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!

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.

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!

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.

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.

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).

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!

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 ;)

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.