Balance

(me with one of my recent continuity babies in August)

We have a much loved and respected faculty member who constantly reminds us that when we chose medicine, we chose more than just a job.

A job is something where you get there around 9, leave around 5, where you routinely get 2 protected days off per week, and whose intricacies don't spill into every other aspect of your life. As an intern, I remember being envious of my friends in the "real world" who were able to go to work and still have the time, energy, and emotional reserve to go out, explore, and experience life's little miracles. While I think I was prepared to endure the long hours of residency, I had no idea how emotionally, mentally, and physically draining our work was, which truthfully left me at the end of the day with very little gas in the tank. On my (rare) days off, I was bascially a vegetable. I could sometimes get myself to do some laundry, but that was about it. You would not catch me going out or jumping out of planes or anything. I couldn't (and still, to some degree still don't) understand how people were able to go home to have the energy to entertain a partner, spouse, care for a kids or a dog, or basically do anything else. I was basically scraping by-- and it was just me.

In an AAFP (American Academy of Family Physicians) article commenting on work-life balance, Jennifer Bush writes, " in an environment that continually asks physicians to know more, do more and be more, is it really possible to practice good medicine and still have something left at the end of the day?"

This is something I have strugged with immensely in my 2+ years here. It is the case with many things--- I can't count the number of times that I have stayed late to "take care of" calling patients (well-- in my case it's usually sending letters), doing discharge summaries or notes, or "tucking in" patients before night float comes on so that there aren't too many things for them to take care of.

This also comes up often, particularly with respect to my doing obstetric care. I adore delivering babies. And I, unlike many of my family medicine classmates, certainly plan to continue do do OB when I graduate, which is one of the main reasons I chose this combined program. But man does this affect life!! Babies never come when they are supposed to. They never come on a timeline that suits their parents' and/or physicians' schedules. I have been fortunate to have now done 11 continuity deliveries (10 is a family medicine residency requirement) of patients who I followed for prenatal care. While inconvenient, I've been able to make so many of the deliveries because they tend to deliver at night or on my days off, when I am very available.

And because I will go out of my way to not miss them. When I have a patient "due," I wear my pager 24 hours a day and rarely feel comfortable going very far-- even out of town. This is a big fault of mine and where my current problem/dilemma lies. I had a stretch of time last year when I was bummed because I didn't have any OB patients to follow. I love seeing OB patients in clinic! Visits are generally fun, the women are generally young/healthy, the notes are easy to write (I would love to stack my clinic with OB visits to avoid the chronic pain patients!), and the patients easily become friends when you see them so much over their 9+- month gestation. But because I scrambled around begging for some new OB patients and I had a lot of clinic in December, I collected like 6 OB patients, who have all been due in the past month and right around now. Four have delivered, and two more are now term. Luckily, none have had preterm labor; however, even deciding to "stick around" for when they are 37 weeks and up (despite the possibility they could go to 41 weeks or more!) is very limiting.

Last weekend after I finished wards, I went to San Francisco to hang out with Jeremy, a friend from college (Go, Spiders!). We went to have dinner the Stinking Rose, this very garlic-y restaurant which I heard about and which I'd wanted to try for a while, and also walked around Chinatown for a bit (see pics below). I came back the same night to find that one of my OB patients had been in/out of triage contracting (not even 37 weeks). And felt like I dodged a bullet in that I was being something of an irresponsible physician by leaving town, if only being 2 hours away.

While I am a bit "on edge" about this patient, who has been in/out of triage about 8 times or something in the past week for "rule out labor," it could still be weeks before she delivers! I was so hoping she would go this week so I could kick back and relax. Until my next one is due in 3 weeks. Phi and Cassie were going to go to see "Wicked" in SF which I really wanted to see. But then thinking that my patient might "go" and the thought of driving separately "in case" I had to come back for her delivery was too much for me. I also was invited to go camping in the Desolation Wilderness with Char tonight into tomorrow. But with "desolation" in the title, I figured I would be totally unreachable and didn't want to potentially cramp anyone else's plans by feeling tempted to return at any point. I just didn't feel comfortable going.

Molly (who is doing her surgery residency in Salt Lake City!) has next weekend off and we have talked about getting together. I have the whole Labor day weekend off (! 3 day weekend!!! Rare in residency!!) and have wanted to visit San Diego for the 2-plus years I have lived here. She has a friend down there, and it would be perfect. Except that this patient is still pregnant. And I am having massive amounts amounts of guilt about even thinking about going. Especially since "Labor" in the title might be something of a sign. When Molly and I talked last week, she said she is willing to come up here to hang out/explore closer "if" the patient does not deliver before Monday (i.e. 2 days from now when we talked about "re-evaluating" the situation). But I don't want to screw up her plans "in case" the patient goes into labor and I have to be at the hospital. Aargh.

It might seem that I am picking my patient (or the "possibility" that she might deliver in this 72 hour window) over my dear friend (there is still a chance she could deliver this week, before labor day weekend even happens). But it's not that easy. I am actually very interested in how my classmates/other residents view situations like these-- do they all feel the same obligation? In some ways, I have been frustrated because I don't have "automatic" balance. In some ways, I feel like my choice is harder. I don't have plans with my husband for 5 years who needs that time for me to be away from work because all that I do is work. I don't have kids' baseball games to not miss. I just have me. My time. My plans. And how valuable are those? Where is that line? Your thoughts?

About a month ago, despite my being "backup provider" for a term patient (whose primary resident could not make her delivery due to moving and being out of town), I did not stick around. Kelvin and I went to Mendocino. It was a hard decision over which I agonized for the better part of a day. However, I rationalized my decision to "go anyway" with the fact that this was not really my patient and that, when this decision came up in my "real life," one in which I had a husband, kids, and outside commitments, I would pick my family. Every time. And so that I needed to start thinking that way now.

Laura, who has been on night float and seen my patient multiple times this past week in triage, is around and I could certainly ask her if she would be willing to be backup for delivery for the sake of continuity; however, I think she is going on vacation next weekend. And I'm not sure quite what to do. I welcome any comments about what the "right thing" to do is in this situation!

Deliveries are amazing. I still get an incredible adrenaline rush and uplifting feeling from being the one to bring a little one into the world, especially and, actually, even more the case with your good old run-of-the-mill vaginal delivery (and especially when I have been the one to have cared for Mom for the whole pregnancy). However, I must say that despite the beauty and joy of a delivery that happened a few weeks ago, and which won me my yogurt, I rode my bike home in the middle of the night to my empty bed, in my empty apartment, and felt so utterly alone and empty myself. I wondered again, is it really possible to be a good doctor, be there for my patients, and still have something left at the end of the day? It is my job to take care of patients. But I wonder-- will someone take care of me?

Things I never thought were possible...

Wards "Senior"

I still find it hard to come to terms with the fact that I am an R3 and supposedly wise, a good leader, etc. I have spent the last three weeks being the "senior" resident on the family medicine wards. When I heard Elis on the phone the other day say, "I think that would be fine... let me just run it by my senior," I thought to myself, "Whoa. That would be me. How is it possible that I am somehow responsible for many of the decisions around here??" Just over a year ago (as I did my "intern" month on wards in May or something of my intern year), I was the intern!! Anyway, I have been pseudo-supervising service for the past 3 weeks and, miraculously, it has gone quite well. Elis and Lynn, my interns, have been hardworking, fabulous, and fun, and I've also been blessed with an awesome AI (acting intern), Emilie, a super "MIC" resident, Kristen (in charge of moms and babies), Susanna and then Phi as night float, good attendings, and good times with Kelvin and Char, who have been on the newborn service but who have kept us us company in the call room and entertained all the while. It really hasn't felt all that much like "work."

We have gotten some great laughs, out of our patients, too, the highlights including:

- a demented nursing home patient who called me names I won't even MENTION on this blog and tried to whack-me-good while I was trying to put in a central line.
- another geriatric patient who, when told we were trying to place her in a SNF (skilled nursing facility) stated, "the last place I was at, they locked me up like a tomato!" Umm... This was followed, just a few minutes later, by a similar statement about being "locked up like a cucumber," at which point I could not keep a straight face any longer. Since when are vegetables held hostage?

And the stories go on...

While the service started out pretty light, it has gotten busy at times! I took two back-to-back 24 hour Saturday calls which works out nicely in terms of knowing the ward patients, but which ends up being pretty tiring. The first Saturday, I think I had something like 9 discharges, 4 OB triage pts, a labor and delivery, newborn to admit, ER admission, and TMTC (too many to count) phone triage calls which ends up being a LOT of EMR note-writing.

Last Saturday, I had a pretty relaxing day, but then ended up having 4 back-to-back ER admissions between about 1:30 and 6:30 a.m. The unbelieveable thing was that in most other circumstances, I would have gotten overwhelmed, stressed, and probably shut down (or cried) and not gotten through it all. Somehow, I have gotten to the point to breathe deeply, gear up, and just take one thing at a time. Although I think I am pretty slow sometimes, I guess that even I have learned something about efficiency and multitasking in residency. Amazing. Definitely something I did not think was possible.

Labor coming at a convenient time...

(which I never thought was, and still realize never will be, possible...)

I had 2 OB patients due this past month (and have a few more "on deck"). I actually tried to plan being on wards at the time that they were term because I would "be around" to catch them in case they came into triage or were in active labor during my day shift. However, despite being physically at the hospital for 100+ hours for the last 3 weeks including those weekend calls as well as rounding every day and being there 12+ hours per day including some late nights, who wants to guess when they came in in labor and delivered? Between the hours of 1800 and 0200 when I was actually supposed to be off (and asleep) :). Ah. Don't we wish we could plan labor around doctors' (residents') schedules?

The first was a patient of mine whose baby was breech until 37 weeks and who we had successfully verted (I was so psyched after this!). She came in ruptured while we were playing Tuesday frisbee. I rushed back to the hospital afterwards, despite Phi's statement that I was being crazy for going back so soon and his bet (a yogurt) that she would not deliver before midnight (I was sure she would!). Let's just say that I think Phi should reserve his betting for Vegas and not for my OB patients! A very smooth labor course and fewer than 4 hours later, she delivered, 9 minutes shy of midnight, a beautiful baby girl (and no, I did not use pitocin, a vacuum, OR nazi-like pushing coaching to "cheat" to win).

My second patient came in two nights later and, poor thing, ended up having a Code C-section called TWICE (the first was while I was still at home laying my head down for a brief moment...) for fetal bradycardia, but baby's heart rate always recovered once she was moved back to the OR. We ended up just doing the c-section due to "fetal intolerance of labor," and silly baby came out circa 2 am with her hand gripping the umbilical cord.

While tiring, it was all worth it.

And now some pictures from recent social events:

What I will do for a yogurt:

My second wasabi challenge in two years (consisting of downing a good-sized blob, unaccompanied by any sushi or anything else to eat)

Trying not to puke ... which is where the real challenge was...

(I still have four yogurts to claim after that one). Yes. I will eat anything. Especially for yogurt.

Phi's birthday: dim sum (+ chicken feet)

Brenden, me, Phi, Matt, Sarah

Never thought I would see Sarah eat chicken feet... mmm :)

Being more tired than my interns

I just enjoyed a beautiful weekend off, courtesy of my stellar interns who, although it was their terminal weekend of their rotation, would not let me come in to round at all.

THANK YOU!!!

What did I spend my Sunday doing?

Skydiving!!!!

Yes. I, someone who is deathly afraid of little eight-legged creatures, conversations with strangers, and who would not get anywhere near a bungee cord even for posterity at Bloukrans Bridge in South Africa, jumped out of a plane at 13,000 feet!

It was a spontaneous decision, but Kelvin and I headed out to check out Skydive Sacramento in Lincoln, CA, which is about 40 minutes from here, for the week's adrenaline rush.

This being the first "jump" for both of us, we went tandem with an instructor.

Here is us, pre-jump. Not at all scared-looking, right? :)

While riding up in the plane, I asked Nick, one of the guides, "how high up are we?" He answered, "Oh, about 1500 feet. 12,000 more to go." !!!!! Despite this, I seriously was totally calm until the very moment when I had to step off the edge of the aircraft and realized that this was quite a crazy thing we had decided to do!

The freefall was intense. It was 1 minute, and 8000 feet, and I felt like I couldn't breathe because of the wind and air in my face. The view was awesome, though. I have never felt anything like it. I really enjoyed the "coasting" part with the parachute deployed, where we sort of soared around looking down at the fields.

Here are the pics that the photographer took of Kelvin. Cool, huh? I'm kind of glad there weren't pics of me on the freefall, because you probably would have seen just a very terrified expression reading something like, "Oh my gosh. I'm going to die. I'm so going to die" (not good for their advertising, either!).

Here is me, though, on the landing. :)

And us afterwards. With my very wind-swept hair.

And, just in case you don't believe that I jumped out of a perfectly-functioning airplane today, here is my certificate to prove it :)




Surprised?? :)

Smiles to start the day

Thank you to Laura for an email this morning which made me crack up at the crack of dawn, and again now when I re-read these hilarious signs! :)

Uh oh...

On conscientiousness at the Zoo...

And in honor of "Frisbee Tuesdays" and our game later today... McKinley Park! 6 p.m.!!!

Anti-texting

I do not really know why I have such an aversion to text-messaging. When did texting become such a big thing? I know I was a bit behind the times with even getting a cell phone in the first place, but I am way behind the times with the texting.

It is kind of weird, because I am someone who doesn't really like talking on the phone that much (esp with people I don't know very well). I am a near-obsessive e-mailer. I am oftentimes relieved when people don't answer the phone when I call them and it goes to voicemail. I make other people call restaurants to make reservations. I would rather send electronic messages to my bank than talk to customer service representatives. I will do just about anything (including sending extremely detailed/longwinded letters) to get around actually calling a patient on the phone (even to just communicate a "normal" lab result). You would think that I would be thrilled to have the opportunity to send messages via my phone to avoid talking to people. But I don't! I still hate texting.

People tell me that it is an efficient and effective way to communicate short messages to people. In theory, I see this point. However, when you text the way I do, efficient is the last thing I would call it. Maybe if I had a black(Crack)berry type (or i-) phone with a keyboard, I could pretend like it was e-mail and actually be quick about things; however, I do not. When my phone died in March (too many hours of sports-bra-induced "water damage"), I thought that the one that was its replacement was really snazzy; however, I've been told by several people (you know who you are... :)) that it is basically outdated. Fine. Call me a Grandma. I don't claim to be technologically savvy, but I don't think I'm too bad with the phone. Except when it comes to texting.

I learned late last year (after having sent about 5 texts total) that there is a "word" function so that when you press the "letters," in sequence, a corresponding word (supposedly the most common word with that combination?) gets typed. I'm sure you all know what I am talking about. I do have to admit that this had made my texting marginally faster. However, this frustrates the heck out of me, too! When I want to write "Tired," (and when I am tired!), it types "Three." "Of" becomes "Me." I average about 5 minutes per text sent. It is much, much, much faster (and less effort) for me to just call, even if for a 45 second conversation. I get very annoyed with whole conversations consisting of text messaging.

I read the messages that are sent to me. I generally just call people back if what they text me seems important (or reply-worthy). For other messages, I just "let 'em go," and no responses are generated. But I started thinking that people might think that that was rude. Even now, from time to time, I tell people that "I couldn't get up the energy to text you back," although this has become more infrequent.

So I truly (and naively) thought that I could live happily in my own anti-texting world, and that people would still love me and keep in touch with me (and occasionally call) despite my attitude towards the text messaging.

Until my phone bill came.

Yesterday, my Verizon phone bill was $58.82!!!!!!!!!!!! This was about $20 more than what my plan is supposed to be. I could not believe my eyes. I guess maybe when I got the plan, I should have really paid attention to what the cost-per-text was (if you were wondering, it happens to be 20 cents). But, at that point, I was not really doing any texting, so I (in addition to being anti-texting, I am rather frugal) did not feel the need to add on the additional $5 it would take to have 250 or so texts per month.

I am being forced to change that. Right now. Let's just say that most of the charges from last month were texts received and not sent and, somehow, I think it's kind of wrong to charge someone (me) for messages that aren't in his/her (my) control. And I have some very text-happy friends (again, you know who you are... ) whose sweet messages I really do appreciate and who I really really hope I'm not offending right now on my anti-texting rant. You do not need to pay my phone bill. You do not need to buy me anything! And because I love these friends so dearly, what do you think I just did (and what I did by actually calling and not electronic-messaging the Verizon support center)?

I added on a flat-rate monthly texting plan. The representative I spoke with looked at my last bill and said to me, "Wow. You like texting, huh?" to which I replied adamantly, "I absolutely do NOT like texting! I just like my friends, who are crazy!" I think she was a bit taken aback by my response. But as of this evening (and she was kind enough to backdate the plan-upgrade to the start of this current statement/billing cycle), I am the not-so-proud subscriber of a phone plan that includes 250 free texts, sent or received, per month.

Now, don't get too excited. May the Lord help me if I ever get close to using that many text messages. This does not mean I will text any more frequently than I currently do, because get this straight and don't forget: I still hate texting. Much like people who finally succumb to Facebook (which I joined quite late as well, just a few months ago, and I must say, has become quite addicting and enjoyable! See! Electronic communication beats the phone!), I kind of feel like a sellout. However, it does mean that at least I won't have to have a mini-seizure every time my phone bill comes and that I might have enough money to afford the other things in life.

And please let it be known that I would really really love it if my friends still called me once in a while... :P