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.

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.

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.

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.

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!

Zoo

A momentous occasion has passed. Owen had his first trip to the zoo! Why is it that the first experience at the zoo is such a milestone? (Or maybe it's not, and I'm just super sentimental. If so, you'll have to humor me for a little while.) This was truly an experience I've been looking forward to since the day I found out I was pregnant - probably even before that. And the outfit he wore has been picked out for just about as long. I've been excited to see the look on his face when he sees the penguins for the first time, curious to know if he'd cry when he hears a lion roar for the first time, eager to watch his little fingers touch the fur of a goat for the first time, and on and on - all for the first time. Needless to say my cameras were charged and ready. The poor kid had a lot of expectations placed on him.

It was such a funny day. Not really in the comical sense, but just a weird day. Unfortunately, I was exhausted because I had worked the night before, and we weren't exactly well prepared because we still had to buy a stroller. (Our original stroller got returned several days ago due to the most annoying wheel on the planet.) I spent the morning and early afternoon learning that early summer is a terrible time to buy a jogging stroller because everyone else is doing the same. I did finally find one, and a pretty good one, at a sporting goods store of all places. Needless to say, that adventure put us a little behind schedule.

Even though we didn't have time to see every exhibit and do everything, I think it was plenty for Owen's little senses to take in. What surprised me was his reaction, or lack there of. He watched the penguins swim like he'd see them a thousand times. He found the stuffed puppy he's played with a hundred time just as entertaining at the sharks. He cried through the entire Madagascar exhibit because he was hungry just like he would have if it was any other afternoon at home. His expression for most of the trip was as follows:

Pretty exciting, huh? Doesn't that face just ooze with the thrill of a new adventure? Come on, Owen, don't you know you're at the Z-O-O! Maybe it would have helped if mom and dad would have made sure he had a nap before we left. He did manage to crack a smile or two, and after a bottle he let out a couple of laughs. All in all, I think he enjoyed it, but I'm sure the excitement will fill his eyes when he's a little older and better able to appreciate the wonder that is the zoo.

Not for Me

Finally, I found a job in medicine that is not for me: Emergency Medicine. This comes as a little bit of a surprise because I thought I would enjoy the fast-paced, high adrenaline nature of it. After all, trauma surgery was one of my most memorable rotations. I guess I still enjoy that part, but it is such a small part of the job it doesn't make up for the remaining, less-of-an-adrenaline-rush, more-like-a-frustrating-headache parts. And, the exciting stuff is a lot less fun when everyone is depending on you to make the split-second decisions of what to do next.

I can see how medical students would love this rotation. You get to see, and more importantly, do a little of everything. Instead of watching residents and doctors do everything, in the ER, students get to dive in: practice suturing, listen to the ambulance scanner call in patients, watch intubations, put in IVs, tap joints, see if your stomach can handle broken bones and amputations, and so much more. And the staff doctors cherry pick the good stuff for the med students to see. Isn't that the real reason we go into medicine - the good stuff? That's what is on t.v. Those are the stories family and friends ask to hear about during the holidays.

Unfortunately, I'm learning that isn't what the ER is. Sure, I've been able to do a handful of stitches, but I can't begin to count the number of abdominal pains, headaches, and back pains I've had to sort through. My clinic is full of these complaints, but in the ER you have a two fold problem. Not only do you need to diagnose and treat the chief complaint, but you also have to assess the patient's motivation. Why did they really come to the ER? After all, they think their problem is an "emergency." It is harder than you think to judge a person's motivations in the five minutes you have to learn their story - to essentially decide if their pain is deserving of relief. Unlike the clinic, there isn't the options of a two-week follow-up, or at least there shouldn't be.

Like I said, Not for Me.

Rest

I'm remembering how valuable a day off is. After three 12+ hour shifts in a row, today is a much needed day of rest. Although I enjoyed each and every day off last month, I must admit that this day off feels a little sweeter - like I really earned it. Not only does my body needed a break from standing in bad shoes for countless hours, dehydration, and sleep deprivation, my mind is also begging for a little less action. The ER seems to be especially draining. I literally was going for nearly twelve and a half hours straight with the exception of one 20 minute break when I escaped to shovel down a salad (with the added challenge of not having a fork)! I want to do a good job, but at the same time understand that I'm not training to be an ER resident. My focus has been on patient care and less on how to efficiently "move the meat" as they say. (In other words, how to get patients in and out, in a less than tasteful phrase.) I am definitely learning a new appreciation for what they do.

On-call nights for the inpatient medicine service might be longer (as in 18 hours longer), but these last days have been equally exhausting. It very well could be that I'm just "out of shape" and it is always difficult to get used to a new environment, system, and group of people. So I'm hoping that I get adjusted and toned up for next weekend with 4 long days in a row and, in the not so distant future, a month of Ob, followed by a month of inpatient pediatrics, followed by back-to-back months of inpatient wards at University. I'm getting palpitations just thinking about it!

I knew this year was going to be challenging, and instead of focusing on the stressful parts, I keep reminding myself that this is a learning experience I'll only "get" to do once. I should take advantage of it. But for now, I'm going to take advantage of a little rest.

Shift #1

Well, yesterday, was a busy day. I'm getting back into the swing of things. It was my first actual shift in the Emergency Department. From 7AM to 7PM (actually is was more like from 6:45AM to 7:20PM) you could find me somewhere down in the "pit" - as some would call it.

Thankfully, it was a good day, and everyone was friendly and helpful, that includes the staff, other residents, nurses, patients, and even the patient's families... except for one patient, I guess. But I forgive her because she is "well-advanced-in-years," already struggles with dementia, and was sick on top of it. I don't really blame her for clenching her mouth closed when I tried to complete my ENT exam, or swinging her stuffed bear at my face when I put my stethoscope on her chest. By the look on her son's face and the genuine look of fear and confusion on hers I had nothing but compassion for her. Her smile will likely come back after a few doses of antibiotics, and if that was the worst attack on my first day, I cannot really complain.

During orientation they instructed us that our goal should be to see 10-12 patients. However, eight was the magic number for yesterday. Even if it didn't meet the quota, it isn't too bad for my first day. Of the eight, one went to the OR, one was waiting for the ortho resident to come tap her likely septic ankle (OUCH!!), three were admitted to the hospital (sorry to my fellow medicine residents who got slammed with admissions yesterday), two went home and one went back up to the labor and delivery floor to watch the birth of his first grandchild. [Must have been a good day to have a birthday. I have to interject that I became an aunt to my first nephew yesterday, too!] I even managed to get away for 30 minutes to sit and eat lunch.

One shift down, seven to go... but who's counting.

Formula

Owen's bottle this morning was a little different color, a little different texture, and I'm sure had a little different taste. He had his first swallow of formula today. To be honest, this too is a bittersweet day. As much as I have found feeding him rewarding, I'm also going to be a little relieved to share the burden with that can of powdered goodness. I'm also looking forward to sharing the burden... I mean, the pleasure, of those 1:00-am feedings with Jason.

My goal is to feed him for at least 6 months and likely be done soon after he has teeth. Before you ask, you should know that there is no science behind my decision. Medicine would say, "Breast is best, but formula is a good alternative." My plan is more of a goal to remind me that I wouldn't do this forever. Some of the more difficult days that I found it reassuring to know there would be an end, and on the good days it encouraged me simply to enjoy it. In just 11 days he'll reach the 6 month milestone, and we all know those teeth are coming sooner rather than later. Additionally, with me going back to work, this seems like a natural time to take that step and introduce formula. After this, I don't really have a plan. My body will have something to say about it just as much as Owen's growing body will, so we'll just play it by ear (or his stomach, rather).

As I dumped the powder in and shook to rid the bottle of every tiny clump, I wondered what he would think of the difference. I hoped he would like it. I worried he would like it better. I planned this to be the time. It was just the two of us. Selfishly, I have wanted to be the one to give the first taste test. I don't really know why, but I guess it's because feeding him has always been my thing. He gladly took the familiar bottle as we sat down in our favorite rocker. However, after one big suck, he scrunched up his nose and released the seal he had created with his lips. He rolled the nipple of the bottle over his tongue as his mind tried to process this new substance. He didn't hate it, but it definitely was something new. Then, after 5 minutes of sampling and analyzing, he decided it was good enough and proceeded to empty the contents. It was a success. What's more, he gave me a little satisfaction by not enjoying it more than my "home-cooked" bottle and at the same time not giving me the frustration of having to force it. Have I told you what a good baby I have?!

Bittersweet

Last days are usually bittersweet - exciting and difficult. This day is definitely no different. My days alone with Owen are coming to an end and my days of being an intern are beginning. It is exciting to get back to work and be a "real" doctor, but at the same time it is going to be extremely difficult to leave my sweet little boy for a long day of work.

I am so glad that we had this month together. As necessary as the usual 6-week maternity leave is, I'm starting to realize that a post-post-partum leave also is nearly essential for working moms. After all, I may have fallen in love with Owen when he was a helpless newborn, but I have really gotten to know him as a priceless little man. What I've learned about my son in this month has been incredible! I know how his cry sounds when he's hungry. I know that when he puts his hands behind his ears he's getting ready to throw a fit that can only be cured with a good nap. I know that he likes green beans better than peas. I know which is his favorite rattle. I know when he lays his head on my neck it's less a sign of affection and more an indication of sleep-deprivation. I know that he likes to listen to stories, and he is more likely to share his own tales when only a few trusted ears are listening. I know he will like baseball like his dad and cooking like his mom. I know he is kind and patience. I know he is persistent and determined. Best of all, I know he loves me.

It is too bad that there isn't a "before-and-after" photo of us. Not just that he is longer and my hair is shorter, but how cool would it be to have an image that shows the incredible bond between us. We went from "mother and baby" to "Mommy and Owen." Like I said - Incredible! Maybe most mothers of 5-month-olds feel this way, and maybe I would have felt like this even if I worked during this time, but even so, I wouldn't trade what we've experienced for anything.

I realize that so far the fact that this is all coming to an end sounds a little more bitter than sweet, but there is a sweet spot to this day. Tomorrow, go ahead and circle June 2 on your calendars, my patients will have appointments with Dr. Newman - not with "med student, Susan" or "part-of-your-medical-team, Susan" or "Sub-I, Susan." I will be their doctor. I am their doctor. How sweet, and awe-inspiring, is that?!