Benefits

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

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

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

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

Eval

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

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

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

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

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

I TRIed

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

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

That first race was down-right scary! Without the faintest idea of what to expect, my stomach was in knots. Looking out over Holmes lake, the buoys were what seemed like miles off shore. How would I ever make it? Then, the gun went off, and into the slimy, green, water we went. After a few moments of panic when the better swimmers passed and dunked me on their way, my breathing settled in. "I'm doing it!" 20-some minutes later my feet hit the sand again, and I was a third of the way done. I hopped on my mountain bike and then faced my worst nightmare. If I would have known that my legs would have to pedal me up that hill three times, my days as a triathlete would have been done before they started. My legs and my lungs were on fire by the top. I swore that the next year, my bike training would be a little, no, a lot, more serious. With the hill behind me, I started the final leg - the 5-K run. Even though my legs were wobbling like jello in an earthquake, the encouragement of the other runners took me to the finish line. What an accomplishment! I was so proud. Exhausted, but proud.

2008 - The adrenaline from the first year was still pumping when the time came to register again. This year, not only had my dad decided to do it again, but my brother, Phil, and my husband, Jason, couldn't resist. It was a blast during the race to know that my family was out on the course with me. The triathlon had officially become "our thing." And, after a summer of teasing each other, I had officially won bragging rights at our house. My time was just under Jason's even though he will tell you that it doesn't count because he was "sick." Blah, blah, blah... I won!

2009 - I almost didn't compete this year, but I felt like my reason was legitimate. 18-weeks pregnant seemed like a good enough excuse. However, as easy as it would have been to sit on the side-line and watch, I really wanted to be able to tell my son that we had done it. So... I did it. My only goal was to finish. All I wanted was to cross that finish line. However, about a third of the way into the swim, I almost gave up. My head had been pushed under the water one too many times, and I couldn't catch my breath. As I swam over to a boat to get a break I questioned if it was really worth it. I must have decided that it was, because once the water was calm and the last aggressive swimmer passed, I let go and finished the race. Forever, Owen and I will have this race.

2010 - Last, but not least, this year. After the last year, I didn't think anything would be able to keep me from doing the race. Then came a very busy year. Not only were we now juggling schedules with Owen, I was also putting in a lot more hours at the hospital and clinic. Training was put off until May, when I had nothing except a little thing called graduation planned. I thought I would have all the time in the world to get ready. However, I let each day in May pass without tying my running shoes, or airing up my bike tires, or putting on my swim suit. I decided that this year wasn't going to happen. The race had also been moved up a month, so I added that to the list of reasons that I would let the registration deadline pass without adding my name to the list of participants. The next morning, when it sank in and there was no turning back, my disappointment clouded the sunny day. "Next year," I told myself, when honestly, I feared that this would be the slippery downhill slide of my dedication and drive. That fear, and learning that Dad had signed up, gave way to a renewed sense motivation. Two mornings later, I bargained with myself that if I could run a 5-K without stopping, I would give myself permission to call the State Games office to see if they would let me register late. I did, and they did. And my training, although starting a little late, went into full gear. Like last year, except for the pregnancy thing, my goal was just to finish.

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

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

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

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

Not Guilty?

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

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

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

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

0.5 years

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

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

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

Zoo

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

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

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

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

Not for Me

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

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

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

Like I said, Not for Me.