This is the work

It’s 10 PM and I’m on the couch, laptop in lap, beer in hand, signing charts. I’m taking a mental health day tomorrow and yet here I am. Working. I suck at relaxing.

Nothing this week was easy or straightforward. Complicated patients with complicated medical histories and even more complicated social histories. A hot and stuffy resident work room. Unrelenting heat outside, unrelenting pressure to move faster inside.

Only two of my private patients showed up this morning (I typically only book private patients on Thursday mornings; the remainder of my clinical time is spent with the residents and students). The student I was working with this morning asked me a number of insightful questions.

What’s this job like?

Why did you stay here?

Loaded questions, for certain. Over the course of our conversation I said things I was not capable of saying six years ago when I started this gig.

I enjoy caring for this diverse patient population. Refugee families, urban families, military families, and everything in between. I enjoy managing all their problems, answering all their questions, and growing with them over time. This is a rare job where you get to know families over their lifetimes, and I relish the opportunity to do so.

I enjoy caring for this community. It is a community in trauma. There is still so much I don’t understand and every day I learn something new that helps me to do my job just a shade better. But I’m not there yet. And this community needs me and my colleagues to do better.

I get to work with some seriously awesome people. I sent a message last night to one of my interns who, earlier in the week, had cared for a couple of rather complex teenagers. When I sat down to cosign his charts last night, I discovered what an incredibly thorough job he did in his documentation. It was careful and complete and left absolutely nothing to the imagination. He deserved a compliment and I was happy to pay him one. At the start of the year I wasn’t sure how he was going to be, but today I can say I’m pretty damn pleased.

The student was happy I was able to openly share my insights on the job and the profession. I often say this is what I do, it’s not who I am. Perhaps I need to revise that statement. My job is as much a part of me as my blood. I cannot exist without it. It makes the separation harder (see above note on signing charts at 10 PM), and it makes the potential for burnout that much more realistic. I’m well supported at home and work. I’m driven to do right by my patients and this community. This is the work I was meant for, in every sense of the phrase.

This is my work.

New traffic pattern ahead

My daughter started a new daycare last week. It’s closer to our house, which means more sleep for all and a shorter commute to work for me. So far, not so bad. I’m amazed by how go-with-the-flow she is. Like any kid, she reacts to a new situation with the appropriate amount of trepidation, but once something familiar clicks, she’s off to the races.

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It’s July 3rd, which means I’ve survived my 6th July 1st as an attending. The calendar year may begin on January 1st and end on December 31st, but my year starts July 1st and ends June 30th. I love June and I hate June; I have to say good bye to all the wonderful doctors I’ve trained, but then I get a new bunch to start training. The three-year cycle ends and begins again. This is my 9th year of academic years, and it’s the first one I haven’t started with dread. I’m not sure if that’s age, experience, or the knowledge that this year’s bunch of interns is the best we’ve had in a while. Maybe it’s a combination of all of those things.

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I’ve started and stopped and started and stopped writing things. I’ve religiously kept a personal journal since January 1, 2014. Sometimes it’s just a photo, sometimes it’s a dissertation. It helps.

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My interns are navigating a new system. They’re doing things differently, perhaps differently than they ever have. New city, new apartment. New friends. New hospital. New everything. The medicine is still the same. The car is the same, the roads are different.

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My drive to work is different. I have less time to rock out to music in my Subaru, but I have more time at home, more time with my family. Every day I have to remind myself to no take THAT exit on my way home. It’s a new traffic pattern. The car is the same, the roads are different.

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I should write more. It helps.

Through darkness, light: redux

It’s Christmas Eve and I have to work. I dropped Emily off at my parents’ house and decided to take the city streets to my office. This place has changed since I was a kid – for the better. Rehabilitation of hobbled buildings, art installations, trendy shops. I glanced at the clock in my car. Ten minutes, door to downtown. I love this place.

Five years ago on the Solstice I signed my contract to take this job. And it was just last week that I recognized why I was hired for it.

Last week my boss did a workshop on planning your career and planning for promotion. I’m inching closer to the point where I can go for promotion, so this is something that matters a lot to me. My boss is a great man – he is encouraging without being pushy, he pushes you forward without being bossy. He has the experience to know that your project might not work out, but that you still have to do it so you can see for yourself (and sometimes, you prove him wrong and he’s perfectly fine with that too).

My boss hired me because he saw my potential when I was not able to see it. He saw in me a physician and educator at a time where I saw myself as someone who needs a job and this seemed like a good fit. He has cultivated within me the academic physician I never knew I could be. I might be accountable for my own success and happiness, but that doesn’t mean I don’t need some help along the way.

At the end of the workshop, he even foisted my own email signature back on the group and now? It makes more sense than it ever has.

I may not have gone where I intended to go, but I have ended up where I needed to be. – Douglas Adams

Never thought I’d be here, but here is where I need to (and want to) be. I need this place just as much as it needs me.

I don’t have much time for writing these days. Work and home keep me busy. The stacks of books are piling up right along side the small projects at home. I still haven’t figured out how to balance home and work – I’m starting to become convinced that such a thing is a false idol to which we all pray. Instead I’m trying to be Pretty Darn Good at everything; Perfection is out of the equation (and has been for a long time).

My brain needed to take a few minutes this morning to write, before I tackle the electronic pile of charts and the chaos on my physical desk. I needed to remind myself that I’ve come a long way since I signed that contract five years ago. Sure, there’s work to be done. But I can now appreciate that process from there to here even more.

Be well this holiday season, my friends. I hope you get what you need, both physically and emotionally and if not, I hope there’s a bottle of wine with your name on it.

What, me worry?

Amazingly, my child is nearly 10.5 months’ old. No one is entirely sure how this has happened, because just yesterday I was cradling a 7-pound bundle in my arms. Now it’s stand sit walk play wave throw   eat    ba ba ma ma da da stand stand fall on butt    nap    stand sit walk etc.

Motherhood thus far has been a hell of a journey. Frustrating, wonderful, anxiety-inducing, panic-rendering, delightful, laughter-filled – everything all at once.

I worry. A lot. Probably as much as your average mom but for someone who does not panic (uh, hi, survived being a black cloud for 4 years of residency – very little throws me) this is a new sensation for me. Most things I am able to talk myself down off the ledge over. For instance, right now she’s going through a no-solid-food phase. She’ll nurse and take a bottle at daycare without problem, but is refusing solids when she used to scarf them down. No idea why, other than it’s probably a behavioral thing and she’ll get over it. Other things I am unable to reassure myself about. Fevers and puking, for example. She’s in daycare. Kids in daycare share – including their germs. Every now and then she’ll have an RPE – random puke event – that cannot be ascribed to anything other than it’s random. But it makes the hairs on the back of my neck stand straight. And then the fevers – I hate fever. She has an underlying kidney problem that we’ve known about since she was born and is on daily medication for it until it gets fixed in a couple of months or so. But whenever a fever pops up, off to the doctor’s we go to make sure it’s not a urinary tract infection. And it’s awful but if they discover an ear infection, that’s good. Because then they don’t have to check her urine. She’s only had one ear infection and one urinary tract infection so far, along with a handful of stomach bugs (those were definitely NOT RPEs – holy moly). So I worry. Probably appropriately. But that doesn’t mean I like it.

It could be worse, though. It could always be worse. One day not all that long ago I was grousing about something or another and was scrolling through Facebook only to find that the son of a medical school classmate of mine was diagnosed with leukemia. He’s doing ok now – achieved remission quickly and is now on maintenance chemotherapy. But crap. Sometimes I get angry that my kid has to have surgery. But she’s healthy. She takes her medicine every day and she’s fine. She’s developmentally normal. So I grouse and whine less.

I had a conversation with a co-worker of mine once about mommy guilt. Some moms (especially those in medicine) have guilt. Guilt about leaving their babies with someone else for the bulk of the day. Guilt about missing achieved milestones. Guilt about never being home. But I really don’t have that. Yes, it sucks that I have to work and that I can’t spend as much time with my daughter as I would like. But there’s a reason for that. It took many years to get to where I am right now in my career and I enjoy working. I make sure I am home every night to put her to bed. I get her up in the morning and get her ready for the day. We chat in the car in the mornings and afternoons. And when she is older I will do my darndest to not miss the dance recitals and soccer games and whatever else may come our way. I don’t expect her to understand while she is young why I am not there with her every waking moment. I do want her to understand that I work very hard so that we can live like we do and that it is an honor and privilege to take care of other people’s children. I work every day to make our community a healthier place. Is it easy? No. But nothing worth doing ever is.

Today I’m spending at home with her, albeit not by choice. She had a fever overnight, which has largely abated by now. It’s probably just some viral crud from daycare. I have so many things to do both here and at work it makes my head spin thinking about it. After we got back from the doctor’s she wanted to stand and walk and dance and play. So we did. I didn’t check my phone or my email. I put on music and danced and walked and stood and played.

Frame shift

Yesterday did not start off as planned. I blame the Bruins for imploding in spectacular fashion on Monday night, because that’s when my bad luck seemed to start. I was working on knitting a baby blanket for a friend when the Blackhawks scored 2 goals in 17 seconds to win the Stanley Cup. In my bewilderment I screwed up and had to rip out stitches.

Tuesday morning I got up and went about my day, getting myself and the baby ready. Monday she was diagnosed with an ear infection after being febrile and whiny for the better part of the weekend. After getting her amoxicillin mostly in her mouth I fed her. Five minutes in she started to whine and then barfed. On me, on her. Yay. After a clothing change times two we set out for daycare. En route a tractor trailer driver realized before it was too late that he would not be able to fit underneath the railroad bridge. However, the road I needed to get to was blocked off because of this. After a short but painful detour, we made it. I settled her with her caretakers and hopped back in the car to try to get to work on time.

Next it was an actual train that impeded my progress. I found myself at the end of a long line of cars at a railroad crossing, cursing anything I could think of for the rotten luck so far in the morning. I wasn’t yet 8 AM. After the train passed, I got on the highway to again try to make it to work on time.

Traffic. Better yet, traffuck. I got off the highway an exit early, thinking I was so smart. Turns out all the other downtown commuters thought the same thing. I eventually made it to work, about five minutes late. I was going to treat myself to an elevator ride because of my foul mood. Once on the elevator, the doors wouldn’t close, no matter how many buttons were mashed. Up the stairs I went.

My boss was out of the office in the morning so it was up to me to run the division meeting. Luckily, no one else was on time either. And then when the meeting finally started 10 minutes late, the trainers from our electronic medical record showed up to do our optimization wrap up, thus thwarting anything I had intended to cover on the meeting’s agenda.

I was in clinic for the morning. I have some spectacular coworkers. They made me laugh for nearly three hours straight. We discussed how the Russians are going to take the Olympic torch into space but they have to make a fake flame for it (danger, vacuums, etc.). We decided to lay blame on all the day’s past and future transgressions on the Space Flame. Damn you, Space Flame!

The afternoon and evening went much better. My little one was feeling much better in the evening and I managed to get some sleep. And today? I smiled all morning. Happy baby, no barfing, easy ride to work. Haven’t tried the elevator though.

I wouldn’t have taken the time to type all this if I hadn’t learned something. I learned three valuable lessons yesterday:

1. Laughter really is the best medicine.
2. Be patient. Sometimes you have to wait for things to pass before you can move forward.
3. Take the stairs. It’s better for you anyway.

I’m now off to my meeting. And I’m going to avoid the elevator.

A moment of peace

So, hi there!

Long time, no blog. I know. Between work, baby, and home I have little time to devote to writing as much as I would like. Trust me – the ideas and prompts are there. But the minutes in the day are not.

I’m home with a sick babe for the second Monday in a row. Last week it was two pukes and she was fine for the rest of the day (no idea what it was, but it was nice to get stuff done at home). Today we made a trip to the pediatrician to discover an ear infection. First time for everything, I guess. She’s currently napping, leaving me a few moments of peace. She’s doing fine now, thanks to the makers of acetaminophen and amoxicillin.

I started this blog almost nine years ago (!), when I was a lowly MS3 starting my clinical rotations. Now I’m just about to start my third year as an attending. Last week while seeing private patients, I saw one of the first patients I added to my panel when I was an intern. She was a preemie that had just been discharged from the NICU after a four-month-long rocky odyssey. Now? She’s headed into 2nd grade, is completely healthy, and bosses her daddy around like it’s her job. I remember being so fearful of this tiny little thing, not having any blessed clue what to do with a kid this small and complicated. She’s now two-thirds my height, smart, and beautiful. Amazing.

We just graduated our third year residents, my first graduating class as an associate program director. I quipped that my little birdies are leaving the nest. They were my interns when I was a brand new attending so in a way we grew up together. Academics parallels a practice in pediatrics impeccably – you watch these fledgling young things grow and develop over time, observing for when they reach certain milestones, picking them up when they fall, and getting misty-eyed when it’s time for them to leave. I like to think I have a pretty good job.

Intern orientation started last week. We now have a set of 13 new birdies (or as the program director called them, baby dragons). They’re so cute at this stage. We haven’t scared them off (or scared them shitless). Yet.

I’ve said it before but it’s worth repeating – I love/hate this time of year. I love that my residents are all rising to the next level and they’re all becoming more and more self-sufficient. It makes precepting in clinic a breeze. The new interns arrive and are excited to being their lives as pediatricians. But then my senior residents leave, as if singing themselves off the stage Sound of Music style. And then I have to repeat everything my interns do for the next six months. Oh well. But it’s finally summer out, the sun is shining brightly, and I have an office with a window in it. And I have snacks.

And the baby? She’s pretty damn cute. She is spoiled rotten by her grandparents and her aunts. She’s happy. She’s a sitter and a clapper and an explorer and a “ba-bah-ba”-er. She  smiles a big two-tooth grin whenever a familiar face appears. And even when she’s not feeling well and only wants to be snuggled, she still melts my heart.So what’s next? Hopefully more time for writing and reflecting, as it’s as good for the mind as it is for the soul. If you’ve stuck around this long, thank you, dear reader. I appreciate it.

 

Solo

Yesterday my husband took The Kid on a road trip. She went with him while he had to time a race at the mountain where he works and then up to Rochester to visit his sister (Favorite Aunt #1) and her boyfriend before they go to visit my in-laws who are winter birding for the month in Phoenix. All of this meant that I was flying solo last night for the first time in nearly 5 months.

I had no idea what to do with myself.

I went to Target and wandered and meandered (much easier to do when you’re not wondering when your kid is going to start throwing a shit fit). I picked up dinner at Wegmans on the way home. I poured myself a BIG glass of wine and had dinner and watched hockey.

And thought non-stop about The Kid.

They didn’t make it home until really late (no thanks to some car snafus) but she was no worse for wear. Thankfully she tends to fall asleep in the car so she had managed to get a long nap in before coming home. Once they got home I gave her a huge snuggle, a quick wipe down with a washcloth, and nursed her to sleep. This week she finally started sleeping for longer stretches overnight and I was worried that her road trip would mess all of that up. It didn’t; she slept straight through until 7 AM. Got up, snuggled a little more, fed her, and now she’s taking her morning nap.

It was incredibly weird here without her last night. I thought about going out, going to a movie, seeing if any of my friends were busy. But it’s been so long since I’ve had more than an hour or two to myself that I decided to hang out at home. I used to crave spending time by myself, even if I was doing absolutely nothing constructive. Now my “alone time” is the 10 minutes I have in the car on my way to and on my way home from work. And you know what? I’m ok with that. I missed having my family around me last night.

But that glass of wine and Chinese food and bowl of ice cream and uninterrupted eating was kind of nice.

The book

Hard to believe but my little girl is 4.5 months old already and I’ve been back to work for 2 months. The transitions are smoother than they were at the start but still rough, mostly because I’m still up twice a night to feed her. She’s settled into a nice routine – get up before mom leaves for work, take a nap, eat, play, take a nap, eat, play, eat, take a nap, eat, bath, eat, bed. Works for us.

We are taught (and I continue to teach) that no kid ever reads “the book.” There are few instances of textbook cases of illnesses (though I did see a patient a couple of weeks ago with textbook pityriasis rosea that I diagnosed on the history alone). And likewise, no kid ever hits a new developmental milestone on a birthday. But because my brain works in funny ways, I’m always waiting on tenterhooks for that next developmental milestone to be achieved. When she wasn’t rolling the minute she turned 4 months old, I panicked. Two weeks later, she did it all on her own, with no coaxing from me. Now when she’s in the mood, she rolls like a pro.

I have shelves of books – Bright Futures, Oski’s Pediatrics, and Zitelli’s Atlas of Pediatric Physical Diagnosis and the like that tell me what things are supposed to look like, and when things are supposed to happen. It took my own kid to remind me that I should still expect the unexpected because no one ever reads the book.

Steep learning curve

In the last four months, I have ridden a steep learning curve right to the top. I buckled in and held on for dear life. Somehow, I didn’t fall off. I still have plenty of learning to do but I had to start somewhere.

I’ve learned that…

• folding the laundry can wait a day or two.
• all that drooling and shoving of fingers in the mouth? Yeah. That’s teething.
• sleep is important to feeling like a human. So is a hot shower and a cup of coffee.
• your best intentions to get things done go straight down the crapper when your baby is so darn cute and happy while she’s playing.
• I can change a diaper with only the light of a nightlight to guide me.
• Vaseline is a nectar of the gods. Good for cracked and dry hands from the hand-washing, even better for preventing diaper rashes.
• my boss is a great guy. He’s been incredibly supportive since I’ve come back to work. I got lucky with him. And to think I almost didn’t take this job…
• when your mom says, “let me watch the baby for a few hours today” I should just let her. Even though I barely see my baby during the week and all I want to do on a Saturday is snuggle her, having a few hours to clean/shop/read a book/relax is also beneficial to my mental health. Plus my kid loves going over there so it’s a win-win.
• I don’t mind getting up multiple times in the middle of the night to feed my baby, though I look forward to the day when she decides to sleep more than 5 hours at a stretch.
• I can type well one-handed.
• experiential learning beats the crap out of book learning. I know more now about breastfeeding and child development through age 4 months than I ever did.

I’m sure there’s more that I’ve learned that I’m leaving out. The last 4 months of my life have been bonkers, but in a good, sleep-deprived way.  And more importantly, I wouldn’t trade this new life for anything.

Why I no longer Livestrong

I’ve been thinking about writing this post for a while, rolling it around in what’s left of my post-partum brain. Now that Lance has come clean (or not really, depending on what you read), it feels like a good time to write about how I rode the Yellow Band wave, only to fall off and land squarely on my ass.

I’ve followed cycling for a long time. I credit my high school French teacher for piquing my initial interest. To teach about the topography and geography of France, she used the Tour de France. We learned about the different regions of the country, the various cities, and mountains. It’s an intriguing sport. Men riding mere slivers of metal up and down mountains, gutting it out to wear a yellow shirt. To win you need not only be fast and strong but play the strategy wisely.

I learned about this scrappy Texan while following the World Cycling Championship in 1993. And I gasped when I learned of his cancer diagnosis in 1996. And I cheered for him when he returned to cycling in 1998 and won his first Tour in 1999. And for the next six Tours I followed him and his team religiously, even reading the French newspapers online to glean some minutiae about how he rode that day. From pain in the Alps to champagne on the Champs-Elysee I drank it all in, every last drop.

And I wore a yellow bracelet. Every damn day. I bought into the Livestrong philosophy, thought it so noble that man donated his money and time to help others go through what he had survived. I donated money. I bought merchandise. I referred others to Livestrong because maybe it could help them, too.

I stood by Lance and stood up for him when the doping rumors started. Even he said he never had a positive drug test so therefore he couldn’t have doped! He’s just incredibly strong and fit!

And then the fall from grace, a slo-mo tumble down the slope of truth.

He lied.

He lied.

I feel duped. I drank the damn Kool-Aid.

What Lance and his foundation does for cancer patients and survivors is wonderful – there’s nothing else like it out there. But what Lance did for sports is shameful. Rather than relying on his body and training to become successful, he artificially enhanced his athleticism to win. And I just can’t sit idly by and support him.

So now what? Where do I stand? My yellow bracelet is in my jewelry box. I haven’t worn it in months. I donated my Livestrong t-shirts. I can’t bear to look at them. I didn’t watch his interview with Oprah. I’ve heard enough. Jen Gunter raises a great point – never mind us, what about his kids? He told one big-ass whopper. What lesson does that teach his children? Fatty has a similar reaction to mine. He will continue to raise money for Livestrong; I will not. Does it matter? Not to Livestrong. But it does to me. My conscience and I can’t continue to support his foundation, because I still see it as an extension of him. Will I come back some day? Maybe, but don’t hold your breath.

I’m not perfect. I will raise my daughter and tell her that under no circumstances am I perfect. I make mistakes. She too will make mistakes. Honesty is truly a virtue to uphold for yourself and for others. I will always be honest to her and will expect the same from her. Mistakes are bitter pills to swallow but are often the encouragement you need to make change in your life.

To me, Lance has made an irreparable mistake, one from which he will not likely recover. And a very small part of me feels bad for him. The rest of me is just flat out ashamed.