MOM.D. - Intern Year

2011-07-02T13:22:00.001-05:00

In case you can't get enough, here's chapter two:

http://momd-thesecond.blogspot.com

See you there!

THE END!

2011-06-30T20:29:00.003-05:00

Today I was in the resident lounge, and it dawned on me - this year is O-V-E-R. There was a fresh batch of interns trying to put on their calm face when inside you know the anxiety was nauseating. They sat at the computers frantically scribbling notes trying to learn the patients they would be responsible for in a few short hours. Several were still trying to figure out how to log into the computers and asking where to find charts. It wasn't long ago that it was me in those shoes. And as much fun as it was to watch the incoming class, it was even more exciting to watch my fellow soon-to-be-former interns. Confident. Knowledgable. Relaxed. What a striking parallel to the nervous, naive, and stressed interns that started the year twelve months ago. Truly remarkable. Change is awesome.

Clearly, I've grown as a doctor in the past twelve months. It would be impossible not to. But it has also been a complete transformation at home. I went back and read my first few blog posts and remembered what it was like it to hold 6-month-old Owen. I didn't think it could get any better. I was wrong. It is so much better. To see that smile and those little feet chugging as fast as they can go to the door when you get home has brought me to tears more than once. My heart melts when he lifts his arms in the air to be held (which doesn't happen very often), and who could resist his sloppy kisses. He is such a little man now. And just think, there is another little one ready to come and melt my heart any day now - maybe any hour. Being a mom has been more than amazing, and more than I could ever express in words. Talk about changing you. It doesn't get any more transformational.

So I guess this is it. This blog is a wrap. "MOM.D. - Intern year" is completed. Intern year is completed. Never will I go back. Never again will I be that low on the totem pole. No more 30-hour call shifts. No more crunchy hospital pillows. No more single stroller jogs. No more family photos of three. No more. Good-Bye. The End.

... at least until I come up with a name for another blog

What a Day

2011-06-21T20:44:00.003-05:00

Have you ever gone to bed at night and thought, "Wow, if I had only known what this day would hold when I woke up this morning..."? It was one of those days today for me. Yesterday at this time our lives were different. More uncertain. So much hanging over us.

As I finished up work on a presentation this morning I heard Jason in the other room on the phone. Anytime he's on the phone, I play this game with myself and try to guess who he's talking to and what they are talking about. Not to brag, but I'm pretty good at it, too. So even though I had it all figured out by the time he hung up, it was still a relief to hear Jason confirm my suspicion. He was indeed talking to our real estate agent, and we indeed had a negotiated contract on our house. Yes! This is what we've been waiting for. Of course there are a lot of hoops yet to jump through, but we are one huge step closer. If everything falls into place we will close on July 27. God's timing is perfect! We'll get to bring Baby Newman #2 home to our home (not to a temporary apartment or hotel), and yet we won't have to pay a single extra month of our mortgage. What's even more, our yearly flood insurance premium is (or would be) due on... you guessed it: July 28. Perfect.

If that isn't enough exciting news for one day, I had an Ob appointment this afternoon. Everything is moving along smoothly, and they started my "checks" today. 2-cm and 50%. Whoohoo. The doctor in me says to chill out because a single check doesn't mean a single thing (I could go into labor tonight or in a month); however, the expectant mom in me is excited that this body of mine is actually doing something, and we'll be having a baby soon. Although my due date would say I still have 4 weeks, I just got a little more hope that it won't be nearly that long.

Wow, what a day.

Just A Theory

2011-06-20T15:02:00.003-05:00

I have a theory. It seems the less I "have" to work the less I "expect" to work.

On months where I slave away for hours and days on end, I seem to be relatively productive with my time. And, I seem to gripe and complain less when I have to go in for a few hours on the weekends. I'm grateful to get off at 5:30 instead of 7:00. However, on months like this one, where I'm working 9-5 or less, I dread going in and count the minutes until I'm on my way home. I hate to admit it, but sometimes I even whine when I have to stay the full time until 5:00. Why is that? Maybe it's just me.

For example, today 9:00am was the start of my work day. On previous rotations I've been there for at least three of four hours by then. Our staff on this rotation is usually late so I even rolled in 5 minutes late today myself. (I was the first one there.) I had a meeting at 11:30 across town, so my "work day" ended at 11:00 and I was home after the meeting around 1:00. I really worked for less than two hours and yet instead of being thankful, I wished instead that I didn't have to go at all.

Then, since I wasn't expecting to have the afternoon off, I concocted all of these brilliant plans for the afternoon. Study for boards. Finish a presentation. Clean. Do laundry. Make some phone calls. Two and half hours in and guess what I've done... check email and facebook (a few times, might I add), and now clearly I'm procrastinating even more by blogging. Pretty pathetic, huh?

I should probably make a mid-year resolution to change my attitude. So for now, I'm going to close my internet and get to work on my presentation... After I check Facebook one more time.

Alzheimer

2011-06-18T12:58:00.002-05:00

I've seen a lot of sick people. I've had to tell a lot of people bad news. I thought telling people they had cancer was going to be the worst part of the job, but I'm quickly learning that people take hearing they have, or their family member has, Alzheimer dementia just as poorly. Who could blame them?

Nearly half of the elderly population have AD, so if you haven't dealt with it yet, just wait. It is also not a very forgiving disease. It slowly steals your life and your dignity. Trust me, it doesn't just steal your memory. First you lose the ability to do things you learned as a young adult. Managing finances. Cleaning and cooking. Then those teenage lessons are gone. Driving. Shopping. Time keeps rolling backward and you loose your childhood. Dressing and hygiene. Finally, you're stripped of all independence. Toileting. Feeding. All gone.

Terrible. Frustrating. Aggravating. I know. To shed a little light on such a gloomy topic, there are a few things out there to slow it down. Aricept. Razadyne. Exelon. Namenda. Take your pick. We might not have a cure, but it's usually better than nothing. And at this point, it's all we've got. People have tried estrogen, testosterone, NSAIDs, and ginkgo, but nothing else has really panned out. Hopefully, there are some smart people somewhere hiding in a lab working on the next "latest-and-greatest".

Maybe we shouldn't just sit around and wait for the robber to come in the middle of the night and take this from us, why don't we try locking the doors and windows first and prevent this relentless beast from taking hold in the first place. Sounds like a great idea, and we've been looking. Unfortunately, NOTHING has been shown to be effective in preventing AD. Few people say that taking omega-3, controlling blood pressure, and staying physically and cognitively active can help, but unfortunately the data just isn't there. Yet. In my opinion though, it can't hurt. So keep playing Rumikub, Grandma!

In One Month

2011-06-11T07:17:00.006-05:00

In one month, our world is going to be rocked! Literally. We'll be rocking Baby boy Newman #2 in a few short weeks. (Although I'm sure it's going to drag on as I not-so-patiently and anxiously wait.) This pregnancy has flown by to say the least. At times it actually makes me sad because I want to savor every big pregnant belly moment and time for those moments is getting less and less as each hour passes. As hard as it is to remember all the details and feelings of carrying Owen almost two years ago, I know that these new feelings of kicks and anticipation will fade with time as well. Thankfully, they will be replaced with memories and emotions of holding a precious perfect little life, and smelling that new baby smell. That's a pretty fair trade if you ask me.

If you think having a baby is a big family change, in one month we will also be packing up and moving to Grand Island. In my opinion each of those events is enough excitement for a year, but don't call us exciting for cramming it all into a few weeks - call us crazy! Just like with this baby's birthday, the date for the big move is yet to be established. Hopefully, they won't pick the same day. This baby will come when he's ready. And our house will sell when it's ready. While that definitely raises the blood pressure of this left-brained planner, I know that it will all work out in the end. The baby may not have a cute nursery to sleep in his first night at home, but I did get him a cute little outfit (including shoes) to leave the hospital with. And, as Jason says, he'll never know, or care. He has two parents, a big brother, and lots of family who love him. God doesn't make mistakes, so it is no mistake that these two events are colliding now. Thankfully, it won't be more than we can handle. We will all just have to wait and see where we are and who we have in just one month.

In a Groove

2011-06-09T16:01:00.003-05:00

Maybe it's the fact that I'm a few weeks away from being done with this year. Maybe it's that I'm burned out from my last few months. Or maybe it is being 8 months pregnant, miserable, and exhausted. Whatever it is, I cannot find my groove this month. Usually by the first week, I've settled into the new routine and its expectations, but this month on geriatrics I am still struggling to be efficient and to take ownership of patients. Nursing homes are not my favorite places to be or to practice medicine, but neither was the cancer floor or the ICU. Hopefully, I'll either find my groove soon or just pray that this month will go by quickly.

Vacay

2011-06-05T07:10:00.002-05:00

What a way to start a month. After just a couple of days of work, I am out. Vacation here we come.

With a 17 month old, a tight budget, and being 8 months pregnant our idea of a vacation is a little limited. Even though he was an angel at 4 or 5 months old when we flew to Texas, there is no way a plane trip would be a pleasant experience now. At least I'm not going to try and find out. And, after several trips to Grand Island, we're learning our driving time is getting shorter and shorter. Owen pulls out his special, shreeking scream just for car trips. It gets under my skin in about 1 minute and under Jason's in 1 second. Add to that Jason's bladder (which, for the record, is much more of an issue than this pregnant lady's), and we are lucky if we can make it out of Omaha. Kansas City seemed like a decent enough challenge - tolerable driving time yet far enough to feel "away."

Even with my type A personality, we haven't planned a lot for this trip. Of course we are going to a baseball game. Jason wouldn't have it any other way. And if you know my husband, we've already had a few detours to random historical sites "on the way." (By that he means 30 minutes out of the way for a 30 second photo op.) Makes me laugh - usually. We are also planning another detour to see some friends who moved to Kansas on our way home. And other than that, our plans include sleeping (except after one night we've discovered that's not one on Owen's agenda), eating lots and lots of the hotel's free breakfast and maybe some barbeque, swimming, visiting some parks, and mostly just relaxing.

Relaxing! That's what I'm looking forward to the most.

Cancer Sucks

2011-05-31T06:56:00.004-05:00

Some days I really can't believe that I survived the last two months. It is the end of a long, long journey. I've grown and learned a lot, but there is one realization I knew going into this that has only been solidified: Cancer Sucks! And, at times, it does Big Time.

Sure there are plenty of other diseases that can give a person a shorter life expectancy, and sure there are more and more treatments and possibilities for cure than every before, but still there are no other more earth-shaking, life-altering, gut-wrenching three words that I, as your doctor, could say than: "You have cancer." And if it's earth-shaking, life-altering, and gut-wrenching for me, there is no possible way to begin to understand what it is like for you, my patient. The faces of the people with whom I've had that conversation are burned in my brain. Over my short career, it hasn't gotten any easier - actually, maybe it's getting more difficult. The other day, I was surprised, and a little relieved, to hear one of our staff oncologists, who does this everyday, say that it hasn't gotten any easier for her either.

To those parents who are, or have, watched their children (grown or not) battle this disease, I'm sorry. So sorry. There are few things that could be more painful or more unfair. I understand that you're angry. When I was frustrated with you for being frustrated with us for not doing things fast enough or good enough even though we were doing things as fast and as good as possible, I imagined Owen laying in that bed. Wow, does that sting. I snap out of it in less than a second because it hurts too much and come back to the reality that I have a healthy boy running around at home. I can't bring myself to even imagine him crying out in pain, full of fear, and leaving me helpless to change it. Me, running back down the hall after I stepped out of his room just to get a drink when I hear a beep echo and think that it is something terrible coming from his room. Thank God, He has a plan.

It has been one thing to take care of patients with cancer this month, but even when it has been my turn to go home and set the pager aside I haven't been able to escape. A few months ago, our sweet Uncle Loyd was diagnosed with cancer. Metastatic. Painful. Incurable. The stubborn man with the great stories and a huge soft spot for Owen is slipping away. And fast. In November he was working two jobs. December, he made his famous Christmas breakfast. January, on a train to California to see his family. February, fighting. March, losing. April, realizing it. Now in May, he's laying in a hospice bed with no chance of balancing relief from the pain with sedation from the medication. Do you mind if I say it one more time? Cancer sucks.

I think I've cried more these past two months than the ten before. I've said prayers, but not enough. To our family facing the reality of cancer, to my patients' families, and to yours if you find yourself stuck in this too, God does have a plan. A wonderful plan. But if it helps, it's okay to admit, to say, to yell: Cancer Sucks!

Other Side of the Coin

2011-05-18T19:43:00.006-05:00

After my rant about being tired and overworked yesterday, I did feel better. However, it also made me reflect on the past few weeks. In the midst of that reflection came a realization that there have been some pretty awesome moments, too. I'd feel like a used car salesman if I only told half of the story and didn't "rant" about the good stuff, too.

On my only night that I didn't get called in for a new admission, I came in for a different reason. One of our patients had a sudden change status. It was so unexpected that I didn't even check my bed hair in the mirror before heading out the door at 2am. His blood pressure and heart rate were off the charts. He had a fever literally radiating off his skin. And when we were able to wake him up we almost wished we hadn't with his swinging arms and kicking legs. Immediately, we started testing and treating for all of the bad things this could be. (After all, there aren't too many good things this could have been.) Within a few long hours and a few wrong hypotheses, we had our answer. Thankfully, we hadn't waited those few long hours to begin treatments, because otherwise, as my boss put it later that week, "we would have diagnosed it on autopsy." He also told me, "The decisions you made that night saved his life." Catch that - Saved His Life. Awesome.

Recently, I've been seeing a patient who is in complete denial about the terminal part of his diagnosis. (And maybe that's not an all bad way to live the short life you have left. After all, no one really can say I have any more days than he does and sometimes I live in denial of that.) I've decided to just let it be. I'm learning that it's not my job to beat it into his head until he cries. He knows. Now I'm just trying to make him feel a little better each day. Today was a good day. "You're the best, Doc" he called out as I left the room this morning. Rewarding.

A hug from a patient or a family member is always lovely. The hug I got a little while ago was even more so. She hugged me out of genuine thanks and gratitude for making the long phone calls that made it able for her to get on a plane from Afghanistan to Omaha in order to be with her dad in his last few days. The pride, peace, and joy in his eyes brought tears to mine. Unforgettable.

Lastly, a patient was sitting in her chair as we came in for morning rounds. A tube was coming out of her nose, IV's connected her arms to poles, and the few hairs left on her head were laying every which way. She scanned the crowd of seven-or-so of us as if trying to figure out who we were. Then her eyes landed on me. They brightened. "Dr. Newman. You're the faithful one." Turning to my boss she said, "She's here everyday." Ahhh... appreciated.

14 Days and a Few Hours

2011-05-17T20:17:00.005-05:00

If this month is any longer than 14 more days and a few hours, it may be the end of me. I'm dying. I knew Oncology would be a difficult month, but it has far exceeded expectations. My patients are awesome... for the most part, and the actual work itself isn't bad. However, there are only two residents on the service (for some ungodly, political reason) to split the call. I'm not that great at mental math, but there aren't too many creative ways to split a month of being on call between two people and end up ahead. What it has boiled down to is what we call "q2" (in layman's terms - I'm on call every other freakin' night). And the way my luck would have it, even though it's calls we can take at home, I'm at 100% for having to go back into the hospital during the night for a new patient or something going on with a current patient. My body is exhausted, sick and dehydrated, and my emotions are fried. When I'm finally able to break away and come home I'm torn between my need to sleep, eat, cry, go to the bathroom, or spend desperately valuable time with Owen and Jason. That doesn't even touch the things I "want" to do: cook, buy groceries, watch the news, buy something for this neglected baby I'm carrying, clean the house we're trying to sell, do laundry, buy my husband a birthday present (especially because his birthday was May 14th), call my parents, hang out with friends who are moving away, go on a date with my husband, take Owen to the zoo, go to church, get a haircut, buy a few more maternity clothes that actually fit this ever-expanding belly, etc... Not that I'm frustrated or bitter or anything. Ahh, the life of an intern. Honestly though, I couldn't make it a second more than 14 days and a few hours. The count down has begun.

whew... that felt good to get off my chest. sorry for being such a debbie-downer. i hate being so negative, so here's a little something that will make anyone smile...

Oncology

2011-05-03T20:19:00.004-05:00

Once again it is a new month. It's a little bit warmer outside, the sun is still up when Owen goes to bed, the grass is greener, the heater is off, and I find myself yet again on another new rotation. This month: Oncology.

The general chatter in the resident lounge on the first day of the month is figuring out what everyone else is doing. Most of the comments thrown my way were: "Susan, glad to be done with ICU?", "Susan, haven't see you in a while, when are you due?", "Oncology this month, huh? Sorry about that", but my favorite - and what says it all: "Oncology right after ICU. Who hates you? [pause] and your baby?!" If you can't tell, Oncology is not going to be a restful month. Today we got the talk by our supervisor (also known as our "fellow" in case I use that term later) that this rotation can be draining, not only physically and on our time, but also on our emotions. If ICU wasn't enough, here comes more bad-news-talks and more dying patients. Oddly enough, that isn't what I dread. (And actually, in some strange way I find that part satisfying. That is, helping people die gracefully - how and where they want. Honestly, my entire job, from PAP smears to doing CPR, is just delaying the inevitable and asking people to choose between quantity and quality of life. Anyway...) What I am dreading more than anything is another month filled with sleepless nights away from my family.

Thankfully, this should be the last worst month of residency. Next month, in June, I'll be doing Geriatrics and basically just taking care of nursing home patients. Honestly, it will probably be more dying patients, but it should be a lot less busy and lot less stressful. I hope. Then, after June, I'll be finished with internship. Can you believe it?! Woohoo! I think I can get through this month because I can see the light at the end of the tunnel.

It's Hard to Believe...

2011-04-29T21:35:00.005-05:00

... that Easter was already nearly a week ago. Although we didn't have spectacular plans, it was a fun weekend. (Really, any weekend I have off is fun.) It was also the first Easter Owen has been old enough to do anything "Easter-y". And it didn't take him long to figure out that finding eggs in the backyard was more than a chore when he realized they were filled with his favorite treats: mini-M&Ms. What can I say the boy loves chocolate... just like his mama! He also looked handsome in his Easter outfit for church. But, as much fun as it is to dress up and eat candy, I hope that he grows up appreciating Easter for its true meaning.

... that my ICU month is down to one more weekend, and one last call. For nearly a year I stressed about this month, but looking back I am so thankful. I still feel like I have so much more to learn, but taking care of some of the sickest patients around has been an awesome experience. I have more respect for my patients. I have more appreciation for their families. I have more awe for unexplained outcomes. I have more confidence in my own instincts. And I have more love for what I do.

... my belly is this big already! In a little over 11 weeks (plus or minus a couple), we'll be meeting little Newman #2. Talk about "it's hard to believe!" We still don't have anything for his nursery, or a baby book, or an outfit to bring him home from the hospital. The one thing we do have is a name... But, no, we aren't sharing. Something has to be a surprise.

... our house is on the market and we are getting ever closer to the big move. Now that the sign is standing tall in our front yard, we just need that special buyer to walk in the front door and sign on the dotted line. Any day now, I hope.

... that I got sucked into the "Royal Wedding." For as little t.v. as I've watched lately, I spent way too much time this evening watching every carefully choreographed move of a couple I have absolutely no attachment to. As useless as my gawking was, I must say that she looked amazing and they way they looked at each other was terribly romantic. Okay, now I'm really getting pathetic.

... that I'm 27. I don't why I thought of that, but I'm getting old.

Post-call Treat for Me

2011-04-20T13:08:00.004-05:00

Sleep deprivation can do a number on a person's ability to make good decisions. At work, we've been told that when we drive home after a 30-hour shift our abilities are equivalent to someone driving legally drunk. Makes you feel pretty safe, huh? They have even contemplated making us take mandatory naps before we leave the hospital. Can you imagine? Back to preschool we go.

In addition to our driving abilities, they have done studies about spending habits when residents are sleep deprived. Sure people buy junk food, clothes, shoes, etc... But, I've even known a resident who bought a car post-call.

Well, after a long, very long, call night (which included me breaking into hormonal tears at one point) I had my own impulse purchase. I finally bought a nice camera! Some impulse purchases people regret, but I'm not regretting this one yet. Although I still have a lot to learn, it has been a lot of fun so far.

Here are a few shots of my favorite subject from my post-call purchase:

Experience

2011-04-12T20:29:00.004-05:00

As I settle into the ICU, I am amazed how much you can learn in twelve days. It is incredible what medicine and technology can do, and yet, what I am learning has less to do with medicine and technology and more to do with personal experience. I see people who are easily in the midst of the worst time of their life.

Obviously, the patient's experience is difficult, but it is surprising how different and unexpected their reactions can be. There are people who have gone 50 years without seeing a doctor who are suddenly dependent on us for their every breath. Some cling to the support with every ounce of strength they have left in an effort to fight the terrible illness that got them there. Others choose a different, yet equally difficult, path and leave our unit peacefully to a quieter room, their home, or their eternity. It truly has been my privilege to be allowed into these personal decisions and private moments. An honor.

What has also been fascinating is the experience of the people who aren't laying in the bed but who are going through an equal amount of pain. Family and friends diligently sit at the bedside. At 2:00AM, the waiting rooms are filled with plastic hospital pillows and cheap white blankets that cover exhausted spouses, parents, children, and friends. When I get the page that someone has taken a turn, it is not unusual to be beaten to the room by their loved ones. The bags under their eyes are darker than mine. Just like the patients themselves, the families reactions are as varied as the colors of the rainbow. Most, to my surprise, are calm, collected, and reasonable. I think my natural reaction would be hysteria and panic, but that is the minority. How do you watch your mom go through painful treatments? How do you come to terms that life will never be the life you and your husband had planned? How do you allow your son decide he wants to go home and rest while the cancer takes over? How do you respect your grandma's wishes when it means the end? How?

I don't have the answer to that question, but I've see it done. There is so much to learn about human experience, and so much more than cannot be understood. And that is endlessly more interesting than the wealth of information I've been learning about ventilators and shock.

Intensive

2011-04-04T16:52:00.004-05:00

My anxiety level has never been higher for starting a monthly rotation than it was on March 31st. I have had a healthy fear of the intensive care unit forever, and an even greater fear for taking care of it's patients. When I volunteered at a hospital in college I would even get a little nervous if I was asked to help in the ICU waiting room just making coffee and cleaning up. Can you imagine how much more intense it is to be thinking about ventilator setting, pressors, and sedation? And while working on the general medicine hospital floors, the ICU seemed like a magical place where you send people you don't know how to, or can't, take care of anymore. Now, I'm it. My team is the one that gets called when doctors don't know how to, or can't, take care of the patients anymore. We're the end of the road. If we can't fix it, it's over. Talk about pressure!

Well, April first came around just like I knew it would. There was no avoiding it now. With lots of prayers for clarity I scanned my badge and entered "the unit". To my surprise, amidst the anxiety and nerves was a sense of calm and confidence. A God thing because I can think of a million reasons why not to feel calm or confident. Without too much trouble I made it through my first morning rounds. We all survived - me and my patients. Success! Normally, that is all that has been asked of my on my first day, but not only was this my first day, but I was also on call. I survived the normal day with my staff and my team to help me out, but what in the heck was I going to do when they all went home to their warm beds and left me alone with the pager all night long?

When the last resident said good-bye, my heart raced a little faster. It picked up tempo every time the pager went off. I was tachycardic when the page came from the ER letting me know they had an admission. Here we go. It's just me, my sweaty palms, and a patient that has just been intubated and put on a ventilator. As soon as I walked into the room the Respiratory Therapist looked at me, read off the most recent labs, and asked what I wanted to do with the ventilator settings. (What I really wanted to do, was run out of the room and let someone else make a decision so I don't kill this guy, but I don't think that was what she was hoping for.) Needless to say, I didn't run, and it all worked out fine. And, it was also good to get my first admission out of the way. Then came the second. Then a third. We all made it through the night - and it was a long night!

Now it's April 4th, and I'm a pro. Okay, not really, but definitely feeling better. Less overwhelmed. Less anxious. More confident. More knowledgeable.

What Kids Do

2011-03-23T12:55:00.003-05:00

Currently, I am working in a Pediatric clinic. As cute and adorable as kids are (and mine in particular - *wink, wink*), Pediatrics was not one of my favorite parts of medicine. However, after a few weeks of seeing them day in and day out, all day long, I've actually grown to love it.

One of the best things is that you never know what you are going to get when you walk into the room. Oh, the stories Pediatricians can tell. The innocence of a child is priceless, and can be stinking funny, too. Kids will do, and say, the funniest things.

Well, I have a pretty stinking funny, priceless, cute Pediatric patient of my very own - Owen! Although we have some good stories from his visits to Dr. Mogenson, he may have topped them all this morning at our house.

As you know, we are getting ready to sell our house, so in the spare moments of the week I've been doing some touch up painting. Today was no different, and I decided to take full advantage of a day off. There had been a small painting incident earlier in the month with Owen, so I decided today I would be wiser and only paint things higher than the door knobs because that it precisely how high his little fingers can reach. My plan was working, and I covered a lot of ground while Owen was running from one room to the next. Of course, painting gets boring so I decided to take a break and do some laundry. (Yeah, I know, some kind of break.) I washed out my brush, put the lid on the paint can, and pushed it against the wall on our nightstand near where I had just finished.

Shortly into my laundry pile, my ears realized the familiar toddler chatter was missing. That is never a good sign. Quickly, I headed off in search of Owen's next great adventure. Sure enough I found him in the bedroom. On the floor was laying an empty water glass that previously had been filled with water on our nightstand, soaking wet slippers "strategically" placed, and...

the white paint can! Can you imagine what was sitting next to this now opened can? Yep, a sweet, innocent, adorable little boy with gooey white hands in his Husker pajamas changed from red to white. Paint was in his hair, and there was a big gob on his face next to a big grin. AAHHHH! Do I scream, laugh, or cry first?!

I swooped him up off the ground and held him out in front in a futile effort to save my clothes. (Trust me, nothing could have saved my clothes in that mess.) We rushed to the only place I could think... the bathtub. This has been our place of refuse for many a mess, but I wasn't sure if even it was ready for this. Thankfully, I tossed the brand new shower curtain out of the way and the matching rug into a heap as far away in the corner as it could get, because it took all of 5 seconds for him to grab the his bath toy with his paint covered hands and pitch it out of the tub. Bounce, bounce it went across the room leaving a wet, white trail in its path. By this point I was laughing uncontrollably.

Thankfully, he cleans up well, as did every surface in the bathroom and, thanks to our Spot Bot, the carpet at the scene of the crime, too. What a way to start the day! I've heard many stories like this from my patients, but to live it was really something else.

Yum!

2011-03-14T17:16:00.008-05:00

Living in the biggest city in Nebraska definitely has its advantages. One of the best is that there are lots of great places to eat! (It also is nice to be pregnant and have an excuse to not care about calories.) As our time here is winding down we have set three ground rules for when we go out to eat: #1) No restaurants that are in Grand Island; #2) No restaurants we have been to before; & #3) No chains. With those in mind, we have been accumulating a list of places to taste before we leave. It's a good thing that Omaha won't be too far away, because we are finding so many great places. Here it is (and of course we are always open to more suggestions):

Twisted fork
Caniglias
Mahogany Prime
Big Mama's Kitchen
Jazz
Mother India
Pitch
Johnny's Cafe
Espana
Anthony's Steakhouse

Here are the places we've already tried: ...Yum!

Stella's - Known for the best hamburger in Omaha, we agree!
O - This is a swanky Chinese place downtown with awesome Pad Thai.
Pudgy's Pizzeria - Funny Story. Several months ago, when this list was being created, I asked Jason where he wanted to eat before we move. He responded quickly, and I busted up laughing. I was expecting him to say some fancy steak place, not Pudgy's! I had never heard of this place, and it literally is a pizza place in a strip mall. Regardless, we went, and it was actually really good.
M's pub - Love the atmosphere, but don't expect to walk in and get a table the day before Valentine's day. Who would have thought?
Vivace - Again, another great restaurant with cool atmosphere in the Old Market.
Zio's - We actually tried this pizza place a long time ago, but it is such an Omaha legend it had to make the list so we don't forget to go again.
Upstream - Yummy martini's (pre-pregnancy, of course).
Petrows - The place to go when you're craving a milkshake and cafe foods. And, I love the cute sayings on their sign.
Lo sole mio - Roasted garlic to die for! Seriously, I'm drooling right now thinking about it.
Kona Grill - We went here while I was pregnant so we didn't try the sushi they are known for, but the California Roll was super yummy.
La Casa - Aunt Jan's favorite pizza.
Piccolo Pete's - Not my favorite, and honestly kind of weird.
Katie's - The med center get's gyros from here pretty frequently, and I'm always happy when I walk into a lunch meeting and smell it.
Bonefish Grill - Even for someone that's not usually a seafood person, this place was impressive.
Brother Sebastian's - Probably one of the standouts for atmosphere - e.g., the waiter's are dressed like monks.
Rick's Cafe Boatyard - We ate here for our anniversary and spent a lot of time chatting and looking out over the river.

Okay, now I'm just hungry. Time to go find a little snack.

D

2011-03-09T20:35:00.002-06:00

A little more free medical advice:

(I feel like I should insert some medical-legal disclaimer in here, but I wouldn't know what to say and that's just not my style. Seriously, though, if you have questions ask your doctor. Okay, moving on...)

A, B, C, D. D. Vitamin D. One of the best kept secrets out there, but we're working to make it a less well hidden secret. At my clinic, we have been checking Vitamin D levels on just about everyone who comes in for their annual exams or is getting lab drawn, and I've been shocked how many people are Vitamin D deficient. It is so prevalent that some doctors in our clinic have stopped checking and just tell everyone to start taking it.

Why does it matter? The benefits in bone health has been known for years and years. Our grandmas have been told to take calcium and vitamin D forever, right? Now, however, there are studies out there showing even more benefits, and it's not just for Grandma anymore.

Here are a few of the benefits:

increased muscle strength
treats psoriasis, a skin condition (obviously not the only treatment, but can't hurt)
better immune system
decreased risk of lymphoma and colon, prostate, & breast cancer; also, if you have one of these cancers it improves your chance of survival.
if taken during pregnancy, it may be able reduce the risk of juvenile (type I) diabetes as well as asthma in the baby
reduces risk for multiple sclerosis, Crohn's disease, rheumatoid arthritis and osteoarthritis
helps to improve high blood pressure and prevent heart failure
decreased risk of depression and other psychiatric diseases

It sounds like the cure all, right?! While all of those things have been documented, it is important to understand that the risk reduction isn't always very dramatic. We're talking about a difference in the range of fractions of a percent. While, unfortunately, it isn't the cure for cancer, depression, or heart disease; it sure can't hurt.

So, check the label of your multivitamin and make sure "D" is in there. Or, you could hang outside in your swim suit for 30 minutes a day in this lovely 30-degree March weather and soak in some sun to get it the "natural" way.

Home

2011-03-05T15:17:00.005-06:00

Several days of my week of vacation (which is a treasured occasion to say the least!) and the weekends that followed have been spent painting, packing, and preparing to sell our house and move the big G.I. Each week as things slowly get packed up and taken to storage, I'm already starting to miss our house. It isn't even for sale yet, and I'm already missing this place we've called home.

Who are those people who move into this house five years ago? No Herbie. No Lambeau. No Owen! I hadn't started med school, and Jason hadn't even finished college. We were a few pounds lighter, and thankfully, Jason didn't have much more hair to lose. The '96 red neon was parked in the driveway, and the third bedroom was just used for storage. I was excited to have a laundry room that didn't take quarters, and Jason was excited to have a lawn of his own to mow.

Now, Herbie has worn a path around the backyard, and the neighbor cats still come around looking for Lambeau. Owen has spit up, crawled, and is now running on our "new" carpet. Med school feels like forever ago, and Jason is well on his way to his Master's. Jason blames Owen for his pant size, and I'm blaming Owen's brother for mine. The neon is long gone, and our driveway has since been graced by the little red Ranger, our Mitsubishi, and now the Rendezvous. The third bedroom has been through multiple make-overs: from a closet, to a dining room, to a nursery, and now to a little boy's favorite place to hang out. I'm a little less excited about doing laundry, but Jason still has the same smile on his face mowing the lawn as he did the first day. (By the way, he still mows it twice every time in different directions to "get the mulch.")

Sometime this summer we'll be pulling all of those boxes back out of storage and unpacking into a new place in Grand Island. Memories will be made there just as they have been in every other place we've called home. That's the best part about home, isn't it: it has a way of finding you where ever, and whenever, you go.

It's a BOY

2011-03-02T20:54:00.002-06:00

Oh my! What am I going to do? Testosterone is going to be flowing through my house. My imagination is filled with wrestling matches, broken windows, black eyes, and T-ball games. Yet, it all brings a smile to my face. Today, Jason and I found out the little life inside me is going to be a little boy. Even though less than twelve hours ago I would have told you I wanted a little girl, at this moment I couldn't be happier. Being able to see his little face and his hands and feet as he squirmed and dodged away from photos sealed the deal. That's my baby - Owen's little brother. I can't wait to meet him and hold him. And I can't wait for all of those wrestling matches, broken windows, black eyes, and T-ball games. He is going to look so cute in little white baseball pants.

What You've Missed

2011-02-25T15:34:00.002-06:00

* Happy Birthday, O!

* Chomp. Chomp. Owen finally has teeth. (Even if they were late bloomers, I still swear that he has been teething since he was 6-months old.)
* Christmas. Done. That's about what I remember considering I was on call Christmas Eve and New Year's Day.

* One long long long month of Cardiology.

* Started and completed my first and last Family Medicine in-patient hospital month.

* Happy Birthday to me. One year closer to...??

* Slow month of Februrary with lots of time off. Yes! How will I ever go back?

* And some other stuff, too. I'm sure.

** Oh Yeah... in case you didn't hear, we're pregnant! Again.

I Am Alive

2011-02-25T15:00:00.002-06:00

No I didn't fall of the face of the Earth. I didn't change careers either. And, believe it or not, I didn't want to stop writing either. So... here's a little explanation:

Around my last post a master email went out to all of the residents warning us about tweets, blogs, facebook, and myspace posts. While it wasn't targeted at me, I felt warned. Like a good girl, I didn't want to disobey and most of all I want to respect my patients. For the last few weeks I've been trying to decide where to go from here. My decision: keep going! I love writing so much, and it has been such a release. I promise to keep my commitment to my colleagues, patients, and myself; but I also intend to keep it fun and exciting. Can't wait!

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

2010-12-11T06:45:00.004-06:00

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.

Dawn of a New Day

2010-11-09T06:26:00.007-06:00

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!

Derm

2010-11-06T20:35:00.002-05:00

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!

Happy HallOWEN!

2010-11-05T13:20:00.003-05:00

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.)

Whew!

2010-10-25T13:35:00.004-05:00

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!

Therapy

2010-10-17T13:09:00.002-05:00

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!

On the Border

2010-10-16T19:34:00.003-05:00

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.

9.11

2010-10-07T18:33:00.002-05:00

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.)

Resources

2010-10-01T19:31:00.002-05:00

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.

Tetany

2010-09-30T20:34:00.002-05:00

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!

Work Hours

2010-09-21T10:40:00.001-05:00

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.

Handwriting

2010-09-18T17:46:00.002-05:00

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. :)

Awesome

2010-09-08T20:23:00.006-05:00

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!

Code

2010-09-06T20:13:00.002-05:00

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.

First Days

2010-09-04T06:46:00.005-05:00

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."

Bedtime Routine

2010-08-27T20:24:00.003-05:00

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!

48 Hours

2010-08-21T21:36:00.025-05:00

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

Zebra

2010-08-14T09:41:00.004-05:00

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!

A Mess

2010-08-10T20:30:00.004-05:00

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!

Survived

2010-08-05T19:40:00.003-05:00

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.

Vacay

2010-08-01T18:56:00.005-05:00

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.

Top 3

2010-07-24T20:08:00.004-05:00

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

2010-07-20T18:11:00.003-05:00

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

2010-07-18T11:41:00.002-05:00

"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

2010-07-17T09:03:00.004-05:00

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?

2010-07-13T21:01:00.002-05:00

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

2010-07-09T18:15:00.008-05:00

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

2010-07-07T19:34:00.004-05:00

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

2010-07-06T19:12:00.006-05:00

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

2010-07-06T18:56:00.003-05:00

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written by guest blogger: Owen T. Newman ;)

New Month

2010-07-04T15:31:00.004-05:00

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.

Benefits

2010-06-28T20:31:00.003-05:00

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

2010-06-24T21:28:00.002-05:00

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

2010-06-22T20:11:00.014-05:00

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?

2010-06-19T15:24:00.003-05:00

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

2010-06-16T21:02:00.004-05:00

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

2010-06-10T21:09:00.003-05:00

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

2010-06-08T08:17:00.002-05:00

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

2010-06-06T14:50:00.003-05:00

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

2010-06-04T08:14:00.003-05:00

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

2010-06-02T20:03:00.002-05:00

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

2010-06-01T16:10:00.005-05:00

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?!

Dear Cousin,

2010-05-31T15:03:00.005-05:00

What are you waiting for? I came to see you this weekend, but you didn't come to see me. My mom has been telling me since I sat on you at her graduation that I would get to meet you soon. Instead, here we are. Waiting. Waiting for you.

Everyone might not understand what it's like for you, but it hasn't been that long since I was in your position. I know what it's like to hear every single one of your mom's heart beats. To have her all to yourself. To be soothed by the rocking of her walk. To have every need met before you even feel it. To know you're loved even before you've shown your face is real, unconditional love. It is cozy in there, and sometimes I miss it, too.

Even though you have it pretty good in there I have to be honest with you that it isn't too bad out here either. The feeling of your moms touch is even more comforting than her heart beat, and your dad's smile is more loving than the muffled voice you've been identifying as his. And your sisters ... oh boy, your sisters! If the way they smother me with kisses, attention, and sticky fingers is any indication, they are going to eat you up.

So even if I didn't get to meet you this weekend, I hope you'll consider making your appearance soon. We are waiting. Just waiting. But please don't make us wait too much longer.

Your Cousin,
Owen Titus

Teething

2010-05-27T11:04:00.002-05:00

For the past month or so, every time our precious 5.5-month old has cried for no apparent reason, or was more difficult to console than usual, someone would say, "Oh, he must be teething." When this started, not only did I not really find that statement very helpful at the moment, but I also didn't believe it. My response was usually, "Maybe." or "Could be." in order to avoid any lengthy conversation on the topic. Remember, my baby was screaming! If you've ever tried to have a conversation with a screaming child in the background, then you understand my rationale.

We have received all kinds of advice (which, by the way, I really do appreciate, even if I don't take it right away). Frozen washcloths seems to be a favorite. Forgive me, however, for throwing away the gift of "teething tablets" - tiny, powdered, white pills - that Jason carried in one afternoon in an unlabeled zip lock baggy. (I'll leave the source of the gift "unlabeled", too.) Seriously though, it could have been sugar or aspirin or morphine or crack for all I knew! It was a very thoughtful gesture though. Thank you.

However, now, after about 4 weeks of the he-must-be-teething excuse, I finally believe it! Although he has always been a spitter and a drooler, now he has taken it to the next level. For example, last night we were at a party, and he was getting passed around like all cute little babies do. At one point, he was being entertained by a small group sitting behind me, and, with my back to them, I could hear their conversation about how much he drooled and how they remember when their kids were going through "that stage." Exhibit A. Exhibit B is the fact that for the last few days it has taken more than an hour to put him down for his morning nap, and we won't even talk about the afternoon one. He used to fuss for a while and then... silence. Now his fuss has become an all-out howl that originates from the depths of his little belly. Maybe it's because I'm his mom, but it is more than a cry to me. It sounds like a plea for a help - a cry of utter pain. Lastly, Exhibit C. One thing I can count on to help quiet his howl into sweet little body-shaking sniffles is that water-filled pink and green chew-toy (for lack of a better, non-canine word) fresh out of the freezer.

My baby is growing up. He's teething!

Doer

2010-05-25T15:05:00.021-05:00

One of my husband, Jason, and my favorite hobbies is "people-watching." Even if you've never heard of people-watching, I'm sure you've participated. It is so intriguing to watch people live their lives. Jason and I could write books about the made-up lives of people we saw for only a few seconds. If they only knew... Hopefully, they'd laugh along with us. One of our most favorite characters was "Dawn" from the hotel during the midnight fire evacuation. Hilarious!

Now, by no stretch of the imagination are we experts on the psyche of man-kind just because of our extensive people-watching research. However, we have come up with some pretty good analysis, if I do say so myself. Recently, we came up with the thought that there are two different categories of people: Dreamers and Doers.

Dreamers are people who are creative and have big ideas. They have contagious excitement about their aspirations, and convince even themselves that they will accomplish the task. Well, some day at least. You see, Dreamers have full intentions to follow through and often even have a plan to get there; but (the infamous "but"), that first step, the step of committing to the task, is often put off until tomorrow. The hesitation isn't because of laziness, inability, or insecurity (at least not all of the time). I think Dreamers hesitate because once they buy the supplies, sign up for the class, write the check, or pick up the phone, their idea has become something tangible and in a sense is no longer a dream. It's no longer perfect, complete, beautiful, and free (literally and figuratively). Now it may fail, be imperfect, and require sacrifice. When it is still a dream it is safe. You know what to expect, there is no buyer's remorse, and you can change it faster than Owen can dirty a clean diaper. For example, the color of the walls in your dream kitchen can go from beige to red, the range from electric to gas then back to electric, this wall can come down or that one or that one, and the floors can go from Italian marble to worn oak, and all of this in the matter of one morning shower.

On the flip side of the coin are Doers: do -ers. Doers do. Give a Doer a task, and it will get done. Set a deadline, and it will be met. Tell them to jump, and they jump. Doers cannot stand to wait around and talk about what should be, or needs to be, done. Why can't we just do something already?! Doers are Dreamers best friends and worst nightmares in one. Doers push, pull, pry, and prod Dreamers in an attempt to turn them into Doers, too. Sometimes, that is exactly what Dreamer need. Sometimes.

I'm not simplistic enough to think that everyone fits into one category or the other. Actually, there are very few people that are completely, 100%, one of them. Most of us have some Dreamer and some Doer in us. I tend to be a Doer - 70% Doer, 30% Dreamer, I would say. Jason tends to be a Dreamer - somewhere around 80%. Jesus was a perfect 50/50.

The whole reason that I got into this topic was just to share what the Dreamer in me has been dreaming and the Doer in me has been doing. I know, what an introduction! I'm almost too exhausted to even tell you now. Maybe I'll just show you pictures instead.

Try to ignore the handsome guy holding the adorable baby. Not that they should be ignored, just try to focus on the bare floor beneath their feet. We tore up every last square inch of nasty carpet in our tiny house. Such a cleansing experience! We've been dreaming about this since the day we moved in; actually, more like since the day we got a cat.

If you tear it out, I guess you'd better replace it. Yes, those are my unpainted toes digging into the softest, cleanest carpet they've ever touched. Our cat is now banished to the outdoors, and I don't think he really minds.

This is the "Before" of our kitchen. Actually, it is the "After, After" picture because it's the third layout we've had in the four years we've lived here. Can we say "Doer"?!

I don't exactly have an "After" picture yet, because I didn't convince my dreamer husband to help me install the cabinets last night. But, here's an action shot to prove that it is getting done.

This is my hideously long hair. To be fair, this is before I did anything with it, and before I put on any make-up. It's almost em-barrassing, actually. I've been dreaming of cutting my hair off for months now. Even before Owen was born I was Googling hairstyles for the perfect new look. But, I didn't want to have hair that I hated in Owen's baby book, so I stuck with the hair that I didn't really like. (For the record, "not liking" is better than "hating".) Then, I didn't want to have that hair in my graduation pictures. Finally, no more major events, so...

Chop-chop. To keep the score even, this photo is also before the make-up went on, and although I did "do" my hair, I did it. This isn't the perfect hair that I had walking out of the salon. You know, the kind that, if you're like me and Jason, you can't stop touching and smelling. It was a 9.7 after she finished, and is now an 8.7 when I finish in the morning. Definitely better than the 5.0 from before, but leaves room for the 10.0 that must be out there.

So, there you have it. At least for now, I'm a doer.

*Definitions

2010-05-24T09:55:00.006-05:00

As promised, here is a list of definitions (in my words, at least) of some of the vocabulary that I use which may be unfamiliar. Or maybe, you've heard me use these words for the last four years and just have never figured out what the heck I was talking about. I promise to keep adding to the list throughout the year as new words pop up. It took me a good four years to learn "doctor-talk" (in addition to the infamous "doctor-handwriting"), so it will be fun to teach it to you. Let me know if you come across other things I should clarify, too.

SUSAN'S MEDICAL SCHOOL/RESIDENCY DICTIONARY:

boards (board exams, medical boards; USMLE (United States Medical Licensing Examination)); see also "Step 1", "Step 2" and "Step 3"

1. [noun]: a series of 3 (really 4) tests, known as "steps," that a person is required to pass during medical school and residency in order to get a medical license in the United States; there are also separate board exams for each medical specialty which certifies that a physician has met the standards required to practice a particular medical specialty

2. [noun]: an exam that is the god of all other exams

CK (Clinical Knowledge); see "Step 2"

CS (Clinical Skills); see "Step 2"

Family Practice (FP, Family Medicine)

1. [noun]: a medical specialty in which a physician is certified to treat everyone: children, adults, and pregnant women

house officer (HO); see also "resident"

1. [noun]: just another word for resident, but can be used to designated the number of years of service by being followed with roman numeral, i.e., HOI (pronounced "H.O. one") = first year resident, HOII (pronounced "H.O. two") = second year resident, and so on

intern

1. [noun]: a physician who is in their first year of residency

synonym: scut-monkey

Match Day

1. [noun]: a day every year in March where fourth year medical students across in the country simultaneously find out where they will be going for residency. The student and residency program are "matched" after the student ranks their top choices for residency programs and the residency programs rank their top choices for students. Then, a magical computer program in the depths of the Earth complies all of these ranks and spits out the fate of every student.

2. [noun]: a moment of shear excitement/terror/panic/relief that is witnessed by your classmates, family, friends, and, at our institution, the world (thanks to live-streaming video on the internet)

M4 (fourth year medical student, senior medical student)

1. [noun]: a person who is in their final year of medical school

synonym: 20th-grader

pimp

1. [verb] pimp-ing, pimp-ed, pimp-s: to be quizzed, questioned, or put on the spot by any of a medical student's superiors at any time during rounds, surgeries, lectures or random encounters

2. [noun]: a person, usually a man, who solicits someone for prostitution in return for a share of the profit (no, this is not a medical reference and is not clearly related to its verb form, but is listed in an effort to be complete)

residency (residency program)

1. [noun]: an institution in which physicians are trained in a medical specialty (e.g. family practice, surgery, radiology, Ob/Gyn, etc...); this training takes a minimum of three years following graduation from medical school depending on the specialty, for example:

Family Medicine - 3 years;

Internal Medicine - 3 years;

General Surgery - 5 years;

Ob/Gyn - 4 years;

upon completing this training period a physician takes an exam and, once passed, becomes "board certified" to practice in that specialty

resident; see also "house officer"

1. [noun]: a physician who is currently in a residency; yes, they are doctors, but they are not yet board certified to practice their specialty of choice

round

1. [noun], rounds: the daily event in which medical students, residents, and their staff physicians meet to discuss their hospital patients and develop a plan of diagnosis and treatment; this can take place in a conference room or at the patients' bed-sides

2. [verb], round-ing, round-ed: the act of making rounds

Step 1; see also "Step 2", "Step 3", & "boards"

1. [noun]: the first exam in the series of USMLE (United States Medical Licensing Examinations) that is taken between the second and third years of medical school (M2 and M3 years); it is an all-day computerized, multiple-choice exam

2. [noun]: a perfectly good way to ruin your last free summer

Step 2; see also "Step 1", "Step 3", & "boards"

1. [noun]: the second exam in the series of USMLE (United States Medical Licensing Examinations) that is taken during the fourth year of medical school; it is divided into two separate, and unrelated exams: CK (Clinical Knowledge) & CS (Clinical Skills)

CK - an all-day, computerized, multiple-choice exam

CS - an all-day, practical exam in which the examinee is graded on encounters with 12 standardized patients/actors (yes, like the episode of Seinfeld); this exam is only given in select cities in the United States and is known among students to be a test of your ability to speak English

Step 3; see also "Step 1", "Step 2", & "boards"

1. [noun]: the third, and final, exam in the series of USMLE (United States Medical Licensing Examinations) that is taken anytime during residency; it is a two-day computerized, multiple-choice test; upon successful completion, a physician can obtain a license to practice medicine in the United States (but... you still have to complete residency to become "board certified" in your specialty)

The Life

2010-05-24T08:12:00.007-05:00

Don't let us fool you. This time in a brand-spanking-new-doctor's life isn't all bad. Multiple times I've heard the last year of med school described as "the best year of your life." It is something of a reward after spending three long years in the anatomy lab, lecture halls, exam rooms and operating rooms. (All of which have no windows I might add. I guess they are being gracious because even if we could see the sun, it would just be a tease. After all, we wouldn't be able to enjoy it. If we did get "let off" by our professors, residents, or attendings, we were never really "off." There was always a book that should have been read yesterday, a test to study for, a pimp* session to panic over, an evaluation to suck up for, or groceries and toilet paper to buy. Okay, I think I've made my point; now, back to the matter at hand.) Similar to your senior year in high school, this is the year that motivates you during the others. It's the year you get to do just about anything you want to do. For example, some of my classmates traveled the world, some had babies, some took the easiest electives they could think of just to be able to sleep in, and some took month after month of the specialty they loved or would never be able to do again. Really, it is a great year. Maybe they are letting us rest up for what promises to be a much different year to come, but let's not think about that.

To be fair, this year isn't all about fun and games. There are a few requirements and expectations. This is also the year we have to officially decide what specialty we will do. For me, Family Practice. We have to spend a lot of time and money (oh my, money and loans, I can't wait to talk about that!) traveling the country for residency interviews. We also have to take Step 2 of boards* which requires even more traveling and even more money.

Actually, I'm a little bit of an exception to the typical M4* rules so I may not be the best person to describe this year for you. I'm sure I'll get into more details later, but essentially, I gave up a usual fourth year and began my residency early. My schedule was a little busier than my peers, but I also didn't have to worry about letters of recommendation, interviews or Match Day*. Although I didn't have as much time off, I do get the entire month of May as vacation so I'm not too tortured.

Right now it is 8:37AM. The birds are chirping, there is a slight breeze, and it is a perfect 77 degrees outside. Now I know that means it is going to be blistering hot today, but that's why we have air-conditioning. I am sitting on the back deck in my pajamas in a chair with a new blue cushion that I bought on one of many recent leisurely shopping trips. My feet are propped up on the table with painted toe nails, my coffee is the perfect temperature beside me, my dog is laying in the yard chewing on a rib bone from yesterday's lunch, my cat is sprawled out on the table soaking up the sun, and my iPad is in my lap. Owen is already taking his morning nap, and I'll be getting out my nook to read another chapter of my Beth Moore book as soon as I finish typing this. What a life, and I am enjoying every moment of it!

*Keep your eyes out for a "Definitions" post coming soon.

Beginning

2010-05-23T19:53:00.010-05:00

Ready or not, here we come. A new batch of doctors is about to be unleashed into the hospitals of our country this summer. I am one of them. You will soon find me walking the halls of the hospital at 2AM in my long white coat with M.D. embroidered after my name. What a humbling thought. It's not a Halloween costume, and it's no longer a dream - I am a doctor.

I am, also, a mother. At this moment, my handsome little guy is asleep in his crib. It is hard to believe he is 5 months old already. I absolutely love being his mom! It is everything I imagined it would be, and at the same time it is nothing that I imagined it would be. Amazing. Absolutely, amazing.

Now comes the challenge. How does one person live two, very busy, lives? And, live them well? These roles are both things that I have wanted and worked very hard to attain. Although it will be a juggling act like no other, I believe God has graciously gifted me the ability to do both. Because I know this year is going to be challenging and life-changing, this "blog" is my attempt to record it, remember it, and learn from it. Journaling has always been an outlet for me, so this doesn't seem too unnatural. Actually, it is exciting. It will be fun to take you, my family and friends, along with me on this journey. Read along. Make comments. Give encouragement. Criticize. As much as I can't wait to see how much my little 14-pound (yes, we know he's a light-weight, but he's healthy and that's all that matters), 20-something inches son will grow, I also am excited to see how much I will grow in the coming year.