soul created coffee and chocolate. Yet, this moments sits far above these, on a baby blue throne that reigns in my soft mommy heart.

Months and months of training and preparing have brought us to this moment, and yet I was still not prepared for the vision before my eyes. Smile plastered across his face. Hazel eyes wide with pride. One hand with a tight grip on the plush basketball that just happens to be the exact size of his head and the other hand and arm straight out to his side creating that perfect 90-degree angle with his body. A little (okay, not so little) round belly out in front leading the way. Legs steady. Feet planted. Then...

wait for it...

wait for it...

One brave little foot leaves the ground. All of the muscles in his body spring into action as in that split second his frame is balanced on a single, size 3 foot. Just as quickly, that brave little foot hits the ground again. But this time it is the ground 4 inches ahead. Steady once again and the smile is bigger and the eyes are brighter. Mission accomplished. However, almost as if it's jealous, the other foot jumps off the ground, reaches in front of its partner, and leaves a teetering body on top. Plop! A gentle landing on a cushioned bottom. There is no break in the smile. And moments later we're going through it all again.

That's right folks. Step right up. It is the dawn of a new day. A new day in the Newman house.

Owen can walk!






Of course he wouldn't walk for the camera, but he did sneeze a noodle out of his nose. :) I'm a proud mama!

Saturday, November 6, 2010

Derm

After months of busy hospital work, I finally have a much needed clinic month. Weekends off and no call! That's music to my exhausted ears. However, it isn't just time to relax, I still get to learn. Currently, I'm working with a Dermatologist at Offutt airforce base, and this is something I've really been needing. It may surprise you, but UNMC doesn't have a dermatologist. That's made it kind of difficult to get much derm experience in the last few years.

Now, after one week I'm feeling more comfortable with skin diseases than I ever have. Have acne, sun damage, a weird mole, eczema, or psoriasis? I'm your doc! Okay, I might not have learned everything yet... but I still have a week to go. ;)

Before you ask, if you're looking for some free advice here's what I have for ya':
1) Don't smoke.
2) Wear sunscreen. Seriously. Wear sunscreen!
3) Ask your doctor about Retin-A. It's great for acne and anti-aging.

Looking forward to next week already!

Friday, November 5, 2010

Happy HallOWEN!

Another first for our family... Owen's first Halloween! or as it is known at our house - Hall-OWEN. Our little lion took to the trick-or-treating streets like he had done this a thousand times. Instead of fussing and pulling at his mane all night long, to our surprise it stayed in place. He didn't even cry until the night was over and he was back in his jammies. It didn't take long for exhaustion take over and for him to fall fast asleep. (It also didn't take long for mom and dad to raid his candy bag.)

Monday, October 25, 2010

Whew!

My last call for internal medicine wards was NOT one to forget. It's hard to believe all of the things that went on could really happen within one 30-hour period. Being able to actually use this stuff is much better learning than reading it in books and taking tests. Without further adieu, here is the list of major events (in addition to all of the high blood pressures, low blood sugars, and need for sleeping/pain pills) that took place on my farewell to Medicine Wards...

1. Pathology came back from the mole I took off in clinic last week. Positive for melanoma - skin cancer in a 29 year old. Negative margins, but my excision was 2-mm short of the goal. Arg!

2. Went to evaluate a patient for chest pain. That is nothing special, but while I was standing outside the room writing orders and a short note, her oxygen saturations dropped to 40%'s (normal is >90%). Thankfully, she improved with some suctioning.

3. A few doors down a patient went from being pleasant to acutely agitated and aggressive. She rips out her own IV. Obviously, I can't get any labs or studies. We calm her down with some Vitamin H (aka Haldol) in time for the nurses to note that she now has unilateral weakness. After a stat head CT scan to look for stroke, we finally get the rest of the studies I wanted originally.

4. Speaking of stroke... All morning I worked on getting a different patient calm enough to have an MRI for her stroke symptoms. We finally got a partial study before she freaked out in the scanner and a short time later the Radiologist called me: definite stroke. Next step, call the neurologist.

5. Beep... Beep... Beep... Code pager! They end up coding the same patient four times for V Tach.

6. Nothing exciting, but we did still have to do the standard admissions from the ER. One renal failure. One probable undiagnosed cancer. One delirious pneumonia.

7. Geriatric patient has passed away and needs to be pronounced. Sure enough. Time of death: 14:02.

8. Once again, called for a acute mental status change. On arrival, realize "nonresponsive" would be a better description. Stat labs/glucose/EKG please. Nurses are busy with that so I check blood pressure myself and it goes from 120s to 70s. Seriously!! Fluids wide open. Temperature now 34 - ask for a rectal - 34.6. Not normal! Another stat head CT once his BP is stable, and off to the ICU.

Think that's all. Guess again...

9. Someone else is throwing up blood. NG lavage gets back a lot more blood and of course now he's wretching with the maroon stained fluid oozing out of the sides of his mouth. Vitals and hemoglobin are stable. Another stat imaging study on its way.

10. What now? Another nonresponsive patient. Before I order my third stat head CT of the night we give a little Narcan to reverse the effects of narcotics. His eyes pop open and he glares at me. No more morphine for you, sir.

And to end the night, just as we start our morning rounds...

Beep... Beep... Beep. Code blue! I'm just down the hall so of course I'm the first doc to arrive. No pulse. Chest compressions going. Here we go. Get some meds going. Finally get an airway cleared of bloody vomit. After 20 minutes we have a rhythm, pulse and ICU bed ready across the hospital. Hold up, not so fast. A nurse two doors down starts yelling for help. You guessed it Code blue down the hall. Do you want to know how many crash carts are on the floor... one! That's not a good scenario when two patients are coding. Everyone rushed down there and supplies arrived from the floor below. Remember, the first patient is far from being stable and also now far from the ICU. Sure enough he goes asystole with only me, his nurse, and a respiratory therapist in the room. I start chest compression while ordering a round of epi again. Respiratory is bagging. The nurse is pushing meds. Other people are flipping from one room to the next to help out. We've almost maxed out our drugs and decide this will be our last round when we get a pulse. A good pulse. It was our window so we rushed him the 1/8-mile trek to the ICU. Prognosis is terrible, but at least he'll have a heart beat when family arrives to likely say their final good-bye's.

After all of that adrenaline I didn't even need my post-call Starbuck's. It was a relief to hand off the code pager to the next intern later that morning, but I was also incredibly grateful for the experience. I guess that is the way to end Medicine wards. You can't really top that!

Sunday, October 17, 2010

Therapy

What would you do with your first two-day weekend since Labor day? It didn't take long for me to decide what I was going to do. I was in desperate need of some retail therapy! Owen and I were two of the first people in the mall Saturday morning, and it didn't take long to have a bag with two new pairs of shoes. It was glorious!

Saturday, October 16, 2010

On the Border

The goal for all of our patients is to get them healthy and out of the hospital as quickly and as safely as possible. Well, we currently have a patient who has been admitted since June. That's correct, they have not been out the walls of the hospital in nearly four months. No fresh air. No warm sunshine on their face other than what filters in through the windows. They came in very sick and unfortunately had one complication after another.

As rocky as the medical course has been, the social issues are even more touchy. Just imagine this: You hop on a plane from Canada for a nice visit to see your family in the States. As you share old memories and laughs you suddenly collapse. Thankfully, you can't remember the whirlwind of being rushed to the emergency department and then flown hours away for more medical care. When your mind finally begins to clear you are surrounded by white coats trying to explain your new circumstances. You can't make out their medical terminology, and in fact, you can't make out anything they are saying because you don't speak their language. For days and weeks you nod your head to be polite and treasure the few minutes a day that they take the time to use the interpreter phone. Some days are physically exhausting; other days are emotionally draining. Not only are you sick, you are lonely. Some days you wonder how this will all end. You are sure you've ruined your family's future as you wrack up hundreds of thousands if not millions of dollars of medical bills. And of course there is no health insurance to cover these expenses. You can no longer eat. You struggle to breath. You can't understand the doctors let alone the television. And your family is hundreds of miles away. Why are these people surprised that you are falling into a depression?

So here we are. What do we do now that they are almost "stable" yet still so medically fragile with a long road ahead? The standard answer would be to transfer to a skilled nursing facility or a rehab center for additional therapy. Unfortunately, the reality is that these places can't really afford to take uninsured, foreign patients. It is a limited resource after all.

Our thoughts wonder how different it would be for this patient if we could just get them home. All that medicine and therapy has too offer will be available from their socialized system. Now, how can we cross that border? Trust me, we've been working with who and what we can, but it's, of course, more complicated than I can begin to imagine. After exhausting our other alternatives, the best plan for now is to get the patient healthy enough to make a 14 hour drive with some family across the country and across border to the nearest Canadian hospital. Even as I type this I hesitate knowing all of the extraordinary things that would have to happen for this to be a safe journey. I know how wiped out I might feel after that road trip let alone all that they will have to deal with along the way. Feeding tubes. Medications. Dressing changes. Stools. The Foley. Suction devices. DVT prophylaxis. And on and on. This is going to require super-human strength.

Thursday, October 7, 2010

9.11

This 9-11 isn't a month late reference to the twin towers tragedy. It is actually a weight: 9 pounds 11 ounces. Yep, a 9-pound 11-ounce baby came into the world this week. What a whopper. A cute whopper, too. Thankfully, we planned her C-section for a week before her due date. Can you imagine how much bigger this kiddo could have been?

This surgery was so much fun and again served as a reminder that my job is awesome. This patient was my first continuity Ob. Meaning that I've been following her in clinic for her entire pregnancy, and I've had the privilege of getting to know their family for the last few months. It makes the delivery even more sweeter than all of the others where I show up at the end, barely introduce myself, and then: "It's a boy!" I much prefer this.

The day actually started bright and early - actually, dark and early because I still had to see all of my hospital patients for the service I'm on currently. I tried not to be too hasty in my excitement, but I was so anxious for the big moment.

Finally, we were standing in the OR and thick black hair was visible through the incision. After a few tries to pull the dark, round head out into the world, we resorted to the vacuum to give a little extra leverage. (You know it's a big kid when you have to use a vacuum during a C-section!) Within moments he was out. I cut the cord and handed my newest patient to the nurse waiting behind me. Perfectly healthy. Perfectly happy. As the baby was screaming and getting accustomed to the world around. I got to sew the muscles, fascia, and tissues back together. The adrenaline pumped as I remembered how much fun surgery is.

Then, shortly before Dad was showing off the tiny face to Mom, the nurse yelled out "Nine Eleven." All I could think was: thank goodness we didn't do a TOLAC*!



(*TOLAC = Trial Of Labor After C-section; i.e. attempting to have a vaginal delivery after having a prior C-section.)

Friday, October 1, 2010

Resources

What a waste! I was so frustrated as I left the hospital today. So often hospital resources are wasted. Just wasted. And it is incredibly frustrating.

One of my patients is a "frequent flier." And that alone generally doesn't bother me. But today all of it was frustrating. Today, my patient was ready to get out the door. "Okay for discharge" was written in the chart and then, with my purse on my shoulder, the dreaded buzz of the pager. (My pager has become such a part of me -loved and hated- that I seriously have phantom pages when I'm not wearing it. It's like people who loose limbs and have terrible phantom pains.) The voice on the other end crushed my soul as she informed me that my patient was now a wobbly mess seeing clocks and dogs that weren't there. "No longer safe to go," was the dagger at the end of the conversation. Crap. No, they weren't having a stroke, an aneurysm hadn't ruptured, and they weren't over medicated. All of which could be possibilities except that we all knew exactly what was happening. Alcohol withdrawal. I had failed to get them out of the hospital before their blood alcohol level bottomed out. Darn it. I tried so hard because I knew this was bound to happen.

Knowing that the patient wasn't interested in quitting, we now had three options: 1) let them go in the middle of withdrawal and hope that they get a drink before they seize; 2) write a "prescription" for beer in the hospital before they leave, and then send them on their way with a little buzz; or 3) keep them for a few more days, go through detox, then discharge them to drink 30 minutes or less after they walk out the door. The first option was bad from a legal standpoint. The second option was tough from a professional and moral standpoint. And the last option was difficult from a practical standpoint. See what I mean? Frustrating. We opted for the third, but it was with hesitation.

The patient's (I mean the government's, actually I mean our) bill will be in the thousands of dollars just so that we won't be legally responsible for the half an hour between them walking out the hospital doors and their next drink. Think of all of the man power that will be wasted between the nurses, techs, doctors, therapists, and support staff in the next few days. Not to mention the tangible stuff like IVs and medications.

Oh well. Big sigh.

Thursday, September 30, 2010

Tetany

There has been a little bit of a theme this week. First, there were several adult patients in clinic that hadn't been immunized for years. (And, no, this isn't going to be a discussion on the need to immunize children... maybe later) Most people know that they should get their tetanus shot every ten years, but very few people actually remember when they are due. You would be surprised how quickly ten years can go.

It goes so quickly that even I let it slide. However, this afternoon my sleeve was rolled up, and my shoulder was in a nurse's pinching grasp. One second later I was good for another 10 years. One less thing on my to-do list. It feels good to not have that over my head.

Then, in our morning teaching session someone presented a case they saw from last month when they diagnosed a real life tetanus infection. And this isn't the first time this has happened in Omaha either. It is everywhere.

Moral of the story: get your vaccine!

Tuesday, September 21, 2010

Work Hours

Resident work hours is a hot topic in medical education lately, and is also a hot topic at our house. It isn't a secret that residents work a lot of hours, but living it is completely different than hearing about it. What surprises most people is that not too long ago the hours were even longer. The limits were only put into place around 2003 and in 2011 they are revamping them again. Our staff roll their eyes at us when we yawn or our heads bob during noon conference, and they will tell us stories about working for 120 hours per week when they were residents. With a smile they say, "The term 'resident' actually means something, you know."

Essentially, the current "recommended" work limits are:
  • A total shift should not exceed 30 hours, but we cannot assume care of new patients after 24 hours. Practically speaking, we come in at 6am, admit patients all night, round with our staff the next morning, and then hopefully leave around noon.
  • The work week should be limited to 80 hours/week averaged over 4 weeks.
  • At least one 24-hour period per week should be free of duties averaged over 4 weeks (i.e. four days off per month, including weekends and holidays).
  • Call cannot be more frequent than every third night. That mostly applies to surgery residents who are notorious for breaking work hours. In medicine, our most frequent call schedule is "q4" (every fourth night), and that only happens when we're working in the ICU.
  • Any of these rules can be broken for the sake of patient care (i.e. one of your patients gets really sick and you want to stay to help take care of them).

It sounds like a lot of work. It is a lot of work. However, time actually goes pretty quickly. There is a lot to do and a lot to learn. Our patients tend to expect to see the same doctor every morning and in the middle of the night when they have questions. And, honestly, sometimes it is tough to hand off patients who you've been working hard to diagnose and treat to another resident who doesn't know nearly as much about them as you do. (Or maybe that is just me and the anal/controlling part of my personality).

Regardless of how difficult it is to trust another person with my patients, it is still always a relief to walk out of the hospital doors and into my living room where a little smiling face and a kiss from a handsome man are waiting.

Saturday, September 18, 2010

Handwriting

There is one thing that doctor's are known for. I'm not talking about long hours or nice cars. Not white coats or stethoscopes. Doctors are known for terrible handwriting! We all know it, and unfortunately we generally live up to the stereotype. Honestly, this is one of my biggest pet peeves.

This week I consulted a few specialists in the hospital. I wanted their expert opinions on how to workup one patient's condition and how to treat another's. The specialists came around and saw the patients just as I had asked. Shortly after, my pager went off, and the nurse let me know they'd been around. I headed back to the hospital after I finishing up at the clinic. I opened the chart in anticipation of their recommendations. On top of the page "cardiology" was scribbled in black ink. There were about five more waving and dotted lines below, but I struggled to make out any other recognizable words. How helpful! I was aggravated but decided to just call them and clarify. I looked at the bottom of the page and there again is a scribbled signature. Not a big deal. After all, the hospital knows that 99.9% of doctor's signatures aren't legible (mine included) so there is a standing policy to write your ID number or pager next to your John Hancock. Sure enough,next to the sribbled signature were several numbers. Do you think I could read them? Nope. Is that a 4 or a 9 or an 8? Aahh!! They basically wasted their time doing the consult.

Now I take pride in having readable writing. And until we go to all electronic medical records, I'm sure I'll be frustrated by other doctor's lack of handwriting pride many more times. So I apologize on behalf of my profession for sometimes forgetting our first-grade lessons. :)

Wednesday, September 8, 2010

Awesome

Trust me, my job is not always overwhelming and depressing. Looking back on the past few stories I've shared, it would be natural to think that I'm crazy to keep doing what I'm doing. But really, my job is awesome! To prove it, here are a few things I love...

... hearing the nurses at my clinic refer patients to "Dr. Newman."
... seeing the bellies of my Ob patients grow at each visit.
... discharging a patient from the hospital happier and healthier than when they came.
... coming up with a treatment plan and then hearing my staff say "I like it!"
... when patients quit smoking.
... hearing a murmur that no one else heard.
... counseling patient's on their end of life wishes before it's necessary.
... post-call naps.
... educating someone that what they read on the internet isn't true.
... knowing what our pediatrician will say when Owen has an appointment.
... when patients say "Thank You."
... trying to answer friends and family's (mostly Jason's) weird medical questions.
... laughing at far-fetched medical dramas.
... free food and Diet Coke.
... every morning when Jason gives me a kiss and says "Save a life today!"

Totally Awesome!

Monday, September 6, 2010

Code

My first call night back at UNMC was... ? ...hard to describe. The afternoon had been excruciatingly busy, so I was gearing up to get slaughtered with new patients. However, we must have soaked up all of the sick people of Omaha during the day because we admitted less than the average number of new patients. As good as that was, cross-covering on other resident's patients was especially busy, and my code pager went off more than anyone would ever want. Once is too many times, and twice is painful. Trust me, I would much rather do an admission than go to a code.

Heading down the stairs after checking an EKG of a chest pain patient, I heard the dreaded and distinctive "beep!-beep!-beep!" of the code pager on my hip. My personal pager is set to vibrate, so I nearly fell down the stairs with this terrible sound. The pager gave the room number, and it happened to be on the opposite end of the hospital. When I say opposite end, I mean 0.25 miles away. As I changed my direction and headed to the room, I quickly scanned the list of our patients in my pocket and hoped that I wouldn't find a matching room number. No match. Whew! It wasn't one of our patients.

To my surprise I was the first one in a long white coat to arrive. My worst nightmare! How could I be the first one if I was nearly as far away as physically possible. In that split second I prepared myself to run the code. My worst worst nightmare!! Instead, one of the nurses that had gathered in the hall outside the room intercepted me and said, "I think he's already passed." (Hello! That's why you called the code blue!) "What's his code status?" I asked instead of sarcastic remark that first came to my mind. "He and his family decided to be DNR/DNI about 30 minutes ago." I prayed that this was documented somewhere. The patient's room was filled with family gathered respectfully around the bed. Who was I to charge in there, expose their family member, and begin pounding on his chest against all of their wishes simply to appease some malpractice lawyer? This quickly became my worst worst worst nightmare!!! Thankfully, before I had time to respond, my supervisor and the patient's primary doctor arrived. The primary doc took over (as they should), and the rest of us left out of respect for the patient and family. Big sigh of relief.

This was in contrast to the "beep!-beep!-beep!" that sounded a few hours later at 3:00AM. It first came across as an "RRT." This stands for "Rapid Response Team" and is intended to get help to a patient who is in trouble but isn't in a code situation... yet. As my supervisor and I arrived at the elevators the "beep!-beep!-beep!" sounded again. Same room. Now a code blue. The room was already filled with nurses, support staff, and all of the contents of the crash cart. This was the real deal. An hour later, it was over. All over. I walked away by myself so I could gather my thoughts of what that night had held. Thankfully, the other residents would be arriving shortly and this night would be done.

Saturday, September 4, 2010

First Days

One of the difficult and frustrating things about residency, and even med school, is starting a new month. Imagine starting a new job with new co-workers, a new boss, a new schedule, a new system, and new expectations every single month. Going to sleep on the 30th or 31st of the month is always a little more difficult because my mind is racing with thoughts of what tomorrow will bring. Before I fall asleep, I say a little prayer that my alarm clock will go off at the new time for which it's set. It rings extra early on the first of the month, and I put in extra effort to get ready. The first day of rounds we walk around in silence as we feel out the new attending and their sense of humor. After rounds, I waste most of my time being inefficient because I haven't learned the shortcuts through the hospital, or where to find the medication lists, or how to call to find results, or this, or that. Everyone knows how "first days" go. A week or two into the month things settle in. I enjoy it for about a week. About then it's almost the end of the month, and I prepare to go through it all again.

August 31st was my last day at Children's hospital, and September 1st was my first day back at UNMC. I went from taking care of kids to adults. From infections of the ears to infections of the lungs. From diabetes type I to type II. From diapers to catheters. From one past medical problem to twenty. From no home medications to thirty (of which they actually only take ten, five as prescribed). From a two day hospital stay to a two week hospital stay. From CPS to APS. From tripping over toys in the morning to stubbing my toe on a walker. From hearing crystal clear heart and lungs, to struggling to hear anything through inches of "soft tissue".

It was more difficult to transition than I had anticipated. Even though I've done inpatient adult medicine several times before, as I sat down at the chart of my first patient early on Wednesday morning, I was suddenly overwhelmed. As much of a challenge as Children's was, in that moment I wanted to go back and find the confidence that I must have left there somewhere in the resident's lounge.

Thankfully, that moment passed, and after one night of call, my feet are back under me. There is still a lot of adjusting and learning left to do, but I'm ready for it now. I even think I can say: "I'm glad to be back."

Friday, August 27, 2010

Bedtime Routine

Looking in the mirror tonight as I was taking out my contacts there was a big wet spot on my shoulder. It put a smile on my face to go with the bags under my eyes. I love, Love, LOVE getting to put Owen to bed! This week has been especially busy, so I haven't been able to for a while. It has been sorely missed.

Our routine starts with dinner. Tonight we shared macaroni and cheese and ice-cream. Don't worry, we each had some other, more nutritious food, but he didn't want my chicken and I definitely didn't want his squash. For a very good - and messy - reason, dinner is followed by a bath. Next, after sharing a few smiles with the cute and wet baby in the bathroom mirror it's a few more minutes of play time. Tonight we played fetch with Herbie outside and enjoyed a few minutes of peek-a-boo. Shortly before the clock hits 8:00 the bottle gets made and we head to his room. He gets the bottle in position as I pick out the story for the night. He eats. I read. We rock. By the end of the bottle and the second book, his eyes are as heavy as bricks. I kiss his shampoo-scented head and lay him into his crib. (Tonight I held him a little longer on my shoulder and his wet lips created the spot on my shirt that I was admiring as I took out my contacts.) As soon as he softly hits the mattress, his hands reach out for his blanket which is snuggled up to his face before I can pull my hands out from under his little body. Some days there are a few last exhausted cries while other days he falls asleep without another peep. So precious!

Saturday, August 21, 2010

48 Hours

Thu 5:00 pm told to go home (so I don't go over hours) by the same supervisor who gave me a new admission 30 minutes ago; fyi - it takes longer than 30 minutes
Thu 7:00 pm Sam's
Thu 9:00 pm getting Owen to sleep a little past his bedtime
Thu 11:00 pm asleep
Fri 1:00 am asleep
Fri 3:00 am puking Burger King for the last hour and thinking about paging on-call friends to call me in some Zofran
Fri 5:00 am seriously alarm clock? I just was getting back to sleep. Lightheaded. Still nauseated. And I'm on call today!
Fri 7:00 am rounding
Fri 9:00 am rounding
Fri 11:00 am finishing rounds
Fri 1:00 pm headache
Fri 3:00 pm hope for a nap is long gone, but thanks for offering to take my pager, Amy. It was a nice thought.
Fri 5:00 pm busy Friday afternoon making everyone crabby
Fri 7:00 pm got dinner before the cafeteria closed, but didn't get to eat it because called for another admission (it was still sitting there when I went home 17 hours later)
Fri 9:00 pm working on yet another admission
Fri 11:00 pm jabbing an abscess with a scalpal... yumm
Sat 1:00 am thinking this night will never end
Sat 3:00 am admitting a too-complicated-for-3am-admission
Sat 5:00 am finishing up paperwork
Sat 7:00 am rounding
Sat 9:00 am rounding
Sat 11:00 am trying to leave Children's, but pager won't freakin' stop
Sat 1:00 pm going to sleep
Sat 3:00 pm asleep
Sat 5:00 pm asleep
Sat 7:00 pm asleep
Sat 9:00 pm just waking up from my "nap"
Sat 11:00 pm ready for bed

Saturday, August 14, 2010

Zebra

There are some diseases that medical students spend hours reading about, studying, and memorizing. On rounds we are pimped about them, and if we're at a loss for a diagnosis, we may order the tests for them. However, we never really expect to see them. These diseases are known as "zebras." Our usual montra is: "common things are common." That means those tough, less than straightforward, cases are usually an uncommon presentation of a common illness and not a common presentation of an uncommon illness. Regardless, we all secretly hope to be the one to come across the path of a zebra.

Yesterday, when my alarm clock rang, I didn't wake up thinking that this would be the kind of day that I would remember for the rest of my career. I went through the same morning routine and walked into the resident workroom at Children's at the same time - 5:57AM. I looked at the board and saw two new patients on my list. Before that moment my hope had been to not have anyone new so rounds would be a little less rushed. Afterall, without a single day off and three long call nights, I was exhausted. That hope quickly evaporated, and I sat down to get the scoop on the new kiddos from a couple of exhausted, and relieved, residents.

One of the new ones sounded particularly interesting. Especially because no one knew quite what was going on yet. There were several tests pending, so we were in hurry-up-and-wait mode. By the time rounds started and before we could dream up the random obscure things this could be, we had our answer... malaria! My first case of malaria!! While this disease affects millions of people in countries around the world, we don't see it here very often. Thankfully. (And don't worry, I don't expect there to be a Nebraska outbreak anytime soon.)

So, even though my morning ended up being a lot more hectic than I had anticipated. I am grateful for a great learning experience!

And the cherry on top of my sundae Friday was that I got to tap a knee at clinic later that afternoon. And the whip cream - a weekend off!! YEAH!

Tuesday, August 10, 2010

A Mess

Yesterday evening was a combination of exhaustion, sleep deprivation, missing my son, missing my husband, and empathy for one of my favorite patients all rolled into one very emotional few minutes. I ended up as a sobbing mess sitting in the rocking chair with a sleeping Owen in my lap as I tried to read overly scientific articles about rare, terrible diseases that this little precious patient could have.

Thankfully, after a few hours of rock solid heavy sleep, I was back under control. However, we still don't know what is wrong with this patient, and we're almost down to grabbing at straws to come up with something. Anything. We've consulted a specialist for just about every one of the little organs in his body, and we keep coming up empty handed. At least that's what the specialists keep saying. The nephrologists say it's not a kidney problem. The hematologists say it's not a blood problem. The oncologists say it's not a cancer problem. The pulmonologists say it's not a lung problem.

It is getting more difficult to go into their room every day and say that we're back at square one. Again. Pretty soon, saying, "At least we know it's not ___, and that's a good thing," won't cut it. What's worse is that the little puffy, tear-filled eyes that peak over the crib every morning remind me of Owen. My heart breaks for them every time, and yet they have been taking it as well and as appropriately as anyone could expect - concerned, worried, terrified, and collected. Hopefully, this nightmare they are living will reach a conclusion sooner rather than later. Then, and until then, we will pray.

I should probably be sleeping right now, and trust me, these eyelids don't have much strength left in them. Too much longer, and I'll end up in the mess I found myself in last night. Hopefully, tonight's sleep will be extra refreshing. Not only because I need to catch up, but also because my turn to be on call is rolling around again tomorrow. If it is anything like Saturday, when I honestly think I only peed twice in my 30-hour shift, my eyes, and every other part of me, might not be able to take much more. Goodnight!

Thursday, August 5, 2010

Survived

Four days into one of the most feared months of my intern year and I'm surviving, actually, I may even be liking it. (There's a little hesitation because I don't want to ginx it this early.) My team is fun and easy to get along with, and the attendings are great teachers. That makes for a great combo! This month might not be the end of me after all.

Yesterday was my first of seven call nights. Never, not even once, have I heard of someone getting any sleep on a call night at Children's, at least not more than 30 minutes, so I geared up for a long night. To everyone's surprise it was a relatively calm night. If it weren't for the perfectly wrong placement of the pharmacy tube directly on the other side of the wall from my pillow that was sending medications up to and down from the floor all night long, I might have even had a couple hours of sleep. One down, six to go - the next of which is Saturday. Oooh... my stomach just contracted a little being reminded that it is just two days away.

Sunday, August 1, 2010

Vacay

Jason and I spent this weekend relaxing at Lied Lodge in Nebraska City. Let me tell you, it was a much needed get away! It was "much needed" for a few reasons...

First of all, it was a celebration of our sixth anniversary. Can you believe it - 6 years?! That alone is more than enough reason for a vacation in our opinion. Every year we've tried to do something fun, and on our tight budget we usually try to find somewhere to go that is close to home. Also, not only was it our anniversary, but we hadn't yet spent a night away from Owen together. Even dinners out together have been sparse lately, so we really needed this. Nebraska City turned out to be a perfect spot. It was romantic in a Nebraska kind of way. There wasn't a white sand, moonlit beach to walk along, but the sunset is just was beautiful there as anywhere, and the coziness of the wooded lodge and the winding forest trail were the perfect settings for some great conversation. I would recommend it to any local couple who is looking for a place to just get away for a day.

Another reason we needed this trip was to honor the end of Jason's summer break. He heads back to work this week, and neither of us is looking forward to it. We needed to do something this weekend to keep us from dreading the busyness and chaos that surely lies ahead.

Lastly, I have been anticipating this long weekend since I got my rotation schedule months ago. When I saw what was planned for August, September, and October, it didn't take long to ask for a four day weekend to close out July. This is my final weekend before beginning back-to-back-to-back in-patient months. Yikes! And, my first month is at Children's, which I've been nervous about since I knew it existed. My stomach is a little uneasy right now knowing that it has been a while since I've taken care of kids sick enough to be hospitalized, and it's also turning a little because I'm on the floor with most of the kids with cancer. Not only will that be incredibly taxing emotionally, but also they can get really sick really fast. Honestly, I'm hoping that the fear of it has been built up and exaggerated so much in my mind that I may actually be pleasantly surprised when I make it through this. Regardless, don't hold it against me if you hear less and less from me in the weeks to come.

Saturday, July 24, 2010

Top 3

Top 3 moments of the day:

#3. 15 Minute Rounds.
Sure, I had been there a little over an hour seeing all of the patients and writing notes, but it was so nice to get done at a decent time this morning and then head home to spend a nice Saturday with the family.

#2. Power Cleaning.
We have found a solution to those days when cleaning the house seems like an insurmountable hurdle. It's easy to avoid those piles of dishes and laundry and toys and random papers. Instead, we decided to just take 30 minutes of our Saturday afternoon and clean as much as we could and then be done when the timer rings. Even if the kitchen wasn't spotless in the end, it was definitely better than it had been - I call that success. And, you might be surprised what you can get accomplished in just 30 minutes.

#1. Tickling Owen.
A laughing baby is one of the sweetest sounds. It is infinitely sweeter when it is your own. Jason had a softball game this morning, and Owen and I went to watch. During the game, I had Owen on my lap, and I found one of his tickle spots. I couldn't resist. Instantly, the giggles poured from his huge smile. Priceless!

Tuesday, July 20, 2010

MDD

Last night I was on call and was hanging out in the doctor's lounge waiting for the next time I needed to go check on my laboring patient. When I realized that watching "The Bachelorette" was a poor use of my time I decided to go through some of my charts on our electronic medical records that were in desperate need of updating. Once my documenting and billing were caught up (and, trust me, that is the worst part of my job but is so much better if you stay on top of it), it was a good time to check on a few of my clinic patients. Some I had sent to see specialists, were scheduled for procedures, or were just interesting cases that I was curious to know what has happened since I saw them last.

I came across one patient who I had been seeing every few weeks this spring. I realized I hadn't seen her for a little while even though I remembered having her schedule a follow up because we weren't yet satisfied with our results. Maybe what we tried the last time was doing the trick, and she was feeling better. Maybe she had gone to see someone else to get a different perspective. (Which by the way, I totally, 100% respect and sometimes even encourage. Medicine is an art and sometimes it just takes finding the right artist.) However, when I clicked on her record I saw the dreaded "History & Physical" note that had been entered since I had seen her last. A few notes later was one titled "Discharge Note." My patient had been hospitalized. Instantly, I feared the worst. Had I missed something? Had I done something that made the problem worse or even created a new one? Hopefully, it was completely unrelated like she fell and broke her leg or something. (Not that I would ever literally hope a patient would break their leg.)

My fears became reality when I opened the notes and saw her reason for admission - suicide attempt. If that wasn't bad enough, she'd tried to take her own life with medications that I had prescribed. Talk about a sock in the gut! I felt terrible. I felt like a failure. Why didn't she come to see me before it got that bad? If she had, what would I have done? What could I have done differently in the first place? My mind raced with questions. I wanted to know more. I wanted to call her or go see her and make sure things were okay. I wanted her to know that I still cared, that I still want to help. Oh how I hope she comes back to clinic, or even that I run into her at Walmart, just to say "hi" and so that I can know that she still smiles.

Sadly, by far the most common disease that I have seen and treated in my clinic has been depression. It is everywhere. Sure, sometimes people just have stressful lives which we try to fix by incorrectly labeling it as depression. However, this terrible disease strikes the least and most suspecting without a second thought. Honestly, sometimes when my clinic is busy and I'm getting behind I hesitate to screen my patients for it for fear that I'm opening a can of worms. Even so, I have never regretted asking. It makes it all worth it for the times that someone comes back for follow-up after their depression is being treated, and instantaneously I know they are feeling better just by the glow on their face from across the room. You can't miss the happiness in their voice or the sparkle in their eyes. It's wonderful.

Although, I wish I could have done more in this case, I also know that I won't, and can't, fix everything. This will not be the last time I come across this when I'm updating my medical records on a long call night. Hopefully, we all learned a little something and can be better people for it.

Sunday, July 18, 2010

Family Practice

"So, Susan, what do you do for a living?" ... "Oh, nice, you're a doctor. What kind are you?" ... "Family Practice, huh. We need more good family doctors. Why did you choose FP?" After answering that question many times and often giving different responses, I think I can finally sum up why I chose to become a Family Doctor.

First of all, I kind of chose it by default. I couldn't decide on anything else because I honestly liked just about everything I did during medical school. I liked suturing and working with my hands during surgery. It was nice working with kids during my pediatric rotation because their medical problems were no fault of their own (unlike some things we see over and over again with adult medicine). Internal medicine was when I really felt like I was a doctor. I loved delivery babies during Ob/Gyn. And although I didn't really like psychiatry, it did cross my mind that because we are in such desperate need for psychiatrists I could probably do it and have the benefit of a nice lifestyle. Although I could have seen myself doing each of those, I hated the thought of giving up the others. That's what was so appealing about family practice, I could do it all.

Another similar reason is that family practice is a pretty flexible field. For example, I can deliver babies, but if in a few years I decide that I don't like getting those calls in the middle of the night anymore, then I can just stop seeing Ob patients in my clinic. Likewise, I can choose to manage rheumatoid arthritis, or heart disease, or hyperthyroidism, or name a disease, but I always have the option to send them to a specialist if it isn't something I feel comfortable managing or if what I try doesn't work. Also, if I find that I really like one aspect of my practice there is the option of making that play a bigger role. For example, family practice physicians can do fellowships in sports medicine, geriatrics, or ob/gyn if they want. Flexibility is a wonderful thing when you're asked to plan the rest of your life at the age of 25.

A third reason is location, location, location. One thing that often keeps people from making the same decision that I have is that it is more difficult to be a family doctor in a city the size of Omaha compared to smaller communities. Omaha family clinics typically are filled with cholesterol and blood pressure checks. The kids go to the pediatricians, the women go to their Ob/Gyns, and the interesting cases get passed off to the specialists. However, we plan to live somewhere much smaller than Omaha. And as difficult as it may be to be a family doctor in Omaha, it is even more difficult to be a specialist in small-town-Nebraska. There simply aren't enough people. And, I love the thought of being a small town doctor. I won't mind running into my patients in the grocery store and making sure things are going well. In my mind, that is what a doctor is.

And finally, the reason I am a family doctor is that is where my personality fits. I have the most fun with the family practice residents, and I feel the most comfortable with the family practice staff. They are the people that ask how Owen and Jason are doing, and try to get rounds done early on Sunday morning so I have a chance to make it to church. That makes such a difference when we spend 80-hours per week together.

So... there's the answer. That's why I'm doing what I'm doing, and so far, I'm loving it!

Saturday, July 17, 2010

Mobility

It was a big week at our house! (If you haven't figured it out already, I tend to be a little sentimental about Owen's "firsts." Who knew there would be so many things for him to experience in seven months?!)

Owen has been rolling all over the place for a few weeks now. It isn't uncommon to find him smashed into the corner of his crib fast asleep as if he'd rolled and rolled until he couldn't roll anymore and then just gave in to his exhaustion. He had actually gotten so good at getting around this way, that I thought that he might not ever need to crawl. After all, crawling isn't one of the developmental milestones, and now I can see why. But... last week while he was laying on his belly he started getting up on his toes with his knees locked, his puffy diapered butt in the air, and his face planted firmly in the carpet. It reminded me of one of those uncomfortable yoga poses. A few times he plowed his forehead across the carpet. When his belly hit the floor and he could lift his head up again, he looked at me with a huge grin on his face and a nice red mark across his forehead. And now, this week he started getting up on his hands and knees! I swear that he took one crawl before he collapsed back onto his little round belly, but I didn't have my camera rolling to prove it. In no time he is going to remind us how small our house is and how thankful we are we don't have stairs.

The next step is now to dust off the baby-proofing kit that has been sitting unopened on the top shelf in his closet and start putting it to good use. I don't think of Jason and I as people with a lot of clutter, but leave it to a little 17-lb ball of curiosity to find every knick-knack, DVD case, loose paper, hidden dog treat, and lint ball that exists two feet off of our floor. We've also made a monumental move in his nursery - we dropped the mattress in his crib down a level. With all of the strength he's found he will surely be pulling himself up soon, too, and one of the last things I want to hear in the middle of the night (even more so than my pager) is a "thud" followed by his terrified screams. Therefore, down the mattress went. Now when he stands up in his crib you can just see his hazel eyes peaking over the top, and I can sleep a little better at night.

Tuesday, July 13, 2010

What's in a Name?

One of the staff physicians I've been working with has a list of rules. One of these rules is to know the names and relations of everyone in the patient's room. This is a great rule which I intend to keep once I'm out in "real" practice. It will hopefully keep me from getting myself into those uncomfortable situations. For example, one time I was taking care of an older middle-aged man. In the room was a young woman who looked as if her driver's license was fresh off of the press. She sat in the corner looking totally disinterested and irritated that she had been dragged along for this. When I came back into the room she was no longer sitting cross-legged in the corner texting away so I asked the patient where his daughter went. The patient immediately broke eye contact with me and stared across the room toward the empty chair with an awkward smile. My cheeks began to fill with red, hot blood as he replied, "That's not my daughter, that's my girlfriend." Oops! Open mouth, insert foot.

Over this last month on Labor and Delivery knowing names has become even more important. That is, I've learned to never assume that the guy in the room is the dad-to-be, or the husband, or the boyfriend. It is also essential to know the person in the room that got you all there in the first place - the baby! One of the first questions I ask when I walk into a labor room is if we know if the baby is a boy or a girl. (Nino or nina? is sufficient in my broken spanish to figure it out for my spanish-speaking moms.) This question is then followed by, "Have you picked a name?" or "Does he/she have a publicly announced name?" Often the response is a big smile and a glance over toward the significant other who is nervously rocking in the chair beside her.

The names of the babies I've met so far have been the standard fare. Most of them have been cute, and a handful of names had been passed down through the family. Nothing too unusual. However, this afternoon while I was sitting at the nurse's station, we got to talking about all of the unusual names they've seen. Wow! Unfortunately, my malpractice lawyers wouldn't appreciate me listing patient's names on here for the world to see, but trust me, people are creative! Creative, and well... actually, let's just leave it at that. Creative.

Friday, July 9, 2010

Physician Profiling

It may be politically incorrect to profile people or people groups, but we know that we all do it. Not only do doctors profile their patients (as much as we try not to), we also profile each other. When you get into the medical field it doesn't take long to learn that each medical specialty has a reputation. This reputation is well known and generally well established. Although some of the stereotypes are derogatory, I would say for the most part we really do appreciate all of the specialties and their areas of expertise. We are like a family: we will pick on each other and talk about each other behind their backs, but if anyone outside of our medical family (e.g. the lawyer bully on the playground) shoves one of us down, we will stand up to defend one of our own. So, I thought I'd introduce you to our family...

Family Medicine is the little brother that everyone dumps on but I think is secretly admired. Because they can do everything, it is assumed that they are experts at nothing. It is no secret that they get picked on the most by the other members of the family, yet even so, they are known to be friendly, approachable, and great teachers.

Internal Medicine is the nerdy one. Anal. When you can't figure something out, call them or one of their specialist cousins. They'll order a thousand tests you've never heard of to diagnose the 6th case ever in the world of some rare disease that you likely can't even treat.

General Surgery is the knife-happy, party-loving, adrenaline-seeking, abrasive, older brother. Their answer to any problem is: "cut it out."

Radiology is the shy, smart one. Sometimes they are likened to bats or vampires because they sit in their dark cave all day long reading CT scans and X-rays and have very little human-to-human interaction. They are also notorious for being good golfers - got to love 9-to-5 with no weekends or holidays.

ER is the rebellious, wild twin brother of Family Medicine. They, too, tend to be criticized by the other specialties for either ordering too many or not enough tests when patients come into the hospital. However, they have the thrill-seeking side of the surgeons because they flock to a good trauma case like flies on poop.

Psychiatry is, like their patients, crazy. But no one can really blame them. We are just happy we don't have their job.

Pediatrics is the sweet, nurturing, older sister - always smiling and reminding you of the brighter side. Do you want a sticker?

Ob/Gyn is the Dr. Jekyll and Mr. Hyde. Slightly creepy on one hand (they seriously stare at vaginas for a living), yet so pure and innocent on the other (welcoming babies into the world). They also have the widest range of individual personalities of any speciality. One Ob doc could be the nicest person you'd ever meet and the next you wouldn't let deliver the baby of your worst enemy.

Anesthesia is the lazy one. You can't go long in the medical community before you'll hear a joke about the anesthesiologist falling asleep during a surgery (which I will not confirm nor deny).

Wednesday, July 7, 2010

Stay-At-Home Dad

Before Owen was ever in the picture, Jason and I realized what an important job parenting is. Thankfully, we have had some outstanding role models in our lives to learn what good parents look like, for example: each of my parents & Jason's mom, Josh & Kassie Sikes, Scott & Jackie Jones, my brother & Alicia, and Jason's Aunt Judy & Uncle Craig, just to name a few. So, when we began to look into our crystal ball and saw kids in our future, we had a lot to talk about. One of the things we realized was how much we wanted to raise our kids. Not the day care. Not the television, computer, or latest gaming station. Not their peers or the parents of their peers.

Considering both of us also have careers, we began to discuss how we could accomplish this. After all, being a parent takes time, a lot of time. One option we considered was having one of us take a break from our career to stay at home and be a full-time parent. That isn't so easy in my profession, but Jason's may be little more flexible. So, we imagined what it would be like if he was a stay-at-home dad. In our minds (or at least mine), it didn't seem too bad. Not only would the Jason half of our "we" constantly be present for parenting duties, but we also wouldn't have to worry about paying for daycare, driving Owen to and from daycare, or Owen getting sick more often because of daycare. We would be able to see each other more often because our work schedules wouldn't constantly be conflicting; and finally, we wouldn't have to hire a maid, lawn service, dog walker, or cook.

Like I said, that didn't seem like too bad of a plan. When this summer rolled around and Jason had a couple months off, we were able to give the "stay-at-home dad" thing a trial run. We are just over half-way through the summer, and I have never been more impressed with the man I married than I have been for these past few weeks. Although he still hesitates to carry the diaper bag because it gives the impression of a purse, he has been an amazing dad. He's stepped up to that plate and hit an out-of-the park grand slam. Owen is lucky to have him as a dad, and I hope he realizes that sooner rather than later. Not only has Jason been changing dirty diapers, he's also been taking care of the house. I can't count the number of loads of laundry he's done, but I can guarantee that it is more than I have done. He also has been working on getting some more graduate classes finished, helping out with the youth group, and still managing to play softball as often as he can. Sorry all of you single ladies, I landed the perfect package! If I could be jealous of myself, I would be.

Now, I can't say that he's enjoyed all of what he's done, and I'm not sure that being a long-term stay-at-home dad is in our future or his personality. It may work out better for us to both work and just prioritize the remaining time to be dedicated spouses and parents. Obviously, I don't know the future, but I do know that I have been beyond impressed by my husband. I know I have an awesome family!

Tuesday, July 6, 2010

Home Call: Part II

As I sat down to start writing this today, Owen was sitting on my lap finishing his dinner. It didn't take too long before the computer was a lot more interesting than his empty bottle. Needless to say, my hands spent more time keeping the keyboard away from his slimy fingers than typing, so I just gave up and let him have at it. That should explain "Part I" you may have read earlier. He had something important to say, but he must have got it out of his system. Now the fabric of the recliner is way cooler than this hard, white computer.


Last night was my first night ever of taking "home call." Even though I think I spent more time driving back and forth to the hospital than I did sleeping, it was a nice change of pace from the types of call I'm used to.

"Call" is a big part of being a resident, and, for that matter, of being a doctor in general. It is something that most doctors, at any level, dread. Unless you've experienced it, it can be pretty confusing, but I'll try to explain it here because it is such a significant part of my life for the next year and beyond.
Simply put, call is a period of time (e.g. overnight), in which a physician is designated as the physician for a group of patients that includes not only their own patients, but also all the patients of the other physicians in the group/team who are not on call. During this period of time, the physician answers questions and addresses concerns about the patients, follows up on tests and procedures, responds to any Code Blue, and admits new patients to the hospital.
There are two basic types of call: "home call" and "in-house call." The duties of the physician don't really change between the two, the only difference is where you are when there aren't things going on with your patients. During "in-house call" you are not allowed to leave the hospital. That is, for 30-hours straight we don't breathe fresh air, we survive on coffee and the occasional cafeteria food, we generally don't take a shower or change our clothes (don't worry, we usually brush our teeth), and we if we ever see our call room, we sleep in uncomfortable beds in 10-minute stretches between the relentless beeps of our pagers. On the other hand, during a home call shift, although you still have to deal with the relentless pager and you still spend a lot time at the hospital dealing with stuff, when there is down time you get to leave and be a normal person within a 30-min radius of the hospital for a little while. Most practicing doctors (not residents) do home call.
Because I've been so used to in-house call that when I was planning for my home-call yesterday it actually crossed my mind just to stay at the hospital anyway. Driving back-and-forth in the middle of the night didn't sound too appealing, and I've had the experience of being the one at the hospital who had to call a resident who had just pulled into their driveway and tell them they needed to come back for something else. But, I decided that I would give the home call system a try.

Yesterday was treated as the July 4th holiday so we were finished after our morning rounds and I was home before noon. My first call woke me up from a good nap at about 3:00 and to the hospital I went. The afternoon was steady with a few patients and the one who was actually in labor was someone else's private patient so that doctor came in to be with her. By the time I made it home Owen was already in bed, but it was good to crawl into my own bed. My good feeling and optimism that I wouldn't get any more calls was ruined at 1:00am when I got called back. As I wrapped things up with that patient, the laboring patient from earlier in the day was about to deliver so I stuck around and watched. (I don't think I'll ever get bored delivering babies!) At 3:45am I debated going home knowing that I'd be back in about two hours anyway. However, a shower sounded really good so back home I went. My eyes didn't get much more rest, but it just felt good to be able to peak in at Owen sleeping during a night on call.

Home Call: Part I

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written by guest blogger: Owen T. Newman ;)


Sunday, July 4, 2010

New Month

After a month of feeling uncomfortable and out of my element, I'm beginning to settle into a new month and new rotation. The Labor and Delivery floor is much more my style compared to the ER. I don't find myself staring at the minute hand on the clock waiting for the precious moment I can go home. Although it can still be painful to lift my head off the pillow in the morning, once I'm talking to patients and taking care of babies the dread drifts away, and I'm reminded why I like my job so much. Surely there will be times in the next days and weeks that I'll go back to struggling with feelings of inadequacy, but there will also be times of great satisfaction.

I've already had two circumcisions and delivered a baby. It was my first delivery with the Family Medicine department, and all eyes were on me. You see, there are a hand full of upper level residents and staff that need to "participate" in deliveries this month to achieve a certain number in order to be certified in the residency, for the hospital, or for some other requirement. This meant that they all wanted to come watch so it would count towards their certification. The delivery was mine to do, but their feet just had to be in the room. Part of me wished they needed to be a little more hands on just so that I could see how they do things here. You see, I learned my techniques from the Ob doctors out in Scottsbluff, so I had no idea what the styles or expectations were of those people in the room - the people who would be evaluating and critiquing me, the people I want to impress. Not to mention, that it has been over 8 months since I've been anywhere near a delivery room. As the time came, 5 pairs of eyes, (not counting the patient's, her husband's, or the nurse's) bore heat into the back of my head which was already damp with sweat from the bright overhead lights and hair cover. Thankfully, I went into the zone and the background just became the background. Later, throughout the day, 5 different people critiqued me from their prospective. It's good to have feedback, but let's just say I was ready to go home by the end of the day.

Monday, June 28, 2010

Benefits

For the first time in my twenty-six years of life I'm getting "benefits." My health insurance will soon be under my own name, and it will not be the standard take-what-you-can-get student insurance. What's even better is that I'll have dental, vision, life, and disability insurance too. (I've actually had most of that already, but it's so much cooler to have it as part of your "salary package.") All of this makes me feel so grown-up.

Some people may not understand my excitement. After all, no one, myself included, actually enjoys paying for insurance, but we all like cashing the rest of that paycheck. It is such a defining part of adult life. A right of passage, so to speak. Most people can remember their first paycheck, and I've been looking forward to this day for a long, long, long time.

After twenty-six years of living I'm finally going to "make a living." I'll be another shovel to get us out of the debt that the backhoe called med school dug us into. My shovel isn't going to be very big for these three years of residency, but it's surely better than nothing.

My stomach churns when I hear people comment negatively on how much doctors make, and it seems like there is more of this talk lately with the health care debate. Sure, there aren't too many doctors making less than six figures out there, but not too many people consider what it has, and will, cost us. Remember, I have gone twenty-six years without having a steady, paying job! That is one-third of my estimated life-time. Doing a little math, if I would have ended after college and earned an average income of $50,000 for the four years I was in med school I would have made $200,000. Instead, I went the opposite way and went into debt nearly $100,000 in just the first three years. During one of our last meetings as a med school class, we were informed that we took out over $15 Million in loans as a class to help pay for our medical education alone. Consider how that will grow with interest! Amazing. Scary. Not only med school, but residency isn't such a big payer either. I calculated that we make approximately $11.50/hr during this period of our careers. Don't get me wrong, I am not looking for pity because we knew what we were getting into... for the most part. However, I do wish people would consider this before some of their comments fly out of their mouths or into their articles. Whew... I'm stepping off my soapbox now. After all, I really just wanted to say that I'm happy to be moving, and growing, up.

Thursday, June 24, 2010

Eval

Every 6 months our residency program director (in my case, Dr. O'Dell) meets with each resident individually for an "evaluation." Usually, it's not something we residents look forward to. You spend 15 uncomfortable minutes in an office crowded with stacks of paper and books with the one person who essentially controls your life sitting across from you trying to make small talk about the weather and family before he cuts to the chase to tell you what has gone well and what you need work on in the future. It can go well, and obviously, it can go not so well. The topic of conversation can focus on your abilities or disappointments. Thankfully, my evaluations have been more on the positive end of the spectrum, but I never feel safe when evaluation day is near.

My most recent evaluation was this week. Anticipation was especially high this time around because I heard through the grape vine that a fellow resident endured a verbal lashing for a lower than expected score on his boards. Although my scores this time around were much improved from Step 1, I didn't ace it by any means, and I didn't know how high was good enough. I also started this 6 month period with maternity leave. Not only was I short one month of staff evaluations boasting my "good communication" and "hard worker" skills, I also didn't have a great first month back to work. Starting in February with a very busy inpatient service was rough. It was even tougher because it was also the first month for our supervisor, our staff was unpredictable - for lack of a better word, and I was trying to pump inconspicuously. This was the first month that I literally went into the bathroom and cried out of exhaustion, and it also was the first, and only, time I've been taken into a supply closet to be yelled at because I didn't know how many times my patient had pooped. (Thankfully, that didn't make it onto the notes for my 6-month evaluation.) What a month!

Needless to say, as I waited outside of Dr. O'Dell's office this week, I had no idea what to expect. I was planning for the worst and hoping for the best. He welcomed me into his office with a smile as always, and I sat down trying to hide my nerves. Relief rushed over me when his tone was pleasant and there wasn't a a trace of that inevitable "but..." lingering in the comments. He simply mentioned my scores and rotation evaluations as if he was just completing the formality of the meeting. Then, painlessly, it was over.

One comment he made did stand out. And, if I can read between the lines, I think it shows where my advantage over my peers lies - a reason that he might overlook a few points on my board scores or a just-average evaluation from a staff member. He said, "During the last year, you have not only become a Sub-I but also a mother." Honestly, it means a lot to have a director that recognizes that my life is not just my work. I hope, and think, that it is genuine.

Regardless of how positive the meeting went, I'm glad that it is over, and I will likely still need to swallow my nerves 6 months from now when I have to go through it all again.

Tuesday, June 22, 2010

I TRIed

For the last four summers, there has been a day that has challenged my physical and motivational limits. Sunday, June 20, was the fourth year that I have competed in the Cornhusker State Games Triathlon. Although, the total combined time of these events over the last four years is less than 8-hours, they are some very memorable hours. This year was no different. It was memorable. To honor this event, I thought I'd revisit each year's unique race.

2007 - In the beginning... What in the world was going through my mind that possessed me to have the crazy idea that I could complete in a triathlon? That moment when I had this crazy idea is still crystal clear in my mind. I was standing outside the lecture hall during my first year of medical school waiting for our free lunch to arrive. It was pizza. As my stomach growled, I overheard my marathon-runner-classmate say the word "triathlon." She said that there was one at the Nebraska State Games, and she also said that it "really wasn't that difficult." And that, my friends, is how it started. She has no clue what her harmless conversation started! I signed up. After word slowly got out, my dad, joined the training. I wasn't going to do it alone.

That first race was down-right scary! Without the faintest idea of what to expect, my stomach was in knots. Looking out over Holmes lake, the buoys were what seemed like miles off shore. How would I ever make it? Then, the gun went off, and into the slimy, green, water we went. After a few moments of panic when the better swimmers passed and dunked me on their way, my breathing settled in. "I'm doing it!" 20-some minutes later my feet hit the sand again, and I was a third of the way done. I hopped on my mountain bike and then faced my worst nightmare. If I would have known that my legs would have to pedal me up that hill three times, my days as a triathlete would have been done before they started. My legs and my lungs were on fire by the top. I swore that the next year, my bike training would be a little, no, a lot, more serious. With the hill behind me, I started the final leg - the 5-K run. Even though my legs were wobbling like jello in an earthquake, the encouragement of the other runners took me to the finish line. What an accomplishment! I was so proud. Exhausted, but proud.
2008 - The adrenaline from the first year was still pumping when the time came to register again. This year, not only had my dad decided to do it again, but my brother, Phil, and my husband, Jason, couldn't resist. It was a blast during the race to know that my family was out on the course with me. The triathlon had officially become "our thing." And, after a summer of teasing each other, I had officially won bragging rights at our house. My time was just under Jason's even though he will tell you that it doesn't count because he was "sick." Blah, blah, blah... I won!
2009 - I almost didn't compete this year, but I felt like my reason was legitimate. 18-weeks pregnant seemed like a good enough excuse. However, as easy as it would have been to sit on the side-line and watch, I really wanted to be able to tell my son that we had done it. So... I did it. My only goal was to finish. All I wanted was to cross that finish line. However, about a third of the way into the swim, I almost gave up. My head had been pushed under the water one too many times, and I couldn't catch my breath. As I swam over to a boat to get a break I questioned if it was really worth it. I must have decided that it was, because once the water was calm and the last aggressive swimmer passed, I let go and finished the race. Forever, Owen and I will have this race.
2010 - Last, but not least, this year. After the last year, I didn't think anything would be able to keep me from doing the race. Then came a very busy year. Not only were we now juggling schedules with Owen, I was also putting in a lot more hours at the hospital and clinic. Training was put off until May, when I had nothing except a little thing called graduation planned. I thought I would have all the time in the world to get ready. However, I let each day in May pass without tying my running shoes, or airing up my bike tires, or putting on my swim suit. I decided that this year wasn't going to happen. The race had also been moved up a month, so I added that to the list of reasons that I would let the registration deadline pass without adding my name to the list of participants. The next morning, when it sank in and there was no turning back, my disappointment clouded the sunny day. "Next year," I told myself, when honestly, I feared that this would be the slippery downhill slide of my dedication and drive. That fear, and learning that Dad had signed up, gave way to a renewed sense motivation. Two mornings later, I bargained with myself that if I could run a 5-K without stopping, I would give myself permission to call the State Games office to see if they would let me register late. I did, and they did. And my training, although starting a little late, went into full gear. Like last year, except for the pregnancy thing, my goal was just to finish.

The morning came. My nerves were pretty calm because my training had been good in the days leading up to the race; however, in the back of my mind I knew that my body was really not prepared as well as it should be. There were also storms in the forecast so we were going to be battling the weather and course conditions, too. Jason, Owen and I met Dad there. We set up our transition area, and then decided one of the tires on the bike I was borrowing from Phil needed a little air. Luck would have it that as we tried to perfect the pressure, it went as flat as a pancake. Without a spare, and our unsuccessful attempts to fix it ourselves, I thought this was it for sure. After all that had happened in the last few weeks, it was over before it started. Oddly enough, amidst the disappointment was a sense of relief. I couldn't fail if I didn't race. And if my tire was flat, it wouldn't be my fault that I didn't race. With not much time to spare before the race was scheduled to start, we went over to register because we didn't know what else to do. Jason had learned of our little predicament, found a bike repair trailer on site, and somehow, with Owen in tow, got my flat-tired-bike over to get fixed. For $6 and in no time flat (no pun intended), there was a new tube and the optimal pressure. Also, during that whole ordeal, the storms had rolled in, and our race was delayed. (I guess it's poor form to let hundreds of people into a lake in the middle of a lightening storm.) So we all crowded into the picnic shelter and watched the rain poor, the lightening crash, and the thunder roll.

About an hour later, they announced that there was a small "window of opportunity." We gathered in our waves and listened to the instructions as lightening continued to strike. Did they just not see it? Were they literally going to let us swim "at our own risk?" Finally, they realized it wasn't any more safe than it had been, and it didn't look like it would be any time soon. No triathlon today.

Instead, the course was changed into a duathlon: run, bike, run. A large number of dejected racers left, but a majority stayed and competed anyway. As much as I like the swim and as much as I don't like to run, that little wave of relief I had during my flat tire returned. I had another way out. Who would blame me for leaving now? Yet, a little voice inside me knew that anything less than crossing the finish line would be giving up. So I slipped on my wet running shoes and joined the pack.

An hour and 24 minutes later I crossed the finish line. Once again exhausted, but also, once again proud.

Saturday, June 19, 2010

Not Guilty?

Tomorrow is "Baby Dedication Sunday" at our church. (Hopefully, our family will be able to participate, but it just so happens to overlap with another big event on our family's calendar. More information about that to come.) In correlation with this celebration, some lovely women from the church also hosted a brunch this morning for the moms to chat, eat, and get to know each other a little bit.

Owen and I went and had a decent time. Just "decent" because, although it was fun and nice and the food was good, it was also awkward to be in a room with people who didn't know me but seemed to know each other. I was proud that I had to guts to be the "new" one in the group, but, if you know me, you know that's not my cup of tea. I'd much rather meet a new patient in an exam room for 15-minutes than stand in a circle of chattering women. (I know that sounds terrible to say, and I also know it has the red flag of insecurity waving all around it.)

In one of those uncomfortable conversation circles this morning, another young mom asked me, "So, are you able to stay at home with Owen?" The question was well-intentioned and only asked in an effort to continue the introductory conversation we had started, but the words stirred something inside me. My defenses went on alert. Why had she chosen those words: "are you able to?" So subtle, but my insecure mind latched on to the phrase like a boa constrictor. Why didn't she just say: "do you?" I felt like my ability was being challenged - and more specifically, my ability as a mother. Now, not only was I battling the insecurity of being the new one, I was also going to be the token "working mom" in the bunch of "stay-at-homers". The conversation continued pleasantly, but I've been thinking about that moment and my reaction ever since. In retrospect, Satan's fingerprints were smudged all over it, but why did I feel the need to defend my choice? Is that the guilty feeling they always talk about when moms go back to work?

The guilt of this working mom is a strange thing. "Guilt" isn't even the best word. I don't feel guilty about being Dr. Mom by any stretch of the imagination. Leaving Owen in the mornings isn't something to look forward to, but I feel like a better mom when I come home from a productive day at work. I am very proud of my roles and accomplishments. However, when I'm in situations like the one this morning (and usually it's around Christian women), I feel like I'm supposed to feel guilty. So, sometimes, in the end I feel guilty for not feeling guilty. That's as good of an explanation as I can come up with: guilty for not feeling guilty.

Wednesday, June 16, 2010

0.5 years

1/2, 0.5-yrs, or 6-months. No matter how you shake it, that's how old my little man is already. It seems too cliche to say that "time flies," but "time flies!" I was thinking the other day of the moment when I saw the two pink stripes come up on the pregnancy test for the first time. Talk about a moment that changes your life. Then, he was only a little ball of cells, and now he is the sweetest person you could ever meet.

There will never be another 6 months where he will grow and change this much ever again. He's topping the scales at 15lbs 12ozs and can sit up on his own for over a minute on a good day. He's downing #2 jars of carrots, applesauce, green beans, and more. Not all at the same time, of course. He has squished bananas and avacados between his fingers but hasn't quite figured out how to get them to his mouth. (Which is odd because everything else instantly finds its way there.) Although those are the things that excites his pediatrician, I'm more excited that now his six month old little face turns to see who's coming through the door when I come home. Even more thrilling is seeing his round cheeks and the corners of his mouth rise up from behind his paci when he realizes it's me. It's even better when the paci falls out of his wide open grin which, shortly after, lets out the most joyful high-pitched squeal. Now those are the moments I feel like a mom.

Dr. Mogenson warned us that it won't be long before he'll be pulling himself up on furniture. Then crawling. Then taking steps. Then, heaven forbid, walking. What is going to happen in the next 6 months? It is going to be fun!