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?